DMII and PN conditions secondary to Hep-C

I include these messages for others to benefit from. I was in the Seattle VA  hospital for a year from 4/09 to 4/10 so I didn’t get to post very much due to illness/4 surgeries. AN

chiefhouse00
Registered: 04/23/09
Posts: 3
04/23/09 #1

GreetingsI was recently denied service connection for Diabetes Mellitus II associated with Agent Orange and Ulnar Nerve Entrapment in my arms/hands primarily because I couldn’t provide NEXUS documentation (no proof of being in Vietnam). The VA C&P examiner (Neurologist) opined that my Ulnar Nerve Entrapment condition was most likely diabetic peripheral neuropathy. He added that it was in all four extremities (worst on the legs by far than the arms). Also, completed an EMG confirming PN both hands and feet by another C&P examiner. I was diagnosed with Hep-C prior to discharge and service connected for Hep-C (20%). Question: Can I claim my DMII and PN conditions as being secondary to Hep-C?

Best Regards
Chiefhouse

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AZeeJensMom
Moderator
Registered: 01/05/09
Posts: 94
04/25/09 #2

Hey Chiefhouse….How recent is your denial for the DM2 & PN?   Were you in country?   It’s pretty specific regarding the presumptive service connection.   Serving offshore doesn’t cut it but, if you set one foot on land during the presumptive period, you might try getting a buddy statement.

Recently, we were told by my husbands GI doctor that DM2 is more and more showing up as a 2ndary to HepC.    You have SC for HepC so I would think this may be an avenue for you to pursue.   However…..

I’m not nearly as informed as some of the others on this board, just wanted to let you know someone will be along soon that can answer your question more specifically.

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chiefhouse00
Registered: 04/23/09
Posts: 3
04/27/09 #3

GreetingsThanks for your reply.  I was denied service connection for DMII and PN this month.  It took a couple years for that decision.  I plan to go in again much better prepared to win this case. The VA already concluded that I have nerve damage in my feet and hands, hypertension and DMII but denied my claim because I couldn’t provide proof of being in Vietnam. Well, I’ve been carrying Hep-C for nearly 40 years and failed three rough treatment sessions. Medical studies have shown that Hep-C can cause these problems. So, I’m going in again and give it my best shot. My overall health condition is not getting any better.

Best Regards

Chiefhouse

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AZeeJensMom
Moderator
Registered: 01/05/09
Posts: 94
04/28/09 #4

First, on behalf of myself and my SC Vietnam Vet husband, I’d like to thank you for your service to our Country.As to your question on the DM2, PN, etc. as a manifestation of the HepC, I’d encourage you to go to the main pain of the HCVets web-site.   Scroll down and just after you see the “Active Duty Alert” in red letters, you’ll find a list…..toggle into the “Understanding the Hepatitis C Liver”

There, you will find information regarding extrahepatic manifestations of the liver, etc.   I did find that DM2, PN may have a direct connection to HCV infection and was found more prevalent in Geno3’s.   I’m certain there is alot more info out there and studies to be done to connect these issues to HepC.

What Geno type are you?  Have you had a Liver Biopsy?   Which risk factor did they tie you in with the HepC SC?  When were you discharged?   What date were you SC for the HepC?

If I’m not mistaken, and someone will correct me if I am, I believe you can re-open the HepC claim due to a worsening of your condition and claim the DM2, PN, etc. as manifestations/residuals.  If those conditions were present when you filed for your HepC, they should back-date your disability date to the date you filed.  This would be an important factor determining if the chicken came before the egg.

In your SSOC for the DM2, did the RO mention anything about the SC of HepC?      How strong are you medrecs?   Since you are already SC for the HepC, if your doctor, private or VA, will write an opinion that your DM2, PN, etc. are a direct residual effect of the HepC that could help alot in your claim for re-opening the HepC.   Having all of your ducks in a row, turkeys trussed, etc., will help immensely in the defense of getting these conditions SC under your HepC dx7354.   The opinion from that doctor should be a just as a Nexus…..more likely than not, positively, etc.   You can find Nexus dialect in the left hand column of the NOD page under FAQ’s.

As a side-bar note, my husband filed his original claim in Feb. 03 while he was on his 1st course of IFN.  The claim was for HepC and DM2 with residuals of both.   Denied 1st time for everything, requested DRO review de novo, denied again, filed for appeal.   This gave us the time to obtain the in-Vietnam AO exposure evidence.   He was SC for DM2 4/08 with PNx4, retinopathy and received a 70% SC for the DM2 issues with an effective date 1 year prior to filing as DM2 is on the presumptive list of AO exposure.

The appeal on the HepC was a different experience….went to the BVA, finally.   He just had his BVA hearing Nov. ’08, appeal remanded for further development….because when the Hep tx was at it’s worse (12/06), he finally had to stop working, filed for SSD, approved right away.   We filed for the SSD for many reasons, HepC, DM2, a much needed and long over due major shoulder surgery, etc.    During all 3 courses of tx, he continued to work, and gradually it became less and less until he finally just could not warrant continuing, especially due to his occupation.  We are awaiting the final decision on the HepC appeal.

We choose to take charge of the illness rather than it being in charge of us.   Sure, some days aren’t as good as others, but they sure do make those good days all that much better.

Hang in there……

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chiefhouse00
Registered: 04/23/09
Posts: 3
05/04/09 #5

GreetingsThanks for your experience and encouragement.  I was awarded service connection for Hep C in 2000 at 20%. I’m a Geno type 1a and failed three treatment sessions. In my most recent RO decision, Hep-C was not mentioned as a cause for DMII or PN.  Hep- was mentioned as a cause of ED which was granted. I have scheduled an appointment with the liver clinic and requested labs to test my blood.  I had two Liver Biopsies and diagnose at stage two,  Yes, my condition is worsening with severe joint pain and fatigue.  I have been fighting this aliment for nearly 40 years and don’t plan to give up until the end. Again, thanks for your advice.

Best Regards
Chiefhouse

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AZeeJensMom
Moderator
Registered: 01/05/09
Posts: 94
05/05/09 #6

Good Evening Chiefhouse….Interesting the VA granted ED from the Hep.   I understand the situation that you aren’t able to Nexus your feet on soil in RVN.   I didn’t realize ED could be a residual of the Hep.   Was it actually from the Hep or from the treatment itself?  Or, do they even know?

3 time treater, that’s a tough one.   My husband is 1a also, and non-responder to 3 courses of IFN.    Every case is different.  Every person’s experience is different.   Even though we know he was a non-responder, we try and think of all those weeks of IFN as giving his liver a chance to regenerate itself.   By way of biopsy in 1/09, we now know he is in Stage 4.   Had he not endured the poison, who knows?    When he was on IFN, it completely changed his life and he did finally get to the point where he couldn’t work.

We know one gentleman who is a 1a, and never missed a day of work while he was on tx.   It different for everybody.

Keep at it, get those records and a Nexus from 1,2 or qualified medical providers the DM2 & PN is a residual of the HepC, you fare well.   I’m pretty certain you could reopen for the PN alone, but while your at it, might as well do the DM2 and…….check rating schedule for HepC.  You could warrant an increase.  Especially while you were on tx.   What you really want is 100% SC for HepC.   Unless you were one of the lucky ones, like our friend, who didn’t experience any of the side effects.

Those medrecs will tell the story themself, so be sure to get all of them before you do anything else.   You have the right to have your records corrected by the Provider if there is something amiss.   I found several errors in my husband’s medrecs, too many severals.   Shouldn’t have been even 1.  One provider stated in one of her chart notes that she had erroneously reported in a previous entry that my husband was an IVDU.   She gave the date of the chart note, and when I read it, there was nothing even there about IVDU (and shouldn’t have been as he never did IVD)   I found errors in med flow charts, and some docs are so busy they template the previous visit and dictate only the changes.  1 doc we saw had an entire exam that was templated and……he only talked with us, never even touched my husband!

Providers make mistakes too often and the patient has the right to review their file.    Heck, the RO who did the review of my husband’s claim for HepC stated the QTC doctor made an error when he reported that his in-service tattoo was on the other arm!   The QTC doctor was right, the RO was not.   If I’d known now what I didn’t then, I would have sent in a NOD and we may have not had to deal with the BVA on this issue.   The look on the VLJ’s face when my husband rolled up his sleeve was priceless.   Right/Left/Right again….jumping tats.

Keep at it and always keep copies of everything and anything you send to VA, send it so they have to sign for it.

Someone else may jump in on this discussion if I erred in any info.

Keep on keeping on….

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RobD1956
Avatar / PictureModerator
Registered: 11/22/08
Posts: 31
05/06/09 #7

I just received my SC for hcv its still in the rating stage after a seven year battle. But I do know that hcv is a prime suspect in pn I have just been dx for that myself. Depending on my rating for cirrhosis and depression from hcv it will be my next claim being the neurologist explained it was more likely than not caused by hcv. This was a VA neurologist. I have been on SSA for the seven year battle so they will most likely give in to TDIU. If that’s the case I will most likely not pursue it . I hope you find that piece of info helpful.__________________
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2009 VA ID cards

04/15/09 #1

My husband has HepC, was diagnosed in 2003, underwent Interferon and Ribaviran treatment in 2004, was not cured, and was denied Service Connected for any pension.  He did get NS pension because we were below poverty level, until my social security kicked.Two weeks ago we received his new VA ID card and on the front it says “Service Connected”.  Our rep at the DAV says husband is in priority group 3 (though he was not a POW or PH medal recipient).HepC is the only thing the VA is treating him for.

In this case, what does the “Service Connected” mean, if anything, on the card?

Has HepC been made “presumptive”?

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NOD
Avatar / PictureManager
Registered: 11/22/08
Posts: 654
04/15/09 #2

Dear BJS1945, The SC or service connected on your husbands card reflects that he has (had?) the NS pension. When I first got my 10% for tinnitus, I too, was on the Priority 3 list. My card says the same. They do not change the card, but do know in the computer what your rating is. They only have one setting after 50% which is 50 to 100%. Unless you are trying to get dental. then you need a 100% or P&T. Oddly enough, having the SC on the card is a mistake on VA’s part if he is technically not SC for anything. Trust me, Hep is only presumptive if you were a POW or if you put in a claim for it within the first year of discharge from active duty. It would only be presumptive if you had it documented as occurring in your service med recs. Even then it would fall under the aegis of 38 CFR 3.303(b). You would have to be able to prove it was chronic via continuing symptoms documented by medrecs after discharge. VA offers a presumptive path as demonstrated via the risk factors questionnaire as well. I expect you are familiar with that one, though. If you lose your SS, he will be SC again. Without seeing any paperwork, that is J1VO(Just one Vet’s Opinion) noodledudeAttached Thumbnails:
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BJS1945
Registered: 04/15/09
Posts: 3
04/16/09 #3

Thanks noodledude.
We suspected that there was either a mistake or that “service connected” on the card meant nothing, and you have confirmed as much.
Barb
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NOD
Avatar / PictureManager
Registered: 11/22/08
Posts: 654
04/17/09 #4

Dear Barb,
Not knowing your circumstances, and hating to pry, but we always wonder why Vets lose. If there is something on this site that will help you win in a refile or if any of us bubbleheads can be of assistance, we would love to see your husband get SC for comp. Pension is nowheresville. Unless a Vet had IVDU issues in service and the willful misconduct thing rears its ugly head, there is a better than even chance a vet can get a win. The odds say 10/100 win. I propose that the ten that do are mighty persistent and do not go quietly into the night. I count myself as one of the 10. It took two shots to get here, but this just isn’t for the faint of heart. I first filed in 94 and lost all 3 claims. I refiled in 07 and got it all at the local level by doing what they advocated here on the HCVets site. Let us know if you need any info or were misinformed by a VSO as is so often the case. An example of this is that the Military Order of the Purple Nurple SO told me I couldn’t win a hep C claim with a Tattoo. Great advice, huh? We’re light years ahead of them here on what Vets need. Good Luck and please thank your husband for his service to our Country for us, too. NDAttached Thumbnails:
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BJS1945
Registered: 04/15/09
Posts: 3
04/18/09 #5

Thanks ND for all the info.
We will be looking into it further.
I have looked all over the internet and you guys have the best and most comprehensive info around.
Gotta get our “stuff” together again and print off some of the info here and see what we can do.
Barb
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NOD
Avatar / PictureManager
Registered: 11/22/08
Posts: 654
04/18/09 #6

Roger that, Barb. Good luck. Just do the I dream of Jeannie thing and put your forearms together and NOD. We’ll be there.ND sendsAttached Images:
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BVA– What happens if I die before…

03/14/09 #1

A Vet’s wife asked me what happens if her husband should pass away during the period after filing, but before final adjudication. I will attach a BVA decision that deals with this. One thing that is not specifically included in this case is that the wife of a deceased Vet may subsequently file a claim for benefits on her husband afterwards. They simply close this out as the Vet has no “standing”. This is certainly not an attempt at humor as we are talking about a man of honor who has passed away and left his wife in an awkward situation. She is free to pick up the reins and refile as the Vet’s wife. Which is what most wives do in situations such as this if they intend to pursue it.Citation Nr: 0843118
Decision Date: 12/15/08 Archive Date: 12/23/08

DOCKET NO. 07-28 112         )         DATE
)

On appeal from the
Department of Veterans Affairs Regional Office in New York,
New York

THE ISSUES

1. Entitlement to service connection for hepatitis C.

2. Entitlement to service connection for major depressive
disorder as secondary to hepatitis C.

REPRESENTATION

Appellant represented by:         Paralyzed Veterans of America,
Inc.

ATTORNEY FOR THE BOARD

M. Riley, Associate Counsel

INTRODUCTION

The veteran served on active duty from November 2004 to
October 2005 and died in September 2008. This case comes
before the Board of Veterans’ Appeals (Board) on appeal from
a January 2007 rating decision issued by the Department of
Veterans Affairs (VA) Regional Office (RO) in New York, New
York, which, in pertinent part, denied entitlement to service
connection for hepatitis C and depression.

FINDINGS OF FACT

1. The veteran in this case served on active duty from
November 2004 to October 2005.

2. On October 30, 2008, the Board was notified by the
veteran’s representative, Paralyzed Veterans of America
(PVA), that the veteran died in September 2008.

CONCLUSION OF LAW

Due to the death of the veteran, the Board has no
jurisdiction to adjudicate the merits of these claims at this
time. 38 U.S.C.A. § 7104(a) (West 2002); 38 C.F.R. § 20.1302
(2008); but see Veterans’ Benefits Improvement Act of 2008,
Pub. L. No. 110-389, § 212, 122 Stat. 4145, 4151 (2008).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

Unfortunately, the veteran died during the pendency of the
appeal. As a matter of law, appellants’ claims do not
survive their deaths. Zevalkink v. Brown, 102 F.3d 1236,
1243-44 (Fed. Cir. 1996); Smith v. Brown, 10 Vet. App. 330,
333-34 (1997); Landicho v. Brown, 7 Vet. App. 42, 47 (1994).
This appeal on the merits has become moot by virtue of the
death of the veteran and must be dismissed for lack of
jurisdiction. See 38 U.S.C.A. § 7104(a) (West 2002); 38
C.F.R. § 20.1302 (2008).

In reaching this determination, the Board intimates no
opinion as to the merits of this appeal or to any derivative
claim brought by a survivor of the veteran. 38 C.F.R.
§ 20.1106 (2008).

ORDER

The appeal is dismissed.

K. L. Wallin
Acting Veterans Law Judge
Board of Veterans’ Appeals

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NOD
Avatar / PictureManager
Registered: 11/22/08
Posts: 654
03/14/09 #2

And in the same vein I mentioned above, this is the method by which a widow of a Vet would attempt to obtain SC for her deceased husband. Here, she was successful and oddly enough, accomplished it with nothing more than a lowly Nurse Practitioner’s nexus rather than a full blown MD’s. The nexus even includes and alludes to IVDU hanky panky, but the VA let it ride. The poor guy is dead, after all.Citation Nr: 0803534
Decision Date: 01/31/08 Archive Date: 02/08/08

DOCKET NO. 06-27 720         )         DATE
)
)

On appeal from the
Department of Veterans Affairs Regional Office in Portland,
Oregon

THE ISSUE

Entitlement to service connection for the cause of the
veteran’s death.

REPRESENTATION

Appellant represented by:         Oregon Department of Veterans’
Affairs

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

L. J. Wells-Green, Counsel

INTRODUCTION

The veteran served on active duty from September 1968 to
January 1971. He passed away in June 2004, and the appellant
is his surviving spouse.

This matter came to the Board of Veterans’ Appeals (Board) on
appeal from a December 2004 rating decision of the Department
of Veterans Affairs (VA) Regional Office (RO) in Portland,
Oregon.

In September 2007, the appellant testified at a travel board
hearing at the RO before the undersigned Veterans Law Judge.
A transcript of that hearing has been associated with the
claims folders.

FINDINGS OF FACT

1. The veteran died in June 2004, at age 53; the immediate
cause of death was listed as cirrhoses of the liver, due to
hepatitis C infection; hepatic encephalopathy and
hypertension were identified as significant conditions
contributing to his death.

2. Resolving all reasonable doubt in the appellant’s favor,
the veteran’s hepatitis C has been etiologically linked to
his service.

CONCLUSION OF LAW

The criteria for service connection for the cause of the
veteran’s death are met. 38 U.S.C.A. § 1310 (West 2002); 38
C.F.R. § 3.312 (2007).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

VA’s Duties To Notify And Assist

In Pelegrini v. Principi, 18 Vet. App. 112 (2004), the United
States Court of Appeals for Veterans Claims (Court) held, in
part, that a Veterans Claims Assistance Act of 2000 (VCAA)
notice, as required by 38 U.S.C.A. § 5103(a), must be
provided to a claimant before the initial unfavorable RO
decision on a claim for Department of Veterans Affairs (VA)
benefits.

The Board has considered the appellant’s claim with respect
to VA’s duties to notify and assist a claimant. The Board
finds that the VA letter dated in October 2004 fully
satisfied VA’s duty to notify the veteran, and that any
defect with respect to the timing of the receipt of the
notice requirements is harmless error in the case. 38
U.S.C.A. §§ 5100 et. seq. (West 2002). Moreover, given the
favorable outcome noted below, no conceivable prejudice to
the appellant could result from this adjudication. See
Bernard v. Brown, 4 Vet. App. 384, 393 (1993). Thus, the
additional delay in the adjudication of this issue, which
would result from a remand solely to allow the RO to apply
the applicable notification and assistance duties, would not
be justified.

Analysis

To establish service connection for the cause of a veteran’s
death, the evidence must show that a disability incurred in
or aggravated by service either caused or contributed
substantially or materially to death. 38 U.S.C.A. § 1310; 38
C.F.R. § 3.312.

For a service-connected disability to be the primary cause of
death, it must singly or with some other condition be the
immediate or underlying cause, or be etiologically related.
38 C.F.R. § 3.312(b).

Contributory cause of death is inherently one not related to
the principal cause. In determining whether the service-
connected disability contributed to death, it must be shown
that it contributed substantially or materially; that it
combined to cause death; that it aided or lent assistance to
the production of death. It is not sufficient to show that
it causally shared in producing death, but rather it must be
shown that there was a causal connection. 38 C.F.R.
§ 3.312(c).

The June 2004 death certificate shows that the immediate
cause of the veteran’s death was cirrhosis of the liver with
the underlying cause listed as hepatitis C. Hepatic
encephalopathy and hypertension were listed as other
significant conditions contributing to death but not
resulting in the underlying cause.

After carefully reviewing the evidence of, and resolving all
reasonable doubt in the appellant’s favor, the Board finds
that service connection is warranted for the cause of the
veteran’s death. The veteran’s service medical records show
he received a blood transfusion in 1969 following an injury.
Medical evidence of record indicates he received another
blood transfusion after his discharge in 1972 for an
unrelated injury. The evidence also indicates that he
frequently gave histories of having been an IV drug user and
that he also had tattoos. Although hepatitis was initially
suspected in April 1989, the evidence is unclear as to when
the veteran was initially diagnosed with hepatitis C. In
June 2006, a VA nurse practitioner, after reviewing the
veteran’s claims file, opined that it could be as likely as
not that the veteran contracted his hepatitis C infection
from his in-service blood transfusion. The nurse
practitioner further opined that it was more likely that his
IV drug use was a more significant risk factor for his
contracting hepatitis C, but that the in-service blood
transfusion could not be excluded as the source of the
veteran’s contraction of the disease. There are no other
medical opinions of record addressing the etiology of the
veteran’s hepatitis C. In light of the foregoing, and
resolving all reasonable doubt in the appellant’s favor, the
Board finds that service connection is warranted.

ORDER

Service connection for the cause of the veteran’s death is
granted.

____________________________________________
KATHLEEN K. GALLAGHER
Veterans Law Judge, Board of Veterans’ Appeals

I commend VLJ Kathleen K. Gallagher for a magnanimous decision in this case. Many Justices would find that one niggling piece of evidence such as the Nurse’s nexus and make life miserable for the widow. She did not. There is some humanity still left at the BVA in spite of what one hears. This is proof. Unfortunately this is the exception to the rule.

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38 CFR § 20.900(c) Hardship Claim

For some of you, this is like going into the deep end before you know how to dog paddle. This info is for Veterans who are handling their own claims. If you feel confident to do this, and have the fire in your belly, then you may be able to accomplish it. Defending yourself pro se (latin for oneself) is not an easy chore. Of course, if you are terminally ill, what are you doing with your spare time other than trying to outguess Drew Carry’s contestants? There’s not a lot of difference sailing a sofa around the known universe and a chair behind a laptop. Look no further than the idiot typing this post. I couldn’t turn one of these on before Nov. 07. All it takes is a terminal illness, anger, and a belief that you are entitled to what the Govt. said you were when you held up your right hand.

First, let me explain a hardship claim. It is applied for much the same way you file for any other claim with the VA. You are asking them to “hurry up” your claim due to financial or medical reasons such as bankruptcy or terminal illness that may kill you prior to the completion of their painfully slow legal process. It allows your claim to be moved to the top of the pile for more immediate adjudication. The VA has to address this communication promptly or they look bad. Dead Vets with old claims are a Bozo no-no at 6 PM on the local news. When they commit suicide in frustration down at the local Vet’s Memorial in town, it becomes a PR nightmare for VA.

Filing, if you represent yourself, is no more complicated than sitting down in front of the C-box and typing in the Dear Sir, etc. Basically you are going to ask for either or both reasons depending on your circumstances. If it’s financial, include evidence of a foreclosure, unpaid medical, credit cards, cars, etc. the more the merrier. If its medical, then evidence of an incurable hep. that is spiraling out of control with cirrhosis and end stage liver symptoms such as ascites and portal gastropathy. These must be medical records signed by an MD. They don’t just take your word for it. I’m sure I don’t need to ask who out there qualifies for this. If your doctor has told you you’re shelf life is shorter than a Hostess Twinkie, you know you qualify. And if there’s a gentleman out in front of your house taking pictures ten days after you missed the mortgage payment, then chances are you,too, are a candidate.

Next, you do not need any special forms for this. While the VA would like you to always use Form 21-4138 to make their life easier, you will notice that they do not always reciprocate. In fact, shockingly enough, I have heard “bad words” said of the VA which we, as civilized, gentle persons, will not repeat here. Some of you Vets have come to the conclusion that the VA does not listen to your complaints and even ignores you. Has anyone ever tried to call the VA and get in touch with a person “knowledgeable” about their personal claim? I am not talking about Dial a Smile here. The drawbridge is always up at their castle and the moat is too wide to ford. So, why should you be forced to abide by their rules and regulations? Fortunately for you, the one size fits all does not apply. The CAVC has long ago decided that any communication you send the VA must pass the legibility test as well as clearly communicate that which you seek. That means you are free to personalize your communications stationary and to use the tried and true Standard Form 8.5X11 W (SF 8.5X11 W) that you load into your printer. See? This is getting easier by the moment. We have now eliminated PDF printable downloads that even I admit having a hard time locating. You may, should you so desire, use toilet paper if that is your personal choice. Its rather inappropriate for the task, but nevertheless permitted. An incarcerated Vet who was a guest of the Texas Corrections Institute of Higher Learning used a paper towel for lack of a better medium. His NOD was accepted after much complaint. As it should have been. Now they all are. All you need to include is your name, rank, airspeed and tail number.

The end result of your filing will be a decision reached in less than 90 days (they say). They did mine in 88. The VARO mailrooms across America have what is known as a Triage system to digest incoming mail. The Vets with the most immediate problems ( and I would say Hardship is among them)get the top drawer treatment. As I mentioned above, no one likes to find dead Vets littering our streets. It give politicians a bad name (or a worse one than they already have now after all this Earmark insanity.) So your filing for hardship will be greeted with the proper respect you would think should be normally accorded any claim you file. It’s unfortunate any Vet should reach the end of his rope before he has to resort to this method. I didn’t make the rules, but I sure can read them. That is why I mention this tried and true path. Do not use this as a shortcut. If you are NOT a hardship case and just impatient, this can cause your claim to end up at the bottom of the pile with an ugly case of black hole gravity that continues to pull it down deeper.

Attached here is the beginning of a BVA file that shows what happens when you are successful in you hardship filing. It is rather anticlimatic, but an illustration nonetheless:

Citation Nr: 0832858
Decision Date: 09/24/08 Archive Date: 09/30/08

DOCKET NO. 04-34 975         )         DATE
)
)

On appeal from the
Department of Veterans Affairs Regional Office in St. Louis,
Missouri
THE ISSUE

Entitlement to service connection for post-traumatic stress
disorder (PTSD).
REPRESENTATION

Appellant represented by:         Texas Veterans Commission
ATTORNEY FOR THE BOARD

B. Berry, Associate Counsel
INTRODUCTION

The veteran served on active duty from January 1953 to
October 1954.

This matter comes to the Board of Veterans’ Appeals (Board)
on appeal from a rating decision dated in July 2003 by the
Department of Veterans Affairs (VA) Regional Office (RO) in
St. Louis, Missouri. The veteran now resides in Texas.

In May 2006, the Board remanded this matter to the RO for
additional research to attempt to verify the claimed in-
service stressor. After accomplishing the requested action
to the extent possible, the RO continued the denial of the
claim (as reflected in the May 2008 supplemental statement of 
the case (SSOC)) and returned this matter to the Board for
further appellate consideration.

In February 2007, the veteran submitted a claim for service
connection for diabetes and leukemia. This matter is
referred to the appropriate RO for further development.

The appeal has been advanced on docket pursuant to 38 C.F.R.
§ 20.900 (c).

This is always filed at the VARO level. It will find its way to Washington if your claim is on appeal. The adjudication occurs at the local level as do all VA claims. They forward the results to wherever the claim resides currently. I hope this shines some light on another dark corner of our illustrious Govt. entity. I know most Vets feel very powerless to take on Goliath, but you will discover you have an inner power that shines in the face of adversity. My hope is to empower Vets, one at a time. You may feel you’re fighting a faceless entity, but you can get justice if you have the patience and the time. Vets are a unique class of humans unto themselves. Historically, our military succeeded where most others have failed because we entrusted so much decision making power to the lowest levels of command. This is why there was no permission slip attached to every hand grenade you were issued. Good Luck and Godspeed, Gentlemen. You are a very unique, illustrious Band of Brothers capable of anything you attempt, whether it be solo or in concert. The VA prays it will be otherwise. I sincerely hope you disappoint them.

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38 CFR § 4.114 DC 7343(IFN TX)

In Part 4 of 38 CFR, you will find Section §4.114 which deals with the Schedule of Ratings for diseases of the digestive tract. There you will find Diagnostic Codes (DCs) that refer to specific diseases. The ones that most concern those of us with Hepatitis are DC 7345 (Hep.B, AIH, and chronic Hep.B), DC 7354 (Hep. C), and DC 7312 ( Cirrhosis). However, it has come to our attention that DC 7343 is a Diagnostic Code that has bearing on those Vets who undergo “Antineoplastic Chemotherapy”- a fancy name for Interferon therapy treatment. Technically, if you are SC for hep and under any chemotherapy treatment of the digestive system, you are eligible to apply for a temporary rating under this DC. Six months after cessation of treatment, VA is obligated to rerate you and base any decision on 3.105(e) and any residuals. We all know about residuals. Veterans may be overlooking a valuable loophole in the regulations by not availing themselves under this DC. There is nothing underhanded about this. Perhaps VA did not anticipate that some idiot would come up with a drug as insidious and nefarious as Interferon. They certainly didn’t anticipate all the side effects associated with it such as Fibromyalgia, Arthritis, DM2, blindness, Cryoglobulinemia, and Peripheral Neuropathy to name just a few. Filing a claim at the outset of IFN therapy if you are SC for HCV should now be a no brainer. The rating is 100% for the duration of the therapy and six months after as I mentioned. I reprint it below for your reading pleasure. Sometimes it is necessary to retire to the dictionary to discover what “chemotherapy” actually is defined as. We have already discovered that “is” has more than one meaning according to Slick Willie.

7343 Malignant neoplasms of the digestive system, exclusive of skin growths         100 %

Note: A rating of 100 percent shall continue beyond the cessation of any surgical, X-ray, antineoplastic chemotherapy or other therapeutic procedure. Six months after discontinuance of such treatment, the appropriate disability rating shall be determined by mandatory VA examination. Any change in evaluation based upon that or any subsequent examination shall be subject to the provisions of §3.105(e) of this chapter. If there has been no local recurrence or metastasis, rate on residuals.

Technically, the definition of malignant neoplasm is a malignant tumor. The term is also synonymous with cancer. As Hep.C creates fibrosis of the liver and eventual Hepatocellular Carcinoma (HCC), it can be classified as a malignant neoplasm. Therefore you will see more and more Vets who are SC and seeking IFN TX investigate this avenue. It will take the sting out of the financial nightmare when the income dries up during therapy. I wish there was some way to inject humor into this post, but I can find no humor with regards to Interferon. It a lot of my friends. One dose ended up causing my Crohns disease to relapse after 12 years in remission. It also turned lose the AIH dragon. VA should step up and offer some financial remuneration for any VET that chooses to use this poison, service connected or not.

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VETERANS SERVICE ORGANIZATIONS

01/31/09

After much talk, with many Vets, I have discovered two schools of thought regarding VSOs in general, and SOs(Service Officers) in particular. There does not seem to be any grey area in between on the subject of positive vs. negative experiences. I have found a total of 3 vets that were marginally appreciative of their SO’s efforts to assist them. I have not kept a running total on dissatisfied Vets, but the numbers are huge. I started a thread on this on our Delphi message board several months ago. I hate to say it but the consensus is that they are in cahoots with the VA proper. How else can they be so inept at filing our stuff, ignoring us after they have our POA, and losing a good percentage of our filings? They blame all these failings on the VA (lost filings) and try to console us.

I have had three encounters of the VSO kind now and all three were less than satisfactory. My first was with the DAV, who came highly recommended in 1989. They never left me out to dry. I will give them that. My rep. went with me to my  RO DRO Hearing in 91 and asked me questions and tried to sound like a doctor. All we succeeded in doing was have all the testimony declared useless as it was “lay” testimony, rather than a statement from a doctor. I did get the 0% popsicle stick for both my left ear and tinnitus. No one ever suggested I file an NOD and attempt to get a higher(read compensable) rating. My  claim was  appealed but I lost the most important one-my back.
My second encounter was with AMVETS in 1994. They did everything but change their phone number after I signed on the POA dotted line. After I was denied, I gave them my Form 1-9 to file the appeal along with an initial rebuttal. To this day, no one knows where that Form 9 was sent-or if it really was. VA insists they never received it. Strangely, I believe them. My SO decided to become a Used Car Salesman shortly after I gave him the F-9. Its possible he wrote his resume on the back of it. Result- no appeal. Needless to say, I didn’t win on the Hepatitis, the PCT, or the reopen of the Tinnitus. Too bad. I really thought I had a better than even chance. I did have hep in service and I was hosed with Agent Orange and Blue. Keep in mind, the SO neglected to point out that in order to win, I needed the 3 Caluza/Hickson elements. Seems pretty simple. Make a note on the desk-Remember to tell Vets to get a nexus! I guess it was above his pay grade.

Again, in 2006. Like a trooper, I marched down to the Military Order of the Purple Heart, with many assurances that they were the golden boys. Again, no mention of the Caluza requirements. I found out about nexus requirements on HCVETS, and brought up the subject with the SO. His reply was that EVERYONE knows about the nexus requirement! I gave them everything to file and soon I discovered that med recs and 4138s were not in my file and they had no recollection of my having handed them in. To remedy this defect, I started filing the stuff with the Head office in Seattle. That didn’t help. They lost my nexus and never filed it. Finally, I started sending the stuff directly to the VA. And wonder of wonders, they started receiving it! At that point I was informed that if I continued doing this, I would lose my MOPH representation. I decided to take them up on their offer. They had just refused to file my NOD on the Tinnitus effective date anyway. They had decided it was “frivolous”. Boy, did I feel pregnant and alone! But guess what? Within the next 9 months I finally succeeded on both of my claims. I had been told I would never win on either one, so this really came as a surprise.

Your SO should be your confidant. He should be knowledgeable in what he is doing. He should be accessible for consultations. After all, he’s getting paid by Uncle Sam to do this. Yes, you read that right. They (the VSO) get paid for every POA they collect. You may notice the ability to reach your SO is inversely proportional to the square of the length of time he has had your POA. Surprised? Don’t be. You are not unique. I’m sorry to be the one to break this to you.

So, after all this discussion, we are wondering who is the best of the best? Who is there when you need them? Who has been successful dealing with Uncle Victor? Guess what. The Vet Jury is in. The winner appears to be the Vietnam Veterans of America, hands down. They do appear to have an extraordinary record up at the BVA level compared to the other big guys. I haven’t analyzed the results from the CAVC, so I’ll hold my opinion on that venue. Perhaps it all depends on the individual, the specific circumstances, the SO, the location in the US, or just blind luck. Who knows? Of course, the best money is still on the real McCoy-John Q. Vetlawyer.

If you have had an adjudication with the VA, an appeal sent up to the BVA, or had the pleasure of an appearance before one(or a panel) of our esteemed CAVC judges, we would be interested in who represented you, an honest assessment of their help, and whether it was instrumental in your success/failure to win. By the same token, we would be interested in how many Vets have attempted to do this Pro Se( by themselves) and their results. If you used a private attorney, we would be interested in how that turned out,as well.

The information will help all of us here to make choices on whether to seek help and from which VSO to seek it. Your input may help another Vet to win in your part of the country.We at Ask Nod try to give you the tools to accomplish this yourself. However, not all Vets are capable of tackling this task on their own. It can be very difficult, time consuming, and often results in frustration and severe depression. HCV, in its own right, is depressing, but this can be even more so. Please help us help you with your comments and input. We at ASK NOD would be very appreciative. I think it goes without saying that Vets would value another Vet’s opinion. Thank you and God Bless you for your Service to America.(Yeah. Kind of corny, I know, but we still believe in God). And we’re politically incorrect, too, so we apologize in advance.

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John Q. Public’s misconceptions about Hep C

 01/23/09

People ask me if having a tattoo will destroy their chances of winning their jetgun claim for Hep. Yes. You read that right. Well, gosh, where should I start? If you have filed your claim, you must have filled out a Risk Factors Questionnaire by now. You may have noticed that they ask you about 10 questions and not one of them mentions jetguns. VA simply doesn’t consider that a risk. Don’t shoot me, I’m the messenger. I think it’s a viable path to infection. Hell, if someone took an air tool covered in blood in a garage setting and jammed it up against my arm and blasted me, I’d say that was pretty unsanitary. I’d say it stood a pretty good chance of pressurizing some blood subcutaneously into my flesh. If he had HCV or AIDS and I didn’t, then I’d be lying if I said I wasn’t worried. VA Examiners don’t see it that way. Now, how does that differ so much from a tattoo? Or shooting up heroin? Or sharing a bloody straw(?) whilst tooting Peru’s main export?

Unprotected sex is another avenue the VA recognizes. However, as with tattoos, the VA considers these vectors of transmission to be a 2 on a scale of 10. If you had unprotected sex with 10 or more partners then you are “at risk” in their parlance. What about the guy that only had 9 partners? Ne problemo? I don’t think so. VA says your chances of getting HCV with one exposure to IVDU a la shared needle are 100%. They say your chances of getting HCV with one Transfusion, which, I might add, involves 800 milliliters of blood, is greater than 60% if it happened before 1989. Do you know if you loaded up syringes of blood, how many it would take to make 800 milliliters? You got me there but it must be more than 200 to 300 syringefuls. Why the disparity in how this disease is transmitted? If you shared razors, toothbrushes, or fingernail clippers they will consider it a risk factor. However , when actually pressed, they will say it is a less that 1 in 10 chance of being infected. It’s actually just “unsanitary” in their book of risks, but they can and do occasionally cave in and hand out a rating for that.

Going back to the IVDU risk, why would you have a 100% chance of catching it the first time out? Or, if snorting coke, why a 100% risk sharing a straw? There is something wrong with the way these risks are assessed. It has a lot to do with morality and public perceptions. VA is not going to suffer bad PR if they turn down a Junkie VET, unless he has an CMOH hanging around his neck. Or a DFC, Bronze Star, Silver Star, CIB or PH. Most decisions involving IVDU that win seem to have a common thread- medics and heroes. If you were in combat, shot up daily, and your buddy managed to inherit the wrong end of a RPG round, you will get SC for picking up all his pieces and carrying them back to the meatwagon or dustoff. You and I know that if he had HCV, it would make sense that you were exposed to his blood, ergo stood a good chance of infection. But that’s a pretty big IF in their book. Fact is, that ugly habit of sticking a not so autoclaved needle in your arm every day was a much higher risk. But the Junkie Combat Vet gets a pass with the CIB. Why? PR and 38 USC 1154(b). Only 15% of us were actually in combat.  85% were thus support troops. John Q. Public is not going to have a problem with VA turning down 12,000 vets each year for HCV just because they were on the wrong end of a dirty jetgun in Basic Training.

The problem is now defined. How shall we HCVets go about convincing the rest of America we have a valid claim to SC? Good Question. I hope you Vets are as good at finding an answer to it as you were defending America. I have faith in you and expect you’ll find the solution. I will continue to find ways to get you SC in the meantime with the risks VA does recognize and new ones you identify. Good Luck, Band of Brothers.

By the way, recognize anyone in this picture? Operating Location Charlie, 1980th Comm. Sq.  1970.  Two of them had Hep in service within 2 months of this photo being taken. One is service connected (me, bottom right in Camo). I don’t know about the other one (right behind me standing looking right). I pray he didn’t come down with C, too.  Sgt. NOD

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BVA-Why not me? He got $.

 Every once in a while we have to go back and reiterate certain principles of VA law that gradually become dim in claimant’s minds. This case is a refresher course . It was posted the other day and thus is brand new. Unfortunately it does not set precedence, something all BVA decisions have in common. BVA adjudications are valuable for one reason for Vets. It gives you an idea of what you are preparing to encounter and and a valuable place to pick up precedent setting Court panel decisions relating to your claim. Beyond that they are just paper and have recycle value.Here is an excerpt from this case that bears examination by all potential appellees:The Board also notes that the Veteran has submitted excerpts from two other Board decision pertaining to appeals of other veterans, in which their hepatitis C was found to be linked to in-service exposure to unsanitary air-jet inoculation guns.  The facts and findings in prior Board decisions pertain to those veterans’ cases and not to the case at hand.  While it appears that excerpts from prior Board decisions may indicate that other Veterans Law Judges accepted medical evidence showing a link between the other veterans’ hepatitis C and their in-service exposure to unsanitary air-jet inoculation guns, any finding in those prior Board decisions is based on evidence associated with the record of those veterans in the other appeals.  The Board is not bound by findings found in previous Board decisions.  Further, any finding made in a prior Board decision pertains only to the veteran who submitted that appeal.  Such a finding is based on the evidence related to that veteran’s medical records and the evidence in that veteran’s claims file.  Those decisions do not provide any specific findings or evidence to establish a link between this Veteran’s hepatitis C and any aspect of his period of service.

Keep the above in mind before you start typing your claim…

http://www4.va.gov/vetapp10/files5/1040550.txt

 

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BVA–Too many DD 214s

    An observant reader sent us this one. It’s priceless. It must have cost VA a bundle to sort this one out, but sort it out they did. I give them credit for being thorough. This is why it takes so long to get a BVA docket date or anything else done at the RO for that matter. One does wonder what he was drinking or smoking to get his story line so messed up. For any of you out there thinking of trying this, remember the Green Berets didn’t refer to themselves as such. They were called Special Forces. Sgt. Barry Sadler was the one who brought us that term. 



Enjoy the read. I did.
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BVA– HAV = Nobucks

 Boy, this is the mistake of a lifetime. Our Vet from New Jersey here, with his County rep. as a VSO, has unwisely elected to get himself service –connected for HAV, not HCV.  When asking for actual compensation instead of the goose egg he is currently receiving, the RO and BVA have decided to take Diagnostic Code 7345 literally and inform him that the standard rating for HAV, infectious hepatitis is 0%. Even assuming an extra-schedular exam, there can be no more. All of his ills that we associate with HCV are not recognized because he isn’t SC for HCV. They also gravitate to the first word “chronic” and point out HAV is an acute rather than a chronic condition- again no bucks.

Diagnostic code 7345

Chronic liver disease without cirrhosis (including hepatitis B, chronic active hepatitis, autoimmune hepatitis, hemochromatosis, drug-induced hepatitis, etc., but excluding bile duct disorders and hepatitis C)

What we find interesting is latter day testing has revealed that the hep. this Vet had in 68-70 was HBV, as in viral hepatitis. Infectious HAV is transmitted through the oral-fecal route-as in eating food prepared by someone infected that went to the bathroom, failed to adequately wash his or her hands and has absolutely no clue how to operate the toilet paper dispenser. (I would like to make an aside and point out that these people are not underemployed but unschooled in hygiene).  They carefully point out that he is HBV immune by virtue of this prior infection but make no other conclusions or observations.  They were’t asked to consider this eventuality. As myopically as possible, they are narrowly focused on just an increase for his HAV. They  have also examined all his complaints and medical info. similarly. As it has nothing to do with HAV and virtually everything to do with HCV, he cannot be rated for it under DC 7345. They summarize it in the standard format. Rule #1 says HAV is a non-chronic form of hep. and therefore it is rated 0% when service connection is granted. Rule #2 says if you have HBV or HCV, then refer back to rule #1. Circular logic is so efficient and takes up very little space when explained and fits conveniently into circular wastebaskets.

     What makes this so tragic was the VSO was supposed to know this and build a case for the Vet that would get around it. By arriving in D.C. without it, this outcome was predictable and a waste of time. Every one of the participants (with the exception of the Vet) could see this coming like a tornado. Look at how much time he had invested. A hearing probably set him back a year or more on top of the denials.  The fact that he lied about his weight has no bearing on it. He could have lost 100 lbs. and been a candidate for the freak show at Barnum and Bailey but still wouldn’t have gotten an increase.  

     It appears it’s back to the drawing board for this guy. He’s claimed he’s unable to work, so he has several options absent another vigorous attack on a HCV rating. Didn’t anyone tell him about Groves v. Peake? Nexus letter?  38 CFR § 3.303(b)?

http://www.va.gov/vetapp11/Files2/1115068.txt

      Sometimes they piss me off.  I refer to both of them- VA and VSOs. They could have taken this ol’ boy aside and explained all this without stringing him out for three years. He probably had a bottle of Dom chilling in the garage refer just waiting for the big moment. Well, maybe Cold Duck or rack of killer IPA anyway. It’s somewhat immaterial at this point, anyway. Regardless, it just sucks what they do to us. 

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