Right Shoulder - Glenohumeral 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 - Glenohumeral 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 28 May 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 28 May 2025;
A primary health care record by the medical officer, Bougainville, dated 14 July 1998;
A primary health care record by the medical officer, Bougainville, dated 23 October 1998;
An MRI right knee and orthopaedic consultation by the orthopaedic surgeon, dated 10 February 1999;
A hospital admission and CT report by the dili, dated 14 November 1999;
An electromyography and neurology consultation by the neurologist, dated 20 January 2000;
An operation report (shoulder arthroscopy) by the orthopaedic surgeon, dated 8 February 2000;
An MRI right hip and orthopaedic consultation by the orthopaedic surgeon, dated 18 July 2000;
A CT right shoulder report by the radiologist, dated 18 May 2001;
An MRI right shoulder report by the radiologist, dated 22 August 2001;
A primary health care record (cold injury) by the medical officer, Middle East, dated 22 February 2003;
A role 3 admission and microbiology report by the middle east, dated 26 May 2003;
A rheumatology consultation by the rheumatologist, dated 2 September 2003;
An endocrinology consultation (bone scan and DXA reports) by the endocrinologist, dated 18 November 2003;
A rheumatology consultation and joint aspirate report by the rheumatologist, dated 14 June 2005;
An X-ray right shoulder report by the radiologist, dated 5 March 2007;
An outpatient health record and X-ray report by the medical officer, base medical centre, dated 20 September 2007;
An MRI right shoulder report by the radiologist, dated 11 October 2007;
An orthopaedic consultation by the orthopaedic surgeon, dated 30 October 2007;
A DXA report by the endocrinologist, dated 15 April 2009;
An MRI right shoulder report and orthopaedic follow-up by the orthopaedic surgeon, dated 5 October 2010;
An operation report (total shoulder arthroplasty) by the orthopaedic surgeon, dated 22 June 2011.

Your service

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

9 January 1988 and 14 March 2014

Right Shoulder - Glenohumeral 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: Glenohumeral Joint Osteoarthritis

Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 28 May 2025, and is supported by an orthopaedic consultation by the orthopaedic surgeon, dated 30 October 2007.

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 morning stiffness, grinding on movement, loss of external rotation and pain with overhead work and lifting on 20 September 2007.

The diagnosis was confirmed by X-ray on 20 September 2007, which showed new glenohumeral joint space narrowing and an inferior osteophyte compared with a preserved joint space on 5 March 2007, and by MRI on 11 October 2007, which showed diffuse cartilage loss of the humeral head and glenoid, marginal osteophytes and subchondral cysts. With the clinical findings of mechanical pain, coarse crepitus and loss of external rotation, these findings meet the Statement of Principles definition of osteoarthritis.

This has then led to further investigations and the diagnosis of your condition of Glenohumeral Joint Osteoarthritis. I have accepted your condition of Glenohumeral 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 12 September 2007.

Right Shoulder - Glenohumeral 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 28 May 2025;
A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 28 May 2025;
A primary health care record by the medical officer, Bougainville, dated 14 July 1998;
A primary health care record by the medical officer, Bougainville, dated 23 October 1998;
An MRI right knee and orthopaedic consultation by the orthopaedic surgeon, dated 10 February 1999;
A hospital admission and CT report by the dili, dated 14 November 1999;
An electromyography and neurology consultation by the neurologist, dated 20 January 2000;
An operation report (shoulder arthroscopy) by the orthopaedic surgeon, dated 8 February 2000;
An MRI right hip and orthopaedic consultation by the orthopaedic surgeon, dated 18 July 2000;
A CT right shoulder report by the radiologist, dated 18 May 2001;
An MRI right shoulder report by the radiologist, dated 22 August 2001;
A primary health care record (cold injury) by the medical officer, Middle East, dated 22 February 2003;
A role 3 admission and microbiology report by the middle east, dated 26 May 2003;
A rheumatology consultation by the rheumatologist, dated 2 September 2003;
An endocrinology consultation (bone scan and DXA reports) by the endocrinologist, dated 18 November 2003;
A rheumatology consultation and joint aspirate report by the rheumatologist, dated 14 June 2005;
An X-ray right shoulder report by the radiologist, dated 5 March 2007;
An outpatient health record and X-ray report by the medical officer, base medical centre, dated 20 September 2007;
An MRI right shoulder report by the radiologist, dated 11 October 2007;
An orthopaedic consultation by the orthopaedic surgeon, dated 30 October 2007;
A DXA report by the endocrinologist, dated 15 April 2009;
An MRI right shoulder report and orthopaedic follow-up by the orthopaedic surgeon, dated 5 October 2010;
An operation report (total shoulder arthroplasty) by the orthopaedic surgeon, dated 22 June 2011.

Your service

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

9 January 1988 and 14 March 2014

Right Shoulder - Glenohumeral 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 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: Glenohumeral 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 (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 psoriatic arthritis of the right shoulder diagnosed in 2003, with a flare of synovitis in February 2010, preceded the documented worsening on 5 October 2010. The Staphylococcus aureus septic arthritis of the right shoulder of May 2003 preceded the worsening on 5 October 2010. The intra-articular humeral head impaction fracture of November 1999 preceded the worsening on 5 October 2010. The haemarthrosis of November 1999, and a second haemarthrosis aspirated after the fall of 3 August 2004, preceded the worsening. Calcium pyrophosphate deposition disease of the right shoulder, confirmed in 2005 with a further attack in March 2009, preceded the worsening. The trauma of 1999 and 2004, and a fall from a maintenance stand onto the right shoulder on 18 April 2010, fell within the 25 years before the worsening, which run from 5 October 1985 to 5 October 2010. The acute chondral tear of the glenoid of November 1999 fell within the 25 years before the worsening. The acute lateral meniscal tear of the right knee of October 1998 fell within the 25 years before the worsening. The cryogenic frostbite over the right shoulder of February 2003 preceded the worsening. The posterior instability and glenoid retroversion persisted throughout the five years before the worsening, from 5 October 2005 to 5 October 2010, with progressive posterior glenoid erosion on CT in 2009. The post-traumatic subchondral osteonecrosis of the humeral head shown in 2001 preceded the worsening. The grip work of more than 30 hours a week from 1988 to 2003 accumulated more than ten years within a continuous 15-year period before the worsening. The use of rivet guns and air hammers on more days than not from 1988 to 2003, about 15 years, fell within the 25 years before the worsening. The asymmetric gait from the right knee injury persisted from October 1998 to the worsening, about twelve years. The lifting of more than 800 000 kilograms in loads of at least 20 kilograms from 1990 to 2000 preceded the worsening, which occurred within the 25 years following that period. The carrying of loads of at least 20 kilograms for about 3 900 hours from 1990 to 2000 preceded the worsening, which occurred within the 25 years following that period. The climbing of more than 150 rungs and stairs a day from 1990 to 2002 fell within the 25 years before the worsening. Your body mass index remained above 25 from 1994 to the worsening, 31.0 in October 2010, more than ten years. Your waist circumference exceeded 102 centimetres from 1995 to the worsening, 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 1988 to 2003 preceded the worsening, which occurred within the 25 years following that period. The internal derangement of the right knee from 1998 preceded the worsening. The chondromalacia patellae of the right knee from 1998 preceded the worsening. The axillary nerve injury with loss of sensation and proprioception of the right shoulder persisted from 1999 to the worsening. Paget's disease of the right proximal humerus, diagnosed in 2003, preceded the worsening. Acromegaly, diagnosed in 2003, preceded the worsening. The instability of the right shoulder from 1999 began eleven years before the worsening. The femoroacetabular impingement syndrome of the right hip diagnosed in 2000 preceded the worsening. From January to July 2010 in the Middle East you had no access to orthopaedic review, imaging, physiotherapy or joint injection for the right shoulder, and continued heavy maintenance work, including after the fall of 18 April 2010, before the worsening documented on 5 October 2010.

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

I have therefore accepted that the worsening of this condition is related to your service with effect from 5 October 2010.

Right Shoulder - Glenohumeral Joint Osteoarthritis — example determination letter

See the letter exactly as it is delivered

Reference Determination Content

Right Shoulder - Glenohumeral Joint Osteoarthritis

Evidence

Your service

Right Shoulder - Glenohumeral Joint Osteoarthritis

Right Shoulder - Glenohumeral Joint Osteoarthritis (Worsening)

Evidence

Your service

Right Shoulder - Glenohumeral Joint Osteoarthritis (Worsening)