Posttraumatic Stress Disorder — DVA claim example

Diagnostic Assessment — Posttraumatic Stress Disorder

Example 1 of 1 · fictitious patient (Veteran DT)

Diagnostic Assessment

Posttraumatic Stress Disorder

BOP Code: 98 of 2022 (Posttraumatic Stress Disorder)
RH Code: 97 of 2022 (Posttraumatic Stress Disorder)

ADF History

Veteran DT, date of birth 12 October 1962, Australian Army, Junior Apprentice, then Medical Assistant and later Medic (Sergeant), enlisted 16 January 1978, medically discharged 30 August 2013. Operational service: Rwanda, United Nations Assistance Mission, 10 February 1995 to 25 August 1995 (peacekeeping); East Timor, 20 September 1999 to 18 February 2000 (warlike); Afghanistan, 06 October 2006 to 22 May 2007 (warlike); Afghanistan, 10 February 2011 to 28 September 2011 (warlike).

Occupational History

As an Army medic the veteran provided first aid and resuscitation at training accidents, in garrison health centres and hospitals, and on operations, where he treated blast, gunshot and crush injuries, cleared casualties from vehicles and aircraft, and dealt with the dead. Medics routinely hear casualties' detailed accounts of traumatic events and carry responsibility for life-and-death decisions.

Operational medics of the period worked under rocket, mortar and small arms fire, at roadblocks and in camps for displaced people, and in role 2 and role 3 hospitals receiving mass casualties, including children. The service culture discouraged help-seeking for mental health problems because of fear of medical downgrading.

History

Veteran DT, an Army medic who had been abused as a 15-year-old junior apprentice, developed posttraumatic stress disorder on 14 June 2007, after cumulative trauma in Rwanda, East Timor and Afghanistan and in peacetime training accidents, and the death and wounding of close friends. It worsened severely on 15 November 2011 after a further deployment to Afghanistan, during which his son was wounded, leading to psychiatric admission and medical discharge.

Timeline

• 21 Aug 1995 — Return to Australia medical examination after peacekeeping service in Rwanda. The veteran described witnessing a massacre of displaced people in April 1995 and helping to count and clear the dead. He reported some difficulty sleeping for a few weeks but no ongoing symptoms. No psychiatric diagnosis was made. "witnessed massacre, sleep settling"
• 18 Mar 2006 — The veteran found the body of a close friend, a fellow sergeant and his son's godfather, who had died by suicide in barracks. He attended a single critical incident debrief. In August 2006 another close friend was critically injured in a truck rollover on a pre-deployment exercise, and the veteran treated him at the scene. "found friend deceased, suicide"
• 18 Feb 2007 — On warlike service in Afghanistan the vehicle the veteran was travelling in struck an improvised explosive device. He was concussed and then cleared two critically injured soldiers from the vehicle. A month earlier, on 20 January 2007, his closest friend had been killed in a rocket attack on a coalition base, and on 03 March 2007 another close friend was shot in an ambush. "IED strike, cleared casualties"
• 22 May 2007 — Return to Australia psychological screening at the end of the Afghanistan deployment. K10 score 15. The veteran reported tiredness but denied nightmares, intrusive memories or avoidance, and no follow-up was arranged. "K10 15, no intrusive symptoms"
• 20 Sep 2007 — A psychiatrist assessed the veteran after his wife urged him to seek help. Since 14 June 2007 he had had nightly nightmares of the IED strike and the Rwandan massacre, intrusive memories, flashbacks, avoidance of crowds and driving, hypervigilance, irritability, poor concentration and emotional numbing. He disclosed abuse at the apprentice school in 1978. PCL-C 58. Diagnosis: posttraumatic stress disorder. Sertraline and trauma-focused therapy were started. "PTSD diagnosed, PCL-C 58"
• 14 Feb 2008 — The veteran was posted to a remote base without a psychologist. Trauma-focused therapy stopped after four sessions. He remained on sertraline with partial improvement and avoided further help for fear of being downgraded. In 2010 he was assaulted with a knife at the health centre and attended a fatal range accident. "therapy stopped, remote posting"
• 12 Apr 2011 — On warlike service at a coalition role 3 hospital in Afghanistan the veteran received his own son, an infantry soldier, wounded by small arms fire. Over the deployment he treated mass casualties and the base was hit by rockets 21 times. In December 2010 his wife had been critically injured in a training vehicle rollover, and in February 2011 a close friend had died by suicide. "son wounded, mass casualties"
• 15 Nov 2011 — Admitted to a psychiatric unit after five weeks on the waiting list. Nightly nightmares, daily flashbacks, panic attacks, explosive anger, alcohol misuse and suicidal thoughts without a plan. PCL-5 64 (up from an equivalent of 38 in 2010). Comorbid major depressive episode. He was medically downgraded and later discharged. "PCL-5 64, psychiatric admission"

Symptoms

At onset the veteran had nightly nightmares, intrusive memories and flashbacks of the IED strike, the Rwandan massacre and the death of his friends, with avoidance of crowds, driving and reminders of deployment, emotional numbing, hypervigilance, an exaggerated startle response, irritability, poor concentration and disturbed sleep. After the 2011 worsening these became severe, with panic attacks, explosive anger, heavy drinking, depression and suicidal thoughts.

He now reports ongoing nightmares several nights a week, intrusive memories, avoidance of crowds and shopping centres, hypervigilance, irritability, social withdrawal, poor concentration and memory, and an inability to work since discharge.

Imaging

No imaging is required to establish this diagnosis.

Onset Date

The most likely date of onset of this condition is 14 Jun 2007.

At that date the veteran was a sergeant medic serving full time in Australia, three weeks after returning from warlike service in Afghanistan. From that date he had persistent nightmares, intrusive memories and flashbacks, avoidance, numbing and hyperarousal, which continued for more than one month and led to the psychiatric diagnosis on 20 September 2007.

This date is appropriate because his return to Australia psychological screening on 22 May 2007 recorded no intrusive symptoms (K10 15), and at his first assessment on 20 September 2007 he dated the continuous symptoms to 14 June 2007. It falls within continuous full-time service.

For the hostile environment factor, he lived and worked under rocket and IED threat in Afghanistan from 06 Oct 2006 to 22 May 2007, more than 4 weeks before onset. For the significant other factors, the 1 year before onset runs from 14 Jun 2006 to 14 Jun 2007 and contains his friend's critical injury in the training rollover (10 Aug 2006) and his friend's gunshot wound in Afghanistan (03 Mar 2007); the 2 years before onset run from 14 Jun 2005 to 14 Jun 2007 and contain the suicide of his friend in barracks (18 Mar 2006) and the death of his closest friend in a rocket attack in Afghanistan (20 Jan 2007). The category 1A and 1B stressors, the aversive exposures and the 1978 childhood abuse all occurred before onset, with no time limit.

For the worsening factors, the documented worsening was on 15 Nov 2011, with psychiatric admission, a PCL-5 of 64 and a comorbid depressive episode. He served in a hostile environment in Afghanistan from 10 Feb 2011 to 28 Sep 2011. The 1 year before the worsening runs from 15 Nov 2010 to 15 Nov 2011 and contains his wife's critical injury (12 Dec 2010) and his son's gunshot wound (12 Apr 2011). The 2 years before it run from 15 Nov 2009 to 15 Nov 2011 and contain the death of his friend in Afghanistan (24 Aug 2010) and the suicide of a close friend (06 Feb 2011).

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

The formal diagnosis is Posttraumatic Stress Disorder (ICD-10-AM F43.1), under the Statements of Principles concerning posttraumatic stress disorder, Balance of Probabilities No. 98 of 2022 and Reasonable Hypothesis No. 97 of 2022.

Posttraumatic stress disorder is a disorder of mental health that follows exposure to actual or threatened death, serious injury or sexual violence. It is characterised by intrusive memories, nightmares and flashbacks of the traumatic events, avoidance of reminders, negative changes in thinking and mood such as guilt, detachment and emotional numbing, and marked arousal, with hypervigilance, irritability, poor concentration and disturbed sleep, lasting more than one month and causing significant distress or impairment. Cumulative trauma, the death or injury of people close to the person and childhood abuse increase the risk. It commonly occurs with depression and alcohol misuse.

The disorder began on 14 June 2007, after cumulative operational and peacetime trauma, was diagnosed by a psychiatrist on 20 September 2007 and worsened severely on 15 November 2011 after a further deployment to Afghanistan.

2. For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition?

14 June 2007.

When did the veteran first present to a health / medical provider for this condition?

20 September 2007.

When was the condition confirmed / formally diagnosed?

20 September 2007.

When did the veteran first present to you (or your practice) for this condition?

05 November 2025.

3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?

The diagnosis was made by a psychiatrist on 20 September 2007 using the DSM criteria and meets the DSM-5-TR criteria in the Statement of Principles. Criterion A was met by direct exposure to life-threatening events, witnessing the killing and critical injury of others, learning of the violent death of close friends and repeated exposure to aversive details as a medic. He had intrusion symptoms (nightmares, intrusive memories, flashbacks), persistent avoidance, negative alterations in mood and cognition (numbing, detachment, guilt) and marked arousal (hypervigilance, startle, irritability, poor concentration, sleep disturbance), lasting more than one month and causing significant impairment at work and at home. The PCL-C score was 58.

The symptoms were not due to a substance or another medical condition: the concussion of February 2007 had resolved, and alcohol misuse developed later. The worsening was confirmed at psychiatric admission on 15 November 2011, with a PCL-5 of 64 and a comorbid major depressive episode.

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.

Legislation: the clinical onset of this condition was on 14 June 2007, after 1 July 2004, during continuous full-time service. This is a Military Rehabilitation and Compensation Act 2004 (MRCA) claim and the Statements of Principles apply. The Balance of Probabilities instrument applies to peacetime service, including the training accidents, the suicides of close friends and the abuse at the apprentice school. The Reasonable Hypothesis instrument applies to the veteran's peacekeeping service in Rwanda in 1995 and warlike service in East Timor in 1999-2000 and Afghanistan in 2006-07, before the onset, and in Afghanistan in 2011, before the worsening. Service before 1 July 2004 is considered under the transitional provisions as part of the cumulative history.

Each factor must be related to the person's relevant service. Under the beneficial approach required by the legislation, the absence of documentation does not mean that an event or exposure did not occur: lack of evidence is not evidence of lack.

Balance of Probabilities — Statement of Principles concerning Posttraumatic Stress Disorder, No. 98 of 2022

Causative factors

Factor 9(1): experiencing a category 1A stressor before the clinical onset of posttraumatic stress disorder; — MET

- On 11 November 1992, during a peacetime live-fire training exercise, a grenade thrown by a trainee fell short and detonated about 4 metres from the veteran's position, killing a soldier beside him and wounding the veteran with fragments to the left thigh. This was a life-threatening event, recorded in the training accident inquiry and his medical record, and it occurred before the clinical onset on 14 June 2007.

Factor 9(2): experiencing a category 1B stressor before the clinical onset of posttraumatic stress disorder; — MET

- In the grenade accident of 11 November 1992 the veteran, as the exercise medic, was an eyewitness to a soldier being killed and gave first aid to the critically injured trainee. On 18 March 2006 he found the body of a close friend who had died by suicide in barracks, a violent death, and helped the military police with the scene. Each is a category 1B stressor in peacetime service before onset.

Factor 9(3): having a significant other who experiences a category 1A stressor within the 1 year before the clinical onset of posttraumatic stress disorder; — MET

- On 10 August 2006, during a peacetime pre-deployment exercise in Queensland, the veteran's closest friend in his unit, a corporal medic he had served with for eight years, was critically injured when a truck rolled over, with a fractured pelvis and a ruptured spleen requiring emergency surgery. The veteran treated him at the scene. This category 1A stressor experienced by a significant other occurred 10 months before the clinical onset on 14 June 2007, within the 1 year before onset.

Factor 9(4): experiencing the traumatic death of a significant other within the 2 years before the clinical onset of posttraumatic stress disorder; — MET

- The close friend found dead by suicide in barracks on 18 March 2006 was a fellow sergeant and the godfather of the veteran's son. This traumatic death of a significant other occurred 1 year and 3 months before the clinical onset on 14 June 2007, within the 2 years before onset.

Factor 9(5): being exposed to repeated or extreme aversive details of severe traumatic events before the clinical onset of posttraumatic stress disorder; — MET

- From 03 February 2003 to 20 December 2005 the veteran was posted as a senior medic to a military hospital emergency department and mortuary support role in Australia, where he repeatedly treated soldiers with severe injuries from training and road accidents, assisted at post-mortem examinations after training deaths and listened to casualties' accounts of their injuries. His posting reports describe this as routine work. This is repeated exposure to aversive details of severe traumatic events before onset.

Factor 9(6): experiencing severe childhood abuse before the clinical onset of posttraumatic stress disorder; — MET

- The veteran enlisted as a junior apprentice at 15 years and 3 months on 16 January 1978. Between January and October 1978, before his sixteenth birthday on 12 October 1978, he was repeatedly beaten and sexually assaulted by senior apprentices and by an adult instructor at the apprentice school, as recorded in a Defence abuse response assessment in 2013 and in his psychiatric history. This is serious physical, psychological and sexual harm whilst a child aged under 16 years, perpetrated by an adult who worked with or around him, and it occurred before onset in the course of his service.

Worsening factors

Factor 9(7): experiencing a category 1A stressor before the clinical worsening of posttraumatic stress disorder; — MET

- On 14 April 2010, during a peacetime period of service in Australia, the veteran was attacked with a knife by an intoxicated soldier while on duty at the garrison health centre and received a laceration to his forearm while disarming him. This serious physical assault and threat with a weapon occurred before the worsening on 15 November 2011.

Factor 9(8): experiencing a category 1B stressor before the clinical worsening of posttraumatic stress disorder; — MET

- On 22 September 2010, during a peacetime live-fire range practice, the veteran was the duty medic and an eyewitness when a soldier was shot dead by a ricochet. He attempted resuscitation and helped clear the body from the range. This category 1B stressor occurred before the worsening on 15 November 2011.

Factor 9(9): having a significant other who experiences a category 1A stressor within the 1 year before the clinical worsening of posttraumatic stress disorder; — MET

- On 12 December 2010 the veteran's wife, an Army nurse, was critically injured when the vehicle she was travelling in on a peacetime training exercise rolled over, with a head injury and chest injuries requiring intensive care for nine days. This life-threatening event experienced by a significant other occurred 11 months before the worsening on 15 November 2011, within the 1 year before it.

Factor 9(10): experiencing the traumatic death of a significant other within the 2 years before the clinical worsening of posttraumatic stress disorder; — MET

- On 06 February 2011 a close friend and fellow medic in the veteran's unit died by suicide in Australia, a traumatic death. They had served together since 1999 and their families were close. This occurred 9 months before the worsening on 15 November 2011, within the 2 years before it.

Factor 9(11): being exposed to repeated or extreme aversive details of severe traumatic events before the clinical worsening of posttraumatic stress disorder; — MET

- As a senior medic in garrison from 2008 to 2010 and in Australia after his 2011 deployment, the veteran repeatedly treated training casualties, attended the fatal range incident of September 2010 and conducted clinical debriefs in which soldiers recounted traumatic events in detail. This repeated exposure to aversive details of severe traumatic events occurred before the worsening on 15 November 2011.

Factor 9(12): experiencing severe childhood abuse before the clinical worsening of posttraumatic stress disorder; — MET

- The severe abuse the veteran suffered as a 15-year-old junior apprentice in 1978, physical and sexual assault by senior apprentices and an adult instructor, occurred before the worsening on 15 November 2011.

Factor 9(13): inability to obtain appropriate clinical management for posttraumatic stress disorder. — MET

- After diagnosis in September 2007 the veteran was posted from 2008 to 2010 to a remote base where no psychologist was available, and his trauma-focused therapy stopped after four sessions. He was then deployed to Afghanistan in February 2011 with active posttraumatic stress disorder, and his referral for inpatient treatment in October 2011 waited five weeks for a bed. Fear of being medically downgraded, reinforced by unit culture, also stopped him seeking help. These barriers to care came before and contributed to the worsening on 15 November 2011.

Reasonable Hypothesis — Statement of Principles concerning Posttraumatic Stress Disorder, No. 97 of 2022

Causative factors

Factor 9(1): experiencing a category 1A stressor before the clinical onset of posttraumatic stress disorder; — MET

- The veteran experienced category 1A stressors on operational service before onset: on peacekeeping service in Rwanda in April 1995 he came under small arms fire and was held at gunpoint at a roadblock; on warlike service in East Timor on 08 October 1999 his patrol was fired on; and on warlike service in Afghanistan on 18 February 2007 the vehicle he was travelling in struck an improvised explosive device, leaving him concussed. Each was a life-threatening event, or a threat with a weapon, before onset on 14 June 2007.

Factor 9(2): experiencing a category 1B stressor before the clinical onset of posttraumatic stress disorder; — MET

- On peacekeeping service in Rwanda in April 1995 the veteran was an eyewitness to the killing of displaced civilians in a massacre at a camp, treated the critically injured and helped clear and count the dead over several days. In Afghanistan in 2007 he cleared critically injured casualties from a vehicle after the IED strike of 18 February 2007. These category 1B stressors occurred before onset.

Factor 9(3): living or working in a hostile or life-threatening environment for a period of at least 4 weeks before the clinical onset of posttraumatic stress disorder; — MET

- From 06 October 2006 to 22 May 2007 the veteran served with a reconstruction task force in southern Afghanistan on warlike service, at a forward operating base under regular rocket and mortar attack, and went on vehicle patrols under threat of improvised explosive devices. He lived and worked in this hostile and life-threatening environment for more than seven months, more than 4 weeks before onset on 14 June 2007.

Factor 9(4): having a significant other who experiences a category 1A stressor within the 1 year before the clinical onset of posttraumatic stress disorder; — MET

- On 03 March 2007, on warlike service in Afghanistan, the veteran's close friend, a sergeant he had trained and served with since 1999, was shot through the chest in an ambush on a patrol the veteran had been rostered for but swapped. The friend survived after emergency surgery. This category 1A stressor experienced by a significant other occurred 3 months before onset, within the 1 year before it.

Factor 9(5): experiencing the traumatic death of a significant other within the 2 years before the clinical onset of posttraumatic stress disorder; — MET

- On 20 January 2007 the veteran's closest friend, a medic seconded to a coalition medical unit, was killed in a rocket attack on a base in Afghanistan during warlike service. The veteran learned of the death the same day and attended the ramp ceremony. This traumatic death of a significant other occurred 5 months before onset, within the 2 years before it.

Factor 9(6): being exposed to repeated or extreme aversive details of severe traumatic events before the clinical onset of posttraumatic stress disorder; — MET

- As a medic on operational service in Rwanda (1995), East Timor (1999-2000) and Afghanistan (2006-07), the veteran repeatedly treated severe trauma, including blast and gunshot injuries, saw the dead of massacres and listened to survivors' and casualties' detailed accounts of their experiences. This is repeated and extreme exposure to aversive details of severe traumatic events before onset.

Factor 9(7): experiencing severe childhood abuse before the clinical onset of posttraumatic stress disorder; — MET

- The veteran was repeatedly physically and sexually assaulted by senior apprentices and an adult instructor at the apprentice school between January and October 1978, while he was 15. The abuse occurred in his service before onset and left him more vulnerable to the operational trauma that followed, as his psychiatrist recorded.

Worsening factors

Factor 9(8): experiencing a category 1A stressor before the clinical worsening of posttraumatic stress disorder; — MET

- On warlike service in Afghanistan from 10 February 2011 to 28 September 2011 the veteran's base was hit by rockets on 21 occasions, and on 07 June 2011 a rocket landed 30 metres from him, wounding two people. These life-threatening events occurred before the worsening on 15 November 2011.

Factor 9(9): experiencing a category 1B stressor before the clinical worsening of posttraumatic stress disorder; — MET

- At a coalition role 3 hospital in Afghanistan in 2011 the veteran received mass casualties after improvised explosive device attacks, saw corpses with traumatic amputations and helped clear critically injured casualties from helicopters, including children. These category 1B stressors occurred before the worsening on 15 November 2011.

Factor 9(10): living or working in a hostile or life-threatening environment for a period of at least 4 weeks before the clinical worsening of posttraumatic stress disorder; — MET

- From 10 February 2011 to 28 September 2011 the veteran served on warlike service in Afghanistan at a base under regular rocket attack, a hostile and life-threatening environment for more than seven months, more than 4 weeks before the worsening on 15 November 2011.

Factor 9(11): having a significant other who experiences a category 1A stressor within the 1 year before the clinical worsening of posttraumatic stress disorder; — MET

- On 12 April 2011 the veteran's son, an infantry soldier on warlike service in Afghanistan, was wounded by small arms fire in a firefight, and the veteran received him at the role 3 hospital where he was working. This category 1A stressor experienced by a significant other occurred 7 months before the worsening, within the 1 year before it.

Factor 9(12): experiencing the traumatic death of a significant other within the 2 years before the clinical worsening of posttraumatic stress disorder; — MET

- On 24 August 2010 a close friend from the veteran's East Timor deployment, an infantry sergeant, was killed by an improvised explosive device on warlike service in Afghanistan. This traumatic death of a significant other occurred 1 year and 3 months before the worsening on 15 November 2011, within the 2 years before it.

Factor 9(13): being exposed to repeated or extreme aversive details of severe traumatic events before the clinical worsening of posttraumatic stress disorder; — MET

- At the role 3 hospital in Afghanistan in 2011 the veteran treated severe blast and gunshot casualties daily and repeatedly heard casualties' and colleagues' detailed accounts of attacks. This is repeated and extreme exposure to aversive details of severe traumatic events before the worsening.

Factor 9(14): experiencing severe childhood abuse before the clinical worsening of posttraumatic stress disorder; — MET

- The severe abuse the veteran suffered as a 15-year-old junior apprentice in 1978 occurred before the worsening on 15 November 2011.

Factor 9(15): inability to obtain appropriate clinical management for posttraumatic stress disorder. — MET

- After the 2007 diagnosis the veteran's trauma-focused therapy stopped after four sessions when he was posted to a remote base without a psychologist. He was deployed on warlike service to Afghanistan in February 2011 with active symptoms and had no access to trauma-focused therapy in theatre, and his urgent referral for inpatient treatment on his return waited five weeks for a bed before the worsening on 15 November 2011.

The % contribution of the causes is 100% and significant.

Sequelae

The posttraumatic stress disorder has resulted in a major depressive disorder, an alcohol use disorder that developed as a way of coping with nightmares and hyperarousal, chronic insomnia and relationship breakdown. These are sequelae of the accepted condition and can be claimed in their own right.

Unintended Consequence

Met. Sertraline, prescribed and paid for by the Commonwealth from 2007, caused sexual dysfunction and weight gain of 14 kg, recorded by his psychiatrist, which added to his distress and relationship difficulties. These are unintended consequences of treatment of the accepted condition (section 6A of the DRCA and the equivalent provisions of the MRCA).

Inability to Attain Appropriate Medical Management

MET. After the diagnosis in September 2007 the veteran's trauma-focused therapy stopped after four sessions when he was posted in 2008 to a remote base without a psychologist. He was deployed to Afghanistan in February 2011 with active posttraumatic stress disorder and no access to trauma-focused therapy in theatre, and on his return his urgent referral for inpatient care waited five weeks for a bed. The service culture of the time, and his well-founded fear of medical downgrading, deterred him from seeking help. Applying the objective and subjective tests in Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), the unavailability of treatment because of postings and deployments, and the barriers created by service culture, amount to an inability to obtain appropriate clinical management before the worsening on 15 November 2011.

5. Please provide a Health Summary and a medication / prescribing history.

See attached report.

References

1. 11 Nov 1992, Training accident inquiry and medical record, Medical Officer
2. 21 Aug 1995, Return to Australia medical examination, Medical Officer
3. 20 Dec 2005, Posting report, Military hospital
4. 18 Mar 2006, Critical incident debrief record, Psychologist
5. 18 Feb 2007, Role 2 record, Medical Officer, Afghanistan
6. 22 May 2007, Return to Australia psychological screening, Psychologist
7. 20 Sep 2007, Psychiatric assessment, Consultant psychiatrist
8. 14 Apr 2010, Incident report and outpatient record, Medical Officer
9. 12 Apr 2011, Role 3 hospital record, Afghanistan
10. 15 Nov 2011, Psychiatric admission and discharge summary, Consultant psychiatrist
11. 20 May 2013, Defence abuse response assessment
12. Statement of Principles concerning Posttraumatic Stress Disorder (Balance of Probabilities) No. 98 of 2022, Repatriation Medical Authority
13. Statement of Principles concerning Posttraumatic Stress Disorder (Reasonable Hypothesis) No. 97 of 2022, Repatriation Medical Authority