SOVALDI–THE NEXT GENERATION OF HCV CLAIMS

Posted on June 24, 2014 by asknod

download (1)I have recently been contacted more times than I can count by Veterans with the “What if I go SVR during my claim?” or the “How will this affect my rating now that I am cured?” Quite simple, actually. 38 CFR Part 4 dictates what is required for what percentage but some other guidelines apply depending on your claim date and your residual symptoms. Let’s analyze the possibilities all the way from very old to very new and the permutations of “residuals”.

An old example would be me. Due to VA’s recent munificence, I am a twenty year protected Vet and am bulletproof. My claim date of March 1994 guaranteed that but there are other metrics to gauge this by too.

If you are over ten years with P&T with a protected DIC for the oke-san, again, the DIC cannot be rescinded. VA would rarely try to disturb this or your P&T via the five-year rule.

If your claim is five years and older with 100%P&T, again this is a substantially protected position to defend. The five-year language in 38 CFR §3.344(c) is benign towards those who are not going to improve:

 (c) Disabilities which are likely to improve. The provisions of paragraphs (a) and (b) of this section apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating.

And then there are the less than five year crowd who emailed me.

Many of you, including attorneys, tend to overlook some of the meat in 38 CFR § 3.340 that you can ultimately use to extract a P&T or 100% schedular rating you can turn into P&T.  Read the fine print:

b) Permanent total disability. Permanence of total disability will be taken to exist when such impairment is reasonably certain to continue throughout the life of the disabled person. The permanent loss or loss of use of both hands, or of both feet, or of one hand and one foot, or of the sight of both eyes, or becoming permanently helpless or bedridden constitutes permanent total disability. Diseases and injuries of long standing which are actually totally incapacitating will be regarded as permanently and totally disabling when the probability of permanent improvement under treatment is remote. Permanent total disability ratings may not be granted as a result of any incapacity from acute infectious disease, accident, or injury, unless there is present one of the recognized combinations or permanent loss of use of extremities or sight, or the person is in the strict sense permanently helpless or bedridden, or when it is reasonably certain that a subsidence of the acute or temporary symptoms will be followed by irreducible totality of disability by way of residuals. The age of the disabled person may be considered in determining permanence.

We have a shifting dynamic on this that ensures a case-by case basis for grants, downward ratings or revisions but the age milestones are protections that are “backflow preventers”.  We know that once we hit the TDIU or 100% schedular wall, we are generally rescheduled for a final C&P to ascertain any improvement after two years. Absent any, we get the P&T designation and a small umbrella of protection. The five-year mark, although an arbitrary milestone, is generally accepted as the boundary of good taste for trying to claw back your protections accorded you via the P&T rating.

And then there are the newly rated. And the liver transplant crowd like Leigh. And on and on. Let’s take Hepper 74 in the “Get High or Die” state of Colorado. We share that left-handed tobacco distinction as I live in the Soviet Socialist Republic of Washington. Randy is blowing a Stage 4 on the hepometer like me. He is recently TDIU  and on appeal for 100% schedular under DC 7354. He’s getting on the Sovaldi Bus this morning. I’m one day ahead of him. My DEROS (Date of Return Off Sovaldi) is December 23, 2014. On paper, at least, but more about that in a minute.

Randy runs the risk of falling into the newly rated but not P&T group-i.e. less than five years. He need not worry. Even if he slays the dragon during his BVA appeal, the Shedden elements were and are met that he filed with the disability and the claim is predicated on what he had at the beginning, not what transpired in between or where he is when the appeal is finally granted. Given that the BVA is more backed up than a monkey who ate a pound of cheese, he’ll probably be on the cusp of five years by then anyway. And then we are going to mention residuals. But first, all you transplant folks.

Leigh of the East, my trooper who has slogged all the way to the CAVC just to extract her abbreviated c-file, is our poster child for liver transplant claims. Her claim is wisely grounded in an HCV claim rather than one of the convoluted cirrhosis claims under Diagnostic Code 7312.  The transplant just cements the gravity of how bad the HCV actually became. When you have to drop a new engine in or replace the transmission on a newer model car, you know it was defective for a long time. Looking back for the predominant risk factor is not a complicated exercise in forensics for those of us who served in the 60-90s. And then the residuals…

Here’s the big kicker in all these cases and brings them together. HCV, Interferon and Ribavirin treatments over the decades have taken their toll. Some of us have thyroid cancers, hypothyroidism, Diabetes Mellitus Type 2, Cryoglobulinemia, Porphyria Cutanea Tarda, kidney stones like hailstorms, Rheumatoid Arthritis, Fibromyalgia, gastrointestinal issues like Crohn’s or Ulcerative Colitis, ad nauseum. In short, but for the disease and the horrible side effects of the treatment, we wouldn’t be sailing on this ship. Residuals are the jetsam that has washed up on our beaches and now infest us.

nrmicro3046-f2Sovaldi is much like a birth control pill. It interrupts one of the six reproductive cycles of the disease and makes it easier for the human immune system to spot and eradicate the one version of the bug left. HCV is like a chimera that constantly metamorphoses ever so slightly so as to make itself unrecognizable. The Sovaldi does a “freeze-frame” on it and prevents any new mutations from evolving. As such, the side effects of Sovaldi alone are reportedly negligible. The Ribavirin and the Interferon are a different matter entirely. Hundreds of thousands of you are still alive to report that much.

Back in the old days, Mark (Hepsick) can tell you about the Interferon roundups. It was akin to surviving a nuclear war and left you slightly decayed and glowing in the dark. That was just the Interferon in its own right. The newer combination with Ribavirin was even more insidious and brought you to your knees whether you achieved SVR or not. Worse, the success rate was like Las Vegas. It almost killed him and he has many residuals that would render the majority of us 100% disabled in their own right. The HCV just ensures it’ll be a bad hair day every day. Removing the virus doesn’t obviate the need for the insulin shots and the dietary vigilance needed to stay afloat nor does it resolve the deep arthritic aches and pains we will always suffer from. These will never disappear but merely be magnified later in life. This is one of the primary reasons VA is going to have a hard time downrating you after SVR. Additionally, what, exactly is SVR? Will it come back in two or three years? Nobody knows. Sovaldi and the whole class of NS5A inhibitors haven’t even been around for three years yet. We’re in relatively uncharted waters yet our doctors would have us believe we’re sailing around in our own bathtubs.

As for some of the autoimmune issues generated by HCV, my doctors smile and say noncommittal things like “Well, I guess we have our fingers crossed on that one” or “It will be interesting to see if they resolve after treatment.”  Not one has said “We don’t have an escape hatch built into this for you AIH guys. Sorry.” The current game plan, much like the old one, is damn the torpedoes and full speed ahead. And once you start, you can’t stop. We now know there is a strong correlation between things like AIH and HCV but the danger of treatment is compounded by the danger of death. In the interests of science, we are apparently requested to “go along with it” unless it threatens to kill us. Sweet.

Things got so crazy in 2010 that my VA “hepatologist” ARNP Eileen Hanson greeted me for my 3 month check up and said “Wonderful news, Buckwheat! We have a cure called Telaprevir. We use it in conjunction with Ribavirin and Interferon”. This is the triple-drug wonder therapy that almost killed WGM down in Texas after two doses back in 2012. He’s clinging to life and his residuals are right off the map. His wife had to quit work to become his full-time caregiver. Eileen also knew I was Interferon-intolerant. Hell, that never stopped VA nurses or doctors. One size fits all in their book.

When I found out about Sovaldi (or Sofosbuvir) last spring, I immediately got in line for the trials. To my chagrin, Gilead didn’t want any AIH guys to queer the results for acceptance. Only a select few were chosen that fit into narrow parameters in order to arrive at a good outcome (early acceptance by the FDA). Someone like me (with AI issues) who tried this might upset the applecart so I was given the wave-off. However, the doctor hastily insisted that once Gilead Science launched the drug commercially that I could promptly get in line for treatment. Seems rather strange to prescribe drugs like that. We know the effects of Interferon and Ribavirin on autoimmune issues. I got a first-hand, close-up look at it in 2007 and and it almost killed me with one dose. What is remarkable is that everyone in the medical field seems to think Ribavirin is benign and only attacks the virus itself, or in the alternative, amplifies the action of Sovaldi. I disagree-as do my pharmacist and any number of folks who have eaten it for long periods of time. Read this:

More specifically:

Contraindications

Ribavirin tablets are contraindicated in:

•
Women who are pregnant. Ribavirin tablets may cause fetal harm when administered to a pregnant woman. Ribavirin tablets are contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus [see Warnings and Precautions (5.1), Use in Specific Populations (8.1), and Patient Counseling Information (17)].
•
Men whose female partners are pregnant.
•
Patients with hemoglobinopathies (e.g., thalassemia major or sickle-cell anemia).
•
In combination with didanosine. Reports of fatal hepatic failure, as well as peripheral neuropathy, pancreatitis, and symptomatic hyperlactatemia/lactic acidosis have been reported in clinical trials [see Drug Interactions (7.1)].

Ribavirin tablets and peginterferon alfa-2a combination therapy is contraindicated in patients with:

•

Autoimmune hepatitis.

•
Hepatic decompensation (Child-Pugh score greater than 6; class B and C) in cirrhotic CHC monoinfected patients before treatment [see Warnings and Precautions (5.3)].
•
Hepatic decompensation (Child-Pugh score greater than or equal to 6) in cirrhotic CHC patients coinfected with HIV before treatment [see Warnings and Precautions 

Seems this is some pretty serious stuff if it is in the same class as Thalidomide.

download (2)Ribavirin is contraindicated in the presence of autoimmune disorders and especially autoimmune hepatitis (AIH).  That much we know. Doctors try to decouple that by saying this interesting phenomenon of runaway autoimmune syndrome is due solely to Interferon.  Nevertheless, the Ribavirin monogram specifically mentions it as a culprit. How, then, can the doctors feel comfortable about prescribing it knowing full well they could be condemning the patient to death? Simple. They recite their little mantras like “Extremely interesting it will be to see how your body reacts. Yessssss. If there is a problem, we can discontinue the prophylaxis. Mmmmm. Put you on Budesonide (steroids) and Imuran (immune suppressant) we shall. Yesssssssss.”

In all this rush to medicate, nobody considers the double whammy. Consumption of the two drugs above (prednisone and Imuran) suppresses the autoimmune function of the body- the very white blood cells combatting the HCV infection.  Unfortunately, by suppressing one, you allow the other to run amok unimpeded. Someone should acquaint these boys with Newton’s Third law of Medical Physics. The current medical philosophy says pretty much what it said in the 90s and the 00’s- let’s run them down the Interferon cattle chute helter skelter and see how many make it. Sure, there’ll be some casualties but what the hey? We all benefit. Now they want to do a similar cattle drive to the Sovaldi ranch and brand us again -with the same, known drugs that cause blindness and DM2. Nary a one of them blinks an eye when queried about the inherent dangers. I doubt they understand the concept.

There are some interesting studies out with all the different combinations of how you can take Sovaldi. Gilead even ran a trial of twelve weeks using only Sovaldi. This Electron2 trial, as it was called, had a success rate of 64% or 16 of the 25 subjects attained SVR-in a mere twelve weeks.  This trial only included Genotype 3 subjects. The GS-7977 trials (all three of them) attained a uniform 82% using Sovaldi and Ribavirin for 24 weeks. Read more simply, in DickandJaneSpeak, it means adding Ribavirin and twelve weeks onto the treatment only resulted in an increase of 18% success in the recipients. If I didn’t know any better, I’d say someone was stuck with a shit ton of Ribavirin and looking for a place to unload it before the financial bottom falls out of it as it has with Interferon and Telaprevir/Boceprevir.

I’m on day 2 of the treatment so it will be interesting to see how things play out. The AIH is always at the back of my mind. I’ve waited 7 years for this and am not inclined to wait any longer. The danger of another napalm strike on top of the AIH to my immune system lurks in the wings with Ribavirin and the doctors consider this “a remote possibility” and “We’ll cross that bridge when we get to it”. Hold the phone, dude. We’ve arrived at the Rubicon and you’re behind me at the other end setting fire to it. How does that work?

download (1)One last observation. We talk of time as in 30 days have September, April, June and November. Apparently, in MedicalWorld, there are always 28 days in a Sovaldi month. Sovaldi comes in 28-pill bottles. Over six months, that amounts to twelve pills (or twelve days). On the Nasdaq exchange that translates out to $12,000.00 based on Gilead’s sales price of $1000.00 per pill. Who says there isn’t shrinkage in the medical sense? If Medicare gets billed $180,000.00 for my six month treatment, who gets to rake off the $12 K? Is this like a VA bonus regardless of whether or not you achieve SVR? I asked my Sovaldi minder ARPN Tobi how that works. I got the same identical shrug of the shoulders as I did when I asked what happens if my AIH goes apeshit on Ribavirin.

One thing is certain. VA will not move too soon on this. There seems to be a movement afoot at the BVA that signals an acceptance of the jetguns as the cause of this disease. It may be a fluke as there are so few of us left. Chances are that they will poke and prod a few, newer cases or ones in the pipeline in an attempt to set some kind of strictures on the newly-healed. Considering the number and severity of the residuals, I think it will be short lived. What’s to be gained from downgrading your Hepatitis C from 60% to 40% if you just turn around and file for fibromyalgia, rheumatoid arthritis, hypothyroidism and Cryoglobulinemia and end up back at the same rating of 100% combined or TDIU? It’s six of one and half a dozen of the other. Besides, the VHA has taken the liberty of admitting all these residuals are part and parcel of HCV and Interferon therapy. What’s to be gained? Well, boy howdy. You haven’t been around the VA as long as I have. Watch. These chowderheads can’t leave well enough alone.

 

 

Posted in HCV Health, HCV Risks (documented), Sofosbuvir | Tagged , , , , , , , , , , , , , , , , , , , , , | 25 Comments

BVA–THE SQUEAKY WHEEL THEORY

Posted on June 23, 2014 by asknod

downloadFor years and in my book, I’ve tried to impress on VA claimants the absolute necessity for continuing to pound home the appeal-even if it involves remand after remand after Joint Motion to Remand. Here it paid off in a unique decision all of us can utilize. Print it up and hand it to you nexus doctor.  Several passages are gold for our claims. To wit:

The Veteran’s attorney submitted an October 2012 statement from a private physician. This physician disagreed with the findings of the August 2012 opinion of the physician’s assistant. He reported a brief explanation and history of Hepatitis C infection, noting that it is usually asymptomatic. He reported that the virus was initially isolated in 1989 and a reliable test was not developed until 1992. He stated that the virus is transmitted blood to blood, usually by tattoos, infected needles, razors, blood transfusions, etc. He added that the acute phase was 6 months and that the person was usually asymptomatic. Further, in approximately eighty percent of infected individuals, the antibody is detectable about 3-15 weeks after infection. He also referred to April 2000 medical testimony presented before the Subcommittee on Benefits on Veterans Affairs, which noted that one out of every 10 veterans were infected with Hepatitis C virus (HCV)), which is a rate five times greater than the 1.8 % infection rate of the general population. In addition he noted a 1999 Veterans Health Administration Study that found that 10 percent of veterans were infected with Hepatitis C.

This physician also noted that you need only one drop of blood of infected blood to come into contact with the blood stream, which can happen with a small nick of a razor or with micro tears in the gums of your mouth. The virus does not have to be directly injected into the veins. He reiterated that the Board conceded that he was exposed to blood while on active duty.

He stated that he disagreed with the findings of the VA examiner in August 2012 regarding the absence of documented treatment for Hepatitis C for an extended period of time after service discharge. He noted that a reliable test for Hepatitis C was not developed until 1992. Moreover, Hepatitis C does not manifest as an acute illness upon contraction of the virus and is usually not detected until decades later when there is late stage liver damage. As such, the VA finding that the lack of a diagnosis of Hepatitis C for nearly 35 years should not apply.

In addition he disagreed with the VA examiner’s reference to the Veteran’s post service high-risk activity. He stated that the Veteran would have had to share intranasal devices contaminated with Hepatitis C and have an open portal of blood entry in his nares. The physician found that there was a much higher chance of contracting Hepatitis C from such in-service activity as multi-injection air gun than any intranasal transfer from drug use. Finally he disagreed with the VA examiner’s statements regarding the fact that the Veteran’s military service represented approximately five percent of his adult life. He argued that regardless of the percentage of time the Veteran spent in the military, he was exposed to blood (as conceded by the Board), then it is just as likely as not that he contracted Hepatitis C while in-service. He stated that “[it] would be impossible for anyone to say specifically which route caused his Hepatitis C infection. There is no way to pinpoint one of those modes of transmission as the only factor.”

Well, there you have it. The first admission by a medical professional that a jetgun is far more lethal than a coke straw. Well, duh.

So:

RO Denial in 2008

BVA remand in 2009

BVA denial  in December 2010

Court JMRs the BVA in April 2011

BVA remands again in September 2011

BVA denies again in December 2012

Court vacates BVA denial and JMRs to the Board again in August 2013

BVA reverses and approves SC May 2014.

Now, just imagine if he had not had Rule 900 and an advancement on the docket? This old boy would either be dead or still sitting at St. Pete’s awaiting the first of those BVA remands from back in 2009. Ain’t justice a wonderful thing when it works?

imagesBookmark this one under “One Drop of Blood”. It’s about time they realize what a lethal disease factory we are. With ten pints of blood, you could theoretically contaminate every man woman and child in America.  At the VA, you could only infect yourself if you shot up or snorted the Devil’s dandruff.

And a warm thank you of appreciation to Kathy Lieberman, Esquire for her bang up job of rainmaker for this gentleman Vet.

Posted in BvA HCV decisions, HCV Health, HCV Risks (documented) | Tagged , , , , , , , , , , , , , , , , , , , | 3 Comments

BVA–PURE JETGUN DECISION

Posted on June 23, 2014 by asknod

GaryJETBasicHere is what appears to be a straight forward jetgun decision. No prevarications. No hemming and hawing. No benefit of the doubt. Two doctors say it was jetguns and no one from VA stands up and says otherwise. This further vindicates my thesis that if you arrive with a pair, VA will probably fold. Here. they denied until the BVA reversed. And not only that, a veteran Veterans Law Judge was the one who did it. Shane Durkin was ricocheting around the BVA for decades as a staff attorney long before he became a VLJ. This is no flash in the pan.

P.S. Here’s another one. Again, no “resolving any benefit of the doubt in favor of the Vet” language. Just a simple ” It was the jetguns”.

Posted in BvA HCV decisions, Jetgun BvA Decisions, Jetgun Claims evidence, Nexus Information | Tagged , , , , , , , , , , , , , , , , , , | 2 Comments

BVA–LITTLE THINGS THAT YOU DO

Posted on June 23, 2014 by asknod

downloadI always look for explicit examples of VA tricks and try to advertize them as a “Buyer Beware”. VA has a propensity to stretch the truth like no other agency of government. They have a tendency to cite to medical evidence as well, that, on it’s face, would not ordinarily be questioned…unless… well, if its seventeen years old. What’s disconcerting is that if and when called on it, the VA examiner will simply says something inane like “Oh, gosh. I guess I accidentally picked up the wrong Dorland’s manual”. Which would beg an explanation of why the old one is still on the shelf in any normal investigation of misfeasance. 

Poor Jane Vet here from the Cigarette Regional Office of Winston tastes good like as a Salem should, discovers this much to her dismay. Seems she did a bang up job of presenting secondaries to her now-connected Hepatitis C. The VA examiner, in what is quite obviously denial mode, searched long and hard to find supportive literature that would dissuade the Veterans Law Judge. And find that supportive literature he did. Nonplussed, Jan appealed. Smart cookie. And much like the song by Billy Gilman, the little things that the VLJ did made Jane glad she appealed.

Considering the VA is a cutting-edge medical organization with all the most up-to-date tomes on Cecil, Book or Medicine and Dorland’s Medical Dictionary, one would find it almost inconceivable that an examiner would be forced to quote outdated medical literature to write a cogent denial. The reason we know this is simple. When reading denials of this type, we see the cite to which year the VA examiner is referring- i.e. Dorland’s (1997). Here, we must assume the VA examiner made the grievous error of actually citing the reference material in such a way as to unveil his/her  grotesque attempt at subterfuge.

Always remember this quirk. Add it to your list of “VA Denial techniques”. We all know they are forced to go farther and farther afield in their attempts to deny but this one is a newer variation. Hepatitis C is unique in many regards. Being cryptogenic, it can lie hidden for decades and we can now defeat the Maxson v. Gober holding. Similarly, we know it is uniquely linear in its progression which allows us to date it within a certainty of a few years of inception. That put a fork in the VA Examiner’s warped logic of stating that there was no evidence of Hepatitis C in the Veteran’s SMRs from 1967. Each of these medical revelations have allowed us to gradually improve our odds of winning. Thus it should come as no surprise that VA will go to any lengths to poke holes in any claims endeavour-even horribly logical, medically-supported ones- that purport to prove a link to the primary disease.

The Veteran contends that she currently experiences GERD, IBS, polyarthritis, and chronic headaches, as a result of hepatitis C. In this regard, the November 2012 VA examiner opined that the weight of the current medical literature was against a nexus (less likely than not) between hepatitis C and the remaining issues of GERD, IBS, polyarthritis and headaches. The examiner noted that those specific conditions had a number of possible etiologies or may be idiopathic in nature, but none of them were shown to have a plausible nexus to hepatitis C per the current medical literature. The examiner cited to medical literature dated in 1997 as support for the opinion. In response to this opinion, the Veteran submitted more recent general medical literature indicating a possible relationship between (1) chronic hepatitis C and IBS; (2) fibromyalgia and IBS; and (3) rheumatic arthralgia and hepatitis C. The literature, most of which is dated subsequent to 2007, suggests that the findings of the November 2012 examiner may be based on outdated medical findings given that the support for his opinion comes from medical literature dated in 1997, a decade before the medical literature submitted by the Veteran in support of her claims. Thus, the November 2012 examiner’s opinion should be revisited in light of the newly received evidence, and the Veteran should be afforded another VA examination to determine the current nature and likely etiology of the GERD, IBS, polyarthritis, and headaches. Significantly, the examiner should determine what symptoms are associated with each condition, particularly given that the November 2012 examiner provided a positive nexus opinion between the hepatitis C and the fibromyalgia.

We have to assume that the “acting” VLJ, A.C. Mackenzie wants to be anally correct and get it right because she’s new to this judging business. Several years from now, she’ll be firmly ensconced in the saddle and this will never happen again. By then, 1997 medial literature, in her book, will be compelling, cutting-edge, accepted medical evidence and the denial will be affirmed.

One reason Jane Vet prevailed here is obvious. Absent a VSO minder to steer her into a blind alley, she went it alone as a pro se claimant. I have nothing against lawyers (or VSOs for that matter). In fact, as most know, I extol their virtues. Here, Miz Jane seems adequate to the task so a rainmaker might be superfluous. This is all well and fine until you get to the rarified oxygen of  625 Indiana Avenue NW on appeal to the Court. Having a mouthpiece there is a must in my book.

images Lastly, let’s revisit the Presumption of Regularity in all things VA does. If we are to believe it, this is simply an oversight or a glitch in the ratings protocols. Likewise, if believing it, we are expected to swallow the pablum that’s it’s a good thing Jane Vet was up to speed on the latest in medical science.  Ignorance was thwarted and Justice was accomplished ergo they all lived happily ever after. Pray tell, with all that is afoot at the VA these days, how can there be any Presumption, other than the one of Ineptitude, VA can get anything right?

The river of deceit, the plethora of bonuses and the gross mis/malfeasance we are seeing uncovered daily contradict everything we could possibly depend on to support our confidence in their system. But then, knowledgeable Vets have known that all along…

Posted in BvA HCV decisions, HCV Health, HCV Risks (documented), Tips and Tricks | Tagged , , , , , , , , , , , , , , , , , , | 2 Comments

Harvard Law Report (2013) on HCV cites Fast Letter 04-13

Posted on June 23, 2014 by Laura

There is a huge disconnect between policy makers and the VA/VHA–and it’s been working really well to keep the public ignorant of the many service-connected factors that relate to the veteran HCV epidemic. 

If any institution can assign people to conduct exemplary research, it would be Harvard.   Harvard Law collaborated with another project team to produce a report:  “Massachusetts State HCV Report” (plus a long dull subtitle) that did not completely disappoint me by ignoring the remarkable oddity of the HCV-epidemic in the veteran population.

In the Background section (page 11) about people at risk, they write: ”

…Still others may have no idea that they were put at risk. For example, veterans, particularly those who served during the Vietnam War era, are considered to be at much higher risk for HCV, and although this risk is thought to be primarily due to injection drug use histories, (30) it is also possible that some of these infections may be associated with past group vaccination practices during military service. (31).

Here’s the citation and remarks:

The Veterans Administration (VA) has taken the position that air-gun vaccinations that were used in this period are a “biologically plausible” transmission mechanism for hepatitis C, although the VA maintains that there is no scientific evidence yet in support of this proposition. Veterans Benefits Administration, Relationship Between Immunization with Jet Injectors and Hepatitis C Infection As It Relates to Service Connection, Fast Letter 04-13, at 2 (June 29, 2004), available at http://www.hepatitis.va.gov/pdf/jetinjectors.pdf.

At least one claim for service connection based on air-gun vaccination and subsequent infection from hepatitis C has been upheld by the Board of Veterans Appeals, eg, Redacted Title, Bd. Vet. App. 0928872, 2009 WL 3321703 (2009).

Veterans

Other populations with high prevalence rates include veterans, with prevalence estimated between 5.4-41.7%. (46) The US Department of Veterans Affairs (VA) reports that among those receiving care at VA healthcare facilities, prevalence is as high as 1 in 20. (47).  Prevalence among veterans is particularly high among those who served during the Vietnam War era ((48) and among homeless veterans. (49).

Footnotes 46, 47, 48 and 49 can be read online at the end of the report.

Most of these citations are to documents that are not current but they do open a little crack.  Based on the subtle language used in footnote 31, I don’t think the Harvard authors place much, if any credence, in the VA’s position on mass vaccinations and this blood-borne pathogen.  Yet they are still timid beyond belief.  The Fast Letter is ten years old and it’s garbage. 

cowardly

Ask proper research questions and roar already.

 

Posted in BvA Decisions, Guest authors, HCV Health, HCV Risks (documented), Jetgun BvA Decisions, Jetgun Claims evidence, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , , , , | 2 Comments

BVA–2nd QUARTER DECISIONS ARE OUT

Posted on June 20, 2014 by asknod

downloadHey folks. Here’s some good news on HCV decisions. The fifth one down I read was a frank admission that jetguns were the primary cause of the Vet’s HCV. Well, at least it started out that way until a DRO blew coffee through his nose when he read the VA Examiner’s write up.

Here’s the link to the site.

The Veteran was afforded another VA examination in January 2013. The examiner concluded that it was at least as likely as not that any diagnosed hepatitis C was related to the Veteran’s period of active service. The examiner explained that the inoculations that he received as part of his service, as well as the lacerations to his scalp and left index finger, were all risk factors for the transmission of hepatitis C.

Then the backtracking and ‘well, not exactly’ began.

In a March 2013 addendum opinion, the examiner further concluded that he was unable to provide an opinion without resorting to mere speculation. The examiner explained that the self-reported post-service intravenous drug use in the 1990s, inoculations in service, as well as the lacerations to the Veteran’s scalp and fingers, were all equally likely possible modes of transmission of the hepatitis C virus.

The VA Examiner might have had his or her employment terminated over that one or was put on detention after work until s/he wrote a disclaimer…

The Veteran was afforded another VA examination in March 2014. The examiner concluded that the Veteran had a history of intravenous drug use in the 1990s, which was the most important risk factor for hepatitis C. The examiner also concluded that it was less likely as not that the inoculations and lacerations to the Veteran’s scalp and left index finger while in service contributed to his hepatitis C. The examiner explained that the preponderance of currently established scientific and medical evidence did not support any relation between inoculations with an air gun and lacerations, with the development of hepatitis C.

downloadWhat this also means is the RO sat on it for a year from the positive nexus for the jetguns (in March 2013) all the way to the negative nexus exactly a year later in March 2014. Sounds to me like they were trying to find someone who would take thirty pieces of silver. Nevertheless VLJ Deborah Singleton came to the right conclusion. Yeppers. The good, old Benefit of the Doubt. Go figure. Honesty at the BVA. What’s the world coming to?

Posted in BvA HCV decisions, HCV Risks (documented), Jetgun BvA Decisions, Jetgun Claims evidence | Tagged , , , , , , , , , , , , , , , , , , | 2 Comments

SOVALDI–IT’S SHOWTIME

Posted on June 19, 2014 by asknod
HCV Decon

HCV Decon

After a five month fight to obtain this magic elixir, I am finally going to proceed on to a six month fight to kill the Dragon. The Decon arrived late today and zero hour’s 9 AM. Protein pills and helmet await me. Words cannot describe the excitement of embarking on this Odyssey. Since the first blast of Interferon almost killed me on April 12th, 2007, I have patiently awaited the onward march of medical science. I theorized that they would come up with a ziploc bag that would encapsulate each virus. Instead, the NS5A inhibitor in Sofosbuvir is a birth control agent. Imagine FedEx throwing $28,000.00 of pills on your back porch.  No signature required. It stupefies me. Of course, the whole idea of any medication costing  a thousand dollars a pill is almost inconceivable. Almost. A liver transplant is conservatively $550,000.oo. VA planned on making me drive 40 miles to their pharmacy every two weeks for fear I might sell them on the black market. 

Much like an application of Frontline Flea juice sterilizes fleas and eliminates them, so too does Sovaldi. It’s probably far more like a birth control pill inasmuch as it interrupts one of the eight or nine critical steps in the viral reproduction.

Treatment of Hepatitis C genotypes 2 and 3 require a twenty four-week course of pills-double the normal 12-week combo therapy for Genotype 1 which still uses the old Interferon poison bug juice. For those of you like Hepsick (Mark) who have already run the gamut of Interferon with no luck, the twenty four-week regimen is also prescribed. Makes sense. If Interferon didn’t kill it the last two times time out, isn’t that the definition of insanity to continue it again and again in hopes of a different, better outcome? Mark thought so. I think it shows Interferon is all washed up. Gilead is introducing the new Sofosbuvir/Ledipasvir double whammy of two different NS5A inhibitors in the new future dose and it won’t involve any ribavirin.

Mark and I both have about the same chance of killing this without the old style crap. My genotype of 3A says 84% with one kicker. If you hit zero bugs in six weeks, you’ll probably win. Mark, with Genotype 1A, had 15 bugs left after four weeks and they didn’t even give him as good odds as they did me. He hit Bingo last Wednesday.

We’ll keep you posted with the Puke Report. News and film at Six every evening. Sovaldi. It’s what’s for dinner. And hey. By rights, Gilead Sciences Stock should have gone up today.

Posted in Food for the soul, HCV Health, Sofosbuvir, Vietnam Disease Issues | Tagged , , , , , , , , , , , , , , , , , | 21 Comments

VA–THE BIG CHILL

Posted on June 18, 2014 by asknod

downloadThis is what I was afraid of. The Big Chill is now settling in and everyone is suddenly assessing their job resumes in case they suddenly find themselves “underemployed”. The smart ones are singing like birds while the higher-up types are strapping on Depends® Undergarments to avoid soiling themselves. Face it. When the news media knows what your secret game plan is and publishes it, you might be in deep doo-doo.

Posted in VA BACKLOG, VA Health Care, VAMC Scheduling Coverup | Tagged , , , , , , , , , , , | 3 Comments

VA–FIRE OUR WORKERS? ARE YOU INSANE? NO WAY

Posted on June 18, 2014 by asknod

download (2)I guess this pretty much sums up what the VA thinks of our insinuations that anyone at the VA was attempting to sandbag our health care. Lord, help us. Thank God this moron is short-lived as VASEC. 

Posted in VA BACKLOG, VA Health Care | Tagged , , , , , , , , , , , , | 1 Comment

CAVC–WEAVER V SHINSEKI– PROTECTING THE PRESUMPTION OF SOUNDNESS

Posted on June 18, 2014 by asknod
The Glenster

The Glenster

Whoooo, doggies. Glen R. Bergman of Bergman & Moore spanked Willy Gunn’s Lumpa Lumpas in this contest. It was a frank reversal-as in bitchslap- administered by none other than our Lady of Indiana Ave. NW-St. Mary of Schoelen. It was also a repudiation of the absence of evidence being a lynchpin in the product of a denial. VA tends to  backslide without constant prodding. Judge Schoelen simply provided the cattle prod. One thing is glaringly evident, though. VA still hasn’t grasped the concept of Colvin v Derwinski lo these twenty-odd years. The bad habits of those pre-1994 three-judge Boards with that confounded doctor/lawyer “super judge” die hard. Veterans Law Judge Thomas Dannaher had to be reminded to take off his Dr. Kildare outfit and stethoscope.

Ern L. Weaver. Gotta like that name. Sounds really down home like Montana or Alaska stock. Of course, in reality, he filed at the David Koresh Memorial RO in Whacko, Texas.

Weaver reversal

M21As with all denial cases, VA utilizes the most up-to-date excuse books put out by Cliff Notes©. They also plagiarize from the Allstate and Nationwide claims manuals to bolster their technique. Emanating just the right amount of sympathy for the denial without dripping it is an artform. In this business there’s just one niggling problem. Since the inception of the Court, VA has been cribbing from one lone excuse book unique to VA law. It’s about one chapter long, fifty-odd pages and has a finite set of denial tools available. They attempt variations of the same excuses over and over again without changing the underlying premise. You would think someone at the OGC would keep score and point out the losing strategies. Fortunately for us, they don’t and probably never will.

downloadErn was one of those guys who wanted to join up and kick some North Korean ass. He tried the Air Force Reserve but couldn’t get in with his bump hip. The Navy overlooked it when Ern showed up for the Meet and Greet at the AAFES entrance examination. This is where you were, in the words of Arlo Guthrie, “injected, inspected, detected, infected, neglected and selected.” At any rate, the Navy felt he was up to speed and accepted him. This is a seminal event in any serviceman/Veterans life. It signals that the military service you enlisted with declared you “sound in body and mind and accepted for service.” Overcoming that presumption is much like winning a clear and unmistakable error (CUE) claim. The presumption of soundness is a two-pronged test as you will read. Both elements of the presumption must be overcome with sound medical reasoning that supports the revocation of the presumption. It can’t be a nebulous argument or medical diatribe unsupported by logic. It also must be unequivocal and not a weak attempt at prevarication. Most importantly, what it cannot rest on is the absence of evidence as it did here.

Old Ern has also been accused of having old timer’s disease and not being able to keep his story straight. Again, this excuse came over on the SS Mayflower and I’m pretty sure Judge Mary has heard it so many times now that it sticks out like a sore thumb. At any rate, Ern turned the tables on the OGC because he did have “a year or more in service” as he claimed reflected on his DD 214. If these gomers at the OGC actually read over the RBA from the BVA they’d see this. Top-sheeting a claim in haste makes waste of valuable judicial resources and results in Happy Vets. Real justice would be served if they fined the gomers at the RO, BVA and OGC for filing frivolous denials.

Ern will live to see another claims day below at the RO and the BVA. His claim was reversed for the presumption that his hip problems increased in severity while in service, his back and hip denial were vacated and the whole shebang was remanded for a new decision based on real law. Veterans Law Judge Thomas J. Dannaher will have to fall on his sword and admit he’s a judicial dolt and shouldn’t be entrusted with the executive washroom key. That has to be hard to swallow. Will he learn from his mistakes?  It’s highly doubtful. Unless or until Congress emancipates the Veterans Law Judges and divorces them and their paychecks from the VBA, we will continue to get this polluted justice.

The decision is valuable as it assembles all the pertinent CAVC and Federal Circuit decisions needed to bolster your legal arguments. Most of us Westlaw or Braille our way to these cites. Thanks to St. Mary, they’re all here in a tidy little 10-page, single-judge memorandum and well-documented for transferral for cut and paste. It’s my version of leagalbeagledotcom for Vets and why I translate it into Joe and Jane Vetspeak.

A warm thank you to Mr. Bergman for a case well-fought and to Judge Schoelen for her insight, wisdom and grasp of law. And a warm thank you to Ern for having the intestinal fortitude to carry this appeal through to fruition. So many file. So few appeal higher. Considering the odds are as high as 60% that you will prevail at the CAVC, why Veterans don’t appeal is the mystery.

Win or Die VA

Posted in CAVC/COVA Decision, Tips and Tricks, Veterans Law | Tagged , , , , , , , , , , , , , , | Leave a comment