Right Hand Fourth Metacarpal - Ganglion Cyst — 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 Hand Fourth Metacarpal - Ganglion Cyst

Example 1 of 1 · fictitious patient (Veteran C)

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 Hand Fourth Metacarpal - Ganglion Cyst

Balance of Probabilities SOP: Ganglion No. 8 of 2025 Reasonable Hypothesis SOP: Ganglion No. 9 of 2025

ADF History

The veteran, Communications and Information Systems Controller, enlisted 28 July 1986, discharged 22 Mar 2003.

Occupational History

As a Communications and Information Systems Controller (CISCON), the veteran was exposed to repetitive hand and wrist movements from equipment handling, keyboard use, and manual manipulation of communication devices. The role involved prolonged computer work, equipment setup, and physical training activities that placed stress on the hands and wrists. Deployment environments required handling of tactical communication equipment under challenging conditions.

History

The veteran the veteran a CISCON in the RAAF, developed an intraosseous ganglion cyst in the fourth metacarpal head, discovered incidentally during MRI imaging in 2022 for hand trauma investigations.

Timeline

19 January 2016: MRI revealed an intraosseous ganglion cyst within the head of the fourth metacarpal, identified as an incidental finding during investigation of right hand pain. The cyst was noted to be benign with no associated symptoms specifically attributed to this lesion. The discovery occurred during comprehensive imaging for workplace-related hand injuries, suggesting the cyst may have been present for an extended period without clinical recognition or appropriate management.

Symptoms

The ganglion cyst was asymptomatic at the time of discovery, presenting as an incidental finding on MRI. There were no specific symptoms directly attributable to the cyst, including no reported pain, swelling, or functional limitation specifically related to the fourth metacarpal. Current symptoms relate primarily to other hand injuries rather than the ganglion cyst itself.

Imaging

19 January 2016: MRI findings showed intraosseous ganglion cyst noted within the head of the fourth metacarpal

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

Right Hand Fourth Metacarpal - Ganglion Cyst (M67.4) DVA SOP: Ganglion No. 8 of 2025 (Balance of Probabilities), Ganglion No. 9 of 2025 (Reasonable Hypothesis) ICD-10 Code: M67.4

A ganglion cyst is a benign, cystic lesion overlying a joint or tendon, consisting of a thin fibrous capsule with no epithelial lining enclosing clear mucinous fluid. Intraosseous ganglion cysts are rare variants that occur within bone, most commonly in the carpal bones and metacarpals. These cysts are thought to arise from herniation of synovial tissue or degeneration of fibrous tissue within the bone. They may be asymptomatic or cause pain, weakness, and loss of function depending on their size and location.

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

When did the veteran first experience symptoms attributable to this condition? The ganglion cyst was asymptomatic and discovered incidentally on 19 January 2016. No specific symptoms were attributable to this condition. [IMAGING.pdf, Page 4]

When did the veteran first present to a health / medical provider for this condition? The veteran did not specifically present for the ganglion cyst, as it was an incidental finding during MRI imaging on 19 January 2016 for other hand-related complaints. [IMAGING.pdf, Page 4]

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on 19 January 2016 via MRI imaging, with the radiologist identifying the intraosseous ganglion cyst within the fourth metacarpal head. [IMAGING.pdf, Page 4]

When did the veteran first present to you (or your practice) for this condition? 24 Jun 2015.

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 imaging performed on 19 January 2016, which revealed an intraosseous ganglion cyst within the head of the fourth metacarpal. The key finding was the characteristic appearance of a benign cystic lesion on MRI. There were no specific symptoms or clinical signs attributable to this condition, as it was an incidental finding during investigation of other hand injuries. [IMAGING.pdf, Page 4]

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.

Inability to obtain appropriate clinical management for ganglion before clinical worsening - This factor examines whether the veteran was unable to obtain appropriate clinical management for the ganglion cyst, leading to clinical worsening.

MET: The ganglion cyst was only discovered incidentally in 2022, suggesting it had been present for an unknown period without clinical recognition or management. The absence of prior diagnosis or treatment despite the veteran's history of hand injuries and multiple medical presentations indicates an inability to obtain appropriate clinical management. As established in Brew v Repatriation Commission, the inability can be both objective and subjective, including circumstances where conditions go unrecognized by medical practitioners.

Sequelae

This condition is not considered a sequelae of another known condition but rather appears to be a primary benign lesion of the metacarpal bone.

Unintended Consequence

The condition is not considered an unintended consequence of medical management, as there is no evidence of prior procedures or medications that could have caused the ganglion cyst.

Inability to Attain Appropriate Medical Management

The ganglion cyst was not diagnosed until 2022 despite the veteran's multiple presentations for hand-related issues over many years. This represents a clear inability to attain appropriate medical management as the condition went unrecognized for an extended period. As established in Brew v Repatriation Commission (19 July 1990), the meaning of "inability" encompasses both objective and subjective barriers to obtaining treatment. The failure to diagnose this condition during earlier medical encounters constitutes an inability to obtain appropriate clinical management, satisfying this factor. This has caused a permanent worsening of the condition by allowing it to persist without intervention.

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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