The prevalence of cirrhosis, end-stage liver disease, and liver cancer is increasing among veterans. The incidence of HCV-related cirrhosis in VHA users nearly doubled from 2001 to 2013, and the rate of death from cirrhosis increased approximately 1.5-fold. The incidence and mortality of hepatocellular carcinoma (liver cancer) has nearly tripled.
Of the approximately nationally 6,000 liver transplant procedures performed every year in the U.S., only about 100 are approved by the VHA. The rate is so low that some VHA physicians advise their patients to obtain private insurance so they are eligible to receive a transplant outside of the system.
Veterans with the highest risks for hepatitis C are those who served during the Vietnam War era, have alcohol or substance use disorders, have been homeless, or have a history of mental illness. In a national VHA survey of those who tested positive for hep C:
- 64 percent were Vietnam veterans
- 18.5 percent were post-Vietnam veterans
- 4.5 percent were Korean War veterans
- 4.2 percent were post-Korean War veterans
- 9.1 percent were veterans from other periods of service
Military Exposure to Hepatitis C
For many years, there was controversy over the military’s use of jet guns for immunizations. Also called air guns, multi-use-nozzle jet injectors are needleless medical devices that use high-pressure fluid to penetrate the skin. Multiple published studies have demonstrated that jet injectors have the capacity to transmit significant amounts of blood and with it, the potential to transmit blood-borne pathogens. For many years, the VHA denied knowledge of hepatitis C transmission via jet guns. The most updated response by the VHA is:
“Although there have been no case reports of hepatitis C being transmitted by a jet gun injection, it is biologically plausible. Any veteran enrolled in the VA health care system who has concerns about hepatitis C infection, because of jet gun injectors, other blood exposure during military service, any of several risk factors, or for any other reason, is welcome and encouraged to request testing for hepatitis C at his or her nearest VA hospital.”
Note that in addition to jet injectors, if you were ever exposed to blood during military service, testing is recommended. Service personnel are exposed to blood in multiple ways, including blood splatter, helping the wounded, handling dead bodies, receiving blood transfusions and during medical procedures. Veterans who receive medical care outside the VHA should tell their community medical providers if they have ever been exposed to blood.
The VHA has made great strides to improve health care to veterans, especially for those with hep C. According to VHA policy, hep C testing is available for any veteran who wants to be tested. Also, hep C treatment is available for veterans regardless of fibrosis stage, and is not restricted, like many of the private insurance and state Medicaid plans are.
For more information, the VHA viral hepatitis website is an excellent resource. If you feel that you are not adequately supported by the VHA, contact HCV Vets.
Last Reviewed: March 5, 2019