Reference Determination Content
Suggested draft · fictitious patient
Left Calf - Soft Tissue Injury (M79.89) Left Calf - Strain
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 10 June 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 10 June 2025;
- A pre-deployment health assessment by the medical officer, RAAF base health centre, dated 2 June 2009;
- An emergency department record by the orthopaedic surgeon, Role 3 hospital, Afghanistan, dated 9 November 2009;
- An ultrasound left calf and ankle report by the radiologist, Role 3 hospital, Afghanistan, dated 10 November 2009;
- An outpatient health record by the medical officer, Afghanistan, dated 20 November 2009;
- A physiotherapy assessment by the physiotherapist, dated 22 March 2010;
- An outpatient health record by the medical officer, RAAF base health centre, dated 4 October 2010;
- An outpatient health record by the medical officer, Role 2 facility, Iraq, dated 3 May 2016;
- An ultrasound left calf and ankle report by Role 2 facility, Iraq, dated 4 May 2016;
- An MRI left calf report and sports medicine consultation by the radiologist and sports physician, dated 15 September 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
23 January 2005 and 11 December 2019
Left Calf - Soft Tissue Injury (M79.89) Left Calf - Strain
You have stated that your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
Diagnosis: Soft Tissue Injury (M79.89) Left Calf - Strain
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 10 June 2025, and is supported by an ultrasound left calf and ankle report by the radiologist, Role 3 hospital, Afghanistan, dated 10 November 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 Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
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 sudden severe pain in the inner left calf, a feeling of being kicked, inability to rise onto your toes or bear weight, then bruising spreading to the ankle, with pain and swelling over the outside of the left ankle on 9 November 2009.
The diagnosis was confirmed by ultrasound on 10 November 2009, which showed a grade 2 partial tear of the medial head of the left gastrocnemius at the musculotendinous junction with haematoma, and a grade 1 sprain of the anterior talofibular ligament. The clinical findings of a palpable defect, bruising and loss of push-off strength immediately after a forceful sprinting injury were typical. This meets the Statement of Principles definition of strain as an injury involving the tearing of a muscle, associated with the onset of pain and tenderness at that site within the 24 hours following the injury, and of sprain for the ankle ligament.
This has then led to further investigations and the diagnosis of your condition of Soft Tissue Injury (M79.89) Left Calf - Strain. I have accepted your condition of Soft Tissue Injury (M79.89) Left Calf - Strain.
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 9 November 2009.
Left Calf - Soft Tissue Injury (M79.89) Left Calf - Strain (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 10 June 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 10 June 2025;
- A pre-deployment health assessment by the medical officer, RAAF base health centre, dated 2 June 2009;
- An emergency department record by the orthopaedic surgeon, Role 3 hospital, Afghanistan, dated 9 November 2009;
- An ultrasound left calf and ankle report by the radiologist, Role 3 hospital, Afghanistan, dated 10 November 2009;
- An outpatient health record by the medical officer, Afghanistan, dated 20 November 2009;
- A physiotherapy assessment by the physiotherapist, dated 22 March 2010;
- An outpatient health record by the medical officer, RAAF base health centre, dated 4 October 2010;
- An outpatient health record by the medical officer, Role 2 facility, Iraq, dated 3 May 2016;
- An ultrasound left calf and ankle report by Role 2 facility, Iraq, dated 4 May 2016;
- An MRI left calf report and sports medicine consultation by the radiologist and sports physician, dated 15 September 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
23 January 2005 and 11 December 2019
Left Calf - Soft Tissue Injury (M79.89) Left Calf - Strain (Worsening)
You have stated that the worsening of your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
Diagnosis: Soft Tissue Injury (M79.89) Left Calf - Strain (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 10 June 2025, and is supported by an ultrasound left calf and ankle report by the radiologist, Role 3 hospital, Afghanistan, dated 10 November 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 Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
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 sudden severe pain in the inner left calf, a feeling of being kicked, inability to rise onto your toes or bear weight, then bruising spreading to the ankle, with pain and swelling over the outside of the left ankle on 9 November 2009.
The diagnosis was confirmed by ultrasound on 10 November 2009, which showed a grade 2 partial tear of the medial head of the left gastrocnemius at the musculotendinous junction with haematoma, and a grade 1 sprain of the anterior talofibular ligament. The clinical findings of a palpable defect, bruising and loss of push-off strength immediately after a forceful sprinting injury were typical. This meets the Statement of Principles definition of strain as an injury involving the tearing of a muscle, associated with the onset of pain and tenderness at that site within the 24 hours following the injury, and of sprain for the ankle ligament.
After the condition arose, it was worsened during your service. During warlike service in Iraq, on 3 May 2016, you landed on a rock after jumping 1.2 metres from a protected vehicle with 35 kilograms of equipment, forcing the left ankle into inversion and worsening the ligament injury to a grade 2 sprain. During warlike service in Iraq, on 3 May 2016, the left calf contracted eccentrically at high intensity to absorb the loaded landing while being stretched, and the medial gastrocnemius re-tore through the old scar to a high-grade tear. On warlike service in Afghanistan in 2009 physiotherapy was withdrawn after two sessions and you were returned to patrols after 11 days because of operational manning needs.
This has then led to further investigations and the diagnosis of your condition of Soft Tissue Injury (M79.89) Left Calf - Strain (Worsening). I have accepted your condition of Soft Tissue Injury (M79.89) Left Calf - Strain (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 3 May 2016.
