Reference Determination Content
Suggested draft · fictitious patient
Right Hip - 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 3 March 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 March 2025;
- A pre-deployment medical examination by the medical officer, dated 2 December 2015;
- A ship's medical record by the medical officer, Middle East Area of Operations, dated 23 April 2016;
- An obstetric ultrasound and clinical notes by the coalition medical facility, dated 26 April 2016;
- An aeromedical evacuation record by the medical officer, dated 30 April 2016;
- A postnatal review and referral by the medical officer, Base health centre, dated 11 July 2016;
- An MR arthrogram right hip by the radiologist, dated 14 December 2016;
- A specialist consultation by the orthopaedic surgeon, dated 1 February 2017;
- A specialist review by the orthopaedic surgeon, dated 18 May 2017;
- An MRI right hip by the radiologist, dated 29 May 2017;
- An operation report by the orthopaedic surgeon, dated 12 October 2017.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
6 February 2011 and 25 October 2019
Right Hip - 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 Tear
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 March 2025, and is supported by an MR arthrogram right hip by the radiologist, dated 14 December 2016.
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 was unable to bear full weight on 23 April 2016.
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 23 April 2016, and persisting clicking, catching and later locking and giving way. MR arthrogram on 14 December 2016 showed a tear of the anterosuperior labrum, and MRI on 29 May 2017 showed its extension with a paralabral cyst.
This has then led to further investigations and the diagnosis of your condition of Labral Tear. I have accepted your condition of 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 23 April 2016.
Right Hip - 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 3 March 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 March 2025;
- A pre-deployment medical examination by the medical officer, dated 2 December 2015;
- A ship's medical record by the medical officer, Middle East Area of Operations, dated 23 April 2016;
- An obstetric ultrasound and clinical notes by the coalition medical facility, dated 26 April 2016;
- An aeromedical evacuation record by the medical officer, dated 30 April 2016;
- A postnatal review and referral by the medical officer, Base health centre, dated 11 July 2016;
- An MR arthrogram right hip by the radiologist, dated 14 December 2016;
- A specialist consultation by the orthopaedic surgeon, dated 1 February 2017;
- A specialist review by the orthopaedic surgeon, dated 18 May 2017;
- An MRI right hip by the radiologist, dated 29 May 2017;
- An operation report by the orthopaedic surgeon, dated 12 October 2017.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
6 February 2011 and 25 October 2019
Right Hip - 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 Tear (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 March 2025, and is supported by an MR arthrogram right hip by the radiologist, dated 14 December 2016.
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 was unable to bear full weight on 23 April 2016.
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 23 April 2016, and persisting clicking, catching and later locking and giving way. MR arthrogram on 14 December 2016 showed a tear of the anterosuperior labrum, and MRI on 29 May 2017 showed its extension with a paralabral cyst.
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 Tear (Worsening). I have accepted your condition of 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 18 May 2017.
