Necrosis

Subchondral bone necrosis

In the SOP for osteoarthritis the necrosis must be of the subchondral bone near the affected joint.

General Information

This type of necrosis is normally described as avascular necrosis (AVN) which may also be known as osteonecrosis, aseptic necrosis, or ischemic bone necrosis.

This type of necrosis results from the temporary or permanent loss of the blood supply to an area of bone.  Without the blood supply, the bone tissue dies and the bone collapses.

Signs and symptoms

Avascular necrosis typically causes pain and reduced range of motion in the affected joint.  While it can affect any bone, avascular necrosis primarily affects the joints at the hip, knee, and shoulder.  Multiple bones can be affected at any one time.

In addition to pain in the hip joint, pain also may radiate into the groin or go down the thigh to the knee.  In the knee, the pain occurs most often on the inside of the knee and worsens with activity.

Signs and symptoms may appear suddenly if caused by an injury.  In other cases, the pain and stiffness may build up slowly over several months.  Some people with avascular necrosis experience no symptoms at all.

Establishing onset

If a person had avascular necrosis he or she may have needed medical attention at some time.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, these records may have been destroyed or can no longer be obtained.  Therefore, if there is a reliable history of appropriate medical treatment at a particular time, this generally will be accepted, unless there is contradictory evidence.  Seek medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to necrosis of the subchondral bone rather than to some other condition.

Last reviewed for CCPS 10 June 2012.

Investigative Documents

Preliminary questions [41607]

41608 there is some evidence that necrosis may be a factor in the development or worsening of the osteoarthritis.

41609 the veteran has had necrosis of a subchondral bone near the affected joint at some time.

41610  the veteran has established the causal connection between necrosis of a subchondral bone near the affected joint and VEA service for osteoarthritis.

41612   the veteran has established the causal connection between necrosis and VEA service for the clinical onset of osteoarthritis.

41632  the veteran has established the causal connection between necrosis of a subchondral bone near the affected joint and operational service for the clinical onset of osteoarthritis.

or

41633  the veteran has established the causal connection between necrosis of a subchondral bone near the affected joint and eligible service for the clinical onset of osteoarthritis.

or

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

41614   the veteran has established the causal connection between necrosis and VEA service for the clinical worsening of osteoarthritis.

41637  the veteran has established the causal connection between the necrosis of a subchondral bone near the affected joint and operational service for the clinical worsening of osteoarthritis.

or

41638  the veteran has established the causal connection between the necrosis of a subchondral bone near the affected joint and eligible service for the clinical worsening of osteoarthritis.

Clinical onset and operational service [41632]

41937 the veteran had the necrosis of a subchondral bone near the affected joint before the clinical onset of osteoarthritis, as a causal result of operational service.

41938 the necrosis of a subchondral bone near the affected joint, on operational service, before the clinical onset of osteoarthritis was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical onset and eligible service [41633]

41939 the veteran had the necrosis of a subchondral bone near the affected joint before the clinical onset of osteoarthritis, as a causal result of eligible service.

41940 the necrosis of a subchondral bone near the affected joint, on eligible service, before the clinical onset of osteoarthritis was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical worsening and operational service [41637]

41941 the veteran had the necrosis of a subchondral bone near the affected joint before the clinical worsening of osteoarthritis, as a causal result of operational service.

41942 the necrosis of a subchondral bone near the affected joint, on operational service, before the clinical worsening of osteoarthritis was due to the veteran's serious default, wilful act or serious breach of discipline.

Clinical worsening and eligible service [41638]

41943 the veteran had the necrosis of a subchondral bone near the affected joint before the clinical worsening of osteoarthritis, as a causal result of eligible service.

41944 the necrosis of a subchondral bone near the affected joint, on eligible service, before the clinical worsening of osteoarthritis was due to the veteran's serious default, wilful act or serious breach of discipline.