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The Long Road to Hep B Care
Hepatitis B, Military Service, and the Long Road to Care: Barriers and Solutions for US Veterans

Released: April 20, 2026

Richelle M. Gaiter
Richelle M. Gaiter, CMSGT Retired USAFR, DMSc, MPAS, MEd
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Key Takeaways

•    Denied or delayed disability ratings, coupled with historically poor transition from active duty to VA care, perpetuate gaps in healthcare access.
•    Key strategies to improve engagement in HBV care include a proactive, registry-based approach to outreach, with peer-driven education campaigns targeted to older veterans, embedded HBV screening prompts, and trauma-informed care.


I joined the Air Force in 1984, at a time when very little was understood about hepatitis B virus (HBV). My diagnosis was incidental in that I was not symptomatic, but it was discovered when I donated blood. What followed was isolation, rather than education or reassurance: Healthcare professionals double-gloved, wrapped everything in plastic, and even kept me from my newborn for several days when he had jaundice. Intentionally or not, I was treated like a pariah. The message was clear: You are a risk.

As I neared the end of active duty, I became symptomatic and was treated with interferon for several months. It was grueling therapy, but the best that could be done in that era. When I separated from active duty in 1995, I received no meaningful guidance about follow-up with the Department of Veterans Affairs (VA), especially considering that I was coming from overseas. There was no structured transition into long-term liver care. I was not granted disability. For years, I had no follow-up because at the time of separation, my liver enzymes were “normal.”

It wasn’t until much later that I was diagnosed with markedly elevated liver enzymes and started on tenofovir. Even then, care was intermittent. I did not engage with the VA because I did not understand I was eligible.

I only reentered the VA system 8-9 years ago because I took a job as a physician assistant within the system, and an onboarding physician questioned why I was not in care. Only then did I receive appropriate ratings for conditions that were previously denied.

My access to consistent HBV care happened because I worked in healthcare. But what about veterans who don’t work in healthcare?

Key Barriers to HBV Care in Veterans
My experience reflects several persistent barriers.

First was the stigma and outdated perceptions of infectious diseases. My early experiences of isolation created lasting mistrust in the healthcare system and resulted in long-term avoidance of care.

Then, a poor transition from active duty to VA care highlights how, historically, veterans were not systematically educated on eligibility, enrollment, or the need for longitudinal surveillance for chronic conditions like HBV.

I, like many veterans, was initially denied benefits. This delay led me to disengage from the system entirely, and I would have been lost to follow-up if I hadn’t taken a job within the VA system many years later.

There is also often a lack of clarity on eligibility, particularly for reservists and older veterans. In the past, reservists who did not deploy were often ineligible for disability benefits, reinforcing the perception that VA care was not available to them.

There is also a significant lack of targeted outreach to older veterans. Although service members separating in the last 10-15 years are generally well briefed and medically assessed before discharge, earlier generations were not. In remote northern California, I routinely meet veterans who were unaware that they qualify for VA services, particularly post-Vietnam era seniors whose records were lost and who may now be newly eligible. Access gaps in rural communities prevent healthcare from reaching those who need it most.

What Has Improved
To the Air Force’s credit, transition briefings are now standard, and separating members receive both physical assessments and education on VA enrollment. Reservists are encouraged to document injuries during deployment. Altogether, the system today is far more proactive than it was in 1995. My own VA care since reengagement has been excellent.

Strategies to Improve Engagement
However, there is still much room for improvement. Based on both my lived and clinical experience, I propose several strategies to meaningfully improve engagement in HBV care for veterans.

First, I believe a proactive, registry-based approach is key to identifying veterans with prior HBV diagnoses or abnormal liver enzymes. Direct outreach is critical for preventing loss to follow-up, especially in rural regions.

To rectify historical gaps in healthcare after discharge, education campaigns targeted to older veterans should be implemented, with clear messaging that eligibility rules have changed and prior denials can be reevaluated. As veterans often trust other veterans, peer-driven education via community talks, VFW/American Legion partnerships, and local health fairs can bridge knowledge gaps for older and younger veterans alike.

On the clinical side, embedded HBV screening prompts in primary care and community clinics would prevent missed opportunities for treatment, particularly in rural non-VA settings where veterans may present without identifying their veteran status. Finally, trauma-informed infectious disease care, acknowledging the stigma that many experienced in the 1980s-1990s, can help to actively rebuild trust in healthcare and support continued engagement.

Chronic hepatitis B is a manageable disease, with effective antiviral therapy and surveillance strategies to prevent cirrhosis and hepatocellular carcinoma. Clinical tools are no longer the primary barrier to HBV care—awareness is. That is, for many veterans, particularly those who served before structured transition programs, the issue is not unwillingness to engage. It is not knowing they can.

My story is not unique. The opportunity now is to ensure that no veteran with chronic hepatitis B remains out of care simply because no one told them they belonged in it.

Your Thoughts
Which of the strategies mentioned here to promote engagement in HBV care do you think is most broadly applicable to your clinical practice? Do you employ any strategies not mentioned? Leave a comment to join the discussion.

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