Diagnostic Assessment — Right Heel - Retrocalcaneal Bursitis
Example 1 of 1 · fictitious patient (Veteran G)
Diagnostic Assessment
Right Heel - Retrocalcaneal Bursitis
BOP Code: 89 of 2024 (Retrocalcaneal Heel Bursitis)
RH Code: 88 of 2024 (Retrocalcaneal Heel Bursitis)
ADF History
Veteran G, date of birth 12 February 1986, Australian Army, Rifleman (Infantry Soldier), enlisted 20 January 2005, medically discharged 14 July 2021. Operational service: Afghanistan, 05 March 2012 to 15 August 2012 (warlike; aeromedically evacuated); Middle East Area of Operations (Iraq), 10 May 2016 to 25 November 2016 (warlike).
Occupational History
Infantry soldiers march, patrol and run on foot over long distances carrying loads of 25 to 45 kilograms, in rigid-heeled combat boots, on rough, rocky and uneven ground. Physical training includes daily running, pack marches, sprints, jumping and obstacle courses, and soldiers preparing for promotion or selection courses commonly run 50 to 70 kilometres a week.
Deployed infantry work in extreme heat and dust with limited sanitation, and gastrointestinal infections, heat illness and skin infections of the feet are common. Prolonged wear of wet boots, blisters and abrasions over the heel are routine hazards of the trade.
History
Veteran G, an infantry soldier in the Australian Army, developed right retrocalcaneal heel bursitis on 18 June 2012 during warlike service in Afghanistan, after weeks of high-volume running and loaded foot patrols in rigid boots and while he had reactive arthritis following dysentery. The bursitis worsened during his 2016 deployment to Iraq, when he had developed a spondyloarthropathy and other systemic arthritic diseases, and the bursa became infected with Staphylococcus aureus.
Timeline
- 08 Nov 2011 — Pre-deployment medical and podiatry screening. Both heels and Achilles tendons were non-tender with full ankle range of movement. He reported no heel pain. He was issued new combat boots with a stiff, high heel counter for the deployment. "heels non-tender, boots issued"
- 29 May 2012 — During warlike service in Afghanistan he presented to the role 1 facility with bloody diarrhoea and fever after a patrol base water supply was contaminated. Stool culture grew Campylobacter jejuni. Over the following week he developed a painful swollen left knee and right ankle with bilateral conjunctivitis. He was training for a promotion course and was running about 60 to 65 kilometres a week on the base perimeter track in addition to patrols. "Campylobacter, reactive arthritis features"
- 21 Jun 2012 — Presented with three days of pain and swelling at the back of the right heel, worse at the start of a run and when lacing his boots. Examination showed a tender, boggy swelling anterior to the distal Achilles tendon, with a positive two-finger squeeze test and redness where the heel counter pressed. Ultrasound at the role 2 facility confirmed retrocalcaneal bursitis. HLA-B27 was later reported positive. Reactive arthritis was diagnosed. "retrocalcaneal bursitis, R heel"
- 14 Aug 2012 — Collapsed on patrol in 47 degree heat with exertional heat stroke and rhabdomyolysis, creatine kinase 186,000 U/L. He developed oliguric acute kidney injury and was aeromedically evacuated. He remained dialysis dependent from 16 August 2012 to 10 December 2012, with an eGFR below 15 mL/min/1.73 m2 throughout, before partial recovery to an eGFR of 58. "heat stroke, dialysis dependent"
- 17 Jul 2014 — A rheumatologist reviewed persistent inflammatory back pain, recurrent heel pain and enthesitis. MRI showed bilateral sacroiliitis. Colonoscopy in March 2014 had confirmed Crohn's disease. Serum urate was 0.58 mmol/L after two attacks of podagra. Diagnoses were HLA-B27 undifferentiated spondyloarthropathy, enteropathic spondyloarthropathy with Crohn's disease, and gout. "sacroiliitis, Crohn's, gout"
- 03 Dec 2015 — Rheumatology review documented progression to ankylosing spondylitis meeting the modified New York criteria, plaque psoriasis with psoriatic arthropathy, positive anti-CCP antibodies with symmetrical small joint synovitis consistent with overlap rheumatoid arthritis, chondrocalcinosis of both knees from calcium pyrophosphate deposition, and Behcet syndrome with recurrent oral and genital ulcers, anterior uveitis and a positive pathergy test. He was cleared to deploy on adalimumab. "AS, PsA, RA overlap, Behcet"
- 26 Aug 2016 — During warlike service in Iraq he presented with a week of severe right heel pain, redness, warmth and fever of 38.6 degrees after a heel blister from his boot became infected. He had been running about 65 kilometres a week and marching under load for 7 to 8 hours a week. Ultrasound showed a 9 mm complex fluid collection in the retrocalcaneal bursa. Aspiration grew Staphylococcus aureus. Ultrasound-guided drainage and podiatry were not available in theatre for 19 days. "septic bursitis, S. aureus"
- 21 Mar 2017 — Orthopaedic foot and ankle review in Australia for persisting right heel pain and swelling despite antibiotics, rest and footwear modification. MRI showed chronic thickened retrocalcaneal bursitis with Achilles insertional enthesopathy. Open bursectomy and debridement of the calcaneal prominence were performed on 22 May 2017. "chronic bursitis, bursectomy planned"
Symptoms
At onset the veteran had pain and swelling at the back of the right heel, worst at the start of runs and when his boot heel counter pressed on it, with stiffness on rising in the morning. After onset the pain became constant during marches and he could not run without pain.
In 2016 the heel became red, hot and severely painful with fever, and he could not wear a boot. He now has persisting posterior heel pain after walking more than two kilometres, cannot run, and wears open-backed footwear or boots with a cut-down heel counter.
Imaging
- 21 Jun 2012 — Ultrasound right heel (role 2 facility): "Distended retrocalcaneal bursa measuring 5 mm in anteroposterior depth with surrounding hyperaemia on Doppler. Achilles tendon intact."
- 17 Jul 2014 — MRI sacroiliac joints: "Bilateral sacroiliitis with bone marrow oedema and early erosions."
- 26 Aug 2016 — Ultrasound right heel (role 2 facility): "9 mm complex fluid collection within the retrocalcaneal bursa with internal debris and marked hyperaemia, consistent with septic bursitis."
- 21 Mar 2017 — MRI right ankle: "Chronic thickened retrocalcaneal bursitis with synovial proliferation, insertional Achilles enthesopathy and calcaneal bone marrow oedema."
Onset Date
The most likely date of onset of this condition is 18 Jun 2012.
At that date the veteran was on warlike service in Afghanistan with an infantry company at a patrol base. He was running 60 to 65 kilometres a week on the base perimeter track while training for a promotion course, was conducting foot patrols of 8 to 10 hours a week under load in issue boots with a stiff heel counter, and had reactive arthritis following Campylobacter dysentery at the end of May 2012.
This date is appropriate because his pre-deployment screening of 08 November 2011 recorded non-tender heels and no heel pain, and he first presented with right posterior heel pain on 21 June 2012, reporting three days of symptoms. It falls within continuous full-time warlike service.
For the running factors, the 4 weeks before onset run from 21 May 2012 to 18 Jun 2012, during which his training log recorded 60 to 65 kilometres a week. For the weight bearing exercise factors, in the same 4 weeks he patrolled on foot and ran for well over 6 hours a week at an intensity above 5 METS. Reactive arthritis was present from early June 2012, and the boots with a stiff heel counter had been worn daily since November 2011.
For the worsening factors, the period after onset runs from 18 Jun 2012 to the documented worsening on 26 Aug 2016, when ultrasound showed the bursa had enlarged from 5 mm to a 9 mm infected collection. The 4 weeks before the worsening run from 29 Jul 2016 to 26 Aug 2016, during which he was on warlike service in Iraq running about 65 kilometres a week and marching under load for 7 to 8 hours a week. The 10 years before the worsening run from 26 Aug 2006 to 26 Aug 2016 and include his period of dialysis-dependent renal failure from August to December 2012. Each of the systemic arthritic diseases was diagnosed between 2012 and 2015 and was present at the worsening.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Right Heel - Retrocalcaneal Bursitis (ICD-10 M77.5), under the Statements of Principles concerning retrocalcaneal heel bursitis, Balance of Probabilities No. 89 of 2024 and Reasonable Hypothesis No. 88 of 2024.
Retrocalcaneal bursitis is inflammation of the deep Achilles bursa, which lies between the distal Achilles tendon and the upper back of the calcaneus and reduces friction as the tendon moves over the bone. It is caused by repetitive ankle dorsiflexion and plantarflexion in running and marching, direct pressure from a rigid heel counter, and systemic inflammatory and crystal arthritides that target the entheses. Infection of the bursa can occur after skin breakdown over the heel. Persistent bursitis is associated with insertional Achilles tendinopathy and a prominent posterosuperior calcaneus.
The diagnosis followed weeks of high-volume running, loaded patrolling and rigid-boot wear on warlike service in Afghanistan, at a time when the veteran had reactive arthritis. It began on 18 June 2012, was confirmed on ultrasound three days later, worsened with infection in Iraq in 2016 and required bursectomy in 2017.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
18 June 2012.
When did the veteran first present to a health / medical provider for this condition?
21 June 2012.
When was the condition confirmed / formally diagnosed?
21 June 2012.
When did the veteran first present to you (or your practice) for this condition?
07 April 2025.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis was made on 21 June 2012 on the clinical findings of a tender, boggy swelling anterior to the distal Achilles tendon with a positive two-finger squeeze test, and was confirmed the same day by ultrasound showing a distended retrocalcaneal bursa with Doppler hyperaemia and an intact Achilles tendon. The swelling was deep to the tendon rather than superficial to it, so this is retrocalcaneal bursitis and not posterior adventitial (superficial calcaneal) bursitis, which the Statement of Principles excludes.
The worsening is documented by ultrasound on 26 August 2016 showing a 9 mm complex collection, by aspiration culture growing Staphylococcus aureus, and by MRI on 21 March 2017 showing chronic thickened bursitis with insertional enthesopathy. Histology from the bursectomy on 22 May 2017 confirmed chronic inflammation of the retrocalcaneal bursa.
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 18 June 2012, after 1 July 2004, during continuous full-time warlike service in Afghanistan. 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 warlike service in Afghanistan in 2012, where the bursitis began, and in Iraq in 2016, where it worsened.
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 Retrocalcaneal Heel Bursitis, No. 89 of 2024
Causative factors (clinical onset or clinical worsening)
Factor 9(1): Running or jogging an average of at least 60 kilometres per week for the 4 weeks before clinical onset or clinical worsening; — MET
- The veteran's training log and the physical training staff record show that he ran 60 to 65 kilometres a week from 21 May 2012 to 18 June 2012, the 4 weeks before onset, as part of a Defence-directed training program for a promotion course. Before the worsening, from 29 July 2016 to 26 August 2016, he ran about 65 kilometres a week. Repeated ankle dorsiflexion compresses the bursa between the tendon and the calcaneus.
Factor 9(2): undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for: (a) a minimum intensity of 5 METS; and (b) for at least 6 hours per week; and (c) for at least the 4 weeks before clinical onset or clinical worsening; — MET
- In the 4 weeks before onset the veteran ran 60 to 65 kilometres a week, about 5 hours, and conducted foot patrols of 8 to 10 hours a week carrying about 40 kilograms, both well above 5 METS and together more than 6 hours a week. In the 4 weeks before the worsening he again ran about 65 kilometres a week and marched under load for 7 to 8 hours a week. All of this was required service training and duty.
Factor 9(3)(a): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: ankylosing spondylitis; — MET
- A rheumatologist documented ankylosing spondylitis meeting the modified New York criteria on 03 December 2015, with bilateral sacroiliitis on MRI from July 2014. It had evolved from the HLA-B27 reactive arthritis that followed dysentery contracted from a contaminated water supply in 2012. The ankylosing spondylitis was present at the worsening on 26 August 2016. Enthesitis at the Achilles insertion is a core feature of the disease.
Factor 9(3)(b): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: Behcet syndrome; — MET
- Behcet syndrome was diagnosed on 03 December 2015 on recurrent oral and genital ulceration, anterior uveitis and a positive pathergy test, and was active at the worsening in August 2016, with oral ulcers recorded in Iraq in July 2016.
Factor 9(3)(c): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease); — MET
- Crohn's disease was confirmed on colonoscopy in March 2014 and a rheumatologist diagnosed enteropathic spondyloarthropathy on 17 July 2014. It was present at the worsening on 26 August 2016.
Factor 9(3)(d): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: gout; — MET
- Gout was diagnosed on 17 July 2014 after two attacks of podagra, with a serum urate of 0.58 mmol/L. The hyperuricaemia followed the renal injury from exertional heat stroke on patrol in 2012. Gout was present, on allopurinol, at the worsening in August 2016.
Factor 9(3)(e): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate; — MET
- Calcium pyrophosphate deposition with chondrocalcinosis of both knees was documented on 03 December 2015, following the period of dialysis-dependent renal failure in 2012. It was present at the worsening in August 2016.
Factor 9(3)(f): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: psoriatic arthropathy; — MET
- Plaque psoriasis with psoriatic arthropathy, including dactylitis of the right second toe, was diagnosed on 03 December 2015 and was present at the worsening in August 2016.
Factor 9(3)(g): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: reactive arthritis; — MET
- The veteran developed reactive arthritis, with a swollen left knee, right ankle arthritis and conjunctivitis, in early June 2012 after Campylobacter jejuni dysentery from a contaminated patrol base water supply on service. It was present at the clinical onset of the bursitis on 18 June 2012 and was diagnosed on 21 June 2012.
Factor 9(3)(h): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: rheumatoid arthritis; — MET
- Positive anti-CCP antibodies with symmetrical synovitis of the metacarpophalangeal joints were documented on 03 December 2015, and the rheumatologist diagnosed overlap rheumatoid arthritis. It was present at the worsening in August 2016.
Factor 9(3)(i): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: undifferentiated spondyloarthropathy; — MET
- HLA-B27 undifferentiated spondyloarthropathy was diagnosed on 17 July 2014 as the reactive arthritis of 2012 became chronic, with inflammatory back pain and recurrent enthesitis at both heels. It was present at the worsening in August 2016.
Factor 9(4): having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening; — MET
- Aspiration of the right retrocalcaneal bursa on 26 August 2016 grew Staphylococcus aureus, after a heel blister caused by his boot became infected. The bacterial infection was present at the worsening, with fever of 38.6 degrees and a 9 mm complex collection on ultrasound.
Worsening factors
Factor 9(5): inability to obtain appropriate clinical management for retrocalcaneal heel bursitis before clinical worsening. — MET
- After the diagnosis in June 2012 the veteran was not referred to a podiatrist or sports physician and was not given modified footwear or a running restriction. He continued high-volume running and marching in the same boots for four years. In Iraq in August 2016 ultrasound-guided drainage and podiatry were not available for 19 days. The bursitis worsened and became infected. Under Brew v Repatriation Commission (1999) this is an inability to obtain appropriate clinical management before clinical worsening.
Reasonable Hypothesis — Statement of Principles concerning Retrocalcaneal Heel Bursitis, No. 88 of 2024
Causative factors (clinical onset or clinical worsening)
Factor 9(1): Running or jogging an average of at least 30 kilometres per week for the 4 weeks before clinical onset or clinical worsening; — MET
- On warlike service in Afghanistan the veteran ran 60 to 65 kilometres a week on the patrol base perimeter track throughout the 4 weeks before onset, from 21 May 2012 to 18 June 2012. On warlike service in Iraq he ran about 65 kilometres a week throughout the 4 weeks before the worsening, from 29 July 2016 to 26 August 2016.
Factor 9(2): undertaking weight bearing exercise involving repeated activity of the ankle joint on the affected side for: (a) a minimum intensity of 5 METS; and (b) for at least 4 hours per week; and (c) for at least the 4 weeks before clinical onset or clinical worsening; — MET
- On warlike service in Afghanistan, in the 4 weeks before onset, he conducted foot patrols of 8 to 10 hours a week carrying about 40 kilograms over rocky ground, in addition to running, all above 5 METS. On warlike service in Iraq, in the 4 weeks before the worsening, he marched under load for 7 to 8 hours a week and ran about 65 kilometres a week.
Factor 9(3)(a): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: ankylosing spondylitis; — MET
- Ankylosing spondylitis, diagnosed on 03 December 2015, developed from the HLA-B27 reactive arthritis triggered by dysentery on warlike service in Afghanistan in 2012. It was present at the worsening during warlike service in Iraq on 26 August 2016.
Factor 9(3)(b): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: Behcet syndrome; — MET
- Behcet syndrome, diagnosed on 03 December 2015, was active during warlike service in Iraq, with oral ulceration recorded in July 2016, and was present at the worsening on 26 August 2016.
Factor 9(3)(c): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: enteropathic spondyloarthropathy (arthritis associated with inflammatory bowel disease); — MET
- Enteropathic spondyloarthropathy with Crohn's disease, diagnosed on 17 July 2014, was present at the worsening during warlike service in Iraq on 26 August 2016.
Factor 9(3)(d): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: gout; — MET
- Gout followed the renal injury from exertional heat stroke on warlike service in Afghanistan on 14 August 2012 and was diagnosed on 17 July 2014. It was present at the worsening in Iraq on 26 August 2016.
Factor 9(3)(e): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: pseudogout (calcium pyrophosphate dihydrate) or crystal-induced arthropathy from the deposition of calcium hydroxyapatite or calcium oxalate; — MET
- Calcium pyrophosphate deposition disease, documented on 03 December 2015 after dialysis for renal failure that began on warlike service in 2012, was present at the worsening in Iraq on 26 August 2016.
Factor 9(3)(f): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: psoriatic arthropathy; — MET
- Psoriatic arthropathy, diagnosed on 03 December 2015, was present at the worsening during warlike service in Iraq on 26 August 2016.
Factor 9(3)(g): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: reactive arthritis; — MET
- Reactive arthritis followed Campylobacter dysentery contracted from a contaminated water supply on warlike service in Afghanistan at the end of May 2012, and was present at onset on 18 June 2012.
Factor 9(3)(h): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: rheumatoid arthritis; — MET
- Overlap rheumatoid arthritis with positive anti-CCP antibodies, documented on 03 December 2015, was present at the worsening during warlike service in Iraq on 26 August 2016.
Factor 9(3)(i): having one of the following systemic arthritic diseases at the time of clinical onset or clinical worsening: undifferentiated spondyloarthropathy; — MET
- HLA-B27 undifferentiated spondyloarthropathy, which evolved from reactive arthritis contracted on warlike service in Afghanistan, was diagnosed on 17 July 2014 and present at the worsening in Iraq on 26 August 2016.
Factor 9(4)(a): having chronic renal failure within the 10 years before clinical onset or clinical worsening as indicated by: a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; — MET
- After exertional heat stroke and rhabdomyolysis on patrol during warlike service in Afghanistan on 14 August 2012, the veteran's eGFR remained below 15 mL/min/1.73 m2 from 16 August 2012 to 10 December 2012, almost four months. This was within the 10 years before the worsening on 26 August 2016, a window that runs from 26 August 2006.
Factor 9(4)(b): having chronic renal failure within the 10 years before clinical onset or clinical worsening as indicated by: undergoing chronic dialysis for renal failure; — MET
- The veteran underwent haemodialysis three times a week from 16 August 2012 to 10 December 2012 for renal failure caused by heat stroke on warlike service in Afghanistan. This was within the 10 years before the worsening on 26 August 2016.
Factor 9(5): having a bacterial infection of the affected retrocalcaneal bursa at the time of clinical onset or clinical worsening; — MET
- On warlike service in Iraq a boot blister over the right heel became infected and aspiration of the retrocalcaneal bursa on 26 August 2016 grew Staphylococcus aureus. The infection was present at the worsening.
Factor 9(6): wearing footwear that causes excessive pressure on the posterior aspect of the heel of the affected foot, at the time of clinical onset or clinical worsening; — MET
- The veteran wore issue combat boots with a stiff, high heel counter daily on warlike service in Afghanistan from March 2012. At onset on 18 June 2012 the examining medical officer recorded redness where the heel counter pressed over the right posterior heel. He wore the same boot model in Iraq, where the heel counter caused the blister that became infected before the worsening.
Worsening factors
Factor 9(7): inability to obtain appropriate clinical management for retrocalcaneal heel bursitis before clinical worsening. — MET
- On warlike service in Afghanistan in 2012 no podiatry or footwear modification was available after diagnosis, and on warlike service in Iraq in August 2016 ultrasound-guided drainage and podiatry were not available for 19 days after the infected bursa was identified. The bursitis worsened and became chronic, requiring bursectomy in May 2017.
The % contribution of the causes is 100% and significant.
Sequelae
The retrocalcaneal bursitis is in part a sequela of the veteran's accepted conditions: the reactive arthritis that followed dysentery on deployment, the spondyloarthropathies and crystal arthropathies that followed, and the renal injury from exertional heat stroke. The chronic bursitis has in turn caused insertional Achilles enthesopathy and required bursectomy, with persisting posterior heel pain and loss of running capacity.
Unintended Consequence
Met. The infection of the bursa in 2016 occurred while the veteran was taking adalimumab, an immunosuppressant prescribed by Defence-arranged rheumatology for his spondyloarthropathy, which increased his susceptibility to Staphylococcus aureus infection. This is an unintended consequence of treatment provided by the Commonwealth while he was serving (section 6A of the DRCA and the equivalent provisions of the MRCA).
Inability to Attain Appropriate Medical Management
MET. After diagnosis in June 2012 the veteran received no podiatry referral, footwear modification or running restriction and continued high-volume running and marching in the same boots for four years. On warlike service in Iraq in August 2016 the infected bursa could not be drained under ultrasound guidance and no podiatry was available for 19 days. The bursitis enlarged from 5 mm to a 9 mm infected collection and became chronic. Applying the objective and subjective tests in Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), the absence of appropriate treatment through service channels and operational constraints amount to an inability to obtain appropriate clinical management.
5. Please provide a Health Summary and a medication / prescribing history.
See attached report.
References
- 08 Nov 2011, Pre-deployment medical and podiatry screening, Medical Officer and Podiatrist
- 29 May 2012, Outpatient health record and stool culture, Medical Officer, Role 1 health facility, Afghanistan
- 21 Jun 2012, Outpatient health record and ultrasound right heel, Role 2 facility, Afghanistan
- 14 Aug 2012, Aeromedical evacuation and intensive care discharge summary, Intensive care physician
- 10 Dec 2012, Renal medicine letter, Renal physician
- 17 Jul 2014, Rheumatology consultation and MRI sacroiliac joints, Rheumatologist
- 03 Dec 2015, Rheumatology review, Rheumatologist
- 26 Aug 2016, Outpatient health record, ultrasound and microbiology, Role 2 facility, Iraq
- 21 Mar 2017, Orthopaedic consultation and MRI right ankle, Orthopaedic foot and ankle surgeon
- 22 May 2017, Operation report and histopathology, Orthopaedic foot and ankle surgeon
- Statement of Principles concerning Retrocalcaneal Heel Bursitis (Balance of Probabilities) No. 89 of 2024, Repatriation Medical Authority
- Statement of Principles concerning Retrocalcaneal Heel Bursitis (Reasonable Hypothesis) No. 88 of 2024, Repatriation Medical Authority
