Diverticular disease of the colon — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 51 of 2025

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting diverticular disease of the colon or death from diverticular disease of the colon with the circumstances of a person's relevant service:

1. (1)
   having systemic sclerosis (scleroderma) before clinical onset;
2. (2)
   having a Body Mass Index (BMI) of 25 or greater (being overweight) for at least the 5 years before clinical onset or clinical worsening; (a) W is the person's weight in kilograms; and (b) H is the person's height in metres;

   Note: Body mass index (BMI) is calculated as W/H2 and where:.

3. (3)
   having diabetes mellitus at the time of clinical onset or clinical worsening of diverticular bleeding;
4. (4)
   inability to undertake any physical activity greater than 3 METs for at least the 5 years before clinical onset or clinical worsening;

   Note: MET (metabolic equivalent) is a unit of measure of the level of physical capability of the cardiorespiratory system. For example, 1 MET = cardiorespiratory effort associated with a person sitting, 3-4 METs = cardiorespiratory effort associated with a person walking at average walking pace (5 km/h) or light gardening.

5. (5)
   having chronic renal failure at the time of clinical onset or clinical worsening as indicated by: (a) a glomerular filtration rate of less than 15 mL/min/1.73 m2 for a period of at least 3 months; or (b) undergoing chronic dialysis for renal failure;
6. (6)
   having a solid organ transplant (excluding corneal transplant) before clinical worsening;
7. (7)
   taking one of the following immunosuppressive medications within the 30 days before clinical onset of diverticular perforation, abscess or fistula: (a) corticosteroids other than inhaled or topical corticosteroids; (b) drugs used to prevent transplant rejection; (c) tumour necrosis factor-α inhibitors; (d) chemotherapeutic agents used for the treatment of cancer; (e) interleukin-6 inhibitors;
8. (8)
   taking one of the following immunosuppressive medications within the 30 days before clinical worsening: (a) corticosteroids other than inhaled or topical corticosteroids; (b) drugs used to prevent transplant rejection; (c) tumour necrosis factor-α inhibitors; (d) chemotherapeutic agents used for the treatment of cancer; (e) interleukin-6 inhibitors;
9. (9)
   taking a nonsteroidal anti-inflammatory medication, excluding aspirin and paracetamol, for a continuous period of at least 4 weeks before clinical onset, where the last dose of the medication within that period was taken within the 7 days before clinical onset of diverticular bleeding, perforation, abscess or fistula;
10. (10)
    taking a nonsteroidal anti-inflammatory medication, excluding aspirin and paracetamol, for a continuous period of at least 4 weeks before clinical worsening, where the last dose of the medication within that period was taken within the 7 days before clinical worsening;
11. (11)
    taking an antiplatelet medication that blocks platelet adhesion or aggregation before clinical onset, where the last dose of the antiplatelet medication was taken within the 7 days before clinical onset of diverticular bleeding;

    Note: Examples of an antiplatelet medication include aspirin, clopidogrel and dipyridamole.

12. (12)
    taking an antiplatelet medication that blocks platelet adhesion or aggregation before clinical worsening, where the last dose of the antiplatelet medication was taken within the 7 days before clinical worsening;

    Note: Examples of an antiplatelet medication include aspirin, clopidogrel and dipyridamole.

13. (13)
    taking an opioid for a continuous period of at least 4 weeks before clinical worsening, where the last dose of the opioid within that period was taken within the 7 days before clinical worsening;
14. (14)
    taking menopausal hormone therapy for at least 1 year before clinical onset;

    Note: menopausal hormone therapy is defined in the Schedule 1 - Dictionary.

15. (15)
    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;

    Note: one pack-year is defined in the Schedule 1 - Dictionary.

16. (16)
    consuming at least 180 kilograms of alcohol within the 10 years before clinical onset;

    Note: Alcohol consumption calculations utilising the Australian Standard of 10 grams of alcohol per standard alcoholic drink.

17. (17)
    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;

    Note: fibre in food is defined in the Schedule 1 - Dictionary.

18. (18)
    consuming an average of at least 200 grams per day of red meat, for at least the 5 years before clinical onset;

    Note: red meat is defined in the Schedule 1 - Dictionary.

19. (19)
    having contact with a foreign object or extraneous material at the affected site at the time of clinical worsening;

    Note: Examples of a foreign object or extraneous material include chicken or fish bones, toothpicks and biliary stents.

20. (20)
    inability to obtain appropriate clinical management for diverticular disease of the colon before clinical worsening;