Thoracic Spondylosis - A specified spinal condition Factor

In the factors that can contribute to spondylosis, the RMA specifies the following spinal conditions:

• Scoliosis
• Spondylolisthesis
• retrospondylolisthesis
• a deformity of a vertebra
• a deformity of a joint of a vertebra;  or
• necrosis of bone

These conditions can result in abnormal distribution of loading forces through the spine.  Seek medical advice if unsure if the particular spinal condition fits within the parameters of the RMA definition.

Additional information

Scoliosis is sometimes a result of diseases of the central nervous system (eg polio, muscular dystrophy), congenital defects of the spine, or uneven leg length.

Necrosis of bone can result from exposure to ionising radiation.

Paget's disease of the spine may result in a vertebral deformity.

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	A Specified Spinal Condition for Spondylosis	MR9279.pdf [3]	MR9279.docx [4]

Preliminary questions [9577]

9593     there is some evidence that a condition from the specified list of spinal conditions may be a factor in the development or worsening of the condition under consideration.

9594     the veteran has had a condition from the specified list of spinal conditions at some time.

35550 the veteran's condition from the specified list of spinal conditions affected side and site of the body.

35551  a condition from the specified list of spinal conditions means scoliosis, spondylolisthesis, retrospondylolisthesis, a deformity of a vertebra, a deformity of a joint of a vertebra or necrosis of bone.

35552  the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and VEA service for the condition under consideration.

35559 the veteran had the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, before the clinical onset of the condition under consideration.

35553   the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and VEA service for the clinical onset of the condition under consideration.

35555  the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and operational service for the clinical onset of the condition under consideration.

or

35556  the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and eligible service for the clinical onset of the condition under consideration.

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.

35560 the veteran had the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, before the clinical worsening of the condition under consideration.

35554   the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and VEA service for the clinical worsening of the condition under consideration.

35557  the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and operational service for the clinical worsening of the condition under consideration.

or

35558  the veteran has established the causal connection between the identified illness or injury, a condition from the specified list of spinal conditions, and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [35555]

35561  the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related to operational service.

Clinical onset and eligible service [35556]

35562  the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related to eligible service.

Clinical worsening and operational service [35557]

35561  the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related to operational service.

35563 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related.

Clinical worsening and eligible service [35558]

35562  the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related to eligible service.

35564 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a condition of side and site of the body from the specified list of spinal conditions, is causally related.

Thoracic Spondylosis - Being obese Factor

The SOPs for cervical, lumbar and thoracic spondyloses include factors for “being obese".  This term is defined in the SOP.  The RMA has also issued a SOP for morbid obesity.  If there is a history of "being obese" but the claim for spondylosis does not succeed via this factor, you will be asked to consider whether there is a history of morbid obesity, as this is an extreme form of obesity.

RMA definition of being obese

In this Statement of Principles the Repatriation Medical Authority has defined being obese as meaning "an increase in body weight by way of fat accumulation which results in a Body Mass Index (BMI) of 30 or greater.

The measurement used to define “being obese” is the Body Mass Index (BMI).

The BMI = W/H2 and where:

W is the person’s weight in kilograms and

H is the person’s height in metres".

(For Imperial weights and measures, BMI = wt. in lbs/(ht in inches2) x 703.1).

This definition excludes weight gain not resulting from fat deposition such as gross oedema, peritoneal or pleural effusion, or muscle hypertrophy.  "Being obese" develops when energy intake is in excess of expenditure for a sustained period of time.

Establishing the presence of obesity

If it is not possible to obtain specific height/weight measurements, a medical comment that the veteran or member was obese will be sufficient.  If height/weight measurements can be obtained, the BMI formula should be applied.

A history of obesity may be documented in the evidence.  However, the veteran or member may not have sought medical attention and the condition may not have been recorded in medical records.  In addition, doctors' and hospitals' records may have been destroyed or can no longer be obtained.

Therefore, a statement by the veteran about his or her weight at a particular time will generally be accepted, unless there is contradictory evidence.  This weight can then be used to calculate whether the veteran was obese at that time.

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Obesity	CR9230.pdf [5]	CR9230.docx [6]
Medical Report	Obesity	MR9305.pdf [7]	MR9305.docx [8]

Preliminary questions [32065]

17512 there is some evidence that obesity may be a factor in the development or worsening of the condition under consideration.

587       the veteran has a history of obesity.

25529 the veteran has been obese for a period of at least 10 years at some time.

25530  the veteran has established the causal connection between the long term obesity and VEA service for the condition under consideration.

8661     the veteran has established the causal connection between the long term obesity and VEA service for the clinical onset of the condition under consideration.

8663     the veteran has established the causal connection between the long term obesity and operational service for the clinical onset of the condition under consideration.

or

8664     the veteran has established the causal connection between the long term obesity and eligible service for the clinical onset of the condition under consideration.

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.

25531   the veteran has established the causal connection between the long term obesity and VEA service for the clinical worsening of the condition under consideration.

25533  the veteran has established the causal connection between the long term obesity and operational service for the clinical worsening of the condition under consideration.

or

25532  the veteran has established the causal connection between the long term obesity and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [8663]

8665     the veteran was obese for at least 10 years before the clinical onset of the condition under consideration.

591       the obesity was caused by operational service.

or

9004     the veteran has a history of morbid obesity.

24666 the veteran was morbidly obese for at least 10 years before the clinical onset of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

Clinical onset and eligible service [8664]

8666     the veteran was obese for at least 10 years within the 25 years before the clinical onset of the condition under consideration.

3407     the obesity was caused by eligible service.

or

9004     the veteran has a history of morbid obesity.

24667 the veteran was morbidly obese for at least 10 years within the 25 years before the clinical onset of the condition under consideration.

9006     the morbid obesity is causally related to eligible service.

Clinical worsening and operational service [25533]

25534 the veteran was obese for at least 10 years before the clinical worsening of the condition under consideration.

591       the obesity was caused by operational service.

17309 the clinical onset of the condition under consideration occurred prior to that part of operational service which caused the obesity.

or

9004     the veteran has a history of morbid obesity.

24668 the veteran was morbidly obese for at least 10 years before the clinical worsening of the condition under consideration.

9005     the morbid obesity is causally related to operational service.

9009     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the morbid obesity is causally related.

Clinical worsening and eligible service [25532]

25535 the veteran was obese for at least 10 years within the 25 years before the clinical worsening of the condition under consideration.

3407     the obesity was caused by eligible service.

17310 the clinical onset of the condition under consideration occurred prior to that part of eligible service which caused the obesity.

or

9004     the veteran has a history of morbid obesity.

24669  the veteran was morbidly obese for at least 10 years within the 25 years before the clinical worsening of the condition under consideration.

9006     the morbid obesity is causally related to eligible service.

9010     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the morbid obesity is causally related.

Thoracic Spondylosis - Carrying or lifting loads while bearing weight Factor

In operational service cases, the SOP requirement is carrying or lifting loads of at least 25 kg while bearing weight through the spine to a cumulative total of 120,000 kg within any 10 year period.

In eligible service cases the requirement is carrying or lifting loads of least 35 kg while bearing weight through the spine to a cumulative total of 168,000 kg within any 10 year period.

• Calculations
• Types of employment
• Physical requirements, duties, and workplace hazards of specific military occupations*

*NB.  This hotword contains an embedded table:  Military occupations with heavy lifting component.

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Carrying or Lifting Heavy Loads	CR9192.pdf [9]	CR9192.docx [10]

Preliminary questions [26428]

26429  the veteran has established the causal connection between carrying or lifting loads while bearing weight and VEA service for the condition under consideration.

26430   the veteran has established the causal connection between carrying or lifting loads while bearing weight and VEA service for the clinical onset of the condition under consideration.

26432  the veteran has established the causal connection between carrying or lifting loads while bearing weight and operational service for the clinical onset of the condition under consideration.

or

26433  the veteran has established the causal connection between carrying or lifting loads while bearing weight and eligible service for the clinical onset of the condition under consideration.

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.

26431   the veteran has established the causal connection between carrying or lifting loads while bearing weight and VEA service for the clinical worsening of the condition under consideration.

26434  the veteran has established the causal connection between carrying or lifting loads while bearing weight and operational service for the clinical worsening of the condition under consideration.

or

26435  the veteran has established the causal connection between carrying or lifting loads while bearing weight and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [26432]

12498 the veteran performed carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any 10 year period.

12499 the veteran performed carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any 10 year period before the clinical onset of the condition under consideration.

12510 operational service made a material contribution to the veteran's carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any ten year period before the clinical onset of the condition under consideration.

Clinical onset and eligible service [26433]

12500 the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg within any 10 year period.

12501 the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg within any 10 year period before the clinical onset of the condition under consideration.

25592 the clinical onset of the condition under consideration occurred within the 25 years following the 10 year period during which the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg.

12512 eligible service made a material contribution to the SOP requirements for carrying or lifting loads before the clinical onset of the condition under consideration.

Clinical worsening and operational service [26434]

12498 the veteran performed carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any 10 year period.

34001 the veteran performed carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any 10 year period before the clinical worsening of the condition under consideration.

25594 the accumulation of at least 120,000 kg within any ten year period before the clinical worsening of the condition under consideration through carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body commenced after the clinical onset of the condition under consideration.

12513 operational service made a material contribution to the veteran's carrying or lifting loads of at least 25 kg while bearing weight through side and site of the body to a cumulative total of at least 120,000 kg within any ten year period before the clinical worsening of the condition under consideration.

Clinical worsening and eligible service [26435]

12500 the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg within any 10 year period.

12511 the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg within any 10 year period before the clinical worsening of the condition under consideration.

25596 the clinical worsening of the condition under consideration occurred within the 25 years following the 10 year period during which the veteran performed carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body to a cumulative total of at least 168,000 kg.

25595 the accumulation of at least 168,000 kg within any ten year period before the clinical worsening of the condition under consideration through carrying or lifting loads of at least 35 kg while bearing weight through side and site of the body commenced after the clinical onset of the condition under consideration.

12515 eligible service made a material contribution to the SOP requirements for carrying or lifting loads before the clinical worsening of the condition under consideration.

Thoracic Spondylosis - Depositional joint disease Factor

The RMA has defined a depositional joint disease as gout, pseudogout, haemochromatosis, Wilson's disease or ochronosis.

Last reviewed for CCPS 14 December 2005.

Preliminary questions [9578]

8667     there is some evidence that a depositional joint disease may be a factor in the development or worsening of the condition under consideration.

8668     the veteran has had a depositional joint disease at some time.

1894     the veteran has gout.

or

8676     the veteran has pseudogout.

or

8677     the veteran has haemochromatosis.

or

8678     the veteran has Wilson's disease.

or

8679     the veteran has had ochronosis at some time.

9600     the identified illness or injury, a depositional joint disease, occurred in side and site of the body.

26422  the veteran has established the causal connection between the depositional joint disease and VEA service for the condition under consideration.

25539 the veteran had the identified illness or injury, a depositional joint disease in side and site of the body, before the clinical onset of the condition under consideration.

9602     the veteran has established the causal connection between the depositional joint disease and VEA service for the clinical onset of the condition under consideration.

9603     the veteran has established the causal connection between the depositional joint disease and operational service for the clinical onset of the condition under consideration.

or

9604     the veteran has established the causal connection between the depositional joint disease and eligible service for the clinical onset of the condition under consideration.

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.

25540 the veteran had the identified illness or injury, a depositional joint disease in side and site of the body, before the clinical worsening of the condition under consideration.

26423   the veteran has established the causal connection between the depositional joint disease and VEA service for the clinical worsening of the condition under consideration.

26424  the veteran has established the causal connection between the depositional joint disease and operational service for the clinical worsening of the condition under consideration.

or

26425  the veteran has established the causal connection between the depositional joint disease and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [9603]

26426  the identified illness or injury, a depositional joint disease in side and site of the body, is causally related to operational service.

Clinical onset and eligible service [9604]

26427  the identified illness or injury, a depositional joint disease in side and site of the body, is causally related to eligible service.

Clinical worsening and operational service [26424]

26426  the identified illness or injury, a depositional joint disease in side and site of the body, is causally related to operational service.

25544 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a depositional joint disease in side and site of the body, is causally related.

Clinical worsening and eligible service [26425]

26427  the identified illness or injury, a depositional joint disease in side and site of the body, is causally related to eligible service.

25545 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a depositional joint disease in side and site of the body, is causally related.

Thoracic Spondylosis - Prisoner of war Factor

Prisoners of war are identified on the client data base.

The veteran's statement of service will also record the fact that he was a prisoner of war.

The Repatriation Commission has defined a prisoner of war as a veteran who has been confined in a camp, building, prison or other restrictive area as a prisoner of the enemy, even if the confinement was for only a few hours.

Last reviewed for CCPS 14 December 2005.

Clinical onset and operational service [8625]

30034 there is some evidence that having been a prisoner of war may be a factor in the development of the condition under consideration.

292       the veteran was a prisoner of war at some time.

25485 the veteran was a prisoner of war before the clinical onset of the condition under consideration.

Thoracic Spondylosis - Inability to obtain appropriate clinical management for thoracic spondylosis Factor

Thoracic spondylosis is a degenerative disease where gradual worsening is part of the normal course of the disease process.  Appropriate clinical management for thoracic spondylosis would include anti-inflammatory drugs to reduce pain and inflammation, and if clinically indicated, X-rays, CT (computerised tomography) scan or MRI (magnetic resonance imaging).  Physiotherapy and exercise may be recommended, but surgery would be uncommon.

Inability to obtain appropriate clinical management

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Inability to Obtain Appropriate Clinical Management	GQACM.pdf [11]	GQACM.docx [12]

Preliminary questions [35566]

11109  the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.

7066     there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.

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.

7378     the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.

7379     the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.

11234   the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.

11235  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.

or

11236  the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.

Clinical worsening and operational service [11235]

7384     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.

21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.

7387     the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7390     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.

7392     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Clinical worsening and eligible service [11236]

7385     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.

7386     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.

7388     the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

7389     the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.

7391     the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.

7393     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.

Thoracic Spondylosis - Inflammatory joint disease Factor

The RMA has defined inflammatory joint disease to mean:

• Rheumatoid arthritis
• Reiter's syndrome
• Psoriatic arthropathy
• Ankylosing spondylitis
• Arthritis associated with Crohn's disease or ulcerative colitis

Conditions such as chondromalacia patellae, Paget's disease, osteoporosis, meniscal or ligament damage are not inflammatory joint disease.

Last reviewed for CCPS 14 December 2005.

Preliminary questions [9575]

8657     there is some evidence that an inflammatory joint disease may be a factor in the development or worsening of the condition under consideration.

8636     the veteran has had an inflammatory joint disease at some time.

20034 the veteran has had Reiter's syndrome at some time.

or

20035 the veteran has had psoriatic arthropathy at some time.

or

20036 the veteran has had ankylosing spondylitis at some time.

or

20038 the veteran has had rheumatoid arthritis at some time.

or

25493 the veteran has had arthritis associated with Crohn's disease at some time.

or

25494 the veteran has had arthritis associated with ulcerative colitis at some time.

8637     the identified illness or injury, an inflammatory joint disease, affected side and site of the body.

9584     the veteran has established the causal connection between the inflammatory joint disease and VEA service for the condition under consideration.

8639     the veteran had the identified illness or injury, an inflammatory joint disease in side and site of the body, before the clinical onset of the condition under consideration.

26403   the veteran has established the causal connection between the inflammatory joint disease and VEA service for the clinical onset of the condition under consideration.

9585     the veteran has established the causal connection between the inflammatory joint disease and operational service for the clinical onset of the condition under consideration.

or

9586     the veteran has established the causal connection between the inflammatory joint disease and eligible service for the clinical onset of the condition under consideration.

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.

25487 the veteran had the identified illness or injury, an inflammatory joint disease in side and site of the body, before the clinical worsening of the condition under consideration.

26404   the veteran has established the causal connection between the inflammatory joint disease and VEA service for the clinical worsening of the condition under consideration.

26405  the veteran has established the causal connection between the inflammatory joint disease and operational service for the clinical worsening of the condition under consideration.

or

26406  the veteran has established the causal connection between the inflammatory joint disease and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [9585]

26407  the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related to operational service.

Clinical onset and eligible service [9586]

26408  the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related to eligible service.

Clinical worsening and operational service [26405]

26407  the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related to operational service.

25491 the clinical onset of the condition under consideration occurred prior to that part of the operational service to which the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related.

Clinical worsening and eligible service [26406]

26408  the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related to eligible service.

25492 the clinical onset of the condition under consideration occurred prior to that part of the eligible service to which the identified illness or injury, an inflammatory joint disease in side and site of the body, is causally related.

Thoracic Spondylosis - Intra-articular fracture Factor

RMA Definition

In the Statement of Principles for osteoarthritis the RMA has defined intra-articular fracture to mean "a fracture involving the articular surface of a joint".

General Information about intra-articular fracture

This type of fracture involves the cartilaginous articular surface of one of the bones of a joint or of the vertebral bodies or facet joints of the spine.  The articular surface refers to the area of bone involved in the joint, i.e. opposing the other bone(s).

Establishing onset

If a person had an intra-articular fracture he or she would have needed significant medical attention at that time.  X-ray evidence would have been obtained to demonstrate the presence of a fracture involving the cartilaginous articular surface of one of the bones of the joint.  Such medical treatment would normally be recorded in doctors' notes and/or hospital records.  However, if these records have been destroyed or can no longer be obtained and there is a reliable history of an intra-articular fracture at a particular time, this generally will be accepted, unless there is contradictory evidence.  Obtain medical advice if it is unclear whether the claimed symptoms and treatment at that time can be attributed to an intra-articular fracture rather than to some other condition.

Last reviewed for CCPS 14 December 2005.

Preliminary questions [9576]

8658     there is some evidence that an intra-articular fracture may be a factor in the development or worsening of the condition under consideration.

4572     the veteran has had an intra-articular fracture at some time.

2485     the veteran has had an intra-articular fracture of side and site of the body at some time.

8829     intra-articular fracture means a fracture involving the articular surface of a joint.

26409  the veteran has established the causal connection between the intra-articular fracture and VEA service for the condition under consideration.

25514 the veteran had the identified illness or injury, an intra-articular fracture of side and site of the body, before the clinical onset of the condition under consideration.

9590     the veteran has established the causal connection between the identified illness or injury, an intra-articular fracture, and VEA service for the clinical onset of the condition under consideration.

9591     the veteran has established the causal connection between the intra-articular fracture and operational service for the clinical onset of the condition under consideration.

or

9592     the veteran has established the causal connection between the intra-articular fracture and eligible service for the clinical onset of the condition under consideration.

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.

25516 the veteran had the identified illness or injury, an intra-articular fracture of side and site of the body, before the clinical worsening of the condition under consideration.

26410   the veteran has established the causal connection between the intra-articular fracture and VEA service for the clinical worsening of the condition under consideration.

26411  the veteran has established the causal connection between the intra-articular fracture and operational service for the clinical worsening of the condition under consideration.

or

26412  the veteran has established the causal connection between the intra-articular fracture and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [9591]

26413  the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related to operational service.

Clinical onset and eligible service [9592]

26414  the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related to eligible service.

Clinical worsening and operational service [26411]

26413  the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related to operational service.

25519 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related.

Clinical worsening and eligible service [26412]

26414  the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related to eligible service.

25520 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, an intra-articular fracture of side and site of the body, is causally related.

Thoracic Spondylosis - Septic arthritis Factor

RMA definition

The RMA has defined septic arthritis as "the bacterial infection of a joint resulting in inflammation within that joint".

General information

There are many bacterial infections which can result in septic arthritis, such as tuberculosis, gonorrhoea or infection with staphylococcus aureus ('golden staph'); however the incidence of septic arthritis in all of them is fairly low. Most cases of septic arthritis arise from trauma or follow surgical operations.

Signs and symptoms

• Where a joint is involved:

Acute joint pain [most often the knee, followed by the shoulder, wrist, hip, phalanges, and elbow] and stiffness. On examination, the joint is warm, tender, and swollen with evidence of effusion. Other signs of infection [eg, fever, chills, or leukocytosis] usually are present. Diagnosis is by analysis of fluid aspirated from the joint and/or blood cultures. The condition is most often treated with antibiotics.

• Where the spine is involved:

Vertebral osteomyelitis usually has an insidious onset and a gradually progressive back pain unrelieved by rest, heat or analgesics, and worsened by movement.  Fever typically is minimal or absent.  Diagnosis is by blood cultures but usually biopsy of the infected bone is required.  Treatment usually involves bed rest and an appropriate antimicrobial agent.  Surgery may be required.

Establishing onset

Acute bacterial arthritis is a medical emergency; the joint may be destroyed if not promptly treated.

If a veteran or member had septic arthritis significant medical attention would have been sought.  Such medical treatment would normally be recorded in the medical documents.

Last reviewed for CCPS 14 December 2005.

Preliminary questions [26452]

26453 there is some evidence that septic arthritis in side and site of the body may be a factor in the development or worsening of the condition under consideration.

25497 the veteran has had septic arthritis at some time.

25498 the veteran has had septic arthritis in side and site of the body at some time.

25499  septic arthritis means the bacterial infection of a joint resulting in inflammation within that joint.

26454  the veteran has established the causal connection between the septic arthritis and VEA service for the condition under consideration.

26516 the veteran had the identified illness or injury, a type of septic arthritis in side and site of the body, before the clinical onset of the condition under consideration.

26455   the veteran has established the causal connection between the septic arthritis and VEA service for the clinical onset of the condition under consideration.

26457  the veteran has established the causal connection between the septic arthritis and operational service for the clinical onset of the condition under consideration.

or

26458  the veteran has established the causal connection between the septic arthritis and eligible service for the clinical onset of the condition under consideration.

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.

26517 the veteran had the identified illness or injury, a type of septic arthritis in side and site of the body, before the clinical worsening of the condition under consideration.

26456   the veteran has established the causal connection between the septic arthritis and VEA service for the clinical worsening of the condition under consideration.

26459  the veteran has established the causal connection between the septic arthritis and operational service for the clinical worsening of the condition under consideration.

or

26460  the veteran has established the causal connection between the septic arthritis and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [26457]

26461  the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related to operational service.

Clinical onset and eligible service [26458]

26462  the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related to eligible service.

Clinical worsening and operational service [26459]

26461  the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related to operational service.

26509 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related.

Clinical worsening and eligible service [26460]

26462  the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related to eligible service.

26510 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, a type of septic arthritis in side and site of the body, is causally related.

Thoracic Spondylosis - Thoracic intervertebral disc prolapse Factor

A thoracic intervertebral disc prolapse is a protrusion, herniation or rupture of an intervertebral disc of the thoracic spine, causing local pain and stiffness.

The intervertebral discs lie between the adjacent surfaces of the bodies of the vertebrae in the spine, each disc being a highly elastic tissue mass which is compressed between the vertebral surfaces.  Degenerative changes gradually cause fragmentation of the nucleus pulposus (soft gelatinous material under tension) and softening of the annulus fibrosus (the periphery of the disc).  A portion of the nucleus may protrude through a rent or tear in the softened annulus and may impinge on the adjacent nerve roots or the spinal cord itself.  The protrusion may be episodic and may continue intermittently over a period of months or years.  In the final stage of the pathological changes commonly described as prolapsed intervertebral disc, the defective disc is replaced by fibrous tissue.

Disc protrusion may occur at any time in adult life.  Classically the onset is sudden following a history of spinal strain, and is clearly defined.  The pain may be aggravated by coughing or sneezing.  Characteristically the symptoms may fluctuate in intensity, or appear intermittently.

In some cases there is no prior history of strain or trauma, and the back pain may begin gradually.  The acute symptoms usually subside in a few weeks and recovery from symptoms may occur though the disc protrusion remains.  Recurrence of symptoms is common and may occur at frequent intervals.

Intervertebral disc prolapse may be demonstrated by plain X-rays, myelography (X-ray of the spinal cord after injection of a contrast medium), CT (computerised tomography) scan or MRI (magnetic resonance imaging).

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Medical Report	Thoracic Intervertebral Disc Prolapse - Thoracic Spondylosis	MR9114.pdf [13]	MR9114.docx [14]

Preliminary questions [26793]

22444  the condition under consideration has been accepted on the basis of an intervertebral disc prolapse.

22445 the veteran has had an intervertebral disc prolapse of side and site of the body at some time.

26444   intervertebral disc prolapse means protrusion, herniation or rupture of an intervertebral disc of the cervical, thoracic or lumbar spine, causing local pain and stiffness.

22447 the condition under consideration is at the level of the identified illness or injury.

26445   the veteran has established the causal connection between the intervertebral disc prolapse and VEA service for the condition under consideration.

22446 the veteran had the identified illness or injury before the clinical onset of the condition under consideration at the level of the intervertebral disc prolapse.

22448  the veteran has established the causal connection between the intervertebral disc prolapse and VEA service for the clinical onset of the condition under consideration.

22449  the veteran has established the causal connection between the intervertebral disc prolapse and operational service for the clinical onset of the condition under consideration.

or

22450  the veteran has established the causal connection between the intervertebral disc prolapse and eligible service for the clinical onset of the condition under consideration.

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.

26446 the veteran had the identified illness or injury before the clinical worsening of the condition under consideration at the level of the intervertebral disc prolapse.

26447  the veteran has established the causal connection between the intervertebral disc prolapse and VEA service for the clinical worsening of the condition under consideration.

26448  the veteran has established the causal connection between the intervertebral disc prolapse and operational service for the clinical worsening of the condition under consideration.

or

26449  the veteran has established the causal connection between the intervertebral disc prolapse and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [22449]

22451  the identified illness or injury is causally related to operational service.

Clinical onset and eligible service [22450]

22452  the identified illness or injury is causally related to eligible service.

Clinical worsening and operational service [26448]

22451  the identified illness or injury is causally related to operational service.

26450 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury is causally related.

Clinical worsening and eligible service [26449]

22452  the identified illness or injury is causally related to eligible service.

26451 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury is causally related.

Thoracic Spondylosis - Trauma to the thoracic spine Factor

Trauma to the thoracic spine means any type of discrete physical injury to the thoracic spine [such as a hit, blow, knock, twisting, bending or crushing injury], and includes G-force induced injury.  Trauma also includes penetrating injuries to the thoracic spine as may occur with projectiles such as bullets and shrapnel.  Trauma does not include activities such as carrying heavy packs unless a specific injury occurred during the performance of such activities, eg slipping or falling while carrying a pack.

Last reviewed for CCPS 14 December 2005.

Investigative Documents

Type	Title	PDF Format	Word Format
Claimant Report	Trauma - Thoracic Spondylosis	CR9089.pdf [15]	CR9089.docx [16]
Medical Report	Trauma to the Thoracic Spine - Thoracic Spondylosis	MR9058.pdf [17]	MR9058.docx [18]

Preliminary questions [26790]

9580     the condition under consideration has been accepted on the basis of trauma.

26436 the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles.

9612     the veteran has established the causal connection between the trauma and VEA service for the condition under consideration.

9620     the veteran has established the causal connection between the trauma and VEA service for the clinical onset of the condition under consideration.

9622     the veteran has established the causal connection between the trauma and operational service for the clinical onset of the condition under consideration.

or

9623     the veteran has established the causal connection between the trauma and eligible service for the clinical onset of the condition under consideration.

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.

9621     the veteran has established the causal connection between the trauma and VEA service for the clinical worsening of the condition under consideration.

9624     the veteran has established the causal connection between the trauma and operational service for the clinical worsening of the condition under consideration.

or

9625     the veteran has established the causal connection between the trauma and eligible service for the clinical worsening of the condition under consideration.

Clinical onset and operational service [9622]

16924 on operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles.

9626     on operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred.

26437 on operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred, before the clinical onset of the condition under consideration.

9629     the trauma to side and site of the body, on operational service, before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

9631     the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles because of an illness or injury which is identifiable.

20129 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred.

26438 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred, before the clinical onset of the condition under consideration.

9632     the identified illness or injury, which caused the trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, is causally related to operational service.

Clinical onset and eligible service [9623]

26439 on eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles.

9627     on eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

9628     as a causal result of eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

26440 as a causal result of eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred, within the 25 years before the clinical onset of the condition under consideration.

9630     the trauma to side and site of the body, on eligible service, within the 25 years before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.

or

9631     the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles because of an illness or injury which is identifiable.

26441 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

26442 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred, within the 25 years before the clinical onset of the condition under consideration.

9633     the identified illness or injury, which caused the trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, is causally related to eligible service.

Clinical worsening and operational service [9624]

16924 on operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles.

9626     on operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred.

20132 as a causal result of operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred.

9634     as a causal result of operational service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred, before the clinical worsening of the condition under consideration.

9637     the trauma to side and site of the body, on operational service, before the clinical worsening of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

9631     the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles because of an illness or injury which is identifiable.

20129 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred.

20131 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least seven days except for where specified medical intervention occurred, before the clinical worsening of the condition under consideration.

9632     the identified illness or injury, which caused the trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, is causally related to operational service.

9639     the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury, which caused the trauma to side and site of the body as defined in the reasonable hypothesis Statement of Principles, is causally related.

Clinical worsening and eligible service [9625]

26439 on eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles.

9627     on eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

9628     as a causal result of eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

9635     as a causal result of eligible service, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred, within the 25 years before the clinical worsening of the condition under consideration.

9638     the trauma to side and site of the body, on eligible service, within the 25 years before the clinical worsening of the condition under consideration, was due to the veteran's serious default, wilful act or serious breach of discipline.

or

9631     the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles because of an illness or injury which is identifiable.

26441 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred.

26443 as a consequence of the identified illness or injury, the veteran had a trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, which lasted for a period of at least ten days except for where specified medical intervention occurred, within the 25 years before the clinical worsening of the condition under consideration.

9633     the identified illness or injury, which caused the trauma to side and site of the body that caused the development of symptoms as defined in the Statement of Principles, is causally related to eligible service.

9640     the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury, which caused the trauma to side and site of the body as defined in the balance of probabilities Statement of Principles, is causally related.