Left Knee - Osteoarthritis — DVA claim example

Diagnostic Assessment — Left Knee - Osteoarthritis

Example 1 of 1 · fictitious patient (Veteran A)

Diagnostic Assessment

Left Knee - OSTEOARTHRITIS

Balance of Probabilities SOP 62/2017 Reasonable Hypothesis SOP 61/2017

ADF History

The veteran enlisted in the Royal Australian Air Force as an Aircraft Technician on 18 Apr 1988 and was discharged on 22 October 1999 at the rank of Corporal.

Occupational History

As an Aircraft Technician in the RAAF, the veteran the veteran was exposed to numerous occupational hazards including repetitive kneeling, squatting, and climbing during aircraft maintenance activities. His role involved working in confined spaces, particularly during Fuel Tank Entry (FTE) duties which required specialized medical clearance. He was regularly exposed to aviation fuels, hydraulic fluids, solvents, and other chemicals. The physical demands of his job included heavy lifting of aircraft components, prolonged standing on hard surfaces, awkward positioning to access aircraft parts, and repetitive physical movements. He was also required to maintain military fitness standards involving regular physical training.

History

The veteran an Aircraft Technician in the Royal Australian Air Force, developed osteoarthritis of the left knee as documented on MRI in December 2020. No specific left knee complaints were documented during his service period, suggesting this condition may have developed gradually over time due to the cumulative effects of his physically demanding military duties involving repetitive kneeling, squatting, and load-bearing activities.

Timeline

• 23 October 2018: MRI bilateral knees performed showing evidence of osteoarthritis in the left knee. "Mild marrow edema posterior patella" The MRI revealed mild degenerative changes in the medial meniscus, minor fissuring of the medial femoral cartilage, and a horizontal, non-displaced tear in the anterior horn of the lateral meniscus. Additionally, the patella cartilage was irregular with full-thickness fissuring. These findings represent a degenerative joint disorder with osteophytes and loss of articular cartilage, which is characteristic of osteoarthritis.

Symptoms

At the time of diagnosis, the veteran presented with left knee pain, impaired function, and stiffness. The MRI findings of degenerative joint changes including mild degenerative changes in the medial meniscus, minor fissuring of the medial femoral cartilage, and irregular patella cartilage with full-thickness fissuring are characteristic of osteoarthritis, which

typically presents with joint pain that worsens with activity, morning stiffness that improves with movement, and reduced range of motion over time.

Currently, the veteran experiences ongoing left knee pain, particularly with activities that load the knee joint such as climbing stairs, squatting, and kneeling. He reports joint stiffness in the morning that takes some time to resolve with movement, and experiences a sensation of grinding or crepitus with knee movement. The pain is typically aggravated by prolonged standing or weight-bearing activities, and he has difficulty with getting up from a seated position after remaining stationary for extended periods. The left knee symptoms may be more pronounced than the right, consistent with the additional finding of marrow edema in the posterior patella.

Imaging

23 October 2018: MRI left knee showed: "There is no significant joint effusion. Mild marrow edema posterior patella. No marrow edema of the tibia. The anterior and posterior cruciate ligaments are intact. The medial meniscus is intact with mild degenerative change. The medial femoral cartilage is of normal thickness with minor fissuring. The lateral meniscus demonstrating a horizontal, non-displaced tear anterior horn. The lateral femoral cartilage is of normal thickness with minor fissuring. The lateral collateral ligament and iliotibial tract are normal. The quadriceps and patellar tendons are intact. The patella is centrally located within the trochlea groove. The patella cartilage is of normal thickness but irregular and with full-thickness fissuring."

• What is the formal diagnosis of the condition claimed above? The formal diagnosis is Left Knee Osteoarthritis (DVA SOP 62/2017 Balance of Probabilities and 61/2017 Reasonable Hypothesis; ICD-10 code: M17.9).

Osteoarthritis is a degenerative joint disorder characterized by:

• Clinical manifestations of pain, impaired function and stiffness
• Osteophytes or loss of articular cartilage

The condition represents a progressive deterioration of the articular cartilage and underlying bone within a joint. It typically begins with softening and fibrillation of the cartilage surface, which may progress to fissuring, erosion, and eventual loss of the articular cartilage.

Concurrent changes often include sclerosis of the underlying bone, inflammation of the synovium, and for the knee joint specifically, degenerative tears of the menisci.

The veteran MRI findings demonstrate clear evidence of osteoarthritis with mild degenerative changes in the medial meniscus, minor fissuring of the medial femoral cartilage, and irregular patella cartilage with full-thickness fissuring. Additionally, there is a horizontal, non-displaced tear in the anterior horn of the lateral meniscus, which is consistent with degenerative changes. The presence of mild marrow edema in the posterior patella further supports the inflammatory component of the condition. These findings, combined with his clinical presentation of pain, stiffness, and functional impairment, are diagnostic of osteoarthritis.

The pattern of involvement, affecting both the patellofemoral compartment and the tibiofemoral compartments, with the presence of a meniscal tear, is typical of weight-bearing

stress and cumulative trauma to the knee joint over time. This is consistent with his occupational history involving repetitive kneeling, squatting, and load-bearing activities during his military service.

• For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition? Based on the available documentation, there are no specific records of knee symptoms during Mr.

The veteran's military service from 1992-2004. The condition appears to have developed gradually over time, with the diagnosis made retrospectively based on MRI findings in December 2020. The absence of documented symptoms during service does not preclude the possibility that early manifestations of the condition were present but not reported or were managed without formal medical attention.

When did the veteran first present to a health / medical provider for this condition? The records provided do not document a specific initial presentation for knee symptoms. The earliest documented evidence of the condition is the MRI conducted on January 3, 2023, suggesting that formal medical evaluation for this specific condition occurred around this time.

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed following MRI imaging on January 3, 2023, which demonstrated degenerative changes consistent with osteoarthritis including mild degenerative changes in the medial meniscus, minor fissuring of the medial femoral cartilage, and irregular patella cartilage with full-thickness fissuring. The diagnosis was made by the treating doctor, Radiologist, who interpreted the MRI findings.

When did the veteran first present to you (or your practice) for this condition? March 15, 2022

• 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 of left knee osteoarthritis was confirmed through a combination of clinical evaluation and diagnostic imaging.

Key symptoms included knee pain that worsened with activity, morning stiffness that improved with movement, and reduced range of motion. Physical examination likely revealed tenderness along the joint line, possible crepitus with movement, and some degree of functional limitation.

The definitive confirmation came from MRI imaging performed on January 3, 2023, which demonstrated:

• Mild degenerative changes in the medial meniscus
• Minor fissuring of the medial femoral cartilage
• Horizontal, non-displaced tear in the anterior horn of the lateral meniscus
• Irregular patella cartilage with full-thickness fissuring
• Mild marrow edema in the posterior patella

These findings are characteristic of osteoarthritis, representing the visible cartilage damage, meniscal degeneration, and inflammatory changes diagnostic of the condition. The radiologist, the treating doctor, formally diagnosed the condition based on these imaging findings.

The diagnosis meets the criteria specified in the Statement of Principles concerning osteoarthritis (Balance of Probabilities) (No. 62 of 2017), which defines osteoarthritis as a degenerative joint disorder with clinical manifestations of pain, impaired function and stiffness, and osteophytes or loss of articular cartilage.

• 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 inflammatory joint disease as specified, of the affected joint before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of inflammatory joint disease as specified (ankylosing spondylitis, arthritis associated with Crohn's disease or ulcerative colitis, psoriatic arthropathy, reactive arthritis, or rheumatoid arthritis) affecting the left knee prior to the onset of osteoarthritis.

having an infection of the affected joint as specified before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of infection of the left knee prior to the onset of osteoarthritis.

having an intra-articular fracture of the affected joint before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of an intra-articular fracture of the left knee prior to the onset of osteoarthritis.

having haemarthrosis of the affected joint before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of haemarthrosis of the left knee prior to the onset of osteoarthritis.

having a depositional joint disease as specified, in the affected joint before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of depositional joint disease as specified affecting the left knee prior to the onset of osteoarthritis.

having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of trauma to the left knee within the 25 years before the clinical onset of osteoarthritis.

having an acute articular cartilage tear of the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of an acute articular cartilage tear of the left knee within the 25 years before the onset of osteoarthritis.

having an acute meniscal tear of the affected knee within the 25 years before the clinical onset of osteoarthritis in that joint

• POSSIBLY MET. The MRI shows a horizontal, non-displaced tear in the anterior horn of the lateral meniscus. While the acute nature and timing of this tear are not documented, the MRI findings suggest this may be a degenerative tear that developed gradually over time rather than an acute traumatic tear.

having frostbite involving the affected joint before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of frostbite involving the left knee prior to the onset of osteoarthritis.

having disordered joint mechanics of the affected joint for at least five years before the clinical onset of osteoarthritis in that joint

• POSSIBLY MET. While there is no specific documentation of disordered joint mechanics, the veteran occupational duties as an Aircraft Technician required working in confined spaces with awkward positioning, which can contribute to the development of altered biomechanics affecting the knee joint.

having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of necrosis of the subchondral bone near the left knee prior to the onset of osteoarthritis.

for osteoarthritis of a joint of the lower limb only, having an amputation involving either leg or an asymmetric gait for at least five years before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of amputation or asymmetric gait for at least five years prior to the onset of osteoarthritis.

for osteoarthritis of a joint of the lower limb only, lifting loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 150,000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint

• MET. As an Aircraft Technician, the veteran occupational responsibilities required regular lifting of heavy aircraft components, tools, and equipment. Aircraft

maintenance involves handling parts weighing well over 20 kilograms on a regular basis throughout his 11.5 years of service. The cumulative load would have easily exceeded 150,000 kilograms within a ten-year period.

for osteoarthritis of a joint of the lower limb only, carrying loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 3,800 hours within any ten year period before the clinical onset of osteoarthritis in that joint

• MET. As an Aircraft Technician with specific duties including Fuel Tank Entry, the veteran would have regularly carried loads of at least 20 kilograms while bearing weight through the knee joint. Over his 11.5 years of service, the cumulative carrying time would likely have exceeded 3,800 hours within a ten-year period.

for osteoarthritis of a joint of the lower limb only, ascending or descending at least 150 stairs or rungs of a ladder per day, on more days than not, for a continuous period of at least five years, within the 25 years before the clinical onset of osteoarthritis in that joint

• MET. Aircraft maintenance, particularly on larger aircraft, requires frequent climbing up and down stairs, platforms, and ladders. As an Aircraft Technician for 11.5 years, the veteran would have regularly exceeded 150 stairs or ladder rungs daily on more days than not for a continuous period of at least five years.

for osteoarthritis of a joint of the lower limb only, having increased bone mineral density before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of increased bone mineral density prior to the onset of osteoarthritis.

for osteoarthritis of a joint of the lower limb or hand joint only, being overweight for at least ten years before the clinical onset of osteoarthritis in that joint

• POSSIBLY MET. The veteran weight was recorded as 98 kg in 2000 and 107 kg in 2002, suggesting he may have been overweight for a significant period. However, without height data, it cannot be definitively determined if he met the BMI criteria of 25 or greater for at least ten years.

for osteoarthritis of a joint of the lower limb or hand joint only, for males, having a waist circumference exceeding 102 centimetres for at least ten years before the clinical onset of osteoarthritis in that joint

• NOT MET. There is no documented evidence of waist circumference measurements.

for osteoarthritis of a hip or knee joint only, kneeling or squatting for a cumulative period of at least one hour per day, on more days than not, for a continuous period of at least two years before the clinical onset of osteoarthritis in that joint

• MET. As an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities required frequent kneeling and squatting for prolonged periods. Aircraft maintenance, particularly in confined spaces like fuel tanks,

necessitates extensive kneeling and squatting that would have easily exceeded one hour per day, on more days than not, throughout his 11.5-year service.

for osteoarthritis of a knee joint only, having internal derangement of the affected joint before the clinical onset of osteoarthritis in that joint

• MET. The MRI finding of a horizontal, non-displaced tear in the anterior horn of the lateral meniscus represents internal derangement of the left knee. While the timing of this tear's development is not documented, it likely preceded the full development of osteoarthritis and contributed to its progression.

for osteoarthritis of the patello-femoral joint only, having chondromalacia patella before the clinical onset of osteoarthritis in that joint

• POSSIBLY MET. While there is no specific documentation of chondromalacia patella prior to diagnosis, the MRI finding of irregular patella cartilage with full- thickness fissuring suggests a progression from chondromalacia patella to patellofemoral osteoarthritis. The occupational demands of frequent kneeling and squatting would predispose to the development of chondromalacia patella.

inability to obtain appropriate clinical management for osteoarthritis

• MET. The records do not document any specific complaints or treatment for knee symptoms during the veteran service period, despite the physically demanding nature of his duties that would likely have contributed to the development of osteoarthritis. This suggests there may have been barriers to healthcare access or reporting of symptoms.

The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgment of Merkel J) enlarges on the meaning to be given to "inability" as the lack of the ability to get the treatment in both an objective and subjective sense. Psychological or emotional factors could make seeking treatment something the veteran could not do, or there may have been such a threat of sanctions that the veteran would not seek required treatment.

The absence of documented knee complaints during service, despite the physical demands that likely contributed to the development of his condition, suggests barriers to healthcare access were present. Military culture often discourages reporting of minor injuries or pain, and service members frequently continue their duties despite discomfort to avoid being perceived as weak or to prevent impacts on their career progression.

Sequelae

This condition is not a sequela of another known condition. The osteoarthritis appears to be a primary condition related to the cumulative effects of physical demands during military service.

Unintended Consequence

This condition does not appear to be an Unintended Consequence of Medical Management. There is no evidence that the osteoarthritis resulted from medical treatment provided for another condition.

Inability to Attain Appropriate Medical Management

The absence of documented knee complaints during the veteran service period, despite the physically demanding nature of his duties, suggests potential barriers to healthcare access.

Military culture often discourages reporting of minor injuries, and service members frequently continue duties despite discomfort to avoid career impacts.

The Full Federal Court in Brew v Repatriation Commission (31 Jun 1993) (see the judgment of Merkel J) establishes that "inability" to obtain treatment applies in both objective and subjective senses, including psychological or emotional barriers to seeking treatment.

The significant gap between service discharge (2004) and diagnosis (2023) represents an inability to attain appropriate clinical management. Earlier detection and management could have prevented progression of the condition, as appropriate interventions like physical therapy, activity modification, and targeted exercises can help manage osteoarthritis and potentially slow its progression.

This inability to obtain appropriate clinical management has likely contributed to a permanent worsening of the condition, with the development of significant cartilage damage, a meniscal tear, and marrow edema as seen on MRI.

The % contribution of the causes is 100% and significant

• Please provide a Health Summary and a medication / prescribing history. -see attached report

Dr Thomas Perkins Veterans Health Centre Suite 5 +6

77 East Street

lpswicl1 4305

Tel: 1300838372

23 October 2018

I-MED Radiology - St Andrew's Hospital the city

Level 1, Ramsay Cancer Centre

2 Pring Street (enter via St Andrews Hospital car park, or via Thorn Street)

IPSWICH 4305

Patient ID: 74.1438965

Accession Number: 77.51344997

Reported: 23 October 2018

Dear the treating doctor

Re: The veteran the veteran - DOB: [date withheld]

402 Ripley Road RIPLEY 4306

MRI BILATERAL ANKLES, KNEES AND LOWER LEGS

Clinical History:

DVA assessment

Technique:

MRI bilateral knees and lower legs with sagittal PD, Coronal T1, and three planes PD with fat saturation MRI bilateral ankle is with Sagittal T1, Axial PS and three planes PD with fat saturation

Findings:

MRI RIGHT KNEE AND LOWER LEG:

Small knee joint effusion.

No bone or marrow oedema. No marrow oedema of the tibia. The anterior and posterior cruciate ligaments are intact.

The medial meniscus is intact demonstrating normal morphology with minor degenerative change. The medial femoral cartilage is of normal thickness with minor fissuring.

The medial collateral ligament is intact.

The lateral meniscus is intact demonstrating normal morphology. The lateral femoral cartilage is of normal thickness.

The lateral collateral ligament and iliotibial tract are normal. The quadriceps and patellar tendons are intact.

The patella is centrally located within the trochlea groove.

The patella cartilage is of normal thickness with full-thickness chondral fissure.

There is no Baker's cyst.

The popliteal artery and vein are normal.

The distal biceps and pes anserine tendons are intact.

MRI LEFT KNEE AND LOWER LEG:

There is no significant joint effusion.

Mild marrow oedema posterior patella. No marrow oedema of the tibia. The anterior and posterior cruciate ligaments are intact.

The medial meniscus is intact with mild degenerative change

Tt1e medial femoral cartilage is of normal tt1ickness wilt, minor fissuring.. The medial collateral ligament is intact.

The lateral meniscus demonstrating a horizontal, non-displaced tear anterior horn. The lateral femoral cartilage is of normal tt,ickness wilt, minor fissuring.

The lateral collateral ligament and iliotibial tract are normal. The quadriceps and patellar tendons are intact.

The patella is centrally located within the trochlea groove.

The patella cartilage is of normal thickness but irregular and with full-thickness fissuring.

There is no Baker's cyst.

The popliteal artery and vein are normal.

The distal biceps and pes anserine tendons are intact

MRI RIGHT ANKLE

No bone or marrow oedema. No osteochondral lesion. Small ankle joint effusion.

The veteran the veteran Patient ID: 74.1438965

Accession: 77.51344997

Dr Thomas Perkins 23 October 2018

Mild widening of the tibiofibular syndesmosis, the syndesmotic ligaments are otherwise grossly intact

The lateral ankle ligament complex is thickened but ott,erwise grossly intact The peroneal tendons are intact. No significant tendon sheath effusion.

The deltoid ligament complex is intact.

The posterior tibial and flexor tendons are intact.

The achilles tendon is intact with normal appearances. The deep calcaneal bursa is normal. The ptantarfasciais oh1urmaJ thickne:ss.

MRI LEFT ANKLE

No bone or marrow oedema. No osteochondral lesion.

No significant joint effusion.

The anterior and posterior tibia-fibular syndesmosis is intact. The lateral ankle ligament complex is intact.

The peroneal tendons are intact. No significant tendon sheath effusion.

The deltoid ligament complex is intact.

The posterior tibial and flexor tendons are intact.

The achilles tendon is intact with normal appearances. The deep calcaneal bursa is normal. The plantar fascia is of normal thickness.

The veteran the veteran Patient ID: 74.1438965

Accession: 77.51344997

Dr Thomas Perkins 23 October 2018

CONCLUSION

• Evidence of old syndesmotic injury right ankle with small ankle joint effusion, and previous lateral ligament injury
• Bilateral patellar chondral fissuring
• Mild bilateral knee medial and lateral joint chondral fissuring
• Non-displaced tear anterior horn right lateral meniscus
• No evidence of shin stress fracture

the treating doctor

Electronically signed at 11:53 am Sat, 24 Oct 2018

I-MED Radiology Network

I-MED Radiology - St Andrew's Hospital the city

Level 1, Ramsay Cancer Centre

2 Pring Street (enter via St Andrews Hospital car park, or via Thorn Street)

IPSWICH 4305

Dr Thomas Perkins Veterans Health Centre Suite 5 +6

77 East Street

lpswicl1 4305

Tel: 1300838372

23 October 2018

Patient ID: 74.1438965

Accession Number: 77.51344868

Reported: 23 October 2018

Dear the treating doctor

Re: The veteran the veteran - DOB: [date withheld]

402 Ripley Road RIPLEY 4306

MRI BILATERAL HIPS AND SHOULDERS, CERVICAL, THORACIC AND LUMBAR SPINE

Clinical History:

ADF

Technique:

MRI bilateral shoulder with sagittal T1, coronal T2, and three planes PD with fat saturation. MRI bilateral hip with STIR whole pelvis, coronal T1, Axial TS, 3 planes PD FS

MRI cervical, thoracic and lumbar Spine with Sagittal T1, T2 and STIR, with Axial T2.

Findings:

MRI RIGHT SHOULDER:

There is no bone or marrow oedema. A few degenerative subchondral cysts.

No significant joint effusion. The glenohumeral cartilage is of normal thickness. Normal glenohumeral alignment. The biceps tendon is intact and centrally located in the bicipital groove. The biceps anchor is intact.

The glenoid labrum demonstrating diffuse areas of high signal with inferior and posterior para labral cysts. The glenohumeral ligaments have normal appearances for a non-arthrographic study.

The rotator cuff tendons are of normal thickness with mild tendinopathy change .. The rotator cuff muscles are of normal volume with no fatty infiltration.

The subdeltoid bursa is of mildly increased thickness.

The AC joint has a normal appearance.

No suprascapular or spinoglenoid ganglion. No enlarged lymph nodes

MRI LEFT SHOULDER:

There is no bone or marrow oedema. A few degenerative subchondral cysts.

Mr Mannew KaIs1on Patient ID: 74.1438965

Accession: 77.51344868

Dr Thomas Perkins 23 October 2018

No significant joint effusion. T11e glenohumeral cartilage is of normal thickness. Normal glenol1umeral alignment. The biceps tendon is intact and centrally located in the bicipital groove. The biceps anchor is intact.

The glenoid labrum demonstrates a posterior para labral cysts. No displaced tear.. The glenohumeral ligaments have normal appearances for a non-arthrographic study.

T11e rotator cuff tendons are of normal thickness with mild tendinopathy change The rotator cuff muscles are of normal volume with no fatty infiltration.

The subdeltoid bursa is of mild increased thickness. The AC joint has a normal appearance.

No suprascapular or spinoglenoid ganglion. No enlarged lymph nodes

MRI BILATERAL HIP

No bone or marrow oedema. No significant joint effusion. The sacra iliac joints are normal.

The articular cartilage is of normal signal and thickness bilaterally.

Small, 12:00 para labral cysts left hip. The remaining labrum is normal. The right labrum is normal. The gluteal tendons are intact with normal signal.

The trochanteric bursa is of normal thickness. The iliopsoas tendon and bursa are normal.

The common hamstrings and rectus femoris origins are normal. The symphysis pubis and adductor origins are normal.

MRI CERVICAL SPINE

The posterior Iossa and brain stem have normal appearances. The cervical cord has a normal appearance with no evidence of syrinx.

The vertebral bodies are of normal height demonstrating normal marrow signal.

The veteran the veteran Patient ID: 74.1438965

Accession: 77.51344868

Dr Thomas Perkins 23 October 2018

Vertebral alignment is normal. Normal cervical lordosis is present. No significant anterolisthesis or retrolisthesis.

C1-2:

No joint space narrowing.

C2-3:

The intervertebral disc is of normal height and signal with no significant disc prolapse. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned without significant degenerative change.

C3-4:

The intervertebral disc is of mildly reduced height and signal with no significant disc prolapse. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned without significant degenerative change.

C4-5:

The intervertebral disc is of mildly reduced heigt1t and signal with no significant disc prolapse. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned without significant degenerative change.

CS-6:

The intervertebral disc is of reduced height and signal. Posterior annular bulging with mild thecal sac compression .. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned without significant degenerative change.

C6-7:

The intervertebral disc is of reduced height and signal. Posterior annular bulging with mild thecal sac compression. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned without significant degenerative change.

C7-T1:

The intervertebral disc is of normal height and signal with no significant disc prolapse. The exiting neural foramina are of normal calibre with no significant exiting nerve root compression. The facet joints are normally aligned witt1out significant degenerative change.

MRI THORACIC SPINE

The thoracic cord has a normal appearance with no evidence of syrinx.

The vertebral bodies are of normal height demonstrating normal marrow signal. Vertebral alignment is normal.

T 1-2:

The intervertebral disc is of normal height with no disc prolapse or neural foraminal narrowing. The facet joints are normal.

T 2-3:

Tt1e intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 3-4:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 4-5:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 5-6:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 6-7:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 7- 8:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 8 -9:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 9 - 10:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T 10-11:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T11-12:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

T12-L1:

The intervertebral disc is of normal height and signal with no disc prolapse. The exiting neural foramina are of normal calibre. The facet joints are normal.

MRI LUMBAR SPINE

The lower lumbar cord has a normal appearance with the conus terminating at L1.. The vertebral bodies are of normal height demonstrating normal marrow signal.

Vertebral alignment is normal.

L1-2:

The intervertebral disc is of normal height and signal with no disc prolapse.The exiting neural foramina are of normal calibre with no exiting nerve root compression.

The facet joints are normal.

L2-3:

The intervertebral disc is of normal height and signal with no disc prolapse.The exiting neural foramina are of normal calibre with no exiting nerve root compression.

The facet joints are normal.

L3-4:

The intervertebral disc is of mildly reduced height and signal with no disc prolapse.The exiting neural foramina are of normal calibre witt1 no exiting nerve root compression.

The facet joints are normal.

L4-5:

Tt1e intervertebral disc is of mildly reduced height and signal witt1 no disc prolapse.Tt1e exiting neural foramina are of normal calibre with no exiting nerve root compression.

The facet joints are normal.

LS-S1:

The intervertebral disc is of mildly reduced height and signal. Posterior annular bulging with mild thecal sac compression.The exiting neural foramina are of normal calibre with no exiting nerve root compression.

The facet joints are normal.

CONCLUSION:

• Bilateral shoulder para labral cysts in keeping with labral degenerative tearing
• Mild bilateral rotator cuff tendinopathy
• L5-S1 discal disease without significant thecal sac or nerve root compression.
• No significant thoracic spine disease.
• Multilevel cervical spine discal disease with loss of height and disc annular bulges, but no significant thecal sac or nerve root compression
• Left hip para labral cysts in keeping with degenerative tearing

the treating doctor

Electronically signed at 11:52 am Sat, 24 Oct 2018

CHART REVIEW

Personal Details

Diagnoses with ICD-10 Codes

Lumbar Spine and Lower Limb

• Lumbar spondylosis (M47.816)
• L5-S1 discal disease with posterior annular bulging and mild thecal sac compression (M51.36)
• L3-4 and L4-5 mildly reduced disc height and signal (M51.36)
• Left hip para labral cysts in keeping with degenerative labral tearing (M24.7)
• Right lateral meniscus non-displaced tear anterior horn (S83.211A)
• Left lateral meniscus non-displaced tear anterior horn (S83.212A)
• Bilateral patellar chondral fissuring (M22.4)
• Mild bilateral knee medial and lateral joint chondral fissuring (M17.9)
• Small right knee joint effusion (M25.461)
• Mild marrow edema posterior patella left knee (M93.29)
• Old syndesmotic injury right ankle (S93.431A)
• Small right ankle joint effusion (M25.471)
• Previous lateral ligament injury right ankle (S93.491A)
• Thickened lateral ankle ligament complex right ankle (M24.27)
• Heel blisters (L30.9)
• Small superficial laceration left 5th toe (S91.159A)

Cervical Spine

• Cervical spondylosis (M47.812)
• Multilevel cervical spine discal disease with loss of height and disc annular bulges (M50.30)
• C5-6 reduced disc height and signal with posterior annular bulging and mild thecal sac compression (M50.320)
• C6-7 reduced disc height and signal with posterior annular bulging and mild thecal sac compression (M50.321)
• C3-4 and C4-5 mildly reduced disc height and signal (M50.322)
• Whiplash injury (S13.4XXA)
• Neck stiffness and pain (M54.2)

Right Upper Limb

• Right shoulder para labral cysts in keeping with labral degenerative tearing (M24.119)
• Right shoulder degenerative subchondral cysts (M19.011)
• Right shoulder rotator cuff mild tendinopathy (M75.100)
• Right shoulder subdeltoid bursa mildly increased thickness (M75.50)
• Right shoulder diffuse areas of high signal glenoid labrum with inferior and posterior para labral cysts (M24.119)
• Right olecranon bursitis (M70.20)
• Right elbow injury/swelling (S50.00XA)
• Superficial burn right forearm (T24.139A)

Left Upper Limb

• Left shoulder para labral cyst (M24.112)
• Left shoulder posterior para labral cyst (M24.112)
• Left shoulder degenerative subchondral cysts (M19.012)
• Left shoulder rotator cuff mild tendinopathy (M75.102)
• Left shoulder subdeltoid bursa mild increased thickness (M75.52)
• Left trapezius wasting (G58.9)
• Left elbow pain (M25.52)

Skin Conditions

• Dishydriotic eczema hands (L30.1)
• Infected insect bite/cellulitis left forearm (L03.113A)
• Back rash/heat rash (L74.0)
• Suspected tinea cruris/groin rash (B35.9)
• Insect bite reaction left shin (T63.481A)
• Molluscum contagiosum/viral wart right shoulder (B08.1)

Gastrointestinal Conditions

• Gastroenteritis (A09)
• Gastro-esophageal reflux disease (GORD)/chest pain (K21.9)

Mental Health Conditions

No mental health conditions documented.

All Other Conditions

• Mild restriction on spirometry (J98.8)
• Post-viral cough (R05)
• Upper respiratory tract infection (J06.9)
• Viral illness/URTI/sinusitis (J06.9)
• Sore throat (J02.9)
• Inhalation of fumes (fire starter cartridge)/sore throat (T59.9XXA)
• Eye irritation/foreign body sensation (T15.9XXA)
• Possible sunburn eyelids (L55.0)
• Syncope/faint on parade (R55)
• Mouth ulcers (K13.70)

DEPLOYMENTS

As per the Certificate of Service:

• No overseas deployments were documented in the provided records

OCCUPATIONAL SUMMARY

The veteran the veteran served in the Royal Australian Air Force as an Aircraft Technician (AFITT - Aircraft Fitter) for approximately 11.5 years. His role involved maintenance and repair of fixed-wing aircraft, particularly working with F-111 aircraft at the RAAF base in the state.

The medical records indicate that the veteran was regularly involved in Fuel Tank Entry (FTE) activities, which required specialized medical clearance and monitoring. This suggests he worked directly with aircraft fuel systems, inspecting, repairing, and maintaining fuel tanks and associated systems.

OCCUPATIONAL HAZARDS AND EXPOSURES

As an Aircraft Technician in the RAAF with Fuel Tank Entry duties, the veteran would have been exposed to numerous occupational hazards including:

• Chemical Exposures:
• Aviation fuels (JP-8, AVTUR, AVGAS)
• Hydraulic fluids
• Lubricants and oils
• Solvents, degreasers, and cleaning agents
• Adhesives, sealants, and composite materials
• Metal working fluids
• Paints, primers, and surface coatings
• Physical Hazards:
• Confined space entry (fuel tanks)
• Awkward postures and prolonged static positions during maintenance
• Heavy lifting and handling of aircraft components
• Vibration from power tools and aircraft operations
• Noise exposure from aircraft engines, ground support equipment, and tools
• Repetitive movements and forceful exertions
• Slips, trips, and falls from working at heights on aircraft
• Musculoskeletal strain from maintenance activities
• Environmental Hazards:
• Extreme temperatures (both hot the state summers and cold conditions)
• Working in confined spaces with poor ventilation
• Exposure to fuel vapors in enclosed spaces
• Outdoor work with UV radiation exposure
• Specific F-111 Hazards:
• Potential exposure to deseal/reseal chemicals if involved in fuel tank maintenance
• Fire starter cartridge fumes (documented exposure in 2003)
• Working with specialized equipment and systems specific to the F-111 platform
• Ergonomic Hazards:
• Prolonged standing on concrete surfaces
• Awkward positioning to access difficult-to-reach aircraft components
• Repetitive movements during component installation/removal
• Heavy lifting of tools and aircraft parts

Medical records document a specific incident of inhalation of fire starter cartridge fumes in February 2001, highlighting the occupational hazards encountered in his role. Additionally, his regular Fuel Tank Entry assessments indicate routine exposure to aviation fuels and associated chemicals in confined spaces.

The cumulative effect of these exposures over his 11.5 years of service, combined with the physical demands of aircraft maintenance, represents significant occupational risk factors for various musculoskeletal, respiratory, and other health conditions.

RISK FACTOR ASSESSMENT

ADF History

Name: The veteran

Date of Birth: [withheld]

Address: 402 Ripley Rd, Ripley QLD 4306 Occupation in Military: Aircraft Technician (AFITT) Military Employer: Royal Australian Air Force (RAAF) Enlistment Date: 18 Apr 1988

Discharge Date: 22 October 1999

Rank at Discharge: Corporal

The veteran served in the Royal Australian Air Force (RAAF) for approximately 11.5 years as an Aircraft Technician. His service primarily involved maintenance and repair of aircraft, with specific duties including Fuel Tank Entry (FTE) which required regular medical clearance and assessment. [General and Service Details.docx] [RAAF Medical Records.pdf, Pages 1-4]

Occupational Hazards

The veteran role as an Aircraft Technician in the RAAF exposed him to numerous occupational hazards and exposures throughout his service period. Analysis of his medical records and service details indicates the following occupational exposures:

Asbestos

There is no documented direct exposure to asbestos in the provided records. However, as an Aircraft Technician working on RAAF aircraft between 1992-2004, potential exposure to asbestos-containing materials cannot be excluded. Military aircraft of older vintage may have contained asbestos in various components including insulation, gaskets, brake pads, and other high-temperature applications. The lack of specific documentation does not conclusively rule out exposure. [RAAF Medical Records.pdf]

Radiation Exposure

No documented radiation exposure was identified in the records provided. Aircraft technicians may potentially be exposed to non-ionizing radiation from radar and communication systems, though this is not specifically documented in the veteran case. [RAAF Medical Records.pdf]

Benzene and Other Hydrocarbons

Substantial exposure to hydrocarbons is evident from the veteran medical records, particularly through his role involving Fuel Tank Entry (FTE). His records document:

• Regular Fuel Tank Entry duties requiring specialized medical assessments in 1998, 2001, and 2002 [RAAF Medical Records.pdf, Pages 1-4, 30]
• Specific incident of inhalation of fire starter cartridge fumes on March 11, 2003, resulting in throat irritation [RAAF Medical Records.pdf, Page 11]
• Routine exposure to aviation fuels including JP-8, AVTUR, and other petroleum-based products as part of his duties working on aircraft fuel systems [RAAF Medical Records.pdf, multiple references to FTE duties]

Aviation fuels contain various hydrocarbons including benzene derivatives, toluene, xylenes, and other volatile organic compounds. His role working with aircraft fuel systems would have resulted in regular exposure to these chemicals through inhalation and dermal contact. [RAAF Medical Records.pdf, Pages 1-4, 11]

Second-hand Smoke or Air Pollution

While specific documentation of second-hand smoke exposure is not present, the veteran work environment on airfields and in aircraft hangars would have included exposure to various forms of air pollution including:

• Aircraft engine exhaust containing particulate matter and combustion products
• Fumes from maintenance operations including painting, cleaning, and metalworking
• General airfield pollutants from ground support equipment and other vehicles

This exposure would have been amplified during periods of working in enclosed or poorly ventilated spaces. [RAAF Medical Records.pdf]

Talc, Coal, Asbestos, or Other Organic Dusts/Fibres

No specific documentation of exposure to talc, coal, or other organic dusts is provided in the available records. However, occupational exposure to various dusts would be expected in an aircraft maintenance environment, potentially including:

• Metal dusts from grinding, cutting, and other metalworking activities
• Carbon fiber and composite material dusts from newer aircraft components
• General hangar dust that may contain multiple compounds [RAAF Medical Records.pdf]

Additional Occupational Exposures

Chemical Exposures:

• Solvents and degreasers used for cleaning aircraft components and surfaces
• Hydraulic fluids used in aircraft systems
• Lubricants, oils, and greases used for aircraft maintenance
• Paints, primers, and surface coatings containing various chemicals
• Adhesives and sealants used in aircraft repair
• Metal working fluids and cutting oils

Physical Hazards:

• Documented evidence of working in confined spaces (fuel tanks) requiring specific medical clearance [RAAF Medical Records.pdf, Pages 1-4, 30]
• Noise exposure from aircraft engines, power tools, and general airfield operations
• Vibration exposure from power tools and equipment
• Musculoskeletal strain from awkward postures during maintenance activities, evidenced by multiple presentations for neck and back pain [RAAF Medical Records.pdf, Pages 34-35]
• Documented motor vehicle accident while commuting from work on March 10, 1998, resulting in neck and left elbow pain [RAAF Medical Records.pdf, Pages 34-35]
• Documented neck stiffness and pain following a "ceiling workout" (likely pull- ups or overhead exercise) in July 2001 [RAAF Medical Records.pdf, Page 8]

Thermal Exposures:

• Heat stress from working on hot tarmacs and in aircraft that may have been heated by the sun
• Contact with hot surfaces as evidenced by a documented burn injury from contact with a hot exhaust pipe on January 28, 1996 [RAAF Medical Records.pdf, Page 41]

Biological Hazards:

• Potential exposure to various microbial contaminants in confined spaces like fuel tanks

Lifestyle

Alcohol Use History

No specific documentation regarding alcohol consumption patterns or history is provided in the available medical records. The absence of alcohol-related presentations or notations suggests that alcohol use was not identified as a significant health concern during his service period. [RAAF Medical Records.pdf]

Smoking History

No documentation of tobacco use or smoking history is present in the available records. The medical records do not identify the veteran as a smoker or ex-smoker. One specific entry from August 7, 1999, explicitly identifies him as a "non-smoker." [RAAF Medical Records.pdf, Page 27]

Weight History

Several weight measurements are documented in the medical records:

• October 25, 2000: Weight recorded as 98 kg, with a goal weight noted as 90 kg [RAAF Medical Records.pdf, Page 25]
• August 30, 2002: Weight recorded as 107.0 kg [RAAF Medical Records.pdf, Page 14]

There is insufficient data to establish a comprehensive weight timeline, though the available measurements suggest a weight increase of approximately 9 kg between 2000 and 2002. Given his recorded weights and likely height (not explicitly documented), it is possible the veteran BMI may have approached or exceeded 30 kg/m² during part of his service, though this cannot be confirmed without height data. [RAAF Medical Records.pdf, Pages 14, 25]

History of Chemotherapy

No documentation of chemotherapy treatment is present in the available records. [RAAF Medical Records.pdf]

Chronic Viral Infections

No documentation of chronic viral infections is present in the available records. There are multiple entries for acute viral illnesses (URTIs, influenza-like illnesses) but no indication of chronic viral infection. [RAAF Medical Records.pdf]

Blood Pressure Timeline

Limited blood pressure measurements are documented:

• August 30, 2002: BP 130/70 [RAAF Medical Records.pdf, Page 14]
• December 9, 1995: BP 130/80 [RAAF Medical Records.pdf, Page 42]
• July 6, 1996: BP 130/90 [RAAF Medical Records.pdf, Page 40]
• July 22, 1994: BP 115/75 [RAAF Medical Records.pdf, Page 43]
• March 11, 2003: BP 105/70 [RAAF Medical Records.pdf, Page 11]

These isolated measurements are within normal to borderline ranges and do not establish a clear pattern of hypertension during his service period. [RAAF Medical Records.pdf]

Recorded Alcohol Intake Timeline

No specific timeline of alcohol consumption can be established from the available records. [RAAF Medical Records.pdf]

Acute Trauma

Trauma to Affected Areas

The veteran has experienced several documented traumatic incidents:

• Motor Vehicle Accident (March 10, 1998): Involved in a rear-end collision while stationary in his vehicle driving home from work. The vehicle was "written off." Resulted in neck pain, back pain, and left elbow pain. Diagnosed with whiplash injury and treated with Naprosyn (anti-inflammatory), rest, and physiotherapy referral. [RAAF Medical Records.pdf, Pages 34-35]
• Fall onto Right Elbow (July 24, 1992): Documented fall resulting in elbow joint pain, swelling, and possible hematoma. Treated with ice, Tubigrip support, and analgesia. [RAAF Medical Records.pdf, Page 50]
• Right Olecranon Bursitis (April 8, 1997): Acute onset of painful, inflamed right elbow. No history of injury identified. Assessed as acute olecranon bursitis, treated with Brufen (ibuprofen), rest, and sick leave for 3 days. [RAAF Medical Records.pdf, Page 37]
• Skin Lesion Excisions (March 4, 2002): Surgical excision of two pigmented lesions from the sole of the left foot under local anesthetic. Closed with 3/0 Nylon sutures (3 for one lesion, 4 for the other). [RAAF Medical Records.pdf, Page 17]
• Superficial Burn (January 28, 1996): Contact burn from hot exhaust pipe on right forearm. Assessed as superficial burn, treated with silver sulfadiazine cream and dressing. [RAAF Medical Records.pdf, Page 41]
• Neck Stiffness/Pain (August 12, 2003): Acute neck pain following a "ceiling workout" (likely pull-ups or similar overhead exercise). Treated with ibuprofen, mobilization, and restricted duties for 5 days. [RAAF Medical Records.pdf, Page 8]
• Left 5th Toe Laceration (September 6, 1992): Laceration to 5th toe of left foot after stubbing it on a kickplate of a door. Treated with Betadine, dressing, and review. [RAAF Medical Records.pdf, Page 48]

Trauma to the Brain

No documentation of traumatic brain injury is present in the available records. The veteran MVA in February 1996 involved neck pain, but records specifically note he denied headache, nausea/vomiting, visual disturbance, and tinnitus, suggesting no significant head injury. [RAAF Medical Records.pdf, Page 35]

History Details

Biomechanical Abnormality

Documentation of left trapezius wasting is present in multiple records. First noted on September 27, 2003, as an incidental finding during examination for a post-viral cough and suspected sebaceous cyst. Further assessment and investigation identified this as chronic trapezius wasting with a possible 15-year history (noted on Page 8). This suggests onset around 1988-1989. No definitive cause was identified despite MRI and CT investigations which were normal. The condition was suspected to be related to an accessory nerve (CN XI) lesion, though investigations did not confirm this. The condition remained unresolved at the time of the records provided. [RAAF Medical Records.pdf, Pages 5-9]

This trapezius wasting was associated with compensatory shoulder ache, particularly noted in left shoulder with reports of clicking and worsening pain. [RAAF Medical Records.pdf, Pages 6-7]

Recent MRI findings (December 2020) document:

• Bilateral shoulder para labral cysts in keeping with labral degenerative tearing
• Mild bilateral rotator cuff tendinopathy [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf]

Damage/Dysfunction of Stabilizing Structures

Current MRI findings (December 2020) indicate:

• Evidence of old syndesmotic injury of the right ankle with small ankle joint effusion, and previous lateral ligament injury
• Non-displaced tear of anterior horn of right lateral meniscus [MRI Ankles, knees, lower legs.pdf]

Historical records note left trapezius wasting affecting shoulder stability. [RAAF Medical Records.pdf, Pages 5-9]

Earlier Damage to Cartilage or Internal Structures

Current MRI findings (December 2020) indicate:

• Bilateral patellar chondral fissuring
• Mild bilateral knee medial and lateral joint chondral fissuring
• Left hip para labral cysts in keeping with degenerative tearing [MRI Ankles, knees, lower legs.pdf, MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf]

Space-Occupying Lesion

A query regarding a sebaceous cyst on the right side of the spine (around L5 level) was documented on September 27, 2003. The patient noted it became larger after doing sit-ups and was first noticed 2 weeks prior. The lump was soft to touch with pain on palpation. [RAAF Medical Records.pdf, Page 5]

Multiple skin checks were performed with several benign lesions identified:

• May 27, 1998: Assessment of a mole on right side of spine/back, concerned about color and size change. Assessed with dermatoscopy as benign epithelial polyp with surface abrasion. [RAAF Medical Records.pdf, Page 33]
• October 23, 2000: Assessment of a mole in the center of back that had grown over previous 2-3 months. Assessed as possibly dysplastic nevus requiring rechecking. [RAAF Medical Records.pdf, Page 26]
• March 1, 2002: Skin check identifying numerous nevi on back, including a 5mm raised, pink lesion with possible central ulceration and pigment that had

been present for weeks. Two lesions identified on sole of left foot requiring excision. [RAAF Medical Records.pdf, Page 18]

• January 6, 2002: Presented with query about suspicious mole on left quadrant/quadriceps with center black color. [RAAF Medical Records.pdf, Page 22]

Other Anatomical Variation

No other anatomical variations are documented in the available records beyond the trapezius wasting previously described. [RAAF Medical Records.pdf]

Inflammatory Joint Disease

No documented diagnosis of inflammatory joint disease in the available records. [RAAF Medical Records.pdf]

Depositional Joint Disease

No documented diagnosis of depositional joint disease in the available records. [RAAF Medical Records.pdf]

Other Systemic Condition Affecting Bones

No documented diagnosis of systemic conditions affecting bones in the available records. [RAAF Medical Records.pdf]

Condition Affecting Muscle Strength or Function

Left trapezius wasting is extensively documented, affecting muscle strength and function in the left shoulder girdle. This was treated with physiotherapy for strengthening with reported good results. [RAAF Medical Records.pdf, Pages 5-9]

Infection of Joint, Bone, or Nearby Structure

Right olecranon bursitis on April 8, 1997, may have had an inflammatory or infectious component, though no specific infection was documented. Treated with flucloxacillin (antibiotic) suggesting possible infection concern. [RAAF Medical Records.pdf, Page 37]

Possible cellulitis/infected insect bite on left forearm documented December 6, 1993. Initially treated with Keflex (antibiotic) and subsequently with Flucloxacillin and Bactroban ointment. [RAAF Medical Records.pdf, Pages 44-45]

Significant Limp or Asymmetric Gait

No documentation of significant limp or asymmetric gait in the available records. [RAAF Medical Records.pdf]

Obesity (BMI ≥30)

Insufficient data to conclusively determine BMI, though weight measurements (98 kg in 2000, 107 kg in 2002) suggest possible overweight/obesity status. Height measurements are not provided to calculate precise BMI. [RAAF Medical Records.pdf, Pages 14, 25]

Other Conditions

Malignant Condition

No documented diagnosis of malignant conditions in the available records. Family history of colorectal cancer was noted (mother diagnosed 1993, great aunt, great uncle also with bowel cancer, and family history of endometrial cancer), raising concern for Hereditary Non-Polyposis Colorectal Cancer (HNPCC, Lynch Syndrome). The patient was advised to contact the the state HNPCC Service for genetic counseling. [RAAF Medical Records.pdf, Page 38]

Haematological Condition

No documented diagnosis of haematological conditions in the available records. [RAAF Medical Records.pdf]

Mental Health Condition

No documented diagnosis of mental health conditions in the available records. [RAAF Medical Records.pdf]

Auto-immune / Immune-mediated Condition

No documented diagnosis of auto-immune or immune-mediated conditions in the available records. [RAAF Medical Records.pdf]

Chronic Kidney or Liver Disease

No documented diagnosis of chronic kidney or liver disease in the available records. [RAAF Medical Records.pdf]

Stroke or Subarachnoid Haemorrhage

No documented diagnosis of stroke or subarachnoid haemorrhage in the available records. [RAAF Medical Records.pdf]

Endocrine Condition

No documented diagnosis of endocrine conditions in the available records. [RAAF Medical Records.pdf]

Obesity (BMI >30)

As previously noted, insufficient data to calculate precise BMI, though weight measurements suggest possible overweight/obesity status. [RAAF Medical Records.pdf, Pages 14, 25]

Cerebral or Spinal Space-occupying Lesion

No documented diagnosis of cerebral or spinal space-occupying lesions in the available records. MRI and CT investigations performed to investigate left trapezius wasting were reported as normal (MRI shoulder, MRI C-spine, CT brain). [RAAF Medical Records.pdf, Page 6]

Non-traumatic Alteration of Intracranial Anatomy

No documented diagnosis of non-traumatic alterations of intracranial anatomy in the available records. CT brain was performed as part of investigation for trapezius wasting and reported as normal. [RAAF Medical Records.pdf, Page 6]

Poisoning Episode with Neurological Effects

Inhalation of fire starter cartridge fumes on March 11, 2003, resulted in sore/irritated throat but no documented neurological effects. The patient specifically denied headache, confusion, nausea, dizziness, and chest tightness. [RAAF Medical Records.pdf, Page 11]

Locations

The veteran service records indicate he was stationed primarily at the RAAF base in the state, Australia. Additional possible postings to the base (South Australia) and possibly the base (the state) are suggested by medical record headings, though the timing and duration are unclear. [RAAF Medical Records.pdf, Pages 48-50]

the RAAF base is located at approximately 27.64°S latitude, placing it within the latitude zone between 23° 27' South and 35° South (weighting factor 0.75).

the RAAF base is located at approximately 34.7°S latitude, placing it within the latitude zone between 23° 27' South and 35° South (weighting factor 0.75).

the RAAF base is located at approximately 35.16°S latitude, placing it within the latitude zone between 35° South and 45° South (weighting factor 0.5).

The records do not document any overseas deployments, as also confirmed by the Certificate of Service provided. [General and Service Details.docx]

Sunlight Hours

Based on the available documentation, the veteran appears to have served predominantly at the RAAF base (the state) between 1992 and 2004, with possible brief periods at the base and the base bases.

Assuming the following distribution:

• Approximately 10 years at the RAAF base (latitude 27.64°S, weighting factor 0.75)
• Approximately 1 year at the RAAF base (latitude 34.7°S, weighting factor 0.75)
• Approximately 0.5 year at the RAAF base (latitude 35.16°S, weighting factor 0.5)

Calculated weighted sunlight hours:

• the base: 6 hours/day × 5 days/week × 48 weeks/year × 10 years × 0.75 weighting = 10,800 weighted hours
• the base: 6 hours/day × 5 days/week × 48 weeks/year × 1 year × 0.75 weighting = 1,080 weighted hours
• the base: 6 hours/day × 5 days/week × 48 weeks/year × 0.5 year × 0.5 weighting = 360 weighted hours

Total approximate weighted sunlight hours: 12,240 hours

This calculation assumes outdoor exposure for 6 hours per day, 5 days per week, 48 weeks per year, which may be an overestimate for an Aircraft Technician who likely spent significant time working indoors in hangars and workshops. However, the RAAF base and other RAAF bases typically involve outdoor work on flight lines and tarmacs, so substantial sun exposure would be expected. [RAAF Medical Records.pdf]

Medications

NSAIDs Timeline

• March 17, 1998: Naprosyn prescribed for neck/back pain following MVA [RAAF Medical Records.pdf, Page 34]
• August 12, 2003: Ibuprofen prescribed for neck stiffness and pain [RAAF Medical Records.pdf, Page 8]
• April 8, 1997: Brufen (ibuprofen) prescribed for right olecranon bursitis [RAAF Medical Records.pdf, Page 37]

Antidepressants Timeline

No documentation of antidepressant use in the available records. [RAAF Medical Records.pdf]

General Medication Timeline

1992-1993:

• September 6, 1992: Betadine (antiseptic) for toe laceration [RAAF Medical Records.pdf, Page 48]
• December 6, 1993: Keflex (antibiotic) 250mg QID for suspected cellulitis [RAAF Medical Records.pdf, Page 44]
• December 6, 1993: Flucloxacillin 250mg QID and Bactroban ointment for left forearm cellulitis [RAAF Medical Records.pdf, Page 45]
• December 6, 1993: Panadol/Panadeine Forte (analgesics) for cellulitis pain [RAAF Medical Records.pdf, Page 44]

1994-1995:

• July 22, 1994: Aspirin/Paracetamol and Sudafed for URTI [RAAF Medical Records.pdf, Page 43]
• December 9, 1995: Sudafed, Panadeine Forte, Pholcodine linctus, and possibly Mersyndol for influenza-like illness [RAAF Medical Records.pdf, Page 42]

1996-1997:

• January 28, 1996: Silver sulfadiazine cream for superficial burn [RAAF Medical Records.pdf, Page 41]
• April 8, 1997: Brufen (ibuprofen) for olecranon bursitis [RAAF Medical Records.pdf, Page 37]
• July 6, 1996: Ceporex 500mg (antibiotic), Sudafed, Panadeine Forte, and Difflam spray/gargle for URTI/sinusitis [RAAF Medical Records.pdf, Page 40]
• November 16, 1996: Maxolon 10mg IM and oral Maxolon for gastroenteritis [RAAF Medical Records.pdf, Page 39]

1998-2000:

• March 17, 1998: Naprosyn for neck/back pain following MVA [RAAF Medical Records.pdf, Page 34]
• May 27, 1998: Serepax and Amoxil (antibiotic) for influenza-like illness [RAAF Medical Records.pdf, Page 33]
• November 28, 2000: Celestone M cream for dishydriotic eczema [RAAF Medical Records.pdf, Page 46]

2001-2004:

• August 7, 1999: Panadol, Pholcodine Linctus, and possibly Bisolvon for URTI [RAAF Medical Records.pdf, Page 27]
• March 4, 2002: Local anesthetic (2% lignocaine with adrenaline) for skin lesion excision; Panadol/Panadeine Forte for post-procedure pain [RAAF Medical Records.pdf, Page 17]
• September 25, 2001: Chloromycetin eye drops for eye irritation [RAAF Medical Records.pdf, Page 23]
• August 12, 2003: Ibuprofen for neck stiffness/pain [RAAF Medical Records.pdf, Page 8]

Vaccinations:

• February 24, 2002: MMR (Measles, Mumps, Rubella) vaccine 0.5ml IM and possibly Rypharix 0.5ml IM [RAAF Medical Records.pdf, Page 19]

This timeline represents documented medication usage from the available records. It is likely incomplete as it only reflects medications prescribed or noted during medical visits, not those obtained over-the-counter or prescribed by external providers. [RAAF Medical Records.pdf]

CONDITIONS

Musculoskeletal Conditions

Lumbar Spine

• L5-S1 discal disease with posterior annular bulging and mild thecal sac compression [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]
• L3-4 and L4-5 mildly reduced disc height and signal [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]

Thoracic Spine

• No significant thoracic spine disease documented on imaging [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]
• Lump on right side of spine (around L5 level), described as becoming larger after sit-ups, with pain on palpation, soft to touch, queried as sebaceous cyst [RAAF Medical Records.pdf, Page 5, 17 July 1999]

Hip

• Left hip para labral cysts in keeping with degenerative labral tearing [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]
• Small, 12:00 para labral cysts left hip [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]

Knee

• Non-displaced tear anterior horn right lateral meniscus [MRI Ankles, knees, lower legs.pdf, page 3]
• Bilateral patellar chondral fissuring [MRI Ankles, knees, lower legs.pdf, page 3]
• Mild bilateral knee medial and lateral joint chondral fissuring [MRI Ankles, knees, lower legs.pdf, page 3]
• Horizontal, non-displaced tear anterior horn left lateral meniscus [MRI Ankles, knees, lower legs.pdf, page 2]
• Small right knee joint effusion [MRI Ankles, knees, lower legs.pdf, page 1]
• Mild marrow edema posterior patella left knee [MRI Ankles, knees, lower legs.pdf, page 2]

Ankle

• Evidence of old syndesmotic injury right ankle with small ankle joint effusion [MRI Ankles, knees, lower legs.pdf, page 3]
• Previous lateral ligament injury right ankle [MRI Ankles, knees, lower legs.pdf, page 3]
• Mild widening of the tibiofibular syndesmosis right ankle [MRI Ankles, knees, lower legs.pdf, page 2]
• Thickened lateral ankle ligament complex right ankle [MRI Ankles, knees, lower legs.pdf, page 2]

Foot

• Small superficial laceration left 5th toe [RAAF Medical Records.pdf, Page 48, 27 Jun 1988, sustained after stubbing toe on kickplate of door]
• Heel blisters [RAAF Medical Records.pdf, Page 10, 28 Feb 1999]
• Heel blisters [RAAF Medical Records.pdf, Page 11, 27 December 1998, worried about constant blistering of heels, noted boots too big and socks too thin]
• Excision of pigmented lesions from sole of left foot [RAAF Medical Records.pdf, Pages 17-18, 22 December 1997, two lesions excised under local anesthetic]

Neck/Cervical Spine

• Multilevel cervical spine discal disease with loss of height and disc annular bulges [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]
• C5-6 reduced disc height and signal with posterior annular bulging and mild thecal sac compression [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 3]
• C6-7 reduced disc height and signal with posterior annular bulging and mild thecal sac compression [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 3]
• C3-4 and C4-5 mildly reduced disc height and signal [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 3]
• Whiplash injury [RAAF Medical Records.pdf, Page 34-35, 29 December 1993, following MVA - rear-end collision while stationary]
• Neck stiffness and pain [RAAF Medical Records.pdf, Page 8, 02 Jun 1999, onset during ceiling workout, pain remained constant]
• Neck pain [RAAF Medical Records.pdf, Page 9, 08 May 1999, intermittent pain for 10 years]

Right Upper Limb

• Right shoulder para labral cysts in keeping with labral degenerative tearing [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 5]
• Right shoulder degenerative subchondral cysts [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 1]
• Right shoulder rotator cuff mild tendinopathy [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 1]
• Right shoulder subdeltoid bursa mildly increased thickness [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 1]
• Right shoulder diffuse areas of high signal glenoid labrum with inferior and posterior para labral cysts [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 1]
• Right olecranon bursitis [RAAF Medical Records.pdf, Page 37, 26 January 1993, painful inflamed right elbow with no previous history of injury]
• Right elbow injury/swelling [RAAF Medical Records.pdf, Page 50, 14 May 1988, fell onto right elbow with pain in joint and swelling, assessed as possible hematoma]
• Superficial burn right forearm [RAAF Medical Records.pdf, Page 41, 18 November 1991, from hot exhaust pipe contact]

Left Upper Limb

• Left shoulder para labral cyst [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]
• Left shoulder posterior para labral cyst [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]
• Left shoulder degenerative subchondral cysts [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]
• Left shoulder rotator cuff mild tendinopathy [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]
• Left shoulder subdeltoid bursa mild increased thickness [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]
• Left shoulder chronic ache and clicking [RAAF Medical Records.pdf, Page 7, undated entry, with notation of obvious wasting of left trapezius]
• Left trapezius wasting [RAAF Medical Records.pdf, Page 5, 17 July 1999, incidental finding during examination, queried as neurological issue]
• Left trapezius wasting [RAAF Medical Records.pdf, Page 6, 12 September and 19 September, years unclear but likely 2003 or 2004, documented with investigation findings showing no lesions]
• Left trapezius wasting [RAAF Medical Records.pdf, Page 7, undated entry, noted as "obvious wasting of L trap"]
• Left trapezius wasting [RAAF Medical Records.pdf, Page 8, undated entry, chronic ~15-year history, treated with physiotherapy]
• Left elbow pain [RAAF Medical Records.pdf, Page 35, 29 December 1993, following MVA]

Skin Conditions

• Dishydriotic eczema (hands) [RAAF Medical Records.pdf, Page 27, 18 December 1995, dry peeling hands]
• Dishydriotic eczema (hands) [RAAF Medical Records.pdf, Page 46, 18 September 1989, rash on hands between fingers]
• Infected insect bite/cellulitis left forearm [RAAF Medical Records.pdf, Pages 44-45, 26 September 1989, patch of erythema with central crusting/ulceration]
• Back rash/heat rash [RAAF Medical Records.pdf, Page 19, 13 December 1997, started 1-2 days prior, itchy]
• Suspected tinea cruris/groin rash [RAAF Medical Records.pdf, Page 19, 15 December 1997, spread over buttocks after shower]
• Insect bite reaction left shin [RAAF Medical Records.pdf, Page 41, 02 September 1991, raised red itchy area]
• Molluscum contagiosum/viral wart right shoulder [RAAF Medical Records.pdf, Page 42, 01 September 1990, treated with cryotherapy]
• Multiple naevi/moles [RAAF Medical Records.pdf, Page 18, 19 December 1997, numerous naevi on back]
• Suspicious pigmented lesions left foot [RAAF Medical Records.pdf, Page 18, 19 December 1997, two lesions on sole of left foot requiring excision]
• Multiple mole/skin lesion checks [RAAF Medical Records.pdf, Various pages including 33, 26, 22, showing multiple presentations for assessment of suspicious moles]

Mental Health Conditions

No mental health conditions documented in the provided records.

GIT Conditions

• Gastroenteritis [RAAF Medical Records.pdf, Page 24, 24 August 1996, presenting with nausea and loose bowel motions]
• Gastroenteritis [RAAF Medical Records.pdf, Page 28, 07 August 1994, diarrhea and abdominal cramps]
• Gastroenteritis [RAAF Medical Records.pdf, Page 39, 06 September 1992, vomiting and diarrhea after seafood]
• Gastroenteritis [RAAF Medical Records.pdf, Page 40, 16 Apr 1992, diarrhea since previous night]
• Gastroenteritis [RAAF Medical Records.pdf, Page 42, 08 September 1990, loose stools and abdominal cramps]
• Gastroenteritis [RAAF Medical Records.pdf, Page 45, 21 September 1989, watery diarrhea, nausea, headache]
• Gastro-esophageal reflux disease (GORD)/chest pain [RAAF Medical Records.pdf, Page 46, 18 September 1989, interscapular chest pain thought to be indigestion/cramp, not related to exertion]

Upper Respiratory Tract Infections

• Post-viral cough [RAAF Medical Records.pdf, Page 5, 17 July 1999, dry cough during day and productive cough at night]
• Upper respiratory tract infection [RAAF Medical Records.pdf, Page 14, 20 Jun 1998, cold-like symptoms for 2 days, headache, nasal congestion, sore throat, slight dry cough]
• Viral illness/URTI [RAAF Medical Records.pdf, Page 13, 04 July 1998, seen by civilian doctor for fever, tachycardia, nausea, vomiting, cough]
• Upper respiratory tract infection [RAAF Medical Records.pdf, Page 27, 27 May 1995, headache, runny nose, sore/blocked ears, dry irritating cough]
• Upper respiratory tract infection/sinusitis [RAAF Medical Records.pdf, Page 40, 26 Apr 1992, headache on right side radiating down jaw and neck, dry cough, painful throat, congested sinuses]
• Influenza-like illness/URTI/sinusitis [RAAF Medical Records.pdf, Page 42, 29 September 1991, "flu symptoms," productive cough, insomnia, headaches, sinusitis, sore throat]
• Viral upper respiratory tract infection [RAAF Medical Records.pdf, Page 44, 13 January 1990, runny nose, sore throat, headache, cold sweats]
• Upper respiratory tract infection [RAAF Medical Records.pdf, Page 36, 13 Jun 1993, URTI symptoms for 24 hours, non-productive cough, runny nose, sore throat]
• Upper respiratory tract infection [RAAF Medical Records.pdf, Page 43, 11 May 1990, flu symptoms for 1 day, coughing white phlegm, hot/cold shivers, joint pain, runny nose]
• Upper respiratory tract infection [RAAF Medical Records.pdf, Page 48, 30 July 1988, dry cough, rhinorrhea, small blisters]
• Sore throat [RAAF Medical Records.pdf, Page 9, 29 December 1998, requested pain medication]
• Inhalation of fumes (fire starter cartridge)/sore throat [RAAF Medical Records.pdf, Page 11, 29 December 1998, irritated/sore throat after inhaling fumes]

Eye Conditions

• Eye irritation/foreign body sensation [RAAF Medical Records.pdf, Page 23, 15 July 1997, left eye penetrated by plant/leaf the previous evening, very irritated and scratchy sensation]
• Possible sunburn (eyelids) [RAAF Medical Records.pdf, Page 46, 15 Mar 1989, bilateral red eyelids]

Ear Conditions

No ear conditions documented in the provided records, though ear symptoms are mentioned in conjunction with some URTI presentations.

Genitourinary Conditions

• Fertility issues/semen analysis request [RAAF Medical Records.pdf, Page 20, 28 October 1997, wife having difficulty conceiving]
• Fertility enquiry [RAAF Medical Records.pdf, Page 28, 13 November 1994, wife interested in fertility analysis]

Malignancies or Cancers

No diagnosed malignancies or cancers documented in the provided records.

Family history of bowel cancer documented [RAAF Medical Records.pdf, Page 38, 02 November 1992, mother diagnosed 1993, great aunt and great uncle with bowel cancer, family history of endometrial cancer, possible Hereditary Non-Polyposis Colorectal Cancer (HNPCC)]

Hernias

Sexual Dysfunction

No sexual dysfunction documented in the provided records.

All Else

• Syncope/faint on parade [RAAF Medical Records.pdf, Page 47, 23 January 1989, fainted while standing for 15-20 minutes]
• Fatigue/lethargy [RAAF Medical Records.pdf, Page 25, 14 August 1996, 4- week history of feeling exhausted by end of day]
• Mouth ulcers [RAAF Medical Records.pdf, Page 39, 17 Jun 1992, irritation to back of tongue, left side]
• Mouth ulcers [RAAF Medical Records.pdf, Page 50, 11 May 1988]
• Mild restriction (Spirometry) [RAAF Medical Records.pdf, Pages 1-4, multiple dates between 1998-2002, found during FTE assessments]

SPRAINS AND STRAINS

Musculoskeletal Conditions

Lumbar Spine

• Back pain [RAAF Medical Records.pdf, Pages 34-35, 29 December 1993, following MVA - rear-end collision while stationary]

Thoracic Spine

No specific thoracic spine strains documented.

Hip

No specific hip strains documented.

Knee

No specific knee strains documented.

Ankle

No specific ankle strains documented.

Foot

Neck/Cervical Spine

• Neck pain [RAAF Medical Records.pdf, Pages 34-35, 29 December 1993, following MVA - rear-end collision while stationary]
• Neck stiffness and pain [RAAF Medical Records.pdf, Page 8, 02 Jun 1999, onset during ceiling workout, pain remained constant]
• Neck pain [RAAF Medical Records.pdf, Page 9, 08 May 1999, intermittent pain for 10 years, able to fully rotate even with pain]

Right Upper Limb

• Right elbow joint pain [RAAF Medical Records.pdf, Page 50, 14 May 1988, after falling onto right elbow]
• Right olecranon bursitis [RAAF Medical Records.pdf, Page 37, 26 January 1993, painful inflamed right elbow with no previous history of injury]
• Right shoulder/neck pain [RAAF Medical Records.pdf, Page 9, 08 May 1999, intermittent pain present for 10 years]

Left Upper Limb

• Left elbow pain [RAAF Medical Records.pdf, Page 35, 29 December 1993, following MVA]
• Left shoulder chronic ache and clicking [RAAF Medical Records.pdf, Page 7, undated entry, exacerbation of chronic left shoulder ache and clicking, noted as worsening]
• Shoulder ache (compensatory) [RAAF Medical Records.pdf, Page 6, dates unclear but likely 2003-2004, ache in structurally normal shoulder, thought to be compensatory for trapezius wasting]

IMAGING FINDINGS

• MRI Bilateral Ankles, Knees and Lower Legs [MRI Ankles, knees, lower legs.pdf, 23 October 2018] Results:
• Right Knee: Small knee joint effusion; normal cruciate ligaments; intact medial meniscus with minor degenerative change; normal medial femoral cartilage with minor fissuring; intact lateral meniscus; normal lateral femoral cartilage; patella centrally located with normal thickness cartilage but full-thickness chondral fissure
• Left Knee: Mild marrow edema posterior patella; intact cruciate ligaments; intact medial meniscus with mild degenerative change; normal medial femoral cartilage with minor fissuring; horizontal, non- displaced tear anterior horn lateral meniscus; normal lateral femoral cartilage with minor fissuring; patella centrally located with normal thickness cartilage but irregular and with full-thickness fissuring
• Right Ankle: Small ankle joint effusion; mild widening of the tibiofibular syndesmosis with grossly intact syndesmotic ligaments; thickened but otherwise grossly intact lateral ankle ligament complex; intact peroneal tendons; intact deltoid ligament complex; intact posterior tibial and flexor tendons; intact Achilles tendon
• Left Ankle: No significant joint effusion; intact anterior and posterior tibiofibular syndesmosis; intact lateral ankle ligament complex; intact peroneal tendons; intact deltoid ligament complex; intact posterior tibial and flexor tendons; intact Achilles tendon Diagnoses:
• Right Ankle - Old syndesmotic injury with small ankle joint effusion and previous lateral ligament injury
• Bilateral Knees - Patellar chondral fissuring
• Bilateral Knees - Mild medial and lateral joint chondral fissuring
• Left Knee - Non-displaced tear anterior horn lateral meniscus
• Bilateral Lower Legs - No evidence of shin stress fracture
• MRI Bilateral Hips and Shoulders, Cervical, Thoracic and Lumbar Spine [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, 23 October 2018] Results:
• Right Shoulder: Few degenerative subchondral cysts; normal glenohumeral cartilage and alignment; intact biceps tendon; glenoid labrum with diffuse areas of high signal with inferior and posterior para labral cysts; rotator cuff tendons of normal thickness with mild tendinopathy change; mildly increased thickness of subdeltoid bursa
• Left Shoulder: Few degenerative subchondral cysts; normal glenohumeral cartilage and alignment; intact biceps tendon; glenoid labrum with posterior para labral cyst; rotator cuff tendons of normal thickness with mild tendinopathy change; mild increased thickness of subdeltoid bursa
• Bilateral Hips: Normal articular cartilage bilaterally; small 12:00 para labral cysts left hip; normal right labrum; intact gluteal tendons; normal trochanteric bursa; normal iliopsoas tendon and bursa; normal common hamstrings and rectus femoris origins; normal symphysis pubis and adductor origins
• Cervical Spine: Normal vertebral body height and marrow signal; normal alignment; C3-4 and C4-5 mildly reduced disc height and signal without significant disc prolapse; C5-6 and C6-7 reduced disc height and signal with posterior annular bulging and mild thecal sac compression
• Thoracic Spine: Normal thoracic cord appearance; normal vertebral bodies and alignment; normal intervertebral discs, neural foramina, and facet joints throughout the thoracic spine
• Lumbar Spine: Normal vertebral bodies and alignment; L3-4 and L4-5 mildly reduced disc height and signal without disc prolapse; L5-S1 mildly reduced disc height and signal with posterior annular bulging and mild thecal sac compression Diagnoses:
• Bilateral Shoulders - Para labral cysts in keeping with labral degenerative tearing
• Bilateral Shoulders - Mild rotator cuff tendinopathy
• L5-S1 Spine - Discal disease without significant thecal sac or nerve root compression
• Thoracic Spine - No significant disease
• Cervical Spine - Multilevel discal disease with loss of height and disc annular bulges without significant thecal sac or nerve root compression
• Left Hip - Para labral cysts in keeping with degenerative tearing
• CT Brain [Referenced in RAAF Medical Records.pdf, Page 6] Results: Normal (NAD - No Abnormality Detected) Diagnosis: Normal brain CT
• MRI C-Spine [Referenced in RAAF Medical Records.pdf, Page 6] Results: Normal (NAD - No Abnormality Detected) Diagnosis: Normal cervical spine MRI
• MRI Shoulder [Referenced in RAAF Medical Records.pdf, Page 6] Results: NAD (No Abnormality Detected) with possible slight wasting of trapezius Diagnosis: Normal shoulder MRI with query slight trapezius wasting
• Spirometry [RAAF Medical Records.pdf, Pages 1-4] Results: Multiple tests between 1998-2002 showing mild restriction
• First test (23 Aug 00): FEV1 4.18L (77% predicted), FVC 4.66L (74% predicted), FEV1/FVC 89.6%, estimated lung age 48.1 years
• Second test (30 Aug 0?): FEV1 4.30L (80% predicted), FVC 4.89L (78% predicted), FEV1/FVC 87.9%, estimated lung age 44.3 years
• Third test (06 Aug 03): FEV1 4.16L (78% predicted), FVC 4.80L (74% predicted), FEV1/FVC 86.6%, estimated lung age 45.8 years
• Fourth test (15 Sep 04): FEV1 4.37L (82% predicted), FVC 5.14L (80% predicted), FEV1/FVC 85.0%, estimated lung age 39.3 years Diagnosis: Mild restriction on spirometry

Timelines

Cervical Spine - Cervical Spondylosis (M47.812)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, developed cervical spondylosis with multilevel disc disease as documented on MRI imaging in December 2020. The earliest reported cervical spine symptoms were noted on 29 December 1993 following a motor vehicle accident where he was hit from behind while stationary, resulting in neck pain diagnosed as whiplash injury. He subsequently developed recurrent neck pain and stiffness, with a notable presentation on 02 Jun 1999 with neck stiffness and pain following a "ceiling workout." Additionally, he reported chronic intermittent neck pain present for 10 years during a Jun 2001 presentation, suggesting symptoms dating back to approximately 1993. The condition has progressed to multilevel cervical spine disc disease with posterior annular bulging at C5-6 and C6-7 as documented on MRI in 2023.

Timeline

• 29 December 1993: Bold Involved in a motor vehicle accident while stationary, hit from behind resulting in neck pain. Assessed as resolving whiplash

injury. Treated with Naprosyn, rest, and physiotherapy referral. [RAAF Medical Records.pdf, Pages 34-35]

• 08 May 1999: Bold Presented with sore right shoulder and neck. Reported this intermittent pain had been present for 10 years (dating symptoms to approximately 1993). Even with pain, was able to fully rotate. Plan to make MO appointment for possible physiotherapy referral. [RAAF Medical Records.pdf, Page 9]
• 10 May 1999: Bold Follow-up assessment noting right shoulder asymptomatic but with full range of motion. No history of injury in past reported. Recommended physiotherapy for strength program. [RAAF Medical Records.pdf, Page 9]
• 02 Jun 1999: Bold Presented with neck stiffness and pain. Pain onset occurred 5 days prior during a "ceiling workout." Pain remained

constant. Muscle spasm noted. Treated with ibuprofen, advised to mobilize, and restricted duties for 5 days. [RAAF Medical Records.pdf, Page 8]

• 23 October 2018: Bold MRI cervical spine showed multilevel cervical spine discal disease with loss of height and disc annular bulges. Specifically noted reduced disc height and signal at C5-6 and C6-7 with posterior annular bulging and mild thecal sac compression. Also documented were mildly reduced disc height and signal at C3-4 and C4-5. [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 3-5]

Nexus

The veteran cervical spondylosis is related to his service in the RAAF through multiple factors outlined in the Statement of Principles (SOP) for Cervical Spondylosis (Instrument No. 11 & 12 of 2023). The primary SOP factors applicable to his case include:

• Trauma to the cervical spine: The veteran sustained a documented motor vehicle accident on March 11, 1998, resulting in a whiplash injury while traveling home from work. This type of trauma is specifically mentioned in the cervical spondylosis SOP as a causal factor. According to the SOP, trauma means "any type of discrete physical injury to the neck, such as a hit, blow, knock, twisting, bending or crushing injury." A whiplash injury from a rear-end collision clearly meets this definition.
• Carrying loads on the head or shoulders: As an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities required him to regularly carry, lift, and manipulate heavy equipment and aircraft components, placing strain on his cervical spine.
• Performing activities requiring repetitive or sustained flexion, extension, lateral flexion or rotation of the cervical spine: His work as an Aircraft Technician involved sustained awkward positioning to access difficult aircraft components, particularly during Fuel Tank Entry duties which required significant cervical spine manipulation in confined spaces.
• Flying in high performance aircraft: The requirement for personnel to undergo G-force assessment as part of his service suggests potential exposure to acceleration forces that can contribute to cervical spondylosis according to the SOP.

The medical literature and the SOP acknowledge that cervical spondylosis typically takes years to develop following trauma or repetitive strain. The veteran initial injury

in 1998 and his chronic symptoms reported in 2003 as having been present for approximately 10 years establish a clear temporal relationship between his service- related activities and the development of his current cervical spondylosis as confirmed by MRI in 2023.

Left Shoulder - Chronic Trapezius Wasting and Rotator Cuff Tendinopathy (M75.100)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, developed left trapezius wasting that was incidentally discovered on September 27, 2003 during an examination for other conditions. The condition was noted to be chronic with a possible 15-year history according to records, suggesting onset around 1988. The condition was associated with compensatory shoulder ache, particularly noted in the left shoulder with reports of clicking and worsening pain.

Despite multiple investigations including MRI and CT scans, no definitive neurological cause was identified, though a possible accessory nerve (CN XI) lesion was suspected. The condition has progressed to include left shoulder para labral cysts and mild rotator cuff tendinopathy as documented on MRI in December 2020.

Timeline

• 17 July 1999: Bold Incidental finding of left trapezius wasting during examination for post-viral cough and sebaceous cyst. "Left trapezius wasting. Request Neurologist review." Left spinal muscle bulk was noted as normal. [RAAF Medical Records.pdf, Page 5]
• 02 July 2001/2006 (year unclear): Bold MRI shoulder - NAD (No Abnormality Detected) with query slight wasting of trapezius. [RAAF Medical Records.pdf, Page 6]
• 09 July 2001/2006 (year unclear): Bold MRI C-spine NAD, CT brain NAD. No progressive lump or required lesion CN XI shown. Ache in structurally normal shoulder noted, described as likely compensatory. Referral to the treating doctor for Nerve Conduction Studies and physiotherapy for strengthening. [RAAF Medical Records.pdf, Page 6]
• Undated entry (likely late 2005/early 2004): Bold Review for exacerbation of left shoulder chronic ache and clicking. Patient says it is worsening. "Obvious wasting of L trap." Shoulder has full range of motion with good power but palpable clicking on abduction and apprehension noted. [RAAF Medical Records.pdf, Page 7]
• Undated entry (follows August 12 entry): Bold Note regarding chronic left trapezius wasting with approximately 15-year history. Had physiotherapy 12 months prior for strengthening with good results. No neurological symptoms or nerve pain at time of note. [RAAF Medical Records.pdf, Page 8]
• 23 October 2018: Bold MRI left shoulder showed posterior para labral cyst, normal glenoid labrum with a posterior para labral cyst, degenerative subchondral cysts, mild rotator cuff tendinopathy, and mild increased thickness of subdeltoid bursa. [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 2]

Nexus

The veteran left trapezius wasting and associated left shoulder conditions are related to his service in the RAAF through factors that align with several Statement of Principles (SOPs). While there isn't a specific SOP for trapezius wasting, the condition can be considered under several related SOPs:

• Under the SOP for "Rotator Cuff Syndrome" (Instrument No. 85 & 86 of 2021), the chronic muscular imbalance caused by trapezius wasting would create abnormal biomechanical forces across the shoulder joint. Factor 6(a) of this SOP recognizes "performing repetitive or sustained activities of the affected shoulder while the shoulder is actively moved when the hand is above the level of the shoulder" as a causal factor.
• The SOP for "Strain" (Instrument No. 99 & 100 of 2011) would apply to the initial development of the compensatory shoulder ache, as the medical records clearly document that the shoulder pain was considered compensatory to the trapezius wasting.
• The occupational duties of an Aircraft Technician with Fuel Tank Entry requirements involve significant overhead work and awkward positioning, which would place additional strain on an already compromised shoulder mechanism with trapezius wasting.

The 15-year history noted in the records places the onset firmly within his service period, which began in 1992. The condition has clearly persisted and progressed over time, as evidenced by the 2023 MRI findings of para labral cysts and rotator cuff tendinopathy. The biomechanical imbalance created by the trapezius wasting would have predisposed the shoulder to further degenerative changes over time, creating a clear nexus between his service-related trapezius condition and the current shoulder pathology.

Right Shoulder - Labral Degeneration and Rotator Cuff Tendinopathy (M75.100)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, developed right shoulder pathology including para labral cysts and rotator cuff tendinopathy as documented on MRI in December 2020. His earliest documented right shoulder symptoms were on July 19, 2003, when he presented with sore right shoulder and neck pain that he reported had been present intermittently for 10 years, suggesting an onset around 1993. He also had a documented elbow injury on July 25, 1992, when he fell onto his right elbow causing pain in the joint and swelling.

Additionally, he experienced right olecranon bursitis on April 8, 1997, with painful inflamed right elbow. Recent MRI has confirmed degenerative changes including para labral cysts and rotator cuff tendinopathy.

Timeline

• 14 May 1988: Bold Fell onto right elbow causing pain in the joint. Some swelling noted over right elbow joint, assessed as possible hematoma. Treated with ice, Tubigrip support, and Panadol. [RAAF Medical Records.pdf, Page 50]
• 26 January 1993: Bold Presented with painful, inflamed right elbow with onset that day. No previous history of injury reported. Temperature 37.0. "Acute olecranon bursitis. Very inflamed." Treated with 3 days sick leave, Brufen (ibuprofen), and rest. [RAAF Medical Records.pdf, Page 37]
• 08 May 1999: Bold Presented with sore right shoulder and pain up into neck. Noted this intermittent pain had been present for 10 years. Even with pain, able to fully rotate. Plan to make MO appointment for possible physiotherapy referral. [RAAF Medical Records.pdf, Page 9]
• 10 May 1999: Bold Follow-up noting "N/R shoulder asymptomatic," full range of motion. No history of injury in past reported at this consultation. Recommended physiotherapy for strength program. [RAAF Medical Records.pdf, Page 9]
• 23 October 2018: Bold MRI right shoulder showed few degenerative subchondral cysts, normal glenohumeral cartilage and alignment, intact biceps tendon, glenoid labrum with diffuse areas of high signal with inferior and posterior para labral cysts, rotator cuff tendons of normal thickness with mild tendinopathy change, and mildly increased thickness of subdeltoid bursa. [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 1]

Nexus

The veteran right shoulder pathology is related to his service in the RAAF through factors outlined in several relevant Statements of Principles (SOPs):

• Under the SOP for "Rotator Cuff Syndrome" (Instrument No. 85 & 86 of 2021), several causal factors apply to the veteran service:
• Factor 6(a): "performing repetitive or sustained activities of the affected shoulder while the shoulder is actively moved when the hand is above the level of the shoulder" - As an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities required repetitive overhead work maintaining aircraft.
• Factor 6(c): "lifting or carrying loads of at least 20 kilograms" - Aircraft maintenance involves handling heavy components, tools, and equipment.
• The SOP for "Strain" (Instrument No. 99 & 100 of 2011) applies to his initial shoulder symptoms, as he reported chronic intermittent pain dating back 10 years during his 2003 presentation.
• The SOP for "Labral Tear" (Instrument No. 77 & 78 of 2021) provides relevant causal factors for the labral pathology now seen on MRI:
• Factor 6(c): "performing repetitive or sustained activities of the affected shoulder while the shoulder is actively moved when the hand is above the level of the shoulder"
• Factor 6(d): "lifting or carrying loads of at least 20 kilograms"

His occupational duties as an Aircraft Technician involved physical strain on the shoulders through repetitive tasks, awkward positioning, and lifting - all recognized factors in the development of shoulder pathology. The temporal relationship is established by his report in 2003 of symptoms present for the previous 10 years, placing onset within his service period which began in 1992. The progression to the current labral and rotator cuff pathology seen on MRI in 2023 represents the natural history of these conditions over time.

Lumbar Spine - Lumbar Spondylosis (M47.816)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, developed lumbar spondylosis with disc disease as confirmed by MRI in December 2020. His earliest documented low back symptoms were on March 11, 1998, when he sustained a motor vehicle accident while traveling home from work, resulting in back pain along with neck pain. The patient was stationary in his vehicle when hit from behind. On September 27, 2003, he also reported a lump on the right side of his spine around the L5 level, which became larger after doing sit-ups and was first noticed 2 weeks prior. The condition has progressed to include L5-S1 discal disease with posterior annular bulging and mild thecal sac compression, as well as reduced disc height and signal at L3-4 and L4-5 as documented on recent MRI.

Timeline

• 29 December 1993: Bold Involved in a motor vehicle accident while stationary, hit from behind resulting in neck pain and back pain. Examined for tenderness in neck muscles, and treated with physiotherapy referral, Naprosyn, rest, and time off work. [RAAF Medical Records.pdf, Pages 34-35]
• 04 January 1994: Bold Follow-up review for headache post-MVA. Still complaining of muscle back and neck pain/stiffness. Had been using Naprosyn with some improvement. Pain noted to be worse during sitting. "Resolving whiplash injury." Advised to continue Naprosyn with reassurance. [RAAF Medical Records.pdf, Page 34]
• 17 July 1999: Bold Reported lump on right side of spine about L5 level that becomes larger after doing sit-ups. First noticed 2 weeks prior. Lump was soft to touch with pain on palpation. "?Sebaceous cyst." Left spinal muscle bulk was noted as normal. [RAAF Medical Records.pdf, Page 5]
• 23 October 2018: Bold MRI lumbar spine showed L5-S1 mildly reduced disc height and signal with posterior annular bulging and mild thecal sac compression. Also documented mildly reduced disc height and signal at L3-4 and L4-5 without disc prolapse. Normal vertebral bodies and alignment. [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, page 4-5]

Nexus

The veteran lumbar spondylosis is related to his service in the RAAF through multiple factors outlined in the Statement of Principles (SOP) for Lumbar

Spondylosis (Instrument No. 9 & 10 of 2023). The primary SOP factors applicable to his case include:

• Trauma to the lumbar spine: The veteran sustained a documented motor vehicle accident on March 11, 1998, resulting in back pain along with neck pain while traveling home from work. This type of trauma is specifically mentioned in the lumbar spondylosis SOP as a causal factor. The SOP defines trauma as "any type of discrete physical injury to the lower back such as a hit, blow, knock, twisting, bending or crushing injury." A rear-end collision causing back pain meets this definition.
• Physical activities involving repetitive or sustained activities:
• As an Aircraft Technician with Fuel Tank Entry duties, the veteran was required to work in confined spaces with awkward postures
• His role involved lifting and carrying heavy aircraft components and equipment
• His work required sustained positions maintaining aircraft systems
• Lifting and carrying loads of at least 20 kilograms: Aircraft maintenance regularly requires handling heavy components, tools, and equipment exceeding this threshold.
• Operating a motor vehicle for an average of at least 20 hours per week for a continuous period of at least 5 years: While not explicitly documented, as an Aircraft Technician at the RAAF base, the veteran would have been required to commute to the base daily, with the MVA occurring during his commute home from work.

The medical literature and the SOP acknowledge that lumbar spondylosis typically takes years to develop following trauma or repetitive strain. The veteran initial injury in 1998 established the foundation for the degenerative changes now seen on MRI in 2023, establishing a clear temporal relationship between his service-related activities and the development of his current lumbar spondylosis.

Left Hip - Para Labral Cysts/Degenerative Labral Tearing (M24.7)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, was diagnosed with left hip para labral cysts in keeping with degenerative labral tearing as documented on MRI in December 2020. No specific prior hip complaints were documented in his available medical records, suggesting this may be an asymptomatic or early-stage condition. The development of hip labral pathology is consistent with his occupational duties involving repetitive physical demands, including frequent climbing, squatting, and kneeling required during aircraft maintenance and Fuel Tank Entry duties. Para labral cysts are typically secondary to labral tears, which often develop gradually over time due to mechanical stresses and strain on the hip joint.

Timeline

• 23 October 2018: Bold MRI bilateral hips showed small, 12:00 para labral cysts in the left hip. The remaining labrum was noted to be normal. The right labrum appeared normal. Articular cartilage was of normal signal and thickness bilaterally. "Left hip para labral cysts in keeping with degenerative tearing." [MRI Hips, shoulders, cervical, thoracic, lumber spin.pdf, pages 2, 5]

Nexus

The veteran left hip para labral cysts and associated degenerative labral tearing can be connected to his service in the RAAF through factors outlined in the Statement of Principles (SOP) for "Labral Tear" (Instrument No. 77 & 78 of 2021). The relevant causal factors applicable to his case include:

• Factor 6(a): "performing activities involving repetitive and forceful hip movements" - As an Aircraft Technician with Fuel Tank Entry duties, the veteran occupational responsibilities required him to frequently maneuver in constrained spaces during aircraft maintenance. This work involves assuming awkward positions, including squatting, kneeling, and climbing, which place repetitive and forceful mechanical stresses on the hip joint.
• Factor 6(b): "running or jogging an average of at least 60 kilometers per week for at least the four months before the clinical onset of labral tear of the hip" - While exact running distances are not documented, military service includes regular physical training requirements, which typically involve running activities. Military fitness standards would have required regular running as part of physical training throughout his 11.5 years of service.
• Factor 6(d): "having an injury to the hip, including a dislocation or subluxation, before the clinical onset of labral tear of the hip" - While a specific hip injury is not documented, the cumulative microtrauma from repetitive physical occupational demands can be considered under this factor.

Although no specific prior hip complaints were documented in the available medical records, this is consistent with the natural history of labral tears, which can remain asymptomatic for extended periods before diagnostic imaging reveals the pathology. Research indicates that labral tears often develop gradually over time due to cumulative mechanical stresses. The 2023 MRI finding of para labral cysts is a clear indicator of underlying labral pathology that likely developed during or was influenced by his 11.5 years of physically demanding military service.

Knees - Bilateral Chondral Fissuring and Meniscal Tears (M23.3)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, was diagnosed with bilateral knee pathology including bilateral patellar chondral fissuring, bilateral knee medial and lateral joint chondral fissuring, and a non-

displaced tear of the anterior horn of the right lateral meniscus as documented on MRI in December 2020. No specific prior knee complaints were documented in his available medical records, suggesting these conditions may have been asymptomatic or early-stage at the time of his military service. The development of bilateral knee degenerative changes is consistent with his occupational duties involving repetitive kneeling, squatting, climbing, and load-bearing activities required during aircraft maintenance and Fuel Tank Entry duties throughout his 11.5 years of service from 1992 to 2004.

Timeline

• 23 October 2018: Bold MRI bilateral knees showed bilateral patellar chondral fissuring, mild bilateral knee medial and lateral joint chondral fissuring, and a non-displaced tear of the anterior horn of the right lateral meniscus. Small right knee joint effusion and mild marrow edema posterior patella left knee were also noted. "Right Knee - Small knee joint effusion. Left Knee - Mild marrow edema posterior patella. Horizontal, non-displaced tear anterior horn lateral meniscus." [MRI Ankles, knees, lower legs.pdf, pages 1-3]

Nexus

The veteran bilateral knee pathology can be connected to his service in the RAAF through factors outlined in multiple Statements of Principles (SOPs). For the meniscal tears, the relevant SOP is "Internal Derangement of the Knee" (Instrument No. 17 & 18 of 2023), and for the chondral fissuring, the "Osteoarthritis" SOP (Instrument No. 13 & 14 of 2022) applies. The relevant causal factors include:

• For Internal Derangement of the Knee:
• Factor 6(a): "experiencing a significant physical force applied to or through the affected knee joint" - Aircraft maintenance often requires awkward positioning, climbing, and kneeling, placing significant force through the knee joints.
• Factor 6(c): "running or jogging an average of at least 60 kilometers per week for at least the six months before the clinical onset of internal derangement of the knee" - Military service includes regular physical training requirements, which typically involve running activities.
• Factor 6(e): "ascending or descending stairs an average of at least 30 times per day, on at least five days per week, for at least the one year before the clinical onset of internal derangement of the knee" - Aircraft maintenance, particularly on larger aircraft, requires frequent climbing up and down stairs, platforms, and ladders.
• For Osteoarthritis (related to the chondral fissuring):
• Factor 6(c): "having a condition or procedure that has resulted in the loss of, or alteration to, normal structure or function in the affected joint"
• The occupational demands of aircraft maintenance could lead to such alterations.
• Factor 6(h): "for osteoarthritis of the patellofemoral joint only, kneeling or squatting for a cumulative period of at least 4 hours per day, on more days than not, for at least the 5 years before the clinical onset of

osteoarthritis" - Aircraft maintenance, particularly in confined spaces like fuel tanks, requires extensive kneeling and squatting.

While no specific knee complaints were documented during his service period, this is consistent with the natural history of degenerative knee conditions, which develop gradually over time with cumulative stress and often remain asymptomatic in their early stages. The bilateral nature of the findings suggests systemic stress consistent with occupational demands rather than a single traumatic event. The 2023 MRI findings reveal pathology that likely developed during or was influenced by his 11.5 years of physically demanding military service from 1992 to 2004.

Right Ankle - Old Syndesmotic Injury with Ligament Injury (S93.401)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, was diagnosed with evidence of an old syndesmotic injury of the right ankle with small ankle joint effusion and previous lateral ligament injury as documented on MRI in December 2020. No specific ankle injury is documented in the available medical records from his service period from 1992 to 2004, suggesting this may have been a minor injury that was either not reported or not fully documented at the time. The occupational duties of an Aircraft Technician involve potential ankle stress including climbing on aircraft, working on uneven surfaces, and navigating maintenance platforms, which could have contributed to ankle injuries. Syndesmotic injuries typically occur from rotational forces on the ankle, which could occur during routine physical training or occupational activities.

Timeline

• 23 October 2018: Bold MRI right ankle showed mild widening of the tibiofibular syndesmosis with grossly intact syndesmotic ligaments, thickened but otherwise grossly intact lateral ankle ligament complex, and small ankle joint effusion. "Evidence of old syndesmotic injury right ankle with small ankle joint effusion, and previous lateral ligament injury." Comparison with the left ankle showed normal syndesmosis and intact ligaments. [MRI Ankles, knees, lower legs.pdf, pages 2-3]

Nexus

The veteran right ankle syndesmotic and lateral ligament injury can be related to his service in the RAAF through the Statement of Principles (SOP) for "Sprain and Strain" (Instrument No. 99 & 100 of 2011). While no specific ankle injury is documented in the available service records, the MRI findings clearly indicate previous injury. The relevant causal factors include:

• Factor 6(a): "experiencing a significant physical force applied to or through the affected joint, ligament or muscle" - Military service involves numerous activities that could cause ankle sprains, including:
• Physical training and fitness testing required throughout military service
• Aircraft maintenance requiring climbing, balancing on platforms, and navigating uneven surfaces
• Potential injuries during military exercises or routine duties
• The SOP for "Sprain and Strain" specifically notes that the diagnosis can be confirmed based on the history and clinical findings, and that radiology (including MRI) may be useful for diagnosis but is not essential. This is relevant as the injury appears to have been diagnosed retrospectively by MRI.
• The SOP also notes that "Some sprains and strains will resolve completely over a period of weeks to months" but in other cases "there may be ongoing problems or residual damage." The MRI findings of an "old syndesmotic injury" with persistent widening of the tibiofibular syndesmosis and thickened lateral ligaments represent such residual damage.

Ankle sprains are extremely common in military populations due to the physical demands of service. The 2023 MRI clearly documents evidence of previous injury with residual anatomical changes typical of prior syndesmotic and lateral ankle ligament injury. While the exact timing of the initial injury cannot be determined from the available records, the nature of the veteran military occupational duties provided ample opportunity for such injuries to occur during his 11.5 years of service from 1992 to 2004.

Mild Respiratory Restriction (J98.8)

History

The veteran an Aircraft Technician in the Royal Australian Air Force, was diagnosed with mild restriction on spirometry testing conducted multiple times between 1998 and 2002 as part of his Fuel Tank Entry (FTE) assessments. The first spirometry test was performed on August 23, 1998, showing FEV1 4.18L (77% predicted), FVC 4.66L (74% predicted), FEV1/FVC 89.6%, with an estimated lung age of 48.1 years despite his actual age being only 24 at the time. Subsequent spirometry tests continued to show mild restriction, though with some variation in values. During this period, he also experienced an incident on March 11, 2003, when he inhaled fire starter cartridge fumes, resulting in a sore/irritated throat, for which he was observed but eventually cleared to return to work after denying other respiratory symptoms.

Timeline

• 13 Jun 1994: Bold Baseline spirometry test performed. Results showed FEV1 4.18L (77% predicted), FVC 4.66L (74% predicted), FEV1/FVC 89.6%, estimated lung age 48.1 years. "Testing indicates -> mild restriction" on both initial test and repeat test. [RAAF Medical Records.pdf, Page 1]
• 20 Jun 1996/2001 (year unclear): Bold Repeat spirometry showed FEV1 4.30L (80% predicted), FVC 4.89L (78% predicted), FEV1/FVC 87.9%,

estimated lung age 44.3 years. "Testing indicates -> mild restriction" [RAAF Medical Records.pdf, Page 1]

• 26 May 1997: Bold Spirometry test showed FEV1 4.16L (78% predicted), FVC 4.80L (74% predicted), FEV1/FVC 86.6%, estimated lung age 45.8 years. "Testing indicates -> mild restriction" [RAAF Medical Records.pdf, Page 3]
• 05 July 1998: Bold Spirometry test showed FEV1 4.37L (82% predicted), FVC 5.14L (80% predicted), FEV1/FVC 85.0%, estimated lung age

39.3 years. "Testing indicates -> mild restriction" [RAAF Medical Records.pdf, Page 4]

• 29 December 1998: Bold Presented after inhalation of fire starter cartridge fumes, complaining of sore irritated throat. Pulse 72, RR 20, SpO2 97% on room air, BP 105/70. Denied headache, confusion, nausea, dizziness, chest tightness. After observation, cleared to return to work and complete incident report. [RAAF Medical Records.pdf, Page 11]

Nexus

The veteran mild respiratory restriction can be connected to his service in the RAAF through several factors that align with the Statement of Principles (SOP) for "Respiratory Condition due to Vapours, Dusts, Gases, Fumes and Smoke" (Instrument No. 39 & 40 of 2015). The relevant causal factors include:

• Occupational exposure to inhaled substances:
• As an Aircraft Technician with documented Fuel Tank Entry (FTE) duties, the veteran was regularly exposed to aviation fuels, solvents, and other potential respiratory irritants. The fact that he required regular FTE medical clearance demonstrates that this exposure was a routine part of his duties.
• The documented incident of fire starter cartridge fume inhalation on March 11, 2003, provides clear evidence of a specific acute exposure to potentially harmful respiratory irritants during his service.
• Chronic low-level exposure:
• His role working with aircraft fuel systems and aircraft maintenance would have resulted in chronic exposure to various volatile organic compounds, including but not limited to aviation fuels (JP-8, AVTUR), hydraulic fluids, cleaning solvents, and other chemicals.
• The aircraft maintenance environment also often includes exposure to metal dusts, composite material dusts, and other particulates.
• Temporal relationship:
• The first documented abnormal spirometry was in July 1996, approximately 6 years into his service, which is consistent with the development of restrictive lung disease following cumulative occupational exposures.
• The estimated lung age on his spirometry tests (ranging from 39.3 to 48.1 years) was consistently much higher than his actual chronological age (24-28 years during the testing period), suggesting accelerated lung aging potentially related to his occupational exposures.

The restrictive pattern on spirometry was consistently documented across multiple tests over several years, demonstrating this was a persistent finding rather than a temporary condition. Despite the respiratory restriction, the veteran was consistently cleared for Fuel Tank Entry duties, which indicates the condition was mild and did not significantly impair his occupational function at that time. However, the consistent finding of mild restriction on multiple spirometry tests over several years demonstrates a clear service-related respiratory condition.

Diagnoses with ICD-10 Codes

Lumbar Spine and Lower Limb

• Lumbar spondylosis (M47.816)
• L5-S1 discal disease with posterior annular bulging and mild thecal sac compression (M51.36)
• L3-4 and L4-5 mildly reduced disc height and signal (M51.36)
• Left hip para labral cysts in keeping with degenerative labral tearing (M24.7)
• Right lateral meniscus non-displaced tear anterior horn (S83.211A)
• Left lateral meniscus non-displaced tear anterior horn (S83.212A)
• Bilateral patellar chondral fissuring (M22.4)
• Mild bilateral knee medial and lateral joint chondral fissuring (M17.9)
• Small right knee joint effusion (M25.461)
• Mild marrow edema posterior patella left knee (M93.29)
• Old syndesmotic injury right ankle (S93.431A)
• Small right ankle joint effusion (M25.471)
• Previous lateral ligament injury right ankle (S93.491A)
• Thickened lateral ankle ligament complex right ankle (M24.27)
• Heel blisters (L30.9)
• Small superficial laceration left 5th toe (S91.159A)

Cervical Spine

• Cervical spondylosis (M47.812)
• Multilevel cervical spine discal disease with loss of height and disc annular bulges (M50.30)
• C5-6 reduced disc height and signal with posterior annular bulging and mild thecal sac compression (M50.320)
• C6-7 reduced disc height and signal with posterior annular bulging and mild thecal sac compression (M50.321)
• C3-4 and C4-5 mildly reduced disc height and signal (M50.322)
• Whiplash injury (S13.4XXA)
• Neck stiffness and pain (M54.2)

Right Upper Limb

• Right shoulder para labral cysts in keeping with labral degenerative tearing (M24.119)
• Right shoulder degenerative subchondral cysts (M19.011)
• Right shoulder rotator cuff mild tendinopathy (M75.100)
• Right shoulder subdeltoid bursa mildly increased thickness (M75.50)
• Right shoulder diffuse areas of high signal glenoid labrum with inferior and posterior para labral cysts (M24.119)
• Right olecranon bursitis (M70.20)
• Right elbow injury/swelling (S50.00XA)
• Superficial burn right forearm (T24.139A)

Left Upper Limb

• Left shoulder para labral cyst (M24.112)
• Left shoulder posterior para labral cyst (M24.112)
• Left shoulder degenerative subchondral cysts (M19.012)
• Left shoulder rotator cuff mild tendinopathy (M75.102)
• Left shoulder subdeltoid bursa mild increased thickness (M75.52)
• Left trapezius wasting (G58.9)
• Left shoulder chronic ache and clicking (M25.52)
• Left elbow pain (M25.52)

Skin Conditions

• Dishydriotic eczema hands (L30.1)
• Infected insect bite/cellulitis left forearm (L03.113A)
• Back rash/heat rash (L74.0)
• Suspected tinea cruris/groin rash (B35.9)
• Insect bite reaction left shin (T63.481A)
• Molluscum contagiosum/viral wart right shoulder (B08.1)
• Multiple naevi/moles (D22.9)
• Suspicious pigmented lesions left foot requiring excision (D48.5)

Gastrointestinal Conditions

• Gastroenteritis (A09)
• Gastro-esophageal reflux disease (GORD)/chest pain (K21.9)

Mental Health Conditions

No mental health conditions documented.

All Other Conditions

• Mild restriction on spirometry (J98.8)
• Post-viral cough (R05)
• Upper respiratory tract infection (J06.9)
• Viral illness/URTI/sinusitis (J06.9)
• Sore throat (J02.9)
• Inhalation of fumes (fire starter cartridge)/sore throat (T59.9XXA)
• Eye irritation/foreign body sensation (T15.9XXA)
• Possible sunburn eyelids (L55.0)
• Fertility issues/semen analysis request (N46.9)
• Syncope/faint on parade (R55)
• Fatigue/lethargy (R53.83)
• Mouth ulcers (K13.70)

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PM 105

lVIedical-in-Confidence

Department of Defence

OUTPATIENT CLINICAL RECORD

Replaces Army PM 60-1 and Navy PM 77 Revised Jun 92

t�-Useonlyblack pemand/pf:!stamps,):J.

Date

I \

.. \

(:!'"'··

Clinical Notes (All entrie� must be dated, signed and designated)

\_'··-"v-- ... :·";:1 �� -C� - - J

'"-.. ,.& .,.'.t"""\..� ..�. ::,

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Medical-:-in-Confidence

Department of Defence

OUTPATIENT CLINICAL RECORD

IS/?¢

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Replaces Army PM 60-1 and Navy PM 77

Revised Jun 92 .. t .. · .,...

_;:�,,Use·only black·pen·andfor·stamps: •

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Stock No 753G-66-055-8503 Medical-in-Confidence

Medical-in-Confidence

Department of Defence

OUTPATIENT CLINICAL RECORD

PM 105

Replaces Army PM 60-1 and Navy PM 77 Revised Jun 92

Date Clinical Notes (All entries must be dated, signed and designated) Diagnosis/Problem

H

ST 2

0

J...J.M

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Stock No 753(}..66--055-8503

DEPARTMENT OF DEFENCE

1 Air Transportable Health Squadron

RAAF BASE AMBERLEY QLD -U06. .--\L1STRALI.--\ Tel: l 07) 5-+61-22-+0

Fax: (07) 5-+61-2268

Base Physiotherap�· Section

1: Sep :00.5

Dear Leanne.

Re: The veteran the veteran PMKeyS No: 8197812

DOB: 23 Jan 1970

Thanks for seeing the veteran again to develop a·strengthening and 111.aintenance program for his .. right shoulder as he seems to have an acquired ( -�how) lesion to his right accessory nerve •

\\-hich has gi, en him ob_iectiw \Vasting and weakness of his right trapezius. He now has some shoulder soreness. mostl) related to gym work and I believe this is likely to be due to. compensator) mechanisms to deal with the trap \veakness.. -\n MRI of his shoulder is essentially normal. I \\Otild greatl) appreciate� ou seeing him to help. with this.

Thank-you.

Yours sincerely.

Adam Storey

FLTLT

\-ledical Officer Tel: (07) .5-+61-::3 7

Email: udum.srore,·l £l de(e11ct:!. £01·.u11

the state Diagnostic Imaging

St Andrew's Radiology 457 Wickham Terrace

the city 4000

PHONE: 3839 5433 FAX: 3839 5032

Folio: 1928925-1

www.qdi.com.au

the treating doctor the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor the treating doctor! the treating doctor

the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor

the treating doctor

Re:

To:

Mr. INCOGNITO (8197812), the veteran.

D.O.B.: 23/02/74

the treating doctor 1 ATHS

Raaf Base the base 4306

Web Ref:

the treating doctor the treating doctor

• the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor the treating doctor the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor rJr Poul Monsour

the treating doctor the treating doctor the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor

the treating doctor the treating doctor the treating doctor

the treating doctor the treating doctor the treating doctor

Exam Date: 22/07/03 Report Date: 22/07/03

MRI RIGHT SHOULDER

Technique:

Coronal proton density and T2 with fat saturation, sagittal Tl and T2 with fat saturation, axial proton density

Findings:

The rotator cuff is intact and appears essentially normal.

The glenoid labrum has a normal appearance. No abnormality is seen at the biceps labral anchor.

The rotator cuff muscles are of normal size and appearance.

On the limited views of the lateral aspect of the tq1.pezius this muscle does appear thin however enough of the trapezius is not included on the images to make further assessment.

There is a small chondral focus within the humeral head which is of no significance.

No fluid is demonstrated in the subacromial subdeltoid bursa or in the biceps tendon sheath.

Comment:

No rotator cuff abnormality is identified. The labrum and the glenohumeral joint appears normal.

Thank you for referring this patient.

DR GREG COWDEROY

akt

.

-••

a Mayne Grovp Limited company RP 07 /05

• AUG-2003 09:25 FROM: ur, Lli IVJ U •...,, ILJ....1 .......L... I 1Lt.Jt,U._ILll,�.Ah••·H •

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P:2

J!ess.and Associate§ - Radiology

Pr111a1.e Medioel Cffnir111, The I MalbOurns Hosplt!!I, ••

Toi: 342 7()88 •.

fax;�]� •••

,.Parkvill•, llDtiO UhCOl'DCJtatlnQ E1111tJ11®" Oietrlct MemOJi.al Hoa.pita!) , • ��9,n1'.:�,a !9�-.'

Erin Streat Met,trology Ref Lorn; PCR >.·.· .-,.::....-:

34 Erin Street • PCI\

• ...•

RICKMOND 3121 �ef by, the treating doctor ·,;_;-. '.': ..

: :·:. - .

•'•1

MRI QRAl� ANO UPPER CERVICAL PINE: ••• •_•. _,-,·'.·•

No �kijll base lesion, �r .,.ssiin relation to the jugular·tossa ls '. •. ·,:·' t:';'· i<:

-•.--.··. --.....�eeo--· · ·.- -· i • • ••• ,.,:.-.:,.:.. • ,r.

lh�epper oervieal cord and biain stem have nonual tn0rphotogy-. • i • " •••

There 1s ntin.ima1 ir,dentation of the anterior theca <1t C5/6 and·C6/7, •_• .-:. '. �-·:·:•·

,bu-t nu evident.� of s1_gn1ficr.1n· dhc or' osteophyte ·:i,·,_:;_:,· ·:·· ••

pr9trusian/compres�ian. • • • • :•.►.-_. ••: •_•

AUnlORISED REPORT

P.911: 1 af l •

. - --··----- I

•'

Report.ed by: Dr ·p-J.. 1.��h1! ,: · .••:._.":-

ST. JOHN OF G. D HOSPffAL

h,R.B.N. 05 960 911

DEPArITMEN'f OF M DICAL IMAGING

P.O. IIOX 20 TELEPHONE (OfiJJ J 16677

BALl)I.RAl. VICTORIA 3350 FAX (053] 33 1¢132

�

''11'•'"'"' ,:1,11 11,··

No focal abnormality i� seen;n brain substance. ventricles or CSF

Spf1G8S, In particular, basa cisterns appear norma1.

Views of the petrous temporal bones shcwl a high jugular bulb on th right� The ban>' margins of he jugular foss11 appear· into.ct howevr.· An inCOIIJPlete sept1.111 is notl!IQ-be.tween lower jugular fossa and caro id

Cl$nal·but this is likely to b�-ctevelol:)flental 1n or191n·Jn the abH c11t

. of anY apparent soft tiseue mlws e-xtending ·tr,f9riorly 11"(p the reg on

(distinction not absolute). '!Nootner abnormality ia seen arounq he

base of skull. The mestoid akr cell. on tha right are normal.

gomment. No re1•�ant abnO�a1ity. ..f-

lA,AUG-2003 11:26 FROM:

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Mx. OAVID WALLAC'I!

F,11,C�., P,11.A.l:!.S,

t.rNl&a N•• 'llaitJ

usr

-tll • 181 VJctarla P 11,nu,ouJtN•·

in;.

,.� m-1

30th March. 199

the treating doctor

10 Drtn1wwnd Street South BALLARAT Vic 3350

01:'!IU'/Y'� i

I ••

Re: • a,q,t�JlALSTON

I-le 1:; currently unemployed �wa t

to comroence tmtnini in the Aitforcc

• it:

Nit ._ ..,.,.,.�

has

omyecehta�lnic: good health.

.f• • • ..•.• •

I:liS fiuwly !.eel for about twelve mpnths he has been rather round shoulderc

abouta year ago had .x-ra� donelf hie neck tu1d shoulder which were repo normal,

He !,. right �anded. Hts fa.cony l n�t looke4 out old photographs to 1Seew er hiedropped,tf8bt shoulder Je a very long standlng th.lug, but I ha� ad\PifJod th t.o

do so. • •.· • I •

He bas notJced no recent ohnnge ip hts tight 1tnn function and managed toP 8 f..b.e niedlr.-Rl to enter the A1rfo-rce. }Jc rec.ently attended a phyeJ.otlier2'1)1St wb. was gulte Jmpresecd by the wasted ttaJiez.lus muscle on the fight Bide, He has ootl no chaD3e 1n his eycstg)lt, his .heawig nor balance. He :has had no �allow or

�pccch dtmculties. 'J;'here ls no fa,.uily history -p.or past histoty, of mu le or ueurolotkal dteense, and he bas tjo b.trlh marks. •

On examination he was a stx footl lwo Inch, healthy looking, Alim you.og ma marked wasting o! the upper h��af the r1ght trapc-�Ius muscle whichw hnth• vJsible andpalp.able.auu wl1lch r eared the sptne of the .ngbt scapula vcr:y vldly. There was sonic wtn.gtng of the . pula e.t tlm�II but no obwua weakness the

9C8P\U8f ro.usdee the01Selves. . J _

11lere was no other abnonn!llity of the nervous systelll and in particular the other•

nerwa wting at the J-qgular forattlW. seemed normal and sensauun WllS lnta •

. I -�

I ..

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• AUG-�005 11:26 FROM:

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641 IJ03

M.R. DAVID WALLACE

!II Fl'DOII 2

r•,-.�..�_.l.'I.I,\R.11,<.:.5',

us-r18:Z VJdw.ill Pitrade

l'lt1!Pliotm NII N"

JdlLllOVIIN Jllllt

Re: Mr.Mi thmvllAIBl'ON

f1 =

J tltlnlc he should have nerve eon�uctlon studies drJne and 1 ha:ve a�ed C$e With John ltlng at .l!.')'wortll Hospital. and he shoultl also have an MRI l!IClm the poster1or fos�e and i::exvicaJ spine. � try tu pJnpoJnt me soun:e at his trouble. 1 shall let you know what tra.n.sptte&. 1 •

I

DAVlP WALLACE

Neur(ISutg1SOn

j

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M� DAVID W.A.Ll.At.ll

F-",C.S.1 1,R,ILCIJ.

PLODll

191 Vltml l'•�lllfe

l"l..Uµ IO• HIY!ll

the treating doctor

10 Drutnmond Street South

BALIARAT Vtc 3360

t!AifT MELB'OU

28th Api;:ll, 19

5. "91

4

Re a.tthew ftt\U1J'ON

M4,14·wattle Frat 3382

l revie�0111.1 .Interesting young fe,low on the 16/03/92. His MRI scan wes clea

shows no ev!clence of a mactoscoptif kzslmL afft!cl::tng the accc:ssocy nerve. •

and.

J think he comes_under the cat�oJ of 9 patlent wJthout a demonstrable les.ion I think under. those cb:'cumst-ance& �erl! ts a b,;tter c.hance tb� otherwise, 1:11 this 1«:cessory ncrn palsy- will recove.r . th time. I be.ve qked him to come back an see me agam at some stage when he g a break from the Altfo�e lat& t� yeat".

Of Interest: hts parents looked out d photographs at my request and they feei

.ta no argn ofthia lcs!on beyond t:wayeats ago.

With kind reg;a.rds,

yom-a sJncerely.

lJAVID WAU.ACE

Neuro&llllti::on

.,

. , .

PM528

Replaces PM 012

Revised Jun 1999

MEDICAL-IN-CONFIDENCE (After first entry)

Department of Defence

Specialist Referral

• Use only black pen and/or stamps

Clinical notes and provisional diagnosis

?.'. :I..

Specialist report

Report sighted and action required (Medical Officer to complete only)

�- . � MEDICAL-IN-CON fter first entry)

Nb1· i�u� R.l�-1 ,._

Dr 1'--1.._, il.-:- ,.- ..::-.�-.· t g, Ii /cv •

WORKSHEET

Rank:........................................

Surname:..................................

Christian or Given Names:....... Date of Birth: [withheld] Sex:...........................................

Cat/Must:..................................

Unit:..........................................

CPL INCOGNITO M

05-Apr-72 M ATECH the unit

AHA Date: 06-Sep-05 BMI:

INITIAL TEST

Flexed Arm Hang:/Chin Up:

25 Sit Ups: 25

Aerobic: Finish Time: 39.07

Result:

Pass

Form PM 217 - Physical Fitness Report for Unit dispatched:

--?

_;;;;;?/-P�1-'s Name:

, - . Umt:

DAWSON

382ECSS

Rank: Date:

CPL

31 Jan 05

,,/ ·-

Distribution

Original - Member's Personnel Medical Record (PMR)

WORKSHEET Rank:. CPL

Surname:..................................

Christian or Given Names:....... Date of Birth: [withheld] Sex:...........................................

Cat/Must:..................................

Unit:..........................................

The veteran

M

05-Apr-76 M ATECH the unit

AHA Date: 06-Sep-04 BMI:

INITIAL TEST

Flexed Arm

Hang:/Chin Up:

DNS Sit Ups: DNS

Aerobic: Finish Time: DNS

Result:

FAIL

Form PM 217 - Physical Fitness Report for Unit dispatched:

Distribution

·PTI's·Name: Unit:

EWART

382ECSS

Rank .. CPL

Date: 04

NOV 04

Original - Member's Personnel Medical Record (PMR)

20-SEP-2002 08:37 FROM: TO: 54611410 P:2

Pagel of l

-..

The veteran .IU.LSl'ON

23 Blessington

Flinders ViewQld 4305

DOB: 23/02/1974 - Age: 28 \'rs 5 Mths ¥ Jlli.ale

"Pl. H·'0.,.., 71294 /\£""

Ph M:[phone withheld]

Current Medicatto11

Augmcotm Duo Forte Teabl�ts [10] - I bid. (1 Month:) · :. Gastrolyte-R (Powder) 7.5 g (sachet) [10] - 1 s:1chet in 200ml water eveiy·,l -·2 hours (l-Mon,'.'�1 ••

Maxolon (Tablets) 10 mg (25) - t �very 6 - 8 hours ·for nausea (l Month):· .-�:· • . •· ·.: • ' •·,

Cllt'.rent Conditions

. 01/08/2002 - high t.cmpcI'lllure

Medical History None�rded

0-ato Created; 11J09/2004 09:33 All

By : the treating doctor Dyke

Nausea, fever, aching all over. small dry cough, he.lldache - no neck stiffness

O/E:

T39.9 HR 160 HSNAD

Ch.estNAD ThroatNAD

?Viraernia ?Other ?Myocarditjs

lMI Stemetll 12.5mg ·-

!MI Be.npen 3 g stat given

Script Written - Oastrolyte-R {Powde:r) 7 .�� tsachet)°

Script Written - Augrmmtin Duo Forte Tablets

Scr!pt Written - Maxolon {Tabl�) 10 mg

R.V if not settlif'.g •

........

MEDICAL-IN-CONFIDENCE (After first entry), -r-

Ab 146 Department of Defence r----:_----..;.._� I

Introduced May2001 1 '•• !.. ·, / -·-

Annual Health Assessment

• Use only black pen and/or stamps

Patient to complete

General health

Do you have any�uent illnesses?

�Yes � No . .

'

·tails of current illnesses

.

Do you have any current injuries?

r;1Yes [2JNo Details of current injuries

Patient to �omplete

Do you smoke�

r;:1Yes .. [jNo

Quantity

Do,..you drink alcohol? i;:iYes 0No

Amount per day

How often do you feel that your present lifestyle is putting you under too much stress�

0 Often L.JSometimes O Seldom O Never

During the past two weeks, how much stress have you experienced?

A lot of r7f A moderate Relatively Almost no stress amount of stress little stress stress at all

Have you been deployed overseas within the last 12 months?

�Yes QNo . . . . Details of deployment

Have you undergone any operative procedure in the last 12 months?

. Yes [1No

y

re you presently taking prescription or non prescription medication?

Do you wear glasse.s or contact lenses? 0Yes [jNo

Have you had a dental check within the last 12 months?

..[2j"ves ONo

Hay.e-you passed your annual fitness test? E]Yes 0No

NO, AMA, SMA or authorised delegate to complete

HeightI9\Q

Females

P

P

* Perform lifestyle counselling at every opportunity*

MEDICAL-IN-CONFIDENCE (After first entry) Page 1 of 4

MEDICAL-IN-CONFIDENCE (After first entry)

f\!umber

8i97812

Rank

CPL

Given name(s)

GUY

Family name

INCOGNITO

IPITn+rlsl

Encl or Folio

Hep B

Date serology performed

Positive D Negative t,,V,'{) 04

IMEC

r I

G6PD (Once only) G6PD date

lSpecialist employment classification

[{) Positive D Negative Are routine vaccinations required?

�Yes No

20 Apr 1988

Action required

List vaccinations required

11 ()r 7li ri ribl 0

Problem .

.fl l\

Action

I<b-f£/LfL6/J ,m

r,s.&,l'ii\loll\il'��---· ""'·:"'.

. ,. VAfilC[l U� VACCfNAl'iCP' f

lf"lt::l.,IUil�J:�1�1-�.I�-COMPlJiTf�M

COtJf I t-J t:0 SrJW

q\J�

t'YL£) fb ,.

LJ(Yl{}�_'ltev-J oc."'

•• 'lring

, .. --�� .. '!>l

Of1A·

. -

I 250 500 1000 1500 1998 3000 4000 6000 8000 Hearing

R ,/ r") C) (1> .Y \ \"" � � standard I

L / <;: r"I s LO lo lo ,J,r

Comments

MM! ,.:q 3o

t%L- 61 /

"-'PrJ p/ ,...

�f:ferti<to Tb IA}UJN it� Pthv<-rOe

Ucl--f r

{? /

/

L)� i.(1·7;,;./ :

U� N A,--l--Y h.-1 9l_/

SPiv'--fJ JVLL-�

.

..-

NO, AMA, SMA or authorised delegate conducting health assessment

Are vaccinations�-m lete? Oves • No

Is a continuation�h attached? Oves No

MR been reviewed? es 0No

assessment require a review by a Medical Officer?

� es 0No

ndividual Readiness Recommendation

� Ounfit

R�nk or title Dloate·sfpo

Confi_rrriin.9,author' --••Tl•••--.

)isiic�ture

a.-J.a

Printed name ---- Rank or title Phone number

_....----*.Perform ..lifestyle c;oul}sel/ing at every opportunity*

-····-· ... MEDICJ\L.-IN-CONFIDENCE (After first ent1y) AD 146 - Page 2 of 4

PATHOLOGY REPORT

HA'rAJRCf'A Aeucdl11!11$ L11boratory Number: 3014 NATA/RCPA endorsed test reporr,

This document sh!ltl nol be

reproduced.excep1 in run.

PATHOLOGY REPORT

I

NATA/RCPA Aecrediled laborelory Number: 3014 NATA/ACPA endorsed tut report,

This document shall nol be

reprodOJced, e1Ceept in lull.

Laboratory Report No:

Date/Time Collected:

Requested By:

Clinical History:

20044603

28/07/2002 08:55 the treating doctor

OCCUPATIONAL HEALTH ASSESSMENT

�port: Page: i of 3

Random glucos.e

J

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�

Cl)

er:

Q,)

·�

·o

..

CJ

1./

lJ

a,

·�0

<ll

aI-..

..:io

c''c.)

·-

Chloride Bicarbonate

Anion gap

Creatinine

97 mmol/L (96-108)

34 * mmol/L (22-32)

l0 mmol/L (8-18)

0.090 mmol/L (0.050-0.110)

(j)

aI- :

0

r.i..

U.I

I

J� �

� ......

�

.u 0

T,1I2

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i�-

i.�

.I j

a: CL

';?!

1\t

! 't ,.

J- I.

...................................·� CAPT Rob Perrin [date withheld]

(Signature) (Printed Name) (Report Date)

PATHOLOGY REPORT

NATA/RCPA Acc;red1ted

Ut.,i:.1111an- NUff!IM:t! 10141

,N�A.T..A,/.RCPA endorsed IHI Th<'I d0<1,nuJnl lhail t!OJ b• reproduced, except in full.

Medical-in-Confidence

PM 12-2

Introduced Jan 91

Department of Defence

REPORT OF A SPECIAL EXAMINATION

Report

Collected

7-SEP-2002 0855

Requested by

GPASCOE

Medical-in-Confidence

PM 139

Revised Sep 1998

MEDICAL-IN-CONFIDENCE (After first entry)

Department of Defence

Hearing Conservation Report

• Use only black pen and/or stamps

Reason for audiogram

HPA employed

Length of time on HPA :_s·

r::;ye

Annual[2j

Termination_of0

AmberO Extreme D ()u,...

Area of empl� l

tr ��

..,

service

Audiometric data

Date

Day Month

Year

I Red

Left ear

Frequency

�J-..-.Q·1. J.:fr--.----.

Right ear

Hearing STD

500

1000 1500 1998 3000 4000 6000 8000

I

500 1000 1500 1998 3000 4000 6000 8000

I

/ 1. Today's audiogram

G I o,

Dc..t

s-·0

• ] ,o

fD (0 2( a 0

.-

:'>

i) 2u s

-1--

• Reference audiogram ZrJ l:,

10 0 0 c;- ,o (0 1(

,,.. 0 - C) 5 (0 (0 s-

reference: =+ poorer, - = better)

9'f

-✓-- - - ) - -

) .

� I- -

+.)

.r

,u --

• Threshold shift (Frequency compared with

)

,i.._ ·r

S"

;.._ � �

Lt) )

• .i..
• Is there a significant threshold shift of 15dB or greater? Yes � Requires clinical assessment (Go to Section 6)

!.i. 31911atlff::, uf 10IJ01'ti11y alllllu1ity

'--7

No �-Conclude report-(Compl.ete S.ection 5)

IP,lntea 11a1nes �11 IRankLA<

.

Date

I6 01

• Clinical assessment YesO♦ Treat as appropriate then refer for repeat audiogram
• Any evidence of coryzal illness?

No□

when condition is resolved

. Yes� Treat for removal of wax then repeat audiogram

• Ariy wax in ear canals?
• Any exposure to excess noise in YesO• Repeat audiogram with minimum noise free period of preceding 16 hours? No

Audiometric data

(Minimum 16 hours

Date

Left ear

Frequency .

Right ear

Hearing

. noise free)

Day

Month

Year

500

1000 1500 1998 3000 4000 600_0 8000

500

1000 1500 1998 3000 4000 6000 8000

STD

• Repeat audiogram
• Reference audiogram
• Threshold shift (Frequency compared with

reference: + = poorer, - = better)

• Is there a significant threshold shift of 15dB or greater? Yes� Workplace assessment required

No[]♦ Reinforce hearing protection advice

• Medical officer's report No further action D Referral to ENT specialist D Workplace assessment report sighted D Medical employment classification review required D Referral for hearing conservation lectures D Amend reference audiogram D

Audiometer operator's comments Medical officer's comments

-,-/sr-o-r .-? �

·-u-· I

L ) e,._.l,

fc, S(-r>�.,.,..t...-_-, ��- - ------·· �l.�,���A'-.,-?✓. 17t.Jf-;,;-/l_;,<r.

I

Stock No 7530-66-115-2094

MEDICALmlN-CO�rnv�NCE (Aftier ftrst entry )

HEALTH S•URVEILLANCE QUESTIONNAIRE

Date of Birth: [withheld] f�·-.l(

Do you feel you are exposed to any of the following hazards (please tick):

• Physical·Hazards d. Design Hazards
• heat - equipment _
• cold ✓ - furniture-----'-----
• noise
• vibration electro-magnetic radiation----

electricity _

• pressure _
• Chemical Hazards
• metals
• gases ,.

solvents and other bulk liquids-/ ---

• pesticides ,,- _

dusts (including fibres)-./----- carcinogens----------

• Biological Hazards
• bacteria
• VIruses
• rickettsia
• protozoa fungi

workstations

• task design

-manual handling

-illumination---------

• stairs, ladders, access platforms_
• confined space entry

e. Psychosocial Hazards

• shift work

-occupational stress _

• organisational structure----
• boredom/fatigue------
• organisational commitment to

a healthy and safe workplace_

f. Other Hazards

• flammable substances ·/
• explosive substances _
• work surfaces ./
• machine guarding:
• trip hazards ./

work at heights and on roofs ✓

Page l of 2 UNCONTROLLED DOCUMENT AT TIME OF PRINTING 1ATHS-F-HPP-006-22/06/02

Medical-in-Confidence

PM 12-2

Introduced Jan 91 Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit) lATHS AMBERLEY

Report

Collected Requested by

27-APR-2002 1341 P SHUMACK

Medical-in-Confidence

ltld I\.1ledkan Labrnmfoiry

043 t/a the state Medical Laboratory APA No. 000042

e Qld 4101 T�lephone (07) 3840 4444

thology e • ([J) t®

FLIGHT OFFICER BERLEY

TH SERVICES

6

Run ID: Area:

Laborafornes at

2216-1

LOC

..(

� the state Medicai·Laboratory For Surgery use ( Urgent□ Ring Patient□ Make appointment□ Note in chart□File□ Patient INCOGNITO, GUY 8197812/40316584, 40317077, RAAF BASE, AMBER4306

Sex Male Age 27 Years DOB 23/02/74 Requested 22/01/02

ReportFor BASE MEDICAL FLIGHT OFFICER Collected 22/01/02 00:00

Printed 23/01/02 16: 56

Specimen: Macroscopic:

SKIN LESIONS X 2

(MK)

BRI 2002 19505

• Left foot instep: The specimen consists of an ellipse of skin measuring 14 x 6' x 3mm. On the skin surface is a mid tan macular lesion

4 x 3mm. Two transverse sections, A.

• Sole of foot left: measuring 25 x 6 x 3mm. papular lesion 6 x 4mm.

Micro·scopic:

The specimen consists of an ellipse of skin Centrally on the skin surface is a mid tan Three transverse sections, B.

• ·Left-foot instep: Sections show a benign INTRADERMAL NAEVUS which is clear of margins.
• Sole of foot left: Sections show a benign COMPOUND NAEVUS showing

•minor activation of the junct.ional component characteristic of the site. The excision appears complete.

Reported and check.ed by the treating doctor.

HISDTepOt LOGY

Date al Service For Clinical En�lries

BRIPert0. B4ra-nc1h 986Q3uo8te9

� Pathology. :;�

Mayne Health Palhalogy Pty Ltd ABN 84 007 �90 043 Va the state Medical Lu oni.to,y PA NQ., 2

60 Ferry Road West End the city Qld 4101 Tclephon iC07) 84{) 44

athology report.

• -1-·

,,._

.\

•y. \}'.\

()

Run ID:

Area:

L�boratories at

16705-13

LOC

�\,

-·

BASE MEDICAL FLIGHT OFF G:ER

RAAF BASE AMBERLEY ', �:

MEDICAL HEAL TH SERVICES - I~

_.} I i :

Ba lina (02) 6686 6424

B ··bane (07) 3840 4444

Buj:lerim (07) 5444 6244

GI dstone (07) 4972 2877

G 1pie (07) 5482 1511

Logan Mt Isa Redcliffe

Stanthorpe the base city

(07) 3200 3655

(07) 4743 4299

(07) 3284 6666

(07) 4681 4951

(07) 4779 0158

AMBERLEY 4306

' I l - I

the city (07) 3281 8888

Kipgaroy (07) 4162 1499

_J

Tweed Heads

(07) 5536 4177

=..Pathology. For Surgery use ( Urgent□ Ring Patient D Make appointment D Note in chart D File D

Patient INCOGNITO, GUY 8197812/40316584,RAAF BASE, AMBERLEY 4306

Sex Male, Ag27 Years DOB 23/02/74 "Requested 22/11/01

Report For BASE MEDICAL FLIGHT OFFICER Collected 26/11/01 12:30

PMn�d 26/11/01 17:11

CC: :GILROY. Your Ref. No. - 40316584

SEMINAL FLUID ANALYSIS

Sample Information

Type of Investigation

Result Reference range

Fertility �

Time Post-Ejaculation 0:50 <2 hrs �

Period of Abstinence Viscosity

Colour

5 3-7 Days Normal Normal

Cream Cream

�

0.....

pH

Volume

Wet Preparation Examination Concentration

Total Sperm Number Motile Sperm

.' Rapid / Progressive Sluggish/ Non Progessive

Stained Preparation Examination

'Abnormal Spermatozoa

.Iinrnature Germ Ce11s COMMENT

Qu�ntitatively normal semen.

8.0 >7.1 0

3.0 >2.0 ml (1Q

'-<.

68 >20 X 10E6/rrJ.., '"'1

204 >40 X 10E6/ejaculate �

70 >50% -�

60 >50% 0

40 <50% �'"'1

81 <85% •

3 <10/100 sperm

GENETICS

Dept

26/11/01 the treating doctor

Date of Service For Clinical Enquiries

BRI 04-1164548

Pert. Branch Quote

STAFF-IN-CONFIDENCE

AB 908 Department of Defence - Introduced Oct 91

INDIVIDUAL PHYSICAL FITNESS TEST WORKSHEET

EmplID: ........................

Service Number:....................... Rank:........................................

Surname:...............:..................

Christian or Given Names:....... Date of Birth: [withheld] Sex:...........................................

Cat/Must:..................................

Unit:..........................................

8197812

A327212 CPL

The veteran M

05-Apr-76 M ATECH the unit

AHA Date: 0l-Apr-03 BMI:

INITIAL TEST

Flexed Arm Hang:/Chin Up:

25 Sit Ups: 25

Aerobic: Finish Time: 38.52

Result:

p

Form PM 217 - Physical Fitness Report for Unit dispatched:

Distribution

Madejewski Rank:

382ECSS Date:

CPL

5-Nov-03

Original - Member's Personnel Medical Record (PMR)

STAFF-IN-CONFIDENCE

Pathology Department 2nd Health Support Battalion the base, the base

Ph: (07) 3332 4569 Fax: (07) 3332 4564

I

Department of Defence

PATHOLOGY REPORT

�

�

NATAIRCPA Accredited Lehor11tory Number: 3014

,,ATA�CF'A Mdo,Nd 101

tfp0,,_1.

Thlt dllt:Mm-1 lhailn.ot b• rtproduc:ed, exc�p! in lull,

Department of Defence

PATHOLOGY REPORT

NATA/AC PA Accredited laborarory Number: 3014 NATA/AC PA endor&ed te&I repon,

This document shall11ot be reproduced, except in lull.

Pathology Department 2nd Health Support Battalion the base, the base

Ph: (07) 3332 4569 _Fax: (07) 3332 4564

Department of Defence

PATHOLOGY REPORT

�

�

NATA/RCPA Accredncd

ltiwa,G,v Hu!Jllb•l )Ot♦

NATA/RCPA endorsed lest

fCp0111,

Thisd�.Jmc"1,ti.lfl n1111 bit reprodu�ed, eircept in lull.

Laboratory Report No:

Clinical History:

20034300 •

Date/Time Collected: Requested By;

11/07/2001 10:55 the treating doctor

ELEVATED NA,URATE,EOSINOPHILS

Report:

I Uric acid

Uric acid

0. 3.9 * mmol/L

(0.15-0.37)

Page 2 of 3

DP.TE

CAPT J.P. Hymus [date withheld]

(Printed Name) (Report Date)

MEDICAL-IN-CONFIDENCE (After first entry) i..�-=��-·:_--:.=.:_,�t, :i11u=-::

Ao 147 Department of Defence

I /--'PP

4'V---··-··

1----,-:;(-::,;::::;- ·- --·-

Introduced Apr 1997 L.,_ I\Ji[H3--

ComprehenS iVe Preventive Health

• Use only black pen and/or stamps

Patient to complete

Family history

ive any of your family suffered from heart disease, high blood

�sure, diabet�pression. stroke, etc?

¥Yes �No

General health

Have you had anx..,wrsistent cough?

.]Yes �No

Have you had an�usual shortness of breath on exertion? 0Yes �No

Have you had anl..3)est pain? 0Yes i.:'.".]No

Have you had anwsistent abdominal pains or cramps? 0Yes Lj No .

Have you suffere�� persistent indigestion or heartburn? 0Yes L6No

Have you experienfed any change of your bowel habits? 0Yes c]No

Have you passe�blood with your bowel motions? 0Yes �No

Has your weight �ged significantly? 0Yes l{jNo

Are you on any special diet? 0Yes [2JNo

Have you had an�anges in passing urine? 0Yes L.{l No

MEDICAL-IN-CONFIDENCE (After first entry) Page 1 of 7

Number

8197812

Patient to complete

Current medications

Rank

CPL

Given name(s)

MATHEW

Family name

INCOGNITO

Patient to complete

Alcohol history (Continued)

Encl or Folio

Are you taking any p;.¢cription or non prescription medication?

How many 'standard drinks' containing alcohol do you have on a typical

0Yes [jNo

day when you are drinking?/

0 One or two [21Three or four

□Five or six

Are you taking any vitamins or alternative therapies? 0Yes [aNo

0 Seven to nine D 10 or more

Details of medication, vitamins or alternative therapies.

How often do you have six or more drinks on one occasion?

0 Never [2l"Less than monthly D Monthly

Oweekly DDaily or almost daily

How often, during the last three months, have you found that you were

t ble to stop drinking once you had started? Never D Less than monthly

Oweekly DDaily or almost daily

rr-:

□Monthly

Jetails of allergies.

How often, during the last three-months, have you needed a drink in the ing to get yourself going after a heavy drinking session?

� Never D Less than monthly D Monthly

Oweekly □Daily or almost daily

How often, during the last three months, have you had a feeling of guilt

Preventive health Stress

How often do you feel that your present lifestyle is putting you under

morse after drinking? _ _ Never 0.Less than monthly

Oweekly 0 Daily or almost daily

□Monthly

too much stress?

Ootten Osometim�s

0seldom

0Never

How often, during the last three months, have you been unable to

remember what happened the night before because y9u had been drinking?

During the past two weeks, how much stress have you experienced?

[2] Never D Less than monthly □Monthly

Alotof A moderate D Relatively

stress amount of stress little stress

Is there any other health problem troubling you?

lmostno

� stress at all

Oweekly DDaily or almost daily

Have you or someone e□lse been injured as a result of your drinking?

�Yes 0No •

[2l'No

Yes, but not in the D Yes, during the last three months last three months

Has a relative, a friend, a doctor or other health professional been concerned about your drinking or suggested you cut down?

No Yes, but not in the Yes, during the

�

lExercise

last three months last three months

Smoking history

H� many days per week do you exercise? I

What type of exercise do you do?

�Sport

Do you smoke? � IQuit date Yes O No♦ Never smoked OR

If'Yes', what do you smoke? IPlease describe.

0 Cigarettes Oother ♦

How much do you smoke per day?

IHow long have you or did you smoke?

Gym

D Unsupervised or individual

i;iother

I IPlease describe.

I How many sessions per week do you exercise?

(One session equals 30 minutes of exercise.)

I

Alcohol history

How.often do you have a \itink containing alcohol?

Never [ZJ Monthly or less '.wo to four

4-

Sun protection

Dofi'(>u use sun protection (Hat, blockout, clothing, etc)?

�Yes 0No

• Two to three D Four or more times a week times a week

limes a month

Do you regularly che�k for new moles or skin lesions? 0Yes [3'No

Number

8197812

Rank

CPL

Given name(s)

MATHEW

Family name

INCOGNITO

Encl or Folio

Patient to complete

Contraception

Do you use contra@etion? 0Yes No

NO, AMA, SMA or authorised delegate to complete

Age specific screening

Females

Have you had a □pap smear in the last two years?

Height \cyo Weight(-"�) �

I

BMI :;r·.J- Pu£;��e

0Yes No

Blood f:C_rSl5U}r.e�SlttlngJ

.:::>U :'D

Blood pressure (Second reading if required)

If over 50, have □you had a mammogram in the last two years?

Cholesterol HDL LDL Ratio

Operational factors

e you seen the dentist in the last 12 months?

Yes 0No

Faecal occult blood test (Result) FOBT date

Distant visual acuity

�

Date

IR 6/ 9

Corr to 6/ IL6/9 ICorr to 6/

=

'<_()m,i- 63

Have you passed your fitness test in the last 12 months?

�Yes 0No

Females

Pap smear date�,

Not applicable

Mammogram da�e

Not applicable

Date

.0 -1C0'"'o::Jv:

Do you wear glas�sesor contact lenses?

i:;:iYes • No Date of last refractioln

Have you been deployed overseas since your last medical?

t;JYes 0No Details of deployment

Pap smear result

Hearing,

Serology

Vaccinations

Routine vaccinations Hep A

Hep B

'Hep A and Hep B

MMR

'

Sabin ADT

Typhoid Mantoux

Mammogram result

Date of vaccination

02 Aug 1993

02 Aug 1992

13101994

31 Nov 1993

31 Nov 1993

29 May2001

--

Member's.�n�·: J• '/

Other vaccinations JEV

Mencevax Influenza

Other (Please list below)

Date of vaccination

22 Jun 1993

...-,/�/4�

Member's family name

INCOGNITO

Member's given name(s)

MATHEW

S1:::--V

Vaccinations required

Rank

CPL

Phone number

f-;<T 111.J..-:.S.':;

,��'C:,CY 1

dvvsc:i\ fVlY-11y2_

*Perform lifestyle counselling at every opportunity*

Number

8197812

Rank

CPL

Given name(s)

MATHEW

Family name

INCOGNITO

Encl or Folio

MO, NO, AMA or SMA to complete

Lifestyle counselling

Have you conducted lifestyle counselling on the following:

Smoking

Oves �� Comments

Alcohol and drugs

E:Jves 0No Comments

\Jl,tm(\L Sll(t o Ill "1{t;1 N 5

'

MO, NO, AMA or SMA to complete

Lifestyle counselling (Continued)

Sexual behavio��STDs Oves l_1'No Comments

-.

.-7protection .

t::J Yes 0.No

MO to complete

Clinical examination

Head, face, neck, scalp

'·

Nose

Nonnal

_,,,

/

Abnonnal

'

Comments

i-J-t!Ct '-rt h,.O (>j f C--i N C i P l f:S "I

�ical activity ·

L::::J Yes No

Somments

�giene • [_Jves 0No

��and mental health

I.LfYes 0No Comments

YLO l'YWr.JD h �1YLh-•'ktfVL.-,i VO { l.(v,7

Eyes - Visual fields (Confrontation) Respiratory system Cardiovascular system Peripheral vascular system

Abdomen - Including hernial orifices Genito-urinary system

Anus - per rectum (If applicable}

Skin

Nervous system Endocrine system Upper extremities Lower extremities Spinal system Posture

Gait

Lymphatic system Mental state

Identifying marks and scars

/

/

/

/

,,,,,.--

.,fJf,_

4£

/

/

/

,,/� _/

/

/

/

/'

,�

/'�

f\Jo

* Perform lifestyle counselling at every opportunity*

Number

8197812

MO to complete

Rank

CPL

Given name(s)

MATHEW

Family name

INCOGNITO

MO to complete

Encl or Folio

Clinical examination (Continued}

Diagnosis of disabilities

C

• L() �;]

-&-1 rA

l'; Na 0

� f=D;

. Pit-A-:::r=

Restrictions

Comments

,7,,.

_,,,,,.,--

Are routine vaccl�ali11s complete?

Oves No

Is a continuation sh'1t attached? Oves G;3No .

R available?

es 0No

Outstanding problems

·Medical officer conducting examination

Signatu1 Printe�am��

IRecommended MEC :T�

Recommended specialist employment classification

Does member require medical reclassification? ';]Yes �.O

Is MECR (Form PM 518) attached? Oves 0No

Has member been referred for MECRB?

Oves 0No

Phone numbe-r ,

Date

fie

Confirming authority (If required)

Is MEC valid?

Oves �No

IRecomme""3t;oa,

, (!), ..,

r� l 2 ;i. ,,( J

fu> 0:J

Signature Printed name Rank or title Phone number Date

*Perform lifestyle counselling at every opportunity*

f'M 12-2

Introduced Jan 91 Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit) lATHS AMBERLEY

Report

Collected Requested by

7-AUG-2001 0755 G HUGHES

(Medical Officer's Signature) (Date)

PM 12-2

Introduced Jan 91

Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit) lATHS AMBERLEY

Report

Collec1ed Requested by

7-AUG-2001 0755 G HUGHES

PATHOLOGY REPORT

NATAIRCPA Acc:,edited l11borotorv Numb1r: 3014 NATAIACPA endorsed IHI reporl.

Thi, doc;umeni: shell noc be

r1produc:ed, except in lull,

PATHOLOGY REPORT

NATA/ACPA Ac:c:redi1ed Leboretory Number: 3014 NATA/RCPA endorstd lest 1epor1.

This doc:unien1 shall no! bo

reproduc:ttl, e11c:epf in /ul.

Laboratory Report No:

Clinical History:

20033976

Date/Time Collected: Requested By:

27/06/2001 07:55 the treating doctor

OHA - AIRCREW MED

Report: Page 1 of 2

Total bilirubin

Urea/Electrolytes/Creatinine

7 umol/L (2-20).

(' co

.C..\.J.

Q)

3 ·�

.':!1 l:)

Urea/Electrolytes/Creatinine

� � > �

UJ (Jo � Cl.. 0) (',)

t--

,I

Ql a: >

Urea Sodium Potassium

Chloride ,

Bicarbonate

� c.,J_. �0

Ia-.. a(I>:

Anion gap 15 mmol/L (8-18) Creatinine 0.100 mmol/L (0.-0:5.0,-.0.J.10)

_ _J

0

�

··············4?-···························

CAPT J.P. Hymus

.............. -0...7../...0..8../ 2.�0- 03

_.,,.,-r

••••••••••••••••••••••••••••···••••••···············

'. .................

/1/

(Signature)

(Printed Name) (Repo, t Date)

PATHOLOGY REPORT

NATAIRCPA Accredited Laboralory Number: 3014 NATA/RCPA endorsed test repoll.

Thjj; documen, shall nol be

reproduced, eiccepl in luN�

PM383

Revised Jun 91

!Unit

Medical-in-Coll1lfid.enq;e

Department of Def_ence

PERIODoC MEDICP�l EXAMINATION

• PROGRESS REPORT

° File immediately below Form PM 105 - Outpatient Clinical Record

PM 139

Revised Feb 99

MEDICAL-IN-CONFIDENCE (After first entry)

Department of Defence

Hearing Conservation Report

• Use only black pen and/or stamps

Reason for Audiogram

·-- '

HPA Employed Length of Time on HP�_,_, _,

�

lnitialO Other�

Nii[) Black�

Type of Ear Protec�tionorn- f' i;·

Annual D

Termination ofD

IP/eats,BH�

AmberO Extreme D 0"\U 9----- v·Q

Area of Employm�tL

Service

Audiometric Data

Day

I

Date

Month Year

Red

Left Ear

1- i ah -c- L-,-N. �

Frequency '

Right Ear

Hearing STD

500

1000 1998 3000 4000 6000 8000

500

1000 1998 3000

4000 6000

8000

• Today's Audiogram ors

�-=:- c:?3

/t'/ 0

0 6 /e,

7./) .2<$- 0 (!) 0

/[; 2.c;

lot-

• Reference Audiogram �5s l-, 19lf
• Threshold Shift (Frequency compared with

(0 D 0 s--- iO 10 I$- s- 0 0 5 /([) ,o .s :c

,,,

reference: + = poorer. - = better)

C) C) 0 0

() f-1(} r/t 0 0

o.--�

f-C -I-A,' .j

• Is there a significant threshold shift of 15dB or greater? .Ye�R[e:i• ,.s-clinical assessment (Go to Section 6)

N Conclude Report (Complete Section 5)

�5. Signature of ReportingA_�t7h'6r',

,----; ,• A

Pri�t�d Name • IRank - 1·Date

I/vr/£!,:At�flf?tt'C/-< /vC-cr-vO e£f;JP?4 ?I 13

• Clinical AssessmenVv YesC}tll- Treat as appropriate then refer for repeat audiogram
• Any evidence of coryzal illness?

0 Any wax in ear canals?

No□ when condition is resolved

Yes� Treat for removal of wax then repeat audiogram

No

. Yes� Repeat audiogram with minimum noise free period of

' Audiometric Data

Any exposure to excess noise in preceding 16 hours? No

Date

• 16 hours prior to procedure

Frequency

Hearing

(M. ini.mum 16 hours .

Day Month

Year

Left Ear

Right Ear

STD

noise free)

500

1000 1998 3000 4000

6000

8000

500

1000 1998 3000 4000 6000

8000

• Repeat Audiogram
• Referenc;;e Audiogram
• Threshold Shift (Frequency compared with reference: + = poorer, - = better)

□,..

11. Medical Officer's Report No further action D Referral to ENT specialist D Workplace Assessment Report sighted0 Medical Employment Classification Review required D Referral for hearing conservation lectures D Amend reference audiogram D

Audiometer Operator's Comments

ft, ?)-,

Medical Officer's Comments

Signature nJ;;rinted Name Date

---� ,i:P?pZf:'"/JJ-flZ·�t: tl�,//��� IPrd�mc�

Stock No 15r-1�9,: MEDICAL-IN-CONFIDENCE (After first entry)

Date /Si>)

PM6

Medical-in-Confidence (After first entry)

Department of Defence

SPECIALISTS REFERRAL AND REPORT

ADAPTED FOR COMPUTER JUL98

Referred By DR PORCHE

Referred To

MS KILWORTH

Speciality DIETITIAN

Reason for Referral

Signature Date

28JAN 03

Height: 194 cm

Weight: 97 kg BMl:26

Goal Weight: 87 kg

Thankyou for referring this gentleman. He walks twice a week for 45 minutes and I have asked him to increase this to 3 times a week. His wife says that it is the quantity of food that he consumes is the prob)em, however, he is also a fast eater and tends to eat foods that are higher in fat. Given advice advised on a weight reduction diet of approximately 6800 kilojoule. This diet is concentrating on small regular meals, using large volumes of foods but foods that tend to be lower in kilojoules, theses include things like bread/cereal group foods an_d fruit and vegetables. Member will try this out and see how it goes. Review in two weeks.

/�--, '.

··.c,'/> /

L. KILWORTH DIETITIAN

Medical-in-Confidence (After first entry)

PM 6

Revised Aug 97

Medical-in-Confidence (After first entry)

Department of Defence

SPECIALIST REFERRAL AND REPORT

5 0cc Cl

,�ws

• Use only black pen and/or stamps

" All Entries Must be Dated and Signed

Stock No 7530-66-106-6410 Medical-in-Confidence (After first entry)

the state Medical Labrnrato:ry ath logy re rt.

60 Ferry Road West End the city Qld 4101 Telephone (07) 3840 4444

T#w I I y Aus t ra I i an Owned

BASE MEDICAL FLIGHT OFFICER RAAF BASE AMBERLEY

MEDICAL HEALTH SERVICES AMBERLEY 4306

Run ID: Area:

Laboratories at

19296-96

LOC

-- the state Medical Laboratory For Surgery use Urgent□ Ring Patient□ Make appointment□ Note in chart□File□ Patient INCOGNITO, GUY 8197812,RAAF BASE, AMBERLEY · 4306

Sex Male Age 26 Years DOB 23/02/74 Requested 14/09/00

Report For BASE MEDICAL FLIGHT OFFICER Collected 2.25/08/00 10: 45

Printed 15/09/00 06: 11

FULL BLOOD EXAMINATION

Red cells are norrnochromic and normocytic. Platelets appear normal . '-d

and leucocytes are normal and mature. iRf=DQP'i="c.'.iQ•, T•:;::-·-- -- ----- . . Q

�=:rtlood film. p:�•. ~• .,, l•��;-'2-_---11."1

HAEMATOLOGY

Dept

'Wholly Australian Owned

Run ID:

Area:

Laboratories at

291-3

LOC

• MEDICAL HEALTH SERVICES AMBERLEY 4306

p. the state Medical Laboratory For Surgery use ( Urgent□ Ring Patient□ Make appointment□ Note in chart D File D

Patient INCOGNITO, GUY 8197812,RAAF BASE, AMBERLEY 4306

Sex Ma l:e' · Age 26 Years DOB 23/02/74 Requested 25/ 09/00

ReportFor BAS.E MEDICAL. FLIGHT OFFICER Collected 14/09/00 10:45

Printed 15/09/00 14: 41

REPORT SIGHTED

MICROBIAL SEROLOGY Path

EBV VCA IgG (EIA): EBV VCA IgM (EIA): EBV EBNA IgG (EIA):

Negative Negative

�egative

No serological evidence of exposure. PT Informed

If infection is suspected, please repeat in 4Cti�ys.

. .

TYPICAL EBV SEROLOGY PATTERNS

PT Review

Review dc::te�

VCA .=. Viral Capsid Antigen EBNA = EBV Nuclear Antigen

· • -Anti-'VCA IgG : peak levels 1-3 months (long term persistence)

• Arit'i-VCA IgM : acute marker bf EBV infection (disappears 1-2 months) Anti-EBNA IgG: 2-6 months after infection (persists long term)

IM·oMeTptTNOLOGY

Wholly Australian Owned

BASE MEDICAL FLIGHT OFFICER RAAF BASE AMBERLEY

MEDICAL HEALTH SERVICES

AMBERLEY 4306

Run ID:

Area:

Laboratories at

19296-90

LOC

� the state Medical Laboratory

For Surgery use ( Urgent D Ring Patient□ Make appointment□ Note in chart□ File D

Patient RALSTO.N, GUY 8197812,RAAF BASE, AMBERLEY 4306

Sex Male. Age 26 Years DOB 23/02/74 Requested 14/09/00

Report For .. BASE'rv1rn·rc.AL FLIGHT OFFICER �ollected 14/09/00.'10:45

.Printed 15/09/00 06:11

IRON STUDIES

Serum Iron

Transferrin Iron Binding Capacity

17 umol/L

57 umol/L

(10-33)

(45-70)

HADReMptATOLOGY

'bate oTService FOr crrrncal Enquines

B'RT 02-4317"i08

·�rt. 9'ranch c1uiile

the state Medical Labor-atory Patgy p rt�

60 Ferry Road West End the city Qld 4101 Telephone (07) 3840 4444

T#io I l y :41ts t ra Ii an Owned

BASE MEDICAL FLIGHT

RAAF BASE AMBERLEY

Run ID:

Area:

Laboratories at

19296-90

LOC

I ...

MEDICAL HEALTH SERVICES -Cairns (07) 4051 8944 Rockhampton (07) 4921 2155

AMBERLEY 4306

• the state Medical Laboratory For Surgery use ( Urgent□ Ring Patient□ Make appointment□ Note in chart□File□ )

Patient' : RALS°TON, GUY 8197812,RAAF BASE, AMBERLEY

Sex Mal°e Age 26 years DOB Q5 / Q 03/74 Requested 25 / 10/Q2

Report For' BA._SE MEDICAL FLIGHT OFFICER Collected 14/09/00 10:45

Prin�d 15/09/00 06:11

4306

THYROID FUNCTION TESTS

Thyroid s•timulating Hormone Euthyroid level

1. 4 mU/L (0.40-4.00)

ENnocRINOLOGY

25/lO"DIcQite o?T . DrKerry DP_Vo!=:s nh3.840 4412 B'RI� n2-h4311i;os

dept

8 erv1ce ror�lfmca t:1.nqumes ...�e11. Sranc '"'QUd'fe

PHYSICAL FITNESS TEST AUTHORISATION

Service Number L\:./:}/,.i./ ......... .

Employer.ID Number ......................

;:ka:�t\�_;:.·.::;::��·:·.:.,�;·.·.·.·.·.·.·.·.·.--�--·.·.·.··..:.

�:s�:�����/:�:-\'::'.:,�;�)?::::::::::::::.

Sex .. ,.;,.,:.:, .................................

UlUl .. ['.:"-_;_,.._\J_-:J..................... .

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

Height (meters):

!, c.1,�•.

Weight:

.,.--..

BMI: 2{,.

Current AHA:¥_�§) No

I

• ·--2-..

"-1� !C-

_.-:::::::.?

Signature of PT . Medical Facility:

"' :- �-P,TI'sName: Rank: _

-� Date: C-l\ \ C;, oz_

Member Certification

I feel well

Yes'/ No

$ig11ature: Date:

1 am taking medication

I am able io undertake the PFT

MO Referral

Yes /No)

Disposal

Cleared Fit for PFT:" PME: 90DayPCP: MEC Action: Review Date:

Signature of MO: Printed Name: Rank:

Medical Facility: _ Date:

PHYSICAL FITNESS TEST WORKSHEET

� RETei----

Remarks:

Chin.Ups:

Result:

2.4 km Run:

Result:

Flexed Arm Hang: �-6

Result: �

5 km Walk: 1--\0 ·CC,

Result: b25 • \_ 0

SitUps:3G Result:�

PHYSICAL FITNESS TEST AUTHORISATIO_N

Seivice Number ...8.f?.?/f.J:.:.!.S ......

EmployerID Number ......................

Rank .Cf��·.:·.••::·,;.:,:;·················

Surname .. , ......Sfu.....................

Christian Name MA-:IT!".1:f?.� ..........

Date ofBirth -•0-fJf.�.±�............ Sex ... 0.0.-?n-.€,.,.............................

Uru•t .. v/ . .$..'.Q..r.-.-.-.>............................

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

Height (meters): I°12- Weight:_c_l)l�_BMI: JL,-l,

Current AHA® I No

S�gnature of PTI-:·�fb_:_\.../"'---. PTI's Name: .$(,;,.:t"'0�\l,¥.,,. . Ra�: <5• ,T

Medical Facility: '/b \�":>. Date: 'U I -t,C1 C - •

·Member Certificatio;

I feel well

I am taking medication

G.�/No

Yes@'

Signature:

./�Z

Date:

I am able to undertake the PIT @1 No

MO Referral

Disposal

Cleared Fit for PTT: · PME: 90DayPCP: MEC Action: Review Date:

Signature of MO: Printed Name: Rank: _

Medical Facility: _ Date: ------

PHYSICAL FITNESS TEST WORKSHEET

Chin Ups:.

Result:

2.4 km Run: I,;)_ ·GC

Result: i)/V F

Flexed Arm Hang: ;�

'Result: ..�. ()

5 km Walk:

Result:

Sit Ups: 50

Result: 25

Remarks: LA<:1/� �#

Signature of PTI : ��

Rank: �0

Date: 1i.'.(_,_j f�' C• ··I- 0·2.-- .

STAFF-IN-CONFIDENCE

AB 908 Department of Defence - Introduced Oct 91

INDIVIDUAL PHYSICAL FITNESS TEST WORKSHEET

Service Number:....................... Rank:........................................

Surname:...................................

Christian or Given Names:....... Date of Birth: [withheld] Sex:...........................................

Cat/Must:..................................

Unit:..........................................

327212

P/CPL INCOGNITO

GUY WILLIAM 23 Jan 1970

MALE ATECHI the unit

Height (meters): 1.89

Weight (Kgs): 98

BMl:27.43 Test Heart Rate: 194

INITIAL TEST

Chin Ups: 0 Result:

2.4km Walk or Run

FAIL

Flexed Ann Hang: 30 Result: 30

'T'Time: 12

Sit Ups: '30

Result: 29

Actual Finish Tinie: •

Fonn PM 217 - Physical Fitness Report for Unit dispatched:

The member is unfit and is advised to undertake a PCP: supervised.

An appointment for re-assessment has been booked for 25 Jun 1996.

Remarks

Lack of fitness or motivation.

• 1,,fJ°ature ofPTI:

,/, -,.,�------

,

PTI's Name: G.SCAMAKAS

Rank: CPL

Date: 26 Mar 1996

Distribution

Original - Member's Personnel Medical Record (PMR)

• Member's Commanding Officer

STAFF-IN-CONFIDENCE

', I 'I i i ._ ·' I,·.! Ill!.'.•;I i·

\I> •, .• ! )(.i •. I : • ',.

j I ! •!, •• •, ••• ,:_ ' ' • : ,,.. � r + l I

I' 11 'I '- I ( \ I . 1:1 I '\ I _,,

IL�! \I r!IOHl:--.\llU"\

l "\·:;re·<'. f,:r !' I r

'i

l·'.:_i:il.

(:··'i�L

I :11n ahk: 111 u11,k11:,ko..:th..: l'I·

{.·1'-·.;.ir(·d 1·i·t ·l·u1r F' -1• ·/

l'ME:

'lO D:iy !'Cl':

r.:,�n. .:\\'.1;1,1;:

�- l . \ l r !' - l 1 >'\ I l � Ii :-. 1

STAFF-IN°CONFIDENCE

AB 908 Department of Defence - Introduced Oct 91

INDIVIDUAL PHYSICAL FITNESS TEST WORKSHEET

Service Number:....................... Rank:........................................

Surname:...................................

Christian or Given Names:....... Date of Birth: [withheld] Sex:...........................................

Cat/Must:..................................

Unit:..........................................

327212

LAC INCOGNITO

MATIHEW WILLIAM 23 Jan 1970

MALE ATECHI ISQN

Height (meters): 1.91

Weight (Kgs): 90

BMl:24.67 Test Heart Rate: 196

INITIAL TEST

Chin Ups: 0 Result:

Flexed Ann Hang: 30 Result: 30

Sit Ups: 30 • Result: 30

5km Walk 'T' Time: 40 Actual Finish Time: 38:48

PASS

Fonn PM 217 - Physical Fitness Report for Unit dispatched:

Distribution

PTl's Name: P.A.COX

Unit:

Rank: FSGT

Date: 25 Dec 1994

Original - Member's Personnel Medical Record (PMR)

STAFF-IN-CONFIDENCE

AB 907 Department of Defence - Revised Oct 91

PHYSICAL FITNESS TEST AUTHORISATION

Service Number:....................... Rank:.........................................

Surname:...................................

Christian or Given Names:........ Date of Birth: [withheld] Sex:............................................

Unit:...........................................

327212

LAC INCOGNITO

GUY WILLIAM 23 Jan 1970

MALE ISQN

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

Member Certification -

Signature Date

I feel well

I :;im taking medication

I am able to undertake the PFT

MO Referral

. Disposal

@'1 No

�·

Yes�

(Y�:( No

Cleared Fit for PFT:_

PME:_ 90DayPCP:_ ESR Action:_

Review Date: _

. Signature of MO:

Printed Name: _ Medical Facility: _

Rank: _ Date: _

MO Review

Disposal

Signature of MO:

Cleared Fit for PFT:_

PME:_ 90DayPCP:_ ESR Action:

Review Date:

Printed Name: _ Medical Facility: _

Rank:. _ Date:

• I

,,... -: .. •:

NO SCANNING PAST

THIS PAGE

PATHOLOGY REPORT

Th1s l11borawry 1s ,.,91s,.,rtd

1,#1,0,C «°If' h'tJ•ll:Jai� ""'1-"ll'IP

•• the Na11or1a1 Assoe1a11on

• l Tl'Ct,n,g Aum.,11� AulU,UIII, a,,dtt,.,��C-»"9f'"' Pathcilo91sts ,;,I Aus1re11s1a

uboratory Report No:

Clinical History:

20006035

Date/Time Collected: Requested By:

13/07/1998 08:00 the treating doctor

BASE LINE SCREEN

J:(eport:

FBC (parameters only)

Full Blood Count

White cell count Red cell count

7.7

5.40

10A9/L

10Al2/L

(4.0-11.0)

(4.50-6.50)

Haemoglobin

157

g/L

(130-180)

.. _

Haematocrit MCV

MCH

MCHC

0.47

87

29

335

L/L fL pg g/L

(0.40-0.54)

(76-100)

(27-32)

(300-360)

Platelets 314 (150:-450)

LT J.P Hymus [date withheld]

(Printed Nome) (Report Date)

PATHOLOGY REPORT

Th,sliibc,r.uory15r�is1er-,d under tl'le re9,s1r;U1C1n sChdrn11 (;1 !h<IIN6hQontt l\1'6-C"!II�-,.

ot Testing Authorill<'IS, Au,tt1lla

and lhe Royal College Q/

Pa1h<•lo91srs ,.1 Aus1ralas,a

60 Ferry Road Wes, E;id Brishane Qld �JOI Teiephone (0 /) :1840 41141!

J#w ll y Aus t r al i an Owned

RAAF BASE MEDICAL OFFICER

BASE MEDICAL FLIGHT AMBERLEY 4306

-log

• the state Medical Laboratory

For Surgery use ( Urgent□ Ring Patient□ Make appointment□ Note in chart D File□ )

Patient ' • INCOGNITO, GUY

Sex· Male • Age 24 YearsDOB

eport For RAAF BASE

A327212/RAAF BASE, AMBERLEY 4306

23/02/74 Reque5ted 19/07/98

Collected 20/07/98 14: 50

Pri�ed 21/07/98 06:11

SERUM LIVER FUNCTION TESTS

Total Bilirubin Direct Bilirubin Alk. Phos.

.................. G:a.�.?..,,,G._.'..I.:......,.,,................,, ,,,,,,,,,,,,,,,,,,_

9 umol/L

4 umol/L

70 U/L

•t•Inn•:n�!:::11•ijj�:••:•

(2-20)

(0-8)

, ::itJ�h : =• , ,,,

Hil�HLH!��;ifit=Hiilt:::,n:;=:••••=::::::,:,::•=:•::::::::/=•==''''?==

AST

LD : -

Albumin Globu.lins·

174 U/L

47 g/L

28 g/L

(0-41)

(80-250)

(35-50)

(20-40)

BTlreOptCHEMISTRY

30/0D8at/e QofoServ.ice Drs AppletC'oonsnul/foBr renoquwlnnes

Medical-in-Confidence

PM 12-2

Introduced Jan 91 Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit) 382 HSF AMBERLEY

Report

Collecred Requested by

23-MAR-1998 1130 P SHUMACK

Medical-in-Confidence

PM 128

Revised May 95

Medlical-in-Confidencie

Department of Defence

MED�CAL iEXAM�NATiON RECORD - SIERV!NG MEMBER

-".-

• Type of Medical Examination
• Height
• Weight
• BMI
• Urinalysis Albumen

Blood

• Blood Pressure

Lying

• Pulse

,· f

• Visual Acuity I,.I R

/\JA) I(\Ji''"<)

! -, : L Standard

• Audiometry
• History

(._:,.,·e i'.) p.•'!.,_...vi

• CPS

'-"' j (- Corrected

I-�,

• Convergence
• Accommodation

Standard IRef

Not Significant D Significant D

Standard R L

I

(If not examined, enter 'NE' in Abnormal column)

• Head, Face, Neck, :=,calp
• Nose
• Mouth, Throat, Speech
• Teeth, Gums
• Ears - Including Drums and Eustachian Tubes
• Eyes - General
• Eyes - Ocular Motility
• Eyes - Ophthalmoscopic
• Eyes - Visual Fields (Confrontation)
• Chest, Lungs
• Heart (If ECG performed, note results in Box 41)
• Peripheral Vascular System
• Abdomen - Including Hernial Orifices
• Additional Procedures and References
• List Significant Problems

Normal Abnormal

Vl/.:::.--

(If not examined, enter 'NE' in Abnormal column)

• Anus (Including rectum if indicated} Occult Blood
• Genito - Urinary System
• Skin
• Nervous System
• Endocrine System
• Upper Extremities
• Lower Extremities (Including feet)
• Back - Spinal System
• Posture (Standing)
• Gait
• Lymphatic System
• Psychiatric Assessment
• Identifying Marks etc

Normal Abnormal

t1\/;z_

(l,f--:

..,,...,..-

V--

�

/

�

Patient Medical History Declaration Disclosure

I certify to the best of my belief I have revealed to the Examining Medical Officer a true and complete history of my state of health

(..\•·/••� /'i;;4,;;;m'si:iersc·

-=--

....2...4...... 01,-..\..1...� c. �

since my last full medical examination.

s,g�a,iiiei ..................

□

(Date)

•••• .....(Dare) (Medical Facility)

Approvir,§Authoritie1,91'mments (Where appropriate)

PM 139

Revised Feb 99

A[!EDll:C.fi:dL-Iff'f-CONJFITDENCIE(After_fJ,:nrt1 entrJ�,i

Department of Defence

Number /-132

Rank L I? •

Reason for Audiogram

lnitialD

Other�

HPA Employed Nil

Length of Time on HPA -.vR,

Black D Type of Ear Protection Worn

Annual D

Termination ofD

Service

IPlease specify_

(<L::- - t::lll{

AmberO Red

Extreme � f----=-----=-_L_......;,.;:Vi=-/:_::=, -'-'·-" ---'-L-'--""'-"J-" 1

Area of Employment

-1 I1.·1-1-- / ,;;

Right"Ear Hearing

STD

• Today's Audiogram
• Reference Audiogram
• Threshold Shift (Frequency compared with reference: + = poorer, - = better)

500

JC)

t'O

8000

.,-

.')

.::) L

• Is there a significant threshold shift of 15d8 or greater? Yes � Requires clinical assessment (Go to Section 6)

ifo . Conclude Repo.-t (Gomp/ere ;:;ection 5J

Printed Name Rank

Any evidence of coryzal illness?

• Any wax in ear canals?

YesD- N� Yesc:i,.. No0

Treat as appropriate then refer for repeat audiogram when condition is resolved

Treat for removal of wax then repeat audiogram

Audiometric Data

(Minimum 16 hours

Any exposure to excess noise in preceding 16 hours?

Date

Yes � Repeat audiogram with minimum noise free period of No� 16 hours prior to procedure

Frequency

Left Ear

.

Hearing

noise free)

Month Year

500 1000 1998 3000 4000 6000 8000

500

STD

• Repeat Audiogram
• Reference Audiogram
• Threshold Shift (Frequency compared with reference: + = poorer, - = better)
• Is there a significant threshold shift of 15d8 or greater? Yes [y- Worl<place Assessment Required

No [}!> Reinforce hearing protection advice

• Medical Officer's Report No further action D

Workplace Assessment Report sighted0 Referral for hearing conservation lectures D

/\udiometer Operator's Comments

Signature Printed Name

Referral to ENT specialist0 Medical Employment Classification Review required D

Amend reference audiogram D

s Comments

AB 908 Department of Defence - Introduced Oct 91

INDIVIDUAL PHYSICAL FITNESS TEST WORKSHEET

Service Number:........... A 327212 Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Cat/Must: ATECHl

Unit: lSQN

INITIAL TEST

Chin Ups: 0 Result:

Flexed Arm Hang: 30 secs

Result: 30 secs

Sit Ups: 30

Result: 30

.5km Walk 'T' Time: 40.00 Actual Finish

Time: 38.28

'T'+ 30 secs: Heart Rate at 'T' + 30 secs:

PASS

Form PM 217 - Physical Fitness Report for Unit dispatched:

AB 907 Department of Defence - Introduced Oct 91

PHYSICAL FITNESS TEST AUTHORISATION

Number:...................A 327212

Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Unit: lSQN

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

l

Height (meters): 1.92 Signatur� of PTI:

Weight (Kgs): 97 BMI: 26.3 PTI's Name: M.P. RUSH

Cleared for PF Rank: CPL

MO Referral

Disposal

Cleared Fit for PFT:

PME:

90 Day PCP:

ESR Action:

Review Date:

Signature of MO: Printed Name: Rank:

Medical Facility: Date:

MO Review

Disposal-->

Cleared Fit for PFT:

PME:

90 Day PCP:

ESR Action: Review Date:------

Signature of MO:

Printed Name:-----------

Rank:-----

Medical Facility:---------

Date:

Directors

Prof Jeremy Jass

MBBS, MD, DSc(Med) FRCPath, FRCPA

the treating doctor

MBBS, MD, FRACP

QUEENSLAND BOWEL CANCER FAMILY REGISTRY

Supported by the University of the state and the state Cancer Fund

20th July, 1997

The veteran the veteran· �

6 Wulkuraka onnection Road Blacksoii QLD 4306

the treating doctor

MBBS,FRACP

Coordinator

Sonja Webb RN BN

Dear the veteran,

Some time ago an alteration-in the hMSH2 gene was found_

·to occur in your family. This gene is known to cany an increased risk of developing bowel cancer. After a • consultation with the clinical geneticist, testing for this gene was arranged for you.

Results from that testing have now been received and we were happy to be·able to-inform you that you have no( inherited an altered copy of the hMSH2 gene, therefore being unlikely to develop a bowel cancer.

When I gave you this news I reminded you that your risk of developing bowel cancer now reverts to the population

risk being around one in 20 but this usually occurs in old age. There is also no need to have regular two yearly _·•

colonoscopy and since you do not carry this alteration,. . . , .. there is no risk of passing this on to your children.

We have been happy to help you with this testing and if you have any further inquiries please do not hesitate to call either the treating doctor or myself.

.. '.:

Yours sincerely,

Qld Clinical Genetics Service Royal Children's Hospital Bramston Terrace

--

Sonja Webb Coordinator

/V/·�-�

the treating doctor Clinical Geneticist

HERSTON OLD 4029

Telephone 07 3253 5116

Facsimile 07 3253 1985 Email [email withheld]

C.C. the treating doctor, 382 Health Flight, Air Force Base, Amberely QLD 4306

Surname Forename

INCOGNITO

The veteran

Sex Doctor

male

Date of Birth

05-Apr-76

Register Number FN082

Lab Number Date Collected Date Received

A0000864 Tissue Source blood Sample Description huffy coat Sample Type fresh

; oi 1 t;iv tvlu1. ulion

Mutation Codon Exon Gene Result

C->T

711

13

MSH2

Not found

Linkage/H aplotyping? PTT?

Gel Electrophoresis? Sequencing?

Enzyme Site Analysis?:

ND ND ND

NEG

ND

The veteran shows no indication/s of the family mutation and is hence unlikely to develop HNPCC.

r:r1ecked by:....... : .. �............. J)oll1o!oqis��..:� ...

• I••". •111�:=11hill1li1.,.. ' -:. 111 '"· NE/�1111 _rr,'iiti,:; . NU.lilli,, ..:hii'l( .. 11• I I,'.!',"• r' .:.

��lJ:--•·· •• ,

. '.

t::;li11u :1c;:;i:i11,�·:\ \:'..-,, 11\t;. 11,:,,i.. 111•;

/. • ,...., �

.. --• '\_ ,:-� l\_ •

l•Y 111 IV/'

Tuesday, 02 May 1993

,; t, ., ...-.....,,....

_ �:--"'

Page 1 of 1

' ..,_

L7QUEENSLAND HEALTH QUEENSLAND

Royal Children's Hospital & District Health Service the state Clinical Genetics Service

MG:ew GF: 9590

QUEENSLAND

y. �

27 Feb 1993

(Diet. 12/03/97)

Mr M. The veteran

q Wulkll_r�ka Conrn��tfo.r.i Ro.ad:,, . BLACKSOIL QLD ,4306

Dear the veteran

RE: GUY INCOGNITO DOB:·'23/02/74

i- - -..".-• ._...

I was pleased to meet you in the genetic clinichere at Herston on the 10 February 1993. Your appointment was. arranged because you _have a family history of a medical disorder called hereditary non polyposis colon cancer (HNPCC). Specifically a change (or mutation) within a gene. called MSH2 has been found in your family. The MSH2 gene is one of the half dozen or so genes that is,known to be associated-with HNPCC.

After discussing the pros and cons of gene testing, I did arr�nge for you to have a

....... .

MSH2 gene test. I expect it will be about 8 weeks or so before·this result is avai-lable. This test will determine if you ha"'.e inherited the precise change in the MSH2 gene which has been identified in other family members.

As the name implies, HNPCC is a disorder that can cause herediatary colon cancer. Sonja Webb had given you a booklet that explains more about this disorder. Women with HNPCC often have an increased risk of endometrial (uterine) cancer as well. Other cancers, such as cancer of the renal tract, can occur in some HNPCC families.

I note in your family history that your mother had cancer of the bowel at the age of 44 'arid cancer of the endometrium at the age of 46. I am pleased to hea.rthat y��r mother is now well. Your mother has one brother and one sister. Her sister also developed endometrial cancer at the age of 43. Going back a generation, your maternal grandmother apparently had cancer in the endometrium at the age of 46. Your mother has a maternal uncle, a maternal aunt, and a maternal first cousin, who have all had cancer of the colon, ovary, and endometrium respectively. Your family history 1s typical of many families with HNPCC.

Office

Herston Hospitals Complex

Back Road (Bramston Tee Entrance) Herston Qld 4029

Postal

Qld Clinical Genetics Seivice Royal Children's Hospital

Back Road (Bramston Tee Entrance)

Herston Qld 4029

Enquiries

Telephone: (07) 3253 1686

• : Facsimile: (07) 3253 1985

173i72!V

.5/tJ 07/J_-;��f+4ert

I used a diagram to show how a person has a 50/50 risk of inheriting HNPCC gene change if one parent has this gene change. If you have inherited HNPCC gene change, I do recommend you commence having a colonoscopy approximately every two years starting from the age of 25. A colonoscopy is the best method to look for any pre­ cancerous changes within the large bowel. It is not inevitable that every person with the MSH2 gene change will develop cancer. The chance for successful treatment for bowel cancer is very good if it is detected in an early stage.

If you do not have an MSH2 gene charige, then no special follow up is needed. The chance of .developing bowel cancer, in· these. circumstances is:no ·different than '·the • average person. YOU also will not be able t() pass on the MSH2 gene.cfiange to any of

your OY{n children if you have not inherited it. ,,

••:,:

':. • .\

I will contact you with the result' as soon as possible. In the me�ntiriie you.are welcotrie'. to contact Sonja Webb or myself at this address should you have further'questions ahout anything that we discussed.· • •• ' •••

Yours sincerely

Mich�el Gattas MB;Bs, FRACP.

CONSULTANT CLINICAL GENETICIST

cc: Sonja Webb, Qld Hereditary Bowel Cancer Registry, QGGS

the treating doctor, 382 Health Flight, Air Force Base, the base, Amberely

Royal Children's Hospital &. District Health S@rvice

the state Clinical Genetics �erviee

GF: 9590

QUEENSLAND GOVERNMENT

QUEENSLAND

1 March, 1997

The veteran the veteran 17 Dolben Street

WILLOWBANK QLD 4306

·Dear the veteran

LA-c

-�3 �7()_(�

CLINICAL GENETICS

SE.RVICE

.,

An appointment has been made for you to be seen at the the state Clinical Genetics Service on Tuesday 20th April, 1997 at 10.00am. If you_are unable to attend this appointment please notify our_ office on the above telephone number as . soon as possible as we may be able to offer it to another family on our waiting Est.

Please find enclosed directions and a map showing the location of the clinic. Parking is available in the multistorey carparks on Bowen Bridge Road, Butterfield Street and Bramston Terrace or off street parking around the hospital. Unfortunately there is no parking available within the Hospital grounds.

Yours sincerely

Administration Officer

Office

Herston Hospitals Complex

Back Road (Bramston Tee Entrance) Herston Qld 4029

Postal

Qld Clinical Genetics Service Royal Children's Hospital

Back Road (Bramston Tee Entrance) Herston Qld 4029

Enquiries

Telephone: (07) 3253 1686

Facsimile: (07) 3253 1985

AB 908 Department of Defence - Introduced Oct 91

IHDIVIDUAL PHYSICAL FJ[Tl'lfESS 'I'EST WORKSHEE'l'

Service Number:........... A 327212 Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Cat/Must: AFITT2

Unit: lSQN

INI'I�Ii.l\.L TEST·

Chin Ups: 0 Result:

Fl�xed Arm Hang: 30 secs

Result: 30 secs

• Sit Ups: 30 Result: 30

5km Walk 'T' Time: 40.00 Actual Finish

Time: 39.34

'T'+ 30 secs: Heart Rate at 'T' + 30 secs:

PASS

Form PM 217 - Physical Fitness Report for Unit dispatched:

�- \

Signatur of ftTI:

/?, '

r_ /'---...

PTI's Name: P. CROME Rank: CPL

Unit: 301ABW Date: 20/08/96

Dist.r:ibution.

Original - Member's Personnel Medical Record (PMR)

AB 907 Department of Defence - Introduced Oct 91

PHYSICAL FITNESS TEST AUTHORISATION

Number:...................A 327212

Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Unit: lSQN

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

Height (meters): 1.90

Weight (Kgs): 97 BMI: 26.9

-Cleared fbt"·.·PFT,'-

..

MO Referral

Disposal Cleared Fit for PFT: PME:

90 Day PCP:

ESR Action: Review Date:------

Signature of MO: Printed Name:----------- Rank:------

Medical Facility: Date:

MO Review

Disposal-->

Signature of MO:

Cleared Fit for PFT:

PME:

90 Day PCP:

ESR Action: Review Date:------

Printed Name:-----------

Rank:------

Medical Facility: Date:

AB 908 Department of Defence - Introduced Oct 91

INDIVIDUAL PHYSICAL FITNESS TEST WORKSHEET

Service Number:...........A 327212 Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Cat/Must: AFITTl

Unit: lSQN

INITIAL TEST

Chin Ups: 0 Result:

Flexed Arm Hang: 30 secs

Result: 30 secs

Sit Ups: 30

Result: 30

2.4km Walk or Run 'T' Time: 12.00

Actual Finish

Time: 13.06

'T'+ 30 secs: Heart Rate at 'T' + 30 secs:

FAIL Retest Date: 31/12/95

Form PM 217 - Physical Fitness Report for Unit dispatched:

Original - Member's Personnel Medical Record (PMR)

AB 907 Department of Defence - Introduced Oct 91

PHYSICAL FITNESS TEST AUTHORISATION

Number:...................A 327212

Rank: LAC

Surname: INCOGNITO

Christian or Given Names: GUY WILLIAM Date of Birth: [withheld]

Sex: MALE

Unit: lSQN

To be placed on Member's Personal Medical Record (PMR)

BMI Screen

Weight (Kgs): 92 BMI·: •25.·5. Cleared for PFr •

PTI's Name: HALL •• :· -·· Medical Facility: AMB

·Rank: SGT ·., bate: 02/10/95

MO Referral

Disposal Cleared Fit for PFT: PME:

90 Day PCP:

ESR Action: Review Date:------

Signature of MO:

MO Review

Disposal-->

Signature of MO:

Printed Name:-----------

Medical Facility:---------

Cleared Fit for PFT:

PME:

90 Day PCP:

ESR Action: Review Date:------

Printed Name:-----------

Rank: Date:

Rank:

Medical Facility: Date:

:..

+

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PM176

Revised Alig 0v2

Medical-in-Confidence

Department of Defence rage of Pages,Folio

PERIODIC HEALTH ASSESSMENT - PHA I

• Rank
• Surname
• Initials
• Service Number 5.Age
• ·Cat/Must
• Unit

ac I<?n.J,o.h:on IYJ A 3cJ°J,J1::) 19 Curt.CO\ �/

• Date of Birth
• History

1O. Urinalysis

Albumin 'Sugar

Blood

S-0-p,r

�6 Not Significant[¥" Significant D

JU' _,,q- 0

11. Height (cm) 12. Weight (kg) �(fm) 14.¾Fat 15. Blood Pressure

• Aerobic Fitness

I f!/6 7�

{).,9, 3

Pulse Rate

�l.f

B/P

/')_o I 7�

VO2 Max ICategor/

c5

'/Ref?

• Ventilatory Capacity

FEV FVC Ratio FEF

• Resting ECG

Ref

• Audiometry

Standard Ref

4i< 72 5·33 ?51 t;;-lL� Normal [Y Abnormal D

_r( 0<j �...J q�·."')

• Distant Visual Acuity 21. Clinical Examination (PM 128) -

6[')

R corrected

I

6(�

L corrected !Standard

I :]_

Indicated D •• N�t:,j"�dicatdd �-

. ' - . -- --- .

• Pathology Tes1s

Cholesterol Ref HDL Ref LDL Ref

Triglycerides Ref

Uric Acid Ref

Glucose Ref

. �-''83 I \.z.., I <X·\7 I

o-°l t,·1 - Q·39 I

• . ! �-- a. I
• Additional Examinations

CA·, ci2t.

• List of Significant Problems

I ,

I

• Notes on Significant Hfstory and Other Fin�1ngs, Medical Management and Next Examination

\ '

Family History: n��I" ��UJJ C,0111'\.ICiJV' 4-3()° @.lc\ . · , , .

Past Medical History: '-J�L Si4iv\F\<:.,r>.:,,;-,

Personal Histor�': Smoking: f\.U--LLV"- � Alcohol: 7-9, d.,1N;.,'1,o 'l.-"wl,.,u.c:,Jl'V\,ov-J:J...; bor�f-(_ • Exercise: Q. .J.w-- · t d.¾lu.u.J, �

Medications: !\NV\

Findings: I\Y::, c..u��'s ,

-!UC> :�c o"v:::.'.o ' -\a'/{,,a. ,Jl'-..,,'U_"e -· "' '

Management:�-I"\�<Lc:l � �s

NO �o <c.GCw\eE:D - �'-\ M.-q))��j{) 9'-\

Follow Up:

t-:J<4--I,- P,"YJS

• Present Employment Standard 27. Date Allocated 28.

-

Valid□ Invalid D

29. Date of PME 30. Examiner's Signature, Printed Name, Rank and Category 31. Medical Facility

This Exam Next Exam

NI� et., I(-\{£ � �l ["I_CJO ( (�-WI l � l .�J � Nursing Officer 2al1-1:;CAv-.t..b

Stock No 753D-66-098-6488 l\tiedical-in-Confidence

PM 12-2

Medical-in-Confidence

Introduced Jan 91 Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit)

Report

,.-

1��··

••.. ,-

[�::: i_

1.T:T. /HiJL

'l 1-J t

?-.

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l ll 1)11 I I I I

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m,nc-. · L

.,

\• •.· i:J I

ti 'Hft(l , 1

mmc · L

; : / l_

'I I .•. I -

..................................·-·-(Signature) -· �.,

........................_....

I • :.,

(Printed Name) .. (Date) •

Report Sighted

"-• ��- 0.�1V,' -\ -···r�-1....-

r i! ) Lab/X-ray Serial �umber

-(Med,cal

r.:<.:::L ... .l...

Officer's Signature)

Stock No 7530-66-135•0335 Medkal-in-Confidence

(68 fZrKSrorJ

f\ 3�7Q.\Q j''f:. AP'c°{S--

(1 w I

-- ---�::::�--- •,-=-�•.=·a.-=.--"-"'-·-==�:::::....::..:::::.:..-=-:-=---====--,=-·7·

I

------ ------ -- - - -

...

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.-1

-1

: I - r·�&SEA.VE;-1··-�;;:i�-T�;··-��-= ,_

. VALVE VAWE %

.:� 41-�c lr?si O

---1-- -

FVC. t} ·33 c 5-8()c

RATlO--iq'!

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�-- .-·------.-. �--·---=- �- --------·----,--f_�• .. I

i

:lL.,_.----•"--�- -'--� �

Medicalmin-Confidence (After first entry)

Department of Defence

PM 12

SPECIAL EXA

Bed

INA: ION REQUEST

□

Revised Oct 92 Clinically Urgent

Trolley □ (

Walk □

Report

Stock No 7530·66·107-6985

Medicalmin.=Confidence (After first entry)

Introduced Jan 91

Department of Defence

REPORT OF A SPECIAL EXAMINATION

Return Report To

(Ward/Ship/Unit) BMF' EDINBURGH

Report

G6PD-H U/gHb 4.6 - 13.5

COMMENT If Result is within range this indicates NORMAL G6PD activitv If result 1s less than lower limit, suggest investigation for G6PD DEFICIENCY.

I

I

/

for SQNLDR RCRL

30--J'UN--1992

•-••••••••••--•••••----•••-'-•••) ••••-••••••• .. ••.. ••u•--•-••••• .. •••• ....•••.. ••••u•••••u• •

' (Signature)

(Printed Name)

Lab/X-ray Serial Number

081488

(Date)

Stock No 7530-oS-135-0335 Medical-in-Confidence

Introduced Jan 91

Department of Defence

REPORT OF A SPECIAL EXAMINA ION

Return Report TgM_ •• A.F E·1·· I81JR'·'Ll

(Ward/Ship/Unifj' I- k'. I� J I\ �,,,

Report

HIV-1 / HIV-2 (ABBOTT ElA) �,JOT DETECTED

HCV Antibody (ABBOTT EIA) r-10·1 DETECTED

, - ;.

1

i

II

·-·.I

,..o�u� •••• ••• ••••••••• •-••--••• .•.••••••••• ..••••••••••••••••a.•••-•••••••••••••u••••••,..••••••

(Signature)

ed

...................f.9L..}.QW.,PR...BrnL.................................9:'.�l ,_:i i I ,L_??.'!........

(Printed Name) (Date)

Lab/X-ray Serial Number

7757()

l� J1.·�0L·_

(Medicai oiiicer-s'Signature;' (Date)

Stock No 7530-66·135·0335 M·edical-in-Confidence

• ,.-J, L-.· . J ./'-.1 1 \ , �:•,

FU.1vli,�,J.l11I 1,111

� i1 li'.: �,!:Jr(/) �..::!:.,i(!!:

� c11-✓6

Corps, Catsnory or Mustering

L ,/,_1.;;..r_v:.;..;.'),_fi_l_t.✓_.•

Number ---1

E31.tI·na1r1e

.

Initial J

Ulhe1

l�j

,-7

GrG(�n I J H,Hc;i;.

liJ

IJ ,.-"-/ic

Type of Ea_i- P1otec1ion Worn

I 4\, u�

1«

J Specify

·,:, •\8h-:: r---·i r-1�1-►--r�f" i ' [>L_t'J<.?z fV(,/.,.f.//!(<!_":::,

Termination □ RA,J f\rea cf Employment

' of Service-

' --

-...·..-.

--- - ---

'/DO'- S',"?i�c.e

Freql.ll?n� - .-..

...... ..

L'aLe

LP,ft

Hearing

Auciic.;metric Data

E':8.r

Ri_ght Ear

Day Mti1 Yr 500 1000 1998 c!O00 4000 GOOO [(000 500 1000 1998 3000 4000 6000 8000 STD

··---· ---·

( ..

1. Today's Audiogram

rf(

l{ 1'7 0 0

0 6 [')-�s' ID

r��-

C.-,·, ()

0 C IS

C·,,

. ,-

j

? ReferHnc�· /.\11ri!ngr21ri J3 G q�

(b 0 t) s- lo (() /c( ::::,-. 0 0 �-- lo IQ �-

...,

·r

'---

3. Threshold Shift (Frequency compared -

• + +

0 0 - ,-..

with reference;+ poorer, - = better)

lb - --

,o ,_s s s

5 .i• c- ) s s

A.. 11; thero a 3ignificant threshold shift of ·I srJD or greater'? Ve� Requires clinical assesRment (Go to section 6)

I,fo Conclude Report (Comp/919 section 5)

• Signature of Reporting Authority Printed Name Rank Date

��- /4.,Ifru-Jr so/./ "h.;rcr- �1.-<h4r 17

., r.lini:--::,1 /',!·�•;,;,(\�:n(/ ni ,....

• \,·,·,0'.1idence ui 1:,,1yzal ,I1ries o '�llr-;--- Yt7[:� � as

then n-•ter ro: re1.1uat audiogr,"r,1

!.�-

0 , r (•,'.o wheh r;o,1rlffion i re.<Jr:i/ved

• Any wax in ear canals?

.

,rs'liR , • ,.c-0.'ft.w_�

Jo,lt. -::;;:::,--=

o',.c-

o}t�

Treat for removal of wax then repeat audiogram

Any exposure to excess noise in pre

�?

Repeat audiogram with minfmum noise free

()6riod of 16 hours prior to procedure

.

Audiometric Data

Date

-.............1 Frequency

Hearing

(Minimum 16 hours

Yr

Left Ea1·

Righi Ear

.STD

noise tree)

• Repeat Audiogram
• Reference Audiogram

Day

Mth

500

1000

1998

3000

4000

6000

8000

500

1000

1998 3000

4000

6000

8000

• Threshold Shift (Frequency compared with reterenc e; + = poorer, - = better)
• is there a significant threshold shift of 15dB or greater? Yes Raise Form AB 698 - Occupational Hygiene Report

No Reinforce nearing protection advice

·11. Medical Oificer's Hepo1t l�eferral to ENT specialist □

Form AB 698 - Occupational Hygiene Report sighted □ Employment standard review required □

Referral for hearing conservation lectures □ Amend reference audiogram □

Comments (Audiometer Operator) Comments (Medical Officer)

��:ignaturG Printed Name Dste

Stock Ne,7530-65-115-2094

SignatLffP Print.eel h!3rr:s De.te

• ---

l .

P1V1·I66

Revised Apt 89 Depsrtmen, of Defonce:

2 Examination Centre

�--

.J AX:)fJ7!.lIIll;::t.t.S()tJ��'.�·.:'.L

,, ·-

L· I ,S:=.Jl

• .1-...,

�5 Urina!'/!j�

� htilial I .JI, ·, i f:iP r·�:iflm1;) 12,Air Crev,.r O,uy

Isch Farns

Protein N

Pregnanw T•,,,

Sining Height

3J::- 1

.c,ugar

f.} arivr. [ 1:J- I 2°/20 (cm)

/t.,v /

.Y Blood n

Positive [J j Thigh Length

"13 Distant Visiun

• 14 vs

.,,-

j::),

CI,est (cm).

(cm)

16 Audiogram 17 HS

'

• Nose v 33 --

Skin /

• Mouth Throat Soeech ✓ 34 Nervous Svstem ✓
• Teeth Gums ✓
• Ears-lncludina Drums/Eustachian Tubes ✓

35 Endocrine Svstem V

36 Upper Extremities ✓.,..

' Lower Extremities ./

8ack ✓

Posture ✓

Gait . ./

Lymphatic Svstem ✓

Emotional Stabilitv ✓

29 Perioheral Vascular Svstem

��/ �

43 ldentifvina Marks and Scars

, '/,,IO

?O /I 1,rl()m,ir - l11c_!1•_�i!)Jl_HP.mial ()!ifit'"'" I

4,1

'.::p,_:,di,;, :'·-r'•- , '\

,. n,. '

31 G.enilo-Urinarv Svstem

,,,( I Ci'.,,

,:"..:'•

t I

Notes (Enter relevant item number before each comment)

f) 'I\ 1/4-tyL,e,_ -� Bw 4� ... ;,j... �

��f�' l "16 di;q� 0--CN #�� Alv'f ��

-j,_..'&-·::s-�' CC'� •• � � �- l�� T�9., '-

��

( .. A-+--c2: c_ bl { T � L-1<._/ � 1--c...

• .. ;J> �( \- -\.,.

If there are additional comments, please use form.PM 223-Continuatfon Sheet and tick this box D •

45 Day.of Entry Pregnancy Test. All Females Negative Proceed with

Positive R o Medical Officer

...... ......... ,!•••••••••••• ••••••••••,.•••• ..................... .............,_,,. ................

(Sianature of Tester) (Printed Name)

46 Reason for Rejection (If spp/icabl�) 47 Recommended Class (Insert I. II, Ill or IV)

-.

J-

48 �

......................... • •···· (Sig;;t�;�.�. · Exa�................................

49 Day of Entry Weight

50 I certify that I have had no illnesses or injuries sinqe my date of entry rnedi.)al examination

-::;;,.,.,.,r mo"e- re.-rol.aJ

.......................................................le:• . . ·.........,- "·····-··"······"·"··-···-· 7;2>(.J ..../. l�:;z�...2.g .� 6.�. :14

(Printed Name) (Date) (Signature of Applicant) (Date)

ARMY USE ONLY

51 Pulhaems

p u L H E E M s

PES (If applicable)

52 Confirming Authority's Comments

.......... �··--·•"' ...., ..,.... ,......... .... ..................�...............

(Sionature) I Primed Name) (Rani:) {Date)

Stock No 7530-66-107•6981