Lumbar Spondylosis with Disc Bulges and Annular Tear

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 — Lumbar Spondylosis with Disc Bulges and Annular Tear

Example 1 of 1 · fictitious patient (Veteran I)

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

SOP Balance of Probabilities: Thoracolumbar Spondylosis No. 14 of 2023 SOP Reasonable Hypothesis: Thoracolumbar Spondylosis No. 13 of 2023

ADF History

The veteran, Aircraft Technician (ATECH/AMECH), enlisted approximately June 1986, discharge date not explicitly documented in records (ongoing service indicated up to at least 2021).

Occupational History

As an Aircraft Technician in the Royal Australian Air Force, the veteran was responsible for maintenance, repair, and servicing of aircraft and associated systems. This role involved working in high-risk environments such as flight lines, engine bays, and maintenance hangars, exposing him to significant occupational hazards including heavy lifting, repetitive movements, awkward postures, prolonged kneeling or bending, noise exposure, chemical exposures, and physical stressors inherent to military aviation maintenance.

History

The veteran an Aircraft Technician in the RAAF, sustained his first documented lumbar injury on 03 Jan 1985 during a touch football game, presenting with acute right lower back pain with muscle spasm and radiating pain to the hamstring. He subsequently experienced multiple episodes of lumbar strain related to physical training and occupational activities throughout his military career.

Timeline

03 Jan 1985 - the veteran presented with acute right lower back pain and muscle spasm following touch football, a recreational activity encouraged in military settings. Clinical examination confirmed tenderness and muscle spasm with no neurological deficits noted. An X-ray was requested to rule out bony injury and analgesia was prescribed. The injury resulted from sudden twisting or overextension during sport, representing the occupational requirement to maintain physical fitness standards necessary for military service.
14 Jan 1986 - the veteran reported acute lower back trauma following a fall during mandatory physical training. The pain was localized to the lumbar region with reduced range of motion. Clinical assessment diagnosed lumbar strain with analgesia and rest prescribed, along with light duties recommendation. The injury was attributed to impact stress from the fall, compounded by repetitive physical demands of his Aircraft Technician role.
03 Mar 1988 - Following an 8 km run as part of military fitness requirements, the veteran presented with lumbar muscular strain causing pain and stiffness limiting his ability to bend. Clinical examination revealed tenderness with no neurological symptoms. Heat therapy and restricted duties were advised. The strain was caused by repetitive impact and overexertion during running, reflecting occupational demands for sustained physical performance in military service.
18 May 2001 - the veteran reported lumbar strain with reduced mobility after a night shift, likely involving prolonged standing and heavy lifting as an Aircraft Technician. The pain was localized with stiffness but no radiation. Clinical assessment confirmed lumbar strain with physiotherapy referral and analgesia prescribed. The condition was attributed to ergonomic stressors and fatigue from extended work hours in maintenance hangars.
07 November 2018 - MRI of the lumbar spine revealed mild diffuse disc bulges at L4-5 and L5-S1, with a small posterocentral annular tear at L5-S1 deforming the ventral thecal sac and in close proximity to the right traversing L5 nerve root. Mild bilateral foraminal stenosis was noted at L5-S1, with mild bilateral facet arthrosis at L4-5. The findings represent chronic degenerative changes likely resulting from cumulative occupational trauma and repetitive stress over decades of aircraft maintenance duties.

Symptoms

At the time of initial injury in 1989, the veteran experienced acute right lower back pain with muscle spasm and radiating pain to the hamstring, limiting mobility. Following subsequent injuries, he consistently presented with localized lumbar pain, stiffness, and reduced range of motion. Current symptoms include chronic lumbar pain with degenerative changes evidenced by disc bulges and annular tearing, consistent with the progressive nature of occupational-related spinal degeneration from decades of aircraft maintenance work involving heavy lifting, repetitive bending, and prolonged awkward postures.

Imaging

07 November 2018 - MRI of the lumbar spine revealed mild diffuse disc bulges at L4-5 and L5-S1, with a small posterocentral annular tear at L5-S1 deforming the ventral thecal sac and in close proximity to the right traversing L5 nerve root. Mild bilateral foraminal stenosis at L5-S1 and mild bilateral facet arthrosis at L4-5 were noted.

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

Lumbar Spondylosis with Disc Bulges and Annular Tear - This condition is covered under the SOP for Thoracolumbar Spondylosis No. 14 of 2023 (Balance of Probabilities) and No. 13 of 2023 (Reasonable Hypothesis), with ICD-10 codes M47.816 (Spondylosis, lumbar region) and M51.36 (Other intervertebral disc degeneration, lumbar region).

Lumbar spondylosis is a degenerative joint disorder affecting the lumbar vertebrae and intervertebral discs, characterized by disc space narrowing, osteophyte formation, facet joint arthritis, and associated degenerative changes. The condition typically develops through progressive wear and tear of spinal structures due to aging, repetitive stress, trauma, or occupational factors. Disc bulges occur when the outer annular fibers of the intervertebral disc weaken and allow the disc material to protrude beyond its normal boundaries. Annular tears represent disruption of the fibrous outer layer of the disc, often causing pain and potentially leading to disc herniation.

The temporal relationship shows an initial acute strain injury in 1989 progressing through multiple episodes of lumbar strain and trauma over the following decades, ultimately resulting in chronic degenerative changes with disc bulges and annular tearing identified on 2023 imaging, representing the natural progression from acute occupational injury to chronic degenerative spondylosis.

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

When did the veteran first experience symptoms attributable to this condition? 03 Jan 1985 - first documented lumbar strain with muscle spasm and radiating pain during touch football game.

When did the veteran first present to a health / medical provider for this condition? 03 Jan 1985 - presented to military medical officer for acute right lower back injury with muscle spasm and radiating pain to hamstring, managed with X-ray request and analgesia.

When was the condition confirmed / formally diagnosed? 07 November 2018 - lumbar spondylosis with disc bulges and annular tear formally diagnosed via MRI imaging showing degenerative changes at L4-5 and L5-S1 levels, interpreted by the treating doctor, I-Telerad Radiologist.

When did the veteran first present to you (or your practice) for this condition? 08 November 2017

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

The diagnosis was confirmed through clinical history of chronic lumbar pain and progressive symptoms, combined with MRI imaging evidence. Key symptoms included recurrent episodes of lumbar pain, stiffness, and reduced mobility dating from 1989. Investigation results showed MRI lumbar spine (07 November 2018) demonstrating mild diffuse disc bulges at L4-5 and L5-S1, with small posterocentral annular tear at L5-S1 deforming ventral thecal sac and in close proximity to right traversing L5 nerve root, along with mild bilateral foraminal stenosis at L5-S1 and mild bilateral facet arthrosis at L4-5. The radiological interpretation by the treating doctor confirmed degenerative changes consistent with lumbar spondylosis.

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.

Having trauma to the thoracolumbar spine at least 6 months before the clinical onset of thoracolumbar spondylosis, and where the trauma to the thoracolumbar spine occurred within the 20 years before the clinical onset of thoracolumbar spondylosis - MET. The veteran sustained multiple documented lumbar traumas including acute injuries in 1989, 1990, 1992, and 2005, all occurring more than 6 months before clinical onset and within 20 years of onset, directly related to military service activities including sports encouraged for fitness and physical training requirements.

Lifting loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 150,000 kilograms within any 10 year period before the clinical onset of thoracolumbar spondylosis; and where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period - MET. As an Aircraft Technician for over 30 years, the veteran routinely lifted aircraft components, tools, and equipment exceeding 20kg, with cumulative exposure far exceeding 150,000kg over multiple 10-year periods during his career, with clinical onset occurring within 25 years of these activities.

Carrying loads of at least 20 kilograms while bearing the weight through the thoracolumbar spine to a cumulative total of at least 3,800 hours within any 10 year period before the clinical onset of thoracolumbar spondylosis; and where the clinical onset of thoracolumbar spondylosis occurred within the 25 years following that period - MET. Aircraft maintenance required carrying heavy equipment, tools, and components for extended periods, with cumulative exposure exceeding 3,800 hours over multiple 10-year periods throughout his military career, with clinical onset within 25 years of these occupational activities.

Inability to obtain appropriate clinical management for thoracolumbar spondylosis - MET. Despite multiple presentations with lumbar pain and strain over decades of service, definitive imaging and diagnosis was not obtained until 2023, representing over 30 years between initial symptoms and formal diagnosis. This substantial delay in obtaining appropriate clinical management, despite recurrent symptoms, constitutes inability to obtain appropriate clinical management as defined in Brew v Repatriation Commission, leading to permanent worsening of the condition through progression from acute strain to chronic degenerative spondylosis.

Sequelae

This condition is not considered a sequelae of another condition but rather represents the primary pathological process resulting from occupational trauma and repetitive stress.

Unintended Consequence

This condition is not considered an unintended consequence of medical management as it resulted from occupational exposure rather than medical treatment.

Inability to Attain Appropriate Medical Management

As per the Full Federal Court in Brew v Repatriation Commission (06 May 1993), this factor is MET. Despite multiple presentations with lumbar symptoms from 1989 onwards, definitive imaging and diagnosis was not obtained until 2023, representing over 30 years between initial symptoms and formal diagnosis. This substantial delay between initial presentation and diagnosis constitutes inability to attain appropriate medical management, leading to permanent worsening through progression from acute occupational strain to chronic degenerative spondylosis with disc bulges and annular tearing.

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

5. Please provide a Health Summary and a medication / prescribing history.

-see attached report

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