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Welcome to The Veterans Disability Nexus, where we provide unique insights and expertise on medical evidence related to VA-rated disabilities. Leah Bucholz, a US Army Veteran, Physician Assistant, & former Compensation & Pension Examiner shares her knowledge related to Independent Medical Opinions often referred to as “Nexus Letters” in support of your pursuit of VA Disability every Tuesday & Wednesday at 7AM Central.
Take control of your medical evidence related to your benefits and visit https://podcast.prestigeveteranmctx.info/veteran/ for more information and to connect directly with us!
Hey guys, it's Leah B from Prestige Veteran Medical Consulting. I am a U. S. Army veteran, physician assistant, and former compensation and pension examiner. Welcome back to our channel where we break down VA disability benefits in plain language and help veterans take charge of their claims.
Leah Bucholz:So I'm Leah for those of you guys who don't know me. As I mentioned I'm a PA and former C and P examiner and today we're going to dig into a condition that affects thousands of veterans and that is hepatitis, especially hepatitis B and C and how veterans can get service connected for this. So this episode is going to cover things like what hepatitis is and how it affects veterans, how it can be directly or secondarily related to your service or linked to your service, what the VA looks at for those types of claims, and what steps you can take to help support your case from a medical perspective. So if you've been diagnosed with hepatitis or you even think you might have been exposed this episode is definitely for you. So what is hepatitis?
Leah Bucholz:So let's start with the basics. Hepatitis is an inflammation of the liver usually caused by a virus. The two types, there's many types, but the most prevalent types are going to be hepatitis B, often referenced in your medical records as HBV or hepatitis B virus and hepatitis C or HCV, hepatitis C virus. Both can lead to chronic liver damage, cirrhosis, liver cancer, and serious complications if left untreated. So how is hepatitis transmitted?
Leah Bucholz:Exposure to infected blood or body fluids, unsterile needles or air gun injections. A lot of air guns were used to do vaccines at one point. I've seen a lot of cases like that. Blood transfusions before 1992, combat trauma or emergency surgeries, in some cases sexual contact or sharing razors. Many veterans especially those who served before the early 90s may have been exposed without even knowing and their symptoms can take years to show up.
Leah Bucholz:So direct service connection for hepatitis. So what is that? How do you get hepatitis and how can it be directly service connected? So three things are going to be relevant to any type of claim right and that's going to be that you have a current diagnosis in this case a current diagnosis of hepatitis B or C, evidence of exposure or symptoms during service, and a medical nexus or essentially a doctor's opinion linking those two. Examples of direct service connection could be things like receiving a blood transfusion during the military before 1992.
Leah Bucholz:You could have been injected with a gun with a air gun for immunizations which were not always properly sterilized. You might have been a combat medic and your records show that you were exposed to blood when you were treating patients. So you served in an area with unsafe water or unsafe medical sanitation standards. The VA has acknowledged that air gun injector risks in hepatitis cases especially for hep C. While not automatically presumptive it can support your claim if you have pretty strong evidence that supports it.
Leah Bucholz:So secondary service connection. Let's talk about secondary service connection for hepatitis. So this is when your hepatitis is caused or worsened by another condition that's already service connected. So again some real world examples could be if you're service connected for PTSD and you develop substance use disorder, you contracted hep C through IV drug use but your alcohol or drug use is medically linked to your PTSD. You could be on immunosuppressive medications for a service connected autoimmune condition and those meds caused a reactivation of a dormant hepatitis B virus.
Leah Bucholz:That could be like an aggravation case. You were treated with VA prescribed blood products or equipment after service that later turned out to be contaminated. These can be kind of tricky but with medical documentation and a solid nexus either from your C and P examiner, your treating provider, whoever, many have been granted. So what does the medical literature say about hepatitis? So medical research is definitely on your side, if some of these circumstances apply to you.
Leah Bucholz:So studies show that veterans who received airgun injections in the military were at increased risk for hepatitis C transmission especially before standard sterilization protocols were enforced. So the VA itself has published guidance on this issue VA Fast Letter 211B that was in 2012 and it even mentions that the need to evaluate hepatitis C claims based on likely exposure during airgun immunization. So hep C can remain dormant for decades as I mentioned meaning that you could have been infected in service and not even diagnosed until many years later. So this type of evidence can support your claim. You can ask your doctor to reference it.
Leah Bucholz:It might make a difference especially if you've been done been denied in the past. So how does VA rate hepatitis? So VA rates chronic hepatitis under 38 CFR 4.114, diagnostic code seven thousand three and fifty four for hepatitis C and seven thousand three hundred and forty five for hepatitis B. The rating depends on things like lab results that show maybe your AST or your ALT or your bilirubin abnormalities, symptoms like fatigue, malaise, anorexia, jaundice, or weight loss. The number and severity of incapacitating episodes requiring bed rest prescribed by a physician.
Leah Bucholz:So some example ratings would be like ten percent for intermittent fatigue or malaise, thirty percent for more persistent symptoms with weight loss, sixty to one hundred percent for near constant fatigue, severe symptoms, liver damage, or hospitalization. In advanced cases, people might also qualify for secondary ratings for things like cirrhosis, liver cancer, hepatic encephalopathy. So what can you expect at a C and P exam? So if you file a claim for hepatitis you're likely going to go to a compensation and pension exam with somebody who has training about the liver. So it doesn't have to be a GI doctor or hepatologist.
Leah Bucholz:It could be a nurse practitioner or a PA. It's within their scope of training or a general physician. The examiner will look at things like your diagnosis and labs, symptoms like fatigue, jaundice or pain, history of treatment or flare ups, possible exposure scenarios. So you may wanna bring your own medical records especially if you haven't submitted them, any lab results, any documentation of in service exposures. Be honest, be specific about how your symptoms affect you daily.
Leah Bucholz:So before we wrap up, I wanna always touch base on tips that can help you strengthen your position and that's to work with a VA accredited representative like a VSO or a claims agent or an attorney. They can help you strategize and navigate the system. You wanna make sure you have that confirmed diagnosis because they wanna see that objective evidence. You can provide that detailed history of in cervix exposure. You can ask your doctor for a nexus letter if they're willing to write you one if they believe that it's related to service using that at least as likely as not language.
Leah Bucholz:They might want to include peer reviewed studies if possible or that VA FAST letter that we talked about. So also if it's secondarily related to your PTSD or other medication that that may want to be referenced. So hepatitis may not always be visible you guys. There's a lot of invisible diseases that we suffer from, but it can change your life. If it's connected to your time and service, you deserve compensation, whether it's from that transfusion that you had, a medical procedure, like an air gun injection, there are several paths to service connection.
Leah Bucholz:So if your claim has been denied, don't give up. Get help from that VSO or accredited rep or a VA attorney, and don't be afraid to appeal things. Don't just give up. So thanks again for watching as always. Hope you guys enjoyed today's episode and please like and subscribe and drop some comments.
Leah Bucholz:I always love to hear you guys' stories of how you overcame things and continued to persist. Let me know if there's any other videos that you'd like to hear about or have me do videos on and I'll add them to the list. Okay thanks guys.