Reference Determination Content
Suggested draft · fictitious patient
Right Hand Second Metacarpal - Ossified Hematoma
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 17 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 17 April 2025;
- A pre-deployment medical examination by the medical officer, dated 24 January 2011;
- An outpatient health record by the regimental medical officer, forward patrol base, Afghanistan, dated 18 June 2011;
- An X-ray right hand and clinical notes by Role 2 facility, Afghanistan, dated 19 June 2011;
- An outpatient health record by the regimental medical officer, Afghanistan, dated 2 July 2011;
- An X-ray right hand by Role 2 facility, Afghanistan, dated 9 August 2011;
- An outpatient health record and referral by the medical officer, Garrison health centre, dated 7 November 2011;
- An X-ray and ultrasound right hand by the radiologist, dated 15 March 2012;
- A specialist consultation by the hand surgeon, dated 11 December 2012;
- An MRI right hand by the radiologist, dated 4 February 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
5 March 2007 and 20 September 2021
Right Hand Second Metacarpal - Ossified Hematoma
You have stated that your condition was caused by:
- having trauma involving the affected site within the 24 hours before clinical onset
Diagnosis: Ossified Hematoma
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 17 April 2025, and is supported by an X-ray right hand and clinical notes by Role 2 facility, Afghanistan, dated 19 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 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 hand, pain on making a fist and reduced flexion of the index finger on 18 June 2011.
The diagnosis of a traumatic subperiosteal haematoma was made clinically on 18 June 2011 and confirmed by X-ray on 19 June 2011, which showed dorsal soft tissue swelling over the second metacarpal with no fracture. The history of a direct crush injury, immediate tense swelling and bruising over the bone, and the absence of fracture meet the Statement of Principles definition of a blood collection in tissue resulting from physical force causing tissue damage and internal bleeding, and the exclusion for blood collections associated with a fracture does not apply.
This has then led to further investigations and the diagnosis of your condition of Ossified Hematoma. I have accepted your condition of Ossified Hematoma.
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 18 June 2011.
Right Hand Second Metacarpal - Ossified Hematoma (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 17 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 17 April 2025;
- A pre-deployment medical examination by the medical officer, dated 24 January 2011;
- An outpatient health record by the regimental medical officer, forward patrol base, Afghanistan, dated 18 June 2011;
- An X-ray right hand and clinical notes by Role 2 facility, Afghanistan, dated 19 June 2011;
- An outpatient health record by the regimental medical officer, Afghanistan, dated 2 July 2011;
- An X-ray right hand by Role 2 facility, Afghanistan, dated 9 August 2011;
- An outpatient health record and referral by the medical officer, Garrison health centre, dated 7 November 2011;
- An X-ray and ultrasound right hand by the radiologist, dated 15 March 2012;
- A specialist consultation by the hand surgeon, dated 11 December 2012;
- An MRI right hand by the radiologist, dated 4 February 2016.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
5 March 2007 and 20 September 2021
Right Hand Second Metacarpal - Ossified Hematoma (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: Ossified Hematoma (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 17 April 2025, and is supported by an X-ray right hand and clinical notes by Role 2 facility, Afghanistan, dated 19 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 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 hand, pain on making a fist and reduced flexion of the index finger on 18 June 2011.
The diagnosis of a traumatic subperiosteal haematoma was made clinically on 18 June 2011 and confirmed by X-ray on 19 June 2011, which showed dorsal soft tissue swelling over the second metacarpal with no fracture. The history of a direct crush injury, immediate tense swelling and bruising over the bone, and the absence of fracture meet the Statement of Principles definition of a blood collection in tissue resulting from physical force causing tissue damage and internal bleeding, and the exclusion for blood collections associated with a fracture does not apply.
After the condition arose, it was worsened during your service. On warlike service in Afghanistan there was no ultrasound, aspiration or hand surgery capability at the patrol base, and the medical officer's recommendations of 19 June and 2 July 2011 for imaging, aspiration, hand surgeon review and rest from loading duties could not be carried out because the detachment was one gunner short during sustained fire missions.
This has then led to further investigations and the diagnosis of your condition of Ossified Hematoma (Worsening). I have accepted your condition of Ossified Hematoma (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 2 July 2011.
