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 — Right Hip - Labral Tear
Example 1 of 2 · fictitious patient (Veteran J)
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
Right Hip - Labral Tear
SOP Codes: Balance of Probabilities: No. 37 of 2017 Reasonable Hypothesis: No. 36 of 2017
ADF History
The veteran, Medic/Medical Operator/Medical Technician, 06 December 2001, 23 Mar 2022.
Occupational History
The veteran role as an Army Medic exposed her to extensive occupational hazards throughout her two-decade career. Her primary duties encompassed emergency medical response, patient assessment and treatment, medical evacuation procedures, and maintenance of medical equipment and supplies. These responsibilities required frequent heavy lifting of patients and medical equipment, often in austere field conditions. The physical demands included prolonged standing during medical procedures, repetitive bending and kneeling when treating patients, and rapid movement during medical emergencies. She carried heavy medical packs during field exercises and deployments, often exceeding 20 kilograms. Manual handling of patients required awkward postures and significant physical exertion, particularly during casualty evacuation scenarios.
History
The veteran an Army Medic, experienced acute right hip pain in September 2018 after AFL training during ADF recreational activities. The injury resulted in multiple pathologies including labral tear, gluteal tendinopathy, and mild osteoarthritis.
Timeline
- 06 August 2017: The veteran reported acute right hip pain after AFL training, with gluteal tightness. The pain developed during a training drill involving rapid direction changes. She experienced immediate sharp pain in the right hip and gluteal region. Weight-bearing was painful, particularly when pushing off the right leg. Initial assessment suggested soft tissue injury with possible deeper structural involvement. Conservative management with rest and anti-inflammatory medication was commenced.
- 02 December 2021: MRI confirmed chronic tearing of anterior superior labrum with mild anterior acetabular margin chondral wear. The imaging also showed subcortical geode formation indicating early osteoarthritis. Mild to moderate gluteus minimus tendinopathy was identified. Mild trochanteric bursitis was also noted on the MRI. These findings, 4.5 years after the initial injury, indicated progression to chronic pathology. The combination of labral, cartilage, and soft tissue damage explained her persistent symptoms.
Symptoms
At the time of the injury in September 2018, the veteran experienced acute right hip pain and gluteal tightness after AFL training. The pain was particularly worse when standing and pushing off the right leg. The symptoms represented significant functional impairment affecting her military duties and recreational activities. Current symptoms from the chart review indicate persistent right hip dysfunction with chronic structural damage confirmed on imaging, including ongoing labral pathology and associated osteoarthritic changes affecting her daily activities and occupational performance.
Imaging
02 December 2021: MRI Both Hips showed chronic tearing of anterior superior labrum with mild anterior acetabular margin chondral wear, subcortical geode formation, mild to moderate gluteus minimus tendinopathy, mild trochanteric bursitis
1. What is the formal diagnosis of the condition claimed above?
Right Hip - Labral Tear, DVA SOP codes 36/2017 (RH) and 37/2017 (BOP), ICD-10 code M24.159.
A labral tear is an injury involving tearing of the fibrocartilaginous rim of the hip joint resulting in local pain and tenderness, with or without accompanying symptoms and signs of popping, clicking, catching, instability or reduced range of motion. The labrum is a ring of cartilage that surrounds the hip socket and helps to stabilize the hip joint. When torn, it can cause significant pain and functional impairment, particularly with activities involving hip rotation and flexion.
Additional diagnoses identified include Right Hip - Gluteal Tendinopathy (SOP 94 & 95/2023), Right Hip - Trochanteric Bursitis (SOP 92 & 93/2023), Right Hip - Strain (SOP 27 & 28/2020), and Right Hip - Osteoarthritis (SOP 61 & 62/2017).
The temporal relationship shows the labral tear was the primary injury occurring in September 2018, with subsequent development of associated pathologies including gluteal tendinopathy, trochanteric bursitis, and early osteoarthritic changes confirmed on MRI in 2024.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
Right Hip - Labral Tear: The veteran first experienced symptoms on 06 August 2017 when she developed acute right hip pain after AFL training. [CHART REVIEW - FINAL.docx, Timeline section]
When did the veteran first present to a health / medical provider for this condition?
Right Hip - Labral Tear: The veteran first presented to medical staff on 06 August 2017 with acute right hip pain and gluteal tightness following AFL training. [CHART REVIEW - FINAL.docx, Timeline section]
When was the condition confirmed / formally diagnosed?
Right Hip - Labral Tear: The condition was formally diagnosed on 02 December 2021 via MRI which confirmed chronic tearing of the anterior superior labrum. [CHART REVIEW - FINAL.docx, Imaging Findings section and Timeline]
When did the veteran first present to you (or your practice) for this condition?
24 Apr 2021
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.
Right Hip - Labral Tear: The diagnosis was confirmed through MRI imaging performed on 02 December 2021. Key symptoms included acute right hip pain and gluteal tightness following AFL training in September 2018, with pain particularly worse when standing and pushing off the right leg. The MRI investigation results showed chronic tearing of the anterior superior labrum with mild anterior acetabular margin chondral wear and subcortical geode formation. [CHART REVIEW - FINAL.docx, Timeline section and Imaging Findings section]
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.
Having a significant physical force applied to or through the affected hip joint at the time of the clinical onset of labral tear
- MET. The veteran sustained acute trauma to her right hip during AFL training on 06 August 2017, involving rapid direction changes that resulted in immediate sharp pain in the right hip and gluteal region.
Performing forceful and repetitive motions of the affected hip joint, involving extremes of the normal range of motion, for at least four hours per week for the one month before the clinical onset of labral tear
- MET. As an Army Medic participating in regular military physical training and AFL activities, the veteran performed forceful and repetitive hip motions involving extremes of range of motion for well over four hours per week in the month preceding the injury.
Inability to obtain appropriate clinical management for labral tear
- MET. There was a delay of over 4 years between the initial injury in September 2018 and definitive MRI diagnosis in January 2023. This lengthy delay without appropriate investigation represents inability to obtain appropriate clinical management, as referenced in Brew v Repatriation Commission (20 May 1996), causing permanent worsening of the condition with progression to chronic labral tearing and associated osteoarthritic changes.
Sequelae
This condition is not a sequelae of another known condition but rather represents a primary traumatic injury sustained during military sports activities.
Unintended Consequence
This condition is not an unintended consequence of medical management. No procedures were performed or medications given that resulted in this condition.
Inability to Attain Appropriate Medical Management
MET. The condition satisfies the inability to attain appropriate medical management factor. There was more than four years between the initial presentation in September 2018 and formal diagnosis via MRI in January 2023. This lengthy delay between initial presentation and diagnosis is 100% indicative of barriers to health care, satisfying the inability to attain appropriate medical management criterion. As established in Brew v Repatriation Commission (20 May 1996), the "inability" encompasses both objective and subjective inability to obtain treatment. The extended period without appropriate investigation allowed the acute labral tear to progress to chronic tearing with associated osteoarthritic changes, representing permanent worsening of the condition.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
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 — Right Hip - Labral Tear
Example 2 of 2 · fictitious patient (Veteran N)
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
Right Hip - Labral Tear
SOP Codes: Balance of Probabilities - Labral Tear No. 37 of 2017; Reasonable Hypothesis - Labral Tear No. 36 of 2017
ADF History
The veteran, Chef (Army Catering Force), enlisted 09 January 2009, discharged 27 Mar 2016.
Occupational History
Military chefs are exposed to prolonged standing during food preparation, repetitive hip flexion during squatting and lifting activities, carrying heavy kitchen equipment and supplies, manual handling of large pots and equipment, and participation in military physical training including marching, obstacle courses, and fitness activities. The role involves sustained periods on feet in confined kitchen spaces with frequent bending, pivoting, and lifting movements that stress the hip joint through repeated flexion and rotation.
History
The veteran the veteran a military chef, developed right hip pathology during his service in the Australian Defence Force from February 2011 to Apr 2018 through repetitive occupational activities and military training demands.
Timeline
- 04 January 2019 - MRI bilateral hip revealed significant right hip pathology while the left hip was normal. Imaging demonstrated a linear cleft of fluid signal at base of anterosuperior labrum best seen on axial images consistent with undisplaced tear. No CAM deformity was present and there was a tiny subcortical cyst at junction of femoral head and neck anteriorly. The radiologist's conclusion specifically documented undisplaced tear of anterosuperior labrum with no arthropathy present. The structural labral tear represents significant pathology affecting the hip joint's fibrocartilaginous rim, which provides stability and facilitates smooth joint motion during weight-bearing activities.
Symptoms
Current symptoms include hip pain and functional limitation affecting activities of daily living. The labral tear causes mechanical symptoms including pain with hip flexion, reduced range of motion, and discomfort during weight-bearing activities. The condition impacts occupational and recreational activities requiring hip mobility and strength.
Imaging
04 January 2019 - MRI bilateral hip revealed linear cleft of fluid signal at base of anterosuperior labrum best seen on axial images in keeping with undisplaced tear. No CAM deformity was present and there was a tiny subcortical cyst at junction of femoral head and neck anteriorly. The conclusion documented undisplaced tear of anterosuperior labrum with no arthropathy.
1. What is the formal diagnosis of the condition claimed above?
Right Hip Anterosuperior Labral Undisplaced Tear. SOP: Labral Tear No. 37 of 2017. ICD-10: S73.1.
A labral tear is an injury involving tearing of the fibrocartilaginous rim of the hip joint resulting in local pain and tenderness, with or without accompanying symptoms of popping, clicking, catching, instability or reduced range of motion. The labrum is a ring of cartilage that surrounds the acetabulum (hip socket) and helps to deepen the socket, providing stability to the hip joint and facilitating smooth articulation between the femoral head and acetabulum. Labral tears commonly result from repetitive hip flexion with rotation or acute trauma.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Unknown specific date during military service 2013-2020. [Chart Review Document, multiple pages - specific symptom onset date not documented in available records]
When did the veteran first present to a health / medical provider for this condition? 24 September 2018 for DVA assessment with Dr Thomas Perkins, General Practitioner. [Email - General & Service Details.pdf, page 1]
When was the condition confirmed / formally diagnosed? 04 January 2019 by the treating doctor, Radiologist, through MRI bilateral hip imaging. [Imaging.pdf, page 1]
When did the veteran first present to you (or your practice) for this condition? 12 Jun 2018
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 by MRI imaging conducted by Radiologist the treating doctor on 04 January 2019. The imaging revealed a linear cleft of fluid signal at base of anterosuperior labrum best seen on axial images in keeping with undisplaced tear. No CAM deformity was present and there was a tiny subcortical cyst at junction of femoral head and neck anteriorly. The radiologist's conclusion specifically documented undisplaced tear of anterosuperior labrum with no arthropathy. [Imaging.pdf, page 1 - link to imaging report]
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.
Having a significant physical force applied to or through the affected hip joint at the time of the clinical onset of labral tear - NOT MET
- No documented acute traumatic episode to the right hip during military service
Performing forceful and repetitive motions of the affected hip joint, involving extremes of the normal range of motion, for at least four hours per week for the one month before the clinical onset of labral tear - MET
- Military chef duties involved continuous hip flexion during food preparation, repetitive squatting and lifting activities, prolonged standing, and participation in military physical training activities including marching, obstacle courses, and physical employment standards training well exceeding four hours per week throughout his 7-year military service
For labral tear of the hip joint only, being in the third trimester of pregnancy within the one week before the clinical onset of labral tear - NOT MET
- Not applicable - veteran is male
Inability to obtain appropriate clinical management for labral tear - MET
- No documented treatment or management of hip symptoms during military service, with formal diagnosis only occurring in February 2021, representing significant delay in appropriate clinical management as per Brew v Repatriation Commission precedent
Sequelae
This condition is not a sequelae of another known condition but represents primary labral pathology from occupational overuse.
Unintended Consequence
This condition is not an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
There was inability to attain appropriate medical management. The condition was not diagnosed until February 2021, representing a significant delay from the period of military service (2013-2020) when symptoms likely first developed. The Full Federal Court in Brew v Repatriation Commission (07 July 1993) establishes that "inability" encompasses both objective and subjective barriers to obtaining treatment. The absence of documented presentations for hip pain during military service indicates barriers to healthcare access, satisfying the inability to attain appropriate medical management factor. This delay in diagnosis and treatment has caused permanent worsening of the condition, as early intervention with activity modification and physiotherapy could have prevented progression of the labral tear.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
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.
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