What: Hearing on VA OUTREACH TO VETERANS AT RISK FOR HEPATITIS C INFECTION
Where: House of Representatives, Subcommittee on National Security, Veterans Affairs, and International Relations,Committee on Government Reform, Washington, DC.
The top guys from the VA were Dr. Thomas L Garthwaite, Veterans Administration, Deputy Under Secretary for Health, and Dr. Tom Holohan, Chief Patient Care Services Officer. (Dr. Garthwaite left the VA and has held several job since then. Dr. Holohan has left too. He doesn’t even list his VA employment on Linkedin. Wonder what happened? Pushed out?)
Rep. Vic Synder had a bill making HCV a presumptive SC illness. The following exchange about dating the onset of HCV infections and SC claims is telling. It’s a doctor-to-doctor exchange. As Nod advises, use their own words to bolster your positions.
Mr. Snyder. I have been grappling with this issue of how a veteran picked up an illness in 1968 and we didn’t test for until 1989 or 1990. No. 1, do any of you have any comments on this issue of how well we are doing in the VA system in terms of our accuracy of either affirming or turning down claims for service connection with regard to hepatitis C? And No. 2, what do we think at this current state of knowledge is the percentage of those with hepatitis C that we don’t have a good guess what the etiology is and we just put them in the unknown category? I don’t know who to direct those questions to.
Dr. Garthwaite. With regards to the accuracy of ratings, no one here is really an expert on that. We could get you for the record obviously what a reasonable response is about the rating decisions that have been made. We are reviewing I believe your bill on presumption and getting comments on that so I think as part of our analysis of that rating, the rating decisions being made, we would like to provide that for the record. Tom, do you have any comment on the other part?
Dr. Holohan. I think the bottom line is that in an individual case from a medical point of view, not a medical legal necessarily but from a medical point of view, it is almost impossible to determine what the precise proximate cause of infection with hepatitis C is. A patient may have one, two or many risk factors and to determine which which was in fact the approximate cause of the disease is in my opinion impossible.
Mr. Snyder. And that does have some revocations. I like your phrase almost impossible to determine because in 20 to 30 years of history, some risk factor may be service connected and some risk factors may not be service connected. I don’t know if my bill is the best way to get at this problem. I haven’t seen anything better out there and I think there really are some challenges, having talked to some of the people who do the ratings. I am a family doctor and I would hate to be the one who had to flip that coin and make that kind of determination on this illness. I think doctors are used to making evaluations on things that you can evaluate, but this is different. You are talking about a point in time. We are physicians, not detectives. At what point in time did that virus enter that bloodstream. I will say any comments,criticisms, suggestions on H.R. 1020, I would be more than receptive to. We are trying to solve what I think is a problem for some veterans. Thank you, Mr. Chairman.