Diagnostic Assessment — Right Clavicle - Fracture
Example 1 of 1 · fictitious patient (Veteran B)
Diagnostic Assessment
Right Clavicle - Fracture
Statement of Principles concerning Fracture (Reasonable Hypothesis) (No. 62 of 2024) Statement of Principles concerning Fracture (Balance of Probabilities) (No. 63 of 2024)
ADF History
The veteran served in the Australian Army as an Analyst in Intelligence Operations (ECN 002/Linguist) and held the rank of Corporal (CPL). His service records indicate active service from at least 1994 until a separation health examination on 11 Jan 2007.
Occupational History
As an Analyst in Intelligence Operations and a Linguist in the Australian Army, the veteran duties would have primarily involved sedentary work, including detailed analysis, screen-based tasks, and report writing. While the core duties are office-based, ADF service inherently includes participation in physical training, field exercises, and potential deployments. These activities can carry risks of physical injury from accidents, falls, or strenuous activities, irrespective of the primary trade. Personnel are expected to maintain a level of physical fitness and may engage in sports or other physical recreational activities during their service.
History
The veteran the veteran, while serving as a Corporal in the Australian Army, sustained a fracture to his right clavicle on 22 July 1999. This injury occurred as a result of a fall from a mountain bike.
Timeline
- 22 Jul 1999: The veteran was involved in a mountain bike accident, resulting in significant trauma to his right shoulder region. He was subsequently diagnosed at the regional hospital with a facture Right claucle (sic). The medical certificate from a medical officer, at the regional hospital, dated 22 Jul 1999, confirms this diagnosis and notes he would be unfit for work for 3 weeks. He was also noted to have sustained multiple abrasions and a head injury in the same incident, for which he received instructions for care. He was admitted to the base medical unit (the base medical unit) on this date.
- 23 Jul 1999: A medical certificate from S.the treating doctor indicated the veteran was suffering from a facture Right claucle and multiple abrasions, rendering him unfit for work from 23 Jul 1999 for 3 weeks. This reiterated the diagnosis made the previous day.
- 24 Jul 1999: The veteran was discharged from the base medical unit. A medical fitness advice form from this date indicates his discharge.
- 04 Aug 1999: A medical fitness advice form notes review for Fracture right clavicle. He was placed on restricted duties for 30 days due to this injury. An outpatient clinical record from the base medical unit on the same day by A. the treating doctor (MO) documents the # clavicle 22/09/01. It notes pain was gradually improving, he was fit for work with restricted duties, and also mentioned associated right shoulder tip pain.
- 20 Sep 1999: An entry by the treating doctor notes Now #R clavicle physio since 05/51. This indicates ongoing physiotherapy for the right clavicle fracture. He was on restricted duties (CHIT) for 30 days and a MEC downgrade was anticipated after physiotherapy.
- 04 Oct 1999: A medical fitness advice form indicates MECR pending, and he was noted as not fit for upper body PT due to the right clavicle injury.
- 25 Jul 2000: A clinical note mentions PHY # (R) clavicle 09/01. Xrayed at the regional hospital. Injured mountain bike injury R shoulder, laceration & ribs. 2 weeks in the base hospital. This entry summarises the past clavicle fracture.
- 16 Jan 2007: During a CPHE, the past history of PHY # (R) clavicle. 09/01. in the base city was noted. This indicates the fracture was a significant part of his past medical history at the time of his separation medical.
Symptoms
At the time of the injury on 22 Jul 1999, the veteran would have experienced acute pain in the right clavicular region, likely with associated swelling, tenderness, and difficulty moving the right arm and shoulder, consistent with a fracture. The records also indicate he sustained a head injury and multiple abrasions simultaneously.
Following the injury, he experienced ongoing pain and functional limitations. On 04 Aug 1999, it was noted that pain was gradually un proving (sic, likely improving) but he still had anterior axillary line pain and right shoulder tip pain. He required physiotherapy for rehabilitation as noted on 20 Sep 1999. Restrictions included being unfit for upper body PT. By 16 Jan 2007, the fracture was noted as part of his past history, implying the acute symptoms had resolved, though any chronic residual symptoms are not detailed in these specific excerpts beyond the historical notation.
Imaging
- 22 Jul 1999: An X-ray of the right shoulder was performed at the regional hospital. The report by the treating doctor states: There is a fracture seen through the Mid shaft of the clavicle with a little inferior displaceMent and overlap by half the width of the shaft. The AC joint is well aligned. No fractures of the shoulder are seen and the glenohumeral joint is enlocated. (Unit Medical Record, page 172)
- 04 Aug 1999: Clinical notes mention "Chase XR results" in the context of the clavicle fracture and possible rib fracture, implying X-rays were reviewed or further X-rays may have been considered, though no new X-ray report from this specific date is detailed in the provided excerpts. (Unit Medical Record, page 71)
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis of the condition is Fracture of Shaft of Right Clavicle.
The DVA SOP that applies is the Statement of Principles concerning Fracture (No. 62 of 2024 for Reasonable Hypothesis and No. 63 of 2024 for Balance of Probabilities).
The ICD-10 code for a fracture of the shaft of the right clavicle, initial encounter for a closed fracture, is S42.021A.
A fracture is defined as an acquired break of bone as a result of an applied force that ordinarily would cause bone breakage in a healthy bone. This includes various types such as avulsion, crush, comminuted, burst, or blowout fractures, and can be closed (skin intact) or compound/open (skin broken). Stress fractures of the fatigue type are also included. The definition encompasses associated damage to adjacent tissues like periosteum, muscle, fascia, skin, nerves, or blood vessels if directly caused by displaced bone fragments, as well as complications like acute vascular shock, compartment syndrome, fat embolism, or wound infection from a compound fracture. It excludes pathological fractures (fractures in diseased bone), bone stress injuries not amounting to a stress fracture, insufficiency type stress fractures, osteonecrosis, periostitis, and fractures of teeth, cartilage, or orthopaedic implants.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The veteran first experienced symptoms (acute pain, inability to use arm properly) attributable to the right clavicle fracture immediately following a fall from his mountain bike on 22 Jul 1999. (Unit Medical Record, page 10, page 72)
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented to a health/medical provider for this condition on 22 Jul 1999 at the regional hospital, where he was attended to by a medical officer. He was also admitted to the base medical unit (the base medical unit) on the same day. (Unit Medical Record, page 8, page 10)
When was the condition confirmed / formally diagnosed?
The right clavicle fracture was confirmed/formally diagnosed on 22 Jul 1999 by a medical officer, at the regional hospital. The diagnosis was confirmed by an X-ray of the right shoulder performed on the same day, which reported a fracture seen through the Mid shaft of the clavicle. (Unit Medical Record, page 10, page 172)
When did the veteran first present to you (or your practice) for this condition?
19 June 2021.
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 of a right clavicle fracture was confirmed through:
- Key symptoms and signs: Following a fall from a mountain bike, the veteran would have presented with acute pain in the right clavicle area, likely deformity or swelling over the fracture site, tenderness on palpation, and an inability to lift the right arm or move the shoulder without significant pain. The medical certificate from 22 Jul 1999 explicitly states facture Right claucle (sic). (Unit Medical Record, page 10)
- Investigation results: An X-ray of the Right Shoulder performed on 22 Jul 1999 at the regional hospital was the definitive investigation. The report stated: "There is a fracture seen through the Mid shaft of the clavicle with a little inferior displaceMent and overlap by half the width of the shaft." This radiological finding confirmed the clinical suspicion of a fracture. (Unit Medical Record, page 172)
- Specialist opinions: The initial diagnosis was made in an emergency department setting by a medical officer (a medical officer). Subsequent management involved medical officers at the base medical unit and the base medical unit, and physiotherapy. While no specific orthopaedic specialist opinion is detailed in these initial excerpts, the diagnosis was clear based on trauma and X-ray.
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.
The cause of the veteran right clavicle fracture was direct physical trauma. The onset of the fracture was 22 July 1999, which is before 29 February 2001. Therefore, this claim falls under the provisions of the Safety, Rehabilitation and Compensation (Defence-related Claims) Act 1987 (DRCA). Under DRCA, there is no requirement to meet specific factors outlined in a Statement of Principles (SOP) in the same way as under the VEA or MRCA for conditions with later onset dates or those related to warlike/non-warlike service. The primary consideration is whether the injury arose out of, or in the course of, his employment with the ADF. While the injury occurred during a recreational activity (mountain biking), if this activity was sanctioned or encouraged as part of maintaining fitness for service, or if it occurred on Defence land or during a period he was considered on duty, it could potentially be linked to his employment. However, for the purpose of this report, we will still analyze against the SOP factors as a comprehensive assessment, while noting the DRCA context.
The relevant Statement of Principles is the Statement of Principles concerning Fracture (No. 62 of 2024 - RH and No. 63 of 2024 - BoP). The key factor for the clinical onset of a fracture is:
Factor 9(1) (RH) / 9(1) (BoP): having significant physical force applied to or through the affected bone at the time of clinical onset;
- Status: MET
- the veteran sustained the fracture when he Fell off cycle 22/09/01, which constitutes a significant physical force applied to or through the right clavicle. (Unit Medical Record, page 72)
No factors relating to fracture non-union (clinical worsening) appear applicable from the provided information, as the fracture seems to have healed, albeit requiring physiotherapy and a period of restricted duties.
Sequelae
The provided records indicate that the veteran underwent physiotherapy for his fractured clavicle and had a period of restricted duties, including being unfit for upper body PT. While the acute fracture healed, potential sequelae of clavicle fractures can include residual pain, stiffness, altered shoulder mechanics, or cosmetic deformity, though these are not explicitly detailed as ongoing chronic issues in the later entries of the provided records. The note from 04 Aug 1999 mentioned anterior axillary line pain & R shoulder tip pain, which could be considered acute sequelae or associated injuries.
Unintended Consequence
There is no indication in the provided medical records that the veteran right clavicle fracture was an unintended consequence of medical treatment paid for by the Commonwealth. The fracture was the result of a traumatic accident.
Inability to Attain Appropriate Medical Management
Following the injury on 22 July 1999, the veteran received immediate medical attention at the regional hospital, including diagnostic X-rays. He was subsequently admitted to the base medical unit and later managed at the base medical unit, receiving physiotherapy and medical reviews. This demonstrates that he was able to access and receive medical management for his fracture. There is no evidence to suggest an inability to obtain appropriate clinical management for the fracture that led to a permanent worsening of the fracture itself. The Full Federal Court in Brew v Repatriation Commission (09 May 1996) discusses "inability" in both objective and subjective senses; no such barriers are evident here for the management of the acute fracture.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
