Reference Determination Content
Suggested draft · fictitious patient
Right 4th Toe - Soft Tissue Injury
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 19 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 19 May 2025;
- A pre-deployment medical examination by the medical officer, dated 16 January 2012;
- A treatment record by the patrol base medic, Afghanistan, dated 6 June 2012;
- A treatment record by the patrol medic, Afghanistan, dated 8 June 2012;
- A treatment record and X-ray report by the medical officer and radiographer, Role 2 facility, Afghanistan, dated 13 June 2012;
- A treatment record by the medical officer, Afghanistan, dated 27 June 2012;
- An outpatient health record and X-ray report by the medical officer and podiatrist, Garrison health centre, dated 4 March 2013;
- A separation medical examination by the medical officer, dated 18 October 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
21 July 2005 and 30 November 2016
Right 4th Toe - Soft Tissue Injury
You have stated that your condition was caused by:
- having trauma involving the affected site within the 24 hours before clinical onset
Diagnosis: Soft Tissue Injury
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 19 May 2025, and is supported by a treatment record and X-ray report by the medical officer and radiographer, Role 2 facility, Afghanistan, dated 13 June 2012.
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 immediate severe pain, swelling and bruising of the right fourth toe, with a purple discolouration under the nail on 6 June 2012.
The diagnosis was made clinically by the patrol base medic on 6 June 2012, who recorded the crush mechanism, swelling and bruising of the right fourth toe and blood beneath the nail, and was confirmed by a medical officer on 13 June 2012. X-ray that day excluded a fracture or dislocation, so the blood collection is not associated with a fracture and falls within the Statement of Principles definition of traumatic contusion or haematoma.
This has then led to further investigations and the diagnosis of your condition of Soft Tissue Injury. I have accepted your condition of Soft Tissue Injury.
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 6 June 2012.
Right 4th Toe - Soft Tissue Injury (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 19 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 19 May 2025;
- A pre-deployment medical examination by the medical officer, dated 16 January 2012;
- A treatment record by the patrol base medic, Afghanistan, dated 6 June 2012;
- A treatment record by the patrol medic, Afghanistan, dated 8 June 2012;
- A treatment record and X-ray report by the medical officer and radiographer, Role 2 facility, Afghanistan, dated 13 June 2012;
- A treatment record by the medical officer, Afghanistan, dated 27 June 2012;
- An outpatient health record and X-ray report by the medical officer and podiatrist, Garrison health centre, dated 4 March 2013;
- A separation medical examination by the medical officer, dated 18 October 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
21 July 2005 and 30 November 2016
Right 4th Toe - Soft Tissue Injury (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: Soft Tissue Injury (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 19 May 2025, and is supported by a treatment record and X-ray report by the medical officer and radiographer, Role 2 facility, Afghanistan, dated 13 June 2012.
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 immediate severe pain, swelling and bruising of the right fourth toe, with a purple discolouration under the nail on 6 June 2012.
The diagnosis was made clinically by the patrol base medic on 6 June 2012, who recorded the crush mechanism, swelling and bruising of the right fourth toe and blood beneath the nail, and was confirmed by a medical officer on 13 June 2012. X-ray that day excluded a fracture or dislocation, so the blood collection is not associated with a fracture and falls within the Statement of Principles definition of traumatic contusion or haematoma.
After the condition arose, it was worsened during your service. On warlike service you had to deploy on a five-day foot patrol from 8 June 2012, during which the medic could not decompress the haematoma and no medical officer or evacuation for a minor injury was available.
This has then led to further investigations and the diagnosis of your condition of Soft Tissue Injury (Worsening). I have accepted your condition of Soft Tissue Injury (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 13 June 2012.
