Right Knee - Patellofemoral Osteoarthrosis — example DVA determination letter

Reference Determination Content

Suggested draft · fictitious patient

Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.

Right Knee - Patellofemoral Osteoarthrosis

Evidence

The evidence that I have considered in making this decision includes:

Formal Claim with supporting statements;
A Statement of your Service from the Department of Defence;
Copies of your Service Medical Records.
A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 16 July 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 16 July 2025;
An emergency department record and X-ray report by the regional hospital, dated 11 August 1996;
An operation report by the orthopaedic surgeon, dated 13 August 1996;
An MRI right knee by the radiologist, dated 15 August 1996;
A bone densitometry report by the sports physician, dated 22 September 1997;
A field hospital operation record by the surgeon, Bougainville, dated 9 May 1998;
A field hospital record and X-ray report by the east timor, dated 18 November 1999;
An arthroscopy report by the orthopaedic surgeon, dated 14 January 2000;
A rheumatology consultation by the rheumatologist, dated 20 June 2003;
An MRI right knee by the radiologist, dated 8 March 2006;
A field medical record by the medical officer, Afghanistan, dated 15 October 2006;
A periodic health examination by the medical officer, Garrison health centre, dated 12 February 2007;
An outpatient health record by the medical officer, Garrison health centre, dated 10 March 2008;
An X-ray right knee with skyline views by the radiologist, dated 14 March 2008;
A bone densitometry report by the endocrinologist, dated 17 August 2011;
An MRI right knee by the radiologist, dated 22 October 2012;
An orthopaedic consultation by the orthopaedic surgeon, dated 30 October 2012.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

19 January 1994 and 3 March 2020

Right Knee - Patellofemoral Osteoarthrosis

You have stated that your condition was caused by:

having inflammatory joint disease as specified, of the affected joint before the clinical onset of osteoarthritis in that joint
having an infection of the affected joint as specified before the clinical onset of osteoarthritis in that joint
having an intra-articular fracture of the affected joint before the clinical onset of osteoarthritis in that joint
having haemarthrosis of the affected joint before the clinical onset of osteoarthritis in that joint
having a depositional joint disease as specified, in the affected joint before the clinical onset of osteoarthritis in that joint
having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint
having an acute meniscal tear of the affected knee within the 25 years before the clinical onset of osteoarthritis in that joint
having frostbite involving the affected joint before the clinical onset of osteoarthritis in that joint
having disordered joint mechanics of the affected joint for at least five years before the clinical onset of osteoarthritis in that joint
having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the upper limb only, performing any combination of repetitive activities or tasks involving repeated or sustained pinch grip or hand/power grip, for an average of at least 30 hours per week, for a cumulative period of at least ten years within a continuous period of 15 years, before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the hand, wrist or elbow joint only, using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having: (i) an amputation involving either leg; or (ii) an asymmetric gait; for at least five years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: lifting loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint; and (ii) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 3 800 hours within any ten year period before the clinical onset of osteoarthritis in that joint; and (ii) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: ascending or descending at least 150 stairs or rungs of a ladder per day, on more days than not, for a continuous period of at least five years, within the 25 years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having increased bone mineral density before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: being overweight for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for males, having a waist circumference exceeding 102 centimetres for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for females, having a waist circumference exceeding 88 centimetres for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a hip or knee joint only: (a) kneeling or squatting for a cumulative period of at least one hour per day, on more days than not, for a continuous period of at least two years before the clinical onset of osteoarthritis in that joint; and (b) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a knee joint only, having internal derangement of the affected joint before the clinical onset of osteoarthritis in that joint
for osteoarthritis of the patello-femoral joint only, having chondromalacia patella before the clinical onset of osteoarthritis in that joint
having a disorder associated with loss of pain sensation or proprioception involving the affected joint before the clinical onset of osteoarthritis in that joint
having Paget's disease of bone of the affected joint before the clinical onset of osteoarthritis in that joint
having acromegaly before the clinical onset of osteoarthritis in that joint
having joint instability or dislocation of the affected joint, at least one year before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a hip joint only, having femoroacetabular impingement syndrome of the affected joint, before the clinical onset of osteoarthritis in that joint

Diagnosis: Patellofemoral Osteoarthrosis

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 16 July 2025, and is supported by an X-ray right knee with skyline views by the radiologist, dated 14 March 2008.

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Osteoarthritis (Balance of Probabilities) (No. 62 of 2017)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

having inflammatory joint disease as specified, of the affected joint before the clinical onset of osteoarthritis in that joint
having an infection of the affected joint as specified before the clinical onset of osteoarthritis in that joint
having an intra-articular fracture of the affected joint before the clinical onset of osteoarthritis in that joint
having haemarthrosis of the affected joint before the clinical onset of osteoarthritis in that joint
having a depositional joint disease as specified, in the affected joint before the clinical onset of osteoarthritis in that joint
having trauma to the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint within the 25 years before the clinical onset of osteoarthritis in that joint
having an acute meniscal tear of the affected knee within the 25 years before the clinical onset of osteoarthritis in that joint
having frostbite involving the affected joint before the clinical onset of osteoarthritis in that joint
having disordered joint mechanics of the affected joint for at least five years before the clinical onset of osteoarthritis in that joint
having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the upper limb only, performing any combination of repetitive activities or tasks involving repeated or sustained pinch grip or hand/power grip, for an average of at least 30 hours per week, for a cumulative period of at least ten years within a continuous period of 15 years, before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the hand, wrist or elbow joint only, using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having: (i) an amputation involving either leg; or (ii) an asymmetric gait; for at least five years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: lifting loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical onset of osteoarthritis in that joint; and (ii) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 3 800 hours within any ten year period before the clinical onset of osteoarthritis in that joint; and (ii) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: ascending or descending at least 150 stairs or rungs of a ladder per day, on more days than not, for a continuous period of at least five years, within the 25 years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having increased bone mineral density before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: being overweight for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for males, having a waist circumference exceeding 102 centimetres for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for females, having a waist circumference exceeding 88 centimetres for at least ten years before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a hip or knee joint only: (a) kneeling or squatting for a cumulative period of at least one hour per day, on more days than not, for a continuous period of at least two years before the clinical onset of osteoarthritis in that joint; and (b) where the clinical onset of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a knee joint only, having internal derangement of the affected joint before the clinical onset of osteoarthritis in that joint
for osteoarthritis of the patello-femoral joint only, having chondromalacia patella before the clinical onset of osteoarthritis in that joint
having a disorder associated with loss of pain sensation or proprioception involving the affected joint before the clinical onset of osteoarthritis in that joint
having Paget's disease of bone of the affected joint before the clinical onset of osteoarthritis in that joint
having acromegaly before the clinical onset of osteoarthritis in that joint
having joint instability or dislocation of the affected joint, at least one year before the clinical onset of osteoarthritis in that joint
for osteoarthritis of a hip joint only, having femoroacetabular impingement syndrome of the affected joint, before the clinical onset of osteoarthritis in that joint

I have noted your contention as to the cause of this condition. The available evidence indicates, I have noted your contention to the cause of your condition. Your service medical records indicate that you presented to the health facility with aching anterior right knee pain, stiffness after sitting, pain climbing ladders and stairs and pain on kneeling on 10 March 2008.

The diagnosis was confirmed by skyline X-rays of the right knee on 14 March 2008, which showed new narrowing of the lateral patellofemoral joint, patellar and trochlear osteophytes and subchondral sclerosis, where skyline X-rays of 12 February 2007 had shown a preserved joint space and no osteophytes. With anterior knee pain, stiffness and impaired function, this meets the Statement of Principles definition of osteoarthritis: a degenerative joint disorder with clinical manifestations of pain, impaired function and stiffness and radiological evidence of loss of articular cartilage and osteophytes.

This has then led to further investigations and the diagnosis of your condition of Patellofemoral Osteoarthrosis. I have accepted your condition of Patellofemoral Osteoarthrosis.

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that this condition is related to your peacetime service.

I have therefore accepted that this condition is related to your service with effect from 3 March 2008.

Right Knee - Patellofemoral Osteoarthrosis (Worsening)

Evidence

The evidence that I have considered in making this decision includes:

Formal Claim with supporting statements;
A Statement of your Service from the Department of Defence;
Copies of your Service Medical Records.
A Diagnostic Assessment by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 16 July 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 16 July 2025;
An emergency department record and X-ray report by the regional hospital, dated 11 August 1996;
An operation report by the orthopaedic surgeon, dated 13 August 1996;
An MRI right knee by the radiologist, dated 15 August 1996;
A bone densitometry report by the sports physician, dated 22 September 1997;
A field hospital operation record by the surgeon, Bougainville, dated 9 May 1998;
A field hospital record and X-ray report by the east timor, dated 18 November 1999;
An arthroscopy report by the orthopaedic surgeon, dated 14 January 2000;
A rheumatology consultation by the rheumatologist, dated 20 June 2003;
An MRI right knee by the radiologist, dated 8 March 2006;
A field medical record by the medical officer, Afghanistan, dated 15 October 2006;
A periodic health examination by the medical officer, Garrison health centre, dated 12 February 2007;
An outpatient health record by the medical officer, Garrison health centre, dated 10 March 2008;
An X-ray right knee with skyline views by the radiologist, dated 14 March 2008;
A bone densitometry report by the endocrinologist, dated 17 August 2011;
An MRI right knee by the radiologist, dated 22 October 2012;
An orthopaedic consultation by the orthopaedic surgeon, dated 30 October 2012.

Your service

I have identified that you have the following service:
Australian Defence Force service between :

19 January 1994 and 3 March 2020

Right Knee - Patellofemoral Osteoarthrosis (Worsening)

You have stated that the worsening of your condition was caused by:

having inflammatory joint disease as specified, of the affected joint before the clinical worsening of osteoarthritis in that joint
having an infection of the affected joint as specified before the clinical worsening of osteoarthritis in that joint
having an intra-articular fracture of the affected joint before the clinical worsening of osteoarthritis in that joint
having haemarthrosis of the affected joint before the clinical worsening of osteoarthritis in that joint
having a depositional joint disease as specified, in the affected joint before the clinical worsening of osteoarthritis in that joint
having trauma to the affected joint within the 25 years before the clinical worsening of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint within the 25 years before the clinical worsening of osteoarthritis in that joint
having an acute meniscal tear of the affected knee within the 25 years before the clinical worsening of osteoarthritis in that joint
having frostbite involving the affected joint before the clinical worsening of osteoarthritis in that joint
having disordered joint mechanics of the affected joint for at least five years before the clinical worsening of osteoarthritis in that joint
having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the upper limb only, performing any combination of repetitive activities or tasks involving repeated or sustained pinch grip or hand/power grip, for an average of at least 30 hours per week, for a cumulative period of at least ten years within a continuous period of 15 years, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the hand, wrist or elbow joint only, using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having: (i) an amputation involving either leg; or (ii) an asymmetric gait; for at least five years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: lifting loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical worsening of osteoarthritis in that joint; and (ii) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 3 800 hours within any ten year period before the clinical worsening of osteoarthritis in that joint; and (ii) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: ascending or descending at least 150 stairs or rungs of a ladder per day, on more days than not, for a continuous period of at least five years, within the 25 years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: being overweight for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for males, having a waist circumference exceeding 102 centimetres for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for females, having a waist circumference exceeding 88 centimetres for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a hip or knee joint only: (a) kneeling or squatting for a cumulative period of at least one hour per day, on more days than not, for a continuous period of at two years before the clinical worsening of osteoarthritis in that joint; and (b) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a knee joint only, having internal derangement of the affected joint before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of the patello-femoral joint only, having chondromalacia patella before the clinical worsening of osteoarthritis in that joint
having a disorder associated with loss of pain sensation or proprioception involving the affected joint before the clinical worsening of osteoarthritis in that joint
having Paget's disease of bone of the affected joint before the clinical worsening of osteoarthritis in that joint
having acromegaly before the clinical worsening of osteoarthritis in that joint
having joint instability or dislocation of the affected joint, at least one year before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a hip joint only, having femoroacetabular impingement syndrome of the affected joint, before the clinical worsening of osteoarthritis in that joint
inability to obtain appropriate clinical management for osteoarthritis

Diagnosis: Patellofemoral Osteoarthrosis (Worsening)

I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:

Statement of Principles concerning Osteoarthritis (Balance of Probabilities) (No. 62 of 2017)

which sets out the factors that can connect the condition with service.

I am satisfied that you have met the following factor:

having inflammatory joint disease as specified, of the affected joint before the clinical worsening of osteoarthritis in that joint
having an infection of the affected joint as specified before the clinical worsening of osteoarthritis in that joint
having an intra-articular fracture of the affected joint before the clinical worsening of osteoarthritis in that joint
having haemarthrosis of the affected joint before the clinical worsening of osteoarthritis in that joint
having a depositional joint disease as specified, in the affected joint before the clinical worsening of osteoarthritis in that joint
having trauma to the affected joint within the 25 years before the clinical worsening of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint within the 25 years before the clinical worsening of osteoarthritis in that joint
having an acute meniscal tear of the affected knee within the 25 years before the clinical worsening of osteoarthritis in that joint
having frostbite involving the affected joint before the clinical worsening of osteoarthritis in that joint
having disordered joint mechanics of the affected joint for at least five years before the clinical worsening of osteoarthritis in that joint
having necrosis of the subchondral bone near the affected joint, including that from dysbaric osteonecrosis, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the upper limb only, performing any combination of repetitive activities or tasks involving repeated or sustained pinch grip or hand/power grip, for an average of at least 30 hours per week, for a cumulative period of at least ten years within a continuous period of 15 years, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the hand, wrist or elbow joint only, using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten years, within the 25 years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having: (i) an amputation involving either leg; or (ii) an asymmetric gait; for at least five years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: lifting loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 150 000 kilograms within any ten year period before the clinical worsening of osteoarthritis in that joint; and (ii) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint: (i) to a cumulative total of at least 3 800 hours within any ten year period before the clinical worsening of osteoarthritis in that joint; and (ii) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a joint of the lower limb only: ascending or descending at least 150 stairs or rungs of a ladder per day, on more days than not, for a continuous period of at least five years, within the 25 years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: being overweight for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for males, having a waist circumference exceeding 102 centimetres for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb or hand joint only: for females, having a waist circumference exceeding 88 centimetres for at least ten years before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a hip or knee joint only: (a) kneeling or squatting for a cumulative period of at least one hour per day, on more days than not, for a continuous period of at two years before the clinical worsening of osteoarthritis in that joint; and (b) where the clinical worsening of osteoarthritis in that joint occurs within the 25 years following that period
for osteoarthritis of a knee joint only, having internal derangement of the affected joint before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of the patello-femoral joint only, having chondromalacia patella before the clinical worsening of osteoarthritis in that joint
having a disorder associated with loss of pain sensation or proprioception involving the affected joint before the clinical worsening of osteoarthritis in that joint
having Paget's disease of bone of the affected joint before the clinical worsening of osteoarthritis in that joint
having acromegaly before the clinical worsening of osteoarthritis in that joint
having joint instability or dislocation of the affected joint, at least one year before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a hip joint only, having femoroacetabular impingement syndrome of the affected joint, before the clinical worsening of osteoarthritis in that joint
inability to obtain appropriate clinical management for osteoarthritis

After the condition arose, it was worsened during your service. Rheumatoid arthritis with right knee synovitis remained active, with flares in 2010 and 2011, before the worsening documented on 22 October 2012. The septic arthritis of May 1998 affected the right knee and preceded the worsening. The intra-articular patellar fracture of 1996 and the trochlear fracture of 1999 preceded the worsening. On 15 June 2012, 40 mL of blood was aspirated from the right knee after the fall on a mast ladder. Calcium pyrophosphate deposition in the right knee persisted, with a further attack in 2010, before the worsening. The fall of 15 June 2012 applied significant force directly to the front of the right knee, with pain, swelling and loss of movement for more than seven days. MRI on 22 October 2012 showed a new chondral fracture of the lateral patellar facet from the fall of 15 June 2012, within the 25 years before the worsening. MRI on 22 October 2012 showed a fresh medial meniscal tear from the fall of 15 June 2012, within the 25 years before the worsening. The frostbite involving the right knee in October 2006 preceded the worsening. The 10 degrees of external tibial rotation persisted throughout the five years before the worsening, from 22 October 2007 to 22 October 2012, with increasing lateral patellar tilt on skyline views. The subchondral osteonecrosis of the medial femoral condyle persisted and preceded the worsening. Gripping work at 32 to 38 hours a week continued from 1997 to 2012, a cumulative 15 years within the continuous 15-year period before the worsening. Use of hammer drills, rock drills and jackhammers on more days than not continued from 1995 to 2012, a cumulative 17 years within the 25 years before the worsening. The asymmetric gait persisted throughout the five years before the worsening, from 22 October 2007 to 22 October 2012. Between January 2002 and December 2011 you continued to lift cable drums, generators and mast sections of 20 to 40 kg while standing, more than 1 500 000 kilograms within that ten-year period, and the worsening fell within the 25 years following it. Between January 2002 and December 2011 you carried loads of 20 kg or more for more than 3 800 hours, and the worsening fell within the 25 years following that period. Pole, mast and ladder climbing of more than 150 rungs a day on more days than not continued from 1994 to 2012, including the five years before the worsening, all within the 25 years before it. Your BMI remained between 30 and 32 from 2002 to 2012, so you were overweight throughout the ten years before the worsening, from 22 October 2002 to 22 October 2012. You are male, and your waist remained above 102 cm, recorded at 108 cm in 2012, throughout the ten years before the worsening. You are male, and your waist exceeded 88 centimetres throughout the ten years before the worsening. Kneeling for at least one hour a day on more days than not continued from 1994 to 2012, more than two years, and the worsening fell within the 25 years following that period. Recurrent patellar instability and the fresh medial meniscal tear of June 2012 are internal derangement of the right knee present before the worsening. Chondromalacia of the right patella persisted and preceded the worsening of the patellofemoral osteoarthrosis. The B12-related loss of pain sensation and proprioception persisted, confirmed on neurological review in 2010, before the worsening. Paget's disease of the right distal femur persisted, with a raised alkaline phosphatase in 2011, before the worsening. Acromegaly, treated by pituitary surgery in 2005, preceded the worsening. Recurrent patellar instability continued from 1999 and contributed to the fall of 15 June 2012. The right femoroacetabular impingement syndrome diagnosed in 2005 persisted before the worsening. After the fall on warlike service in Afghanistan on 15 June 2012 you could not obtain MRI, orthopaedic review or physiotherapy at the patrol base and continued mast and cable duties in a brace for 14 weeks.

This has then led to further investigations and the diagnosis of your condition of Patellofemoral Osteoarthrosis (Worsening). I have accepted your condition of Patellofemoral Osteoarthrosis (Worsening).

Having considered your service records and the available medical evidence, I am satisfied the SOP is met and that the worsening of this condition is related to your peacetime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 22 October 2012.

Right Knee - Patellofemoral Osteoarthrosis — example determination letter

See the letter exactly as it is delivered

Reference Determination Content

Right Knee - Patellofemoral Osteoarthrosis

Evidence

Your service

Right Knee - Patellofemoral Osteoarthrosis

Right Knee - Patellofemoral Osteoarthrosis (Worsening)

Evidence

Your service

Right Knee - Patellofemoral Osteoarthrosis (Worsening)