Reference Determination Content
Suggested draft · fictitious patient
Left Wrist - Ganglion Cyst (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 9 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 9 April 2025;
- An outpatient health record by the medical officer, Role 1 facility, Afghanistan, dated 6 May 2010;
- An X-ray report by Role 2 facility, Afghanistan, dated 7 May 2010;
- A post-deployment health assessment by the medical officer, Garrison health centre, dated 15 September 2010;
- An outpatient health record by the medical officer, Garrison health centre, dated 20 January 2011;
- An ultrasound report by the radiologist, dated 2 February 2011;
- A procedure note by the sports physician, dated 11 April 2011;
- An ultrasound report by the radiologist, dated 22 July 2011;
- A referral to hand surgeon by the medical officer, Garrison health centre, dated 19 August 2014;
- An outpatient health record by the medical officer, Iraq, dated 14 May 2015;
- An ultrasound report by the radiologist, dated 18 September 2015;
- An operation report by the hand surgeon, and histopathology report, Pathologist, dated 10 November 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
10 March 2005 and 22 October 2017
Left Wrist - Ganglion Cyst (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for ganglion before clinical worsening
Diagnosis: Ganglion Cyst (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 9 April 2025, and is supported by an ultrasound report by the radiologist, dated 2 February 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 Ganglion (Balance of Probabilities) (No. 8 of 2025)
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 ganglion 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 a firm lump on the back of the left wrist, more prominent when the wrist was flexed, with aching on wrist extension, push-ups and gripping vehicle fittings on 20 January 2011.
The diagnosis is based on a firm, smooth, transilluminating swelling on the dorsum of the left wrist over the scapholunate interval, more prominent on flexion, and ultrasound on 2 February 2011 showing an anechoic thin-walled cyst with a stalk to the scapholunate interval. Aspiration yielded thick clear mucinous fluid, and histopathology of the excised lesion on 10 November 2015 showed a fibrous-walled cyst without epithelial lining containing mucinous material. This meets the Statement of Principles definition of ganglion and excludes bursal, epidermoid and synovial cysts.
After the condition arose, it was worsened during your service. After the ganglion recurred following aspiration, a medical officer at the garrison health centre referred you to a hand surgeon for excision on 19 August 2014, but the referral was placed on a routine waiting list and you had not been seen when you deployed on 3 February 2015.
This has then led to further investigations and the diagnosis of your condition of Ganglion Cyst (Worsening). I have accepted your condition of Ganglion Cyst (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 14 January 2011.
