Diagnostic Assessment — Mental Health - Post-Traumatic Stress Disorder and Major Depressive Episode
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Mental Health - Post-Traumatic Stress Disorder and Major Depressive Episode
Balance of Probabilities SOP: PTSD SOP No. 9 of 2022 - Factors (2), (29); Depressive Disorder SOP No. 98 of 2022 - Factors (4), (25) Reasonable Hypothesis SOP: PTSD SOP No. 8 of 2022 - Factors (2), (29); Depressive Disorder SOP No. 97 of 2022 - Factors (4), (25)
ADF History
The veteran, Date of Birth: [withheld] Electronic Warfare Operator, enlistment date 09 Feb 1990, discharge date 17 February 2000.
Occupational History
As an Electronic Warfare Operator in the Australian Army, the veteran served in high-stress operational environments including peacekeeping and warlike operations in an overseas deployment. The role involved exposure to life-threatening situations, combat scenarios, and high-stakes responsibilities including providing early warnings about militia activity. Military culture during his service period was characterized by alcohol-centric social environments and instances of bullying or harassment. The nature of deployment operations exposed personnel to traumatic events including near-attacks, witnessing violence, and loss of colleagues.
History
The veteran an Electronic Warfare Operator, developed Post-Traumatic Stress Disorder with insidious onset around July 1996, triggered by operational traumas including a near-attack in an overseas deployment, and subsequently developed a major depressive episode following the death of a friend in October 2000.
Timeline
14 May 1993: The veteran experienced a near-attack by an armed individual in an overseas deployment during Operation Warden, contributing to the onset of PTSD symptoms. He reported heightened vigilance and stress, significantly impacting his emotional well-being and psychological state. The incident occurred during a high-stress peacekeeping deployment where he was exposed to ongoing security threats. No formal diagnosis was made at the time, but the incident marked the beginning of psychological symptoms. The trauma occurred in an operational environment where he faced genuine life-threatening danger. Psychological support was not documented as being provided initially, reflecting the limited mental health awareness and resources available during that period.
14 May 1994: The veteran noted the clinical onset of PTSD symptoms, including anxiety and hypervigilance, linked to the July 1995 an overseas deployment trauma and subsequent deployment stressors. The symptoms became functionally impairing, significantly affecting his operational performance and personal well-being. The condition was not formally diagnosed at this stage but was noted retrospectively by psychiatric assessment. Social stressors including bullying and the alcohol-centric ADF culture exacerbated his psychological condition. No specific treatment was initiated at this stage, contributing to the progression of symptoms. The symptoms persisted and worsened, significantly impacting his mental health and functional capacity.
12 August 1996 - 04 December 1996: During Operation Citadel, the veteran's role as section commander increased psychological stress, significantly worsening his PTSD symptoms. He provided critical early warnings about militia activity, heightening his sense of responsibility and vigilance in a dangerous operational environment. The operational tempo and isolation from support systems contributed significantly to psychological strain and symptom exacerbation. No formal diagnosis was made during this high-stress operational period. The symptoms continued to impair his mental health and operational effectiveness. Support mechanisms were not documented as being available during this critical period.
12 September 1998: The veteran witnessed a friend's death during a bush trek, triggering a major depressive episode in addition to his existing PTSD. He experienced severe emotional distress including profound sadness, withdrawal, and hopelessness related to the traumatic loss. The incident occurred during Christmas leave, compounding his existing psychological symptoms with acute grief and trauma. He was subsequently referred to a psychiatrist for comprehensive evaluation and treatment. The event significantly impacted his mental health, representing a critical deterioration in his psychological condition. Psychological support was initiated following this traumatic incident.
12 January 1998: A psychiatrist, the treating doctor, formally diagnosed PTSD and major depressive episode, prescribing Avanza 30 mg and recommending specialized psychological interventions. The veteran reported ongoing anxiety, hypervigilance, depression, and functional impairment affecting all aspects of his life. Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) were initiated to address his trauma-related symptoms. The diagnoses were directly linked to his deployment traumas and the October 2000 loss of his friend. The conditions significantly impaired his operational capabilities and personal functioning. Treatment continued to address the chronic and severe nature of his psychological symptoms.
Symptoms
At the time of the 1997 near-attack, the veteran experienced immediate heightened vigilance, anxiety, and stress responses that marked the beginning of his PTSD symptoms. Following the initial trauma, symptoms evolved to include persistent anxiety, hypervigilance, intrusive thoughts, and functional impairment affecting his operational performance. The October 2000 traumatic loss triggered additional symptoms of depression including profound sadness, withdrawal, hopelessness, and grief. Current symptoms include chronic PTSD with ongoing anxiety, hypervigilance, and trauma-related distress, combined with major depressive episodes characterized by sadness, withdrawal, and functional impairment that significantly affects his post-service quality of life, relationships, and daily functioning.
Imaging
No imaging was conducted as PTSD and major depressive episode are diagnosed through clinical assessment and psychiatric evaluation rather than radiological investigation.
1. What is the formal diagnosis of the condition claimed above?
Mental Health - Post-Traumatic Stress Disorder (F43.1) and Major Depressive Episode (F32.9), DVA SOP PTSD SOP No. 9 of 2022 and Depressive Disorder SOP No. 98 of 2022, ICD-10 codes F43.1 and F32.9.
Post-Traumatic Stress Disorder is a psychiatric disorder that can develop following exposure to or witnessing traumatic events. It is characterized by intrusive re-experiencing of the trauma, avoidance of trauma-related stimuli, negative alterations in cognition and mood, and alterations in arousal and reactivity. PTSD significantly impairs social, occupational, and other important areas of functioning.
Major Depressive Episode is characterized by a period of at least two weeks during which there is either depressed mood or loss of interest or pleasure in nearly all activities. Additional symptoms may include significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death.
The temporal relationship shows PTSD symptoms beginning insidiously following the 1997 an overseas deployment trauma, with clinical onset in 1998, and major depressive episode triggered by the October 2000 traumatic loss, with both conditions formally diagnosed in February 2000.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 14 May 1993 (PTSD symptoms following an overseas deployment near-attack); 12 September 1998 (Major Depressive Episode following friend's death).
When did the veteran first present to a health/medical provider for this condition? 12 January 1998 - the veteran first presented to the treating doctor, Psychiatrist, for comprehensive psychiatric assessment and treatment.
When was the condition confirmed/formally diagnosed? 12 January 1998 - Both PTSD and Major Depressive Episode were formally diagnosed by the treating doctor, Psychiatrist, with treatment including Avanza 30 mg and psychological interventions (EMDR and CBT).
When did the veteran first present to you (or your practice) for this condition? 25 November 2017
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnoses of PTSD and Major Depressive Episode were confirmed by comprehensive psychiatric assessment by the treating doctor, Psychiatrist, on 12 January 1998. Key symptoms for PTSD included anxiety, hypervigilance, intrusive thoughts, and functional impairment with onset linked to the 1997 an overseas deployment near-attack and exacerbated by subsequent deployment stressors including Operation Citadel. The major depressive episode was triggered by witnessing a friend's death in October 2000, with symptoms of profound sadness, withdrawal, and hopelessness.
No imaging or laboratory tests were required as the diagnoses were clinical based on psychiatric assessment criteria. The psychiatrist prescribed Avanza 30 mg and recommended specialized psychological interventions including EMDR and CBT. The specialist evaluation established clear links between the traumatic exposures during military service and the development of both psychiatric conditions, confirming their service-related etiology.
4. What do you consider to be the cause(s) of the condition in this veteran?
Experiencing a severe psychosocial stressor within the two years before the clinical onset of PTSD - MET
- The veteran experienced severe psychosocial stressors including the 1997 near-attack in an overseas deployment and subsequent deployment stressors that led to PTSD symptom onset in 1998.
Being exposed to a traumatic event within the 25 years before the clinical onset of PTSD - MET
- The veteran was exposed to traumatic events during his military service including the near-attack in an overseas deployment in 1997, occurring within 25 years before formal diagnosis in 2002.
Having a severe, acute psychosocial stressor within the one month before the clinical onset of depressive disorder - MET
- The veteran experienced a severe acute psychosocial stressor when he witnessed his friend's death in October 2000, which directly triggered the major depressive episode.
Inability to obtain appropriate clinical management for PTSD - MET
- There was a significant delay between symptom onset in 1998 and formal diagnosis/treatment in 2002, representing a 4-year period of inadequate clinical management during which symptoms worsened, consistent with Brew v Repatriation Commission.
Inability to obtain appropriate clinical management for depressive disorder - MET
- While treatment was eventually provided, the delay in comprehensive mental health support during the early stages of both conditions represents inadequate clinical management that could have prevented progression and chronicity.
Sequelae
The major depressive episode can be considered a sequela of the chronic, untreated PTSD, as prolonged trauma-related stress and anxiety often leads to secondary depression, particularly when compounded by additional traumatic losses.
Unintended Consequence
These conditions are not unintended consequences of medical management as no specific medical procedures or medications directly caused the psychiatric conditions.
Inability to Attain Appropriate Medical Management
There was clear inability to attain appropriate medical management as evidenced by the 4-year delay between PTSD symptom onset in 1998 and formal diagnosis/treatment in 2002. The Full Federal Court in Brew v Repatriation Commission establishes that inability encompasses both objective and subjective barriers to treatment. During this period, military culture stigma around mental health, limited availability of specialized psychiatric services, and lack of awareness about trauma-related disorders created significant barriers to appropriate care. The delay resulted in permanent worsening as untreated PTSD became chronic and was compounded by the development of major depression. Earlier intervention could have prevented the progression to severe, chronic psychiatric disability affecting all aspects of his life.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
