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Top Guns with the Department of Veterans Affairs (VA)
are going on the offensive to prevent veterans from
getting service connected disability for HEPATITIS C
transmitted by airgun shots before, during, and
after the Vietnam War.
Three decades after the
end of the war, hundreds of thousands of brave men and
women who served their country are dying, and the Bush
Administration is fighting their attempts to get
pensions and adequate VA medical treatment. An estimated
95% of all claims are denied, despite reliable
scientific evidence.
In April 2002, a
delegation of members representing the HEPATITIS C
Movement for Awareness (HMA) and HCVets.com, a HEPATITIS
C military claims support organization for families,
went to Washington DC on a mission to educate
representative concerning HEPATITIS C related issues.
The delegation had
appointments with Congressional and Veterans Affairs
representatives. One of these meetings was with Lawrence
Deyton MSPH, MD Chief Consultant, Public Health
Strategic Health Care Group, for the VA.. Members met
specifically with Dr. Deyton to expressed concern
regarding transmission methods for the HEPATITIS C virus
listed by the VA, and the need to reform qualifications
for testing Veterans. Those attending the VA will not
get tested because they did not use drugs or become an
alcoholic, risk factors used to qualify patients for
testing. Members requested Dr. Deyton include reused
needles, vials, syringes and airguns in this
determination to test Veterans.
Dr. Deyton acknowledged
these risks, stating "his hands were tied". He stated,
"Anyone receiving airgun injections, should get tested
for HEPATITIS C." Deyton did not just say "Veterans",
says Ed Wendt, Vietnam era Veteran, transplant survivor
and HMA's Government Relations Director. Quoting
members who attended the meeting, Deyton
implied "everyone" receiving shots administered by the
now defunct style airguns, should be tested.
HMA published Dr. Deyton's quote in
an upcoming newsletter which resulted in a Veteran
service connected for HEPATITIS C at the regional VA
level. The decision was based on that quote, plus other
evidence submitted that demonstrated the products used
to
sanitize & disinfect medical and dental
equipment, did not kill the HEPATITIS C virus.
In order to counteract the decision
and avoid accountability for the 2 plus million service
related infections, the National VA office, in charge of
the regional office that approved the claim, issued a
"Fast Track" letter, a sort of report, to all regional
offices, calling Dr. Deyton's quote, a misquote. But,
Wendt, says, "we
did not misquote Dr. Deyton as the allegations suggest
in the VA Fast letter." "Members were very clear on
what they heard." Further quotes were made by Dr. Deyton
to the Kansas City Star's investigative report Mike
McGraw. Dr. Deyton is quoted as saying,
"it's
possible the devices could transmit HEPATITIS C:
Deyton continues, "I am sure that, with the right degree
of misuse, the devices could become contaminated."
In the
Fast Track letter, Carolyn F. Hunt, Acting Director, for
Compensation and Pension Service states:
"..needles (and
other objects that puncture the skin) are contaminated
with HCV infected blood and are then used by others, HCV
can be transmitted. HCV can potentially be transmitted
with reuse of needles for tattoos, body piercing, and
acupuncture.", ".......infections may have come from
blood-contaminated cuts or wounds, contaminated medical
equipment or
multi-dose vials of medications."
 Vaccinations
were routinely given with
multi-dose vials and reused needles.
Injection give by the airguns included HEPATITIS B
vaccine; responsible for the outbreak of AIDS in New
York City, in which an astounding
64% of the men who got the vaccine developed AIDS
and other blood-borne viruses. Access is not available
for testing stored patients blood samples for HEPATITIS
C infection rate The U.S. Department of Justice is
keeping this information "classified" and "unavailable"
for public research and investigation..
Ms. Hunt also
states, "Blood-contaminated cuts or wounds can spread
HEPATITIS C". This statement speaks volumes,
says Harry Hooks, Vietnam combat Veteran and manager of
HCVets.com. "Airplane and auto mechanics, or others at
risk for cuts, that shared rags to wipe the wound,
could be at risk. HEPATITIS C lives for weeks after the
blood has dried. It can be reconstituted and transmit to
others."
In the letter, Ms. Hunt
continues to say "It is essential that the report upon
which the determination of service connection is made
includes a full discussion of all modes of transmission,
and a rationale as to why the examiner believes the
airgun was the source of the veteran’s HEPATITIS C."
But Hooks says,
"Veteran's submitted convincing scientific studies,
military reports and physicians letters in support with
their claims, showing the only risk for their HEPATITIS
C infection was the service." Evidence submitted, such
as the "Vaccines in the Military:" A Department of
Defense-Wide Review of Vaccine Policy and practice; an
Infectious Diseases Control Subcommittee of the Armed
forces Epidemiological Board review presented in August
1999. Page 61 discusses the
Paris Island Air Force inspection in which inspectors
indirectly observing high volume recruit immunization
using jet injectors. It was noted 1997 DoD Jetgun
Report "jet
injector nozzles were frequently contaminated with
blood, yet, sterilization practices were frequently inadequate
or not followed." The complete report can be
viewed here
http://www.ha.osd.mil/afeb/reports/vaccines.pdf if
the link is still available.
Military Veterans also submitted
government testimony in support of their claims. Such as
the statement
by Robert Harrington, owner of the company PED-O-JET,
maker of the military airguns used on the troops. During
a meeting with the FDA, VA and others, he states
"if the gun was not wiped off, it
could contaminated
31 out
of 100 patients." Despite their efforts, the claims are
still denied.
"All people that served in the
military know the airguns were not wiped off for
military application", says Hooks.
"The
VA would prefer if veterans evidence was not included",
Hooks continues, "according to correspondence with a
Pittsburgh VA, the VA has a staff of medical personnel
to review information and provide judgment based on
their training and research. The problem is, say's
Hooks, "to the best of my knowledge, no one's training
these adjustors about HEPATITIS C transmission. I think
the denial rate for VA claims proves that."
"One thing is very
clear", says Tricia Lupole, National Director for HMA,
"the VA lacks rationale. The VA denied service
connection to one Veteran shot in the chest in Vietnam
in 1968 and was transfused. He died from HCV liver cancer in
2003. Another patient was hospitalized with HEPATITIS
during military service and the VA claims his HEPATITIS
C is not service connected. Yet another, denied because
he fell within the group that, according to the VA, has
"no clue" how the virus was transmitted; virtually
ignoring every statement Ms. Hunt made.
A claim recently
denied, would not acknowledge the fact the Veteran found
a buddy stationed with him during most of his service.
The buddy also has the same strain of HEPATITIS C. The
virus has many different types of strains, called
genotypes. There are 6 different genotypes and over 50
subtypes within those strains. The state and federal
court system use a test to determine "same source"
infection when exposure to the virus occurs though
hospital neglect, meaning that science can tell if
people were infected by the same source. But, the VA
will not run this test or accept any evidence to support
it. We're not going to let the VA get away with this."
Lupole says, "Despite the attempts to
portray HCVets.com an unreliable source, the letter
works to the Veterans advantage because it acknowledges
possible ways for transmitting the virus previously
denied by the VA claims adjusters.
Claims that are pending or previously denied, should
consider this as critical evidence to include.
More information on service
related transmission methods for the HEPATITIS C virus
can be found at
http://hcvets.com
DEPARTMENT OF VETERANS AFFAIRS
Veterans Benefits Administration
Washington, D.C. 20420
June
29, 2004
Director
(00/21)
In Reply Refer To: 211
All VA
Regional Offices
Fast
Letter 04-13
SUBJ:
Relationship Between Immunization with Jet Injectors and
HEPATITIS C
Infection as it Relates to Service Connection
BACKGROUND: In August 2003, one regional office issued
a rating decision granting service connection for
HEPATITIS C virus (HCV)
infection as the result of immunization with a
“jet air gun.” A misleading statement, incorrectly
ascribed to Lawrence Deyton MSPH, MD Chief Consultant,
Public Health Strategic Health Care Group, US Department
of Veterans Affairs, Washington,†DC is posted on the
Internet (http://www.hcvets.com/).
On this site, the following is incorrectly
ascribed to Dr. Deyton: "Anyone who had inoculations
with the jet injector were [sic] at risk of having
HEPATITIS C and should be tested."
KEY
POINTS:
• HCV
is spread primarily by contact with blood and blood
products. The highest prevalence of HCV infection is
among those with repeated, direct percutaneous (through
the skin) exposures to blood (e.g., injection drug
users, recipients of blood transfusions before screening
of the blood supply began in 1992, and people with
hemophilia who were treated with clotting factor
concentrates before 1987).
•
Since the 1990’s, injection drug use has been the
principal mode of transmission of HCV. Because of
screening procedures, HCV is now only rarely transmitted
by blood product transfusion or organ transplant.
Clotting factor concentrates are processed in such a way
that the virus is inactivated; these viral inactivation
procedures have virtually eliminated clotting factor
concentrates as a source for HCV.
•
Population studies suggest HCV can be sexually
transmitted. However, the chance for sexual
transmission of HEPATITIS C is well below comparable
rates for HIV/AIDS or HEPATITIS B infection.
Researchers studied five groups of
Page 2
Director (00/21)
All VA
Regional Offices
monogamous couples, in which only one was infected with
HCV. Less than five percent of the uninfected partners
became infected with HCV during the time periods
studied.
•
Occupational exposure to HCV may occur in the health
care setting through accidental needle sticks. A
veteran may have been exposed to HCV during the course
of his or her duties as a military corpsman, a medical
worker, or as a consequence of being a combat veteran.
•
When needles (and other objects that puncture the
skin) are contaminated with HCV infected blood and are
then used by others, HCV can be transmitted. HCV can
potentially be transmitted with reuse of needles for
tattoos, body piercing, and acupuncture.
• The
HEPATITIS B virus is heartier and more readily
transmitted than HEPATITIS C. While there is at least
one case report of HEPATITIS B being transmitted by an
airgun injection, thus far, there have been no case
reports of HCV being transmitted by an airgun
transmission.
• The
source of infection is unknown in about 10 percent of
acute HCV cases and in 30 percent of chronic HCV cases.
These infections may have come from
blood-contaminated cuts or wounds, contaminated medical
equipment or multi-dose vials of medications.
CONCLUSION:
The large majority of HCV infections can be accounted
for by known modes of transmission, primarily
transfusion of blood products before 1992, and injection
drug use. Despite the lack of any scientific evidence
to document transmission of HCV with airgun injectors,
it is biologically plausible. It is essential that
the report upon which the determination of service
connection is made includes a full discussion of all
modes of transmission, and a rationale as to why the
examiner believes the airgun was the source of the
veteran’s HEPATITIS C.
/s/
Carolyn F. Hunt
Acting Director
Compensation and Pension Service
VA claim approved for service connected for HEPATITIS C
based solely on the airguns.
DEPARTMENT OF
VETERANS AFFAIRS CLEVELAND REGIONAL OFFICE
Tiger Team Remand Unit P.O. Box 998020 Cleveland, Ohio
44199-8020
Rating Decision August 5, 2003
INTRODUCTION
The records reflect that the
veteran served during the Vietnam Era in the Army from
August 25, 1967 to April 17, 1971. The Board of Veterans
Appeals remanded the case on December 27,2001; and based
upon a review of the evidence listed below, the
following decision(s) were made in the claim. .
DECISION
Service-connection for HEPATITIS C is granted with an
evaluation of 10 percent effective April 17,2000. .
EVIDENCE
. VA Fonn 21-526, Application for Compensation and/or
Pension received April 12, 2OO2'
Page2
- Service Medical Records from
the National Personnel Records Center
- Outpatient treatment reports
from the VA Medical Center, Buffalo for the period
of August 1999 through October 2000
- Medical Records from 1996
through 1999 DD Form 214 ,
- Article submitted entitled
"Risk Factors for HEPATITIS C Virus Infection in
United States Blood Donors",
- Statement received from the
Veteran on January 29,2001 Board of Veterans
Appeals' Order dated December 27,2001
- VA Form 4138, Statement in
Support of a Claim received January 8, 2002 with
attachment .
Medical Records .from for' the period of May 30,
1995 through March 22, 2000
- Response from the National
Personnel Records Center (NPRC) dated August 2, 2002
.
- VA Examination dated June 5,
2003 and Hospital for the period of '
..........REASONS FOR DECISION
Service-connection for HEPATITIS
C.
Service-connection for HEPATITIS C
has been established as directly related to military
service. -This decision is based upon the VA examiner's
opinion dated June 5,2003
coupled with the supporting evidence of articles
relative to jet inoculations submitted by', the veteran.
,Specifically, the V A examiner provided a causal
relationship finding that the veteran's HEPATITIS C
currently diagnosed was incurred in service as a result
of the jet inoculations given therein. Moreover, the
examiner relied upon these articles which note that due
to cross-contamination, anyone who had inoculations with
Jet injectors were at risk for having HEPATITIS C and
should be tested.'" Further, the veteran denied having
incurred any of the known risk factors subsequent to
service, such as N drug use; blood transfusions;
tattoos; surgeries, or needle sticks. Accordingly,
service-connection is granted as a result of the
evidence of record. 'An evaluation of 10 percent is
assigned from April 17, 2000. This date is being used,
because it is the date of the veteran's original claim
for service-connection that was subsequently denied, and
timely appealed to the Board of Veterans' Appeals. .
An evaluation of 10 percent is
assigned for chronic liver disease without cirrhosis;
but with intermittent fatigue, malaise, and anorexia,
or; incapacitating episodes (with . symptoms such as
fatigue, malaise, nausea, vomi1ing, anorexia,
arthralgia, and right upper quadrant pain) having a
total duration of at least one week, but less than two
weeks, during the past 12-monthperiod.
Page 3
In this case, the most recent VA
opinion of June 2003 was merely a review of records
contained in the claims file, and thus, no objective or
subjective evidence was obtained that could be used for
evaluation purposes. However, the medical records o
coupled with the outpatient treatment records from the V
A Medical Center, Buffalo do provide such evidence.
Specifically, these records demonstrate that prior to
inception of the claim, the veteran was placed on
Interferon, but due to complications of the medication,
it was .ceased. . Subsequently, between 1998 and 1999,
he remained asymptomatic for the disease. However, right
around inception of this claim in 2000; the. notes
indicate that the veteran's viral load started to rise.
Subsequently, he was placed on Infergen, 15 mg three
times per week. A note of September 2000, indicates
that, at that time, the veteran complained of incurring
flu-like symptoms for a day after the shot is given.
Also, between March 2000 and September 2000, he had lost
20 pounds of weight due to these problems. Accordingly,
based upon these complaints, an evaluation of 10 percent
is assigned. .
A higher evaluation of 20 percent
is not warranted at this time, because there has been no
evidence submitted demonstrating that the veteran
suffers from chronic liver disease without cirrhosis,
but with daily fatigue malaise and anorexia (without
weight loss C?r . hepatomegaly), requiring dietary
restriction or continuous medication, or; incapacitating
episodes (with symptoms such as fatigue; malaise,
nausea, vomiting, anorexia, art a1gia, and right upper
quadrant pain) having a total duration of at least two
weeks, but less than four weeks, during the past
12-month period.
REFERENCES: .
Title 38 of the Code of Federal
Regulations, Pensions, Bonuses and Veterans' Relief
contains the regulations of the Department of Veterans
Affairs which govern entitlement to all veteran
benefits. For additional information regarding
applicable laws and . regulations, please consult your
local library, or visit us at our web site,
www.va.gov.
Non-Drug Related Transmission of
HEPATITIS C Virus 2003-2005
Click Here
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Jet injector nozzles were frequently
contaminated with blood
click here
Vaccines in the Military
Department
of Defense-
Wide review of Vaccine Policies
and Procedures
Read excerpt- Page 61 in particular says,
"Of note is that the AFEB made a site
visit to the MTF at Parris Island and
directly observed high volume recruit
immunization using jet injectors. It was
noted that jet injector nozzles were
frequently contaminated with blood, yet
sterilization practices were frequently
inadequate or not followed." View complete
report at
http://www.ha.osd.mil/afeb/reports/vaccines.pdf
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