New and need help please

HepMe
Registered: 12/01/10
Posts: 7

	12/01/10	#1

Hello fellow Vets.Army Vet here, dates of active service June95 thru Oct97 then in ARNG thru 2003. Already 20% rated DAV for disabilities unrelated to Hepatitis. Recently (like two weeks ago) diagnosed during a routine physical as being Hep C positive. Stunned to say the least! All I know right now is that I have 1a type and my viral load is 3,400,000. Still in shock, not sure about a lot of things. Because I lack most if not all of the serious risk factors for Hep C, my first thought was that this could be service connected. Like many Vets, I had the air jet gun injections done to me, also I had two operations done while on active duty, one of which was done overseas. Also had much dental work performed, some of it overseas. In addition, I was stationed for a full year in Egypt (1996) and it’s my understanding Egypt has the greatest percentage of Hepatitis infection in the world. Worked closely with many local civilians, and it was local civilians who prepared all of my food while stationed there.On the other side of this coin, I recently (within the past two years) had two tattoos done (my only two tats ever) but both were done in what I would describe as clean, licensed, experienced tattoo parlors. I have never done injection drugs, never had a blood transfusion (I don’t think) and never done any of the other activities commonly associated with Hep C. In fact, I made a decision to quit drinking alcohol two years ago, and never looked back. Clearly this was one of the best decisions I ever made in my life. In the past two years I have made a bunch of of other really healthy choices too like improving my diet and getting back in shape, I could almost pass a PT today if I had too, always struggled a bit with the push-ups, still do. Anyway, I spoke with a DAV Officer yesterday and officially declared my intention to make a claim for service connected Hep C, as well as a review for increase in my two other VA rated disabilities. My date of claim then in Nov 30, 2010. I have two appointments to see doctors coming up as soon as I could get them. Later this month I see a GI doctor, and in January I see a Hepatitis specialist at Tufts. I have done a lot of reading and I’m scared and nervous and clueless really. No idea what to expect, if it’s worth it, or if I’m doing it right. I need as much guidance and assistance as I can get. If this is service connected, all I expect from the VA is to take responsibility and rate me accordingly, if it’s not service connected, I would withdraw the claim myself and apologize for wasting anybody’s time. At this point I just don’t have enough real information to determine if I really believe it is connected. Presently I just think it’s possible, if not more than likely. Makes me wonder then, did I file the claim too soon before finding out more from the doctors? Please help me. HepMe

NOD

Manager
Registered: 11/22/08
Posts: 652

12/01/10

Dear Sir,

On the far left margin, under the subtitle of “Print VA Forms” is a category with “VA Risk Form”. You will eventually be filling this out in the event you file(which you apparently have already). I strongly suggest you acquaint yourself with it immediately and go over each and each risk factor. Consider them individually and take your time. Leave it for a day and come back and think about it again. You may or may not jog your memory, but you will have given the brain box time to digest the different risks and whether any apply to you. We commiserate with you on your new, unwanted disease as that is what we all have in common here. Forget the stigma and opprobrium that some would attach to this. Your biggest risk factor, as near as any of us can tell, is that you were in the military. Proceeding from there, you can get into subsets of risk such as service in Egypt.

First off, your HCV is a blood born, single stranded RNA virus, not the double stranded DNA type encountered in HAV and HBV. While the B variant is most commonly transmitted via the blood/mucus path, it is extremely rare to unheard of to be transmitted via the oral/fecal route. That would eliminate your theory of tainted food in Egypt. Analyzing the genotype is another clue. 1A, while not exclusive to the U.S., nevertheless is the predominant type found here. Egypt has a much higher incidence of 1B and 3B. While this isn’t dispositive of your infection while stationed there, it certainly mitigates against the assumption.

As for the recent tattoos, while the risk of infection from that vector can’t be discounted, your initial thoughts are most likely correct. The natural fear of many to the HIV/HCV threat has brought about a sea change in the way tattoo parlors do business. Where autoclaves were once exclusively found in hospital and dental clinics, their presence in clean, modern parlors is almost a given in the last decade. You didn’t mention where you had those done, but we will assume it was in the U.S.

The possibility of your disease occurring in service is probably the biggest risk factor. The extensive dental work you mentioned, is certainly suspect, as the safeguards now in place were not the norm in the mid 90’s. A trip to the dentist today is all the evidence you need to see the disparity in antiseptic protocol practiced then. You described two operations but were not specific. If they involved a transfusion, they are always suspect in spite of safeguards instituted since 1992.

It is said that fully 30% of HCV infections are never traced to a defined source. These are referred to as Cryptogenic infections and it may be that yours is one. However the jetguns in your case are a definite risk in our minds. If you can have a board certified gastroenterologist certify that: “it is at least as likely as not” (in those exact words) that your infection was caused by the guns ,then you could win your case on appeal. Read the jetgun BVA decision on the Forums page. They are not precedence-setting decision but are a good road map to accomplishing what you are attempting. In addition you will have to obtain all of your military and medical records from the NPRC in St. Louis and provide them to the gastrodoc for his perusal. Part of the requirements for a nexus letter linking your disease to service entails your doctor stating that he has reviewed these contemporary records from your time in service and stating as much. He must also discuss why he has discarded any other theories or risk factors cogently to make the nexus bulletproof. We cannot tell you how many Vets have lost their cases on appeal for lack of these prerequisites mentioned above. The VA examiner who will eventually rule on your claim will still go out and seek his own opinion from an outside source and review your nexus letter for some discrepancy. Should they find one, all your and your doctor’s hard work will be for naught. This is a recipe. You cannot substitute ” He probably got it from the jetguns”. You cannot make any lay statements of a medical nature in your defense. You are limited in your testimony to what you can ascertain from your five senses. Any deviation from the recipe will make your souffle fall flat.

To obtain the records we mentioned, look at the left hand margin under Print VA Forms for the SF-180 form and follow the instructions. The delay, from what we’ve heard is currently 2 months +or -. Do not expect your VSO to do this or you may never see them. You are the final arbiter of your claim and responsible for it. If it goes awry, you will have no one to blame but yourself. VSOs are a wonderful invention , but they are absolutely blameless. Become a DIY guy if you can.

We hope this has been informative and if you have any other questions as your claim progresses, please don’t hesitate to ask us. That’s what we are here for. Do it once and do it right. I doubt you will get any of this advice from your VSO. They are not trained in the minutiae of the claims process. Think of them as nothing more than a mailman to the VA and then make sure they file everything you give them. Its like nuclear compliance. Trust, but verify. Keep copies of everything you hand over in the event they “misplace” it. Never give them originals-only copies. Best of luck and be prepared for a long journey. —————Sgt. Nod.

HepMe
Registered: 12/01/10
Posts: 7

	12/01/10	#3

Sgt NOD,Thank you for the reply. Much information there.I looked over the risk factor checklist and have some questions that maybe I could ask you in a PM? With regard to the tattoos, both were done in the USA, yes. One in NH, the other in Florida. With regard to the surgeries I had in service, the overseas one involved the removal of a meniscus cyst from my knee and was done in Tel Aviv in 96 by a civilian doctor I believe. Can’t say for sure but I don’t think blood transfusion was involved. The other surgery involved the fusion of my right great toe and was done by an Army doctor at Fort Drum in 1997. Again, I don’t think blood transfusion was involved. I will get grooving right away on getting my military medical records. Will (should?) the DAV already have that because they helped me the first time I filed a VA claim? Does it help that I am already a disabled American Veteran and in the system so to speak? Have I filed this claim too soon? Should I be gathering up info, records, and letters BEFORE making the claim? Edit: Regarding my theory about food in Egypt, is it possible that a Hep C infected Egyptian cook could have bled into my food and then I contracted it by consumption of the tainted blood? Is that even possible to get it that way?

NOD

Manager
Registered: 11/22/08
Posts: 652

	12/01/10	#4

To contact me via secure mail, log in and click on the member’s list. Click on N and then click on NOD. It will reveal my profile and on the left is a private e mail link. We can safely say that you didn’t have a transfusion based on your info re surgeries.The DAV does not have the military and medical records unless you specifically asked them to retrieve them. If they had, you would have had to fill out one of those SF-180s at some time in the past. If you had, you would be in possession of them and not the DAV. Remember, they are the mailmen, not repositories of records for Vets. Their job, ostensibly, is to represent you, be it in a courtroom, before a VLJ or a DRO at a hearing. Ofttimes you won’t meet the guy until an hour before the hearing. Bad idea. That leaves you no time to coordinate your defense and marshal your offence. You should have your battle plan and a synopsis printed beforehand. All too often Vets are not prepared for these encounters. They are not versed in public speaking and feel marginalized by the presence of the SO. The SOs I have come across often appear to be a bump on the log at these meetings and contribute very little other than support. Perhaps you will have more luck than me. I’m 0/3 with them and 3/3 defending myself. Because we are in the midst of two wars, the delay right now on initial adjudications is six to 9 months out depending on the complexity of your case. What, for instance, was your MOS? Medics are high risk for needle sticks and exposure to blood products. It doesn’t really help you to be in the system other than your local Regional Office aka “Veterans Service Center” in Boston(?) has constructed a file for you for the two prior claims. They have your C-file which contains your military, medical, and VA adjudication records. It is far easier to get them from St. Louis than the RO. To get a copy of your C-File entails closing down anything they are doing with your claim in order to copy it. It’s a paper system and fraught with lost files and accidental destruction of important records. Try to avoid this route if possible. Occasionally, St. Louis will tell you they sent all you stuff to the Local RO. In that case you would be forced to request a copy of the whole file from VA. In response to your last paragraph, I would put the probability of what you describe at 1%. The Hep C virus is very robust , but I severely doubt it could withstand the rigors of stomach acids, bile and the like. It is said that HCV infected blood can dry on a surface and still be viable for three months. I am not a doctor or a scientist so I don’t know the veracity of this. Trying to base your claim on this tenuous a connection would be fatal. You would almost have to locate this cook and prove that not only did he have hep, but that it was the same genotype as yours. That’s a pretty tall order. It would necessitate some expensive airline tickets and a good hotwire.com deal to start with. Again, the odds are astronomically stacked against this idea. Without trying to pry into your private life, we will just say that it wasn’t willful misconduct to contract the clap from ladies with, shall we say, questionable mores. That defense is recognized and many Vets have attained SC via that path. Explaining it to the better half can be daunting, though. You have your marching orders. Now go out and assemble the claim. You appear to be of above average intelligence or else you have a phenomenal spell check program,sir. Assuming the former, we almost want to question your choice of using a VSO rather than defending your claim pro se. We hope none of this conflusticates you. Feel free to ask more questions as needed.