Reference Determination Content
Suggested draft · fictitious patient
Right Hip - Labral Scarring (labral Tear)
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 9 June 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 9 June 2025;
- A pre-deployment medical examination by the medical officer, dated 14 July 2009;
- Clinical notes and obstetric ultrasound by Role 2 facility, Afghanistan, dated 6 October 2009;
- An aeromedical evacuation record by the medical officer, dated 21 October 2009;
- A postnatal review and referral by the medical officer, Garrison health centre, dated 11 January 2010;
- An MR arthrogram right hip by the radiologist, dated 28 June 2010;
- A specialist consultation by the orthopaedic hip surgeon, dated 14 September 2010;
- A specialist review by the orthopaedic hip surgeon, dated 22 February 2011;
- An MRI right hip by the radiologist, dated 3 March 2011;
- An operation report by the orthopaedic hip surgeon, dated 17 August 2011.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
11 July 2006 and 14 March 2016
Right Hip - Labral Scarring (labral Tear)
You have stated that your condition was caused by:
- having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of clinical onset
- performing forceful and repetitive motions of the affected shoulder joint or the affected hip joint, involving extremes of the normal range of motion, for at least 4 hours per week for the 1 month immediately preceding clinical onset
- being in the third trimester of pregnancy within the 1 week before clinical onset of labral tear of the hip joint
Diagnosis: Labral Scarring (labral Tear)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 9 June 2025, and is supported by an MR arthrogram right hip by the radiologist, dated 28 June 2010.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Labral Tear of the Hip and Shoulder (Reasonable Hypothesis) (No. 33 of 2026)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- having a significant physical force applied to or through the affected shoulder joint or the affected hip joint at the time of clinical onset
- performing forceful and repetitive motions of the affected shoulder joint or the affected hip joint, involving extremes of the normal range of motion, for at least 4 hours per week for the 1 month immediately preceding clinical onset
- being in the third trimester of pregnancy within the 1 week before clinical onset of labral tear of the hip joint
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 severe right groin pain with a painful click and inability to bear full weight on 6 October 2009.
The Statement of Principles requires relevant symptoms and corresponding clinical signs of a labral tear together with imaging consistent with a tear of the acetabular labrum. You had acute groin pain with a painful click and a positive flexion, adduction and internal rotation test on 6 October 2009, and persisting clicking, catching and later locking. MR arthrogram on 28 June 2010 showed a tear of the anterosuperior labrum, and MRI on 3 March 2011 showed its extension with chronic scarring at the tear margins.
This has then led to further investigations and the diagnosis of your condition of Labral Scarring (labral Tear). I have accepted your condition of Labral Scarring (labral Tear).
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 6 October 2009.
Right Hip - Labral Scarring (labral Tear) (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 9 June 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 9 June 2025;
- A pre-deployment medical examination by the medical officer, dated 14 July 2009;
- Clinical notes and obstetric ultrasound by Role 2 facility, Afghanistan, dated 6 October 2009;
- An aeromedical evacuation record by the medical officer, dated 21 October 2009;
- A postnatal review and referral by the medical officer, Garrison health centre, dated 11 January 2010;
- An MR arthrogram right hip by the radiologist, dated 28 June 2010;
- A specialist consultation by the orthopaedic hip surgeon, dated 14 September 2010;
- A specialist review by the orthopaedic hip surgeon, dated 22 February 2011;
- An MRI right hip by the radiologist, dated 3 March 2011;
- An operation report by the orthopaedic hip surgeon, dated 17 August 2011.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
11 July 2006 and 14 March 2016
Right Hip - Labral Scarring (labral Tear) (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for labral tear of the hip and shoulder before clinical worsening
Diagnosis: Labral Scarring (labral Tear) (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 9 June 2025, and is supported by an MR arthrogram right hip by the radiologist, dated 28 June 2010.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Labral Tear of the Hip and Shoulder (Balance of Probabilities) (No. 34 of 2026)
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 labral tear of the hip and shoulder 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 sudden severe right groin pain with a painful click and inability to bear full weight on 6 October 2009.
The Statement of Principles requires relevant symptoms and corresponding clinical signs of a labral tear together with imaging consistent with a tear of the acetabular labrum. You had acute groin pain with a painful click and a positive flexion, adduction and internal rotation test on 6 October 2009, and persisting clicking, catching and later locking. MR arthrogram on 28 June 2010 showed a tear of the anterosuperior labrum, and MRI on 3 March 2011 showed its extension with chronic scarring at the tear margins.
After the condition arose, it was worsened during your service. Appropriate management of an acute traumatic labral tear with mechanical symptoms is prompt MR arthrography and orthopaedic review, protected weight bearing and early arthroscopic repair when symptoms persist.
This has then led to further investigations and the diagnosis of your condition of Labral Scarring (labral Tear) (Worsening). I have accepted your condition of Labral Scarring (labral Tear) (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 peacetime service.
I have therefore accepted that the worsening of this condition is related to your service with effect from 22 February 2011.
