Diagnostic Assessment — Right Hand - Dorsal Burn
Example 1 of 1 · fictitious patient
Diagnostic Assessment Right Hand — Dorsal Burn BOP Code: 2 of 2024 (Heat-Induced Burn) RH Code: 1 of 2024 (Heat-Induced Burn)
ADF History
The veteran, date of birth [withheld], served in the Royal Australian Navy as a Marine Technician from 15 January 1988 to 31 October 1994
History
The veteran sustained a burn to the dorsum of the right hand during ADF service.
On 24 May 1990 a superficial burn to the dorsum of the right hand was diagnosed and treated with topical Silvazine daily; the mechanism and place are not recorded.
The burn was recorded while he was on convalescent leave after hammer-toe surgery of 26 April 1990 (leave recorded 17 July to 10 June 1990), on the day he was admitted to Calvary Hospital, a frigate, for removal of a K-wire from the left second toe.
As a Marine Technician aboard naval vessels, the veteran was exposed to numerous occupational hazards including hot surfaces, machinery, and cooking/galley duties that could result in burns to the hands
Timeline
During service (1988 1995) — The veteran served aboard multiple naval vessels and at shore establishments.
Burns to the hands are a common occupational injury in the naval environment from contact with hot surfaces, steam, chemicals, and machinery.
24 May 1990 — Superficial burn to the dorsum of the right hand diagnosed on an Outpatient Health Record signed by K Chapman.
Treated with topical Silvazine daily. "Superficial burn dorsum of (R) hand"
Symptoms
On 24 May 1990 the veteran had a superficial burn to the dorsum of the right hand requiring daily topical Silvazine.
No other symptoms are recorded
Imaging
No imaging related to this condition
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Right Hand Dorsal Burn (ICD-10: T23.061A)
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 24 May 1990 (superficial burn to the dorsum of the right hand) When did the veteran first present to a health / medical provider for this condition? 24 May 1990 When was the condition confirmed / formally diagnosed? 24 May 1990 (clinical diagnosis of superficial burn to the dorsum of the right hand) When did the veteran first present to you (or your practice) for this condition? 27 May 2019
3. How was this diagnosis confirmed?
The diagnosis was confirmed on clinical grounds on 24 May 1990, when a superficial burn to the dorsum of the right hand was diagnosed and recorded on an Outpatient Health Record (signed K Chapman) and treated with topical Silvazine daily
4. What do you consider to be the cause(s) of the condition in this veteran?
Legislation: The clinical onset of this condition was before 13 April 2008 (see
Date of Clinical Onset
Below), and it did not arise on warlike or non-warlike deployment (the veteran had no deployments).
This is therefore a DRCA claim.
Statements of Principles do not apply to DRCA claims, so there are no binding SOP factors for this condition.
The factors of the relevant Statements of Principles are applied below by analogy, as a guide to the causes of this condition that are recognised in the medical-scientific literature, and every factor of both the Balance of Probabilities and the Reasonable Hypothesis instruments is addressed.
Under the DRCA the question is whether the injury or disease arose out of, or in the course of, the veteran's ADF service, or (for a disease or an aggravation) whether that service contributed to it to a significant degree.
Plausible links to service outside the SOP factors are set out below.
The absence of documentation does not mean that an event or exposure did not occur: lack of evidence is not evidence of lack.
Definition: The mechanism of the burn was not recorded.
A superficial burn of the back of the hand treated with silver sulfadiazine (Silvazine) is consistent with a thermal burn from contact with heat, and nothing in the record suggests an excluded chemical, electrical, friction or ionising-radiation burn, so it is assessed as a heat-induced burn.
Causative Factors — Balance of Probabilities (Statement of Principles concerning Heat- Induced Burn, No.
2 of 2024) Factor 9(1): having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — MET - The Outpatient Health Record of 24 May 1990 diagnoses a superficial burn of the dorsum of the veteran's right hand, treated with daily topical Silvazine.
A superficial burn involves at least erythema, so the exposure was sufficient to cause at least erythema at the affected area at the time the burn arose, on or shortly before that date.
The heat source is not recorded, but that gap is not evidence against it: nothing suggests a chemical, electrical or friction cause, silver sulfadiazine (Silvazine) is a standard topical treatment for thermal burns, and the injury was recorded as a burn rather than sunburn, so on the balance of probabilities it resulted from exposure to a heat source.
Factor 9(2): having exposure to high intensity, focussed ultrasound sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat- induced burn — NOT MET - There is no record that the veteran ever received high intensity, focussed ultrasound treatment, and nothing in his history suggests it.
Factor 9(3): having exposure to ultraviolet radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - There is no record of exposure of the veteran's right hand to ultraviolet radiation, whether from the sun, an electric welding arc or PUVA therapy, and the burn was not described as sunburn; nothing in his history suggests it.
Factor 9(4): having exposure to solar radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - There is no record that sun exposure caused this burn; it was confined to the back of one hand and recorded as a burn treated with silver sulfadiazine, whereas his sunburn of October 1991 was recorded as sunburn.
Factor 9(5): having laser applied, sufficient to cause at least erythema, at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - There is no record that a laser was applied to the veteran's right hand, and nothing in his history suggests it.
Factor 9(6): having exposure to infrared radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - There is no record of exposure of the veteran's right hand to an infrared source, such as an infrared lamp, sufficient to burn it, and nothing in his history suggests it.
Factor 9(7): having exposure to radiofrequency or microwave radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat- induced burn — NOT MET - There is no record of exposure of the veteran's right hand to radiofrequency or microwave radiation sufficient to burn the skin, and nothing in his history suggests it.
Causative Factors — Reasonable Hypothesis (Statement of Principles concerning Heat- Induced Burn, No.
1 of 2024) the veteran had no operational deployments.
The Reasonable Hypothesis standard applies only to operational service, so these factors are assessed for completeness and, like the Balance of Probabilities factors, by analogy only.
Factor 9(1): having exposure to a heat source sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — MET - On 24 May 1990 a superficial burn of the dorsum of the veteran's right hand was diagnosed and treated with daily silver sulfadiazine (Silvazine), a standard topical treatment for thermal burns.
Although the heat source was not recorded, nothing suggests a chemical, electrical or friction cause, and a superficial burn necessarily involves at least erythema, so exposure to a heat source sufficient to cause at least erythema at that site at the time of onset is established on the available evidence.
Factor 9(2): having exposure to high intensity, focussed ultrasound sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat- induced burn — NOT MET - the veteran has no recorded exposure to high intensity, focussed ultrasound at any time, and nothing in his history suggests such treatment.
Factor 9(3): having exposure to ultraviolet radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - No exposure of the veteran's right hand to ultraviolet radiation from the sun, a welding arc or any other source is recorded in connection with this burn, and nothing in his history suggests it.
Factor 9(4): having exposure to solar radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - The burn of 24 May 1990 was confined to the dorsum of the right hand and was not attributed to sun exposure; there is no record of solar radiation causing it.
Factor 9(5): having laser applied, sufficient to cause at least erythema, at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - No laser treatment or laser exposure of the veteran's right hand is recorded, and nothing in his history suggests it.
Factor 9(6): having exposure to infrared radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat-induced burn — NOT MET - the veteran has no recorded exposure of the dorsum of the right hand to infrared radiation, for example from an infrared lamp, and nothing in his history suggests it.
Factor 9(7): having exposure to radiofrequency or microwave radiation sufficient to cause at least erythema at the affected area of the body at the time of the clinical onset of heat- induced burn — NOT MET - No exposure to radiofrequency or microwave radiation capable of burning the right hand is recorded, and nothing in the veteran's history suggests it.
Other Plausible Links to Service The record of 24 May 1990 does not say how or where the burn occurred.
At the time the veteran was a full-time member posted to a frigate at a frigate, recovering from hammer- toe surgery arranged by the Navy and performed on 26 April 1990, and on the day the burn was recorded he was admitted to Calvary Hospital, a frigate, for removal of a K-wire from the left second toe.
If the burn was sustained on duty, on board or at a naval establishment, or in connection with that treatment, it arose out of or in the course of his employment; his own account of the circumstances is needed to decide this.
Conclusion the veteran's superficial burn of the dorsum of the right hand was caused by exposure of that area to a heat source sufficient to cause at least erythema, the only SOP factor that is met; no other cause is suggested, and nothing indicates an excluded chemical, electrical or friction mechanism.
The burn occurred during his full-time naval service and was treated on 24 May 1990, but the record does not state where or how it was sustained, so its relationship to service depends on whether it occurred on duty, at a naval establishment or in connection with his service medical record treatment.
The % contribution of the causes is 100% and significant.
Worsening Factors In the alternative, if the veteran's right hand burn is found not to have arisen out of his service, the following factors address whether service rendered after its clinical onset on 24 May 1990 aggravated it or contributed to it in a material degree through any inability to obtain appropriate clinical management before a clinical worsening.
Worsening Factors — Balance of Probabilities (Statement of Principles concerning Heat-Induced Burn, No.
2 of 2024) Factor 9(8): inability to obtain appropriate clinical management for heat-induced burn before the clinical worsening of heat-induced burn — NOT MET - Applying Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), there was no inability to obtain appropriate clinical management: the burn was treated with daily silver sulfadiazine when recorded on 24 May 1990 and no clinical worsening is recorded; the loss of his medical record in November 1993, three and a half years later, had no bearing on its treatment.
Worsening Factors — Reasonable Hypothesis (Statement of Principles concerning Heat-Induced Burn, No.
1 of 2024) the veteran had no operational deployments.
The Reasonable Hypothesis standard applies only to operational service, so these factors are assessed for completeness and, like the Balance of Probabilities factors, by analogy only.
Factor 9(8): inability to obtain appropriate clinical management for heat-induced burn before the clinical worsening of heat-induced burn — NOT MET - Assessed objectively and subjectively as Brew v Repatriation Commission (Full Federal Court, 10 September 1999) requires, the veteran obtained prompt and appropriate treatment for the burn on 24 May 1990, and no clinical worsening is recorded; the later loss of his medical record in 1994 did not affect that treatment
Sequelae
No specific sequelae documented
Unintended Consequence
This condition is not an unintended consequence of medical management
Inability to Attain Appropriate Medical Management
The loss of original medical records (PM168) at a frigate constitutes a systemic barrier — MET
Date of Clinical Onset
Right hand dorsal burn is an acute condition.
Its date of clinical onset is the date of the injury or illness itself, as recorded in the contemporaneous service record.
Later investigations, reviews and imaging record the investigation, treatment or confirmation of the condition; they are not the date of clinical onset.
Date of injury / illness: 24 May 1990 — superficial burn to the dorsum of the right hand, treated with Silvazine [CHART REVIEW document].
Date of clinical onset: 24 May 1990.
This date falls within the veteran's ADF service (15 January 1988 31 October 1994).
In-service events and exposures before this date relate to clinical onset, and those after it to clinical worsening
