Reference Determination Content
Suggested draft · fictitious patient
Left Knee - External Bruise
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 3 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 February 2025;
- A pre-deployment medical examination by the medical officer, dated 10 February 2011;
- A patrol log and casualty card by the crew commander and crew medic, Afghanistan, dated 7 July 2011;
- An outpatient health record by the medical officer, patrol base aid post, Afghanistan, dated 11 July 2011;
- An ultrasound report and procedure note (role 2 facility) by the afghanistan, dated 13 July 2011;
- An outpatient health record by the medical officer, Afghanistan, dated 2 August 2011;
- An outpatient health record by the medical officer, garrison health centre, dated 15 February 2012;
- An ultrasound left knee by the radiologist, dated 22 February 2012;
- A specialist consultation by the sports physician, dated 15 March 2012;
- A separation medical examination by the medical officer, dated 9 November 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
25 January 2009 and 14 March 2017
Left Knee - External Bruise
You have stated that your condition was caused by:
- having trauma involving the affected site within the 24 hours before clinical onset
Diagnosis: External Bruise
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 February 2025, and is supported by an outpatient health record by the medical officer, patrol base aid post, Afghanistan, dated 11 July 2011.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Traumatic Contusion or Haematoma (Reasonable Hypothesis) (No. 43 of 2024)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- having trauma involving the affected site within the 24 hours before clinical onset
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 sharp pain over the front of the left knee, rapidly spreading purple bruising and swelling over the kneecap on 7 July 2011.
The diagnosis was made clinically by the crew medic on 7 July 2011, who recorded bruising and swelling over the left kneecap immediately after the blow, and by the medical officer on 11 July 2011, who recorded extensive bruising from the lower thigh to the mid-shin and a tense prepatellar haematoma. Ultrasound on 13 July 2011 confirmed a 6 by 4 by 2 centimetre prepatellar haematoma with an intact joint and tendons, and aspiration yielded altered blood. This meets the Statement of Principles definition of a traumatic contusion or haematoma.
This has then led to further investigations and the diagnosis of your condition of External Bruise. I have accepted your condition of External Bruise.
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 7 July 2011.
Left Knee - External Bruise (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 3 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 February 2025;
- A pre-deployment medical examination by the medical officer, dated 10 February 2011;
- A patrol log and casualty card by the crew commander and crew medic, Afghanistan, dated 7 July 2011;
- An outpatient health record by the medical officer, patrol base aid post, Afghanistan, dated 11 July 2011;
- An ultrasound report and procedure note (role 2 facility) by the afghanistan, dated 13 July 2011;
- An outpatient health record by the medical officer, Afghanistan, dated 2 August 2011;
- An outpatient health record by the medical officer, garrison health centre, dated 15 February 2012;
- An ultrasound left knee by the radiologist, dated 22 February 2012;
- A specialist consultation by the sports physician, dated 15 March 2012;
- A separation medical examination by the medical officer, dated 9 November 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
25 January 2009 and 14 March 2017
Left Knee - External Bruise (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for traumatic contusion or haematoma before clinical worsening
Diagnosis: External Bruise (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 February 2025, and is supported by an outpatient health record by the medical officer, patrol base aid post, Afghanistan, dated 11 July 2011.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Traumatic Contusion or Haematoma (Reasonable Hypothesis) (No. 43 of 2024)
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 traumatic contusion or haematoma before clinical worsening
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 sharp pain over the front of the left knee, rapidly spreading purple bruising and swelling over the kneecap on 7 July 2011.
The diagnosis was made clinically by the crew medic on 7 July 2011, who recorded bruising and swelling over the left kneecap immediately after the blow, and by the medical officer on 11 July 2011, who recorded extensive bruising from the lower thigh to the mid-shin and a tense prepatellar haematoma. Ultrasound on 13 July 2011 confirmed a 6 by 4 by 2 centimetre prepatellar haematoma with an intact joint and tendons, and aspiration yielded altered blood. This meets the Statement of Principles definition of a traumatic contusion or haematoma.
After the condition arose, it was worsened during your service. On warlike service in Afghanistan from 07 to 11 July 2011 the patrol could not halt or return to base because of the tactical situation, the vehicle could not spare its gunner, and there was no means of cooling, compressing or elevating the injured knee.
This has then led to further investigations and the diagnosis of your condition of External Bruise (Worsening). I have accepted your condition of External Bruise (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 11 July 2011.
