Reference Determination Content
Suggested draft · fictitious patient
Right Hand - Metacarpal Injury/Strain
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 14 August 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 14 August 2025;
- A pre-deployment medical examination by the medical officer, Naval health centre, dated 12 November 2013;
- A treatment record by the medic, Middle East, dated 22 March 2014;
- An X-ray and ultrasound right hand reports and consultation by the radiologist and medical officer, Middle East, dated 3 April 2014;
- A treatment record by the medic, Middle East, dated 6 May 2014;
- An MRI right hand report and specialist consultation by the radiologist and hand surgeon, dated 20 August 2014;
- An operation report by the hand surgeon, dated 9 October 2014;
- A specialist review and hand therapy report by the hand surgeon and hand therapist, dated 15 April 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
9 January 2011 and 14 August 2020
Right Hand - Metacarpal Injury/Strain
You have stated that your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
Diagnosis: Metacarpal Injury/Strain
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 14 August 2025, and is supported by a treatment record by the medic, Middle East, dated 22 March 2014.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
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 sudden tearing pain across the back of the right hand between the ring and little finger knuckles, with swelling and bruising within hours, pain on gripping and on moving the ring finger sideways, and weakness of grip on 22 March 2014.
The diagnosis was made clinically on 22 March 2014 on the history of a forced sideways and backward wrench of the ring and little fingers, with immediate pain, swelling and bruising, tenderness over the radial collateral ligament of the ring finger metacarpophalangeal joint and the fourth dorsal interosseous muscle, pain on ligament stress and on resisted abduction, and weak grip, all within 24 hours of the injury. Ultrasound on 3 April 2014 confirmed a partial-thickness tear of the radial collateral ligament and a strain of the fourth dorsal interosseous muscle with haematoma, and X-ray excluded fracture.
This has then led to further investigations and the diagnosis of your condition of Metacarpal Injury/Strain. I have accepted your condition of Metacarpal Injury/Strain.
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 21 March 2014.
Right Hand - Metacarpal Injury/Strain (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 14 August 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 14 August 2025;
- A pre-deployment medical examination by the medical officer, Naval health centre, dated 12 November 2013;
- A treatment record by the medic, Middle East, dated 22 March 2014;
- An X-ray and ultrasound right hand reports and consultation by the radiologist and medical officer, Middle East, dated 3 April 2014;
- A treatment record by the medic, Middle East, dated 6 May 2014;
- An MRI right hand report and specialist consultation by the radiologist and hand surgeon, dated 20 August 2014;
- An operation report by the hand surgeon, dated 9 October 2014;
- A specialist review and hand therapy report by the hand surgeon and hand therapist, dated 15 April 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
9 January 2011 and 14 August 2020
Right Hand - Metacarpal Injury/Strain (Worsening)
You have stated that the worsening of your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
Diagnosis: Metacarpal Injury/Strain (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 14 August 2025, and is supported by a treatment record by the medic, Middle East, dated 22 March 2014.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
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 sudden tearing pain across the back of the right hand between the ring and little finger knuckles, with swelling and bruising within hours, pain on gripping and on moving the ring finger sideways, and weakness of grip on 22 March 2014.
The diagnosis was made clinically on 22 March 2014 on the history of a forced sideways and backward wrench of the ring and little fingers, with immediate pain, swelling and bruising, tenderness over the radial collateral ligament of the ring finger metacarpophalangeal joint and the fourth dorsal interosseous muscle, pain on ligament stress and on resisted abduction, and weak grip, all within 24 hours of the injury. Ultrasound on 3 April 2014 confirmed a partial-thickness tear of the radial collateral ligament and a strain of the fourth dorsal interosseous muscle with haematoma, and X-ray excluded fracture.
After the condition arose, it was worsened during your service. On warlike service on 6 May 2014, during a replenishment at sea to keep the ship on station, the jackstay messenger line snatched while you hauled it, jerking your right hand and forcing the ring finger sideways at the metacarpophalangeal joint. The maximal-effort hauling and line snatch of 6 May 2014 on warlike service forcibly stretched the contracting interosseous muscles and extensor mechanism of the right ring finger, with renewed interosseous pain and swelling and new extensor tendon subluxation recorded that day. On warlike service from 21 March to 2 August 2014 no splint, hand therapy or hand surgeon was available at sea, and operational manning kept you on boarding and line-handling duties with buddy strapping only.
This has then led to further investigations and the diagnosis of your condition of Metacarpal Injury/Strain (Worsening). I have accepted your condition of Metacarpal Injury/Strain (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 6 May 2014.
