Reference Determination Content
Suggested draft · fictitious patient
Right Temple Inferior - Solar Keratosis
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 7 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 7 February 2025;
- A post-liberation medical examination by the medical officer, Singapore, dated 2 October 1945;
- A dermatology consultation and PUVA treatment record by the dermatologist, dated 4 April 1967;
- A renal transplant discharge summary by the renal physician, dated 18 February 1971;
- A specialist consultation by the renal physician, dated 2 January 1974;
- An outpatient health record by the medical officer, dated 18 March 1974;
- An outpatient health record by the medical officer, dated 12 September 1974;
- A histopathology report and dermatology consultation by the dermatologist, dated 30 September 1974;
- A histopathology report and procedure note by the dermatologist, dated 21 July 1975.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
16 June 1941 and 30 June 1975
Right Temple Inferior - Solar Keratosis
You have stated that your condition was caused by:
- having sunlight exposure to unprotected skin at the affected site for a cumulative period of at least 4,500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis
- undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of solar keratosis
- having PUVA therapy involving the affected site where: (a) the first PUVA treatment commenced at least 5 years before the clinical onset of solar keratosis; and (b) at least 50 PUVA treatments were administered before the clinical onset of solar keratosis
- taking hydroxyurea or voriconazole for at least the 3 months before the clinical onset of solar keratosis
Diagnosis: Solar Keratosis
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 7 February 2025, and is supported by a histopathology report and dermatology consultation by the dermatologist, dated 30 September 1974.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Solar Keratosis (Balance of Probabilities) (No. 80 of 2021)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- having sunlight exposure to unprotected skin at the affected site for a cumulative period of at least 4,500 hours while in a tropical area, or having equivalent sunlight exposure in other latitude zones, before the clinical onset of solar keratosis
- undergoing organ or tissue transplantation, excluding corneal transplant, before the clinical onset of solar keratosis
- having PUVA therapy involving the affected site where: (a) the first PUVA treatment commenced at least 5 years before the clinical onset of solar keratosis; and (b) at least 50 PUVA treatments were administered before the clinical onset of solar keratosis
- taking hydroxyurea or voriconazole for at least the 3 months before the clinical onset of solar keratosis
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 rough, scaly, slightly tender spot on the lower right temple that caught on your comb and spectacle arm on 12 September 1974.
The diagnosis was made clinically on 12 September 1974 from a 6 mm scaly, erythematous papule on the inferior right temple on a background of severe sun damage, and confirmed by shave biopsy on 30 September 1974, which showed keratinocyte atypia confined to the lower epidermis with solar elastosis and no invasion. This meets the Statement of Principles definition of solar keratosis. Imaging is not required for this diagnosis.
This has then led to further investigations and the diagnosis of your condition of Solar Keratosis. I have accepted your condition of Solar Keratosis.
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 peacetime service.
I have therefore accepted that this condition is related to your service with effect from 12 September 1974.
Right Temple Inferior - Solar Keratosis (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 7 February 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 7 February 2025;
- A post-liberation medical examination by the medical officer, Singapore, dated 2 October 1945;
- A dermatology consultation and PUVA treatment record by the dermatologist, dated 4 April 1967;
- A renal transplant discharge summary by the renal physician, dated 18 February 1971;
- A specialist consultation by the renal physician, dated 2 January 1974;
- An outpatient health record by the medical officer, dated 18 March 1974;
- An outpatient health record by the medical officer, dated 12 September 1974;
- A histopathology report and dermatology consultation by the dermatologist, dated 30 September 1974;
- A histopathology report and procedure note by the dermatologist, dated 21 July 1975.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
16 June 1941 and 30 June 1975
Right Temple Inferior - Solar Keratosis (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for solar keratosis
Diagnosis: Solar Keratosis (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 7 February 2025, and is supported by a histopathology report and dermatology consultation by the dermatologist, dated 30 September 1974.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Solar Keratosis (Balance of Probabilities) (No. 80 of 2021)
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 solar keratosis
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 rough, scaly, slightly tender spot on the lower right temple that caught on your comb and spectacle arm on 12 September 1974.
The diagnosis was made clinically on 12 September 1974 from a 6 mm scaly, erythematous papule on the inferior right temple on a background of severe sun damage, and confirmed by shave biopsy on 30 September 1974, which showed keratinocyte atypia confined to the lower epidermis with solar elastosis and no invasion. This meets the Statement of Principles definition of solar keratosis. Imaging is not required for this diagnosis.
After the condition arose, it was worsened during your service. After biopsy confirmed the solar keratosis on 30 September 1974, cryotherapy and topical fluorouracil were recommended, but you were posted to a remote training area in northern Queensland from October 1974 to June 1975, with no dermatologist and a medical officer visit only monthly, and the treatment was not given.
This has then led to further investigations and the diagnosis of your condition of Solar Keratosis (Worsening). I have accepted your condition of Solar Keratosis (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 30 September 1974.
