Right Groin - Inguinal Hernia — ICD-10 K40.90

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 invented and all dates changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment — Right Groin - Inguinal Hernia

Example 1 of 1 · 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 invented and all dates have been changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment

Right Groin - Inguinal Hernia

BOP Code: 48 of 2021 (Inguinal Hernia)
RH Code: 47 of 2021 (Inguinal Hernia)

ADF History

Veteran O, date of birth 03 February 1971, Australian Army, Ammunition Technician, enlisted 16 January 1990, medically discharged 28 February 2022. Operational service: Sudan, 05 July 2006 to 20 March 2007 (non-warlike); Afghanistan, 10 March 2009 to 15 November 2009 (warlike).

Occupational History

An ammunition technician receives, stores, inspects, repairs and disposes of explosive ordnance. The work involves repeated manual handling of ammunition boxes, projectiles and pallets weighing 20 to 45 kilograms, often in confined magazines, on vehicle tailgates and in field ammunition points where mechanical aids are limited. Stocktakes and surge issues during exercises and operations involve lifting for whole shifts.

Field and deployed postings expose the trade to dust, diesel exhaust and smoke from open burning, to heat, to poor sanitation with outbreaks of gastroenteritis, and to tropical infections in endemic areas. Bending, twisting and straining under load are a constant part of the job.

History

Veteran O, an ammunition technician in the Australian Army, developed a right indirect inguinal hernia containing the ureter of his transplanted kidney (a uretero-inguinal hernia) on 11 March 2019, during a period of heavy lifting at an ammunition depot while he was on continuous ambulatory peritoneal dialysis for renal failure that followed severe malaria on operational service in Sudan. The hernia worsened on 09 January 2021, when it perforated after a colonoscope entered the hernia sac during colonoscopy.

Timeline

22 Jan 2007 — During non-warlike service in Sudan the veteran was admitted with severe falciparum malaria, a parasitaemia of 9 per cent and acute kidney injury with a creatinine of 640 micromol/L. He required haemodialysis for eleven days in a coalition hospital and completed the deployment on restricted duties. On return a renal physician documented incomplete renal recovery, with a creatinine of 190 micromol/L at three months. In the final months of the deployment he had also reported intensely itchy papular skin lesions on the buttocks and thighs. "severe falciparum malaria, AKI, haemodialysis"
14 Aug 2008 — A dermatologist confirmed onchocerciasis on skin snips taken from the hips and thighs, with Onchocerca volvulus microfilariae seen, acquired in Sudan. He had chronic onchocercal dermatitis with lichenified skin and enlarged firm inguinal and femoral lymph nodes. Ivermectin was commenced every three months. Treatment was continued for several years because microfilariae persisted on repeat skin snips. "skin snips positive, O. volvulus"
19 Feb 2010 — After warlike service in Afghanistan, where he worked beside an open burn pit at a forward operating base for eight months, he presented with a productive cough for four months. A respiratory physician diagnosed chronic bronchitis attributed to the burn pit smoke and dust, with mild airflow obstruction on spirometry. Flares of severe coughing recurred each winter. "chronic bronchitis, burn pit exposure"
03 Mar 2014 — His chronic kidney disease progressed to stage 5, with an eGFR of 9 mL/min/1.73 m2. A Tenckhoff catheter was placed and he commenced continuous ambulatory peritoneal dialysis with four 2.5-litre exchanges a day. He was placed on light duties at an ammunition depot and referred for kidney transplant assessment. "CKD stage 5, CAPD commenced"
12 Aug 2016 — Transplant work-up found a prostate-specific antigen of 8.4 micrograms/L and biopsy showed prostate adenocarcinoma, Gleason 3+4. A urologist performed a robot-assisted laparoscopic radical prostatectomy. Margins were clear and the PSA was undetectable at six weeks. A dermatologist in the same year recorded bilateral hanging groin, with loose redundant skin containing the enlarged inguinal and femoral nodes. "robot-assisted radical prostatectomy, margins clear"
19 Sep 2017 — He received a deceased-donor kidney transplant in the right iliac fossa, with the transplant ureter implanted into the bladder. Peritoneal dialysis stopped. Graft function was initially good, with a creatinine of 130 micromol/L. In 2018 biopsy showed chronic antibody-mediated rejection and graft function declined. "deceased-donor renal transplant, right iliac fossa"
13 Mar 2019 — He had restarted continuous ambulatory peritoneal dialysis on 21 January 2019 for graft failure. He presented to the garrison health centre with a painful right groin lump that appeared on 11 March 2019 while lifting 30 kg ammunition boxes during a depot stocktake. He also reported a flare of chronic bronchitis with severe coughing and constipation with straining from calcium-based phosphate binders. Examination showed a reducible right inguinal swelling with a cough impulse. "reducible right groin lump, cough impulse"
02 Apr 2019 — CT of the abdomen and pelvis confirmed a right indirect inguinal hernia containing a loop of the transplant ureter, with mild hydronephrosis of the transplant kidney, and peritoneal dialysate within the sac. A general surgeon diagnosed a uretero-inguinal hernia and listed him for open repair with ureteric protection. Surgery was postponed repeatedly, including by the suspension of elective surgery in 2020. "uretero-inguinal hernia, listed for repair"
09 Jan 2021 — The day after a colonoscopy for a positive faecal occult blood test, he presented with severe right groin pain and fever. The colonoscopy report recorded that the colonoscope had entered the right inguinal hernia, which by then also contained the caecum. CT showed free gas in the hernia sac from a caecal perforation. He underwent emergency surgery with caecal resection and open repair. He had undergone laparoscopic repositioning of his peritoneal dialysis catheter on 18 Dec 2020 and had a severe bronchitis flare in the preceding month. "perforated hernia after colonoscopy"

Symptoms

At onset the veteran had a sudden painful lump in the right groin while lifting, with an aching dragging sensation that was worse with standing, lifting and coughing, and that reduced when he lay down. Dialysate drainage became slower and the lump enlarged with each exchange. From 2020 the swelling extended into the scrotum and he had intermittent obstructive symptoms and episodes of reduced transplant urine output.

After the 2021 perforation and emergency repair he reports chronic right groin pain and numbness in the upper inner thigh, pain on lifting more than 10 kilograms and difficulty with prolonged walking. He has been unable to return to peritoneal dialysis and now receives haemodialysis.

Imaging

20 Mar 2019 — Ultrasound right groin: "Right indirect inguinal hernia with a 22 mm neck, containing fluid and a tubular structure, increasing with Valsalva. Hanging groin with enlarged inguinal lymph nodes."
02 Apr 2019 — CT abdomen and pelvis: "Right indirect inguinal hernia containing a loop of the transplant ureter, with mild hydronephrosis of the right iliac fossa transplant kidney. Peritoneal dialysate within the hernia sac."
17 Nov 2020 — Ultrasound right groin: "Enlarging right inguinoscrotal hernia, neck 34 mm, now containing bowel loops as well as the transplant ureter."
09 Jan 2021 — CT abdomen and pelvis: "Caecum within the right inguinal hernia with free gas and fluid in the hernia sac, consistent with caecal perforation."

Onset Date

The most likely date of onset of this condition is 11 Mar 2019.

At that date the veteran was serving full time as a warrant officer at an ammunition depot in Australia. He was on continuous ambulatory peritoneal dialysis, which he had restarted on 21 January 2019 after the failure of his 2017 kidney transplant, and he was taking part in a depot stocktake that required repeated lifting of ammunition boxes weighing up to 30 kilograms.

This date is appropriate because his transplant clinic review on 05 February 2019 recorded examination of the groins with no hernia, and he first presented with the lump on 13 March 2019, two days after it appeared while he was lifting. It falls within continuous full-time service.

For the acute pressure factor, the 30 days before onset run from 09 Feb 2019 to 11 Mar 2019. The depot stocktake ran from 25 Feb 2019 to 08 Mar 2019, with lifting of 20 to 30 kilogram boxes for most of each shift, and the bronchitis flare with severe coughing and the constipation with straining were both documented throughout this period. For the prostatectomy factor, the five years before onset run from 11 Mar 2014 to 11 Mar 2019, and the radical prostatectomy on 12 Aug 2016 falls within it. Peritoneal dialysis, chronic onchocerciasis with a hanging groin, and the kidney transplant were each established before 11 Mar 2019 and present on that date.

For the worsening factors, the hernia enlarged into the scrotum and came to contain the caecum by November 2020, and it perforated on 09 Jan 2021. The 30 days before the worsening run from 10 Dec 2020 to 09 Jan 2021, during which he underwent laparoscopic catheter repositioning with pneumoperitoneum on 18 Dec 2020 and had a severe bronchitis flare. The five years before the worsening run from 09 Jan 2016 to 09 Jan 2021 and include the prostatectomy of 12 Aug 2016. The 24 hours before the perforation include the colonoscopy of 08 Jan 2021.

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

The formal diagnosis is Right Inguinal Hernia (ICD-10 K40.90), an indirect inguinal hernia containing the transplant ureter (uretero-inguinal hernia), complicated in 2021 by perforation, under the Statements of Principles concerning inguinal hernia, Balance of Probabilities No. 48 of 2021 and Reasonable Hypothesis No. 47 of 2021.

An inguinal hernia is a protrusion of abdominal contents through the inguinal canal, either through the deep inguinal ring (indirect) or through a weakness in the posterior wall of the canal (direct). It presents as a groin lump that enlarges with straining and may extend into the scrotum. Raised pressure within the abdomen, whether sudden or sustained, is the main driver of its formation and enlargement. A uretero-inguinal hernia is a rare form in which the ureter lies within the hernia sac, most often after kidney transplantation, and it risks obstruction of the transplant kidney. Complications include incarceration, strangulation and perforation of contained bowel.

The hernia followed renal failure from malaria on operational service, peritoneal dialysis, prostatectomy and kidney transplantation. It began on 11 March 2019 during heavy lifting, was confirmed on CT on 02 April 2019 and worsened with perforation on 09 January 2021.

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

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

11 March 2019.

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

13 March 2019.

When was the condition confirmed / formally diagnosed?

02 April 2019.

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

18 June 2025.

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

The diagnosis was made clinically on 13 March 2019, when examination showed a reducible right inguinal swelling with a cough impulse, and confirmed by ultrasound on 20 March 2019 and CT on 02 April 2019, which showed a right indirect inguinal hernia containing a loop of the transplant ureter with mild hydronephrosis. A general surgeon confirmed a uretero-inguinal hernia. This meets the Statement of Principles definition of inguinal hernia, a protrusion of abdominal contents through the inguinal canal, and of uretero-inguinal hernia.

Repeat ultrasound on 17 November 2020 confirmed enlargement into the scrotum with bowel content, and CT on 09 January 2021 confirmed perforation of the caecum within the hernia sac, confirmed at emergency surgery. The perforated hernia meets the Statement of Principles meaning of perforated inguinal hernia.

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 11 March 2019, 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. The Reasonable Hypothesis instrument applies to the veteran's non-warlike service in Sudan in 2006 and 2007, where he acquired the malaria that led to his renal failure and the onchocerciasis, and his warlike service in Afghanistan in 2009, where the burn pit exposure caused his chronic bronchitis.

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 Inguinal Hernia, No. 48 of 2021

Causative factors

Factor 9(1): having acute elevation of pressure within the abdominal cavity due to any one of the following: (a) anti-G straining manoeuvre; (b) lifting heavy weights; (c) physical trauma to the abdomen involving a direct blow to the abdomen; (d) pneumoperitoneum induced for laparoscopic surgery; (e) significant coughing; (f) significant sneezing; (g) straining at micturition due to bladder outlet or urethral obstruction; or (h) straining at stool due to constipation or diarrhoea; within the 30 days before the clinical onset of inguinal hernia; — MET

- During the depot stocktake from 25 February 2019 to 08 March 2019, a service duty, the veteran repeatedly lifted ammunition boxes weighing 20 to 30 kilograms, and the hernia appeared on 11 March 2019 while he was lifting a 30 kilogram box. Over the same 30 days, from 09 February 2019 to 11 March 2019, he had a flare of chronic bronchitis with documented significant coughing, and constipation with straining at stool caused by calcium-based phosphate binders prescribed for his renal failure. Heavy lifting, significant coughing and straining at stool are each listed alternatives in this factor.

Factor 9(2): having chronic elevation of pressure within the abdominal cavity due to any one of the following: (a) ascites; (b) chronic ambulatory or automatic peritoneal dialysis; (c) extensive intra-abdominal neoplastic disease or mass; or (d) pregnancy; at the time of the clinical onset of inguinal hernia; — MET

- The veteran restarted continuous ambulatory peritoneal dialysis on 21 January 2019, with four 2.5-litre exchanges a day, after the failure of his kidney transplant, and was on it at onset on 11 March 2019. He had previously been on peritoneal dialysis from 03 March 2014 to 19 September 2017. The renal failure followed severe malaria with acute kidney injury during service in Sudan in 2007. CT on 02 April 2019 showed dialysate within the hernia sac.

Factor 9(3): undergoing radical retropubic prostatectomy, laparoscopic radical prostatectomy or robot-assisted laparoscopic radical prostatectomy within the five years before the clinical onset of inguinal hernia; — MET

- The veteran underwent a robot-assisted laparoscopic radical prostatectomy on 12 August 2016 for prostate adenocarcinoma found on Defence-funded transplant work-up. This falls within the five years before onset, from 11 March 2014 to 11 March 2019. Prostatectomy weakens the deep inguinal ring and the transversalis fascia on the operated side.

Factor 9(4): having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical onset of inguinal hernia; — MET

- Onchocerciasis acquired during service in Sudan was confirmed on skin snips on 14 August 2008, and microfilariae persisted on repeat snips despite ivermectin. A dermatologist recorded bilateral hanging groin in 2016, with loose redundant skin containing enlarged inguinal and femoral nodes, and the ultrasound of 20 March 2019 showed the hanging groin was still present at onset on 11 March 2019.

Factor 9(5): for uretero-inguinal hernia only, having a kidney transplant before the clinical onset of uretero-inguinal hernia; — MET

- CT on 02 April 2019 showed the transplant ureter within the hernia sac, so this is a uretero-inguinal hernia. The veteran received a deceased-donor kidney transplant in the right iliac fossa on 19 September 2017, before onset on 11 March 2019, for renal failure that followed malaria on service in Sudan.

Worsening factors

Factor 9(6): having acute elevation of pressure within the abdominal cavity due to any one of the following: (a) anti-G straining manoeuvre; (b) lifting heavy weights; (c) physical trauma to the abdomen involving a direct blow to the abdomen; (d) pneumoperitoneum induced for laparoscopic surgery; (e) significant coughing; (f) significant sneezing; (g) straining at micturition due to bladder outlet or urethral obstruction; or (h) straining at stool due to constipation or diarrhoea; within the 30 days before the clinical worsening of inguinal hernia; — MET

- The hernia worsened with perforation on 09 January 2021. In the 30 days before, from 10 December 2020 to 09 January 2021, the veteran underwent laparoscopic repositioning of his peritoneal dialysis catheter on 18 December 2020 with a pneumoperitoneum induced at 12 mmHg, and had a severe flare of chronic bronchitis with significant coughing. He also took bowel preparation on 07 January 2021, with repeated straining at stool. Pneumoperitoneum, significant coughing and straining at stool are listed alternatives.

Factor 9(7): having chronic elevation of pressure within the abdominal cavity due to any one of the following: (a) ascites; (b) chronic ambulatory or automatic peritoneal dialysis; (c) extensive intra-abdominal neoplastic disease or mass; or (d) pregnancy; at the time of the clinical worsening of inguinal hernia; — MET

- The veteran remained on continuous ambulatory peritoneal dialysis, with four 2.5-litre exchanges a day, through 2020 and at the worsening on 09 January 2021. Ultrasound on 17 November 2020 showed the hernia had enlarged into the scrotum under the dialysate load.

Factor 9(8): undergoing radical retropubic prostatectomy, laparoscopic radical prostatectomy or robot-assisted laparoscopic radical prostatectomy within the five years before the clinical worsening of inguinal hernia; — MET

- The robot-assisted laparoscopic radical prostatectomy of 12 August 2016 falls within the five years before the worsening, from 09 January 2016 to 09 January 2021.

Factor 9(9): having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical worsening of inguinal hernia; — MET

- Chronic onchocerciasis with bilateral hanging groin persisted, and the hanging groin was described again on the ultrasound of 17 November 2020, before the perforation on 09 January 2021.

Factor 9(10): for perforated inguinal hernia only, having a colonoscopy where the colonoscope enters the inguinal hernia within the 24 hours before the perforation of the inguinal hernia; — MET

- The veteran underwent colonoscopy on 08 January 2021 for a positive faecal occult blood test arranged by Defence health services. The procedure report records that the colonoscope entered the right inguinal hernia containing the caecum. Caecal perforation within the hernia sac was confirmed on CT and at surgery on 09 January 2021, within 24 hours of the colonoscopy.

Factor 9(11): inability to obtain appropriate clinical management for inguinal hernia. — MET

- The veteran was listed for repair on 02 April 2019, but the operation was postponed repeatedly over 21 months, including during the suspension of elective surgery in 2020 and because no surgeon with transplant experience was available at his posting location. The hernia enlarged, came to contain the caecum and perforated. Under Brew v Repatriation Commission (1999) this is an inability to obtain appropriate clinical management.

Reasonable Hypothesis — Statement of Principles concerning Inguinal Hernia, No. 47 of 2021

Causative factors

- In the 30 days before onset, from 09 February 2019 to 11 March 2019, the veteran had a flare of chronic bronchitis with significant coughing. The chronic bronchitis was diagnosed on 19 February 2010 and attributed to eight months working beside an open burn pit on warlike service in Afghanistan in 2009. His straining at stool was caused by phosphate binders for renal failure that followed malaria on non-warlike service in Sudan. He was also lifting 20 to 30 kilogram boxes throughout that period.

- The veteran was on continuous ambulatory peritoneal dialysis at onset on 11 March 2019 for end-stage renal failure. The renal failure began with severe falciparum malaria and acute kidney injury requiring haemodialysis on non-warlike service in Sudan on 22 January 2007, from which his kidneys never recovered.

- The robot-assisted laparoscopic radical prostatectomy of 12 August 2016, within the five years before onset, from 11 March 2014 to 11 March 2019, was performed for a prostate cancer detected on the transplant work-up required because of renal failure that followed malaria on non-warlike service in Sudan.

Factor 9(4): having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical onset of inguinal hernia; — MET

- The veteran acquired onchocerciasis on non-warlike service in Sudan between July 2006 and March 2007, an area where the disease is endemic, and it was confirmed on skin snips on 14 August 2008. The chronic infection produced a bilateral hanging groin, recorded in 2016 and present at onset on 11 March 2019.

Factor 9(5): for uretero-inguinal hernia only, having a kidney transplant before the clinical onset of uretero-inguinal hernia; — MET

- The hernia contains the transplant ureter. The kidney transplant of 19 September 2017, before onset, was performed for end-stage renal failure that followed malaria on non-warlike service in Sudan.

Worsening factors

- In the 30 days before the perforation, from 10 December 2020 to 09 January 2021, the veteran had a severe flare of the chronic bronchitis caused by burn pit smoke on warlike service in Afghanistan, with significant coughing. On 18 December 2020 he had a pneumoperitoneum induced for laparoscopic repositioning of the dialysis catheter he needed for renal failure that followed malaria in Sudan.

- Continuous ambulatory peritoneal dialysis for renal failure that followed malaria on non-warlike service in Sudan continued up to the worsening on 09 January 2021.

- The prostatectomy of 12 August 2016, performed after the cancer was found on transplant work-up for renal failure linked to service in Sudan, falls within the five years before the worsening, from 09 January 2016 to 09 January 2021.

Factor 9(9): having chronic onchocerciasis in the presence of a hanging groin at the time of the clinical worsening of inguinal hernia; — MET

- The chronic onchocerciasis acquired on non-warlike service in Sudan, with its hanging groin, was present at the worsening on 09 January 2021.

- The colonoscope entered the right inguinal hernia during colonoscopy on 08 January 2021, and the caecum within the hernia perforated within 24 hours. The hernia had enlarged under the dialysate load of treatment for renal failure that followed malaria on service in Sudan.

Factor 9(11): inability to obtain appropriate clinical management for inguinal hernia. — MET

- The repair, listed on 02 April 2019, was postponed for 21 months, during which the hernia enlarged and perforated. The complexity that delayed it, a transplant ureter within the sac and peritoneal dialysis, arose from renal failure that followed malaria on non-warlike service in Sudan.

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

Sequelae

The inguinal hernia is a sequela of the veteran's accepted renal failure, which followed severe malaria on non-warlike service in Sudan: the peritoneal dialysis, the kidney transplant whose ureter lies in the hernia, and the prostatectomy performed on the transplant pathway. It is also a sequela of his accepted chronic bronchitis from burn pit exposure in Afghanistan, through repeated severe coughing. The hernia has in turn caused chronic groin pain, the caecal resection and the loss of peritoneal dialysis as a treatment option.

Unintended Consequence

Met. The perforation of the hernia is an unintended consequence of a colonoscopy arranged and paid for by Defence health services while the veteran was serving, and the constipation and straining that contributed to onset are an unintended consequence of calcium-based phosphate binders prescribed for his renal failure (section 6A of the DRCA and the equivalent provisions of the MRCA).

Inability to Attain Appropriate Medical Management

MET. The veteran was listed for repair of his uretero-inguinal hernia on 02 April 2019, but surgery was postponed for 21 months because elective surgery was suspended in 2020 and no surgeon with transplant experience was available at his posting location. During that time the hernia enlarged into the scrotum, came to contain the caecum and perforated on 09 January 2021, requiring emergency bowel resection. Applying the objective and subjective tests in Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), a delay in surgery of this length, caused by circumstances outside the veteran's control, amounts to an inability to obtain appropriate clinical management, and it materially contributed to the worsening of the hernia.

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

See attached report.

References

22 Jan 2007, Hospital admission and discharge summary, Deployed medical facility, Sudan
14 Aug 2008, Specialist letter and skin snip report, Dermatologist
19 Feb 2010, Respiratory consultation and spirometry, Respiratory physician
03 Mar 2014, Renal medicine consultation, Renal physician
12 Aug 2016, Operation report and histopathology, Urologist
12 Aug 2016, Dermatology review, Dermatologist
19 Sep 2017, Transplant operation report, Transplant surgeon
05 Feb 2019, Transplant clinic review, Renal physician
13 Mar 2019, Outpatient health record, Medical Officer, Garrison health centre
20 Mar 2019, Ultrasound right groin, Radiologist
02 Apr 2019, CT abdomen and pelvis and surgical consultation, General surgeon
17 Nov 2020, Ultrasound right groin, Radiologist
18 Dec 2020, Operation report, laparoscopic catheter repositioning, General surgeon
08 Jan 2021, Colonoscopy report, Gastroenterologist
09 Jan 2021, CT abdomen and pelvis and emergency operation report, General surgeon
Statement of Principles concerning Inguinal Hernia (Balance of Probabilities) No. 48 of 2021, Repatriation Medical Authority
Statement of Principles concerning Inguinal Hernia (Reasonable Hypothesis) No. 47 of 2021, Repatriation Medical Authority

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Right Groin - Inguinal Hernia — DVA claim example