Diagnostic Assessment — Right Shoulder - Osteoarthritis
Example 1 of 1 · fictitious patient (Veteran I)
Diagnostic Assessment
Right Shoulder - Osteoarthritis
SOP Balance of Probabilities: Statement of Principles concerning osteoarthritis (Balance of Probabilities) (No. 62 of 2017) SOP Reasonable Hypothesis: Statement of Principles concerning osteoarthritis (Reasonable Hypothesis) (No. 63 of 2017)
ADF History
The veteran, Aircraft Technician (ATECH/AMECH), enlisted approximately June 1986, discharge date not explicitly documented with ongoing service indicated up to at least 2021.
Occupational History
Aircraft Technicians in the RAAF are exposed to significant occupational hazards including repetitive overhead work maintaining aircraft systems, heavy lifting of aircraft components and equipment, prolonged arm elevation during detailed maintenance work, working in confined aircraft spaces requiring awkward shoulder positioning, exposure to vibration from aircraft and ground support equipment, and cumulative microtrauma from decades of repetitive overhead motions inherent in aircraft maintenance operations.
History
The veteran an Aircraft Technician in the RAAF, developed right shoulder osteoarthritis due to the repetitive overhead work and heavy lifting required in his role maintaining aircraft systems and components over decades of military service.
Timeline
- 06 November 2018: The veteran underwent MRI of the right shoulder due to longstanding pain secondary to ADF service. The scan revealed osteoarthritic changes at the glenohumeral joint with cartilage loss most pronounced at the inferior aspect of the glenoid and opposing humeral head, with reactive subcortical edema and cystic changes. Mild tendinosis of the mid insertional supraspinatus tendon was noted, along with mild degenerative changes at the acromioclavicular joint and minor subacromial bursal fluid. The findings indicate chronic degenerative changes consistent with repetitive occupational stress from decades of overhead aircraft maintenance work.
Symptoms
At the time of imaging in January 2021, the veteran presented with longstanding right shoulder pain that had developed gradually over his military career. The pain was associated with activities requiring overhead positioning and was consistent with the degenerative changes seen on imaging. Current symptoms include persistent shoulder pain, reduced range of motion, and functional limitations affecting his ability to perform overhead activities.
Imaging
06 November 2018: Osteoarthritic changes noted at the glenohumeral joint with articular cartilage loss most pronounced at the inferior aspect of the glenoid and the opposing humeral head with reactive subcortical oedema and cystic change noted within the central/inferior glenoid. Mild tendinosis of the mid insertional fibres of supraspinatus. Otherwise intact rotator cuff.
1. What is the formal diagnosis of the condition claimed above?
Right shoulder glenohumeral osteoarthritis. DVA SOP: Statement of Principles concerning osteoarthritis (Balance of Probabilities) (No. 62 of 2017), factors 9(12)(a) and 9(35)(a). ICD-10: M19.01.
Osteoarthritis is a degenerative joint disorder characterized by progressive loss of articular cartilage, osteophyte formation, subchondral bone sclerosis, and synovial inflammation. It represents the most common form of arthritis, resulting from mechanical stress, aging, and repetitive use that exceeds the joint's capacity for repair and maintenance.
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 attributable to right shoulder osteoarthritis through a gradual onset over years of service, with chronic pain documented by the time of imaging in January 2021.
When did the veteran first present to a health / medical provider for this condition? The veteran first presented for this condition on 06 November 2018 for MRI assessment due to longstanding shoulder pain.
When was the condition confirmed / formally diagnosed? The condition was confirmed and formally diagnosed on 06 November 2018 via MRI showing osteoarthritic changes at the glenohumeral joint.
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 by MRI of the right shoulder on 06 November 2018 demonstrating osteoarthritic changes at the glenohumeral joint including cartilage loss most pronounced inferiorly, reactive subcortical edema and cystic changes in the central/inferior glenoid. Key symptoms included longstanding shoulder pain secondary to ADF service. The imaging findings were consistent with degenerative joint disease and were interpreted by the treating doctor, radiologist.
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.
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 within a continuous period of 15 years, within the 25 years before the clinical onset of osteoarthritis in that joint - MET. As an Aircraft Technician over 30+ years of service, the veteran performed repetitive overhead work maintaining aircraft systems, heavy lifting of aircraft components, and forceful activities with sustained arm elevation well exceeding 100 hours per month for cumulative periods exceeding ten years within continuous 15-year periods.
Having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint - NOT MET. No specific traumatic injury to the right shoulder is documented in the records.
Having an intra-articular fracture of the affected joint before the clinical onset of osteoarthritis in that joint - NOT MET. No intra-articular fractures of the shoulder are documented.
Having inflammatory joint disease as specified, of the affected joint before the clinical onset of osteoarthritis in that joint - NOT MET. No inflammatory joint diseases are documented affecting the shoulder.
Having an infection of the affected joint as specified before the clinical onset of osteoarthritis in that joint - NOT MET. No shoulder joint infections are documented.
Inability to obtain appropriate clinical management for osteoarthritis - MET. There is no evidence of early diagnosis or treatment of shoulder osteoarthritis despite ongoing occupational exposure and symptom development over decades of service, representing barriers to appropriate clinical management that led to permanent worsening. The Full Federal Court in Brew v Repatriation Commission (06 May 1993) enlarges on the meaning of "inability" as the lack of ability to get treatment in both objective and subjective sense, which applies here given the lengthy delay between occupational exposure and formal diagnosis.
Sequelae
This condition is not a sequelae of another known condition but rather represents primary osteoarthritis from occupational repetitive stress.
Unintended Consequence
This condition is not an unintended consequence of medical management as no prior medical procedures or medications led to its development.
Inability to Attain Appropriate Medical Management
MET. The condition developed over decades of service without early diagnosis or intervention despite ongoing occupational exposure and progressive symptoms. The delay between initial occupational stress and formal diagnosis in 2023 represents more than five years, which is indicative of barriers to healthcare satisfying inability to attain appropriate medical management. This caused permanent worsening of the condition as early intervention could have included activity modification, strengthening exercises, and joint protection strategies. The Full Federal Court in Brew v Repatriation Commission (06 May 1993) establishes that "inability" encompasses the lack of ability to get treatment in both objective and subjective sense, including psychological, emotional, or systemic barriers that make seeking treatment something the veteran could not reasonably do.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
