Reference Determination Content
Suggested draft · fictitious patient
Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.
Skin - Basal Cell Carcinoma
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 14 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 14 April 2025;
- An enlistment medical examination by the medical officer, dated 6 August 1940;
- A repatriation medical examination of recovered prisoner of war by the medical officer, dated 15 October 1945;
- A battalion and field hospital records by the medical officer, Korea, dated 10 October 1951;
- A dermatology consultation by the dermatologist, dated 14 June 1968;
- A histopathology and radiotherapy completion summary by the pathologist and radiation oncologist, dated 20 November 1998;
- A transplant operation report by the transplant surgeon, dated 11 March 2011;
- A full skin examination by the dermatologist, dated 11 March 2024;
- A comprehensive medication review by the geriatrician, dated 22 July 2024;
- A general practice consultation by the general practitioner, dated 16 September 2024;
- A histopathology report by the pathologist, dated 23 September 2024;
- A specialist review and repeat histopathology by the mohs surgeon and pathologist, dated 3 March 2025;
- CT facial bones and paranasal sinuses by the radiologist, dated 10 March 2025;
- A mohs surgery operation report by the mohs surgeon, dated 24 March 2025.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
6 August 1940 and 31 March 1977
Skin - Basal Cell Carcinoma
You have stated that your condition was caused by:
- being a prisoner of war of Japan before clinical onset
- having sunlight exposure to unprotected skin for a cumulative period of at least 2,250 latitude equivalent hours before clinical onset
- having at least 5 sunburns at the affected site at least 2 years before clinical onset
- having ultraviolet radiation exposure from an ultraviolet-emitting tanning device (excluding sunlamps) on at least 10 occasions at the affected site before clinical onset, at least 2 years before clinical onset
- having received a burn from an electric welding device on at least 10 occasions at the affected site, at least 10 years before clinical onset
- having PUVA therapy, where: the first PUVA treatment commenced at least 5 years before clinical onset; and
- having PUVA therapy, where: at least 50 PUVA treatments were administered before clinical onset
- having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected site at least 10 years before clinical onset
- undergoing a course of radiotherapy for cancer at the affected site, at least 5 years before clinical onset
- undergoing a course of radiotherapy for acne at the affected site, at least 5 years before clinical onset
- being infected by the same human papillomavirus type 16, 18 or 33 for at least 2 consecutive years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin
- being infected with human immunodeficiency virus before clinical onset
- undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 5 years before clinical onset
- taking one of the following medications within the 10 years before clinical onset: acalabrutinib
- taking one of the following medications within the 10 years before clinical onset: azathioprine
- taking one of the following medications within the 10 years before clinical onset: ciclosporin
- taking one of the following medications within the 10 years before clinical onset: elotuzumab
- taking one of the following medications within the 10 years before clinical onset: fingolimod
- taking one of the following medications within the 10 years before clinical onset: hydroxycarbimide (hydroxyurea)
- taking one of the following medications within the 10 years before clinical onset: ibrutinib
- taking one of the following medications within the 10 years before clinical onset: methotrexate
- taking one of the following medications within the 10 years before clinical onset: mycophenolate
- taking one of the following medications within the 10 years before clinical onset: ruxolitinib
- taking one of the following medications within the 10 years before clinical onset: siponimod
- taking one of the following medications within the 10 years before clinical onset: sirolimus
- taking one of the following medications within the 10 years before clinical onset: tacrolimus
- taking one of the following medications within the 10 years before clinical onset: tofacitinib
- taking one of the following medications within the 10 years before clinical onset: upadacitinib
- taking one of the following medications within the 10 years before clinical onset: ustekinumab
- taking one of the following medications within the 10 years before clinical onset: zanubrutinib
- taking one of the following medications within the 10 years before clinical onset: tumour necrosis factor-α inhibitors adalimumab, certolizumab, etanercept, golimumab, or infliximab; or
- taking one of the following medications within the 10 years before clinical onset: BRAF kinase inhibitors dabrafenib, encorafenib, vemurafenib
- taking ripretinib within the 10 years before clinical onset of squamous cell carcinoma of the skin
- taking ozanimod or ponesimod within the 10 years before clinical onset of basal cell carcinoma of the skin
- taking voriconazole continuously for at least 3 months, at least 6 months before clinical onset of squamous cell carcinoma of the skin
- taking a cumulative dose of at least 25 g of hydrochlorothiazide, at least 6 months before clinical onset of squamous cell carcinoma of the skin
- taking a cumulative dose of at least 50 g of hydrochlorothiazide, at least 6 months before clinical onset of basal cell carcinoma of the skin
- having autoimmune hepatitis at the time of clinical onset
- having inflammatory bowel disease at the time of clinical onset
- having psoriasis at the time of clinical onset
- having rheumatoid arthritis at the time of clinical onset
- having sarcoidosis at the time of clinical onset
- having chronic osteomyelitis with a sinus tract draining to the affected skin site at least 2 years before clinical onset
- having non-Hodgkin lymphoma before clinical onset
- having mature B-cell lymphoid leukaemia and small lymphocytic lymphoma before clinical onset
- having phimosis for a continuous period of at least 2 years before clinical onset of squamous cell carcinoma of the glans penis or prepuce of the penis
- having a scar at the affected site at least 5 years before clinical onset
- having ulceration at the affected site for a cumulative period of at least 6 months, at least 5 years before clinical onset
- having lichen sclerosus at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin
- having hidradenitis suppurativa at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the skin
- having chronic lymphoedema at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the skin
- smoking at least 15 cigarettes per day for at least 5 years, or the equivalent thereof in other tobacco products, at least 5 years before clinical onset of squamous cell carcinoma of the skin, and where smoking has ceased, clinical onset occurred within 20 years of cessation
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; consuming arsenic containing compounds (for example, Fowler's solution) for a cumulative period of at least 3 months; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least 2 years; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; inhaling, ingesting or having cutaneous contact with a pesticide containing arsenic, or arsenic in copper smelting operations, for a cumulative period of at least 1,000 hours; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; having clinical evidence of chronic arsenic toxicity
- having cutaneous contact at the affected site with coal-tar distillate, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; creosote
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; shale oil
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; soot
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; mineral oil
Diagnosis: Basal Cell Carcinoma
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 14 April 2025, and is supported by a histopathology report by the pathologist, dated 23 September 2024.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Non-Melanoma Malignant Neoplasm of the Skin (Reasonable Hypothesis) (No. 78 of 2024)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- being a prisoner of war of Japan before clinical onset
- having sunlight exposure to unprotected skin for a cumulative period of at least 2,250 latitude equivalent hours before clinical onset
- having at least 5 sunburns at the affected site at least 2 years before clinical onset
- having ultraviolet radiation exposure from an ultraviolet-emitting tanning device (excluding sunlamps) on at least 10 occasions at the affected site before clinical onset, at least 2 years before clinical onset
- having received a burn from an electric welding device on at least 10 occasions at the affected site, at least 10 years before clinical onset
- having PUVA therapy, where: the first PUVA treatment commenced at least 5 years before clinical onset; and
- having PUVA therapy, where: at least 50 PUVA treatments were administered before clinical onset
- having received a cumulative equivalent dose of at least 0.1 sievert of ionising radiation to the affected site at least 10 years before clinical onset
- undergoing a course of radiotherapy for cancer at the affected site, at least 5 years before clinical onset
- undergoing a course of radiotherapy for acne at the affected site, at least 5 years before clinical onset
- being infected by the same human papillomavirus type 16, 18 or 33 for at least 2 consecutive years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin
- being infected with human immunodeficiency virus before clinical onset
- undergoing solid organ (excluding corneal transplant) or bone marrow transplantation at least 5 years before clinical onset
- taking one of the following medications within the 10 years before clinical onset: acalabrutinib
- taking one of the following medications within the 10 years before clinical onset: azathioprine
- taking one of the following medications within the 10 years before clinical onset: ciclosporin
- taking one of the following medications within the 10 years before clinical onset: elotuzumab
- taking one of the following medications within the 10 years before clinical onset: fingolimod
- taking one of the following medications within the 10 years before clinical onset: hydroxycarbimide (hydroxyurea)
- taking one of the following medications within the 10 years before clinical onset: ibrutinib
- taking one of the following medications within the 10 years before clinical onset: methotrexate
- taking one of the following medications within the 10 years before clinical onset: mycophenolate
- taking one of the following medications within the 10 years before clinical onset: ruxolitinib
- taking one of the following medications within the 10 years before clinical onset: siponimod
- taking one of the following medications within the 10 years before clinical onset: sirolimus
- taking one of the following medications within the 10 years before clinical onset: tacrolimus
- taking one of the following medications within the 10 years before clinical onset: tofacitinib
- taking one of the following medications within the 10 years before clinical onset: upadacitinib
- taking one of the following medications within the 10 years before clinical onset: ustekinumab
- taking one of the following medications within the 10 years before clinical onset: zanubrutinib
- taking one of the following medications within the 10 years before clinical onset: tumour necrosis factor-α inhibitors adalimumab, certolizumab, etanercept, golimumab, or infliximab; or
- taking one of the following medications within the 10 years before clinical onset: BRAF kinase inhibitors dabrafenib, encorafenib, vemurafenib
- taking ripretinib within the 10 years before clinical onset of squamous cell carcinoma of the skin
- taking ozanimod or ponesimod within the 10 years before clinical onset of basal cell carcinoma of the skin
- taking voriconazole continuously for at least 3 months, at least 6 months before clinical onset of squamous cell carcinoma of the skin
- taking a cumulative dose of at least 25 g of hydrochlorothiazide, at least 6 months before clinical onset of squamous cell carcinoma of the skin
- taking a cumulative dose of at least 50 g of hydrochlorothiazide, at least 6 months before clinical onset of basal cell carcinoma of the skin
- having autoimmune hepatitis at the time of clinical onset
- having inflammatory bowel disease at the time of clinical onset
- having psoriasis at the time of clinical onset
- having rheumatoid arthritis at the time of clinical onset
- having sarcoidosis at the time of clinical onset
- having chronic osteomyelitis with a sinus tract draining to the affected skin site at least 2 years before clinical onset
- having non-Hodgkin lymphoma before clinical onset
- having mature B-cell lymphoid leukaemia and small lymphocytic lymphoma before clinical onset
- having phimosis for a continuous period of at least 2 years before clinical onset of squamous cell carcinoma of the glans penis or prepuce of the penis
- having a scar at the affected site at least 5 years before clinical onset
- having ulceration at the affected site for a cumulative period of at least 6 months, at least 5 years before clinical onset
- having lichen sclerosus at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the penis, vulva or perianal skin
- having hidradenitis suppurativa at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the skin
- having chronic lymphoedema at the affected site, at least 5 years before clinical onset of squamous cell carcinoma of the skin
- smoking at least 15 cigarettes per day for at least 5 years, or the equivalent thereof in other tobacco products, at least 5 years before clinical onset of squamous cell carcinoma of the skin, and where smoking has ceased, clinical onset occurred within 20 years of cessation
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; consuming arsenic containing compounds (for example, Fowler's solution) for a cumulative period of at least 3 months; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; consuming drinking water with an average arsenic concentration of at least 50 micrograms per litre for a cumulative period of at least 2 years; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; inhaling, ingesting or having cutaneous contact with a pesticide containing arsenic, or arsenic in copper smelting operations, for a cumulative period of at least 1,000 hours; or
- being exposed to arsenic as detailed below, at least 10 years before clinical onset; having clinical evidence of chronic arsenic toxicity
- having cutaneous contact at the affected site with coal-tar distillate, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; creosote
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; shale oil
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; soot
- having cutaneous contact at the affected site with one of the following polycyclic aromatic hydrocarbons, for a cumulative period of at least 1,500 hours, at least 5 years before clinical onset of non-melanoma malignant neoplasm of the scrotal skin; mineral oil
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 small, painless, pearly papule on the right nasal ala that bled easily on 16 September 2024.
The diagnosis was confirmed by histopathology of a shave biopsy on 23 September 2024, which showed a nodular basal cell carcinoma arising from the basal layer of the epidermis of the right nasal ala. This is a primary malignant neoplasm of the non-melanotic cells of the epidermis and meets the Statement of Principles definition of non-melanoma malignant neoplasm of the skin, which expressly includes basal cell carcinoma.
This has then led to further investigations and the diagnosis of your condition of Basal Cell Carcinoma. I have accepted your condition of Basal Cell Carcinoma.
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 9 September 2024.
Skin - Basal Cell Carcinoma (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 14 April 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 14 April 2025;
- An enlistment medical examination by the medical officer, dated 6 August 1940;
- A repatriation medical examination of recovered prisoner of war by the medical officer, dated 15 October 1945;
- A battalion and field hospital records by the medical officer, Korea, dated 10 October 1951;
- A dermatology consultation by the dermatologist, dated 14 June 1968;
- A histopathology and radiotherapy completion summary by the pathologist and radiation oncologist, dated 20 November 1998;
- A transplant operation report by the transplant surgeon, dated 11 March 2011;
- A full skin examination by the dermatologist, dated 11 March 2024;
- A comprehensive medication review by the geriatrician, dated 22 July 2024;
- A general practice consultation by the general practitioner, dated 16 September 2024;
- A histopathology report by the pathologist, dated 23 September 2024;
- A specialist review and repeat histopathology by the mohs surgeon and pathologist, dated 3 March 2025;
- CT facial bones and paranasal sinuses by the radiologist, dated 10 March 2025;
- A mohs surgery operation report by the mohs surgeon, dated 24 March 2025.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
6 August 1940 and 31 March 1977
Skin - Basal Cell Carcinoma (Worsening)
You have stated that the worsening of your condition was caused by:
- inability to obtain appropriate clinical management for non-melanoma malignant neoplasm of the skin before clinical worsening
Diagnosis: Basal Cell Carcinoma (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 14 April 2025, and is supported by a histopathology report by the pathologist, dated 23 September 2024.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Non-Melanoma Malignant Neoplasm of the Skin (Reasonable Hypothesis) (No. 78 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 non-melanoma malignant neoplasm of the skin 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 small, painless, pearly papule on the right nasal ala that bled easily on 16 September 2024.
The diagnosis was confirmed by histopathology of a shave biopsy on 23 September 2024, which showed a nodular basal cell carcinoma arising from the basal layer of the epidermis of the right nasal ala. This is a primary malignant neoplasm of the non-melanotic cells of the epidermis and meets the Statement of Principles definition of non-melanoma malignant neoplasm of the skin, which expressly includes basal cell carcinoma.
After the condition arose, it was worsened during your service. Your operational service left you with multiple accepted conditions and frailty that made travel for specialist surgery difficult.
This has then led to further investigations and the diagnosis of your condition of Basal Cell Carcinoma (Worsening). I have accepted your condition of Basal Cell Carcinoma (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 9 September 2024.
Example document — fictitious patient. This is a suggested draft determination prepared by the Veterans Health Centre from the matching example Diagnostic Assessment, to show how a DVA delegate could determine the claim. The veteran is fictitious: names, dates, service details and clinicians have been invented. It is not a decision of the Department of Veterans' Affairs and must not be relied upon as a record of any real claim.
