Left Wrist - TFCC Sprain — DVA claim example (Diagnostic Assessment)

Example document — fictitious patient. Every report published here is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious: names, dates of birth, service numbers, units, locations and treating clinicians have been withheld or altered and all dates changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment — Left Wrist - TFCC Sprain

Example 1 of 1 · fictitious patient (Veteran N)

Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment

Left Wrist - TFCC Sprain

SOP Balance of Probabilities: Sprain and Strain No. 28 of 2020 SOP Reasonable Hypothesis: Sprain and Strain No. 29 of 2020

ADF History

The veteran, Chef, 09 January 2009, 27 Mar 2016.

Occupational History

Military chef duties involve repetitive bilateral wrist loading during food preparation activities, heavy lifting of kitchen equipment, prolonged gripping of utensils and equipment, and participation in military physical training activities. The triangular fibrocartilage complex is particularly vulnerable to injury during rotational wrist movements, ulnar deviation, and loading activities common in food preparation. The occupation requires sustained repetitive wrist movements, forceful gripping, and heavy lifting that place significant stress on the TFCC and surrounding structures.

History

The veteran the veteran developed left wrist TFCC sprain during his military service as a Chef in the Australian Defence Force from February 2011 to Apr 2018. The condition likely developed through repetitive occupational activities and training, representing cumulative occupational trauma rather than a single incident.

Timeline

07 January 2019 - MRI both wrists revealed significant left wrist pathology affecting the TFCC complex. The radial attachment of the TFCC was intact but there was a partial-thickness tear of the foveal attachment, with a delaminating component extending into the main body of the TFCC. The styloid attachment showed degeneration with a probably tiny intrasubstance tear. The radiologist specifically commented on the tear of the TFCC representing structural damage from chronic loading. The findings suggest chronic degenerative changes consistent with occupational overuse during military service, with the left wrist showing more severe pathology indicative of cumulative trauma.

Symptoms

The veteran developed insidious onset of left wrist pain during his military service, particularly with rotational movements and loading activities. Current symptoms include ulnar-sided wrist pain that worsens with gripping and rotational activities, pain with ulnar deviation, clicking or catching sensations with wrist movement, and functional limitation with heavy lifting activities. The symptoms are consistent with TFCC pathology and chronic ligamentous dysfunction.

Imaging

07 January 2019 - MRI both wrists: Partial-thickness tear of the foveal attachment, with a delaminating component extending into the main body of the TFCC. The styloid attachment showed degeneration with a probably tiny intrasubstance tear.

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

Left Wrist TFCC Sprain (Partial-Thickness Tear with Delaminating Component), DVA SOP: Sprain and Strain No. 28 of 2020, ICD-10: S63.51.

A TFCC sprain involves injury to the triangular fibrocartilage complex, which consists of the triangular fibrocartilage disc, meniscus homologue, extensor carpi ulnaris tendon sheath, dorsal and volar radioulnar ligaments, and ulnocarpal ligaments. The TFCC acts as a stabilizer for the distal radioulnar joint and provides load transmission across the ulnocarpal joint. Sprain injuries involve tearing or stretching of these ligamentous structures, associated with the onset of pain and tenderness. The foveal attachment is a critical component for TFCC stability, and tears in this region can result in significant functional impairment and chronic pain.

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

When did the veteran first experience symptoms attributable to this condition? Unknown specific date during military service 2013-2020. No specific documentation of symptom onset found in the provided records.

When did the veteran first present to a health / medical provider for this condition? 24 September 2018 during DVA assessment with Dr Thomas Perkins at Veterans Health Centre [Email - General & Service Details.pdf, page 1].

When was the condition confirmed / formally diagnosed? 07 January 2019 by Radiologist the treating doctor via MRI both wrists imaging [IMAGING.pdf, page 1].

When did the veteran first present to you (or your practice) for this condition? 15 July 2018.

3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.

The diagnosis was confirmed by MRI imaging conducted by Radiologist the treating doctor on 07 January 2019. The imaging revealed partial-thickness tear of the foveal attachment with a delaminating component extending into the main body of the TFCC, and styloid attachment degeneration with probable tiny intrasubstance tear [IMAGING.pdf, page 1]. The radiologist specifically commented on the tear of the TFCC representing significant structural damage to this critical wrist stabilizing structure.

4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.

Factor 9(1): experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament

MET. Military chef duties involved repeated significant physical forces applied through the left wrist during heavy lifting, forceful gripping, and rotational movements with kitchen equipment that exceeded the tolerance of the TFCC complex.

Factor 9(3): experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament

MET. Ongoing military duties throughout his 7-year service continued to apply significant physical forces through the wrist joint, contributing to progressive worsening and development of the delaminating TFCC tear observed on imaging.

Sequelae

This condition is not a sequelae of another known condition but represents primary occupational TFCC sprain from military service activities.

Unintended Consequence

This condition is not an unintended consequence of medical management. No procedures or medications were administered that contributed to the development of this condition.

Inability to Attain Appropriate Medical Management

There was an inability to attain appropriate medical management during military service. The condition was not diagnosed or treated during the veteran's 7-year military service despite ongoing occupational exposure to causative factors. Per the Full Federal Court in Brew v Repatriation Commission (07 July 1993), inability encompasses both objective and subjective lack of ability to obtain treatment. The absence of presentations for wrist pain during military service indicates barriers to healthcare, satisfying inability to attain appropriate medical management. This inability resulted in permanent worsening as the condition progressed from reversible acute sprain to irreversible structural damage including partial-thickness tears with delaminating components as demonstrated on MRI imaging.

The % contribution of the causes is 100% and significant.

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

Need a Diagnostic Assessment like this written from your own medical record? A VHC Chart Review finds every claimable condition in your file, and each one is written up against its Statement of Principles. Fixed fee $600 + GST per stage — see all fees or book an appointment.