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http://www.index.va.gov/search/va/bva_search.jsp
Summery:
More
than 100 appeals
mentioning jet
guns have been
granted since
1992 and half
mention the
devices as the
sole probable
cause,
Board
of Veterans'
Appeals- Jetgun
Hepatitis C
Claims Granted
Service
Connection
1992 - 2014
Doctors
Testimony
VA
physicians
cited in BVA
decisions
Private
Physicians
cited in BVA
decisions
VA
Physicians Cited
Case #
0617051
“An October 2004
VA examination
report, for
which the claims
folder was not
reviewed, noted
an impression of
hepatitis C,
etiology
undetermined.
Subsequently,
the veteran was
afforded another
examination in
April 2005 for
which the
veteran's claims
folder was
reviewed in
conjunction with
examination of
the veteran. The
examiner
diagnosed
chronic
hepatitis C and
noted that
historically it
was at least as
likely as not
that any of the
situations
during service
(dental work,
jet injection,
and fist fights)
could at least
as likely as not
be the source of
exposure to
hepatitis C. He
further noted
the order of
greater
possibility was
the series of
immunizations
through a common
injector gun
along with 74
other men
injected one
after another on
the same day
without
sterilization or
cleaning the gun
in between
injections, or
next the
possibility of
blood exposure
during one of
his fist fights.
The examiner
also noted the
possibility of
exposure during
dental procedure
but found that
this situation
was less likely
than the other
two situations.
He added that it
was not possible
to state with
certainty which
situation caused
the veteran to
be infected with
hepatitis C but
it was at least
as likely that
any of the three
situations was a
situation in
which he could
have been
exposed. The
examiner further
acknowledged the
lack of
symptomatology
from service to
diagnosis in
2000 but stated
that was how
hepatitis C
presents
itself.”
Case # 0724695
“A VA
examination
report dated in
April 2003 noted
private medical
records showed
liver function
tests were
initially found
to be abnormal
in September
2001, and that
subsequent
testing
including liver
biopsy in 2002
that confirmed
the presence of
chronic
hepatitis C. The
examiner opined
that the
transmission of
hepatitis C
through
pneumatic
injectors was
possible, and
observed that
the veteran did
not seem to have
any other risk
factors for
acquiring
hepatitis C.”
Case # 0925662
VA physician
tries to
discredit
airguns as
causality but
cannot
completely rule
them out.
“Regarding the
origin of the
Veteran's
hepatitis C, the
examiner stated
that there had
been no
discernible
cause, but it
was less likely
caused by the
alleged exposure
to jet gun
injections,
although he
could not rule
it out with 100
percent
certainty.”
Case # 0928872
"With respect to
medical nexus,
the Veteran's VA
physician wrote
in a June 2007
letter that his
only risk factor
for hepatitis C
was the "gun
shot"
vaccination he
received in
service. She
indicated that
his chronic
hepatitis C
should be
considered
service-connected.”
Case #1024366
" The March 2010
letter lists no
known risk
factors except
for sharing
shaving razors
and inoculations
with jet
injectors, and
the examiner
opined that this
is more likely
than not how the
Veteran acquired
the hepatitis C
virus.”
Case # 1028817
“Additionally,
in July 2009, a
VA examiner,
after an
examination of
the Veteran and
a review of his
claims file,
stated that the
Veteran's main
hepatitis risk
factors were his
tattoo in 1991
and exposure to
blood during his
inoculation with
a contaminated
tip
of an
inoculation gun.
He further
stated that:
I believe that
it is plausible
that, if
indeed there was
blood on the tip
of the
inoculation gun,
blood could have
been
injected under
the skin and
exposed him to
Hepatitis C.
However, I
cannot say this
is
the most likely
cause without
resorting to
speculation.”
Case # 1101581
Finding of Fact
“An etiological
relationship
between the
Veteran's
hepatitis C and
air gun injector
inoculations in
active service
has been shown
to be
biologically
plausible, and
such etiology
has not been
definitively
excluded by
competent
medical evidence
of record.”
Case # 1113197
“In November
2010, the Board
requested an
expert medical
opinion from the
Veterans Health
Administration (VHA).
In a December
2010 statement,
the examiner
noted that
Hepatitis C was
first discovered
in 1989;
therefore,
although the
disease existed,
there was no way
to diagnose it
until 1989. The
examiner noted
that
jet-injector
devices have
been in use
since 1952 in
one form or
another, and the
Department of
Defense issued a
recall of these
devices in 1997
because of
concern for
potential
transmission of
blood-borne
infections. The
examiner
reported that in
1986, the Center
for Disease
Control reported
an outbreak of
Hepatitis B
related to
contamination of
a jet-injector
device. The
examiner
explained that
Hepatitis B is
also transmitted
parenterally,
like Hepatitis
C, and it is
logical to
conclude that it
is possible to
transmit
Hepatitis C by
contaminated
jet-injector
devices. The
examiner stated
that several
investigators
have reported
small blood
droplets at
injection sites
and another in
vitro study in
1998
demonstrated
that needle-less
injectors become
contaminated
during use and
cross-contamination
can occur with
immediate re-use
of the
jet-injector
device. The
examiner opined
that it is
highly likely
that the Veteran
has chronic
Hepatitis C, and
it is more
likely than not
that the Veteran
acquired
Hepatitis C
during his
service. Also,
the examiner
noted that
Hepatitis C
could be
transmitted from
contaminated
injector guns
used for mass
inoculations.
According to the
examiner, the
acute onset of
the infection
would have gone
undiagnosed, as
existence of the
virus was not
known then, and
most infections
are silent and
without
symptoms. Based
on this
information, the
examiner opined
that it is as
likely as not
that the Veteran
contracted
Hepatitis C
infection from a
contaminated
injector gun, in
absence of any
other known risk
factors.”
Case # 1142926
“The May 2008 VA
examiner opined
that it was at
least as likely
as not that the
Veteran's
contraction of
hepatitis C
occurred in
service due to
either air-gun
injections or
sharing of
razors and
toothbrushes and
that it was less
likely due to
unprotected
sexual activity
in service with
a minimum number
of sexual
partners prior
to his marriage
at a young age.
The examiner
indicated that
based on the
chronicity of
the development
of end-stage
liver disease,
i.e., 40 years,
it was at least
as likely as not
that the
appellant
contracted
hepatitis C
during the time
frame when he
was on active
duty. The
examiner's basis
for her opinion
was various lay
statements,
including the
Veteran's, and
the opinion of a
liver expert. In
particular,
while the
Veteran and his
brother are not
competent to
report that he
had hepatitis
soon after
service, they
are competent to
report that he
was hospitalized
for appearing to
have jaundice.”
Case # 1224138
“A February 2010
statement from
the Veteran's VA
liver transplant
doctor, an
Associate
Professor of
Medicine and
Pharmacology,
Gastroenterology
and Hepatology
at Vanderbilt
University
School of
Medicine, stated
the Veteran was
diagnosed with
hepatitis C in
1990 and he had
no additional
risk factors for
hepatitis C
except for the
in-service air
gun
inoculations.”
Case # 1231843
Finding of Fact
"the evidence is
at least in
equipoise as to
whether the
Veteran
contracted
hepatitis C
through
receiving air
gun injections
during active
military
service.”
Moreover, “The
finds that the
Mayo Clinic
article, the NIH
report, and VBA
Fast Letter
discussed above
constitute
competent and
probative
evidence that
hepatitis C can
be transmitted
by air gun
injection, even
if there have
been no
documented cases
of such
transmission,
according to the
VBA Fast Letter.
In this regard,
the United
States Court of
Appeals for
Veterans Claims
(Court) has held
that a medical
article or
treatise can
provide
important
support for a
claim if it is
combined with an
opinion of a
medical
professional.
Sacks v. West,
11 Vet. App.
314, 317 (1998).
The Court
further held
that a medical
article or
treatise
evidence,
standing alone,
can provide
support if it
discusses
generic
relationships
with a degree of
certainty such
that, under the
facts of a
specific case,
there is at
least a
plausible
argument for
causality based
upon objective
facts rather
than an
unsubstantiated
lay medical
opinion. Id.”
And, “Here, not
only do the
articles and
reports
submitted by the
Veteran make a
"plausible
argument" for
the transmission
of hepatitis C
through air gun
injections based
on objective
facts, but there
is also both a
VA and a private
medical opinion
of record
specific to the
Veteran's case
which support a
relationship
between the
Veteran's
hepatitis C and
the air gun
injections he
received during
active service.
See id.
Specifically, in
a February 2006
VA examination
report, the
examiner opined
after reviewing
the claims file
and the
pertinent
medical history
that the
Veteran's
hepatitis C with
liver fibrosis
was related to
receiving air
gun injections
during active
service because
he did not have
a history of any
of the risk
factors for
contracting
hepatitis C
other than from
this source. She
noted that a
medical resource
she consulted
stated that
there are other,
rare sources of
percutaneous
transmission of
hepatitis C,
including
through the use
of contaminated
equipment during
the performance
of medical
procedures. The
Board notes in
this regard
that, as
discussed above,
there is
competent
medical and
scientific
evidence that
air gun
injections can
transmit
blood-borne
illnesses, to
include
hepatitis C, as
shown in the
Mayo Clinic
article, NIH
report, and VBA
Fast Letter.”
Case # 1234244
"It is this
examiner's
opinion that the
[V]eteran's
hepatitis C is
at least as
likely as not a
result of the
use of the
automatic
injection
devices used for
immunizations
during military
service. Given
the fact that
hepatitis C
generally takes
20-30 years to
induce liver
cirrhosis, this
fits in with the
time period in
which the [V]eteran
underwent the
jet injector
administration
of immunizations
that were
employed by the
military for
mass
immunization
during his
service time.”
Case # 0841711
VA examiner
opined, "It is
as likely as it
is not likely
that the
patient's
current hepatic
and renal
medical
condition...are
related to his
time in the
service with a
potential
introduction of
hepatitis C from
mass
immunizations
with an air
gun."
Case # 1003545
VA
gastroenterologist
opined “in
relation to the
etiology of the
Veteran's
hepatitis C, the
only positive
event is that
the Veteran was
vaccinated with
the air gun.”
Case # 1325994
”With respect to
other risk
factors, the VHA
specialist
indicated that
VA acknowledged
on its own
website that air
gun use was a
theoretically
possible mode of
transmission for
hepatitis C. He
noted that
without testing
prior to service
as well as after
discharge, there
was not medical
methodology to
dispute the
possibility of
this mode of
transmission. He
further noted
evidence of an
epidemic in
which there was
isolation of air
gun versus
needle injection
use,
demonstrating
clear-cut
transmissibility
of a hepatitis
virus-hepatitis
B in this
particular case
(which was
medically
equivalent in
all aspects of
mode of
transmission
with hepatitis
C)-when
injections were
given via air
gun route. Thus,
the VHA
specialist
concluded that
air gun
transmission,
which
demonstrated a
24 percent
incidence of
hepatitis
transmission,
was a real and
not just
theoretical
possibility.”
Case # 1328188
"Accordingly,
the Board
determined that
another medical
opinion was
necessary and
referred the
case for an
expert opinion
from the VHA in
accordance with
VHA Directive
1602-01. In July
2013, an opinion
was prepared by
a medical doctor
with the
Division of
Infectious
Disease,
Hepatology,
Federal Health
Care Center. The
examiner opined
that it was at
least as likely
as not (50
percent or
higher degree of
probability)
that the
Veteran's
hepatitis C was
related to
service,
specifically his
reported
exposure to
unsterilized air
gun devices used
to administer
vaccinations and
shaving razors
contaminated
with blood from
other service
members.”
Private
Physicians Cited
Case # 1142926
"In a November
2006 statement,
Dr. Torok, an
assistant
professor of
medicine in a
liver transplant
program, noted
that from her
assessment and
her review of
his medical
history, she did
not find any
risk factors
that would have
exposed him to
the hepatitis C
virus with the
exception of the
injections he
received during
basic training
in 1966 from the
use of jet air
guns. That
doctor indicated
that these guns
were used to
immunize mass
numbers of
military
personnel in
succession with
little or no
regard to
sterilization.
That physician
stated that she
suspected that
air-gun
injections were
the manner in
which he
contracted
hepatitis C. Her
basis for her
suspicion was
the fact that
the date of the
Veteran's
transplant, May
10, 2002,
compared to the
date of his
enrollment in
service, June 2,
1966, coincides
with the 30 to
40 years it
takes for
end-stage liver
disease to
develop. Dr.
Torok concluded
by opining that
the appellant
acquired
hepatitis C
during active
service.”
Case # 1103336
"The record
reflects that
Dr. DPJ is a
specialist in
infectious
diseases and one
of the Veteran's
treating
physicians. Dr.
DPJ stated that
it is entirely
possible that
the Veteran
acquired his
hepatitis C
infection
through air gun
inoculations. He
indicated that
his opinion was
based on the
Veteran's
history and the
medical
literature.
Moreover, Dr.
DPJ reported
that he directly
witnessed the
use of air gun
injectors at the
Orlando
Naval Recruit
Command. He
indicated that
hundreds of
recruits would
be processed
each morning and
that bleeding
from the
injectors was
frequent and the
injectors were
only momentarily
swiped with
alcohol between
uses. Dr. DPJ
related that the
sterilization
technique would
not remotely
meet the
sterilization
standards of
today. For these
reasons, he
concluded that
the Veteran's
hepatitis C
infection was
more likely due
to the air gun
inoculations.”
Case # 1028817
“It is entirely
possible that he
contracted the
virus from a
dirty nozzle on
an inoculation
gun. The manner
in which the
inoculations
were given to
multiple
soldiers using
the same gun
obviously
increased the
risk of
transmission
from a number of
infectious
diseases
including
Hepatitis C. At
that time,
little was known
about Hepatitis
(non A, -non B),
as testing was
not available.
Therefore, it is
just as likely
his Hepatitis C
was
contracted by
inoculations as
any other high
risk behavior.”
Case # 1016262
"Dr. A. A. [hepatologist]
noted that the
Veteran went to
boot camp in
1955, at which
time the Veteran
reported
receiving "air
injections"
without the
corpsman
properly
sterilizing the
injection gun
between
patients. Dr. A.
A. added that,
certainly, this
was a very
common way of
contracting
hepatitis C, but
Dr. A. A. found
no etiology. In
summary, Dr. A.
A. stated that
hepatitis C
might have been
contracted
during boot
camp, but that,
obviously, given
the lack of
records, it
would be
impossible to
completely
determine this
for certain.”
Case # 0938394
"Dr. C noted
that the
Veteran's
alleged exposure
to blood
in-service and
jet gun
vaccinations
could have
spread the
hepatitis C
virus.”
Case # 1204519
"In July 2003,
Howard P.
Monsour, Jr.,
M.D. (a
hepatologist and
specialist in
transplant
medicine) stated
that he had seen
the Veteran in
January 2000
when the Veteran
had liver
cirrhosis and
end stage liver
disease from
hepatitis C. He
found that there
were no risk
factors for
liver diseases
other than
multiple
injections that
the Veteran
received in the
military. He
stated that
injectors that
were utilized to
administer
vaccinations
were not
properly
cleansed and
were passed from
one Veteran to
another in line.
It was his
opinion that the
Veteran most
likely
contracted
hepatitis C in
this manner. He
explained that
the usual time
from hepatitis C
contraction and
cirrhosis
coincides with
the time the
Veteran
developed
cirrhotic liver
disease lately
leading to
transplantation.”
Case # 0719864
“The physician
further noted
that the mass
immunizations
also are a
possible source
if there was not
appropriate
attention to
technique and
cleaning the
administration
device of blood
contamination in
between
vaccines.”
Case # 0811510
“In January
2004, Dr. KV
reported to VA
that he had been
treating the
veteran since
August 2001,
shortly after
his initial
diagnosis of
hepatitis C.
Assessment of
the potential
risk factors
revealed the use
of multidose
non-single
person use
injection
devices for
immunizations
while on active
duty as the only
cause of the
veteran's
infection. All
other risk
factors had been
ruled out.”
Case # 0837526
“The physician
stated the
examination of
the techniques
used with the
air gun and the
poor cleansing
of the apparatus
in between
patients made it
probable that
the immunization
gun was the
cause. He opined
that the use of
the air gun
without adequate
cleansing
between patients
was the probable
mode of
transmission in
the veteran's
case and was
more likely then
not the cause of
his Hepatitis
C.”
Case # 0841041
Two VA examiners
and an
Infectious
Disease
Physician all
opined it was
least as likely
as not, or that
it is 50-50
probability that
the airguns were
the etiology of
the veteran’s
HCV.
Case # 1024254
"Dr. B.D. stated
that the Veteran
received
inoculations
injections from
an air gun
during his
military service
and therefore,
it was possible
that he
unknowingly
receive blood
particles
resulting in
hepatitis C. The
physician
essentially
stated that
hepatitis C is
possibly
transmitted by
this mode.”
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