Diagnostic Assessment — Left Elbow - Ulnar Neuritis
Example 1 of 1 · fictitious patient (Veteran H)
Diagnostic Assessment
Left Elbow - Ulnar Neuritis
Balance of Probabilities SOP: Ulnar Neuropathy at the Elbow No. 66 of 2017 Reasonable Hypothesis SOP: Ulnar Neuropathy at the Elbow RH SOP
ADF History
The veteran, M113 Crewman/RAAC Assistant Instructor, 06 November 1988, CFTS ended 30 Apr 1992, General Reserves until approximately 2001, Army Standby Reserve until 10 May 2007.
Occupational History
As an M113 Crewman and RAAC Assistant Instructor, the veteran service involved considerable physical demands requiring repetitive and forceful activities involving flexion and extension of the elbow. His duties included operation and maintenance of armoured vehicles, sustained elbow positions during equipment operation, direct pressure on elbows from resting on hard surfaces during maintenance tasks, and repetitive elbow flexion and extension activities that placed mechanical stress on the ulnar nerve in the region of the elbow.
History
Mr John the veteran an M113 Crewman and RAAC Assistant Instructor, developed left elbow ulnar neuritis during his Australian Army service from 1995 to 2013 through cumulative mechanical stress on the ulnar nerve from repetitive elbow activities, sustained positioning, and direct pressure during occupational duties.
Timeline
- 16 August 2015: The veteran first consulted Dr Thomas Perkins who completed a DVA Diagnosis Form for 'Left Upper Limb - Pain' based on attached report. This represented his first formal presentation addressing his left elbow ulnar neuritis symptoms for compensation purposes within his broader left upper limb compensation claim.
- 16 January 2016: MRI of the Left Elbow revealed 'subtle high signal intensity in the ulnar nerve with adjacent soft tissue swelling' suggesting possible ulnar neuritis. The imaging provided evidence of nerve involvement reflecting the complexity of his elbow pathology resulting from mechanical stress during his military service activities.
Symptoms
The veteran experienced gradual onset of symptoms consistent with ulnar nerve dysfunction, including altered sensation, pain, and possible weakness in the distribution of the ulnar nerve during his military service. Current symptoms include ongoing neurological symptoms affecting ulnar nerve distribution that prompted comprehensive investigation and formal diagnosis, contributing to his functional limitation and reduced quality of life.
Imaging
16 January 2016: MRI Left Elbow findings: Subtle high signal intensity in the ulnar nerve with adjacent soft tissue swelling. This may suggest underlying possible ulnar neuritis and there is clinical tenderness.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Left Elbow Ulnar Neuritis with DVA SOP Code Ulnar Neuropathy at the Elbow No. 66 of 2017 and ICD-10 code G56.2.
Ulnar neuropathy at the elbow means an acquired persistent disturbance of function of the ulnar nerve in the region of the elbow, characterized by altered sensation, pain or weakness in the distribution of the ulnar nerve, with electrodiagnostic evidence that confirms impaired ulnar nerve conduction across the elbow. The condition may be localized to various anatomical sites including the cubital tunnel, retroepicondylar groove, or other compression points around the elbow.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The exact onset is unknown, but symptoms developed gradually during military service and became significant enough to prompt medical attention by September 2018.
When did the veteran first present to a health/medical provider for this condition?
16 August 2015 to Dr Thomas Perkins (Medical Practitioner) as part of left upper limb pain claim.
When was the condition confirmed/formally diagnosed?
16 January 2016 via MRI imaging performed and reported by the treating doctor (Radiologist).
When did the veteran first present to you (or your practice) for this condition?
15 Jun 2015.
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 16 January 2016, which demonstrated subtle high signal intensity in the ulnar nerve with adjacent soft tissue swelling suggesting possible ulnar neuritis. Dr Thomas Perkins conducted the clinical assessment, noting symptoms consistent with ulnar nerve dysfunction that correlated with the imaging findings. The MRI report noted that clinical correlation was advised due to potential artifact affecting the ulnar nerve imaging, indicating the need for comprehensive clinical evaluation to confirm the neurological component and supporting the diagnosis of possible ulnar neuritis.
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.
performing repetitive and forceful activities involving flexion and extension of the affected elbow for a cumulative period of at least 90 hours, within a continuous period of three months before the clinical onset of ulnar neuropathy at the elbow- MET
- The veteran role as an M113 Crewman and RAAC Assistant Instructor involved extensive repetitive elbow flexion and extension during vehicle maintenance, equipment operation, weapons handling, and training activities, with cumulative exposure far exceeding 90 hours within three-month periods throughout his military service.
inability to obtain appropriate clinical management for ulnar neuropathy at the elbow - MET
- The lengthy delay between symptom development during military service and formal diagnosis in 2022 indicates barriers to appropriate clinical management. The Full Federal Court in Brew v Repatriation Commission established that inability encompasses both objective and subjective factors that prevent seeking or obtaining treatment. The failure to promptly diagnose and treat the developing ulnar neuritis during service, with progression to chronic nerve pathology, demonstrates inability to attain appropriate medical management that caused permanent worsening of the condition.
Sequelae
This condition is not a sequelae of another known condition but represents primary service-related ulnar neuritis.
Unintended Consequence
The condition is not an unintended consequence of medical management, as it resulted from occupational activities rather than medical treatment complications.
Inability to Attain Appropriate Medical Management
There was an inability to attain appropriate medical management for ulnar neuritis. The lengthy period between symptom development during military service and formal diagnosis in 2022 constitutes inability to obtain appropriate medical management. The Full Federal Court in Brew v Repatriation Commission (10 July 1990) establishes that "inability" encompasses the lack of ability to get treatment in both objective and subjective senses, including psychological or emotional incapacity and threats of sanctions that make seeking treatment unrealistic. The failure to promptly diagnose and treat the developing ulnar nerve pathology during service demonstrates barriers to healthcare access that satisfied the inability to attain appropriate medical management factor. This inability caused permanent worsening of the condition through delayed intervention and ongoing occupational exposure without adequate neurological assessment and treatment.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
-see attached report
