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Veterans and Hepatitis C

Of all the many health problems faced by veterans who served their country during the last 50-60 years, Hepatitis C remains one of the major threats to the well-being of vets, especially those who served on foreign soil.

What is Hepatitis C?

Hepatitis, in general, is a serious inflammation of the liver. The inflammation is caused by viruses or by other factors, such as the abuse of alcohol or the use of certain medications. There are four types of viral hepatitis: A, B, C, and hepatitis.

Hepatitis C is caused by a virus. The Centers for Disease Control estimate that it affects about 1.8 percent of the population. However, the VA reports that about 10 to 20 percent of all veterans are infected with Hepatitis C (HCV).

Hepatitis C can be very mild in some cases and often remains latent in the body for up to 30 years. Some people never exhibit symptoms or show only mild symptoms that are flu-like in appearance. However, more than any of the other types of hepatitis, HCV most often leads to chronic liver disease including cirrhosis and liver cancer.

How is it transmitted?

Exposure to infected human blood is the most common way to contract Hepatitis C. Those who received blood transfusions prior to 1990 are at high risk of developing the disease. Also, drug users who share needles are often infected with HCV and this remains the major cause of the spread of the disease.

For veterans, the major causes include field bleeding during combat, surgery, transfusions, and exposure to blood by military medics and surgeons. Those who fought in the Vietnam Conflict have the highest number of reported cases of Hepatitis C virus, but there have also been service-connected cases from veterans who served in World War II and Korea.

The Department of Veterans Affairs lists the following reasons for the high rate of HCV among Vietnam vets:

A high number of blood transfusions were performed during the war years. At that time, blood was not screened for diseases thus soldiers may have received tainted blood.
There was a high incidence of Hepatitis C among Vietnamese citizens in general.
More than 2.1 million soldiers and support personnel handled the war wounded and any of those individuals may have been exposed to human blood infected by the disease.
Large numbers of active duty personnel chose to receive a tattoo during their years of service. The equipment used may not have been properly sterilized or may have been re-used on many individuals.
An estimated 3 percent of those who served in Vietnam used "hard" drugs like heroin, psychedelics such as LSD, amphetamines, barbiturates, and cocaine. Use of shared needles was common practice and it is believed that this is the major cause of infection among Vietnam vets.

How is HCV Diagnosed and Treated?

As with other diseases that remain latent for several decades, Hepatitis C virus can be quite difficult to diagnosis. Often, symptoms do not arise for up to 30 years. Furthermore, there were no reliable screening tests available until less than 20 years ago, so vets from the Vietnam era could not be tested during or immediately after service in the armed forces.

A diagnosis is generally achieved via a blood test that checks for the presence of a particular antibody connected with the disease. Other tests may be ordered to certify these findings because the antibody only appears in about 50 percent of all cases. Because HCV can cause severe damage to the liver, a liver biopsy is often ordered as well.

In 1998, the VA issued a set of guidelines for screening veterans entering VA healthcare facilities who are considered to have one or more of these risk factors:

Has even used a needle to inject drugs, even if only once and long ago
Had a blood transfusion or organ transplant before 1992
Is a healthcare worker who had contact with blood on-the-job
Was on long-term kidney dialysis
Was born of a mother who had Hepatitis C at the time of her pregnancy
Is a Vietnam-era veteran
Had exposure to blood on the skin
Has tattoos or body piercings
Has ever snorted cocaine
Has liver disease
Has a history of alcohol abuse
Has had an abnormal liver function test

Though this is not part of the 1998 guidelines, those who received immunizations with air gun injectors may wish to be tested as well, the VA notes.

Those who are diagnosed with acute HCV are advised to get lots of rest, drink fluids, and abstain from alcohol consumption. Symptoms should disappear in 3 to 4 weeks.

However, many veterans develop the chronic form of the disease, which is much harder to treat. Often, a synthetic form of the drug interferon is used but is only successful in treating approximately 10 to 40 percent of all cases. Many victims of the disease go on to develop much more serious complications like cancer and cirrhosis of the liver.

The VA and Hepatitis Treatment

A veteran with Hepatitis C who is seeking treatment from the VA healthcare system must be able to definitively show a service-related connection to their disease. The list above outlines potential service-related causes of the disease. However, because there was no reliable testing until 1992 and because the disease remains latent for such a long period of time, making the connection can be quite difficult.

If a veteran applies for HCV treatment benefits and has other risk factors besides those listed above, he/she may be determined ineligible for benefits unless he/she can prove that service presented a "greater risk" for infection.

Sources

Heather French Foundation for Veterans
http://www.heathersveterans.org/hepatitis.htm

HCV Advocate
http://www.hcvadvocate.org/hcsp/articles/vietvet.html

Department of Veterans Affairs
http://www.hepatitis.va.gov/vahep?page=prtop02-va-02