Evidence Checklist: Ulcerative Colitis

Colonoscopy documenting extent of mucosal inflammationCritical

Colonoscopy report documenting continuous mucosal inflammation starting from the rectum, with the extent classified (proctitis, left-sided, or pancolitis) and severity scored.

Biopsy confirming chronic active colitis and crypt architectural distortionCritical

Pathology report from colonoscopic biopsies showing crypt distortion, crypt abscesses, and chronic active inflammation consistent with ulcerative colitis.

Nexus opinion linking ulcerative colitis to service ("at least as likely as not")Critical

A medical opinion connecting UC to service-related stress, infectious triggers, NSAID use, or other service-related factors.

Labs showing disease activity (CRP, CBC, albumin, fecal calprotectin)

Serial lab results documenting anemia, low albumin, elevated inflammatory markers, or elevated fecal calprotectin indicating active colitis.

Treatment records (mesalamine, biologics, immunosuppressants, surgery)

Records documenting the treatment escalation from aminosalicylates to corticosteroids, immunomodulators (azathioprine, 6-MP), biologics (infliximab, vedolizumab), and any surgical colectomy.

Dysplasia/colorectal cancer surveillance records

Surveillance colonoscopy records and pathology reports — long-standing UC carries elevated colorectal cancer risk, and surveillance compliance documents ongoing disease severity.

Documentation of incapacitating flares and hospitalizationsCritical

Medical records or personal log documenting flares requiring hospitalization, IV steroids, or bed rest. Incapacitating episode count per year is the primary VA rating driver.

Buddy statement from spouse, family, or fellow service member

A written statement from someone who can describe observable symptoms and how your condition affects daily life.

Completed DBQ Intestinal Conditions (other than Small or Large Intestine)Critical

Standardized form capturing UC extent, stool frequency, bloody stools, incapacitating episodes, weight changes, and complications.

Service treatment records (STRs)Critical

Military medical records showing in-service treatment, complaints, or injuries related to this condition.