Reference Determination Content
Suggested draft · fictitious patient
Right Hand - 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 22 January 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 22 January 2025;
- A pre-deployment medical examination by the medical officer, dated 14 January 2012;
- A ship's medical record and X-ray report by the medical officer, frigate, dated 18 April 2012;
- A ship's medical record by the medical officer, frigate, dated 20 April 2012;
- A ship's medical record by the senior medic, frigate, dated 2 July 2012;
- An ultrasound right hand report by the radiologist, dated 28 September 2012;
- A hand therapy assessment by the hand therapist, dated 12 October 2012;
- An outpatient health record by the medical officer, Fleet base health centre, dated 11 June 2014;
- An MRI right hand report by the radiologist, dated 17 June 2014;
- A specialist consultation by the hand surgeon, dated 17 June 2014;
- A medical employment classification review by the senior medical officer, dated 5 November 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
21 July 2003 and 15 December 2015
Right Hand - 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: Strain
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 22 January 2025, and is supported by a ship's medical record and X-ray report by the medical officer, frigate, dated 18 April 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 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 immediate pain over the radial side of the index knuckle and the first web space, swelling and bruising, pain on gripping and on pinching, and weakness when abducting the index finger on 18 April 2012.
The diagnosis was made clinically by the ship's Medical Officer on 18 April 2012 on the history of a forceful wrenching injury, with tenderness and pain on stressing the radial collateral ligament of the index metacarpophalangeal joint and pain on resisted index abduction and gripping. X-rays excluded a fracture or avulsion. This meets the Statement of Principles definitions of a strain of muscle and a sprain of a joint ligament.
This has then led to further investigations and the diagnosis of your condition of Strain. I have accepted your condition of 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 18 April 2012.
Right Hand - 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 22 January 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 22 January 2025;
- A pre-deployment medical examination by the medical officer, dated 14 January 2012;
- A ship's medical record and X-ray report by the medical officer, frigate, dated 18 April 2012;
- A ship's medical record by the medical officer, frigate, dated 20 April 2012;
- A ship's medical record by the senior medic, frigate, dated 2 July 2012;
- An ultrasound right hand report by the radiologist, dated 28 September 2012;
- A hand therapy assessment by the hand therapist, dated 12 October 2012;
- An outpatient health record by the medical officer, Fleet base health centre, dated 11 June 2014;
- An MRI right hand report by the radiologist, dated 17 June 2014;
- A specialist consultation by the hand surgeon, dated 17 June 2014;
- A medical employment classification review by the senior medical officer, dated 5 November 2015.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
21 July 2003 and 15 December 2015
Right Hand - 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: Strain (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 22 January 2025, and is supported by a ship's medical record and X-ray report by the medical officer, frigate, dated 18 April 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 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 immediate pain over the radial side of the index knuckle and the first web space, swelling and bruising, pain on gripping and on pinching, and weakness when abducting the index finger on 18 April 2012.
The diagnosis was made clinically by the ship's Medical Officer on 18 April 2012 on the history of a forceful wrenching injury, with tenderness and pain on stressing the radial collateral ligament of the index metacarpophalangeal joint and pain on resisted index abduction and gripping. X-rays excluded a fracture or avulsion. This meets the Statement of Principles definitions of a strain of muscle and a sprain of a joint ligament.
After the condition arose, it was worsened during your service. On 2 July 2012, on the same warlike deployment, the painter line of a rigid-hulled inflatable boat snatched taut in a heavy swell and forced your right index finger sideways. During the boat recovery on 2 July 2012, on warlike service, the snatching painter line forcibly stretched your gripping intrinsic hand muscles. On warlike service aboard the frigate no thermoplastic splint, hand therapist, physiotherapist or ultrasound was available, and because the boat's crew was short-handed you returned to line handling five days after the injury of 18 April 2012.
This has then led to further investigations and the diagnosis of your condition of Strain (Worsening). I have accepted your condition of 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 2 July 2012.
