Reference Determination Content
Suggested draft · fictitious patient
Right Loin - External Bruise
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 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 February 2025;
- A pre-deployment medical examination and pathology by the medical officer, dated 4 December 2006;
- A boarding log and ship's medical record by the ship's medic, North Arabian Gulf, dated 14 April 2007;
- A ship's medical record by the ship's medical officer, North Arabian Gulf, dated 15 April 2007;
- A ship's medical record and pathology by the ship's medical officer, North Arabian Gulf, dated 18 April 2007;
- A CT abdomen and lumbar spine and surgical note by the radiologist and surgeon, coalition medical facility, dated 26 April 2007;
- An ultrasound right loin and surgical consultation by the radiologist and general surgeon, dated 5 October 2007;
- An operation report and histopathology by the general surgeon and pathologist, dated 17 March 2009;
- A separation medical examination by the medical officer, dated 2 October 2013.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
7 March 2003 and 12 December 2013
Right Loin - External Bruise
You have stated that your condition was caused by:
- having trauma involving the affected site within the 24 hours before clinical onset
Diagnosis: External Bruise
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 February 2025, and is supported by a ship's medical record by the ship's medical officer, North Arabian Gulf, dated 15 April 2007.
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 a severe blow and sharp pain in the right loin, then rapidly spreading red-purple bruising from the lower ribs to the hip and tenderness on bending and twisting on 14 April 2007.
The diagnosis was made clinically on 15 April 2007 by the ship's medical officer, who recorded extensive bruising over the right loin from the twelfth rib to the iliac crest and a tender subcutaneous swelling, with no rib or spinal tenderness and no haematuria, after a documented crushing injury the previous day. These findings meet the Statement of Principles definition of a blood collection in the skin and tissue from physical force.
This has then led to further investigations and the diagnosis of your condition of External Bruise. I have accepted your condition of External Bruise.
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 14 April 2007.
Right Loin - External Bruise (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 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 3 February 2025;
- A pre-deployment medical examination and pathology by the medical officer, dated 4 December 2006;
- A boarding log and ship's medical record by the ship's medic, North Arabian Gulf, dated 14 April 2007;
- A ship's medical record by the ship's medical officer, North Arabian Gulf, dated 15 April 2007;
- A ship's medical record and pathology by the ship's medical officer, North Arabian Gulf, dated 18 April 2007;
- A CT abdomen and lumbar spine and surgical note by the radiologist and surgeon, coalition medical facility, dated 26 April 2007;
- An ultrasound right loin and surgical consultation by the radiologist and general surgeon, dated 5 October 2007;
- An operation report and histopathology by the general surgeon and pathologist, dated 17 March 2009;
- A separation medical examination by the medical officer, dated 2 October 2013.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
7 March 2003 and 12 December 2013
Right Loin - External Bruise (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: External Bruise (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 3 February 2025, and is supported by a ship's medical record by the ship's medical officer, North Arabian Gulf, dated 15 April 2007.
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 a severe blow and sharp pain in the right loin, then rapidly spreading red-purple bruising from the lower ribs to the hip and tenderness on bending and twisting on 14 April 2007.
The diagnosis was made clinically on 15 April 2007 by the ship's medical officer, who recorded extensive bruising over the right loin from the twelfth rib to the iliac crest and a tender subcutaneous swelling, with no rib or spinal tenderness and no haematuria, after a documented crushing injury the previous day. These findings meet the Statement of Principles definition of a blood collection in the skin and tissue from physical force.
After the condition arose, it was worsened during your service. On warlike service the operational demands on the ship prevented the rest, compression and cooling prescribed on 15 April 2007, there was no imaging on board, and transfer ashore was delayed for twelve days because the ship could not leave its patrol area.
This has then led to further investigations and the diagnosis of your condition of External Bruise (Worsening). I have accepted your condition of External Bruise (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 18 April 2007.
