Diagnostic Assessment — Skin - Traumatized Skin Tags
Example 1 of 1 · fictitious patient (Veteran N)
Diagnostic Assessment
Skin - Traumatized Skin Tags
No specific Statement of Principles (SOP) available for skin tags. However, the traumatic injury to pre-existing skin tags may be considered under occupational injury principles or as an aggravation of a pre-existing condition through service-related activities.
ADF History
Name: The veteran Date of Birth: [withheld]
Occupation: Chef Enlistment Date: 09 January 2009 Discharge Date: 27 Mar 2016
Occupational History
As a military chef, the veteran was required to handle heavy field kitchen equipment, pack and unpack cooking apparatus, and perform repetitive lifting and carrying activities. Military chefs are exposed to physical demands including equipment manipulation, heavy lifting, and working in confined spaces where equipment handling could cause friction or trauma to skin surfaces. Field kitchen operations require frequent packing, unpacking, and transportation of equipment which increases risk of skin trauma.
History
The veteran developed painful traumatized skin tags in the right axilla area during his service as a Chef in the Australian Defence Force. The skin tags had been present for years but became traumatized and painful due to repetitive packing and unpacking of field kitchen equipment.
Timeline
- 13 December 2014 - the veteran presented with right axilla skin tags that had been present for years but had become traumatized while packing and unpacking field kitchen equipment, making them painful. The occupational trauma from equipment handling had caused the previously asymptomatic skin tags to become symptomatic and require medical intervention. Both skin tags were treated with freeze-thaw-freeze cycle cryotherapy due to occupational trauma.
Symptoms
The skin tags had been present asymptomatically for years prior to becoming traumatized. Following repeated trauma from field kitchen equipment handling, the skin tags became painful and symptomatic, requiring medical attention. The trauma was specifically related to the repetitive packing and unpacking activities associated with field kitchen operations during military service.
Imaging
No imaging studies were performed for this condition as clinical examination was sufficient for diagnosis and treatment planning.
1. What is the formal diagnosis of the condition claimed above?
Traumatized skin tags (acrochordons) of right axilla. No specific DVA SOP code applies as no Statement of Principles exists for skin tags. ICD-10 code: L91.8 (Other hypertrophic disorders of skin).
Skin tags (acrochordons) are benign, soft, pedunculated growths composed of loose fibrous tissue covered by epidermis. They commonly occur in areas of friction such as the axilla, neck, and groin. While typically asymptomatic, skin tags can become painful when subjected to trauma, twisting, or irritation. In occupational settings, repeated friction or direct trauma can cause inflammation, pain, and bleeding of pre-existing skin tags, necessitating medical treatment.
The temporal relationship demonstrates pre-existing asymptomatic skin tags that became symptomatic and required medical intervention due to occupational trauma from field kitchen equipment handling.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The veteran experienced symptoms from traumatized skin tags in January 2017, though the skin tags had been present asymptomatically for years prior to the occupational trauma. [Chart Review - STEPHAN MACKENZIE.docx, page 85]
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented for medical assessment on 13 December 2014 to military medical personnel for treatment of the traumatized and painful skin tags. [Chart Review - STEPHAN MACKENZIE.docx, page 85]
When was the condition confirmed / formally diagnosed?
The condition was confirmed and formally diagnosed on 13 December 2014 by military medical staff who identified the skin tags as having been traumatized by occupational activities, leading to cryotherapy treatment. [Chart Review - STEPHAN MACKENZIE.docx, page 85]
When did the veteran first present to you (or your practice) for this condition?
12 Jun 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 through clinical examination on 13 December 2014 by military medical personnel. The key findings included right axilla skin tags that had been present for years but had become traumatized and painful due to packing and unpacking field kitchen equipment. The occupational nature of the trauma was clearly documented, and both skin tags were treated with freeze-thaw-freeze cycle cryotherapy due to the occupational trauma. [Chart Review - STEPHAN MACKENZIE.docx, page 85]
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.
This condition does not fall under a specific Statement of Principles as no SOP exists for skin tags. However, the traumatic aggravation of pre-existing skin tags through service-related activities constitutes a service-related injury through occupational trauma.
The skin tags themselves represent a constitutional predisposition, as acrochordons commonly develop in areas of friction and are often familial. However, the symptomatic traumatization of these previously asymptomatic skin tags was directly caused by occupational activities involving packing and unpacking field kitchen equipment during military service.
The occupational mechanism involved repetitive friction and direct trauma to the axillary area during equipment handling, causing inflammation and pain in pre-existing skin tags that had been asymptomatic for years.
Sequelae
This condition is not a sequelae of another compensable condition but represents direct occupational trauma to pre-existing anatomical structures.
Unintended Consequence
NOT MET - This condition does not represent an unintended consequence of medical treatment but rather occupational trauma from service-related activities.
Inability to Attain Appropriate Medical Management
MET - The skin tags had been present asymptomatically for years without any preventive management or assessment for occupational risk. Once traumatized, treatment was limited to cryotherapy without comprehensive assessment of occupational modifications to prevent recurrence. There is no evidence of ergonomic assessment of field kitchen equipment handling techniques or protective measures to prevent further trauma during ongoing service activities.
As established in Brew v Repatriation Commission (07 July 1993), "inability" encompasses the lack of ability to obtain appropriate treatment in both objective and subjective senses. The military environment and ongoing operational requirements may have prevented comprehensive occupational health assessment and preventive management strategies for equipment handling techniques.
The failure to provide ongoing dermatological follow-up and occupational health assessment to prevent recurrence represents an inability to attain appropriate comprehensive clinical management for this occupational injury.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
