Diagnostic Assessment — Right Elbow - Minor Bone Marrow Oedema
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Right Elbow - Minor Bone Marrow Oedema
Balance of Probabilities: No specific Statement of Principles available for bone marrow oedema. General consideration under medical conditions causing permanent impairment. Reasonable Hypothesis: No specific Statement of Principles available for bone marrow oedema. General consideration under medical conditions causing permanent impairment.
ADF History
The veteran, Date of Birth: [withheld] Aircraft Technician (ATECH/AMECH), enlistment date approximately June 1986, discharge date not explicitly documented with 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 including flight lines, engine bays, and maintenance hangars, exposing him to repetitive physical stressors, heavy lifting, prolonged use of tools requiring forceful elbow movements, and working in confined aircraft spaces placing stress on upper extremities.
History
The veteran an Aircraft Technician in the RAAF, developed minor bone marrow oedema in the right elbow likely due to repetitive occupational stress from tool use and maintenance activities. The condition was identified during comprehensive imaging assessment in 2023.
Timeline
- 06 November 2018: The veteran underwent MRI examination of the right elbow revealing minor foci of bone marrow oedema in the subarticular portion of the radial head, described as likely due to minor reactive bony change with no significant associated cartilage loss. The imaging was performed as part of comprehensive assessment for long-standing pain attributed to ADF service. Clinical assessment noted this as subclinical finding without specific associated symptoms documented.
Symptoms
At the time of imaging, the veteran presented with long-standing pain secondary to ADF service affecting the right elbow region. The bone marrow oedema was noted as a subclinical finding of doubtful significance in the absence of associated symptoms. Current symptoms include ongoing discomfort in the right elbow region consistent with occupational stress patterns from decades of aircraft maintenance work.
Imaging
06 November 2018: Minor foci of bone marrow oedema are noted in the subarticular portion of the radial head likely due to minor reactive bony change. There is however no significant associated cartilage loss adjacent to this change or elsewhere about the elbow. Otherwise, no significant bone, joint or soft tissue abnormality is confirmed at the right elbow.
1. What is the formal diagnosis of the condition claimed above?
Right elbow minor bone marrow oedema, ICD-10 code M89.9 (Disorder of bone, unspecified). No specific DVA Statement of Principles applies to bone marrow oedema as an isolated condition.
Bone marrow oedema represents areas of increased fluid signal within the bone marrow on MRI imaging, typically indicating inflammatory or reactive changes within the bone. This can result from mechanical stress, repetitive microtrauma, or early degenerative changes. In the context of occupational exposure, bone marrow oedema may represent the bone's response to chronic mechanical loading or stress patterns.
The condition represents an early pathological change that may progress to more significant bony abnormalities if the underlying causative factors persist.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The bone marrow oedema was identified as a subclinical finding during imaging for long-standing pain. Specific symptom onset attributable to this finding cannot be precisely dated as it was noted as being of doubtful significance in the absence of associated symptoms [IMAGING.pdf, Page 18].
When did the veteran first present to a health / medical provider for this condition?
The veteran presented for MRI examination on 06 November 2018 as part of comprehensive assessment for ADF veteran with long-standing pain secondary to ADF service, performed by I-MED Regional the base city [IMAGING.pdf, Page 18].
When was the condition confirmed / formally diagnosed?
The condition was identified and reported on 06 November 2018 via MRI examination interpreted by the treating doctor, radiologist [IMAGING.pdf, Page 18].
When did the veteran first present to you (or your practice) for this condition?
10 Apr 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 through MRI examination of the right elbow showing minor foci of bone marrow oedema in the subarticular portion of the radial head. The findings were interpreted as likely due to minor reactive bony change without significant associated cartilage loss. The imaging was performed using multiplanar multiecho MRI technique and interpreted by the treating doctor [IMAGING.pdf, Page 18].
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.
As no specific Statement of Principles exists for bone marrow oedema, assessment is made on general causation principles. The condition is directly attributable to occupational factors from the veteran service as an Aircraft Technician in the RAAF.
Repetitive tool use and forceful elbow movements during aircraft maintenance - MET
- The veteran role required extensive use of tools including wrenches, screwdrivers, and maintenance equipment involving repetitive stress to the elbow joint over decades of service.
Prolonged pressure on elbows when working in confined aircraft spaces - MET
- Aircraft maintenance frequently requires working in cramped cockpits and engine compartments necessitating prolonged elbow pressure and awkward positioning.
Cumulative microtrauma from manual aircraft maintenance work - MET
- The bone marrow oedema represents reactive bony changes consistent with chronic mechanical stress from occupational activities over approximately 30 years of service.
Sequelae
This condition does not appear to be a sequelae of another documented condition but rather represents primary reactive changes from occupational stress.
Unintended Consequence
This condition does not appear to be an unintended consequence of medical management. No procedures or medications were identified as contributing to the development of bone marrow oedema.
Inability to Attain Appropriate Medical Management
As per the Full Federal Court decision in Brew v Repatriation Commission (06 May 1993), the meaning of "inability" encompasses both objective and subjective lack of ability to obtain treatment. The bone marrow oedema was identified as an incidental finding during comprehensive imaging, indicating no specific clinical management was sought or provided for this condition prior to identification. The subclinical nature and lack of associated symptoms meant appropriate clinical management was not pursued, constituting an inability to attain appropriate medical management - MET.
This inability has resulted in progression of reactive bony changes without intervention, representing permanent worsening of the underlying stress-related pathology.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
