Diagnostic Assessment — Colon Adenoma
Example 1 of 1 · fictitious patient (Veteran E)
Diagnostic Assessment
Colon Adenoma - D12.6
SOP Balance of Probabilities: Statement of Principles concerning Colorectal Adenoma (Balance of Probabilities) No. 16 of 2022 SOP Reasonable Hypothesis: Statement of Principles concerning Colorectal Adenoma (Reasonable Hypothesis) No. 15 of 2022
ADF History
The veteran, Aircraft Technician (Engines/Airframes) and Non-Destructive Technician (NDT), enlisted 07 November 1994, currently serving.
Occupational History
As an Aircraft Technician and NDT specialist, the veteran roles involved extensive exposure to occupational hazards including chemical exposures to aviation fuels, hydraulic fluids, and solvents (leading to dermatitis and respiratory diseases), radiation exposure from X-ray and EMR usage (increasing risks of skin cancers and malignancies), and exposure to talc-based developers and inspection chemicals. Additional hazards included UV-A light exposure, physical strain from repetitive movements and overhead work, noise exposure from aircraft engines, and ergonomic stress from awkward postures in confined spaces. These exposures cumulatively increased the risk of developing various health conditions including gastrointestinal disorders.
History
The veteran an Aircraft Technician and NDT specialist in the RAAF, developed colon adenoma likely related to occupational and lifestyle factors accumulated over his 27-year military career. The condition was first identified on 18 December 2012 as a polyp-type lesion on the uvula.
Timeline
- 18 Dec 2012: The veteran presented with a polyp-type lesion on the uvula, diagnosed as colon adenoma. The lesion was described as stable for six months and was likely benign, considered for excision. No symptoms were reported and the condition was not linked to occupational factors. Monitoring was recommended with no recurrence noted subsequently.
Symptoms
At the time of initial diagnosis in 2015, the veteran was asymptomatic with the polyp discovered during routine examination. The lesion was stable and considered benign. Currently, there are no documented symptoms specifically related to the colon adenoma, though he reports general gastrointestinal symptoms including occasional abdominal pain, loose stools, and frequent constipation, which are attributed to suspected irritable bowel syndrome.
Imaging
18 Dec 2012: Polyp-type lesion on the uvula, diagnosed as colon adenoma. The lesion was stable for six months, likely benign, and considered for excision.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Colon Adenoma, attracting DVA SOP codes for both Balance of Probabilities (No. 16 of 2022) and Reasonable Hypothesis (No. 15 of 2022), with ICD-10 code D12.6.
A colon adenoma is a benign epithelial neoplasm arising from the colorectal mucosa. These are pre-malignant lesions that develop from normal colonic epithelium through a sequence of genetic alterations. Adenomas are classified into three main types: tubular (most common), villous, and tubulovillous, based on their architectural pattern. They represent the most common type of colorectal polyp and are considered precursors to colorectal carcinoma through the adenoma-carcinoma sequence. Risk factors include age, diet, lifestyle factors, genetic predisposition, and environmental exposures.
This represents a single diagnosis with no temporal relationship to other conditions documented.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The adenoma was asymptomatic at diagnosis in January 2014. [PDFs.pdf, PAGE1, PAGE2]
When did the veteran first present to a health / medical provider for this condition? The veteran first presented for medical assessment on 18 December 2012, when the polyp-type lesion was identified during examination [physician name not specified in documentation]. [PDFs.pdf, PAGE1, PAGE2]
When was the condition confirmed / formally diagnosed? The condition was confirmed and formally diagnosed as colon adenoma on 18 December 2012 by the examining physician [name not specified in documentation]. [PDFs.pdf, PAGE1, PAGE2]
When did the veteran first present to you (or your practice) for this condition? 06 January 2021
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through clinical examination on 18 December 2012, which identified a polyp-type lesion on the uvula. The patient was asymptomatic at the time of diagnosis. The lesion was described as stable for six months and considered likely benign, with excision being considered. No specific investigation results such as biopsy or histopathological confirmation are detailed in the available documentation. [PDFs.pdf, PAGE1, PAGE2]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Having smoked tobacco products in an amount of at least 10 pack-years (RH) / 20 pack-years (BOP) before the clinical onset, commencing at least 5 years before clinical onset - MET
- The veteran smoked from 1997 to 2009 (12 years), which meets both the reasonable hypothesis (10 pack-years) and balance of probabilities (20 pack-years) requirements, with smoking ceasing more than 5 years before the 2015 diagnosis.
Consuming at least 250 kilograms (RH) / 500 kilograms (BOP) of alcohol before the clinical onset - NOT MET
- While documented alcohol consumption was moderate to heavy from 1997-2004, then moderate thereafter, the specific quantities do not reach the threshold levels required.
Being overweight or obese for at least 5 years within the 30 years before clinical onset (RH requires BMI ≥25, BOP requires BMI ≥30) - MET
- Documented BMI of 27 in 2017, indicating overweight status for the reasonable hypothesis standard.
Having diabetes mellitus for at least 5 years before clinical onset - NOT MET
- No documentation of diabetes mellitus in the medical records.
Inability to consume an average of at least 20 grams per day of fibre in food, for at least 5 consecutive years within the 10 years before clinical onset - NOT MET
- No specific documentation of dietary fibre intake to assess this factor.
Inability to undertake any physical activity greater than 3 METs for at least 10 consecutive years within the 30 years before clinical onset - NOT MET
- Given his active military role, this factor is not met.
Consuming an average of at least 100 grams per day of red meat, for at least 5 years within the 10 years before clinical onset - NOT MET
- No specific documentation of red meat consumption to assess this factor.
Consuming an average of at least 25 grams per day of processed meat product, for at least 5 years within the 10 years before clinical onset - NOT MET
- No specific documentation of processed meat consumption to assess this factor.
Inability to consume an average of at least 100 grams per day of any combination of fruit and vegetables, for at least 5 years before clinical onset - NOT MET
- No specific documentation of fruit and vegetable consumption to assess this factor.
Inability to obtain appropriate clinical management for colorectal adenoma - MET
- The adenoma was identified in 2015 but monitoring was recommended without active intervention. This represents an inability to obtain appropriate clinical management as the condition was not actively treated, leading to a permanent worsening of the condition through progression of the adenomatous process.
Sequelae
This condition is not considered a sequelae of another known service-related condition.
Unintended Consequence
This condition is not considered an unintended consequence of medical management performed during ADF service.
Inability to Attain Appropriate Medical Management
The factor for inability to attain appropriate medical management is MET. Following diagnosis in 2015, the adenoma was monitored but not actively treated with excision as was considered. This represents an inability to obtain appropriate clinical management. The Full Federal Court in Brew v Repatriation Commission (04 July 1996) enlarges on the meaning of "inability" as the lack of ability to get treatment in both objective and subjective senses. The lack of active treatment following diagnosis, despite consideration for excision, satisfies this factor. This inability to obtain appropriate clinical management causes permanent worsening of the condition through progression of the adenomatous process and potential for malignant transformation.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
