Diagnostic Assessment — Left Knee - Strain
Example 1 of 2 · fictitious patient (Veteran K)
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 - Strain
Balance of Probabilities: Sprain and Strain No. 28 of 2020 Reasonable Hypothesis: Sprain and Strain No. 27 of 2020
ADF History
The veteran, Technician Electronic Systems, enlisted 08 February 2002, discharged 02 December 2010.
Occupational History
As a Technician Electronic Systems in the Australian Army, the veteran was responsible for maintenance, repair, and operation of electronic systems, including communication equipment and vehicle electronics such as those used in the ASLAV (Australian Light Armoured Vehicle). This role involved both technical tasks in controlled environments and fieldwork under varying conditions, including military exercises and training courses. The occupational hazards were multifaceted, encompassing physical, environmental, and ergonomic challenges. Technicians are frequently exposed to repetitive strain from handling tools and equipment, prolonged periods in awkward postures, and physical demands of lifting or moving heavy electronic components. The role required participation in physically intensive military activities, such as pack marches, leopard crawling, and battle physical training, which increase the risk of musculoskeletal injuries.
History
The veteran a Technician Electronic Systems in the Australian Army, developed chronic left knee pain and stiffness attributed to repetitive military service activities including pack marches, leopard crawling, pushing trailers, carrying logs, parades, and battle physical training from 2008 to 2017.
Timeline
- 04 February 2016: The veteran presented with ongoing left knee pain, described as stiffness, mild pain, and occasional clicking, linked to ADF service activities. He reported symptoms worsening with stairs, squatting, and prolonged standing, with rest alleviating discomfort. The pain was noted 3 days per week for 4 hours, with stiffness 5 days per week for 12 hours. No specific traumatic event was recalled, but symptoms were attributed to repetitive military activities. An MRI was ordered to investigate the cause of knee pain and stiffness. The veteran reported that symptoms had been stable but worsened with increased activity since October 2014.
- 06 February 2016: MRI of the left knee revealed no abnormalities, with intact menisci, ligaments, and cartilage, and no evidence of osteoarthritis or effusion. The clinical presentation of knee strain was diagnosed based on persistent pain and stiffness without structural damage. Symptoms continued to limit activities like squatting and prolonged walking, as reported by the patient. The condition was noted as stable but worsening with increased activity, consistent with chronic strain. No specific management was documented, but activity modification was advised.
Symptoms
At the time of injury during military service, the veteran experienced the gradual onset of left knee pain, stiffness, and occasional clicking without a specific traumatic event. The symptoms developed progressively through repetitive military activities and stabilized in October 2014. Current symptoms include pain experienced 3 days per week for 4 hours, stiffness 5 days per week for 12 hours, occasional clicking 1 day per week for 1 hour, joint instability feelings 1 day per week for 1 hour, and range of motion loss 5 days per week for 12 hours. The condition limits activities including squatting, stair climbing, prolonged standing, and walking long distances. Symptoms worsen with stairs, squatting, uneven surfaces, prolonged standing, walking long distances, cold weather, running, and high impact activities. Rest, reduced movement, avoiding prolonged standing, and avoiding long walks provide symptomatic relief.
Imaging
- 06 February 2016: MRI bilateral knee showed no abnormalities in the left knee, with intact menisci, ligaments, and cartilage, and no evidence of osteoarthritis or effusion.
1. What is the formal diagnosis of the condition claimed above?
Left Knee - Strain (M25.662), DVA SOP Sprain and Strain No. 27 of 2020 (Reasonable Hypothesis) and No. 28 of 2020 (Balance of Probabilities), ICD-10 code M25.662.
A strain is an injury involving the tearing or stretching of a muscle or tendon, associated with the onset of pain and tenderness at that site within 24 hours following the injury. It includes complete tear or rupture of a muscle or tendon but excludes drug-induced disease of tendons or muscles. In the context of the knee, strain typically affects the muscles and tendons surrounding the knee joint, including the quadriceps, hamstrings, and other supporting musculature. Chronic strain can result from repetitive stress and overuse, leading to ongoing pain, stiffness, and functional limitation without structural joint damage visible on imaging.
The temporal relationship shows this is a chronic condition that developed during military service through repetitive activities and stabilized in October 2014, representing an ongoing strain injury to the left knee musculature and supporting structures.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
During service period from 2008-2017, with symptoms stabilizing in October 2014. [PTQ.pdf, Page 2]
When did the veteran first present to a health / medical provider for this condition?
04 February 2016, when he presented with ongoing left knee pain to a Medical Officer. [PTQ.pdf, Page 1; CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline section]
When was the condition confirmed / formally diagnosed?
06 February 2016, when the condition was diagnosed based on clinical presentation and MRI findings by Medical Officer assessment. [CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline section]
When did the veteran first present to you (or your practice) for this condition?
26 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 assessment by a Medical Officer based on persistent symptoms of left knee pain, stiffness, and occasional clicking without structural abnormalities on MRI. Key symptoms included pain 3 days per week for 4 hours, stiffness 5 days per week for 12 hours, clicking 1 day per week for 1 hour, joint instability feelings 1 day per week for 1 hour, and range of motion loss 5 days per week for 12 hours. Functional limitations included difficulty with stairs, squatting, and prolonged standing. MRI performed on 06 February 2016 showed no meniscus, ligament, or chondral injury, leading to a diagnosis of strain based on clinical symptoms rather than structural damage. [PTQ.pdf, Pages 2-4; CHATY REVIEW - WILLIAM THURLOW - TOM.docx, Timeline and Conditions sections]
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.
Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon - MET
- The veteran military service as a Technician Electronic Systems required participation in repetitive, high-impact activities including pack marches, leopard crawling, pushing trailers, carrying logs, parades, and battle physical training from 2008 to 2017. These activities involved forceful stretching and high intensity use of the muscles and tendons surrounding the left knee joint through repetitive loading and stress.
Inability to obtain appropriate clinical management for sprain or strain - MET
- There is a significant delay of approximately 4.5 years between symptom stabilization in October 2014 and first medical presentation in February 2019. This lengthy delay between onset and diagnosis constitutes inability to attain appropriate medical management as per the precedent established in Brew v Repatriation Commission. The absence of medical presentations for this joint condition during the 4.5-year period indicates barriers to healthcare access, satisfying the inability to obtain appropriate clinical management factor.
Sequelae
This condition is not a sequelae of another known condition but represents a primary strain injury from military service activities.
Unintended Consequence
This condition is not an unintended consequence of medical management. No medical procedures or medications were administered that resulted in this condition.
Inability to Attain Appropriate Medical Management
The condition meets the criteria for inability to attain appropriate medical management. There was more than four years between symptom stabilization in October 2014 and first medical presentation in February 2019. This lengthy time period considering the natural history of strain injuries is indicative of barriers to healthcare access, satisfying the inability to attain appropriate medical management factor as established in the Full Federal Court decision in Brew v Repatriation Commission (14 July 1990). The lack of medical presentations during this extended period indicates both objective and subjective inability to access appropriate care, which has resulted in permanent worsening of the condition through lack of early intervention and appropriate treatment.
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 - Strain
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 - Strain
Balance of Probabilities SOP: Sprain and Strain No. 28 of 2020 Reasonable Hypothesis SOP: Sprain and Strain No. 27 of 2020
ADF History
The veteran, Rifleman, 11/06/2013, [date withheld]
Occupational History
Military service as a Rifleman involves repetitive high-impact activities that can cause acute muscle and tendon strains, particularly in joints previously compromised by traumatic injury. Activities include pack marching, tactical movement, vehicle operations, and combat training that place ongoing stress on healing and compromised joint structures.
History
The veteran the veteran a Rifleman with the Australian Army, developed left knee strain secondary to his initial traumatic dislocation circa 2013-2014 and subsequent military training activities that placed ongoing stress on the compromised joint structures.
Timeline
- circa 2013-2014 - Initial traumatic knee dislocation during infantry training created structural predisposition to subsequent muscle and tendon strains around the compromised joint through altered biomechanics and weakened supporting structures during the recovery and rehabilitation period.
- 2016-2017 - During an overseas area of operations deployment on Operation HIGHROAD, ongoing strain symptoms developed from repetitive vehicle operations and operational activities. 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, indicating ongoing mechanical stress.
- 2017-2018 - Multiple physiotherapy assessments documented ongoing issues with the left knee requiring continuous rehabilitation and strengthening exercises. Physiotherapy notes consistently documented history of previous dislocation and ongoing biomechanical issues affecting muscle and tendon function around the compromised joint.
- Multiple 2017-2018 - Physiotherapy management for left knee condition with various assessments documenting chronic symptoms and functional limitations. Treatment focused on biomechanical correction, strengthening exercises, and functional improvement, suggesting ongoing strain-related symptoms affecting military duties and training activities.
- 05 May 2013 - Pre-separation health examination documented left knee as active ongoing condition with chronic strain effects. Medical officer noted ongoing functional limitations and impact on military-specific activities including pack marching difficulties and recurrent episodes affecting military performance.
Symptoms
Symptoms included ongoing pain and functional limitations related to the previously dislocated knee, with particular difficulty during high-impact activities, prolonged kneeling, and weight-bearing exercises. Current symptoms include chronic pain, functional limitations with military activities, and ongoing strain effects from the compromised joint mechanics following the initial traumatic injury.
Imaging
20 August 2011: Imaging excluded acute structural damage but confirmed soft tissue changes consistent with chronic strain effects and post-traumatic changes affecting the joint and surrounding structures.
1. What is the formal diagnosis of the condition claimed above?
Left knee strain (S83.90), Sprain and Strain SOP No. 28 of 2020, ICD-10 code S83.9.
A strain means an injury involving the tearing or stretching of a muscle or tendon, associated with the onset of pain and tenderness at that site within 24 hours following the injury. This includes complete tear or rupture of a muscle or tendon but excludes drug-induced disease of tendons or muscles. In this case, the strain represents ongoing effects of muscle and tendon damage secondary to the initial traumatic dislocation and subsequent military activities that placed continued stress on compromised structures. The left knee strain developed as a consequence of altered joint mechanics, weakened supporting structures, and ongoing military training demands on a previously injured joint.
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 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? Multiple presentations for ongoing left knee problems, with first comprehensive assessment for strain-related symptoms on 18 August 2011 at the treating doctor Health Centre. [CHART REVIEW.docx]
When was the condition confirmed/formally diagnosed? Ongoing strain effects documented through multiple physiotherapy assessments throughout 2017-2018 addressing chronic biomechanical issues and functional limitations. [CHART REVIEW.docx]
When did the veteran first present to you (or your practice) for this condition? 19 August 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 ongoing clinical assessments documenting functional limitations and pain consistent with chronic strain effects secondary to the initial traumatic injury. Multiple physiotherapy assessments addressed biomechanical abnormalities and strengthening deficits consistent with chronic strain patterns. Clinical examination revealed ongoing tenderness and functional limitations affecting military duties and daily activities. [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): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon - MET
- Ongoing military activities including pack marching, tactical training, vehicle operations, and deployment duties placed forceful stretching and high-intensity demands on muscles and tendons around the previously injured knee, causing ongoing strain effects.
Factor 9(4): forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon - MET
- Deployment activities during an overseas area of operations service, particularly repetitive vehicle operations leading with the left leg, caused clinical worsening of strain symptoms in the compromised joint.
Factor 9(5): inability to obtain appropriate clinical management for sprain or strain - MET
- While some treatment was provided, ongoing symptoms and functional limitations suggest inadequate management of the chronic effects of the initial trauma and subsequent strain complications.
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 on a compromised joint.
Inability to Attain Appropriate Medical Management
There was inability to attain appropriate medical management for the ongoing strain effects. While initial emergency treatment was provided for the dislocation and some subsequent physiotherapy was available, ongoing management of secondary strain effects was inadequate, as evidenced by persistent symptoms and functional limitations documented throughout military service. The condition required continuous management but adequate long-term rehabilitation and biomechanical correction was not achieved, leading to ongoing strain patterns. As established in Brew v Repatriation Commission, this constitutes inability to obtain appropriate clinical management, causing permanent worsening of the condition through inadequate treatment of chronic 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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