Diagnostic Assessment — Left Palm - Laceration
Example 1 of 1 · fictitious patient
Diagnostic Assessment Left Palm — Laceration BOP Code: 38 of 2025 (Cut, Stab, Abrasion and Laceration) RH Code: 37 of 2025 (Cut, Stab, Abrasion and Laceration)
ADF History
The veteran, date of birth [withheld], served in the Royal Australian Navy as a Boatswain's Mate from 12 December 1989 to 27 September 1996
History
The veteran sustained a laceration to the palm of the left hand during ADF service, documented on 20 February 1993 as a puncture wound with a stick in a river (the activity and whether he was on duty are not recorded), which was irrigated, cleansed, explored and sutured.
On 21 February 1993 he presented for review of the wound with some discomfort and the need for investigation of a possible foreign body; X-ray of the left hand reported on 22 February 1993 showed no radio-opaque foreign body.
The wound was slightly inflamed and not progressing well on 22 February 1993, requiring rest in a sling and continued antibiotics, and was gradually healing by 26 February 1993, when he was fit for normal duties but not sea duty
Timeline
20 Feb 1993 — Laceration to the palm of the left hand from a puncture wound with a stick in a river.
No motor or neurological deficit.
The wound was irrigated, cleansed, explored and sutured.
Tetanus covered.
Placed on light duties with review in 2 days (the treating doctor). "Laceration palm L hand" 21 Feb 1993 — ABSR the veteran presented for review of a wound to the left hand at a patrol boat.
He reported some discomfort which was easing.
The wound was reviewed and the treating medical officer noted that investigation for a possible foreign body was required.
Preventative antibiotics were prescribed and a X-ray of the left hand was requested to exclude a foreign body.
He was placed on light duties. "Review wound, left hand" 22 Feb 1993 — X-ray of the left hand reported by Gale and Roberts Medical to the referring doctor, the treating doctor. "No radio opaque foreign body seen" 22 Feb 1993 — Review of the laceration of the palm of the left hand.
Continuing discomfort and slight inflammation; not progressing so well.
Rest in a sling, continued antibiotics and review in 2 days, with possible orthopaedic review.
Light duties only. "Not progressing so well" 24 Feb 1993 — Review of the wound to the left hand.
No progression of inflammation; improving.
Wound redressed, with review in 2 days. "Improving" 26 Feb 1993 — Review of the wound to the left hand.
Gradually healing, with the radial end still moist.
Daily dressings to continue and sutures to be removed on 22 or 23 June.
Fit for normal duties but not sea duty. "Wound gradually healing"
Symptoms
At the time of presentation on 20 February 1993, the veteran had a puncture wound laceration to the palm of the left hand, with no motor or neurological deficit.
He had ongoing discomfort, raising concern for a retained foreign body, and slight inflammation on 22 February 1993; by 17 June there was no progression of inflammation and the wound was improving
Imaging
21 Feb 1993 — X-ray left hand requested to exclude foreign body.
22 Feb 1993 — X-ray left hand: "No radio opaque foreign body seen."
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Left Palm Laceration (ICD-10: S61.412A)
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 20 February 1993 [CHART REVIEW document] When did the veteran first present to a health / medical provider for this condition? 20 February 1993 When was the condition confirmed / formally diagnosed? 20 February 1993 When did the veteran first present to you (or your practice) for this condition? 24 April 2021
3. How was this diagnosis confirmed?
The diagnosis was confirmed on clinical grounds by the attending medical officer, who on 20 February 1993 diagnosed a laceration of the palm of the left hand from a puncture wound with a stick in a river, with no motor or neurological deficit, and irrigated, explored and sutured the wound [CHART REVIEW document].
The wound was visible on examination and required investigation for a possible foreign body [CHART REVIEW document]; X-ray of the left hand reported on 22 February 1993 showed no radio-opaque foreign body [CHART REVIEW document].
Reviews on 15, 17 and 26 February 1993 documented slight inflammation, then improvement and gradual healing [ [CHART REVIEW document], pages 56, 57, 59]
4. What do you consider to be the cause(s) of the condition in this veteran?
Legislation: The clinical onset of this condition was before 11 March 2010 (see
Date of Clinical Onset
Below), and it did not arise on warlike or non-warlike deployment (the veteran had no deployments).
This is therefore a DRCA claim.
Statements of Principles do not apply to DRCA claims, so there are no binding SOP factors for this condition.
The factors of the relevant Statements of Principles are applied below by analogy, as a guide to the causes of this condition that are recognised in the medical-scientific literature, and every factor of both the Balance of Probabilities and the Reasonable Hypothesis instruments is addressed.
Under the DRCA the question is whether the injury or disease arose out of, or in the course of, the veteran's ADF service, or (for a disease or an aggravation) whether that service contributed to it to a significant degree.
Plausible links to service outside the SOP factors are set out below.
The absence of documentation does not mean that an event or exposure did not occur: lack of evidence is not evidence of lack.
Causative Factors — Balance of Probabilities (Statement of Principles concerning Cut, Stab, Abrasion and Laceration, No.
38 of 2025) Factor 9(1): having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration — MET - On 20 February 1993 the veteran sustained a puncture wound to the palm of his left hand from a stick in a river, recorded in the Outpatient Health Record of that date as a laceration of the palm of the left hand.
The stick penetrated the skin of the left palm, which is direct physical trauma to the affected site, and the wound was produced at the moment of that trauma.
The medical officer irrigated, explored and sutured the wound the same day and found no motor or neurological deficit, and the X-ray of 22 February 1993 showed no retained radio-opaque foreign body.
Causative Factors — Reasonable Hypothesis (Statement of Principles concerning Cut, Stab, Abrasion and Laceration, No.
37 of 2025) the veteran had no operational deployments.
The Reasonable Hypothesis standard applies only to operational service, so these factors are assessed for completeness and, like the Balance of Probabilities factors, by analogy only.
Factor 9(1): having direct physical trauma to the affected site at the time of the cut, stab, abrasion or laceration — MET - The Outpatient Health Record of 20 February 1993 documents a puncture wound to the palm of the veteran's left hand from a stick in a river, which was irrigated, explored and sutured that day.
The stick penetrating the skin of the left palm was direct physical trauma to the affected site at the time the laceration occurred.
Other Plausible Links to Service The record does not state what the veteran was doing when the stick pierced his palm or whether he was on duty; the absence of that detail is not evidence that he was off duty.
He was then serving at a patrol boat, a waterfront naval base, and his work as a Boatswain's Mate and Boatswain's Mate included work in and around the water, such as the tide-pole diving recorded in July 1991.
If the injury was sustained on duty, or in an activity associated with his employment or undertaken at the Navy's direction, it arose in the course of his employment, and his own account of the circumstances bears directly on that question.
Conclusion the veteran's left palm laceration was caused by direct penetrating trauma from a stick on 20 February 1993, which satisfies the direct-trauma factor of both Statements of Principles; there is no other cause.
It was sustained during his full-time naval service while he was posted to a patrol boat and was treated under his service medical care.
The record does not state what he was doing, so whether it arose in the course of his employment turns on whether it was sustained on duty or in an activity associated with his employment, which his duties in and around the water make plausible.
The % contribution of the causes is 100% and significant.
Worsening Factors In the alternative, if the veteran's left palm laceration is found not to have arisen out of his service, the following factors address whether service rendered after its clinical onset on 20 February 1993 aggravated it or contributed to it in a material degree, in particular before the slight inflammation of the wound recorded on 22 February 1993.
Worsening Factors — Balance of Probabilities (Statement of Principles concerning Cut, Stab, Abrasion and Laceration, No.
38 of 2025) Factor 9(2): inability to obtain appropriate clinical management for cut, stab, abrasion or laceration before clinical worsening — NOT MET - Applying Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), there was no inability, objective or subjective, to obtain appropriate clinical management: the wound was sutured on the day of injury, with antibiotics and a X-ray the next day, and the slight inflammation of 22 February 1993 settled with a sling and continued antibiotics.
Worsening Factors — Reasonable Hypothesis (Statement of Principles concerning Cut, Stab, Abrasion and Laceration, No.
37 of 2025) the veteran had no operational deployments.
The Reasonable Hypothesis standard applies only to operational service, so these factors are assessed for completeness and, like the Balance of Probabilities factors, by analogy only.
Factor 9(2): inability to obtain appropriate clinical management for cut, stab, abrasion or laceration before clinical worsening — NOT MET - Assessed objectively and subjectively as Brew v Repatriation Commission (Full Federal Court, 10 September 1999) requires, the veteran obtained prompt and continuous care from the day of injury, with reviews on 14, 15, 17 and 26 February 1993; there was no inability to obtain appropriate clinical management before the slight inflammation of 22 February 1993
Sequelae
No specific sequelae documented
Unintended Consequence
This condition is not an unintended consequence of medical management
Inability to Attain Appropriate Medical Management
Not applicable
Date of Clinical Onset
Left palm laceration is an acute condition.
Its date of clinical onset is the date of the injury or illness itself, as recorded in the contemporaneous service record.
Later investigations, reviews and imaging record the investigation, treatment or confirmation of the condition; they are not the date of clinical onset.
Date of injury / illness: 20 February 1993 — puncture wound to the palm of the left hand with a stick in a river [CHART REVIEW document].
The later records, including the X-ray of the left hand on 22 February 1993, concern investigation or follow-up and do not alter the date of clinical onset.
Date of clinical onset: 20 February 1993.
This date falls within the veteran's ADF service (12 December 1989 27 September 1996).
In-service events and exposures before this date relate to clinical onset, and those after it to clinical worsening
