Right Shoulder - Degenerative Labral Tear/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 - Degenerative Labral Tear/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 26 May 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 26 May 2025;
A primary health care record by the regimental medical officer, Somalia, dated 22 February 1993;
A field hospital admission and X-ray report by the somalia, dated 18 March 1993;
Nerve conduction studies and neurology consultation by the neurologist, dated 10 May 1993;
An operation report (arthroscopic Bankart repair) by the orthopaedic surgeon, dated 12 August 1993;
A rheumatology assessment (reactive arthritis) by the rheumatologist, dated 2 May 1995;
An MRI right shoulder report by the radiologist, dated 15 March 1997;
A CT right shoulder report by the radiologist, dated 20 March 1997;
A hospital admission and microbiology report by the east timor, dated 8 January 2000;
An MRI right knee and orthopaedic consultation by the orthopaedic surgeon, dated 2 March 2000;
An MRI right hip and orthopaedic consultation by the orthopaedic surgeon, dated 9 May 2000;
A primary health care record (cold injury) by the medical officer, Afghanistan, dated 18 January 2007;
A primary health care record and joint aspirate report by the medical officer, Afghanistan, dated 11 April 2007;
An endocrinology consultation (bone scan and DXA reports) by the endocrinologist, dated 10 October 2007;
An X-ray right shoulder report by the radiologist, dated 20 August 2008;
An outpatient health record and X-ray report by the medical officer, Garrison health centre, dated 24 June 2009;
An MRI right shoulder report by the radiologist, dated 14 August 2009;
An orthopaedic consultation by the orthopaedic surgeon, dated 1 September 2009;
A DXA report by the endocrinologist, dated 10 March 2010;
An MRI right shoulder report and orthopaedic follow-up by the orthopaedic surgeon, dated 22 September 2011.

Your service

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

12 February 1986 and 30 June 2016

Right Shoulder - Degenerative Labral Tear/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: Degenerative Labral Tear/Osteoarthritis

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 26 May 2025, and is supported by an orthopaedic consultation by the orthopaedic surgeon, dated 1 September 2009.

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 deep, aching pain in the right shoulder with stiffness after rest, grinding and catching on reaching overhead and behind your back, and loss of external rotation on 24 June 2009.

The diagnosis was confirmed by X-ray on 24 June 2009, which showed new narrowing of the glenohumeral joint space and an inferior humeral head osteophyte compared with a normal joint space on 20 August 2008, and by MRI on 14 August 2009, which showed diffuse chondral thinning of the humeral head and glenoid, marginal osteophytes and degenerative fraying and tearing of the labrum. These findings, with the clinical picture of mechanical pain, crepitus and loss of external rotation, meet the Statement of Principles definition of osteoarthritis.

This has then led to further investigations and the diagnosis of your condition of Degenerative Labral Tear/Osteoarthritis. I have accepted your condition of Degenerative Labral Tear/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 16 June 2009.

Right Shoulder - Degenerative Labral Tear/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 26 May 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 26 May 2025;
A primary health care record by the regimental medical officer, Somalia, dated 22 February 1993;
A field hospital admission and X-ray report by the somalia, dated 18 March 1993;
Nerve conduction studies and neurology consultation by the neurologist, dated 10 May 1993;
An operation report (arthroscopic Bankart repair) by the orthopaedic surgeon, dated 12 August 1993;
A rheumatology assessment (reactive arthritis) by the rheumatologist, dated 2 May 1995;
An MRI right shoulder report by the radiologist, dated 15 March 1997;
A CT right shoulder report by the radiologist, dated 20 March 1997;
A hospital admission and microbiology report by the east timor, dated 8 January 2000;
An MRI right knee and orthopaedic consultation by the orthopaedic surgeon, dated 2 March 2000;
An MRI right hip and orthopaedic consultation by the orthopaedic surgeon, dated 9 May 2000;
A primary health care record (cold injury) by the medical officer, Afghanistan, dated 18 January 2007;
A primary health care record and joint aspirate report by the medical officer, Afghanistan, dated 11 April 2007;
An endocrinology consultation (bone scan and DXA reports) by the endocrinologist, dated 10 October 2007;
An X-ray right shoulder report by the radiologist, dated 20 August 2008;
An outpatient health record and X-ray report by the medical officer, Garrison health centre, dated 24 June 2009;
An MRI right shoulder report by the radiologist, dated 14 August 2009;
An orthopaedic consultation by the orthopaedic surgeon, dated 1 September 2009;
A DXA report by the endocrinologist, dated 10 March 2010;
An MRI right shoulder report and orthopaedic follow-up by the orthopaedic surgeon, dated 22 September 2011.

Your service

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

12 February 1986 and 30 June 2016

Right Shoulder - Degenerative Labral Tear/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 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: Degenerative Labral Tear/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 (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. The reactive arthritis of the right shoulder from 1995, with flares in 1996 and 2002 and a further flare in March 2010, preceded the documented worsening on 22 September 2011. The melioidosis septic arthritis of the right shoulder of January 2000 preceded the worsening on 22 September 2011. The intra-articular glenoid rim fracture of March 1993 preceded the worsening on 22 September 2011. The haemarthrosis of March 1993, and a second haemarthrosis aspirated after a fall on 4 June 1994, preceded the worsening on 22 September 2011. Gout of the right shoulder, confirmed by urate crystals in April 2007 and recurring in October 2008 and February 2010, preceded the worsening on 22 September 2011. The trauma to the right shoulder of 1993, 1994 and 1996, and a further fall onto the right shoulder from a vehicle step on 30 May 2011, all fell within the 25 years before the worsening, which run from 22 September 1986 to 22 September 2011. The acute chondral flap tear of the humeral head of March 1993 fell within the 25 years before the worsening. The acute medial meniscal tear of the right knee of October 1999 fell within the 25 years before the worsening. The frostbite over the right shoulder of January 2007 preceded the worsening on 22 September 2011. The anterior instability with glenoid bone loss persisted throughout the five years before the worsening, from 22 September 2006 to 22 September 2011, with increasing posterior humeral head subluxation on CT in 2010. The subchondral osteonecrosis of the humeral head shown in 1997, which had enlarged on MRI on 14 August 2009, preceded the worsening. The power grip work of more than 30 hours a week from 1987 to 2001 accumulated more than ten years within a continuous 15-year period before the worsening. The use of jackhammers, rock drills and post drivers on more days than not from 1988 to 2000, about 12 years, fell within the 25 years before the worsening. The asymmetric gait from the right knee injury persisted from October 1999 to the worsening, about twelve years, well over five years. The lifting of more than 1 000 000 kilograms in loads of at least 20 kilograms from 1988 to 1998 preceded the worsening, which occurred within the 25 years following that period. The carrying of loads of at least 20 kilograms for about 4 100 hours from 1987 to 1997 preceded the worsening, which occurred within the 25 years following that period. The ladder and tower climbing of more than 150 rungs a day from February 2001 to November 2006 fell within the 25 years before the worsening. Your body mass index remained above 25 from 1996 to the worsening, 32.4 on 22 September 2011, more than ten years. Your waist circumference exceeded 102 centimetres from 1997 to the worsening, 114 centimetres in 2011, more than ten years. Your waist circumference exceeded 88 centimetres throughout the ten years before the worsening. The kneeling and squatting of more than an hour a day from 1987 to 2001 preceded the worsening, which occurred within the 25 years following that period. The internal derangement of the right knee from 1999 preceded the worsening. The chondromalacia patellae of the right knee from 1993 preceded the worsening. The brachial plexus injury with loss of sensation and proprioception of the right shoulder persisted from 1993 to the worsening. Paget's disease of the right proximal humerus, diagnosed in 2007, remained active with a raised alkaline phosphatase in 2011, before the worsening. Acromegaly, diagnosed in 2007, preceded the worsening. The instability of the right shoulder from 1993 began eighteen years before the worsening. The femoroacetabular impingement syndrome of the right hip diagnosed in 2000 preceded the worsening. From January to August 2011 in Afghanistan you had no access to orthopaedic review, imaging, physiotherapy or joint injection for the right shoulder, and you continued carrying body armour and a load of about 35 kilograms despite a painful, stiff shoulder, with the worsening documented on 22 September 2011.

This has then led to further investigations and the diagnosis of your condition of Degenerative Labral Tear/Osteoarthritis (Worsening). I have accepted your condition of Degenerative Labral Tear/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 peacetime service.

I have therefore accepted that the worsening of this condition is related to your service with effect from 22 September 2011.

Right Shoulder - Degenerative Labral Tear/Osteoarthritis — example determination letter

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Reference Determination Content

Right Shoulder - Degenerative Labral Tear/Osteoarthritis

Evidence

Your service

Right Shoulder - Degenerative Labral Tear/Osteoarthritis

Right Shoulder - Degenerative Labral Tear/Osteoarthritis (Worsening)

Evidence

Your service

Right Shoulder - Degenerative Labral Tear/Osteoarthritis (Worsening)