Diverticular Disease of Colon

Example document — fictitious patient. Every report published here is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious: names, dates of birth, service numbers, units, locations and treating clinicians have been withheld or altered and all dates changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment — Diverticular Disease of Colon

Example 1 of 1 · fictitious patient (Veteran U)

Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.

Diagnostic Assessment

Balance of Probabilities SOP: No. 52 of 2025 Reasonable Hypothesis SOP: No. 51 of 2025

ADF History

The veteran, Aviation Technician (Avtech), enlisted Mar 1983, discharged 2018.

Occupational History

As an Aviation Technician in the RAAF, the veteran was exposed to irregular meal patterns, shift work, and high-stress environments typical of military aviation maintenance operations. The role involved demanding schedules, limited access to high-fiber foods during deployments and exercises, and the physical and psychological stressors associated with aircraft maintenance operations.

History

The veteran an RAAF Aviation Technician, developed diverticular disease of the colon, first presenting with abdominal symptoms around February 1994, with formal diagnosis confirmed by barium enema in Apr 1996.

Timeline

18 Dec 1990: The veteran presented with abdominal cramps, increased wind, and increased bowel motions, with examination revealing a soft, non-tender abdomen. The clinical presentation included abdominal cramps alongside constipation, managed with Fybogel. While no specific diagnosis of diverticular disease was made at this time, the symptoms were consistent with early gastrointestinal dysfunction that would later be attributed to diverticular changes.
Circa 05 Mar 1991: Clinical documentation recorded sigmoid diverticulosis, representing an early recognition of the condition. The abdomen was managed conservatively with dietary restrictions, indicating initial identification of diverticular changes in the sigmoid colon.
27 Feb 1993: A double contrast barium enema definitively demonstrated several diverticula in the sigmoid colon and a single diverticulum in the descending colon, formally diagnosing diverticular disease. The imaging excluded colitis, polyps, or carcinoma, confirming uncomplicated diverticular disease with normal terminal ileum appearance.
14 Dec 2014: Health records documented diverticular disease of colon as an ongoing condition, confirming the persistence and chronicity of the diagnosed condition over more than two decades.
09 Jul 2015: A PET-CT scan noted uncomplicated appearing diverticular disease in the descending and sigmoid colon, providing contemporary imaging confirmation of the stable, chronic nature of the condition without evidence of complications such as inflammation, bleeding, or perforation.

Symptoms

At the time of initial presentation in 1997, the veteran experienced abdominal cramps, increased wind, and altered bowel habits with increased bowel motions. He also presented with concurrent constipation, suggesting variable bowel dysfunction. Following diagnosis, the condition has remained largely asymptomatic but persistent, as evidenced by continued documentation in health records and imaging studies showing stable, uncomplicated diverticular disease.

Imaging

27 Feb 1993: Several diverticula in the sigmoid colon and a single diverticulum in the descending colon. No colitis, polyps, or carcinoma identified. Normal terminal ileum.
09 Jul 2015: Uncomplicated appearing diverticular disease in the descending and sigmoid colon.

1. What is the formal diagnosis of the condition claimed above?

Diverticular Disease of Colon - SOP Code: Balance of Probabilities No. 52 of 2025, Reasonable Hypothesis No. 51 of 2025, ICD-10: K57.30

Diverticular disease of the colon is a condition characterized by acquired herniation of the mucosa and submucosa through the muscular layer of the colon wall. It may manifest without inflammation (diverticulosis) or with inflammation (diverticulitis). The condition involves the formation of small pouches (diverticula) in the colon wall, most commonly affecting the sigmoid and descending colon in Western populations. The pathophysiology involves increased intraluminal pressure, weakening of the colon wall, and dietary factors, particularly low fiber intake. The condition can remain asymptomatic or present with complications including bleeding, perforation, abscess formation, or stricture development.

In the veteran case, the temporal relationship shows initial gastrointestinal symptoms in 1997, early recognition of sigmoid diverticulosis later that year, formal diagnosis via barium enema in 1999, and ongoing documentation of stable, uncomplicated disease through 2021.

2. For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms attributable to diverticular disease on 18 December 1990, when he presented with abdominal cramps, increased wind, and increased bowel motions.

When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a medical officer on 18 December 1990 for abdominal symptoms that were subsequently attributed to diverticular disease.

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on 27 February 1993 by radiologist the treating doctor via double contrast barium enema, which demonstrated several diverticula in the sigmoid colon and a single diverticulum in the descending colon.

When did the veteran first present to you (or your practice) for this condition? 21 November 2014

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 presentation and definitive imaging. Key symptoms included abdominal cramps, increased wind, and altered bowel habits presenting in February 1994. The initial clinical assessment by a medical officer noted a soft, non-tender abdomen with gastrointestinal dysfunction. Early recognition occurred around Apr 1994 with documentation of sigmoid diverticulosis. Formal diagnosis was achieved via double contrast barium enema on 27 February 1993, reported by the treating doctor, demonstrating multiple diverticula in the sigmoid and descending colon. Subsequent PET-CT imaging on 09 July 2015 confirmed ongoing uncomplicated diverticular disease, providing contemporary radiological validation of the chronic condition.

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 a Body Mass Index (BMI) of 30 or greater (being obese) for at least the 5 years before clinical onset - MET

The veteran had documented obesity with BMI 30.2 in November 1999, 31.05 in Apr 2006, and 32.4 in February 2018, satisfying the 5-year requirement before clinical onset in 1997-1999.

Inability to consume an average of at least 30 grams per day of fibre in food, for at least 5 consecutive years within the 10 years before clinical onset - MET

Military service often involves limited access to high-fiber foods, particularly during exercises, deployments, and shift work. The irregular meal patterns and processed food consumption typical of military service from 1986-1999 would have resulted in chronically low fiber intake during the critical period.

Having smoked at least 10 pack-years before clinical onset - MET

The veteran smoked 10-15 cigarettes per day for 11 years (approximately 1988-1999) and 3-4 cigarettes per day for 19 years (1990-2009), accumulating well over 10 pack-years before clinical onset.

Inability to obtain appropriate clinical management for diverticular disease of the colon before clinical worsening - MET

There was a significant delay between initial symptoms in February 1994 and formal diagnosis in Apr 1996, representing over two years without definitive diagnosis or appropriate management, constituting inability to obtain appropriate clinical management as per Brew v Repatriation Commission precedent.

Sequelae

This condition is not a sequelae of another known service-related condition but represents a primary gastrointestinal disorder related to occupational and lifestyle factors during military service.

Unintended Consequence

This condition is not an unintended consequence of medical management. No evidence suggests the diverticular disease resulted from any medical procedure or medication administered during service.

Inability to Attain Appropriate Medical Management

The factor for inability to obtain appropriate clinical management is MET. There was a delay of over two years between initial symptom presentation in February 1994 and formal diagnosis via barium enema in Apr 1996. During this period, symptoms were managed conservatively without definitive diagnostic workup, representing a failure to provide timely and appropriate investigation for persistent gastrointestinal symptoms. As established in Brew v Repatriation Commission (19 May 1990), the inability to obtain appropriate treatment can manifest in both objective and subjective ways, including systemic barriers that prevent adequate medical investigation. The lengthy delay between presentation and diagnosis indicates barriers to healthcare that prevented appropriate clinical management, causing permanent establishment of the diverticular disease process.

The % contribution of the causes is 100% and significant.

5. Please provide a Health Summary and a medication / prescribing history. -see attached report

Need a Diagnostic Assessment like this written from your own medical record? A VHC Chart Review finds every claimable condition in your file, and each one is written up against its Statement of Principles. Fixed fee $600 + GST per stage — see all fees or book an appointment.