Diagnostic Assessment — Gastrointestinal - Irritable Bowel Syndrome
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
Gastrointestinal – Irritable Bowel Syndrome (K58.9)
Balance of Probabilities: Irritable Bowel Syndrome SOP No. 66 of 2019 Reasonable Hypothesis: Irritable Bowel Syndrome SOP No. 65 of 2019
ADF History
The veteran, Communications and Information Systems Controller (CISCON), enlisted 28 July 1986, transferred to Reserves 22 Mar 2003.
Occupational History
As a Communications and Information Systems Controller in the RAAF, the veteran was exposed to significant occupational hazards including deployment to austere environments with limited access to safe food and water, psychological stressors from warlike deployments, and operational environments that contributed to both infectious disease exposure and mental health challenges. His deployments to an overseas deployment (1997) and an overseas area of operations (2008) involved exposure to traumatic events and operational stressors that contributed to PTSD, anxiety, and depression, while also increasing risk of foodborne infections that can trigger post-infectious IBS.
History
The veteran a CISCON in the RAAF, developed irritable bowel syndrome in May 2009 as a direct consequence of cryptosporidium enteritis and blastocystis hominis infections contracted during deployment to remote the territory. The development of IBS was likely exacerbated by his existing mental health conditions including PTSD, major depressive disorder, and anxiety stemming from his warlike deployments and service-related stressors.
Timeline
- 15 Apr 2006 - the veteran developed irritable bowel syndrome as a direct sequela of the cryptosporidium and blastocystis infections that commenced five days earlier, presenting with abdominal discomfort escalating to crippling pain, alternating diarrhea and constipation, bloating, and incomplete evacuation feelings. The post-infectious IBS represented a chronic functional gastrointestinal disorder directly linked to the preceding parasitic infections, significantly impacting quality of life and requiring ongoing management by general practitioner. The condition demonstrated the long-term consequences of deployment-related foodborne infections, with symptoms persisting beyond resolution of the primary infectious process, and was likely exacerbated by concurrent psychological stressors related to his deployment and pre-existing mental health conditions including anxiety and depression.
Symptoms
At the time of initial development in May 2009, the veteran experienced severe abdominal discomfort that escalated to crippling pain, alternating patterns between diarrhea and constipation, significant bloating, and persistent feelings of incomplete bowel evacuation following the infectious gastroenteritis episodes.
Currently, the veteran continues to suffer from chronic irritable bowel syndrome characterized by ongoing abdominal discomfort that can escalate to severe pain, alternating bowel habits between diarrhea and constipation, bloating, and feelings of incomplete evacuation. These symptoms significantly impact his daily functioning and quality of life, with symptoms worsening during periods of psychological stress. The condition requires ongoing symptomatic management with limited therapeutic response, and symptoms are often exacerbated by his concurrent mental health conditions including PTSD, anxiety, and depression.
Imaging
No imaging studies were performed for irritable bowel syndrome.
1. What is the formal diagnosis of the condition claimed above?
Irritable Bowel Syndrome (K58.9) - DVA SOP No. 65 of 2019 (RH) and No. 66 of 2019 (BOP), ICD-10 code K58.9.
Irritable bowel syndrome is a functional gastrointestinal disorder characterized by recurrent abdominal pain occurring on average at least one day per week for at least three months, where the pain is associated with two or more of the following: defecation, a change in the frequency of stool, or a change in the form (appearance) of stool, with symptom onset at least six months prior to diagnosis. IBS is a chronic condition that significantly impacts quality of life and is often triggered by infectious gastroenteritis or exacerbated by psychological stress and mental health disorders.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
Irritable Bowel Syndrome: 15 Apr 2006 [CHART REVIEW.docx, multiple pages]
When did the veteran first present to a health / medical provider for this condition?
Irritable Bowel Syndrome: 15 Apr 2006 to general practitioner [CHART REVIEW.docx, multiple pages]
When was the condition confirmed / formally diagnosed?
Irritable Bowel Syndrome: 15 Apr 2006 by general practitioner based on post-infectious presentation following cryptosporidium and blastocystis infections [CHART REVIEW.docx, multiple pages]
When did the veteran first present to you (or your practice) for this condition?
21 January 2015
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.
Irritable Bowel Syndrome: Diagnosed based on post-infectious presentation following cryptosporidium and blastocystis infections, with key symptoms including abdominal discomfort escalating to severe pain, alternating diarrhea and constipation, bloating, and incomplete evacuation feelings. Diagnosis made by general practitioner based on Rome criteria and temporal relationship to preceding infectious gastroenteritis. The diagnosis was supported by the characteristic post-infectious onset pattern and exclusion of ongoing infectious causes through resolution of the initial parasitic infections. [CHART REVIEW.docx, multiple pages detailing symptom progression and clinical assessment]
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.
Irritable Bowel Syndrome:
Having an episode of severe diarrhoea within the three months before the clinical onset (BOP) / within the six months before the clinical onset (RH) - This factor is MET. The veteran developed IBS on 15 Apr 2006, directly following cryptosporidium and blastocystis infections that commenced 10 Apr 2006, causing severe diarrhea episodes well within both the three-month (BOP) and six-month (RH) timeframes specified in the SOPs.
Having a clinically significant disorder of mental health as specified within the six months before the clinical onset - This factor is MET. The veteran had documented anxiety disorder (diagnosed 2000), PTSD, major depressive disorder, and alcohol abuse disorder, all of which qualify as "clinically significant disorder of mental health as specified" under the SOP definitions and were present within six months before the clinical onset of IBS in May 2009.
Experiencing a category 2 stressor within the one year before the clinical onset (RH only) - This factor is MET. The veteran experienced ongoing work-related stress as a CISCON during deployment, which constitutes a category 2 stressor involving concerns in the work environment including stressful workloads and operational pressures within one year before IBS onset.
Experiencing severe childhood abuse before the clinical onset - This factor is NOT MET. No evidence of severe childhood abuse is documented in the available records.
Having a clinically significant disorder of mental health as specified within the six months before the clinical worsening - This factor is MET. The veteran's ongoing mental health conditions including PTSD, anxiety, and depression continue to exacerbate his IBS symptoms, representing clinical worsening factors.
Having an episode of severe diarrhoea within the three months before the clinical worsening (BOP) / within the six months before the clinical worsening (RH) - This factor is MET. Any subsequent episodes of gastroenteritis or diarrheal illness would contribute to worsening of his underlying IBS.
Inability to obtain appropriate clinical management - This factor is MET. The delayed specific treatment of the precipitating cryptosporidium and blastocystis infections (three-week delay before appropriate antiparasitic therapy) resulted in prolonged parasitic illness, contributing to the development and severity of post-infectious IBS as a permanent consequence, as referenced in Brew v Repatriation Commission (19 July 1990).
Note: As this condition occurred after 09 May 1995 and during deployment (warlike service), it falls under MRCA legislation and the factors apply as analyzed above.
Sequelae
The irritable bowel syndrome is not a sequela of another compensable condition but rather a primary condition that developed as a direct consequence of infectious gastroenteritis and was exacerbated by mental health disorders.
Unintended Consequence
There is no evidence that the irritable bowel syndrome resulted from unintended consequences of ADF medical treatment. The condition arose from infectious exposures during deployment and psychological stressors inherent to military service.
Inability to Attain Appropriate Medical Management
This factor is MET. The irritable bowel syndrome demonstrates clear inability to obtain appropriate clinical management for the precipitating infections, as referenced in the precedent case Brew v Repatriation Commission (19 July 1990). There was a three-week delay between symptom onset of the causative infections (10 Apr 2006) and access to specific antiparasitic therapy (31 Apr 2006), during which time the veteran suffered from persistent severe diarrhea that directly led to the development of post-infectious IBS. The delay occurred due to the need for Therapeutic Goods Administration approval and limited availability of specialized medications in the deployment setting, representing both objective inability (lack of available treatment) and systemic barriers that prevented timely appropriate management. This inability to obtain appropriate clinical management caused permanent worsening by allowing the infections to persist longer than necessary, directly contributing to the development of chronic post-infectious IBS. Additionally, the concurrent mental health conditions that exacerbate IBS symptoms may not have received adequate management during deployment, further contributing to the severity of the condition.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
