No hygiene for the recruit masses

Silvia’s jetgun photos, quotes from HCVets Tricia Lupole and in an excellent article by Paul Harashim,  Jet guns should be a recognized risk factor for hepatitis C, (Las Vegas  Review Journal, 2/25/17) will be appreciated by NOD readers (Link).  He writes from personal experience:

When I watch the federal government’s current public service messages on TV urging baby boomers to get tested for hepatitis C, I can’t stop thinking about how my arm, and those of many men next to me, bled as we received jet gun vaccinations during our earliest days in the military.

Powerful air pressure from the jet gun forced a tiny stream of medication through our skin without a needle. Because the shot hurt, many of us flinched. Our skin broke, and as we started bleeding, the blood blew back on the jet gun.

The medic injected the next man without cleaning the gun. So it went when I was at Fort Leonard Wood, Missouri.

Hundreds of arms, a few bloody devices.  Day after day, year after: Arm-to-arm-to-arm–Lax hygiene? Nope, no hygiene. Blood borne pathogens like HCV, had found a new transmission vehicle to spread into new human hosts exponentially. 

Posted in General Messages, Guest authors, HCV Epidemiology, HCV Risks (documented), hepatitis, Jetgun Claims evidence, Vietnam Disease Issues | 4 Comments

CAVC– WELCH V. SHULKIN–PISSING OFF THE POPE

Most Veterans don’t understand how this VA poker game works. I know it took me around the block three times with Veterans Services Organizations running interference for VA against me. Every once and a while I like to look back on VA law as it appeared at the dawn of my last and latest effort to climb the hill. Go back to 2008 and the glorious days of Gordon Erspamer cutting new swaths of law. His work, along with that of the Robert Chisholms, Virginia Girard-Bradys and Ken Carpenters of the industry, have begun to make a resounding dent in VA jurisprudence. With the 25th anniversary (of sorts) of NOVA in a Baltimore, MD. hotel room in 1992, we’ve come a long waaaaaaaay, baby.

And now for this one. It’s a reversal so you know it’s going to have an interesting backstory. That it isn’t authored by Greenberg  immediately piqued my interest.

 Rest in Peace, Gordon. We got them to go electronic. Now, if we could just enforce that with more emphasis and power to punish mis/malfeasance at the agency level.  Perhaps we should demand more continuing legal education for older Veterans Law Judges to keep them abreast of precedence. Who knows what the recipe is? A senility test?

Whatever we choose, we have to dispense with petty jurisdictional disputes. Witness a Board member of the BVA feeling the CAVC and Federal Circuit are too lenient and constantly disrupting settled precedent prejudicial to, and to the detriment of, good order and established law. It’s kind of like a guy who rents in a trailer park offering sage advice to millionaire homeowners with a straight face. He’s not even in the same league.

Welch BVA decision

From long-time staff attorney, acting Veterans Law Judge and lastly, a vested VLJ, Thomas H. O’Shay has this to say about his cohorts above- appointed by none other than the President of our United States…

In this case, the most recent final denial, prior to the January 2003 rating decision which arose out of the March 20, 2001 claim on which this appeal is based, was a February 1994 rating decision, which denied service connection for paranoid schizophrenia. The Veteran did not file a notice of disagreement for that decision,

and none of the increasingly myriad of ways the Court has diminished the concept of finality apply in this case;

therefore, the decision became final.

Shocked. I am shocked. And you can just imagine the look on Chief Judge Davis’ face when he got the brief on this. He probably got the vapors and Greg Block had to hang it on Judge Hagel lickety spit. Sort of like the Pontius Pilot ceremonial washing of the hands. We can’t have the Chief Judge involved with this! Judge Hagel pretty much took the same mighty dim view of Tombo McShay thinking COVA judges were pretty sketchy and got their JDs at the University of Mexico. His muted rejoinder below is a

Judge BOG Hagel (boots on ground)

reminder that civilized legal behaviour depends on verbal constraint and brevity. One’s views about how his decision will be be received if appealed to a higher tribunal should never enter the analysis of a decision. If a Judge, CAVC or Federal Circuit, is overly confident in his memorandum decision, and discretion is absolute, then the potential for a miscarriage of justice is magnified one hundredfold. Trying to view a Veterans Law Judge at the Administrative level of an Agency as a “judge” ignores the cannons of law enshrined in 38 USC- not to mention redefining and inflating a legal term. VLJs are finders of Fact. They are the “one review on appeal” deadman switch designed to right a wrong. The Federal level is strictly the arbiter of case or controversy without the distraction of being a factfinder or court of equity.

 Here’s Judge Hagel’s not so subtle rejoinder. Brevity is a keen sword wielded correctly. At ten pages, you’ll find most of it is laying the engine out on the floor and performing a piece-by-piece analysis of the parts- something the tribunal below neglected to do. Haste makes waste, or in this case, myriads of ways to do same.

The Secretary encourages the Court to vacate the Board decision because the Board inadequately explained its determination that the February 1994 rating decision considered and denied a request to reopen a previously denied claim for benefits for paranoid schizophrenia and that Mr. Welch did not appeal that decision, rendering it final. The Secretary reasons that nowhere in the February 1994 rating decision did the regional office specifically state that it was considering a request to reopen a previously denied claim for any psychiatric disorder. Further, the Secretary concedes, to the extent that the regional office indicated that its jurisdiction was premised on a reopened claim, nowhere in its decision did it indicate which claim, of the three it addressed, was subject to reopening, nor does the decision contain any discussion or evaluation of whether new and material evidence was received that would lead to a conclusion that the regional office was addressing Mr. Welch’s September 1992 request to reopen a “service-connected disability.” The Court agrees that the Board did not adequately explain its finding that the February 1994 rating decision reopened and denied a previously denied claim for benefits for schizophrenia, but the Court also believes that another, more definite error is apparent.

 What I’m reading is the OGC is shitting bricks and trying to get this back to Tombo to fix it before it goes to the bitchslap stage. Too late. Here it comes. Wait for it…

The Court has made it clear that the identification of a particular diagnosis by the veteran in his or her application for benefits does not limit the scope of the claim to that particular condition. Clemons v. Shinseki, 23 Vet.App. 1, 5 (2009). Instead, VA must consider the general nature of the claim and, by assisting the veteran in gathering evidence, including providing a medical examination, VA narrows the claim’s scope. Id. As the focus of the claim is narrowed, the scope and type of evidence needed to prove the claim are likewise narrowed and made more clear for the benefit of the veteran. The evidence necessary to establish entitlement to benefits for paranoid schizophrenia varies greatly from that necessary to establish entitlement to benefits for posttraumatic stress disorder. Thus, the Court must look to exactly what was adjudicated and at the procedural posture of Mr. Welch’s claim at the time the adjudications took place.

You just know old Hagel and his staff disassembled this thing and laid it out on the garage floor looking for those myriad ways. Finally someone said hey- it was a schizobrain claim in 86. Now it’s a nervous condition in 88 -but hey, it’s a PTSD thing in 94. So if they granted SC for schizo in 2010, then they’re ignoring Clemons and about a ton of other precedence. Plus, they finally granted what he was asking for in 86.

Judge Hagel didn’t set this aside and remand it. He didn’t vacate it and send it back for development. Shoot no. He flat ass reversed it and told Tombo to read ’em and weep as to the myriad ways you can screw up a simple BVA decision by mischaracterizing what the hell was claimed versus what was granted.

cavc welch

Meanwhile, back at the ranch…

In the decision on appeal, the Board repeated this inaccurate statement of the history of Mr. Welch’s claim for benefits for a psychiatric disorder: “In a February 1994 rating decision, the [regional office] denied [Mr. Welch’s] petition to reopen a previously denied claim for service connection for paranoid schizophrenia.” This conclusion is clearly erroneous for three reasons.

First, the cover letter that accompanied that decision merely stated: “We regret we cannot allow your claim for service-connected disability compensation

Second, the substance of the February 1994 decision itself does not contain any discussion of the evidence necessary to reopen a previously denied claim

Third, although the regional office in February 1994 stated on the final page of the rating decision that its jurisdiction was based on a “[r]eopened claim” and indicated that “[s]chizophrenic reaction (previously disallowed)” was among Mr. Welch’s non-service-connected conditions, the face of the rating decision stated that the regional office was considering “[s]ervice connection for post-traumatic stress disorder,” and the substance of the regional office’s decision, quoted in full above, addressed only post-traumatic stress disorder.

The actual coup de gras is delicious…

Despite the acting Board member’s frustration regarding the “increasingly myriad [] ways the Court has diminished the concept of finality,” the Court’s decision in this case rests on one of the earliest: A claim remains pending until there is either a recognition of the substance of the claim in a regional office decision from which a claimant could deduce that the claim was adjudicated or an explicit adjudication of a subsequent claim for the same disability. Ingram v. 4 Nicholson, 21 Vet.App. 232, 243 (2007); see also Hanson v. Brown, 9 Vet.App. 29, 31 (1996) (holding that a claim remains pending until final action is taken or the claim is withdrawn). The regional office’s failure in February 1994 to address Mr. Welch’s September 1992 request to reopen a previously denied claim for benefits for a psychiatric disability [schizobrain] rendered that request pending and unadjudicated until March 2011 when the Board granted his reopened claim.

Judge Hagel could have been spiteful. Rather, he allowed decorum to reign and reined in his tongue-no small feat for a Hoosier- unless, of course, you are a Patrician or had a gentle upbringing. Don’t mistake Judge Lawrence Hagel for a softy, either. He was an Marine Infantry Officer and did an extended tour in country way down yonder in Viet-Nam. I respect anyone wearing a CAR or a CIB from that era. They weren’t handing them out like Mardi Gras beads back then.

The best part of this that our Vet Christopher NMI Welch did it pro se without a law dog. I expect he’s a bit like me. After about thirty years of letting the VSO Pros do it, he finally figured out the poker game was rigged and started gambling at the table with no marked cards. You always win there-eventually.

Congratulations, Mr. Welch. You kicked ass and took names. Thirty one years it took, yesssssssssssssssss. Here’s a panacea for the “Judge”. 

 

 

 

 

 

Posted in All about Veterans, CAVC ruling, Earlier Effective dates, Equitable tolling, KP Veterans, PTSD | Tagged , , , , , , , , , , , , , | 1 Comment

NAVAL INTELLIGENCE

Received from the Oorah contingent (who else?) this morning is an interesting commentary on the relative intelligence of Officers versus Non-Commissioned Officers. Far too often, the commands come down from above in “Make it so, Numbah One!” format. This has to be translated into a comprehensive order that can be implemented intelligently and competently such that the desired outcome actually transpires. This is where the genius if the NCO enters. 

Likewise, when tasked with getting the most bang for the buck, an NCO has to make do with far less than the tools given him or her. Ingenuity abounds in this sector if the NCO has an innovative persona as we see here.

Retirement Bonus
 

   The Navy found they had too many officers and decided to offer an early
Retirement bonus. They promised any officer who volunteered for
Retirement a bonus of $1,000 for every inch measured in a straight line
Between any two points in his body.. The officer got to choose what
those two points would be.
 
   The first officer who accepted asked that he be measured from the top of
his head to the tip of his toes. He was measured at six feet and walked
out with a bonus of $72,000.
 
   The second officer who accepted was a little smarter and asked to be
measured from the tip of his outstretched hands to his toes. He walked
Out with $96,000.
   The third one was a non-commissioned officer, a grizzly old Chief who,
when asked where he would like to be measured replied,
‘From the tip of my weenie to my testicles.’
   It was suggested by the pension man that he might want to reconsider,
explaining about the nice big checks the previous two Officers had
received.

   But the old Chief insisted and they decided to go along with him
providing the measurement was taken by a Medical Officer.
   The Medical Officer arrived and instructed the Chief to ‘drop ’em,’
which he did. The medical officer placed the tape measure on the tip of
the Chief’s weenie and began to work back. “Dear Lord!”, he suddenly
exclaimed,

”Where are your testicles?”

The old Chief calmly replied, ” Vietnam ”.

The inevitable joke always pops up several minutes later. Seems the Army folks always have to contribute their views on the subject of the Navy. Which brings to mind what I encountered when I went to sign up. The recruiter looked me in the eye and said ” Son, you seem to be reasonably intelligent. Why would you want to join the Navy? You’re stuck on a ship with no women (in 1970) and everyone has BO. In the Army, you have to march from here to eternity with a heavy load. The Marines aren’t much better and have lousy food. The best one is the Air Force. You don’t have to sail, march or hike there. They have good food and they fly you to your destination in a real airplane-not one of those shaky rotary wing affairs called a chopper. So, what will it be?

 Womens’ Quarters aboard ships- 2017

Department of the Navy is now assigning females to quarters in a separate private “OFF LIMITS” area on all aircraft carriers. Addressing all boat personnel at Pearl, CINCPAC advised, “female sleeping quarters will be “out-of-bounds” for all males. Anyone caught breaking this rule will be fined $50 the first time.” He continued, “Anyone caught breaking this rule the second time will be fined $150. Being caught a third time will cost you a fine of $500. Are there any questions?”

At this point, a Marine Gunnery Sergeant from the security detail assigned to the ship stood up in the crowd and inquired…

“How much for a season pass?”

 

Posted in Humor, Vietnam Disease Issues, Vietnam War history | Tagged , , , , , , , , | Leave a comment

Parkinson’s disease and HCV research

 We know that HCV and Parkinson’s Diseases are epidemics in the veteran community.  There is some new research that readers might want to know about.  I’m copying the text of a response to a large study with citations to three other studies.  If you are working on this issue, your librarian should be able to track them down.

Alex has posted about AO, Parkinsons, and Lewy bodies: (Link) which underscores the need to try to keep toxins out of brains and not to let the VA deny their effects.

Hepatitis C virus infection and Parkinson disease: Possible role for interferon

Tsai et al. reported an association between hepatitis C virus (HCV) infection and Parkinson disease (PD) in their study of nearly 50,000 patients with HCV, hepatitis B virus (HBV), or HCV/HBV co-infection from the Taiwan National Health Insurance Research Database (2000-2010). [1] Another recent and comparably large study found a similar association between PD with HCV infection. [2] These studies lacked an analysis of the association between treatment of HCV and development of PD.

We recently published a case report/literature review of 12 patients who developed parkinsonism in the context of interferon therapy, with reversible and progressive cases. [3] Importantly, our review included cases with and without HCV, and suggested the potential for an association between exposure to interferons and development of PD.

The same Taiwanese database has been used to identify 8,747 patients with HCV from 2004 to 2007, of which 919 (10.5%) were treated with interferons for 3 months or more. [4] Tsai et al. potentially have data to perform a much needed analysis of the association between HCV treatment (specifically interferon) and development of PD to clarify whether there is any additive or confounding effect of interferon exposure on the risk for PD.

1. Tsai HH, Liou HH, Muo CH, et al. Hepatitis C virus infection as a risk factor for Parkinson disease. Neurology Epub 2015 Dec 23.

2. Wu WY, Kang KH, Chen SL, et al. Hepatitis C virus infection: a risk factor for Parkinson’s disease. J Viral Hepat 2015;22:784-791.

3. Wangensteen KJ, Krawitt EL, Hamill RW, Boyd JT. Parkinsonism in patients with chronic hepatitis C treated with interferons: Case reports and review of the literature. Clin Neuropharmacol 2016;39:1-5.

4. Chen YC, Hwang SJ, Li CY, Wu CP, Lin LC. A Taiwanese Nationwide Cohort Study Shows Interferon-Based Therapy for Chronic Hepatitis C Reduces the Risk of Chronic Kidney Disease. Medicine (Baltimore) 2015;94:e1334.

Posted in Food for thought, Guest authors, HCV Health, hepatitis, Medical News, Uncategorized | Tagged , | Leave a comment

Can VA chaplains help fill the gap of too few mental health workers?

Most, or perhaps all VA hospitals, employ VA chaplains and have a chapel. This one at the Baltimore VA is an uplifting space.  Chaplains are trained to work with all faiths in addition to their connection to their home denomination laypeople.  A long list of chaplains by state is here (Link);  they are either part-time, full-time, intermittent or fee-based providers.  

One can easily see that most veterans are under-served by VA chaplains but VA is starting to address this (link) with free training for volunteer clergy.  If you have time to read about this, this is a good page to start (link). Webinars are here: (link).

Many chaplains have advanced training in mental health fields and this seems like a whole untapped group of caring people that could help support those thinking about suicide, divorce, addiction or  so many other sad thoughts and problems.   

New spiritual guidelines are needed according to a 2016 OIG report (link).  It deals with these issues:

  • Ensuring every patient’s constitutional right to free exercise of religion
  •  Protecting veterans from the imposition of religious beliefs or activities
  • Allowing holiday displays to be placed in public areas at VHA facilities

This is very important but I do think VA chaplains could do a lot of extra good tasks–now.  Any experiences with VA chaplains to share?

Posted in All about Veterans, Food for the soul, Food for thought, Future Veterans, General Messages, Guest authors, Uncategorized, VA Health Care | 3 Comments

BVA–ANOTHER “CLEAN” JETGUN APPEAL

One thing that will never happen is that a Regional Office will grant a jetgun-based appeal for Hepatitis C (HCV). VA is batting .1000 on that metric. However, in regards to appeals at the BVA, a new breed of Veterans Law Judges (VLJs), such as VLJ David L. Wight here, are becoming increasingly frequent. Not frequent enough by my standards of jurisprudence, but the old 2004 FAST letter is now being read in context and buttressed by the findings of the CDC and other august bodies of medical research. 

Sadly, the reason we have no evidence of cross-contamination via jetgun is that by the time they figured out sanitary protocols and protected the blood supply in 1992, it became increasingly obvious sharing a syringe to do drugs was just as risky as “sharing” a jetgun with about 600 other recruits in a day. Simply put, jetguns were withdrawn from use because the evidence of potential cross-contamination was so compelling that it wasn’t necessary to confirm it by testing to determine the potential. What could possibly be gained in 1993 by purposefully contaminating a jetgun with the HCV virus, or any virus for that matter,  to then gauge the potential for cross-transmission? It was fairly obvious and well-documented by then that Hepatitis B (HBV), a similar DNA-based virus, was only transmitted by blood-to-blood contact. HCV, albeit an RNA-based virus, was still transmitted in like manner-via blood. With that knowledge, it was apparent that the military was going to have to bite the bullet and begin buying disposable syringes and lancets and adopt a one-use policy. That the jetguns remained in use for another six years after insurmountable evidence accrued arguing for withdrawal,  oddly mimics VA’s refusal to begin using an electronic form of record keeping for compensation until they became the last Federal agency in denial on the subject. Do you see a pattern emerging here?

At any rate, here’s a lovely decision that grants HCV due solely to jetguns. We can only hope this vein of thinking becomes mainstream and the accepted premise for viral contraction in the absence of other risks. While I severely doubt it will ever become presumptive, it is heartening to see some realization of the premise beginning to evolve at the BVA. Neanderthal thinking in a judicial setting is counterproductive and openly adversarial to the Veteran.

Bon chance. https://www.va.gov/vetapp16/files6/1648273.txt

It is interesting to note how they (VA doctors) frequently attempt to insert self-reported drug usage manufactured out of whole cloth. Poor Vets spend years trying to erase this kind of fleeting derogatory evidence which besmirches their otherwise honorable service. If it were not unique to VA jurisprudence, it would appear innocent on its face. Nevertheless, when every other appeal regurgitates the same story line of a Vet sporting a two-car garage in his nose housing the financial equivalent of several Maseratis, you begin to suspect there may be a VA doctor or two (or three) with their pants on fire.

Which brings to mind an interesting legal theory. If a Vet testifies that he was in Vietnam but he has no medical and/or service records to substantiate his presence there, his testimony is deemed “incredible” and his credibility is demolished. On the other hand, if a doctor or nurse states (hearsay, mind you) that the Vet tacitly admitted to a predilection for the White Lady, it is incontrovertible evidence that he is/was a raging drug addict and thus the willful misconduct regulation (38 CFR §3.301) is trotted out to deny him. Absent any evidence in the c-file of drug misfeasance in service (other than hearsay), it would seem there is a dichotomy in how VA evidence is evaluated. Shocked. I am shocked that this might enter in to a decision-and at the VA, of all places. That pretty much sums up how our own Agency views us and our service to America-as Walmarket™-shopping trailer trash seeking VA welfare.

P.S. I guess I don’t have to point out the obvious but Vets will note this is the product of using a real VA attorney (Mike Viterna) instead of a VSO.

Posted in BvA HCV decisions, Jetgun BvA Decisions, Jetgun Claims evidence, KP Veterans, Nexus Information, VA Medical Mysteries Explained | Tagged , , , , , , , , , , , , , , | 1 Comment

VA-issued sharps disposal container

Update:  On 11/3/16 (Link) I wrote

A few weeks ago I pricked my finger on my old Marine’s used blood glucose lancet tip.  It hurt. My careless error because I didn’t buy a sharps bin when he recently started testing.

He’s been SVR since late 2004.  By American Red Cross rules, I have been exposed (blood-to-blood) to HCV in the same way an accidental needle stick in a health care setting can occur even though a lot of  “time has gone by.”

Should I get re-tested for HCV again post-stick? I was tested in 2004 and again in 2015, when Medicare made the screening free for all boomers. Again, I was safe.  Will my doctor recommend another test due to this incident when I see her next?

My PCP did test me for HCV again because even though my husband is SVR, the accidental prick is considered an exposure.  Medicare should cover the cost.  Result: no exploitive HCV.

We told my husband’s VA PCP about the incident and asked if he could be issued a sharps container.  Below is a photo of the one they sent us.  The VA should issue these automatically with certain treatments/tests but it’s good to know that they are available at no cost if you ask and have a need.  This size can be purchased for under $10.00 but the VA will ship the refills which is helpful.

Posted in DM II, Food for thought, General Messages, Guest authors, HCV Health, Uncategorized, VA Health Care | 1 Comment