Right Hip - Trochanteric Bursitis — 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 — Right Hip - Trochanteric Bursitis

Example 1 of 1 · 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 - Trochanteric Bursitis

SOP Codes for Balance of Probabilities: SOP 93/2023 SOP Codes for Reasonable Hypothesis: SOP 92/2023

ADF History

The veteran, Medic/Medical Operator/Medical Technician, 06 December 2001, 23 Mar 2022.

Occupational History

The veteran served as an Army Medic, exposing her to extensive occupational hazards including repetitive heavy lifting of patients and medical equipment, prolonged standing during medical procedures, carrying heavy medical packs exceeding 20 kilograms during field exercises, and manual handling of patients requiring awkward postures and significant physical exertion. Her role involved frequent patient assessment and treatment, medical evacuation procedures, and maintenance of medical equipment in both controlled medical facilities and harsh field conditions during exercises and deployments.

History

The veteran an Army Medic, developed right hip trochanteric bursitis secondary to an acute right hip injury sustained during AFL training in September 2018. The condition was subsequently identified on MRI imaging in January 2023, representing a chronic inflammatory process affecting the trochanteric bursa.

Timeline

06 Aug 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 during authorized military sports participation. She experienced immediate sharp pain in the right hip and gluteal region affecting her ability to bear weight and perform military duties.
02 Dec 2021: MRI confirmed mild trochanteric bursitis affecting the right hip. This imaging was performed over 4 years after the initial injury, demonstrating the chronic nature of the inflammatory process. The finding explained the persistent lateral hip symptoms and functional limitations experienced since the original trauma.

Symptoms

At the time of injury in September 2018, the veteran experienced acute right hip pain and gluteal tightness worse when standing and pushing off the affected leg. Following the injury, she developed chronic lateral hip pain affecting her military duties and physical activities. Current symptoms include persistent lateral hip discomfort, particularly with prolonged weight-bearing activities and physical training requirements of military service.

Imaging

02 Dec 2021: MRI showing mild trochanteric bursitis

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

Right Hip - Trochanteric Bursitis, DVA SOP codes 92/2023 (Reasonable Hypothesis) and 93/2023 (Balance of Probabilities), ICD-10 code M70.6.

Trochanteric bursitis is an inflammatory condition affecting the trochanteric bursa, a fluid-filled sac located over the greater trochanter of the femur. The condition typically presents with lateral hip pain and tenderness, often aggravated by activities such as lying on the affected side, climbing stairs, or prolonged walking. The trochanteric bursa serves to reduce friction between the iliotibial band and the greater trochanter during hip movement. When inflamed, it causes characteristic lateral hip pain that may radiate down the lateral thigh.

This condition developed secondary to the acute right hip injury sustained during military sports activities, representing a chronic sequela of the initial trauma.

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 symptoms attributable to right hip trochanteric bursitis on 06 August 2017 during AFL training when she developed acute right hip pain and gluteal tightness. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

When did the veteran first present to a health / medical provider for this condition? The veteran first presented to military medical staff on 06 August 2017 for acute right hip pain following AFL training. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on 02 December 2021 when MRI imaging confirmed mild trochanteric bursitis of the right hip. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

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.

The diagnosis was confirmed through MRI imaging performed on 02 December 2021 which demonstrated mild trochanteric bursitis. Key symptoms included lateral hip pain and tenderness over the greater trochanter region, with pain aggravated by weight-bearing activities and lying on the affected side. Clinical signs included point tenderness over the greater trochanter and pain with resisted hip abduction. The MRI provided definitive imaging confirmation of bursal inflammation. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

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.

undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

Military physical training, sports participation, and occupational duties as a Medic involving prolonged standing, patient handling, and load carriage clearly exceeded these requirements.

increasing the frequency, duration or intensity of activity involving the hip on the affected side by at least 100 percent to a minimum intensity of 5 METs for at least 4 hours per day within the one week before the clinical onset or clinical worsening of trochanteric bursitis - MET

The AFL training activities that precipitated the injury involved intense physical activity exceeding baseline requirements.

having direct trauma to the hip on the affected side within the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

The acute right hip injury during AFL training on 06 August 2017 constitutes direct trauma to the affected area.

having a significantly abnormal gait for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

Compensatory gait patterns from pre-existing left hip pathology since 2008 created altered biomechanics predisposing to right hip problems.

inability to obtain appropriate clinical management for trochanteric bursitis before the clinical worsening of trochanteric bursitis - MET

The delay of over 4 years between initial injury and formal diagnosis with appropriate imaging represents inability to obtain timely appropriate clinical management, satisfying the Brew v Repatriation Commission precedent.

Sequelae

This condition represents a sequela of the acute right hip injury sustained during military sports activities in September 2018.

Unintended Consequence

No evidence that this condition resulted from an unintended consequence of military medical treatment.

Inability to Attain Appropriate Medical Management

There was a significant delay of over 4 years between the initial right hip injury in September 2018 and the formal diagnosis of trochanteric bursitis via MRI in January 2023. This lengthy delay between initial presentation and definitive diagnosis satisfies the criteria for inability to attain appropriate medical management as established in Brew v Repatriation Commission. The Full Federal Court in Brew v Repatriation Commission (20 May 1996) establishes that "inability" encompasses both objective and subjective barriers to obtaining treatment. This delay prevented timely intervention and contributed to the chronic nature of the condition, causing permanent worsening.

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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