Reference Determination Content
Suggested draft · fictitious patient
Influenza
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 21 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
- A periodic health examination and spirometry by the medical officer, dated 12 February 2009;
- A pre-deployment medical examination by the medical officer, dated 28 May 2009;
- A regimental aid post record by the medical officer, Solomon Islands, dated 24 July 2009;
- An admission record (chest X-ray and obstetric ultrasound) by the deployed medical facility, Solomon Islands, dated 26 July 2009;
- An influenza PCR report by the pathology laboratory, dated 26 July 2009;
- An aeromedical evacuation record by the aeromedical evacuation team, dated 29 July 2009;
- A hospital admission and high-dependency record by the respiratory physician, dated 29 July 2009;
- A viral sequencing report by the reference laboratory, dated 14 August 2009;
- A specialist letter by the infectious diseases physician, dated 14 August 2009;
- A respiratory follow-up and spirometry by the respiratory physician, dated 10 December 2009.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
11 April 2005 and 2 May 2016
Influenza
You have stated that your condition was caused by:
- being exposed to influenza virus as specified, within the three weeks before the clinical onset of influenza
- for avian influenza only, being exposed to an avian influenza virus as specified, within the three weeks before the clinical onset of influenza
- for swine influenza only, being exposed to a swine influenza virus as specified, within the three weeks before the clinical onset of influenza
- inability to obtain influenza vaccination between ten days and six months before the clinical onset of influenza
- for severe influenza only: having a medical condition as specified at the time of the clinical onset of influenza
- for severe influenza only: being in the third trimester of pregnancy or the following six weeks before the clinical onset of influenza
Diagnosis: Influenza
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by an admission record (chest X-ray and obstetric ultrasound) by the deployed medical facility, Solomon Islands, dated 26 July 2009.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Influenza (Reasonable Hypothesis) (No. 44 of 2017)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- being exposed to influenza virus as specified, within the three weeks before the clinical onset of influenza
- for avian influenza only, being exposed to an avian influenza virus as specified, within the three weeks before the clinical onset of influenza
- for swine influenza only, being exposed to a swine influenza virus as specified, within the three weeks before the clinical onset of influenza
- inability to obtain influenza vaccination between ten days and six months before the clinical onset of influenza
- for severe influenza only: having a medical condition as specified at the time of the clinical onset of influenza
- for severe influenza only: being in the third trimester of pregnancy or the following six weeks before the clinical onset of influenza
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 abrupt high fever, rigors, headache, severe generalised muscle aches, sore throat, a dry cough and profound fatigue on 24 July 2009.
The diagnosis was confirmed by polymerase chain reaction on a nasopharyngeal swab taken on 24 July 2009, reported on 26 July 2009 as influenza A(H1N1)pdm09, and sequencing reported on 14 August 2009 characterised the virus as a swine-origin triple reassortant carrying avian-lineage gene segments. The clinical picture was typical: abrupt fever of 39.4 degrees, rigors, myalgia, headache, cough and sore throat during a confirmed outbreak.
This has then led to further investigations and the diagnosis of your condition of Influenza. I have accepted your condition of Influenza.
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 wartime service.
I have therefore accepted that this condition is related to your service with effect from 24 July 2009.
Influenza (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 21 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
- A periodic health examination and spirometry by the medical officer, dated 12 February 2009;
- A pre-deployment medical examination by the medical officer, dated 28 May 2009;
- A regimental aid post record by the medical officer, Solomon Islands, dated 24 July 2009;
- An admission record (chest X-ray and obstetric ultrasound) by the deployed medical facility, Solomon Islands, dated 26 July 2009;
- An influenza PCR report by the pathology laboratory, dated 26 July 2009;
- An aeromedical evacuation record by the aeromedical evacuation team, dated 29 July 2009;
- A hospital admission and high-dependency record by the respiratory physician, dated 29 July 2009;
- A viral sequencing report by the reference laboratory, dated 14 August 2009;
- A specialist letter by the infectious diseases physician, dated 14 August 2009;
- A respiratory follow-up and spirometry by the respiratory physician, dated 10 December 2009.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
11 April 2005 and 2 May 2016
Influenza (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for influenza
Diagnosis: Influenza (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by an admission record (chest X-ray and obstetric ultrasound) by the deployed medical facility, Solomon Islands, dated 26 July 2009.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Influenza (Reasonable Hypothesis) (No. 44 of 2017)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- inability to obtain appropriate clinical management for influenza
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 abrupt high fever, rigors, headache, severe generalised muscle aches, sore throat, a dry cough and profound fatigue on 24 July 2009.
The diagnosis was confirmed by polymerase chain reaction on a nasopharyngeal swab taken on 24 July 2009, reported on 26 July 2009 as influenza A(H1N1)pdm09, and sequencing reported on 14 August 2009 characterised the virus as a swine-origin triple reassortant carrying avian-lineage gene segments. The clinical picture was typical: abrupt fever of 39.4 degrees, rigors, myalgia, headache, cough and sore throat during a confirmed outbreak.
After the condition arose, it was worsened during your service. On non-warlike service in the Solomon Islands from 24 to 29 July 2009, oseltamivir was unavailable for more than 72 hours after onset because the outbreak had exhausted stocks, intensive care was not available in theatre, and aeromedical evacuation was delayed for three days by weather.
This has then led to further investigations and the diagnosis of your condition of Influenza (Worsening). I have accepted your condition of Influenza (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 wartime service.
I have therefore accepted that the worsening of this condition is related to your service with effect from 29 July 2009.
