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Determination Letters › Chronic Fatigue Syndrome

Suggested Determination Letter

Chronic Fatigue Syndrome — example determination letter

A suggested DVA determination for Chronic Fatigue Syndrome, pre-written from the matching example Diagnostic Assessment. It sets out the evidence, the diagnosis, the Statement of Principles and every factor met — including the inability to obtain appropriate clinical management — in a form a delegate can adopt as much of as they find useful. The worsening is determined separately, in the same document.

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This is the PDF a veteran receives: Times New Roman, set out as a Reference Determination, with both determinations for Chronic Fatigue Syndrome. It is the same letter shown in full below.

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Reference Determination Content

Suggested draft · fictitious patient

Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.

Chronic Fatigue Syndrome

Evidence

The evidence that I have considered in making this decision includes:

  • Formal Claim with supporting statements;
  • A Statement of your Service from the Department of Defence;
  • Copies of your Service Medical Records.
  • A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 8 April 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 8 April 2025;
  • A health record by the medical officer, Army apprentice school, dated 23 September 1982;
  • An incident report and post-contact health record by the unit medical officer, Afghanistan, dated 14 April 2012;
  • A post-incident health record by the unit medical officer, Afghanistan, dated 23 June 2012;
  • A return to Australia psychological and medical screening by the medical officer, dated 2 August 2012;
  • A physical fitness assessment record by the unit, dated 15 August 2012;
  • An outpatient health record and pathology by the medical officer, Garrison health centre, dated 14 September 2012;
  • A serology (echocardiogram and infectious diseases consultation) by the infectious diseases physician, dated 5 October 2012;
  • An ultrasound abdomen by the radiologist, dated 8 October 2012;
  • An MRI brain by the radiologist, dated 12 February 2013;
  • A diagnostic polysomnography report by the sleep physician, dated 28 February 2013;
  • A psychiatric assessment by the consultant psychiatrist, dated 7 March 2013;
  • A specialist consultation by the infectious diseases physician, dated 21 March 2013;
  • An outpatient health record by the medical officer, Garrison health centre, dated 18 November 2013.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

18 January 1982 and 14 November 2014

Chronic Fatigue Syndrome

You have stated that your condition was caused by:

  • having an acute infection from the specified list of infections at the time of the clinical onset of chronic fatigue syndrome

Diagnosis: Chronic Fatigue Syndrome

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 8 April 2025, and is supported by a specialist consultation by the infectious diseases physician, dated 21 March 2013.

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Chronic Fatigue Syndrome (Balance of Probabilities) (No. 106 of 2021)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

  • having an acute infection from the specified list of infections at the time of the clinical onset of chronic fatigue syndrome

I have noted your contention as to the cause of this condition. The available evidence indicates, I have noted your contention to the cause of your condition. Your service medical records indicate that you presented to the health facility with an abrupt febrile illness with sweats, headache, muscle aches and profound exhaustion on 14 September 2012.

The diagnosis was made by an infectious diseases physician on 21 March 2013, applying criteria equivalent to those adopted in the Statement of Principles. You had a new and definite onset of severe fatigue on 10 September 2012, not improved by bed rest and worsened by physical and mental exertion, persisting for more than 6 consecutive months, not due to ongoing exertion, and substantially interfering with your work and daily activities. You had seven of the eight listed symptoms concurrently: post-exertional malaise lasting more than 24 hours, unrefreshing sleep, impaired short-term memory and concentration, muscle pain, joint pain without swelling, new daily headaches and tender cervical lymph nodes, none of which preceded the fatigue.

This has then led to further investigations and the diagnosis of your condition of Chronic Fatigue Syndrome. I have accepted your condition of Chronic Fatigue Syndrome.

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that this condition is related to your peacetime service.

I have therefore accepted that this condition is related to your service with effect from 10 September 2012.

Chronic Fatigue Syndrome (Worsening)

Evidence

The evidence that I have considered in making this decision includes:

  • Formal Claim with supporting statements;
  • A Statement of your Service from the Department of Defence;
  • Copies of your Service Medical Records.
  • A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 8 April 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 8 April 2025;
  • A health record by the medical officer, Army apprentice school, dated 23 September 1982;
  • An incident report and post-contact health record by the unit medical officer, Afghanistan, dated 14 April 2012;
  • A post-incident health record by the unit medical officer, Afghanistan, dated 23 June 2012;
  • A return to Australia psychological and medical screening by the medical officer, dated 2 August 2012;
  • A physical fitness assessment record by the unit, dated 15 August 2012;
  • An outpatient health record and pathology by the medical officer, Garrison health centre, dated 14 September 2012;
  • A serology (echocardiogram and infectious diseases consultation) by the infectious diseases physician, dated 5 October 2012;
  • An ultrasound abdomen by the radiologist, dated 8 October 2012;
  • An MRI brain by the radiologist, dated 12 February 2013;
  • A diagnostic polysomnography report by the sleep physician, dated 28 February 2013;
  • A psychiatric assessment by the consultant psychiatrist, dated 7 March 2013;
  • A specialist consultation by the infectious diseases physician, dated 21 March 2013;
  • An outpatient health record by the medical officer, Garrison health centre, dated 18 November 2013.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

18 January 1982 and 14 November 2014

Chronic Fatigue Syndrome (Worsening)

You have stated that the worsening of your condition was caused by:

  • inability to obtain appropriate clinical management for chronic fatigue syndrome

Diagnosis: Chronic Fatigue Syndrome (Worsening)

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 8 April 2025, and is supported by a specialist consultation by the infectious diseases physician, dated 21 March 2013.

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Chronic Fatigue Syndrome (Balance of Probabilities) (No. 106 of 2021)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

  • inability to obtain appropriate clinical management for chronic fatigue syndrome

I have noted your contention as to the cause of this condition. The available evidence indicates, I have noted your contention to the cause of your condition. Your service medical records indicate that you presented to the health facility with an abrupt febrile illness with sweats, headache, muscle aches and profound exhaustion on 14 September 2012.

The diagnosis was made by an infectious diseases physician on 21 March 2013, applying criteria equivalent to those adopted in the Statement of Principles. You had a new and definite onset of severe fatigue on 10 September 2012, not improved by bed rest and worsened by physical and mental exertion, persisting for more than 6 consecutive months, not due to ongoing exertion, and substantially interfering with your work and daily activities. You had seven of the eight listed symptoms concurrently: post-exertional malaise lasting more than 24 hours, unrefreshing sleep, impaired short-term memory and concentration, muscle pain, joint pain without swelling, new daily headaches and tender cervical lymph nodes, none of which preceded the fatigue.

After the condition arose, it was worsened during your service. After the diagnosis on 21 March 2013 the infectious diseases physician recommended referral to a specialist fatigue service for activity pacing and graded management and a period of modified duties.

This has then led to further investigations and the diagnosis of your condition of Chronic Fatigue Syndrome (Worsening). I have accepted your condition of Chronic Fatigue Syndrome (Worsening).

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that the worsening of this condition is related to your peacetime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 18 November 2013.

Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.
Dr Thomas Perkins, Veterans Health Centre

Reviewed by Dr Thomas Perkins

Founding doctor, Veterans Health Centre · former RAAF aviation medical officer · 13 years working exclusively with ADF members and veterans. Full profile →