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TESTIMONY OF

PHILIP R. WILKERSON, DEPUTY DIRECTOR

APRIL 13, 2000

Mr. Chairman and Members of the Subcommittee:

The American Legion appreciates the opportunity to express our views on several legislative initiatives being considered today.

HR 1020

This bill is entitled the "Veterans’ Hepatitis C Benefits Act of 1999." It would add new section 1119 to title 38, United States Code, to provide that, for the purposes of entitlement to service connection, hepatitis C shall be considered to have been incurred in or aggravated by military service, if the veterans experienced one or more enumerated risk factors during such service. These risk factors include: transfusion of blood or blood products before December 12, 1992; blood exposure on or through the skin or mucous membrane; hemodialysis; tattoo or body piercing or acupuncture; unexplained liver disease; unexplained abnormal liver function tests; or working in a health care occupation.

While hepatitis is not a new disease, the prevalence of hepatitis C and the long-term health consequences have only recently become recognized as a major public health problem. This is an easily transmitted blood-borne virus, which can have potentially fatal long-term health consequences. The circumstances of military training, combat, and other activities in locations around the world offer many opportunities for contact with infected blood or blood products. What is of particular concern is the epidemic proportion of this type of infection in our veteran population. VA estimates that ten to twenty percent of veterans have hepatitis C, as compared with a rate of under two- percent of the general population. Study data indicate that Vietnam veterans appear to be the group most directly affected. Many of these veterans, both men and women, unknowingly contracted the hepatitis C virus in Vietnam 25 or 30 years ago and may only now become symptomatic with possibly severe liver disease and other related problems. In addition to Vietnam, American armed forces have served in various countries where hepatitis C is endemic. Studies have also established that the virus can, in fact, remain dormant for a person’s entire lifetime or, in others, it can become active at some point in time and attack various organs, particularly the liver. According to VA, fifty-two percent of VA’s liver transplant recipients have hepatitis C.

We have been pleased by VA’s pro-active response to what is clearly a national health policy and health care challenge. They have developed a five-point strategic initiative. It addresses veterans’ need for information and education about the risks of hepatitis C and the need to be tested. Similarly, health care providers also need to be better informed about hepatitis C, in order to advise and assist veterans who may have been exposed to the virus at some point in the past. As a major part of its education and research efforts, VA has established Centers of Excellence in Miami and San Francisco. There are also screening and treatment programs underway to identify those who test positive for hepatitis C. If nonsymptomatic, they can be monitored and any problems treated early. For those with more serious medical problems, VA has available a course of drug treatment. The purpose of the screening, monitoring, and treatment programs is to try and avoid some the more tragic, costly, and risky consequences that can result from untreated hepatitis C, such as liver transplants

Mr. Chairman, we believe there is sufficient and compelling scientific evidence of a link between certain risk factors inherent in the training, combat, and other activities associated with military service and veterans with a current diagnosis of hepatitis C. In light of this evidence, The American Legion wrote to Secretary West in August of 1999 recommending that regulations be developed and promulgated, in accordance with title 38, United States Code, establishing hepatitis C as a presumptive disease for the purposes of entitlement to service-connected disability compensation and VA medical care. It is now difficult for a veteran to get service connection for hepatitis C or a related medical problem, because of an inability to prove the virus was acquired during military service. Those hepatitis C veterans who may have been treated for acute hepatitis in service and who now claim service connection are also being turned down by VA, again, because they cannot prove the current condition is related to a prior exposure to hepatitis. The Board of Veterans Appeals often rejects a claim for service connection, because the service medical records do no show the presence of hepatitis C at time of separation or discharge from service.

We believe also that the nature and extent of this problem requires either administrative action by the Department of Veterans Affairs or the Congress to establish specific presumptions in claims for service connection for hepatitis C. Over the years, the presumptive provisions of the law and regulations have been amended to reflect advances in medical research on a variety of diseases. However, with regard to the risk factors enumerated in HR 1020, The American Legion does not have a formal position on these or the specifics of the presumptions that should apply. However, we do support efforts to establish an appropriate presumption for hepatitis C, in light of the prevalence of this disease, which can remain inactive for many years before it becomes manifested.

The provision for presumptive service connection for hepatitis C will be important for a number of reasons. The first is that it would remove an often-insurmountable legal hurdle and enable those veterans disabled by reason of hepatitis C and related problems to receive needed financial compensation. It would also entitle them to vocational rehabilitation benefits and assistance. Equally important, it would entitle them to the necessary VA medical treatment and care.

With regard to current treatment regimen for this disease, it is very similar to chemotherapy for cancer, in that there can be debilitating side effects. These often severely impact the individual’s ability to work or return to work. This fact should be reflected in a separate diagnostic code for hepatitis C, to include a provision for an assignment of a 100% evaluation for a 6-month period while the individual is undergoing therapy. At the end of this period, the rating should be revised to reflect the current level of residual disability.

HR 3816

This bill would amend title 38, United States Codes, section 101(24) to expand the definition of a disability for which service connection can be granted to include a heart attack or stroke by a member of the reserve components of the armed forces performing inactive duty for training. Section 101(24), as currently interpreted, distinguishes between a disability which is due to a physical injury and that which is due to a disease process. A heart attack or stroke occurring during a period of inactive duty for training has been generally considered by VA as being to due to a pre-existing disease process and, unless it was clearly shown to have been precipitated by an injury or trauma, service connection would be denied.

Veterans, in order to remain in a reserve program, must participate in often strenuous physical training activity during their periods of inactive duty for training. During such training, some of these veterans may suffer a heart attack or stroke and become disabled. The American Legion believes it would beneficial and appropriate to revise the current statute to recognize this added risk factor associated with inactive duty for training and provide entitlement to compensation for any resulting disability.

HR 3998

This bill, entitled the "Veterans’ Special Monthly Compensation Gender Equity Act," would amend title 38, United States Code, section 1114(k) to add the loss of one or both breasts due to a radical mastectomy or a modified radical mastectomy to the list of loss or loss of use disabilities.

Section 1114(k) authorizes an additional monthly statutory award where there is the anatomical loss or effective loss of use of one or more creative organs, a hand, a foot, or both buttocks, blindness, deafness, or aphonia. This payment is over and above the basic rate of compensation payable for the particular condition.

Most patients having mastectomies are female. This procedure and its after effects can cause long-term serious physical and emotional problems. It appears this legislation is intended to entitle both men and women veterans to additional special monthly compensation at the (k) rate of $76 currently, when one or both breasts have been surgically removed as a result of a radical or modified radical mastectomy due to some underlying disease process or injury. While The American Legion does not have a formal position on this proposal, we would offer no opposition, since we believe that with the enactment of this measure it will make the Department of Veterans Affairs compensation program more equitable and fair for all of our nation's disabled veterans.

HR 4131

The legislation, entitled the "Veterans’Compensaiton Cost of Living Adjustment Act of 2000," would increase the monthly rates of disability compensation and Dependency and Indemnity Compensation (DIC) by the same percentage as the increase authorized in Social Security benefits for 2000-2001. The increase in VA benefits shall be effective on December 1, 2000.

Mr. Chairman, VA has included a cost-of-living adjustment of 2.5% in disability compensation and DIC rates in the budget request for FY 2001. The American Legion supports an annual cost-of-living adjustment (COLA) in these benefits, in order to ensure they are providing an appropriate level of financial assistance. For the record, we too express our opposition to any proposal that would automatically index such COLAs to the annual adjustment in Social Security benefits. The American Legion believes it is important that Congress hold annual hearings on a proposed COLA, because such occasions provide an important forum in which to discuss the adequacy of these benefit programs and particular problems affecting the welfare and wellbeing of disabled veterans, their families, and survivors. If future COLAs were indexed, this valuable opportunity would be lost.

Mr. Chairman, that concludes our statement.

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