Diagnostic Assessment — Thoracic Spine - Strain
Example 1 of 1 · fictitious patient (Veteran N)
Diagnostic Assessment
Thoracic Spine - Strain
SOP Codes: Balance of Probabilities: Sprain and Strain (No. 28 of 2020) Reasonable Hypothesis: Sprain and Strain (No. 27 of 2020)
ADF History
The veteran, Chef, enlisted 09 January 2009, discharged 27 Mar 2016.
Occupational History
Military chefs are exposed to significant occupational hazards including prolonged standing during food preparation, heavy lifting of large pots and equipment, repetitive bending and lifting activities, sustained forward posturing during cooking activities, carrying heavy field kitchen equipment, and physical training requirements. The role involves sustained thoracic spine loading through repetitive lifting movements, prolonged static positioning, and manual handling of equipment weighing 20+ kilograms in kitchen environments. Extended periods of forward head posturing and sustained neck flexion during food preparation place additional stress on the thoracic spine musculature.
History
The veteran the veteran a military chef, developed thoracic spine strain during his military service through occupational activities involving prolonged standing, heavy lifting, and sustained positioning during food preparation activities in the Australian Defence Force.
Timeline
- 07 December 2012 - the veteran experienced mid-back pain during prolonged standing while performing his duties as a military chef. This episode occurred during routine food preparation activities that required extended periods of standing and forward posturing, placing stress on the thoracic spine musculature and contributing to the development of strain symptoms.
- 12 February 2014 - the veteran presented with thoracic discomfort after lifting during military service activities. This episode demonstrates the ongoing occupational stressors placed on the thoracic spine through heavy lifting requirements inherent to military chef duties, including handling large pots, equipment, and supplies in kitchen environments.
- 22 Apr 2015 - Documentation of thoracic stiffness indicating ongoing thoracic spine symptoms related to continued occupational demands and military service activities. The recurrent nature of symptoms demonstrates the cumulative effect of sustained thoracic spine loading through military chef duties.
- 27 Mar 2016 - End of military service. The veteran completed his military career having been exposed to seven years of occupational thoracic spine stressors through chef duties and military training activities.
Symptoms
The veteran experienced thoracic spine symptoms characterized by mid-back pain during prolonged standing activities, thoracic discomfort following lifting activities, and thoracic stiffness associated with ongoing occupational demands. The symptoms were directly related to his military chef duties, particularly prolonged standing during food preparation, heavy lifting of kitchen equipment, and sustained forward posturing required in kitchen environments.
The symptoms demonstrated a pattern of occupational strain related to the physical demands of military chef duties, with episodes occurring during or immediately following specific work-related activities such as prolonged standing and heavy lifting.
Imaging
No specific imaging of the thoracic spine for strain is documented in the available records.
1. What is the formal diagnosis of the condition claimed above?
Thoracic Spine Strain, SOP Sprain and Strain (No. 28 of 2020), ICD-10 M54.6 (Pain in thoracic spine).
Thoracic spine strain is a soft tissue injury involving the tearing or stretching of muscles or tendons supporting the thoracic vertebrae, associated with the onset of pain and tenderness at the site within 24 hours following the injury. The condition typically results from mechanical stress placed on the thoracic musculature through activities involving lifting, prolonged positioning, or sustained postural demands. Thoracic strain commonly affects the erector spinae, rhomboids, and other paraspinal muscles that support the mid-back region. The condition may present with localized muscle pain, stiffness, and functional limitation, particularly with movements involving thoracic extension or rotation.
The temporal relationship indicates episodic thoracic strain during military service (2017-2019) related to specific occupational activities including prolonged standing and heavy lifting.
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 thoracic spine strain symptoms on 07 December 2012 with mid-back pain during prolonged standing while performing military chef duties [Service Medical Record, Page 12].
When did the veteran first present to a health / medical provider for this condition? The veteran presented to military medical staff on 07 December 2012 for mid-back pain during prolonged standing [Service Medical Record, Page 12]. Subsequent presentations occurred on 12 February 2014 for thoracic discomfort after lifting [Service Medical Record, Page 35] and 22 Apr 2015 for thoracic stiffness [GP Consultation Notes, Page 7].
When was the condition confirmed / formally diagnosed? The condition was diagnosed by military medical staff on 07 December 2012 as thoracic strain based on clinical presentation of mid-back pain related to occupational activities [Service Medical Record, Page 12]. Ongoing episodes were documented throughout military service confirming the recurrent nature of the condition.
When did the veteran first present to you (or your practice) for this condition? 19 July 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 assessment by military medical staff based on the pattern of thoracic spine symptoms directly related to occupational activities. Key symptoms included mid-back pain during prolonged standing, thoracic discomfort following lifting activities, and thoracic stiffness associated with ongoing military chef duties [Service Medical Record, Page 12; Service Medical Record, Page 35; GP Consultation Notes, Page 7]. The temporal relationship between symptoms and specific occupational activities (prolonged standing and heavy lifting) supported the diagnosis of occupational thoracic strain.
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.
Factor 9(2): Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
- MET. The veteran military chef duties involved forceful stretching and high intensity use of thoracic muscles and tendons through heavy lifting of kitchen equipment, sustained forward posturing during food preparation, and prolonged standing activities that placed significant stress on the thoracic spine musculature.
Factor 9(4): Forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- MET. Ongoing military chef duties and physical training requirements involved continued forceful stretching and high intensity use of thoracic muscles and tendons through repetitive lifting, sustained positioning, and occupational demands that contributed to clinical worsening of the initial strain episodes.
Factor 9(5): Inability to obtain appropriate clinical management for sprain or strain
- MET. While episodes were documented, the recurrent nature of symptoms (2017, 2018, 2019) without evidence of comprehensive management or prevention strategies suggests barriers to obtaining appropriate clinical management during military service, constituting inability to attain appropriate medical management as defined in Brew v Repatriation Commission.
Sequelae
This condition is not a sequelae of another known condition but represents a primary occupational injury related to military service duties.
Unintended Consequence
This condition is not an unintended consequence of medical management. No medical procedures or medications contributed to the development of thoracic spine strain.
Inability to Attain Appropriate Medical Management
MET. The Full Federal Court in Brew v Repatriation Commission (07 July 1993) enlarges on the meaning of "inability" as the lack of ability to get treatment in both objective and subjective sense. The recurrent presentations for thoracic spine symptoms (2017, 2018, 2019) that were managed conservatively without evidence of comprehensive investigation or specialist referral indicates barriers to obtaining appropriate clinical management during military service. The lack of preventive measures or workplace modifications to address the underlying occupational causes demonstrates inability to attain appropriate medical management. This failure to provide comprehensive clinical management contributed to ongoing episodes of thoracic strain throughout military service, representing a permanent worsening of the condition.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
