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Determination Letters › Vaccine-Induced Thrombotic Thrombocytopenia

Suggested Determination Letter

Vaccine-Induced Thrombotic Thrombocytopenia — example determination letter

A suggested DVA determination for Vaccine-Induced Thrombotic Thrombocytopenia, 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 Vaccine-Induced Thrombotic Thrombocytopenia. 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.

Vaccine-Induced Thrombotic Thrombocytopenia

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 9 September 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 9 September 2025;
  • A pre-deployment medical examination and full blood count by the medical officer, dated 22 March 2021;
  • An immunisation record by the base health centre, dated 23 March 2021;
  • A role 1 treatment record by the medical officer, Middle East, dated 5 April 2021;
  • An emergency admission by the CT venogram and pathology, Coalition hospital, Middle East, dated 8 April 2021;
  • Inpatient progress notes and CT brain and abdomen by the coalition hospital, Middle East, dated 10 April 2021;
  • An aeromedical evacuation record by the aeromedical evacuation team, dated 11 April 2021;
  • A haematology consultation (anti-PF4 ELISA and platelet activation assay) by the haematologist, dated 12 April 2021;
  • An MRI brain and MR venography by the radiologist, dated 13 April 2021;
  • A neurology review and MRI by the neurologist, dated 14 October 2021.

Your service

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

6 September 1993 and 30 September 2022

Vaccine-Induced Thrombotic Thrombocytopenia

You have stated that your condition was caused by:

  • having received an adenovirus vector coronavirus disease 2019 (COVID-19) vaccine within the 100 days before the clinical onset of vaccine-induced thrombotic thrombocytopaenia

Diagnosis: Vaccine-Induced Thrombotic Thrombocytopenia

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 9 September 2025, and is supported by a haematology consultation (anti-PF4 ELISA and platelet activation assay) by the haematologist, dated 12 April 2021.

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

Statement of Principles concerning Vaccine-Induced Thrombotic Thrombocytopaenia (Reasonable Hypothesis) (No. 33 of 2022)

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

I am satisfied that you have met the following factor:

  • having received an adenovirus vector coronavirus disease 2019 (COVID-19) vaccine within the 100 days before the clinical onset of vaccine-induced thrombotic thrombocytopaenia

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 a severe, constant headache, worse lying down and on straining, with nausea, unrelieved by simple analgesia on 5 April 2021.

The diagnosis was confirmed by a haematologist on 12 April 2021. You had thrombosis of the cerebral venous sinuses on CT venography on 8 April 2021 in association with a low platelet count of 42 x 10^9/L, and you had had no exposure to heparin within the 30 days before onset, meeting the Statement of Principles definition of vaccine-induced thrombotic thrombocytopaenia. The diagnosis was supported by a D-dimer above 20 mg/L, a low fibrinogen of 1.2 g/L, a strongly positive anti-PF4 ELISA and a positive platelet activation assay.

This has then led to further investigations and the diagnosis of your condition of Vaccine-Induced Thrombotic Thrombocytopenia. I have accepted your condition of Vaccine-Induced Thrombotic Thrombocytopenia.

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 wartime service.

I have therefore accepted that this condition is related to your service with effect from 2 April 2021.

Vaccine-Induced Thrombotic Thrombocytopenia (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 9 September 2025;
  • A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 9 September 2025;
  • A pre-deployment medical examination and full blood count by the medical officer, dated 22 March 2021;
  • An immunisation record by the base health centre, dated 23 March 2021;
  • A role 1 treatment record by the medical officer, Middle East, dated 5 April 2021;
  • An emergency admission by the CT venogram and pathology, Coalition hospital, Middle East, dated 8 April 2021;
  • Inpatient progress notes and CT brain and abdomen by the coalition hospital, Middle East, dated 10 April 2021;
  • An aeromedical evacuation record by the aeromedical evacuation team, dated 11 April 2021;
  • A haematology consultation (anti-PF4 ELISA and platelet activation assay) by the haematologist, dated 12 April 2021;
  • An MRI brain and MR venography by the radiologist, dated 13 April 2021;
  • A neurology review and MRI by the neurologist, dated 14 October 2021.

Your service

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

6 September 1993 and 30 September 2022

Vaccine-Induced Thrombotic Thrombocytopenia (Worsening)

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

  • inability to obtain appropriate clinical management for vaccine-induced thrombotic thrombocytopaenia

Diagnosis: Vaccine-Induced Thrombotic Thrombocytopenia (Worsening)

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 9 September 2025, and is supported by a haematology consultation (anti-PF4 ELISA and platelet activation assay) by the haematologist, dated 12 April 2021.

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

Statement of Principles concerning Vaccine-Induced Thrombotic Thrombocytopaenia (Reasonable Hypothesis) (No. 33 of 2022)

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 vaccine-induced thrombotic thrombocytopaenia

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 a severe, constant headache, worse lying down and on straining, with nausea, unrelieved by simple analgesia on 5 April 2021.

The diagnosis was confirmed by a haematologist on 12 April 2021. You had thrombosis of the cerebral venous sinuses on CT venography on 8 April 2021 in association with a low platelet count of 42 x 10^9/L, and you had had no exposure to heparin within the 30 days before onset, meeting the Statement of Principles definition of vaccine-induced thrombotic thrombocytopaenia. The diagnosis was supported by a D-dimer above 20 mg/L, a low fibrinogen of 1.2 g/L, a strongly positive anti-PF4 ELISA and a positive platelet activation assay.

After the condition arose, it was worsened during your service. On non-warlike service in the Middle East from 02 to 11 April 2021 you could not obtain recognition of the condition, anti-PF4 testing, haematology advice, intravenous immunoglobulin or a non-heparin anticoagulant.

This has then led to further investigations and the diagnosis of your condition of Vaccine-Induced Thrombotic Thrombocytopenia (Worsening). I have accepted your condition of Vaccine-Induced Thrombotic Thrombocytopenia (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 wartime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 10 April 2021.

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 →