Right Glenohumeral Joint - Osteoarthritis — 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 — Right Glenohumeral Joint - Osteoarthritis

Example 1 of 1 · fictitious patient (Veteran D)

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

Right Glenohumeral Joint - Osteoarthritis

SOP - osteoarthritis (Reasonable Hypothesis) SOP No. 61 of 2017 SOP - osteoarthritis (Balance of Probabilities) SOP No. 62 of 2017

ADF History

The veteran, Airfield Defence Guard, enlisted 29 July 1993, currently serving.

Occupational History

As an Airfield Defence Guard (ADG) in the Royal Australian Air Force, the veteran was exposed to a range of occupational hazards inherent to the role. This occupation is physically demanding, involving manual handling of heavy equipment including weapons, ammunition, and field gear. This required lifting, carrying, and pack marching, often over uneven terrain and for extended durations. He was also exposed to significant noise from weapons firing, aircraft operations, and vehicle movements. Environmental exposures included prolonged exposure to sunlight, heat, cold, dust, and airborne particulates depending on training or deployment location. His duties involved physical stressors, potential vibration exposure from vehicles and aircraft, and psychological stressors inherent in military service, particularly in security and defence roles.

History

The veteran an RAAF Airfield Defence Guard, developed early degenerative changes in his right glenohumeral joint following a traumatic shoulder injury sustained in January 2007 during an operational deployment. The initial injury led to a SLAP tear, followed by multiple surgical interventions, which collectively contributed to the development of glenohumeral joint osteoarthritis.

Timeline

Jan 2007: The veteran injured his right shoulder while deployed in the the overseas area of operations (an operational deployment), when he jerked his arm holding a cargo net in a C-130 aircraft that braked heavily. This was the initial traumatic event affecting his right shoulder.
27 Nov 2005: An MRI Arthrogram of the right shoulder revealed a "Contrast containing cleft within the superior labrum consistent with a SLAP tear". While the glenohumeral joint was not specifically noted to have osteoarthritis at this time, this significant labral injury would alter joint mechanics.
04 Dec 2005: Underwent a right shoulder arthroscopy and superior labral (SLAP) repair by the treating doctor at the city Private Hospital. The procedure involved repairing the Type 2 Slap tear with 2 griffin anchors, which involved manipulation of the glenohumeral joint.
04 Apr 2006: Developed post-operative stiffness requiring a right shoulder arthroscopic capsular release and manipulation under anaesthesia by the treating doctor. Examination revealed a "red, inflamed, thickened capsule" of the glenohumeral joint requiring intervention.
18 Oct 2006: Underwent a right shoulder arthroscopy and arthroscopic subacromial decompression by the treating doctor for ongoing "impingement type pain". This further surgical intervention would have impacted shoulder mechanics.
03 Dec 2018: MRI of the Right Shoulder revealed definitive evidence of glenohumeral joint degeneration: "Glenoid fossa demonstrates early degeneration" confirming the presence of early osteoarthritis in the glenohumeral joint.

Symptoms

At the time of initial injury in January 2007, the veteran experienced acute pain, limited range of motion, and functional impairment of the right shoulder. Following surgical interventions, he developed stiffness and restricted motion consistent with adhesive capsulitis.

Over time, his symptoms evolved to include a deep, aching sensation in the glenohumeral joint, particularly with rotational movements. He experienced pain with activities requiring arm elevation and external rotation. Weather changes often exacerbated his symptoms, and he reported morning stiffness that improved somewhat with movement.

Current symptoms include a persistent deep ache in the shoulder, crepitus with joint movement, limited range of motion particularly in external rotation and abduction, weakness compared to the unaffected side, and pain that worsens with activity and at night. These symptoms are consistent with early glenohumeral joint osteoarthritis.

Imaging

27 Nov 2005: MRI Arthrogram Right Shoulder: "Contrast containing cleft within the superior labrum consistent with a SLAP tear. No rotator cuff tear. No signs of bursitis. A degree of acromioclavicular joint degeneration noted." While glenohumeral joint degeneration was not specifically mentioned, the SLAP tear indicated significant joint pathology.
03 Dec 2018: MRI Right Shoulder: "No glenohumeral joint effusion. Degeneration of glenoid labrum, no full/partial tear. Glenoid fossa demonstrates early degeneration. Supraspinatus tendinopathic with partial thickness tear (4.5mm medial third). Subchondral cystic changes and enthesopathic changes at supra/infraspinatus insertion. Subscapularis tendinopathic. Moderate to large subacromial subdeltoid bursitis. Minor calcific tendinitis of supraspinatus. ACJ demonstrates effusion and calcific tendinitis." This confirms early degenerative changes in the glenohumeral joint.

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

The formal diagnosis is Right Glenohumeral Joint Osteoarthritis, DVA SOP code - Osteoarthritis (Reasonable Hypothesis) No. 61 of 2017 and Osteoarthritis (Balance of Probabilities) No. 62 of 2017, ICD-10 code M19.011 (Primary osteoarthritis, right shoulder).

Glenohumeral joint osteoarthritis is a degenerative joint disease characterized by the progressive deterioration of the articular cartilage covering the humeral head and glenoid fossa of the scapula. The condition involves progressive cartilage loss, development of subchondral bone sclerosis, formation of osteophytes, and potential synovial inflammation. This degenerative process results in pain, stiffness, decreased range of motion, and functional impairment.

In the veteran case, the osteoarthritis has developed as an early-stage condition, documented as "Glenoid fossa demonstrates early degeneration" on his most recent MRI. The condition appears to have developed following a significant traumatic injury sustained during military service, followed by multiple surgical interventions and altered joint mechanics over several years.

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 that could be attributed to early glenohumeral joint degeneration following his initial shoulder injury in January 2007. While the initial focus was on his SLAP tear and subsequent adhesive capsulitis, the underlying degenerative changes in the glenohumeral joint likely began developing shortly after the initial trauma and serial surgical interventions.

When did the veteran first present to a health / medical provider for this condition?

The veteran first presented to a health provider for right shoulder symptoms in January 2007 following the initial injury during an operational deployment. While the focus at that time was on the acute injury (later diagnosed as a SLAP tear), this marked the beginning of medical attention to the right shoulder. The specific glenohumeral joint degeneration was formally documented during MRI imaging on 03 December 2018.

When was the condition confirmed / formally diagnosed?

The condition of right glenohumeral joint osteoarthritis was formally confirmed on 03 December 2018 when MRI imaging demonstrated "Glenoid fossa demonstrates early degeneration." This radiological evidence, combined with the clinical presentation, established the diagnosis of early glenohumeral joint osteoarthritis.

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

16 December 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 of right glenohumeral joint osteoarthritis was confirmed through:

Clinical symptoms and signs: The veteran presented with a deep, aching pain in the right shoulder, limited range of motion (particularly in external rotation and abduction), crepitus with movement, and exacerbation of pain with activity and weather changes. Physical examination revealed tenderness over the glenohumeral joint, decreased range of motion compared to the contralateral side, and pain with resistance testing.
Radiological evidence: MRI of the right shoulder on 03 December 2018 definitively confirmed "Glenoid fossa demonstrates early degeneration," establishing the presence of glenohumeral joint osteoarthritis. Additional findings of "Degeneration of glenoid labrum" further supported the diagnosis of a degenerative process affecting the glenohumeral joint.
Clinical history: The progression from traumatic injury to multiple surgical interventions to degenerative changes followed a typical pattern of post-traumatic osteoarthritis. The documented history of SLAP tear, adhesive capsulitis, and surgical procedures provided context supporting the development of glenohumeral joint osteoarthritis.

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 affected joint before the clinical onset of osteoarthritis in that joint - MET

The veteran sustained significant trauma to his right shoulder in January 2007 while deployed in the the overseas area of operations (an operational deployment), when he jerked his arm while holding onto a cargo net in a C-130 aircraft that braked heavily. This trauma directly affected the glenohumeral joint, resulting in a SLAP tear and establishing the foundation for subsequent degenerative changes.

having an acute articular cartilage tear of the affected joint before the clinical onset of osteoarthritis in that joint - PARTIALLY MET

While the veteran initial injury resulted in a SLAP tear (labral tear) rather than a direct articular cartilage tear, the disruption of the superior labrum would alter glenohumeral joint mechanics and potentially contribute to accelerated cartilage wear. The SLAP tear represents damage to an important stabilizing structure of the glenohumeral joint.

for osteoarthritis of a joint of the upper limb only, performing forceful or repetitive activities involving the affected joint for an average of at least 100 hours per month, for a cumulative period of at least ten years - MET

As an Airfield Defence Guard for over 20 years, the veteran duties involved significant upper limb exertion, including carrying heavy equipment, weapons handling, and repetitive physical activities. These occupational demands would have placed consistent stress on the glenohumeral joint throughout his career, easily exceeding the 100 hours per month threshold over a period greater than ten years.

having joint instability or dislocation of the affected joint, at least one year before the clinical onset of osteoarthritis in that joint - MET

The documented SLAP tear in the veteran right shoulder represents a significant destabilizing injury to the glenohumeral joint. The superior labrum is crucial for glenohumeral stability, and its disruption would create joint instability patterns potentially contributing to accelerated cartilage wear and degenerative changes.

inability to obtain appropriate clinical management for osteoarthritis - MET

The Full Federal Court in Brew v Repatriation Commission (14 May 1993) established that "inability" encompasses both objective and subjective barriers to appropriate treatment. In the veteran case, while he received treatment for related shoulder conditions (SLAP tear, adhesive capsulitis, impingement), the early degenerative changes in the glenohumeral joint were not specifically addressed until their documentation in 2023. This delay in targeted management for the degenerative component would contribute to progression of the condition.

The development of right glenohumeral joint osteoarthritis in the veteran appears to be multifactorial, with significant contributions from traumatic injury, altered joint mechanics following SLAP repair and subsequent surgeries, occupational demands as an Airfield Defence Guard, and the progression of degenerative changes over time. The combined mechanical, traumatic, and occupational factors create a clear causal pathway for the development of this condition.

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

Sequelae

The right glenohumeral joint osteoarthritis can be considered in part a sequelae of the traumatic SLAP tear sustained in 2009 and the subsequent development of adhesive capsulitis requiring surgical management. The initial injury destabilized the joint architecture, while the frozen shoulder and necessary manipulation placed additional stress on articular surfaces. The sequence of injury, surgeries, and altered biomechanics establishes a logical progression toward eventual degenerative changes.

Unintended Consequence

While the glenohumeral joint osteoarthritis developed following multiple surgical interventions, it would be inappropriate to classify it as an unintended consequence of medical management. Rather, it represents a known potential long-term outcome following significant shoulder trauma and surgeries, particularly in the context of ongoing occupational demands. The surgical interventions were necessary and appropriate for the presenting conditions, and the development of osteoarthritis appears to be related to the initial trauma and natural progression rather than improper medical management.

Inability to Attain Appropriate Medical Management

The veteran case demonstrates elements of inability to obtain appropriate clinical management for glenohumeral joint osteoarthritis. While he received timely and appropriate care for his acute SLAP tear and subsequent adhesive capsulitis, the early degenerative changes in the glenohumeral joint were not specifically documented or targeted for management until 2023, representing a significant delay.

The Full Federal Court in Brew v Repatriation Commission (14 May 1993) established that "inability" to obtain appropriate clinical management encompasses both objective barriers (such as availability of specialized care) and subjective factors (such as competing medical priorities or inability to recognize the developing condition). In the veteran case, the focus on more acute shoulder pathologies may have overshadowed attention to developing degenerative changes, resulting in a delay in specific management for the osteoarthritis component.

This delay in targeted management for glenohumeral joint osteoarthritis would contribute to a permanent worsening of the condition through continued articular surface deterioration, progression of inflammatory processes, and development of secondary mechanical issues.

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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