Reference Determination Content
Suggested draft · fictitious patient
Right Elbow - Minor Bone Marrow Oedema
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 7 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 7 April 2025;
- A pre-deployment medical examination by the medical officer, naval health centre, dated 12 January 2012;
- A ship's medical record by the ship's medical officer, dated 23 April 2012;
- An X-ray right elbow (coalition medical facility) dated 26 April 2012;
- A ship's medical record by the ship's medical officer, dated 18 May 2012;
- A post-deployment health assessment by the medical officer, dated 28 August 2012;
- An MRI right elbow by the radiologist, dated 5 September 2012;
- An orthopaedic consultation by the orthopaedic surgeon, dated 12 September 2012;
- A repeat MRI right elbow and orthopaedic review by the orthopaedic surgeon, dated 14 March 2013.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
14 January 2007 and 30 June 2017
Right Elbow - Minor Bone Marrow Oedema
You have stated that your condition was caused by:
- having trauma involving the affected site within the 24 hours before clinical onset
Diagnosis: Minor Bone Marrow Oedema
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 7 April 2025, and is supported by an MRI right elbow by the radiologist, dated 5 September 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 over the back of the right elbow, with pain on straightening the elbow and on lifting on 23 April 2012.
The diagnosis is based on a direct blow to the right olecranon on 23 April 2012, followed immediately by pain, swelling, bruising and tenderness recorded by the ship's medical officer that day. X-ray on 26 April 2012 excluded a fracture, which is important because the Statement of Principles excludes blood collections associated with a fracture.
This has then led to further investigations and the diagnosis of your condition of Minor Bone Marrow Oedema. I have accepted your condition of Minor Bone Marrow Oedema.
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 23 April 2012.
Right Elbow - Minor Bone Marrow Oedema (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 7 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 7 April 2025;
- A pre-deployment medical examination by the medical officer, naval health centre, dated 12 January 2012;
- A ship's medical record by the ship's medical officer, dated 23 April 2012;
- An X-ray right elbow (coalition medical facility) dated 26 April 2012;
- A ship's medical record by the ship's medical officer, dated 18 May 2012;
- A post-deployment health assessment by the medical officer, dated 28 August 2012;
- An MRI right elbow by the radiologist, dated 5 September 2012;
- An orthopaedic consultation by the orthopaedic surgeon, dated 12 September 2012;
- A repeat MRI right elbow and orthopaedic review by the orthopaedic surgeon, dated 14 March 2013.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
14 January 2007 and 30 June 2017
Right Elbow - Minor Bone Marrow Oedema (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: Minor Bone Marrow Oedema (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 7 April 2025, and is supported by an MRI right elbow by the radiologist, dated 5 September 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 over the back of the right elbow, with pain on straightening the elbow and on lifting on 23 April 2012.
The diagnosis is based on a direct blow to the right olecranon on 23 April 2012, followed immediately by pain, swelling, bruising and tenderness recorded by the ship's medical officer that day. X-ray on 26 April 2012 excluded a fracture, which is important because the Statement of Principles excludes blood collections associated with a fracture.
After the condition arose, it was worsened during your service. On warlike maritime service from 23 April to 18 May 2012 the ship could not provide the recommended rest, sling or imaging, and operational tasking prevented you from being landed for MRI.
This has then led to further investigations and the diagnosis of your condition of Minor Bone Marrow Oedema (Worsening). I have accepted your condition of Minor Bone Marrow Oedema (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 18 May 2012.
