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Requesting the U.S. Department of Veterans Affairs Improve Chronic Hepatitis B Virus (HBV)Screening & Follow Up for Veterans Born between 1945 and 1980


Requesting the U.S. Department of Defense Update and Separately Codify Policies for Identification and Administration of Personnel with Chronic HBV Infection

WHEREAS, Hepatitis and HIV/AIDS are among the eight (8) health campaigns recognized by the World Health Organization;

WHEREAS, most individuals with chronic Hepatitis B enjoy good health, are symptoms free and may not even know they have the silent disease; and

WHEREAS, in developed countries like the U.S. chronic Hepatitis B is a preventable, highly treatable long-term illness HBV infection occurs when there is an exchange of bodily fluids, acute infection ensures, and the Hepatitis B virus (HBV) remains in the person’s body. More than 90% of healthy unvaccinated adults who become infected will recover naturally from the virus; however when the virus is transmitted from an infected mother to her baby at birth or from a family member to a child under 5 years, the infection generally becomes a silent but chronic condition. In the U.S. since 1982, at-risk pregnant women are screened and Hepatitis B vaccinations are administered to infants or required for school children. Since 2002, HBV vaccinations have been required for all incoming U.S. military personnel; and

WHEREAS, although Asian & Pacific Islander Americans (APIAs) comprise less than 5% of the total U.S. population, they disproportionately account for more than 50% of the estimated 2 million U.S. cases of chronic HBV due to the fact that nearly 70% of APIAs were born, or have parents who were born in countries where HBV is common and screening and vaccination are not. Immigrants from other world areas where HBV is endemic are likewise disproportionately impacted by HBV; and

WHEREAS, the Department of Health & Human Services, in 2011, released our nation’s first-ever comprehensive Action Plan for the Prevention, Care and Treatment of HBV, further

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updated in 2014 (www.whitehouse.gov/the-press-office/2014/07/25/presidential-proclamation-world-hepatitis-day-2014). In annual Hepatitis Day Proclamations since 2011,President Obama has called for education and action to stem the Hepatitis epidemic which affects 2 million in the U.S. and over 350 million people world-wide; and

WHEREAS, in 2015 the 113th Congress introduced a bill (H.R. 4486) which included language for the VA regarding Hepatitis B testing and treatment by implementing Center of Disease Control and Prevention (CDC) HBV testing recommendations as well as electronic medical record prompting for HBV screening for WW II, Korea, Vietnam-era veterans and APIAs who are considered to be at-risk. Approved by the House of Representatives, H.R. 4486 died in the U.S. Senate; and

WHEREAS, in November 2014, a study on U.S. Veterans with Hepatitis B was presented to the American Association for the Study of Liver Disease (Serologic testing rates among US veterans with Hepatitis B) . The study concluded that the rates of testing for HBV by the VA were “suboptimal” and, “that HBV infection was twice as common in the Veteran population as in the general population of the country.” The study concludes by stating that “those who were further tested by the VA received antiviral therapy only 25% of the time, but individuals referred to a specialist were significantly more likely to receive treatment” and

WHEREAS, the American with Disabilities Act of 1990, and as amended in 2008 prohibits discrimination and ensure equal opportunity for persons with disabilities in employment, State and local government services, public accommodations, commercial facilities , and transportation and was the basis for a Department of Justice investigation and settlement agreement (www.justice.gov/opa/pr/2013/March/13-crt-271) after New Jersey medical schools “unlawfully excluded applicants because they have Hepatitis B”; and

WHEREAS, the Department of Defense has in 2013 discharged an APIA sergeant at Joint Base Lewis-McChord due to chronic Hepatitis, which was initially diagnosed in 2008 – four years after his first enlistment, and reconfirmed in 2012 – and despite the fact that the sergeant’s condition was stable, he did not require antiviral medication, and his duties did not involve combat, (already having served nine months in Afghanistan in 2006 and fifteen months in Iraq in 2008) healthcare or patient service; and

WHEREAS, Department of Defense recruiters in Eastern & Southwestern regions of the U.S. were approached by APIA medical and dental students who expressed interest in military service and the military scholarship program, and the recruiters informed the students they

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were ineligible due to chronic HBV, even though each student was taking a daily pill and already successfully responding to antiviral treatment. This being in violation of standard DOD procedure – complete a written survey, undergoes a physical exam by an army contracted physician; and an opportunity to appeal denial from service; and

WHEREAS, transparency and accessible documentation are among the best means to educate and prevent stigma and discrimination; and

WHEREAS, since the founding of our nation, military service has served as a vehicle for first and second generation immigrants pursuing employment, skills, national identity or citizenship. In failing to update and document DOD policies for HBV-infected personnel, DOD withholds information and opportunity from personnel and individuals in the APIA and other U.S. immigrant communities which disproportionately impacted by HBV; now therefore

BE IT RESOLVED, that the Veterans of Foreign Wars through its National Office request the U.S. Department of Veterans Affairs take steps to improve HBV screening, follow up testing and treatment referral of veterans born between 1945 and 1980 following the latest Center for Disease Control recommendations on viral hepatitis testing; and

BE IT FURTHER RESOLVED, that the Veterans of Foreign Wars through its National Office requests the U.S. Department of Defense take steps to update and separately codify policies for identification and administration of personnel with chronic HBV infection – similar to the manner by which policies are currently codified for military personnel with HIV – in order to educate and ensure the HBV policies are documented, transparent, equitable, and subject to frequent change and updating as medical capabilities, technologies, evidence-based practices, and DOD policy considerations evolve.

Submitted to the Department of Hawaii for consideration at its 56th State Convention in June 2015 by VFW Post 8616.


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