Reference Determination Content
Suggested draft · fictitious patient
Left Hip - Adductor Strain and Hamstring Origin Tendinopathy
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 pre-deployment medical examination by the medical officer, Garrison health centre, dated 26 November 2008;
- A patrol treatment record by the unit medic, Afghanistan, dated 17 June 2009;
- A treatment record by the medical officer, Patrol base, Afghanistan, dated 18 June 2009;
- An MRI left hip and groin by the radiologist, dated 2 November 2009;
- A physiotherapy assessment and rehabilitation programme by the physiotherapist, dated 2 November 2009;
- An outpatient health record by the medical officer, Garrison health centre, dated 22 August 2013;
- An MRI left hip and groin and X-ray pelvis by the radiologist, dated 26 August 2013;
- A specialist consultation by the sports physician, dated 14 January 2014;
- A treatment record by the deployed medical officer, Iraq, dated 3 May 2015;
- An MRI left hip and pelvis by the radiologist, dated 5 August 2015;
- A specialist consultation by the sports physician, dated 5 August 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
20 January 2002 and 8 March 2019
Left Hip - Adductor Strain and Hamstring Origin Tendinopathy
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: Adductor Strain and Hamstring Origin Tendinopathy
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a treatment record by the medical officer, Patrol base, Afghanistan, dated 18 June 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, sharp pain in the left groin and front of the hip, with a limp, pain on bringing the leg inwards and bruising of the upper inner thigh within 24 hours on 17 June 2009.
The diagnosis was made clinically by the patrol medic on 17 June 2009 and the medical officer on 18 June 2009, who recorded a typical mechanism of forced abduction, tenderness at the adductor longus origin and the anterior hip, pain on resisted adduction and passive abduction, and bruising of the medial thigh within 24 hours. This meets the Statement of Principles definitions of strain and sprain.
This has then led to further investigations and the diagnosis of your condition of Adductor Strain and Hamstring Origin Tendinopathy. I have accepted your condition of Adductor Strain and Hamstring Origin Tendinopathy.
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 17 June 2009.
Left Hip - Adductor Strain and Hamstring Origin Tendinopathy (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 pre-deployment medical examination by the medical officer, Garrison health centre, dated 26 November 2008;
- A patrol treatment record by the unit medic, Afghanistan, dated 17 June 2009;
- A treatment record by the medical officer, Patrol base, Afghanistan, dated 18 June 2009;
- An MRI left hip and groin by the radiologist, dated 2 November 2009;
- A physiotherapy assessment and rehabilitation programme by the physiotherapist, dated 2 November 2009;
- An outpatient health record by the medical officer, Garrison health centre, dated 22 August 2013;
- An MRI left hip and groin and X-ray pelvis by the radiologist, dated 26 August 2013;
- A specialist consultation by the sports physician, dated 14 January 2014;
- A treatment record by the deployed medical officer, Iraq, dated 3 May 2015;
- An MRI left hip and pelvis by the radiologist, dated 5 August 2015;
- A specialist consultation by the sports physician, dated 5 August 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
20 January 2002 and 8 March 2019
Left Hip - Adductor Strain and Hamstring Origin Tendinopathy (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: Adductor Strain and Hamstring Origin Tendinopathy (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a treatment record by the medical officer, Patrol base, Afghanistan, dated 18 June 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 (Balance of Probabilities) (No. 28 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, sharp pain in the left groin and front of the hip, with a limp, pain on bringing the leg inwards and bruising of the upper inner thigh within 24 hours on 17 June 2009.
The diagnosis was made clinically by the patrol medic on 17 June 2009 and the medical officer on 18 June 2009, who recorded a typical mechanism of forced abduction, tenderness at the adductor longus origin and the anterior hip, pain on resisted adduction and passive abduction, and bruising of the medial thigh within 24 hours. This meets the Statement of Principles definitions of strain and sprain.
After the condition arose, it was worsened during your service. On 22 August 2013, in a unit rugby match that formed part of your peacetime physical training at your garrison, you were tackled and your left leg was forced into abduction and external rotation, a collision that applied a significant force through the left hip joint. In the same tackle on 22 August 2013 the adductor longus was forcefully stretched while you were side-stepping at speed. Appropriate management of a grade 2 adductor strain is relative rest for two to three weeks followed by a supervised, graduated strengthening programme over at least eight to twelve weeks before return to running and loaded activity.
This has then led to further investigations and the diagnosis of your condition of Adductor Strain and Hamstring Origin Tendinopathy (Worsening). I have accepted your condition of Adductor Strain and Hamstring Origin Tendinopathy (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 peacetime service.
I have therefore accepted that the worsening of this condition is related to your service with effect from 26 August 2013.
