Diagnostic Assessment — Right Loin - External Bruise
Example 1 of 1 · fictitious patient
Diagnostic Assessment Right Loin — External Bruise BOP Code: 44 of 2024 (Traumatic Contusion or Haematoma) RH Code: 43 of 2024 (Traumatic Contusion or Haematoma)
ADF History
The veteran, date of birth [withheld], Royal Australian Air Force, Aircraft Technician, 3 January 1980 to 19 October 1986
History
The veteran sustained a bruise to the right loin area during ADF service.
The documented slip and fall on 3 November 1984 at FIMA Alexandria/a maintenance squadron resulted in bruising to the right ribs posteriorly at the T10 T12 level, which anatomically encompasses the right loin (flank) region.
The mechanism of landing on the floor polisher and striking the back would have involved the right flank/loin area.
Under DVA legislation, the absence of specific documentation of a "right loin bruise" as a separate diagnosis does not mean the injury did not occur, particularly when the documented mechanism and location of injury (right posterior ribs at T10 T12, which overlaps with the loin region) is consistent with right loin bruising.
A bruise of the right loin region was also expressly recorded on 11 February 1982, after a fall at work directly onto his back the previous night
Timeline
03 Nov 1984 — ABSR the veteran slipped on a wet polished floor at FIMA Alexandria/a maintenance squadron, landing on the polisher and striking his back.
Tender right ribs posteriorly at approximately T10 T12 region — the anatomical location that overlaps with the right loin. "Bruised right ribs"
1. What is the formal diagnosis of the condition claimed above?
Right Loin External Bruise / Contusion (ICD-10: S30.1XXA).
The right loin (flank) region anatomically overlaps with the right posterior ribs at T10 T12 where tenderness was documented following the 3 November 1984 fall.
Dates: Symptom onset: 3 November 1984 [ [CHART REVIEW document], pages 8 9].
First presentation: 3 November 1984.
Diagnosis confirmed: 3 November 1984.
First presentation to practice: 15 May 2021.
Confirmed: Clinical findings of tenderness in the right posterior T10 T12 region following documented slip and fall [ [CHART REVIEW document], pages 8 9].
Causes: DRCA legislation.
Sustained during ADF duties (deck polishing).
100% service- related
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 1 April 2000 (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 Daily Injury Record for the fall of 3 November 1984 names bruising of the right posterior ribs, tender over the 9th to 12th ribs, rather than of the loin; those lower ribs form the upper boundary of the right loin, and a bruise of the right loin region itself was expressly recorded after an earlier fall at work onto his back on 10 February 1982 (Outpatient Health Record of 11 February 1982).
Either injury is a traumatic contusion within the meaning of the Statements of Principles.
Causative Factors — Balance of Probabilities (Statement of Principles concerning Traumatic Contusion or Haematoma, No.
44 of 2024) Factor 9(1): having trauma involving the affected site within the 24 hours before clinical onset — MET - At about 11.00 am on 3 November 1984, while scrubbing a deck before laying polish at FIMA Alexandria, the veteran slipped and landed on the floor polisher, injuring his back (Daily Injury Records of 3 November 1984).
Bruising was diagnosed, with tenderness over the right posterior 9th to 12th ribs and the lower lumbar spine; the right loin lies between those ribs and the pelvis beside the lumbar spine, so the impact involved the affected site on the day the bruising began, within the 24 hours before clinical onset.
The factor is equally met if the condition is identified with his fall at work onto his back on 10 February 1982, after which a right loin bruise was found the next morning.
Causative Factors — Reasonable Hypothesis (Statement of Principles concerning Traumatic Contusion or Haematoma, No.
43 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 trauma involving the affected site within the 24 hours before clinical onset — MET - The fall onto the floor polisher on 3 November 1984, with tenderness over the right lower posterior ribs and lower back, was trauma involving the right loin region on the day the bruising began, within the 24 hours before clinical onset; the same applies to the fall at work onto his back on 10 February 1982, after which a right loin bruise was found.
Other Plausible Links to Service The injury of 3 November 1984 arose out of, and in the course of, the veteran's employment as a member.
The compensation copy of the Daily Injury Record (PM 278) records that he was on duty, deck polishing and scrubbing, when at 11.00 am at FIMA Alexandria he 'slipped on a wet soapy water whilst scrubbing the deck prior to laying polish, and landed on polisher injuring back'.
Scrubbing and polishing decks are routine Aircraft Technician's duties, and the fall was a direct consequence of them.
The right loin had also been bruised in service earlier.
The Outpatient Health Record of 11 February 1982, while he was serving in a maintenance squadron at a maintenance squadron, records that he 'fell last night at work direct fall onto back', with a bruise of the right loin region, urinalysis negative for blood, a lumbosacral x-ray showing no bony injury and mild irritation of the right L4 nerve root; he was excused duty for two days.
That fall also occurred at work, so whichever injury is taken as the origin of the right loin bruise, it arose in the course of his service.
Conclusion The bruising of the veteran's right loin was caused by his fall onto the floor polisher on 3 November 1984, while he was scrubbing and polishing a deck on duty at FIMA Alexandria, which is trauma involving the affected site at the onset of the bruising and meets factor 9(1) of both Statements of Principles.
A bruise of the right loin was also recorded after a fall at work onto his back on 10 February 1982; both injuries arose out of or in the course of his service, and no other cause is identified.
The % contribution of the causes is 100% and significant.
Worsening Factors In the alternative, if the bruising of the veteran's right loin is found not to have arisen out of his service, the following factor addresses whether it was worsened after its clinical onset on 3 November 1984.
He remained in service, on light duties for the associated back injury in the following weeks, until his discharge on 19 October 1986.
Worsening Factors — Balance of Probabilities (Statement of Principles concerning Traumatic Contusion or Haematoma, No.
44 of 2024) Factor 9(2): inability to obtain appropriate clinical management for traumatic contusion or haematoma before clinical worsening — NOT MET - Assessed objectively and subjectively as Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J) requires, there was no inability: after the fall of 3 November 1984 the veteran was examined, x-rayed, reviewed and referred to an orthopaedic surgeon within a week and given physiotherapy and light duties, and the loin bruise of February 1982 was examined and treated the next day.
Worsening Factors — Reasonable Hypothesis (Statement of Principles concerning Traumatic Contusion or Haematoma, No.
43 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(2): inability to obtain appropriate clinical management for traumatic contusion or haematoma before clinical worsening — NOT MET - Applying Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), there was no objective or subjective inability: each injury to the right loin was examined and treated promptly, and the bruising resolved without further presentation
Sequelae, Unintended Consequence, Inability
No specific sequelae.
Not an unintended consequence.
Inability to obtain appropriate clinical management: NOT MET, as both the 1985 and the 1982 injuries were examined and treated promptly (Brew v Repatriation Commission)
Date of Clinical Onset
Right loin external bruise 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: 3 November 1984 — fall onto a floor polisher at a maintenance squadron, with bruising and tenderness of the right posterior ribs and loin [ [CHART REVIEW document], pages 8 9].
Date of clinical onset: 3 November 1984.
This date falls within the veteran's ADF service (3 January 1980 19 October 1986).
In-service events and exposures before this date relate to clinical onset, and those after it to clinical worsening
