Right Shoulder - Acromioclavicular Joint Osteoarthritis — 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 Shoulder - Acromioclavicular Joint Osteoarthritis

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 10 April 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 10 April 2025;
A recruit training medical record by the medical officer, dated 14 April 1987;
A post-release medical assessment and nerve conduction study by the medical officer and neurologist, dated 23 March 1993;
An emergency department by the x-ray and MRI reports, Orthopaedic registrar and Radiologist, dated 15 March 1997;
A bone densitometry report by the nuclear medicine physician, dated 9 June 1999;
A field hospital record and knee arthroscopy report by the orthopaedic surgeon, East Timor, dated 2 February 2000;
A rheumatology consultation by the rheumatologist, dated 12 June 2004;
An operation report by the orthopaedic surgeon, dated 14 August 2006;
An MRI right shoulder report by the radiologist, dated 20 November 2008;
An endocrinology consultation and joint aspirate report by the endocrinologist, dated 19 August 2009;
A bone scan report by the nuclear medicine physician, dated 11 October 2011;
A periodic health examination by the medical officer, dated 8 February 2012;
An outpatient health record and X-ray report by the medical officer, Garrison health centre, dated 21 June 2012;
A bone densitometry report by the nuclear medicine physician, dated 3 August 2016;
A role 2 hospital record and X-ray by the medical officer, Iraq, dated 20 September 2017;
An MRI right shoulder report by the radiologist, dated 16 October 2017;
An operation report by the orthopaedic surgeon, dated 14 March 2018.

Your service

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

6 February 1987 and 15 March 2019

Right Shoulder - Acromioclavicular Joint Osteoarthritis

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: Acromioclavicular Joint Osteoarthritis

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 10 April 2025, and is supported by an outpatient health record and X-ray report by the medical officer, Garrison health centre, dated 21 June 2012.

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 constant aching over the top of the right shoulder, sharp pain when reaching across your body, carrying loads on the shoulder and lifting overhead, night pain when lying on the right side, stiffness and grinding on 21 June 2012.

The diagnosis was made on 21 June 2012 on the combination of pain, impaired function and stiffness of the right acromioclavicular joint with tenderness, crepitus and a positive cross-body adduction test, and X-ray showing joint space narrowing, subchondral sclerosis and osteophytes. This meets the Statement of Principles definition of osteoarthritis: a degenerative joint disorder with clinical manifestations of pain, impaired function and stiffness and imaging evidence of loss of articular cartilage or osteophytes, and it is not an acute cartilage tear or osteochondritis dissecans.

This has then led to further investigations and the diagnosis of your condition of Acromioclavicular Joint Osteoarthritis. I have accepted your condition of Acromioclavicular Joint Osteoarthritis.

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 14 June 2012.

Right Shoulder - Acromioclavicular Joint Osteoarthritis (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 10 April 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 10 April 2025;
A recruit training medical record by the medical officer, dated 14 April 1987;
A post-release medical assessment and nerve conduction study by the medical officer and neurologist, dated 23 March 1993;
An emergency department by the x-ray and MRI reports, Orthopaedic registrar and Radiologist, dated 15 March 1997;
A bone densitometry report by the nuclear medicine physician, dated 9 June 1999;
A field hospital record and knee arthroscopy report by the orthopaedic surgeon, East Timor, dated 2 February 2000;
A rheumatology consultation by the rheumatologist, dated 12 June 2004;
An operation report by the orthopaedic surgeon, dated 14 August 2006;
An MRI right shoulder report by the radiologist, dated 20 November 2008;
An endocrinology consultation and joint aspirate report by the endocrinologist, dated 19 August 2009;
A bone scan report by the nuclear medicine physician, dated 11 October 2011;
A periodic health examination by the medical officer, dated 8 February 2012;
An outpatient health record and X-ray report by the medical officer, Garrison health centre, dated 21 June 2012;
A bone densitometry report by the nuclear medicine physician, dated 3 August 2016;
A role 2 hospital record and X-ray by the medical officer, Iraq, dated 20 September 2017;
An MRI right shoulder report by the radiologist, dated 16 October 2017;
An operation report by the orthopaedic surgeon, dated 14 March 2018.

Your service

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

6 February 1987 and 15 March 2019

Right Shoulder - Acromioclavicular Joint Osteoarthritis (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 before the clinical worsening of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint before the clinical worsening of osteoarthritis in that joint
having an acute meniscal tear of the affected knee 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 three 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 upper limb only: using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten 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 three 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 to a cumulative total of at least 100 000 kilograms within any ten year period before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 3 800 hours within any ten year period before the clinical worsening of osteoarthritis in that joint
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 two years, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having osteoporosis 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, 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 one year before the clinical worsening of osteoarthritis in that joint
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: Acromioclavicular Joint Osteoarthritis (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 (Reasonable Hypothesis) (No. 61 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 before the clinical worsening of osteoarthritis in that joint
having an acute articular cartilage tear of the affected joint before the clinical worsening of osteoarthritis in that joint
having an acute meniscal tear of the affected knee 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 three 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 upper limb only: using a hand-held, vibrating percussive tool or object on more days than not, for a cumulative period of at least ten 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 three 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 to a cumulative total of at least 100 000 kilograms within any ten year period before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: carrying loads of at least 20 kilograms while bearing weight through the affected joint to a cumulative total of at least 3 800 hours within any ten year period before the clinical worsening of osteoarthritis in that joint
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 two years, before the clinical worsening of osteoarthritis in that joint
for osteoarthritis of a joint of the lower limb only: having osteoporosis 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, 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 one year before the clinical worsening of osteoarthritis in that joint
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. Psoriatic arthropathy involving the right acromioclavicular joint was active during warlike service in Iraq in 2017, before the worsening on 20 September 2017. The septic arthritis of 2006 preceded the worsening on warlike service in Iraq on 20 September 2017. The intra-articular fracture of 1997 preceded the worsening on warlike service in Iraq. The haemarthrosis of 1997 preceded the worsening on warlike service in Iraq. Gout involving the right acromioclavicular joint flared in March 2017 on warlike service in Iraq, before the worsening. The suspension in captivity on warlike service in Somalia and the falls of 1997 and 2010 preceded the worsening on warlike service in Iraq. The acute articular cartilage tear of 1997 preceded the worsening on warlike service in Iraq. The acute medial meniscal tear sustained on warlike service in East Timor preceded the worsening. The frostbite over the right acromioclavicular joint of 2005 preceded the worsening on warlike service in Iraq. The malunion of the distal clavicle persisted for 20 years before the worsening on warlike service in Iraq, well over three years. The subchondral necrosis of the distal clavicle preceded the worsening on warlike service in Iraq. Sustained power grip for more than 30 hours a week from 2002 to 2016, 14 years within a continuous 15-year period, included plant operation on warlike service in Afghanistan, before the worsening. The 15 cumulative years of vibrating percussive tool use, including in Somalia and Rwanda, preceded the worsening on warlike service in Iraq. The asymmetric gait following the meniscal tear sustained on warlike service in East Timor persisted for 17 years before the worsening. Lifting of about 190,000 kilograms from 2000 to 2010, including on warlike service, preceded the worsening. Carrying of about 4,200 hours from 1998 to 2008, including on warlike service, preceded the worsening. Climbing of about 200 steps and rungs a day from 2002 to 2008, including on warlike service in Afghanistan, preceded the worsening. Bone densitometry on 3 August 2016 showed osteoporosis of the distal forearm with a T-score of -2.6, attributed to secondary hypogonadism after pituitary surgery and prednisolone, before the worsening on warlike service in Iraq on 20 September 2017. You were overweight throughout the ten years before the worsening, including on warlike service in Iraq. Your waist exceeded 102 centimetres throughout the ten years before the worsening on warlike service in Iraq. Your waist exceeded 88 centimetres throughout the ten years before the worsening on warlike service in Iraq. Kneeling for mine clearance on operational service from 1993 to 1999 preceded the worsening. The internal derangement of the right knee from East Timor preceded the worsening. Chondromalacia patellae preceded the worsening on warlike service in Iraq. The brachial plexus injury from captivity in Somalia, with loss of shoulder sensation and proprioception, persisted to the worsening. Paget's disease of the right clavicle preceded the worsening on warlike service in Iraq. Acromegaly preceded the worsening on warlike service in Iraq. The acromioclavicular dislocation of 2010 occurred more than seven years before the worsening on warlike service in Iraq. Cam-type femoroacetabular impingement of the right hip preceded the worsening on warlike service in Iraq. On warlike service in Iraq from February to September 2017 you could not obtain orthopaedic review, imaging, injection or physiotherapy, and the joint progressed to bone-on-bone change by 20 September 2017.

This has then led to further investigations and the diagnosis of your condition of Acromioclavicular Joint Osteoarthritis (Worsening). I have accepted your condition of Acromioclavicular Joint Osteoarthritis (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 wartime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 20 September 2017.

Right Shoulder - Acromioclavicular Joint Osteoarthritis — example determination letter

See the letter exactly as it is delivered

Reference Determination Content

Right Shoulder - Acromioclavicular Joint Osteoarthritis

Evidence

Your service

Right Shoulder - Acromioclavicular Joint Osteoarthritis

Right Shoulder - Acromioclavicular Joint Osteoarthritis (Worsening)

Evidence

Your service

Right Shoulder - Acromioclavicular Joint Osteoarthritis (Worsening)