Reference Determination Content
Suggested draft · fictitious patient
Thoracic Strain
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 21 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
- A pre-deployment medical examination by the medical officer, dated 11 August 1999;
- A patrol casualty record by the patrol medic, East Timor, dated 3 December 1999;
- A field medical record by the regimental medical officer, East Timor, dated 5 December 1999;
- A post-deployment medical review and physiotherapy referral by the medical officer, dated 24 January 2000;
- An X-ray thoracic spine by the radiologist, dated 17 August 2001;
- A field medical record by the medical officer, Solomon Islands, dated 22 September 2003;
- An MRI thoracic spine by the radiologist, dated 10 December 2003;
- A specialist consultation by the sports physician, dated 10 December 2003;
- A discharge medical examination by the medical officer, dated 2 November 2006.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
8 February 1996 and 14 December 2006
Thoracic Strain
You have stated that your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
Diagnosis: Thoracic Strain
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a field medical record by the regimental medical officer, East Timor, dated 5 December 1999.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical onset of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical onset of a strain to that muscle or tendon
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 sharp pain along the medial border of the left scapula and over the left upper back, worse with deep breathing, reaching and rotating your trunk, with muscle spasm and difficulty carrying your pack on 3 December 1999.
The diagnosis was made clinically by the regimental medical officer on 5 December 1999 on the history of a fall under load with a wrenching injury to the left upper back, and the findings of spasm and tenderness along the medial border of the left scapula from T4 to T7, point tenderness over the left T5/6 costotransverse joint, pain on rib springing and painful restriction of thoracic rotation, with a normal chest examination. These findings meet the Statement of Principles definitions of strain and of sprain.
This has then led to further investigations and the diagnosis of your condition of Thoracic Strain. I have accepted your condition of Thoracic Strain.
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 3 December 1999.
Thoracic Strain (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 21 May 2025;
- A Diagnosis Form (D9287) by Dr Thomas Perkins, General Practitioner, Veterans Health Centre, dated 21 May 2025;
- A pre-deployment medical examination by the medical officer, dated 11 August 1999;
- A patrol casualty record by the patrol medic, East Timor, dated 3 December 1999;
- A field medical record by the regimental medical officer, East Timor, dated 5 December 1999;
- A post-deployment medical review and physiotherapy referral by the medical officer, dated 24 January 2000;
- An X-ray thoracic spine by the radiologist, dated 17 August 2001;
- A field medical record by the medical officer, Solomon Islands, dated 22 September 2003;
- An MRI thoracic spine by the radiologist, dated 10 December 2003;
- A specialist consultation by the sports physician, dated 10 December 2003;
- A discharge medical examination by the medical officer, dated 2 November 2006.
Your service
I have identified that you have the following service:
Australian Defence Force service between :
8 February 1996 and 14 December 2006
Thoracic Strain (Worsening)
You have stated that the worsening of your condition was caused by:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
Diagnosis: Thoracic Strain (Worsening)
Basis of diagnosis: The diagnosis was made in the Diagnostic Assessment by Dr Thomas Perkins dated 21 May 2025, and is supported by a field medical record by the regimental medical officer, East Timor, dated 5 December 1999.
I am satisfied this is the appropriate diagnosis.
In determining your claim for this condition, I have applied the SOP:
Statement of Principles concerning Sprain and Strain (Reasonable Hypothesis) (No. 27 of 2020)
which sets out the factors that can connect the condition with service.
I am satisfied that you have met the following factor:
- experiencing a significant physical force applied to or through the affected joint, at the time of the clinical worsening of a sprain to that joint ligament
- forceful stretching or high intensity use of a muscle or tendon at the time of the clinical worsening of a strain to that muscle or tendon
- inability to obtain appropriate clinical management for sprain or strain
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 sharp pain along the medial border of the left scapula and over the left upper back, worse with deep breathing, reaching and rotating your trunk, with muscle spasm and difficulty carrying your pack on 3 December 1999.
The diagnosis was made clinically by the regimental medical officer on 5 December 1999 on the history of a fall under load with a wrenching injury to the left upper back, and the findings of spasm and tenderness along the medial border of the left scapula from T4 to T7, point tenderness over the left T5/6 costotransverse joint, pain on rib springing and painful restriction of thoracic rotation, with a normal chest examination. These findings meet the Statement of Principles definitions of strain and of sprain.
After the condition arose, it was worsened during your service. The worsening on 19 September 2003 occurred on non-warlike service in Solomon Islands, when the gunwale of a surging patrol boat struck you across the left upper back. On the same date, on non-warlike service in Solomon Islands, you were twisting to lift a 40 kilogram outboard motor when the boat lurched, forcefully stretching the left rhomboid and middle trapezius during a maximal contraction. MET.
This has then led to further investigations and the diagnosis of your condition of Thoracic Strain (Worsening). I have accepted your condition of Thoracic Strain (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 19 September 2003.
