Reasonable Hypothesis SOP [1] | 62 of 2023 |
Balance of Probabilities SOP [2] | 63 of 2023 |
ICD-10-AM Code: M88
This chronic bone disorder involves abnormal bone remodelling. This means that there is initially an excessive breakdown of bone tissue followed by the formation of bone tissue that is structurally disorganised and weaker than normal bone. It can occur at a single or multiple sites. The commonly affected areas include the skull, spine, pelvis and long bones of the leg. Individuals may experience bone pain, joint stiffness or fractures. If the skull is affected, headaches and hearing loss may also be reported. Some people report no symptoms at all despite deformity, bowing or enlargement of the bones.
Diagnosis usually requires X-rays showing a characteristic appearance. Blood tests measuring markers of bone turnover can also help to confirm the diagnosis. Bone scans can show the extent of the disease.
The relevant medical specialist is an endocrinologist, rheumatologist or orthopaedic surgeon.
* another SOP applies
Onset is typically after age 55. It is most often asymptomatic and detected incidentally following imaging performed for another indication, or from routine blood chemistry showing an elevated serum alkaline phosphatase concentration. Symptoms can include pain and deformity at the affected site.
The only SOP factor is for inability to obtain appropriate clinical management. Effective drug therapies are available that can alter the course of the disease. Treatment is indicated for symptomatic disease and in asymptomatic patients with biochemical abnormalities or imaging changes that indicate a risk of complications.
Confirmation of a diagnosis of Paget's disease of bone
If the diagnosis you have is simply Paget's disease, you need to be sure that the correct diagnosis is in fact Paget's disease of the bone, and not Paget's disease of the breast [ICD code 174.0] or extramammary Paget's disease of the skin [which should be coded to malignant neoplasm of the skin].
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.
[Link to "Inability to obtain appropriate clinical management for Paget's disease of bone"]
The clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
[Link to "N007/Onset"]
The condition under consideration permanently worsened.
[Link to "N007/Onset"]
The veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
[Link to "Inability to obtain appropriate clinical management for Paget's disease of bone"]
The inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
Place holder node for Rulebase for Paget's disease of bone
Paget's disease of bone - Inability to obtain appropriate clinical management for Paget's disease of bone Factor
Last reviewed for CCPS 18 July 2006.
Investigative Documents
Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM] Preliminary questions [17672] 11109 — the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7334 [7] the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service. the condition under consideration permanently worsened. the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 [10] 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] or 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. [15] [16] Clinical worsening and eligible service [11236] or 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. [15] [16]
Links
[1] http://www.rma.gov.au/assets/SOP/2023/6f12d533a5/062.pdf
[2] http://www.rma.gov.au/assets/SOP/2023/1151c93949/063.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20237_0.pdf
[4] https://clik.dva.gov.au/node/73573
[5] https://clik.dva.gov.au/user/login?destination=comment/reply/63951%23comment-form
[6] https://clik.dva.gov.au/ccpsother-31
[7] https://clik.dva.gov.au/node/70310
[8] clikpopup://CCPS/Reject/OnsetAfterService
[9] clikpopup://CCPS/Reject/NoPermanentWorsening
[10] https://clik.dva.gov.au/17672-inability-obtain-appropriate-clinical-management-pagets-disease-bone
[11] clikpopup://CCPS/ACM/NoContribution
[12] clikpopup://CCPS/ACM/NotOpService
[13] clikpopup://CCPS/ACM/NotOperDuties
[14] clikpopup://CCPS/rejectwilful
[15] clikpopup://CCPS/ACM/NoIllness
[16] clikpopup://CCPS/reject7390,7391No
[17] clikpopup://CCPS/Paget's disease of bone/ACM - onset prior to operational service
[18] clikpopup://CCPS/ACM/OnsetFailOper
[19] clikpopup://CCPS/ACM/NotEligService
[20] clikpopup://CCPS/ACM/NotEligDuties
[21] clikpopup://CCPS/Paget's disease of bone/ACM - onset prior to eligible service
[22] clikpopup://CCPS/ACM/OnsetFailElig