[Congressional Record Volume 144, Number 141 (Friday, October 9, 1998)]
[Senate]
[Pages S12167-S12168]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE:
  S. 2599. A bill to amend title 38, United States Code, to establish a 
presumption of service-connection for certain veterans with Hepatitis 
C, and for other purposes; to the Committee on Veterans' Affairs.


                    hepatitis c veterans legislation

 Ms. SNOWE. Mr. President, today I introduce legislation to 
address a serious health concern for veterans infected with the 
hepatitis C virus. This legislation would make hepatitis C a service-
connected condition so that veterans suffering from this virus can be 
treated by the VA.
  Specifically, the bill will establish a presumption of service 
connection for veterans with hepatitis C, meaning that we will assume 
that this condition was incurred or aggravated in military service, 
even if there is no record of evidence that the condition existed 
during the actual period of service, provided that certain conditions 
are met.
  Under this legislation, veterans who received a transfusion of blood 
during a period of service before December 31, 1992; veterans who were 
exposed to blood during a period of service; veterans who underwent 
hemodyalisis during a period of service; veterans diagnosed with 
unexplained liver disease during a period of service; veterans with an 
unexplained liver dysfunction value or test; or veterans working in a 
health care occupation during service, will be eligible for treatment 
for this condition at VA facilities.
  I am introducing this legislation today because of medical research 
that suggests many veterans were exposed to hepatitis C in service and 
are now suffering from liver and other diseases caused by exposure to 
the virus.
  I am troubled that many ``hepatitis C veterans'' are not being 
treated by the VA because they can't prove the virus was service 
connected, despite that fact that hepatitis C was little known and 
could not be tested for until recently.
  Mr. President, we are learning that those who served in Vietnam and 
other conflicts, tend to have higher than average rates of hepatitis C. 
In fact, VA data shows that 20 percent of its inpatient population is 
infected with the hepatitis C virus, and some studies have found that 
10 percent of otherwise healthy Vietnam veterans are hepatitis C 
positive.
  Although hepatitis C is a very serious infection, it was actually 
unknown until recently. Hepatitis C was not isolated until 1989, and 
the test for the virus has only been available since 1990. Hepatitis C 
is a hidden infection with few symptoms. However, most of those 
infected with the virus will develop serious liver disease 10 to 30 
years after contracting it. For many of those infected, hepatitis C 
leads to liver failure, transplants, liver cancer, and ultimately 
death.
  And yet, most people who have hepatitis C don't even know it and 
often do not get treatment until it's too late. Only five percent of 
the estimated four million Americans with hepatitis C know they have 
it, but with new treatments, some estimates indicate that 50 percent 
can have the virus eradicated.
  Vietnam Veterans in particular are just now starting to show up with 
liver disease caused by hepatitis C. And detection and treatment now 
may help head off serious liver disease for many of them. However, many 
veterans with hepatitis C will not be treated by the VA because they 
cannot establish a service connection for their condition in spite of 
the fact that we now know that many Vietnam-era and other veterans got 
this disease serving their country.
  Many of my colleagues may be interested to know how veterans likely 
were exposed to this virus. Many veterans received blood transfusions 
while in Vietnam. This is one of the most common ways hepatitis C is 
transmitted. Medical transmission of the virus through needles and 
other medical equipment is possible in combat. And Medical care 
providers in the services were likely at increased risk, and may have, 
in turn, posed a risk to the service members they treated.
  Researchers have discovered that hepatitis C was widespread in 
Southeast Asia during the Vietnam war, and that some blood sent from 
the U.S. was also infected with the virus. Researchers and veterans 
organizations, including the Vietnam Veterans of America, with whom I 
worked to prepare this legislation, believe that many veterans were 
infected after being injured in combat and getting a transfusion or 
from working as a medic around combat injuries.
  Yet, veterans cannot establish a service connection because 
frequently there were no symptoms when they were infected in Vietnam. 
In addition, while medical records may show a short bout of hepatitis, 
hepatitis C was not known then and there was no testing to detect the 
hepatitis C infection at discharge.
  The hepatitis C infected veterans are essentially in a catch 22: the 
VA is reluctant to depart from their routine service connection 
requirements and veterans cannot prove that they contracted hepatitis C 
in combat because the science to detect it did not exist during the 
period of service. Without congressional authority in the form of 
legislation providing for presumptive service connection, thousands of 
Vietnam vets infected with hepatitis C in service will not get VA 
health care testing or treatment. I believe the government will 
actually save money in the long run by testing and treating this 
infection early on. The alternative is much more costly treatment of 
end-stage liver disease and the associated complications, or other 
disorders.

  I would like to describe some of the research that has led me to the 
conclusion that hepatitis C may be service connected in many veterans. 
A number of studies have established a link between hepatitis C in 
veterans and high risk factors for hepatitis C that are unique to 
combat or are highly prevalent in combat situations.
  A study published in the American Journal of Epidemiology in 1980 
found that veterans have a higher incidence of hepatitis C compared to 
non-veterans. The study of veterans receiving liver transplants at the 
Nashville, Tennessee VA medical center, which was conducted by 
researchers at the Vanderbilt University Medical Center, found that 
there ``was a significantly greater incidence of hepatitis C . . . in 
veterans compared with non-VA patients.'' The study claims to confirm 
that ``veteran patients have a higher incidence of hepatitis C. . .''
  A study published in Cancer in 1989 found that veterans have 
increased risk of liver cancer as compared to non-veterans. The study 
found that there was a 50 percent increase in the rate of liver cancer 
among male veterans using VA medical systems from 1970 to 1982.
  A study published in Military Medicine in 1997 found that from 1991 
to 1994, the number of veterans diagnosed with hepatitis C increased 
significantly from 6,612 in 1991 to 18,854 in 1994, which is an 
increase of more than 285 percent. The study notes that ``total 
patients seen nationally . . . increased by only 4.87 percent during 
the same period.'' Therefore, this increase cannot be explained by 
increased in workload. Over the subsequent year, this increased to 
21,400 (in 1996), and has since continued to increase.
  Some will argue that further epidemiologic data is needed to resolve 
or prove the issue of service connection. I agree that we have our work 
cut out for us, and further study is required. However, while the 
research being done is providing more and more data on the relationship 
between military service

[[Page S12168]]

and hepatitis C, we should not force those who fought for our country 
to wait for the treatment they deserve.
  It should be noted that some progress has been made in recent years 
in the effort to address this health concern. This is not a new issue.
  The VA has done some screening and testing for hepatitis C in 
veterans. VA Under Secretary for Health, Ken Kizer, issued a directive 
that all VA medical centers should test veterans for hepatitis C if 
they fall into certain risk categories. However, I understand that 
medical centers are not complying with this directive uniformly. In 
addition, there is no mention of treatment in the Kizer directive. 
Therefore, if the virus is detected, the VA does not necessarily treat 
it.
  I would also note that the FY98 VA-HUD Appropriations report contains 
the following language: ``The Committee is concerned that the rates of 
serious liver disease, liver cancer and liver transplants related to 
hepatitis C infection are expected to rise rapidly among veterans 
populations over the next decade. Veterans health care facilities will 
bear a large part of the treatment cost. Those costs can be reduced 
with early screening and treatment of veterans infected with hepatitis 
C. Therefore, the Committee directs the Department to determine rates 
of hepatitis C infection among veterans receiving health services from 
the VA and to establish a protocol for screening new entrants to the VA 
health care system. The Committee also directs the Department to 
provide counseling and access to treatment for veterans who test 
positive for hepatitis C. The Department should pay special attention 
to rates of hepatitis C among veterans of Vietnam and more recent 
deployments.''
  Former Surgeon General C. Everett Koop, well respected both within 
and outside of the medical profession, has said, ``In some studies of 
veterans entering the Department of Veterans Affairs health facilities, 
half of the veterans have tested positive for HCV. Some of these 
veterans may have left the military with HCV infection, while others 
may have developed it after their military service. In any event, we 
need to detect and treat HCV infection if we are to head off very high 
rates of liver disease and liver transplant in VA facilities over the 
next decade. I believe this effort should include HCV testing as part 
of the discharge physical in the military, and entrance screening for 
veterans entering the VA health system.''
  The VA requires that a veteran demonstrate onset during service or 
within requisite presumptive periods with chronic residuals of a 
disease or injury that had its onset during active military service. 
How does a veteran prove service connection under these criteria for a 
condition that did not even have a name until 10 years ago.
  Veterans have already fought their share of battles--these men and 
women who sacrificed in war so that others could live in peace 
shouldn't have to fight again for the benefits and respect they have 
earned.
  In closing, let me say that we are just now beginning to learn the 
full extent of this emerging health threat to veterans and the general 
population. We still have a long way to go before we know how best to 
confront this deadly virus. A comprehensive policy to confront such a 
monumental challenge can not written overnight. It will require the 
long-term commitment of Congress and the Administration to a 
serious effort to address this health concern.

  I hope this legislation will be a constructive step in this effort, 
and I look forward to working with the Veterans' Affairs Committee, the 
VA-HUD appropriators, Vietnam Veterans of America, and others to meet 
this emerging challenge.
                                 ______