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May 2014 VA Hep C Treatment Guidelines
UPDATE: Feb 26, 2016-
Funding and Prioritization Status Update

UPDATE: March 2016
VA Hep C Treatment Guidelines
VA to treat all vets in system
 

By Judith Graham
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

 
Orange Count Registry
Vietnam vets blame 'jet guns' for their hepatitis C
By Lily Leung Feb. 14, 2016 
 
CBS News Investigates
Congress outraged over hepatitis C treatment VA can't afford
Dr. Raymond Schinazi played a leading role developing a drug that cures hepatitis C while working seven-eighths of his time for the VA
 
ibtimes.com| By amynordrum
 


Hepatitis C drug costing VA, DoD millions
By Patricia Kime, Staff writer
We're looking at a company who is milking a cash cow for everything it's worth," Sanders said. 
 


VA to outsource care for 180,000 vets with hepatitis C
Dennis Wagner, The Arizona Republic 12:27 a.m. EDT June 21, 2015
 


VA to outsource care for 180,000 vets with hepatitis C
, The Republic | azcentral.com 11:51 a.m. MST June 19, 2015
Dr. David Ross, the VA's director public-health pathogens programs, resigned from the working group. "I cannot in good conscience continue to work on a plan for rationing care to veterans," he wrote.
 


VA Region Stops Referring Patients To Outside Hospitals Thanks To Budget Shortfall
Michael Volpe Contributor ...According to a memo — the entire region has been forced to stop all “non-VA care” referrals due to a budget shortfall.
 

DisabledVeterans.org
OIG INVESTIGATES VA CHOICE PROGRAM PROBLEMS
Sen. Mark Kirk admitted the VA Choice Program is a failed joke in a letter to Secretary Bob McDonald despite attempts to fix it.
 

 
Denied Hep C VA dental care?
Please click here

 
Dried Hepatitis C Blood Exposure 11/23/2013 Weeks later inconspicuous blood transmits virus and more likely to cause accidental exposures to Hep C
 

Lack of Standards for
Mass Vaccinations
1970 Jetgun Nursing Instructions
 

2014 AASLD Study Hepatitis C not an STD

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Info: Plan Backfires-
VBA Fast Letter Boost Claims
 
Legal- Fed Regs state:
Judge decision may be relied upon
Cotant v. Principi, 17 Vet.App. 116, 134 (2003),
 
Service Connected Claims
# 1 Conclusion of Law 
# 2 Conclusion of Law 
 
More Claims
Jetgun Decisions
Hep C Decisions

BVA Granted Claims
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Doctors Testimony

VA physicians
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Search Board of Appeals Website
BVA Jetgun Decisions
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Great Advice!  
After the jetgun win
What to do next

 

 

1992-2014 Board of Veterans Appeals Estimate on Jetgun Claims Granted Service Connection

 


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.”