Reference Determination Content
Suggested draft · fictitious patient
Right Hand Fourth Metacarpal - Ganglion Cyst
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 August 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 19 August 2025;
- A pre-deployment health assessment by the medical officer, dated 15 November 2010;
- A role 2 treatment record and X-ray report by the medical officer, Afghanistan, dated 8 March 2011;
- A role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 30 June 2011;
- A role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 10 August 2011;
- An ultrasound report and hand surgeon referral by the radiologist and medical officer, Garrison health centre, dated 19 October 2011;
- An MRI right hand report by the radiologist, dated 4 September 2012;
- A specialist consultation by the hand surgeon, dated 13 September 2012;
- An operation report and histopathology report by the hand surgeon and pathologist, dated 12 November 2012.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
14 April 2008 and 30 June 2018
Right Hand Fourth Metacarpal - Ganglion Cyst
You have stated that your condition was caused by:
- having acute trauma due to a significant physical force applied to the affected joint or tendon within the 1 year before clinical onset
Diagnosis: Ganglion Cyst
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 19 August 2025, and is supported by a role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 30 June 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 (Reasonable Hypothesis) (No. 7 of 2025)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- having acute trauma due to a significant physical force applied to the affected joint or tendon within the 1 year 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 a firm, rounded lump on the back of your right hand over the base of the fourth metacarpal, with aching on gripping the turret controls and the hatch on 30 June 2011.
The diagnosis was made on 30 June 2011 on the finding of a firm, smooth, rounded lump over the dorsum of the base of the right fourth metacarpal, confirmed by point-of-care ultrasound showing a 12 millimetre anechoic cyst arising from the fourth carpometacarpal joint. Formal ultrasound on 19 October 2011 and MRI on 4 September 2012 confirmed a ganglion with a stalk to that joint. This meets the Statement of Principles definition of ganglion, a benign cystic lesion overlying a joint or tendon.
This has then led to further investigations and the diagnosis of your condition of Ganglion Cyst. I have accepted your condition of Ganglion Cyst.
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 30 June 2011.
Right Hand Fourth Metacarpal - 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 19 August 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 19 August 2025;
- A pre-deployment health assessment by the medical officer, dated 15 November 2010;
- A role 2 treatment record and X-ray report by the medical officer, Afghanistan, dated 8 March 2011;
- A role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 30 June 2011;
- A role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 10 August 2011;
- An ultrasound report and hand surgeon referral by the radiologist and medical officer, Garrison health centre, dated 19 October 2011;
- An MRI right hand report by the radiologist, dated 4 September 2012;
- A specialist consultation by the hand surgeon, dated 13 September 2012;
- An operation report and histopathology report by the hand surgeon and pathologist, dated 12 November 2012.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
14 April 2008 and 30 June 2018
Right Hand Fourth Metacarpal - 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 19 August 2025, and is supported by a role 2 treatment record with point-of-care ultrasound by the medical officer, Afghanistan, dated 30 June 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 (Reasonable Hypothesis) (No. 7 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, rounded lump on the back of your right hand over the base of the fourth metacarpal, with aching on gripping the turret controls and the hatch on 30 June 2011.
The diagnosis was made on 30 June 2011 on the finding of a firm, smooth, rounded lump over the dorsum of the base of the right fourth metacarpal, confirmed by point-of-care ultrasound showing a 12 millimetre anechoic cyst arising from the fourth carpometacarpal joint. Formal ultrasound on 19 October 2011 and MRI on 4 September 2012 confirmed a ganglion with a stalk to that joint. This meets the Statement of Principles definition of ganglion, a benign cystic lesion overlying a joint or tendon.
After the condition arose, it was worsened during your service. On warlike service in Afghanistan from 30 June 2011 no hand surgeon was available, aspiration was not offered because of the infection risk in the field, no splint was provided, and you remained on continuous patrol duties gripping turret controls and hatches.
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 wartime service.
I have therefore accepted that the worsening of this condition is related to your service with effect from 10 August 2011.
