Dave Jenkins knew his younger brother, Greg, had problems.
His 54-year-old brother was a homeless drifter most of his adult life, in part because of schizophrenia that led to decades of alcohol abuse and other physical problems.
But Dave Jenkins, 62, who saw his brother regularly despite his wandering, never thought Greg was near death -- until he got sick during an inpatient visit at the Pittsburgh Veterans Affairs University Drive hospital in the fall of 2011.
"All I know is, when he went in to the VA for some psoriasis, he was OK," Mr. Jenkins said in an interview at his home Friday in Edinboro, Erie County. "But after, he was never right; he never came back to what he was."
Eleven months later, on Oct. 17, 2012, Greg Jenkins died at the VA hospital in Erie.
On Greg's death certificate, the attending physician listed three primary causes -- cirrhosis of the liver, congestive heart failure and coronary artery disease. There were also two contributing factors: anemia and diabetes.
It wasn't until several weeks after his brother's death, during a call from Pittsburgh VA officials, that Mr. Jenkins ever heard anyone mention that his brother had contracted Legionnaires' disease during that hospital stay in 2011. The water-borne disease is spread through inhalation of contaminated water but predominantly affects people who are physically compromised from other health problems.
"Greg had mentioned pneumonia before, but I didn't think much of it," Mr. Jenkins said.
Unbeknownst to Mr. Jenkins or his brother, Greg had contracted the disease during a two-year-long Legionnaires' outbreak at the Pittsburgh VA that is believed to have played a direct role in the deaths of at least five other veterans and sickened at least 17 others. Greg's case was listed by VA officials as one of the 17 who recovered from the disease.
Legionnaires', though, isn't just a form of pneumonia, as Mr. Jenkins knows, it's one of the worst forms.
Mr. Jenkins, like his father, several uncles, and Greg, is a veteran. So the 1976 Legionnaires' outbreak that killed 25 members of the American Legion during a convention in Philadelphia was well known to him.
Even if a person survives the initial bout of Legionnaires', it can cause so much damage to the lungs and severe respiratory problems that it compromises a patient's health long after he is deemed recovered.
"It is a common complaint from patients who contract Legionnaires' disease that they're never the same after, almost like a post-traumatic syndrome," said Victor Yu, a Legionnaires' expert and researcher who for nearly 30 years worked with doctors at the Pittsburgh VA in treating patients with the disease before he was fired by VA management in a dispute in 2006.
Dr. Yu and others have long worried that that focus on the five men at the VA who died after contracting the disease has overshadowed the impact Legionnaires' has had on others who got the infection but recovered -- as Greg Jenkins did initially.
French Stafford, 57, a veteran who lives in Weirton, W.Va., knows that first-hand.
"Let me tell you, it's something you don't want to get," said Mr. Stafford, an Army veteran and former mechanic who is on disability because of problems with his knees, diabetes and, now, respiratory problems. He contracted Legionnaires' during visits to the Pittsburgh VA and is listed as one of the 17 patients who recovered.
When he first was struck by the disease in September 2012, he remembers collapsing in the hallway at the hospital.
All at once he was hit by a high fever, shortness of breath, diarrhea and a cough, and, Mr. Stafford said: "If someone had walked in that first day I had it and had a gun, I would have begged him to shoot me."
While he was still being treated for the disease at University Drive, he was placed on oxygen to help him breathe.
"The doctor, he looked at me and said, 'You may never come off of that,' " Mr. Stafford recalled.
Nine months later, he's still on oxygen.
And for a man who used to walk up to five miles a day to stay in shape: "Now, I can't walk very far without the oxygen, I'll tell you that."
Dave Jenkins now suspects that Legionnaires' may have played a role in his brother's death. He said it was clear that his brother was never the same after he contracted the disease.
"Before he went [to the Pittsburgh VA] he wasn't going to die then, or a year from then; maybe later, but not when he did," said Mr. Jenkins, a production supervisor at a chemical company.
Ali Sonel, the Pittsburgh VA chief of staff, knows well all of the 22 Legionnaires' cases that occurred during the outbreak -- "They're not just case numbers to me; they're people," he said.
Asked about Greg Jenkins dying 11 months after contracting Legionnaires', Dr. Sonel said: "The scientific evidence will say it can't be a contributing factor to death that far out."
Still, Dr. Sonel said: "I certainly appreciate anything a family member of a veteran who passed away experienced. We're very sorry any of these patients contracted Legionnaires' because of our water."
The federal Centers for Disease Control and Prevention, which was called in to assess the outbreak, deemed the deaths of patients during the outbreak as a direct result of Legionnaires', or contributing result, only if the patient died within 30 days after the onset of the disease, he said.
In addition to Greg Jenkins, at least one other of the 17 patients deemed to have recovered died beyond the 30-day window.
Dave Jenkins said he will continue to push the VA for answers in his brother's death and wants to ensure problems are corrected. "I think everything happens for a reason, and maybe the reason here is that they'll solve the problem and no other veterans will get this disease in the future. And I think I owe it to my brother, too, to find out what happened."
Sean D. Hamill: firstname.lastname@example.org or 412-263-2579.