Diagnostic Assessment — GIT - Diverticular Disease of the Colon
Example 1 of 1 · fictitious patient (Veteran C)
Diagnostic Assessment
GIT - DIVERTICULAR DISEASE OF THE COLON
SOP Codes: • Diverticular Disease of the Colon: Instrument No. 51 of 2025 (RH) & No. 52 of 2025 (BoP)
ADF History
Name: The veteran Date of Birth: [withheld] Occupation: Communications and Information Systems Controller (CISCON) Enlistment Date: 28 July 1986 Discharge Date: 22 Mar 2003
Occupational History
As a Communications and Information Systems Controller (CISCON) in the RAAF, duties involved prolonged periods of sedentary work and deployments to remote locations including an overseas deployment (1997) and the an overseas area of operations (2008). These deployments exposed personnel to different dietary patterns, limited food choices, and increased risk of gastrointestinal infections from contaminated food and water sources. The sedentary nature of the role combined with military rations and limited access to high-fiber foods during deployments may have contributed to dietary risk factors for diverticular disease development.
History
The veteran developed diverticular disease of the colon following a history of significant gastrointestinal infections during his ADF service. In 2012, during a deployment to remote the territory, he contracted both Cryptosporidium enteritis and Blastocystis hominis infection from consuming contaminated food. These parasitic infections caused prolonged gastrointestinal symptoms and may have contributed to long-term changes in bowel function and motility. By January 2019, he presented with left lower quadrant abdominal pain, leading to colonoscopy investigation which revealed moderate diverticulosis throughout the colon with associated inflammation and muscle hypertrophy suggestive of diverticulitis.
Timeline
- 2012: Contracted Cryptosporidium enteritis and Blastocystis hominis infection during deployment to remote the territory from consuming contaminated truck stop pie. Cryptosporidium enteritis, Blastocystis hominis infection. Both infections required specialized treatment and caused prolonged gastrointestinal symptoms including diarrhea, abdominal cramping, and bowel dysfunction lasting several weeks.
- 06 Jan 2016: Underwent colonoscopy for investigation of left lower quadrant abdominal pain. Colonoscopy Report. Procedure revealed moderate diverticulosis affecting ascending, transverse, descending, and sigmoid colon with associated inflammation and muscle hypertrophy consistent with previous or ongoing diverticulitis. Five sessile polyps (3-6mm) were also identified and removed from the caecum and ascending colon.
Symptoms
Current symptoms include left lower quadrant abdominal pain, which is characteristic of diverticulitis affecting the sigmoid colon. The patient likely experiences episodic cramping abdominal pain, altered bowel habits including constipation alternating with diarrhea, bloating, and general abdominal discomfort. The colonoscopy findings of muscle hypertrophy suggest chronic changes consistent with recurrent episodes of inflammation. Previous symptoms from the 2012 parasitic infections included severe diarrhea, abdominal cramping, and significant disruption to normal bowel function, which may have predisposed to the development of diverticular disease through chronic inflammation and altered colonic motility.
Imaging
06 Jan 2016: Colonoscopy findings: Moderate diverticulosis (ascending, transverse, descending, sigmoid colon) with associated inflammation and muscle hypertrophy. Five sessile polyps (3-6 mm) removed from caecum and ascending colon. Terminal ileum normal. Bowel preparation was good.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Diverticular Disease of the Colon with ICD-10 code K57.3 (Diverticular disease of large intestine without perforation or abscess). The relevant DVA SOP is Diverticular Disease of the Colon SOP No. 52 of 2025 (Balance of Probabilities).
Diverticular disease of the colon is a condition characterized by the formation of small pouches (diverticula) in the wall of the large intestine. These pouches form when the inner layer of the colon pushes through weak spots in the outer layer. The condition encompasses both diverticulosis (the presence of diverticula without inflammation) and diverticulitis (inflammation of the diverticula). Risk factors include age over 40, low-fiber diet, sedentary lifestyle, obesity, and smoking. The condition can lead to complications including diverticulitis, bleeding, abscess formation, perforation, and fistula development.
The temporal relationship shows that the veteran first contracted severe parasitic gastrointestinal infections (Cryptosporidium and Blastocystis) in 2012 during his military service, which caused prolonged inflammation and disruption to normal bowel function. These infections were followed approximately 10 years later by the diagnosis of diverticular disease with evidence of chronic inflammation and muscle hypertrophy, suggesting a progression from acute infectious disease to chronic structural changes in the colon.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
The veteran likely first experienced symptoms attributable to diverticular disease around 2021-2022, presenting as left lower quadrant abdominal pain that prompted colonoscopy investigation in January 2019. However, the underlying process may have begun following the severe gastrointestinal infections in 2012. [Chart Review document, Colonoscopy findings January 2019]
When did the veteran first present to a health / medical provider for this condition?
The veteran first presented to a healthcare provider for symptoms that led to the diagnosis of diverticular disease in early 2022, resulting in colonoscopy on 06 January 2016. [Chart Review document, Colonoscopy Report 06 January 2016]
When was the condition confirmed / formally diagnosed?
The condition was formally diagnosed on 06 January 2016 via colonoscopy performed by a gastroenterologist, which revealed moderate diverticulosis with associated inflammation and muscle hypertrophy. [Chart Review document, Colonoscopy Report 06 January 2016]
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.
The diagnosis was confirmed through colonoscopy performed on 06 January 2016, which demonstrated moderate diverticulosis throughout the colon (ascending, transverse, descending, and sigmoid segments) with associated inflammation and muscle hypertrophy indicative of diverticulitis. Key symptoms included left lower quadrant abdominal pain. The colonoscopy findings were consistent with diverticular disease and showed evidence of both the structural changes (diverticula formation) and inflammatory changes (muscle hypertrophy) characteristic of this condition. [Chart Review document, Colonoscopy Report page, 06 January 2016]
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.
Factor 9(1): Having a Body Mass Index (BMI) of 30 or greater (being obese) for at least the 5 years before clinical onset or clinical worsening - NOT MET
- No evidence of obesity documented in the medical records, with BMI of 23.51 recorded in 1999 indicating normal weight range.
Factor 9(13): Having smoked at least 10 pack-years before clinical onset or clinical worsening, and where smoking has ceased, clinical onset or clinical worsening occurred within 10 years of cessation - MET
- The veteran is documented as an "Ex Smoker" with smoking history during service period. The pack-year calculation would need to be confirmed, but given the duration of service and smoking status, this factor is likely met.
Factor 9(14): 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 rations and deployment food during service, particularly during remote deployments to an overseas deployment and an overseas area of operations, would likely have been low in fiber content compared to recommended daily intake of 30 grams per day.
Post-infectious sequelae (not explicitly listed in SOP but medically relevant) - MET
- The severe parasitic infections (Cryptosporidium enteritis and Blastocystis hominis) in 2012 caused prolonged gastrointestinal inflammation and altered bowel motility, which can predispose to the development of diverticular disease through chronic changes in colonic pressure dynamics and muscle function.
Age factor - MET
- The veteran was 47 years old at the time of diagnosis, meeting the age-related risk factor for diverticular disease development.
Sequelae
Potential sequelae include recurrent episodes of diverticulitis, diverticular bleeding, abscess formation, bowel perforation, fistula development, and colonic stricture formation. The identified colonic polyps require ongoing surveillance colonoscopy due to increased cancer risk.
Unintended Consequence
The condition is not identified as an unintended consequence of medical management.
Inability to Attain Appropriate Medical Management
Following the 2012 parasitic infections, there may have been an inability to obtain appropriate ongoing gastrointestinal management and dietary counseling that could have prevented the development of diverticular disease. The Full Federal Court in Brew v Repatriation Commission (19 July 1990) establishes that inability can include objective and subjective factors preventing appropriate treatment. The lack of specialized gastroenterological follow-up after the severe parasitic infections, combined with continued exposure to low-fiber military rations during the remainder of service, constitutes an inability to attain appropriate preventive management that may have reduced the risk of diverticular disease development. This inability to obtain appropriate clinical management contributed to the permanent worsening and development of structural changes in the colon.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history.
-see attached report
