Respiratory - Allergic Rhinitis — 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 — Respiratory - Allergic Rhinitis

Example 1 of 1 · fictitious patient (Veteran C)

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

Respiratory – Allergic Rhinitis (J30.4)

Balance of Probabilities SOP: No specific SOP exists for Allergic Rhinitis. Analogous factors from Sinusitis SOP No. 74 of 2018 apply. Reasonable Hypothesis SOP: No specific SOP exists for Allergic Rhinitis. Analogous factors from Sinusitis SOP No. 73 of 2018 apply.

ADF History

The veteran, Communications and Information Systems Controller, enlisted 28 July 1986, discharged 22 Mar 2003.

Occupational History

Communications and Information Systems Controllers are exposed to various environmental allergens during deployments and field exercises, including grass pollen, dust mites, and particulate matter in austere environments. Deployment conditions often involve exposure to high concentrations of airborne allergens, dust storms, and environmental irritants that can trigger or exacerbate allergic rhinitis. Field exercises and outdoor operational duties increase exposure to seasonal allergens.

History

The veteran a Communications and Information Systems Controller in the RAAF, developed allergic rhinitis due to environmental allergen exposure during service, particularly to grass pollen and dust mites encountered in military training environments and deployment settings.

Timeline

Pre-deployment (Date Illegible): The veteran reported allergies to pollen and dust during a pre-deployment health screen, diagnosed as allergic rhinitis, with symptoms of nasal congestion and sneezing, linked to environmental exposures in service settings. The clinical presentation included ongoing allergic symptoms requiring medication management, though specific drugs were not detailed. The condition was noted as a consideration for deployment readiness, indicating functional impact. No specific examination findings were documented, suggesting a clinical diagnosis based on history.
2007-2008: The veteran received ongoing specialist care for allergic rhinitis, presenting with nasal congestion, sneezing, and rhinorrhea, managed with desensitization injections targeting grass pollen and dust mites. The clinical presentation included chronic allergic symptoms significantly impacting quality of life, requiring specialist intervention. The condition showed good response to immunotherapy, though multiple sessions were needed, indicating persistence. The dermatologist adjusted treatment protocols with regular monitoring to manage symptoms. The condition was linked to service-related exposures, particularly in deployment environments with high allergen loads.

Symptoms

At the time of onset, the veteran experienced nasal congestion, sneezing, rhinorrhea, and seasonal allergic symptoms affecting his ability to perform duties effectively. Following specialist treatment, symptoms improved with desensitization therapy but required ongoing management. Currently, from the chart review, allergic rhinitis is managed with immunotherapy and environmental controls, with significant improvement in symptom control achieved through specialist intervention.

Imaging

No specific imaging was performed for allergic rhinitis diagnosis.

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

Allergic Rhinitis (ICD-10 J30.4). No specific DVA SOP exists for Allergic Rhinitis. Analogous factors from Sinusitis SOP No. 74 of 2018 (Balance of Probabilities) and No. 73 of 2018 (Reasonable Hypothesis) may be considered.

Allergic rhinitis is a chronic inflammatory condition of the nasal passages triggered by environmental allergens such as grass pollen, dust mites, and other airborne substances. The condition is characterized by nasal congestion, sneezing, rhinorrhea (runny nose), and itching of the nose and eyes. It is an IgE-mediated hypersensitivity reaction that can be seasonal or perennial depending on the triggering allergens.

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 allergic rhinitis symptoms during pre-deployment screening (date illegible) [Pre Deployment Health Screen - Standard, UMR 1-100.pdf, Page 4], with ongoing symptoms managed from 2007-2008 [Letters from Specialist Medical Practitioners, UMR 1-100.pdf].

When did the veteran first present to a health / medical provider for this condition? The veteran first presented during pre-deployment health screening to military medical officer (date illegible) [Pre Deployment Health Screen - Standard, UMR 1-100.pdf, Page 4] and subsequently to specialist dermatologist in 2007-2008 [Letters from Specialist Medical Practitioners, UMR 1-100.pdf].

When was the condition confirmed / formally diagnosed? The condition was confirmed during pre-deployment health screening by military medical officer (date illegible) [Pre Deployment Health Screen - Standard, UMR 1-100.pdf, Page 4] and managed by specialist dermatologist with desensitization therapy 2007-2008 [Letters from Specialist Medical Practitioners, UMR 1-100.pdf].

When did the veteran first present to you (or your practice) for this condition? 21 January 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 history of allergic symptoms including nasal congestion, sneezing, and rhinorrhea triggered by specific environmental allergens (grass pollen and dust mites). Specialist dermatologist confirmed the diagnosis and initiated desensitization immunotherapy targeting the identified allergens [Letters from Specialist Medical Practitioners, UMR 1-100.pdf]. The condition was noted during pre-deployment health screening indicating impact on operational readiness [Pre Deployment Health Screen - Standard, UMR 1-100.pdf, Page 4].

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.

Exposure to environmental allergens including grass pollen and dust mites in military environments

MET. The veteran was exposed to high concentrations of environmental allergens during field exercises, training, and deployment environments, with specialist confirmation of sensitization to grass pollen and dust mites requiring desensitization therapy.

Occupational exposure to dusty deployment environments with high allergen loads

MET. The veteran's service included deployments to austere environments with significant dust and particulate matter exposure, exacerbating allergic symptoms and requiring specialist intervention for symptom control.

Being required to perform outdoor duties during high pollen seasons

MET. The veteran's role as Communications and Information Systems Controller involved field exercises and outdoor operational duties during various seasons, increasing exposure to seasonal allergens that triggered and maintained allergic rhinitis symptoms.

Inability to obtain appropriate clinical management for allergic rhinitis

NOT MET. The veteran received appropriate clinical management including specialist dermatologist referral, desensitization immunotherapy, and ongoing monitoring. Treatment was comprehensive and appropriate for the condition severity.

Sequelae

This condition is not a sequelae of another known condition.

Unintended Consequence

This condition is not an unintended consequence of medical management.

Inability to Attain Appropriate Medical Management

This factor is NOT MET. The veteran received appropriate clinical management for allergic rhinitis including specialist dermatologist referral, comprehensive desensitization immunotherapy targeting specific allergens (grass pollen and dust mites), and ongoing monitoring with treatment adjustments as needed. The management provided was appropriate and comprehensive for the standards of care. The successful response to immunotherapy demonstrates effective treatment was available and provided. There is no evidence of inability to access appropriate medical management. The Full Federal Court in Brew v Repatriation Commission (19 July 1990) established that inability encompasses both objective and subjective barriers to treatment, but in this case specialized treatment was readily available and provided with good clinical response.

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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