[Senate Hearing 111-278]
[From the U.S. Government Publishing Office]
S. Hrg. 111-278
HAWAII FIELD HEARINGS DURING
THE 111TH CONGRESS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED ELEVENTH CONGRESS
FIRST AND SECOND SESSIONS
__________
AUGUST 25, 2009 AND JANUARY 7, 2010
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
Daniel K. Akaka, Hawaii, Chairman
John D. Rockefeller IV, West Richard Burr, North Carolina,
Virginia Ranking Member
Patty Murray, Washington Lindsey O. Graham, South Carolina
Bernard Sanders, (I) Vermont Johnny Isakson, Georgia
Sherrod Brown, Ohio Roger F. Wicker, Mississippi
Jim Webb, Virginia Mike Johanns, Nebraska
Jon Tester, Montana Scott P. Brown, Massachusetts\1\
Mark Begich, Alaska
Roland W. Burris, Illinois
Arlen Specter, Pennsylvania
William E. Brew, Staff Director
Lupe Wissel, Republican Staff Director
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\1\ Hon. Scott P. Brown was recognized as a minority Member on March
24, 2010.
C O N T E N T S
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August 25, 2009
Field Hearing on VA Outreach to Returning Guard Units
SENATORS
Page
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 1
WITNESSES
Tamayo, 1LT Tulsi Gabbard, Hawaii Army National Guard............ 3
Prepared statement........................................... 5
Tuimalealiifano, SFC Sualauvi, III, Hawaii....................... 7
Park, ``Clay'' William Clayton Sam, Veterans Program Director,
Papa Ola Lokahi................................................ 8
Prepared statement........................................... 10
Tuimalealiifano, Shannon, veteran and wife of SFC Sualauvi
Tuimalealiifano................................................ 17
Betts, Tracey, Honolulu Regional Office Director, Veterans
Benefits Administration, U.S. Department of Veterans Affairs... 20
Prepared statement........................................... 22
Cullen, Sheila, Director, Veterans Integrated Service Network
(VISN) 21, U.S. Department of Veterans Affairs; accompanied by
James Hastings, M.D., Director, VA Pacific Islands Health Care
System; and Adam W. Darkins, M.D., Chief Consultant for Care
Coordination, Veterans Health Administration................... 25
Prepared statement........................................... 27
Ishikawa, BG Gary M., Deputy Adjutant General, State of Hawaii... 33
Prepared statement........................................... 35
Jefferson, Raymond, Assistant Secretary, Veterans' Employment and
Training, U.S. Department of Labor............................. 36
Prepared statement........................................... 37
APPENDIX
Moses, Mark S., Director, Office of Veterans Services, State of
Hawaii; letter................................................. 53
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January 7, 2010
State of VA Services on Maui, Hawaii
SENATORS
Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii........ 55
WITNESSES
Calleon, Karl, Vietnam Veteran and Commander,
DAV, Chapter 2, Maiu, HI....................................... 56
Evangelista, Rogelio G., Advisory Board Member, VA Pacific
Islands Health Care System..................................... 58
Prepared statement........................................... 59
Helm, CDR Larry, Molokai Veterans Caring for Veterans............ 61
Kamai, Clarence, Jr., Molokai Representative, Veterans Caring for
Veterans....................................................... 63
Kanahele, Danny, VA Advisory Council Member...................... 64
Laub, Paul, President, Maui County Veterans Council.............. 65
Prepared statement........................................... 66
Poaipuni, Terry, Wife of a Vietnam Veteran....................... 67
Prepared statement........................................... 68
Skaggerberg, Mitch, President, Vietnam Veterans of Maui County... 69
Prepared statement........................................... 70
Sodetani, Lloyd K., Maui Representative, Hawaii Office of
Veterans Services.............................................. 71
Prepared statement........................................... 72
Attached Survey.......................................... 73
Addendums................................................ 78
Betts, Tracey, Director, Honolulu VA Regional Office, U.S.
Department of Veterans Affairs................................. 94
Prepared statement........................................... 96
Response to request arising during the hearing by Hon. Daniel
K. Akaka.................................................128, 130
Cullen, Sheila, Director, VA Sierra Pacific Network (VISN 21),
Veterans Health Administration, U.S. Department of Veterans
Affairs........................................................ 97
Prepared statement........................................... 98
Halliday, Linda, Deputy Assistant Inspector General for Audits
and Evaluations, Office of Inspector General, U.S. Department
of Veterans Affairs............................................ 105
Prepared statement........................................... 106
Attachment................................................... 109
FIELD HEARING ON VA OUTREACH TO
RETURNING GUARD UNITS
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TUESDAY, AUGUST 25, 2009
U.S. Senate,
Committee on Veterans' Affairs,
Honolulu, HI
The Committee met, pursuant to notice, at 10:30 a.m., at
the Oahu Vet Center, 1298 Kukila Street, Honolulu, Hawaii, Hon.
Daniel K. Akaka, Chairman of the Committee, presiding.
Present: Senator Akaka.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. Aloha.
Audience. Aloha.
Chairman Akaka. A big welcome to all of you. Thank you very
much for your patience. Welcome to today's hearing of the
Senate Committee on Veterans' Affairs.
This is the first of two field hearings that I am chairing
here in the State this week. Today's hearing will focus on the
benefits and services provided to returning Guard units and
related transition issues. We held several hearings on this and
related topics in the State before, and most recently held a
hearing on the same topic last year in Washington, DC. Much has
improved in recent years, for which I am grateful. However, it
is important for the Committee to understand the remaining
challenges.
I applaud the efforts of VA employees in Hawaii. These men
and women work hard to help the veterans who seek assistance.
There are many things that VA does well in Hawaii. However,
there is always room for improvement.
Indeed, our unique geography, our diversity, and our way of
life require that VA develop a unique strategy to care for our
islands' veterans, including Hawaii veterans of the National
Guard and Reserves. I want to hear what tools VA needs to make
a difference in the lives of these men and women of the Hawaii
National Guard and Reserves.
Back in Washington, we have worked hard to ensure that VA
has the resources to provide the best possible care. In my
first 2 years as Chairman--2007 and 2008--Congress provided
record-breaking funding increases to VA. This year we are
working to get VA the funding it needs for next year. We are
also hard at work fixing the broken way that VA's health care
system is funded.
I introduced legislation to fund VA health care 1 year
ahead of the current budget process, which will allow VA health
care dollars to go further for veterans and taxpayers. I am
pleased to tell you that this bill, the Veterans Health Care
Budget Reform and Transparency Act, passed the Senate just
before the August break.
We have also been focusing on finding ways to improve how
VA and the Department of Defense work together to improve the
transition process for servicemembers and veterans. We are
working hard on seamless transition between active service and
life as a civilian, which is part of our goal. Given the
existing relationship between VA and Tripler Army Hospital,
Hawaii should be on the forefront of national efforts to have
the two Departments work more closely together. We will explore
that issue today.
Here in Hawaii, more than 5,000 members of the Guard and
Reserve have been deployed. The Hawaii National Guard has
recently returned from its second deployment and over 85
percent of those mobilized were already combat veterans. It is
important that these soldiers, and indeed all of those who have
been sent into harm's way, know that VA will be there for them
when they return home.
After years of war, we appreciate that there are distinct
challenges facing the reintegration of these citizen
servicemembers. Unlike their active-duty counterparts, Guard
veterans must transition from their civilian life and
employment to active military service and back again. Despite
VA's best efforts to conduct outreach to this population, it
seems clear that some are still unaware of all that VA has to
offer and how to access those services and benefits; and this
is something that we also need to work on, to provide the
information that they need. More work needs to be done.
I hope that both of our panels will shed some light on why
we continue to hear from veterans that they just did not know
about their eligibility for VA benefits and services. We need
to know how VA and the Congress can help bridge this
information gap. This is particularly important for those who
suffer from the invisible wounds of war and need more help
readjusting to their civilian lives.
I appreciate the Department of Labor and Hawaii National
Guard's participation in today's hearing, as they both have
important roles in the transition process.
Finally, I note that there are many veterans here today who
would like to testify. While we cannot accommodate everyone's
request to speak, we do want to hear your views. The Committee
is accepting written testimony, which will be reviewed and made
part of the record of today's hearing. If you have brought
written testimony with you, please give it to the Committee
staff who are located here in the room. And if you do not have
written testimony but would like to submit something, Committee
staff will assist you. In addition, the Committee staff is
joined by VA staff, who can respond to the questions, concerns,
and comments that you raise.
At this point, let me ask my staff members to please raise
your hand. If you want to talk to one of them, please do so.
Let me ask the VA staff who are here to raise your hands.
These are the folks that you can talk to if you have any
questions and want to make any statements.
I hope today's witnesses will provide us with a real sense
of what the next steps are so that no member of the Guard, or
indeed any servicemember is unaware of their eligibility and
the benefits available to them.
Thank you very much again, and now, I would like to
introduce our first panel. We have First Lieutenant Tulsi
Gabbard Tamayo, Hawaii Army National Guard; Sergeant First
Class Sualauvi Tuimalealiifano III from the U.S. Army; and also
Clay Park, who is Veterans Program Director from Papa Ola
Lokahi.
We are waiting for the Sergeant to return, but in the
meantime, I am going to ask Lieutenant Tamayo to please proceed
with her statement. Welcome.
STATEMENT OF FIRST LIEUTENANT TULSI GABBARD TAMAYO, HAWAII ARMY
NATIONAL GUARD
Lieutenant Tamayo. Thank you, Senator. Good morning,
Chairman Akaka and everyone gathered here. Thank you for the
opportunity to speak here today regarding the VA's outreach and
services to Guard and Reserve servicemembers.
By way of introduction, I am a First Lieutenant, a Military
Police Officer in the Hawaii Army National Guard. I enlisted in
2003, earned my commission in 2007, and have just returned from
my second deployment overseas. My statement today reflects only
my personal opinions and experiences as an individual.
As you are well aware, since September 11, 2001, the VA has
begun to see a new kind of clientele. Veterans are younger--a
new generation who grew up in a different culture and face new
challenges. The Reserve component of the military has taken a
role front and center like never before. The VA is now faced
with hundreds of thousands of customers who are young combat
veterans, but who also still actively serve in the National
Guard or Reserves.
My underlying message to you today, the bottom line shared
up front, is that the DOD and the VA need to work together to
think outside the box and find comprehensive strategies to
reach, educate, and serve Guard and Reserve veterans.
The VA's presence in our redeployment process, from point
of reentry back to the U.S. to being released from active duty,
has improved since 2006 when I returned from my first
deployment. About a week and a half ago, as we went through
demobilization at Fort Hood, TX, we received about a 2-hour
briefing from the local VA rep on the various benefits
available to us as veterans. He ensured that all 400 of us in
the briefing tent filled out enrollment papers to join the VA
or be registered in the VA and assisted and encouraged soldiers
to fill out disability claims, applications, as well as talked
about the VA Home Loan Guarantee. It was a lot of information
packed into a short period of time, but it was informative and
I walked away learning a few new things about the VA. However,
this should not be the end of the story.
I understand that the VA and DOD are two very separate
agencies. However, for Guard and Reserve soldiers, the idea of
a clean and complete transition between the DOD and VA is not a
reality. The Reserve component has hundreds of thousands of
servicemembers who are dual members of both agencies, eligible
for benefits from both. It is highly likely, as you mentioned,
that a servicemember will transition between Reserve and active
status multiple times throughout his or her career.
A short personal example, which I know is not an isolated
incident, is I was attempting to take advantage of my G.I. Bill
benefits while deployed and took a few classes. It took 7
months, and I am still waiting for the VA to get confirmation
from DOD that I am actually eligible for this G.I. Bill
benefit. I called once a month, and every time I called was
told that it takes a long time for the VA to get information
from the DOD and to call back next month. I was also told that
as a member of the National Guard, it takes even longer.
As members of the Reserve component, there are specific
limits to what benefits we are eligible for as well as special
benefits that we are entitled to. However, in my experience the
outreach and the education of Reservists and National Guard
members has not been focused and comprehensive. Upon our
redeployment, we don't have the luxury of time, unlike the
active component. Like I said, in Texas, we were there for 5
days and we received one briefing from the VA.
Therefore, connecting with this group of veterans and
ensuring education and access to all that the VA has to offer
requires a different strategy.
One thing I noticed is that under the VA Web site, there is
not easily found a section that caters specifically to National
Guard or Reservists. I have a lot of questions. Throughout my
deployment I have talked to soldiers who I worked with and
members of my command and there is neither knowledge nor
understanding about what benefits are available to us. I know
of a lot of things from my work with you, but this is not known
by the mass Guard population. I think if there was an easy way
on the Web site to find focused information about medical
benefits and education benefits that target, specifically, the
Reserve component, that would be helpful.
Regarding VA outreach at the local level in each State, I
think it is really about developing relationships between the
local VA and the local Reserve units and commands. Because
access to Guard and Reserve soldiers is sparse and spread out,
the local VA developing a partnership with the local Guard and
Reserve leadership so that they can coordinate and integrate
the Guard schedule with VA outreach, would also provide a lot
more access and direct access for the soldiers from to VA. To
me, this partnership should not be short-term, but rather a
continuous conversation. By doing this, the VA would provide
faces and names to these soldiers and their families before,
during, and after deployments--to include the break between
deployments--which would greatly improve availability and
access. It would take away the common view that the VA is a big
bureaucratic organization that is not user friendly.
The best counselors are veterans themselves. I have talked
to soldiers during my deployment who would like to help other
soldiers upon returning from deployments and feel that they
have the gift and the need to help other soldiers, but they
don't have the training, the official training or the degree or
the background to do so. If there is a way that the VA could
channel those veterans interested into a training program where
they could have the official training and certification,
possibly along with a commitment from the veteran to work for
the VA, both sides would be served well.
I also think there should be mandatory counseling, both
one-on-one and in groups, for returning Guard and Reserve
veterans. As many of us know, soldiers may be too proud to seek
assistance or seek help or know where to go to get it. These
one-on-one counseling sessions would provide that opportunity
for a soldier to speak freely.
Also, these counselors should be trained to ask the right
questions, be personable, develop a relationship, and know what
the unique challenges that Reserve veterans face with
reintegrating back into their civilian life. This would also
provide the soldier the opportunity to enroll in the VA system,
provide focused information, as well as a face, a name, and a
phone number that the soldier can utilize to follow up for any
additional care.
There are other concerns and issues that exist, as well as
those that we have not discovered yet. By working together and
being creative in finding solutions, progress can be made.
Thank you for the opportunity to share my experiences and
thoughts.
[The prepared statement of Lieutenant Tamayo follows:]
Prepared Statement of First Lieutenant Tulsi Gabbard Tamayo,
Hawaii Army National Guard
Chairman Akaka, and Members of the Committee, thank for the
opportunity to speak here today regarding the VA's outreach and
services to Guard and Reserve Servicemembers.
I am a First Lieutenant, Military Police officer, in the Hawaii
Army National Guard. I enlisted in 2003, earned my commission in 2007,
and have just returned from my second deployment overseas. My statement
today reflects only my personal opinions and experiences as an
individual.
As you are well aware, since 9/11, the VA has begun to see a new
kind of clientele. Veterans are younger, a new generation who grew up
in a different culture, and face new challenges. Also, the reserve
component of the military has taken a role front and center like never
before. The VA is now faced with hundreds of thousands of customers who
are young combat veterans, but who also still actively serve in the
National Guard or Reserves.
Between the period of September 2001 and November 2007, over
450,000 Reserve and National Guard Soldiers were deployed to either
Iraq or Afghanistan. Thousands more have deployed since that time, many
on their second and third tours.
My underlying message to you, the bottom line up front, is that the
DOD and the VA need to work together to think outside the box, and find
comprehensive strategies to reach, educate, and serve Guard and Reserve
veterans.
The VA's presence in our redeployment process (from point of re-
entry back to the US, to being released from active duty) has improved
since 2006, when I returned from my last deployment. About a week and a
half ago, as we went through demobilization at Ft. Hood, TX, we
received a roughly 2-hour briefing from the local Texas VA rep, on all
the various benefits available to us as veterans. He ensured that all
400 of us in the briefing tent filled out the enrollment papers,
assisted those who wished to fill out disability claims applications,
and passed out the application for VA Home Loan guaranty. It was
informative, and I walked away learning a few new things. However, this
should not be the end of the story.
1. DOD and VA cross-talk & coordination
I understand that the VA and DOD are two very separate agencies;
however, for Guard and Reserve Soldiers, the idea of a clean and
complete transition between the DOD and VA is no longer a reality. The
Reserve component has hundreds of thousands of servicemembers who are
dual members of both agencies, eligible for benefits from both. It is
highly likely that a servicemember will transition between reserve and
active status multiple times in his/her career.
A short personal example, I have been waiting 7 months for the VA
to get confirmation from the DOD that I am indeed eligible for the GI
Bill (even though I was deployed and sent the VA a copy of my
mobilization orders). I have called at least once a month for the last
7 months, provided all the documentation that was requested, but am
still being told that nothing can be done. I was told by the VA Case
Manager that it takes a lot longer to get information from the DOD when
dealing with a Guard servicemember. Perhaps with a better system of
coordination between the DOD and the VA, Guard and Reserve Soldiers who
go back and forth between active/reserve status, would not get caught
in this gray area of ``in-between.''
2. Outreach to reserve component members
As members of the Reserve component, there are some specific limits
to what benefits we are eligible for, as well as specific benefits we
are entitled to. However, the outreach and education of Reservists does
not seem to be focused and comprehensive.
Upon redeployment, the Guard/Reserve do not have the luxury of
time, unlike the Active Component. Guard and Reservists have to take
time off from civilian work to seek help. Therefore, connecting with
this group of veterans, and ensuring education and access to all that
VA has to offer requires a different strategy.
a. I could not easily find under any tab on the va.gov web
site, a section that catered solely to Reserve component
members. There are many questions our benefits, especially in
the areas of health care, home loans, and education that could
be answered in a specific section, rather than trying to sift
through all the information and figure out what applies to us
and what doesn't.
b. VA offices in each state could develop a partnership with
the local Guard/Reserve leadership to coordinate and integrate
VA outreach with the annual training/work schedule, and to find
innovative ways to meet the needs of Guard and Reserve
veterans.
This partnership should not be short-term, but rather a
continuous conversation. VA's providing a face and continuous
outreach to Soldiers and their families before, during, and
after deployments, to include the break between deployments,
would greatly improve availability and access. It would take
away the common view that the VA is a big bureaucratic
organization that is not user-friendly.
3. The best counselors are veterans themselves. Those who have been
through what we have been through can provide the best understanding
and support. However, many veterans do not have a 4-year degree or are
not certified counselors. VA could channel those who are interested
into a program that would give them the additional training needed,
along a commitment from them to work for the VA, so that these veterans
can become counselors.
4. There should be mandatory counseling--both one-on-one and in
groups--for returning Guard/Reserve Veterans. If this is a DOD/VA
mandate, local commands will find time for this to ensure it is
executed properly. Soldiers may be too proud to seek assistance on
their own. These one-on-one counselors should be trained to ask the
right questions, encourage the Soldier to enroll in the VA system,
provide focused information to the Soldier based on whatever benefits
he/she find applicable, and then provide a name and phone number who
the Soldier can follow-up with for any additional care that is
required.
After my last deployment, we were required to come in 6 months
after returning home for the Post-Deployment Health Re-Assessment. The
VA was present and provided counseling to those who needed, and also
had a table set up to enroll any one had not yet enrolled in the VA. I
don't know if this has changed since then, but the VA should be front
and center at these briefings, since at this time Soldiers have had a
chance to get through the excitement of being at home, have settled in,
and had more time to think about what kinds of benefits the VA has to
offer them.
5. A central 800 number for Guard/Reserves, which will
automatically route the call directly to a local VA office, similar to
how the phone company or Pizza Hut have their systems, will put a
Soldier directly in touch with their local VA rep who is familiar with
the Guard/Reserve.
There are other concerns and issues that exist, as well as those we
have not discovered yet. By working together and being creative in
solutions, progress can be made. Thank you for the opportunity to share
my experiences and thoughts.
Chairman Akaka. Mahalo and thank you very much, Lieutenant
Tamayo. We certainly are grateful to hear you share your
personal challenges. This will certainly help us to restructure
our system so that we can provide services that are needed to
our veterans.
I would like to call now on Sergeant Sualauvi
Tuimalealiifano. Thank you so much for being here. At this
time, we would like to receive your statement.
STATEMENT OF SERGEANT FIRST CLASS SUALAUVI TUIMALEALIIFANO III,
HAWAII
Sergeant Tuimalealiifano. Good morning, Senator Akaka.
Chairman Akaka. Good morning.
Sergeant Tuimalealiifano. I want to thank you for the
privilege, honor, and opportunity to testify before you today.
I am Sergeant First Class Sualauvi Malua Tuimalealiifano III of
the 96th Civil Affairs Battalion, Airborne, Fort Bragg, North
Carolina. I am processing through the Bravo Company Warrior
Transition Unit of Tripler Army Medical Center.
My 13-year career brought me to Fort Bragg, North Carolina,
with two tours in Iraq, Operation Iraqi Freedom, and a third in
Afghanistan, Operation Enduring Freedom, as part of the proud
and legendary All-American 82nd Airborne Division and the USA
Special Operations Command, Civil Affairs with Third and
Seventh Special Forces Group, Airborne. The results of a
mission in mid-July 2007 in South Afghanistan brought me here
today and to my home of Hawaii.
After 11 months as an inpatient through four different
hospitals in three different States, I have come to know of
many challenges related to injuries and recovery. Because of
what happened on the day I was injured, I am here before you
today. Just as a rock tossed into the water will have a ripple
effect that continues on, the day that I was injured has caused
ripple effects that still continue. I believe this is also true
for others who are wounded in the service of their country.
Today, I hope to represent not just myself, but other injured
servicemembers, whether their injuries are physical, like mine,
or within.
My testimony will focus on what I can offer this Committee,
honest answers based on the experiences I have had in the
service of my country. I will not focus on studies, promises,
or the ideas of others. My strength is that I can speak
firsthand of what a wounded soldier has experienced and what I
have seen others go through.
Senator Akaka, I have with me additional points and issues
that I wanted to bring before you and the Committee.
A lack of confidence in therapists and limited time with
therapy--not according to a group overall, but individual to
that soldier's will and his or her injury.
Acupuncture, but not massages. We'll allow skin-piercing
needles with jolts of electricity but not manual body/muscle
stimulation to body and nerves as well, according to a soldier
or patient.
I have a story of a National Guard Texas soldier who was
left with no unit support while in the care of James Haley
Veterans Affairs Hospital in Tampa, Florida. I was unaware of
any soldier not having any connection or ties with their unit
or the unit that they were mobilized with. With this individual
soldier, he was 23 years old, just got married before he
deployed, and is now a double amputee--both legs above the
knee. We met at the Fisher House.
After we spoke and got together, the wives and myself found
out that he has had no connection with any of his unit members.
I was very upset, very upset. I found out the unit's
information and discussed it with the person on the other side.
But his wife and family were unaware of the way the military
works. His wife was very bitter, and I understood why. She
didn't see any help. According to them, they didn't see any
help in any way--maybe sending a soldier of the unit there
periodically, maybe once a month to check up on them--but there
were no ties of any kind. I was told they probably demobilized,
and I don't know what else became of that, but from what I
could have done, I did. I just hope from being there that no
other soldier, injured or not, returning home would have to go
through that.
I also have on my list here Special Operations. We have an
organization that we call the Care Coalition, and throughout
the time in the hospital the Care Coalition is very
informative, very supportive to, it is sad, but it is to the
Special Operations soldiers and families.
There are things and events that are accessible, funded and
looked after by this Care Coalition. I spoke with them in 2007,
shortly after the War Transition Units were starting to stand
up--and they are working their way in sharing the ideas and
ways of standing up an organization or program to support all
soldiers, regardless of National Guard, Reserves, or active
duty. I think that there are citizen soldiers that were sent
overseas to do what we can do to keep home safe, and when we
return, I think we should all have a similar status of whatever
care and help that we can get.
The other notation I have here is regarding Fisher House.
It provides a great service but could be more family friendly.
It is a nice museum. Everything is beautiful--top-notch funds,
I guess--but they are not friendly toward or prepared for
children. I think the main purpose for that house is to house
the wives and the husbands who come there with their children
to support their loved ones. The Fisher House I have been
through hasn't been family-friendly. They have a very nice
parlor, but no child-friendly room to play in, unlike the
Ronald McDonald House geared toward the family and the
children.
And the last one, sir, is the G.I. Bill. I believe it is
earned and should be used as desired. The question is, for
seminary or church classes--we are not allowed to use it toward
theology without getting the State involved. The point I am
trying to make is, I tried to take classes through my church
school, but I am not allowed to use the G.I. Bill for any
Christian courses and I just want to know why, or if we are
looking into it.
That is all, and I would like to thank you for your time,
for hearing me out, and for letting me come by and testify.
Thank you, sir.
Chairman Akaka. Thank you very much, Sergeant
Tuimalealiifano, for our testimony.
Now, we will hear from Clay Park, who is the Veterans
Program Director, Papa Ola Lokahi. Clay, will you please
proceed with your testimony.
STATEMENT OF CLAY PARK, VETERANS PROGRAM DIRECTOR, PAPA OLA
LOKAHI
Mr. Park. Good morning, Mr. Chairman and Members of the
U.S. Senate Committee on Veterans' Affairs. Thank you for the
opportunity to address the Committee. My name is William
Clayton Sam Park. I am of Native Hawaiian ancestry, a disabled
veteran who served as a combat medic during the Vietnam War,
and a retired Master Sergeant with 3 years active duty with the
U.S. Army and 21 years of service with the Hawaii Army National
Guard. I am presently the Veterans Program Director with Papa
Ola Lokahi. My comments today are based on my experiences in
that role, and in particular with regard to situations faced by
our returning OEF/OIF National Guard and Reserve troops as they
transition from the military to veteran status and back to
their lives in the community.
Though the impact of this current war will be my focus, my
work on a recent day in which veterans I served included an 88-
year-old World War II veteran from Guam and a 19-year-old Oahu
Iraqi war veteran reminds me to emphasize the message of
General Shinseki during his confirmation hearing for the
position of Secretary of the Department of Veterans Affairs. We
must care for all of our veterans. We cannot allow those who
have served their country at any time, in any role, to be
neglected.
Having worked with the community agencies for the past
several years in outreach efforts to our veterans, it is
evident to me that the challenges faced by our newest warriors
and their families remain great. As I have done in testimony
before this Committee in prior years, I would like to use the
stories of those who come to me to provide you with the human
side of the statistics reported to you by officials of the
military or the VA.
Let me start with the experience of a full-time National
Guard soldier activated in Iraq and wounded during that
deployment. This individual was medically boarded with a
disability rating and then discharged from the National Guard.
Since his full-time position with the Guard was his employment
and being a member of the Guard is required for that
employment, this veteran is now without a job, without adequate
income to maintain his former standard of living, and without
health benefits for his family.
Next, consider the young man activated with his Reserve
unit for a second tour in Iraq and sent to the mainland for
training, despite the unit knowing he had a medical condition
likely to limit his performance. He was returned to Hawaii
because he was not able to complete assigned functions. His
unit was deployed to Iraq without him. He is now in limbo. He
hears from the VA that they cannot help him because he is still
an active duty soldier. The military tells him he is not truly
on active duty, since his unit is overseas and he is here.
Consequently, he has no income and no access to health care.
A young Reservist's wife from a State on the mainland
contacted me after reading an airplane article about the
community outreach work in Hawaii. Her husband, a medic, was
being deployed for the fourth time and she was fearful for his
physical and emotional well-being but did not know where to
turn for help. She believed if she spoke with anyone in his
command about her fears or if word got to command from any
other source she might share her fears with, this would reflect
badly on her husband's career.
I hear from other wives of physical and verbal abuse by the
returning husbands. They are fearful for their children,
contemplating divorce, and yet knowing the person they loved
before he was deployed is still there somewhere, desperate to
find him again but not knowing how to do that or where to go
for help.
In another situation, during a briefing with a Reserve unit
about our community outreach efforts, I could see two young
women soldiers in the audience, one with the 1,000-yard stare.
After the briefing, she asked to speak with me off-line about
her experience while deployed in Iraq. This young woman
reminded me of one of my own daughters, and while she cried
while telling me of being raped in Iraq by a fellow soldier, I
knew I was limited in what I could do. She was fearful that she
would be booted out of her unit and possibly even lose her
full-time Federal job if she told anyone what happened. She
felt she could certainly not trust that the other soldiers in
her unit would be supportive and anticipated revenge instead of
support.
One can only wonder how many other women face this
situation alone. I am so thankful that she had the courage to
trust me and that I have a network of people and organizations
in this community available as resources in such situations. In
other situations where the individual is eligible for VA care,
I do everything possible to bridge the trust and get the person
to see one of our caring VA providers.
Since I last testified to this Committee in 2007, I have
seen changes in the VA, such as more emphasis on outreach, more
visible service for women veterans. But as General Shinseki
stated, we must care for all of our veterans. There are still
those who do not reach the safety net of the VA through
established channels or who are frustrated in attempts to seek
help by bureaucratic obstacles. Transitioning home still is not
easy. Senator Akaka's comments in 2007 still hold true. More
can be done to assist veterans and their families in the
reintegration of the wounded or injured veterans into their
community.
Mahalo nui loa for allowing me the time to share my mana'o
with you today. Mr. Chairman, I will be pleased to answer
questions you or your Members of your Committee have for me at
this time.
[The prepared statement of Mr. Park follows:]
Prepared Statement of Clay Park, Veterans Program Director,
Papa Ola Lokahi
Mr. Chairman and Members of the U.S. Senate Committee on Veterans
Affairs: My name is William Clayton Sam Park. I am of Native Hawaiian
ancestry, a disabled veteran, who served as a combat medic during the
Vietnam War, and a retired Master Sergeant with 3 years active duty
with the U.S. Army and 21 years of service with the Hawai'i Army
National Guard. I am presently the Veterans Program Director with Papa
Ola Lokahi. Thank you for the opportunity to address the Senate
Veterans' Affairs Committee.
My comments today are based on my experiences in that role, and in
particular with regard to situations faced by our returning OEF/OIF
National Guard and Reserve troops as they transition from military to
veterans status, and back to their lives in the community. Though the
impact of this current war will be my focus, my work on a recent day in
which the veterans I served included an 88 year old WWII veteran from
Guam and a 19 year old Oahu Iraq War veteran reminds me to emphasize
the message of General Shinseki during his confirmation hearing for the
position as Secretary of the Department of Veterans Affairs (VA)--we
must care for all of our veterans. We cannot allow those who have
served their country at any time, in any role, to be neglected.
Having worked with community agencies for the past several years in
outreach efforts to our veterans, it is evident to me that the
challenges faced by our newest warriors and their families remain
great. As I have done in testimony before this Committee in prior
years, I would like to use the ``stories'' of those who come to me to
provide you with the human side of the statistics reported to you by
officials of the military or the VA. Let me start with the experience
of a full time, National Guard soldier, activated for duty in Iraq and
wounded during that deployment. This individual was medically boarded
with a disability rating and then discharged from the National Guard.
Since his full time position with the Guard was his employment, and
being a member of the Guard is required for that employment, this
veteran is now without a job, without adequate income to maintain his
former standard of living, and without health benefits for his family.
Next, consider the young man activated with his Reserve Unit for
his second tour in Iraq, and sent to the Mainland for training despite
the Unit knowing he had a medical condition likely to limit his
performance. He was returned to Hawaii because he was not able to
complete assigned functions; his Unit was deployed to Iraq without him.
He is now in limbo--he hears from the VA that they cannot help him
because he is still an active duty soldier. The military tells him he
is not truly on active duty since his unit is overseas and he is here.
Consequently, he has no income and no access to health care.
A young Reservist wife from a State on the Mainland contacted me
after reading an airplane magazine article about the community outreach
work in Hawaii. Her husband, a medic, was being deployed for the fourth
time and she was fearful for his physical and emotional well-being, but
did not know where to turn for help. She believed if she spoke with
anyone in his Command about her fears, or if word got to Command from
any other source she might share her fears with, this would reflect
badly on her husband's career. I hear from other wives of physical or
verbal abuse by their returning husbands. They are fearful for their
children, contemplating divorce, yet knowing that the person they loved
before he was deployed is still there somewhere--desperate to find him
again, but not knowing how to do that or where to go for help.
In another situation, during a briefing with a Reserve Unit about
our community outreach efforts, I could see two young women soldiers in
the audience--one with that ``thousand yard stare.'' After the briefing
she asked to speak with me ``off-line'' about her experience while
deployed in Iraq. This young woman reminded me of one of my own
daughters, and while she cried while telling me of being raped in Iraq
by a fellow soldier, I knew I was limited in what I could do. She was
fearful that she would be booted out of her unit and possibly even lose
her full time Federal job if she told anyone what happened. She felt
she certainly could not trust that the other soldiers in her unit would
be supportive, and anticipated revenge instead of support. One can only
wonder how many other women face this situation alone. I am so thankful
that she had the courage to trust me, and that I have a network of
people and organizations in this community available as resources in
such situations. In other situations, when the individual is eligible
for VA care, I do everything possible to bridge the trust and get the
person to see one of our caring VA providers.
Since I last testified to this Committee in 2007, I have seen
changes in the VA, such as more emphasis on outreach and more visible
services for our women veterans. But, as General Shinseki stated--we
must care for all of our veterans. There are still those who do not
reach the safety net of the VA through the established channels, or who
are frustrated in attempts to seek help by bureaucratic obstacles.
Transitioning home is still not easy. Senator Akaka's comments in 2007
still hold true, ``. . . more can be done to assist veterans and their
families in the . . . reintegration of the wounded or injured veterans
into their community.''
Mahalo nui loa for allowing me the time to share my mana'o with you
today. Mr. Chairman, I would be pleased to answer any questions that
you or the Members of the Committee have for me at this time. Aloha.
Chairman Akaka. Thank you very much, Mr. Park, for your
testimony, and I thank all of you for your testimonies.
I have a question here for each of you, so I will call on
you starting with Lieutenant Tamayo. This question is to all of
you, because you each bring your unique perspectives to today's
discussion. It is clear that if we cannot reach veterans, their
needs will go unmet. Over the years that I have been working
with VA, one of the structuring goals is we want to change the
structure from World War II to Iraq and Afghanistan, meaning to
update what we are doing and to try to restructure VA so that
we can deliver the necessary services to those veterans today.
So the question is, what can VA do to improve the
effectiveness of its outreach efforts--our outreach efforts?
Nothing is off the table. We are looking for creative solutions
and you folks have been there.
That said, let me call on Lieutenant Tamayo for your
response.
Lieutenant Tamayo. I think the most important piece to
answer that question is about building relationships and making
veterans and servicemembers feel comfortable and feel that we
have access to the local VA. I think it is easy--you know, the
common perception is that the VA is just a big, huge government
organization that is out there somewhere. Maybe we have access,
maybe we don't. We have to wait in long lines, wait forever to
get benefits.
But by the local VA office or representatives developing
relationships with these Guard and Reserve commands and units
and having that access and availability there where you have a
name, you have a face, and you know that if you have any
questions, you can talk to them, and making that level of
comfort be present at all levels so that the leaders in the
Guard, from the platoon leaders to the company commanders, the
battalion commanders, they feel comfortable. So, they know when
they have a soldier who they are concerned about or a soldier
who is seeking help, that relationship is there where it is not
just calling an 800 number and not knowing who you are going to
get at the other end of the line.
It is developing that relationship and comfort not only
with the units, but I think that is where it starts, because
from there, you have the families. And I know something that is
changing now that is different from our last deployment is the
Family Readiness Groups are trying to remain active and not
shutting down now that we are home. They are trying to stay
active for each other and continue the support between the
family members, but also the support that they experienced
while we were gone. So that is another way for the VA to also
develop relationships with the spouses and with the families
and see what kind of care they are looking for and concerns
they may have about their returning servicemember.
Another thing is, you know, a lot of times those of us in
the military, we say, OK, you have to go to this briefing or
that briefing. You have to go to a suicide prevention briefing
or an anger management briefing, you know, getting ready to
come home. Too often, these become kind of check-the-block.
Here is a 30-slide PowerPoint presentation. OK, you saw it.
Sign your name. You are good to go. There is a difference
between that and actually talking to someone or hearing from
someone who is able to reach us.
We had a briefing from a Major from Wyoming in Kuwait right
before we came back, and he just--he is a social worker in his
civilian job. He is a National Guard soldier. And he said, you
know, this is called an anger management briefing, but I am
here to talk to you about basically how to deal with yourself,
how to deal with the experiences you have had and how to deal
with your family. He talked a lot about himself, and it was a
personal conversation. There were about 150 of us in the room,
but I know each of us felt touched by his message and what he
had to tell us because it was practical. It was real. We
weren't just going through the motions.
So, I think the more we can try to push that, and again,
it's about developing relationships and having local support
and local access.
Chairman Akaka. Thank you very much.
Let me now call on Sergeant Tuimalealiifano.
Sergeant Tuimalealiifano. Thank you, Senator Akaka. I
think, amongst many things and many ways, I think the best
thing we could do is maybe, with the soldiers that have
returned that are willing to help and assist those who are
still there and still sitting in the same positions--
depressions that they were in--if we can take those veterans,
train them--whether it be by certifying them or not--but to
train them maybe with people skills or talking from their own
personal experience, we take those veterans, train them up if
that is what they desire to do.
Like myself, that is what I would love to do, is to get
back into the field that I just left, which is the field of
depression. There is a large field that comes with depression
and a lot of things that different soldiers and injuries,
whether they come back fully physically able, they might not be
within themselves.
I think if we take those soldiers that have recovered to a
certain extent, that have the desire to go back into those
areas, that way, I think, when they are talking to those
soldiers and helping them out, they convey that they have been
there. They have done that. They have shared that. They know
how it feels. They know how it was. I think if we take those
veterans and train them and put them back in that field, if
that would be desired, they could better help those that are
coming in.
The VA, I think, like the Lieutenant said, is a lot about
the relationship. There are soldiers like Mr. Clay here shared
that had the courage to come up and speak about rape. And there
are many others that probably turned away because the
information is not out there, not sharing the opening up to
everyone to see that the VA is available, that there are
organizations and programs available.
But I think relationships, as the Lieutenant mentioned,
with soldiers that are coming and going, I think the VA can do
that, and then just putting themselves out there and to reach
them, whether they want to be heard or not, I think.
That is all I have, sir.
Chairman Akaka. Thank you very much, Sergeant.
Mr. Park?
Mr. Park. Thank you, Mr. Chairman. That is a tough
question, you know.
Chairman Akaka. Yes. Your response to the question?
Mr. Park. One of the things when I look at this is the
predeployment briefing. I have never heard of the VA doing a
predeployment briefing. I have done a predeployment briefing
with the Hawaii Army National Guard, the 29th Brigade; and what
I tell these people is that when you become Title X, when you
are activated, keep all your documents because documentation is
the key. You know, if you are in country and you are standing
next to a sign that says, ``Welcome to Iraq,'' take a picture,
because if the VA comes back and says, we have no evidence that
you were in country, guess what, here it is.
Look for LODs. Make sure you get your LODs if you got hurt
while you were in the military. And again, I go back to
documentation is the key. So these young men and women need to
understand that they need all these documents. They need their
orders. They need to know that the people they go with in
country can write a buddy letter for them when they come back.
So they need to understand that they can work with these people
to help them with their application process, as well.
An open door policy. The VA has an open door policy that if
a veteran is having difficulty with talking to someone, maybe
he can go up the chain and talk to somebody else.
You know, we do education and training. That is the key,
education and training, as well.
The biggest thing is connecting with the community,
connecting with community organizations. Hawaii is very unique.
The people in Hawaii, we are so diverse--different ethnic
backgrounds, the different ways we think. When you go to a
community--I am going to pick a place like Hana. If you go to
Hana to talk to the people in Hana, the first thing you need to
do is you need to seek out the elders out there. Go talk to the
Kupuna, because they are the ones that can give you guidance on
where all these people are, where they are in the bush. They
are the ones that can help you. So make that connection with
the community. Thank you.
Chairman Akaka. Mahalo. Thank you very much. As I said, we
want to be creative in thinking of other ways that are not
being used now to try to deal with the needs that our veterans
have.
Tulsi, as a veteran of several deployments, can you talk
about improvements, improvements that have been made since your
last assignment overseas? What challenges remain?
Lieutenant Tamayo. Like I mentioned before, my return from
my last deployment in 2006, the outreach and the process just
in that short demobilization period--from where we are returned
to the U.S. and released from active duty--the VA had a bigger
presence this time and it was more focused solely on benefits.
I don't know if this is how it is everywhere, but the VA
rep who spoke to us was very encouraging and, I want to say,
forceful in a good way in getting all soldiers to enroll in the
VA and all soldiers to make sure they got a paper talking about
the VA Home Guarantee. People were timid in the beginning. Like
I said, there were over 400, 500 of us in the tent, but he made
sure and he said, hey, you need to get one of these forms, or
you need to fill this out. First, people weren't raising their
hands, and he got basically almost everyone in the whole tent
to raise their hands saying that they were interested and made
himself available afterwards.
So that, to me, was a big improvement from the last time we
returned, where I was not left with an impression of the VA.
The bottom line is, I didn't come back feeling that I had some
big connection with the VA or something that I could take away.
Six months after we returned home, we went through a post-
deployment health reassessment, and at that time, the VA was
also available to us and provided one-on-one counseling to
those who requested it. It was not a front and center piece in
that PDHRA process. We will see in 6 months and see how things
have changed this time around.
Personally, I know that there has been a lot of development
from the VA about benefits for Guard and Reserve soldiers and
there is a lot more available to us now than there was
previously. But again, it comes down to having that focused
outreach to Guard and Reserves saying, this is what is
available to you, this is what you are eligible for, rather
than kind of getting a big, fat book of, hey, this is what the
VA has to offer to everyone and trying to sift through it to
find what actually applies to me or my family?
Chairman Akaka. Thank you very much.
Sergeant, will you describe your experiences with the
Warrior Transition Battalion?
Sergeant Tuimalealiifano. With the Warrior Transition
Battalion, or War Transition Unit, my experience is not much. I
have been through Fort Bragg's WTU. They were just standing it
up. It was fairly new. My interactions with WT there were not
much. I was still an active duty soldier, so I was still
returning back to the unit, to and from, because I was from
Fort Bragg.
I came here to Hawaii and have been with Tripler's WTU.
While the intentions are good, they still need more work. And
there is a lot of--because the Guard, I believe they work with
the active duty and I think with the Reserves, they don't
really hold the same authority over each other. I am still
trying to figure out where in there I might be able to fit in
if I was to go to COAD.
But as far as the WTU, Senator Akaka, the way they are
moving, I think the way they are moving is progressing. They
are getting better in what they are supposed to be doing and in
what they are doing. Like anything else, a new program that you
stand up, you run into obstacles and you learn to adapt to
overcome or change routes or routines.
My experience with the one here--I have been with the WTU
here since January. They have been very supportive out there to
really get you involved in activities and events, going out for
a walk type deals or going to the beach and stuff like that. I
would rather be doing therapy myself, but they have a lot of
good intentions, a lot of good events for soldiers in regards
to their active duty, National Guard and Reserves. They provide
a lot of events. They provide courses and classes for those who
need help with depression, if they feel suicidal.
I think they are going in the right way, the right route
and direction with what they are trying to provide soldiers.
But with the wars now, you have got a lot of us young guys,
young gals, a lot of new and different ways of looking at
things. Some guys, we got our chest out too high or too far and
chin up so high that we forget that on the inside it is always
turning and it needs to be checked up or checked out every once
in a while.
But I think that the WTU is doing a great job, still
progressing, still young, still new.
Chairman Akaka. Thank you very much, Sergeant.
Mr. Park, in your testimony, you state that trust must be
established in order for servicemembers and veterans to be
successfully served. My question to you is, how should VA go
about building this trust?
Mr. Park. One of the things that we established is what we
call our Uncles Program, and I am happy to say that I have a
few of my uncles in here right now. It is disabled veterans
that help the veterans navigate the system in getting the
application, going through the application process.
And what happens with this is that when the veteran calls
and needs somebody to talk to, these are the uncles that talk
to these veterans. You know, in Hawaii, that is who you turn
to. You turn to your uncle, and then your uncle helps you with
whatever problems, whatever you have. Because the VA is a
government organization and because the soldiers are asking if
the command doesn't take care of them, the NCOs don't take care
of them, they are looking at a government organization. They
come right out and they go right back to another government
organization. So the trust that you need to establish with the
soldier is to be straight up front and tell them, this is how
it is. This is what you have got.
I will give you an example. My PHD tells me 10, 10, 30 adds
up to 50, and my PHD is my public high school diploma.
[Laughter.]
Well, when a veteran comes up with 10, 10, 30 on his
disability and they give him 40, he is going to start thinking,
you know, my PHD tells me 10, 10, 30 is 50, it is not 40. You
need to explain to these guys, we have a formula here. That is
why you got 40, you didn't get 50. So the VA needs to be up
front in telling these young soldiers, these veterans, that
this is what we have and they need to educate these people on
how to get the information across to them, because local guys,
if you tell them no, that is it. They are out the door. They
give up. You can't let them give up. We can't. I have got no
time to sit back and let these guys give up, and I don't. And
my uncles, they don't let them give up, either. I have a young
uncle right there in that uniform. He just started, came back
from Iraq.
I think what the VA needs to do is they need to make that
connection. They need to get that trust from the veterans. They
need to go to the National Guard units and the Reserve units
and talk to the commander, talk to the First Sergeant, talk to
the NCOs. That is where it all begins. Thank you.
Chairman Akaka. Thank you very much, Clay. When you say
uncles, I am sure you also mean aunties.
Mr. Park. That, too. [Laughter.]
There is a Dr. Kathleen M. McNamara who holds a women's
group in Maui. I think she is the only one that I know who does
a women's group in Maui, and she does it in the evenings. I
think there is a women's group here on Oahu. I am not sure
there is, but I think there is one at the VA here on Oahu. But
with my counterpart, Babette Galaang, standing there, we are
trying to establish an aunties group, as well.
Chairman Akaka. Thank you. This is really about the
relationship between two people, and in this particular case,
veterans with VA, right?
Mr. Park. Yes, sir.
Chairman Akaka. Well, thank you very much.
This question is for all members of the panel. In your
experiences, how are families affected by the reintegration
process? I know this is a very sensitive question. However,
this Committee would appreciate your candor so we can gain
insight into the nature of this happy and sometimes difficult
process.
Let me first call on Sergeant Tuimalealiifano.
Mrs. Tuimalealiifano. Excuse me, Senator, for barging in
here.
Chairman Akaka. Will you please identify yourself?
STATEMENT OF SHANNON TUIMALEALIIFANO, VETERAN AND WIFE OF
SERGEANT TUIMALEALIIFANO
Mrs. Tuimalealiifano. My name is Shannon Tuimalealiifano,
and I am Sergeant Tui's wife. Very briefly, before I speak on
your question, let me say who I am. My mother was an active
duty Army soldier in the Vietnam era. My father, as well, was a
Vietnam veteran of 24 years. He retired. He spent the majority
of his time at Fort Bragg, the mighty mighty Fort Bragg, NC.
So, I am very familiar with the military historically and
having also joined the military, I am a 10-year veteran myself.
After 9/11, I was activated. My husband and I got married.
I left active duty service after 6 years and was reactivated
twice after
9/11. So, I am familiar with the Reserve component and its
difficulties, and the active-duty component and its novelties,
and families of all types and sorts, growing up from a Vietnam
veteran family, having been a member, and having not only dealt
with deployment issues, but traumatic deployment issues. So, I
just want to say that to let people know that when I speak, I
am speaking from a broad array of experiences. I am so
thankful, Senator, that you are asking for creative ideas on
how to make a difference. I would like to say that the biggest
reason that my husband and I came home after he was injured,
was that the military gave us permission, because we knew
without a shadow of a doubt that even though initially his neck
was broken and he could not function from the neck down, we
knew that God is good all the time and that the best healing
comes at home. So we requested for a transfer. We were granted
that transfer.
The reason we came was because, as Mr. Park has said,
Hawaii is different from the entire rest of the United States.
Where the majority of the United States has had a breakdown in
family components, there is still ohana here. You will still
find uncles and aunties and grandmas and grandpas in the
family, helping. In the mainland especially and in the
military, you are disseminated throughout the United States.
You are very far from any kind of support. And if your command
is not strong and the wives of that command are not strong
enough to understand that their role is to mentor the young
wives coming in, then there is a lack of family connection at
all.
And the Lieutenant is very right. The main thing that we
can do to help veterans, families, and all of the issues
sprouting from the war and being military, period, is
relationship.
We have three children. The youngest was born when he
deployed. He was injured 2 weeks before coming home, so the
baby was one. The number 1 thing, sir, that I can say that
would assist families, when people come home, they need to
reconnect. When they come home different from the way they
left--injured in any capacity--it is traumatizing. It is
wonderful to focus on the outreach of the veterans to take care
of them, but if the families are not cared for, then you are
not caring for the veteran, because the brunt of the burden of
the care will fall on that family. Because after business hours
when everybody shuts down, the therapist, the counselors, and
the family will take over--weekends, holidays, et cetera.
So, the thing that I would say, sir, would be that programs
such as child care so that the couple can seek counseling, or
even can simply get together and reconnect in an informal
atmosphere, of going on a date and simply talking. We need
programs with child care, programs in the VA that reach out to
the community for the family. There were so many things that my
husband could not speak to me on, but he could speak to fellow
veterans, and I understood that. I gave them their time to
connect and console each other so that healing could come. Even
just talking is wonderful.
I received so many helpful people who would give me Web
sites and numbers to call, applications to fill out. With three
small children, one an infant, and my husband unable to
function, if you give me a Web site, you might as well not give
me information. I don't have the time.
The VA would do well to have an organization, and I model
this after the Care Coalition because they were our salvation
when he was hurt. We were so overwhelmed with the future and
the prospects of our entire lives. They banded around us. They
poured love on us. They poured out information in pamphlets,
but they also contacted organizations for us. They saw the
need. They went to the community for us because I didn't have
time to leave the hospital to go ask these people for help.
And they came back with gift cards and gas cards for me
driving back and forth to hospitals. I think many people are
aware of Hero Miles, where they give free tickets for the
families to help--gas cards and food, grocery cards--because we
were living out of the Fisher House. We needed groceries. We
needed all these things that normally we would have at home.
But it was an expense out of our pocket with a sudden loss of
income because, of course, I could not continue working.
So if the VA could form a group where their purpose is to
reach out to the community for these families, connect them to
these groups, connect them to the families of their local
environment, get things like gas cards or grocery cards or free
child care tickets or things that just would take the pressure
off of the couple trying to juggle their lives in the middle of
the chaos while they are still trying to plan their future.
These are the kind of programs and groups needed.
And as I said, the Care Coalition, I do believe, is working
with active duty components to attempt to form some groups, and
they are doing the same thing. They are trying to draft some of
these young soldiers who do not feel that they can continue in
the military so that they don't have the bleak outlook of, I
don't have a future. They ask them, would you like to reach out
to other soldiers? Join our organization, be on staff, come
talk to other soldiers in the hospital so that they don't give
up on life because they don't see what can happen after, if
they lose limbs, if they lose families from the stress.
And the children, most importantly--we were blessed because
my family lived nearby, and being Vietnam veterans they
understood. When he got hurt, my parents took the children. I
went to the hospital. My children didn't have to experience the
trauma of watching me break down and cry. They were allowed to
remain children because there was an environment to care for
them. But without relationship, without a trusting back-up
plan, I would have had to take them and they would have had to
see every sordid detail of him coming off the plane, being
connected to wires, tubes, and a neck brace. That was not
something I wished for my children. But had those programs not
been in place, I wouldn't have had a choice.
So again, I say, it can be traumatic if there is not
someone there to take the pressure off of the soldier and the
spouse so that families can heal slowly instead of trying to
put a pressure dressing immediately and keep it there while you
are trying to figure out everything. So, thank you for letting
me speak.
Chairman Akaka. Mahalo. Thank you so much for that.
[Applause.]
Lieutenant, do you have a response to that?
Lieutenant Tamayo. Just very briefly to touch on something
you mentioned earlier and that you mentioned regarding soldiers
not coming home the same way that they left. This comes in many
shapes and forms. There is the physical aspect of it, and I
know you have worked and you have talked a lot about the
invisible wounds. My mom had actually asked me about PTSD the
other day and asked me, how do they figure out who has PTSD and
who doesn't, and that is the thing.
Coming back from these experiences, there is no cut-and-dry
formula, you had this many bullets shot at you or you went
through this many explosions, therefore, you qualify or
whatever. I can only speak from a Guard-Reservist perspective,
but the baseline of leaving home, putting life on pause, and
being away from your family is a stress in and of itself on a
good day, but when you put together all the things that happen
to a majority of us--not only the stresses of the mission but
also being aware of and knowing things that are going on at
home, things that are not going on at home that should be, and
knowing that you can't do anything about it and you are
powerless and have no control, you can't go home and save the
day, you can't take care of things--there is a lot of stress in
that and different people deal with it in different ways.
The important thing is that when we come home, the support
that was there for the families while we were gone continues
for the families and us as we come home. I know for our unit--
and this is, I think, a testament to the Guard leadership
here--there was quite a bit of family support. Families had a
lot of gatherings, they had a lot of meetings, they had a lot
of information and things that were available. I think it is
definitely important that support continues now that we are
home while we are trying to put all the pieces back together.
Chairman Akaka. Thank you very much.
Let me call on Clay Park for his response.
Mr. Park. Well, Senator, after four children, 13
grandchildren, and four great-grandchildren, I have come a long
way.
When I came back from Vietnam, I was angry. When I was told
that I had PTSD, I said, no, I don't. And they said, well, then
why do you sleep with a loaded pistol under your pillow? How do
you know that?
One day, my son got angry at me and he was going to throw
something at me; and I still remember this in my mind right
now. I was going to kill him, because I remembered that I had
seen this young kid throw a grenade in the helicopter; and at
that time I thought my son was a young VC. If my wife didn't
yell at me, I would have run him over.
I see a lot of spouses that go through their husbands self-
medicating. They are drinking, they are doing drugs, and the
wives are getting hit at night. They don't know what to do. The
families are getting pretty much beat up, and the reason for
that is because they aren't getting help from nobody. They are
doing it on their own. I know the VA is now trying to help the
families, but that is my personal experience with PTSD. Maybe I
have got a Traumatic Brain Injury, too, I don't know, but I
have come a long way. So, after 35 years married to my wife, I
have got a long way to go yet. Thank you, Senator.
Chairman Akaka. Thank you for sharing your personal
experience, Mr. Park.
I want you to know that we have passed legislation on home
care out of Committee. Hopefully we can pass it finally through
the full Senate in September when we go back into Session.
This comes down to helping the family help the soldier--
which includes training the family member and providing
stipends that will help the family.
This has been a great panel. Thank you so much for sharing
your personal experiences. And without question, your responses
will help us be more creative in trying to find services that
can help you and your families. Mahalo nui loa. [Applause.]
I want to welcome our second panel. Our first witness is
Tracey Betts. She is the Honolulu Regional Office Director.
Also, Sheila Cullen, who is Director of the Veterans
Integrated Service Network 21 at the Veterans Health
Administration. She is accompanied by Dr. James Hastings,
Director of the VA Pacific Islands Health Care System, and Dr.
Adam Darkins, who is the Chief Consultant for Care Coordination
in the Office of Patient Services.
And we have Brigadier General Gary Ishikawa, Deputy
Adjutant General for the State of Hawaii.
Our final witness is the Honorable Ray Jefferson. I want to
welcome Ray home. He has just been confirmed as Assistant
Secretary of Veterans' Employment and Training at the
Department of Labor.
I want to thank all of you on the second panel for being
here this morning. Your full testimony will be, of course,
printed in the record.
Ms. Betts, will you please begin with your statement.
STATEMENT OF TRACEY BETTS, HONOLULU REGIONAL OFFICE DIRECTOR,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
Ms. Betts. Chairman Akaka, it is my pleasure to be here
today to discuss our efforts to meet the needs of veterans
residing in the Pacific Region. The Honolulu Regional Office is
responsible for delivering non-medical VA benefits and services
to veterans and their families through the administration of
comprehensive and diverse benefit programs. Today, I will
specifically discuss important outreach and services provided
to members of the National Guard and Reserves here in Hawaii.
The Honolulu Regional Office serves the veteran population
in Hawaii and the Pacific region, including Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands.
The Honolulu RO is also responsible for outreach to the
veterans residing in the insular islands of the Republic of
Palau, Federated States of Micronesia, and the Republic of the
Marshall Islands.
The Honolulu RO administers the following benefits and
services: disability compensation, vocational rehabilitation
and employment assistance, the Home Loan Guarantee Program,
specially adaptive housing grants, and Native American direct
home loan programs, outreach for all veterans, and survivor
benefits.
Over 118,000 veterans live in the jurisdiction served by
the dedicated employees of the Honolulu RO. Of these veterans,
approximately 19,200 currently receive disability compensation
benefits.
The Honolulu RO has two dedicated Military Service
Coordinators who perform many of the outreach functions
provided to returning servicemembers. The MSCs conduct regular
briefings covering the full range of VA benefits as part of the
Military Transition Assistance Program, referred to as TAP, at
various military installations. Servicemembers are informed of
the array of VA benefits and services available, instructed how
to properly complete VA application forms, and advised of the
evidence needed to support their claims. Since the beginning of
the fiscal year, the Honolulu RO has conducted 171 TAP
briefings to approximately 5,100 servicemembers in Hawaii.
Claims submitted by seriously injured veterans of the Operation
Enduring Freedom or Operation Iraqi Freedom receive priority
processing through case management.
The Honolulu RO has a Veterans Service Representative that
travels throughout Hawaii to provide monthly benefit counseling
to veterans residing in Kona, Hilo, Maui, Kauai, with bimonthly
services to veterans on Molokai and semi-annual services to
veterans on Lanai. Veterans Service Representatives travel to
provide benefit briefings, answer questions, and accept the
benefit claims. Outreach to the insular islands is scheduled to
occur on a quarterly basis.
In fiscal year 2009, the Honolulu Loan Guarantee Division
closed 47 Native American direct loans totaling $8.3 million.
The success of this program is attributed to the Loan Guarantee
staff's promotion of the NADL program through weekly outreach
with the Department of Hawaiian Homelands.
We have expanded our outreach programs for National Guard
and Reserve components, our participation in the OEF/OIF
community events, and other information dissemination
activities to ensure that benefit briefings are conducted when
local National Guard and Reserve units return from deployment.
In September 2009, the MSCs and our other Honolulu RO
employees will be participating in the Hawaii Beyond the Yellow
Ribbon Exposition at the convention center, where it is
expected that over 3,000 soldiers and their families will
attend.
The Honolulu RO is also working with the Department of
Defense to expand its role in their military pre-separation
process. Specifically, we are working to place our MSCs on the
grounds of the military treatment facility to expedite the
delivery of consistent service to the wounded, ill, and injured
servicemembers and veterans. Relocation of the MSCs will enable
servicemembers and members of the National Guard and Reserve to
file pre-separation claims, receive benefit briefings, and
participate in personal interviews.
Our vocational rehabilitation and education counselors have
a presence in the Wounded Warrior battalions located at the
Schofield Barracks and the Kaneohe Marine Corps Base. In fiscal
year 2009 our counselors completed 20 briefings and provided
education and vocational counseling to approximately 1,200
servicemembers.
Claims with a known discharge date between 60 and 180 days
can also be processed as benefits delivery at discharge. The
Honolulu RO is a BDD intake site and is responsible for taking
and developing claims received from the eight military
installations within its jurisdiction, to include Camp Smith,
Fort Shafter, Hickham Air Force Base, Marine Corps Base, Pearl
Harbor, San Island Coast Guard, Schofield Barracks, and Tripler
Army Medical Center. Upon receipt of an application, the
Honolulu RO coordinates with the Honolulu VA medical center to
provide the separating servicemember with a VA examination.
When the claim is fully developed, the claim is sent to the
Rating Activity Site, located in Salt Lake City, UT. The
Honolulu RO refers an average of 14 BDD claims per week to the
RAS, which prepares rating decisions for all VA BDD intake
claims for veterans separating in Honolulu. On an average,
claims are completed by the RAS in less than 90 days.
Claims received from servicemembers with a known discharge
date of less than 60 days are categorized as quick-start
claims. At the time of filing a quick-start claim, the
servicemember is advised of the full array of VA benefits, to
include disability compensation, health care, insurance,
vocational rehabilitation, loan guarantees, specially adaptive
housing, and education benefits. The Honolulu RO receives an
average of ten quick-start claims per week. Upon receipt,
medical examinations are ordered and the claim is sent to San
Diego for expedited processing. The San Diego Regional Office
has 100 employees dedicated specifically to processing quick-
start claims.
The Honolulu Regional Office works diligently to provide
services to the veteran population residing here in the Pacific
region.
Mr. Chairman, this concludes my testimony.
[The prepared statement of Ms. Betts follows:]
Prepared Statement of Tracey Betts, Director, Honolulu Regional Office,
Veterans Benefits Administration, U.S. Department of Veterans Affairs
Chairman Akaka, it is my pleasure to be here today to discuss our
efforts to meet the needs of Veterans residing in the Pacific Region.
The Honolulu Regional Office (RO) is responsible for delivering
non-medical VA benefits and services to Veterans and their families
through the administration of comprehensive and diverse benefit
programs. Our goal is to deliver these benefits and services in a
timely, accurate, and compassionate manner.
Today I will specifically discuss important outreach and services
provided to members of the National Guard and Reserves in Hawaii.
honolulu regional office
The Honolulu RO serves the Veteran population in Hawaii and the
Pacific Region, including Guam, American Samoa, and the Commonwealth of
the Northern Mariana Islands (CNMI). The Honolulu RO is also
responsible for outreach to Veterans residing in the Insular Islands of
the Republic of Palau, Federated States of Micronesia, and Republic of
the Marshall Islands.
The Honolulu RO administers the following benefits and services:
Disability Compensation
Vocational Rehabilitation and Employment Assistance
Home Loan Guaranty, Specially Adapted Housing Grants, and
Native American Direct Home Loans
Outreach for all Veteran and survivor benefits
Over 118,000 Veterans live in the jurisdiction served by the
dedicated employees of the Honolulu RO. Of these Veterans,
approximately 19,200 receive disability compensation benefits.
outreach
The Honolulu RO actively participates in various outreach
activities. The Honolulu RO has two dedicated Military Service
Coordinators (MSCs) who perform many of the outreach functions provided
to returning servicemembers. The MSCs conduct regular briefings
covering the full range of VA benefits as part of the military
Transition Assistance Program (TAP) at various military installations
in Hawaii. TAP briefings aim to prepare retiring and separating
military personnel for return to civilian life. At these briefings,
servicemembers are informed of the array of VA benefits and services
available, instructed how to properly complete VA application forms,
and advised of the evidence needed to support their claims. Following
the general instruction segment, personal interviews are conducted with
those servicemembers who request assistance in preparing and submitting
their applications for compensation and/or vocational rehabilitation
and employment benefits. Since the beginning of the fiscal year, the
Honolulu RO has conducted 171 TAP briefings to approximately 5,177
servicemembers in Hawaii.
Claims submitted by seriously injured Veterans of Operation
Enduring Freedom or Operation Iraqi Freedom (OEF/OIF) receive priority
processing through case management. The Honolulu RO OEF/OIF coordinator
works with military medical facilities and VA medical centers to ensure
these servicemembers and their families receive expedited delivery of
all benefits.
In addition, the Honolulu RO has a Veterans Service Representative
(VSR) travel throughout Hawaii to provide benefit counseling to
Veterans. The VSR travels and provides monthly benefit services to
Veterans residing on Kona and Hilo, Hawaii; and on Maui and Kauai.
Quarterly service is also provided to the Veterans residing on Molokai,
and semi-annual service is provided to Veterans residing on Lanai.
The Honolulu RO is committed to providing benefit information and
access to VA programs to Veterans and their dependents living on Guam
and in the Insular Islands, to include the Federated States of
Micronesia, the Republic of the Marshall Islands, and the Republic of
Palau through their increased outreach presence. Veterans Service
Representatives travel to these remote locations to provide benefits
briefings, answer questions, and accept benefit claims. Outreach to the
Insular Islands is scheduled to occur on a quarterly basis. The
Honolulu RO also distributes informational materials, such as VA
pamphlets and DVDs, to Veterans residing on the Insular Islands. A
dedicated telephone line was established for Insular Island Veterans to
contact the Honolulu RO to inquire about their individual claims and to
request general VA benefit information.
Homeless claims are case managed and processed expeditiously. The
Honolulu RO has a Homeless Coordinator who actively works with the
Veterans Health Administration Homeless Coordinators to provide
services to homeless Veterans such as living placement, clothing, and
food. The Homeless Coordinator participates in various outreach
activities to include Homeless Stand Down events in Hilo on April 17,
2009, and Kauai July 4, 2009.
The Native American Direct Loan (NADL) Program, established in 1992
and made permanent by Public Law 109-233, provides financing for homes
for Native American Veterans and Veterans with Native American spouses.
In fiscal year 2009, the Honolulu Loan Guaranty (LGY) Division closed
47 Native American Direct Loans totaling $8,375,639. The success of
this program is attributed to the Honolulu Loan Guaranty staff that
regularly promotes the NADL Program through weekly outreach with the
Department of Hawaiian Homelands. Quarterly outreach for the NADL
Program is provided to Veterans in American Samoa, Guam, and CNMI.
Continual training with lenders and realtors in the community is
conducted.
The RO staff and I regularly participate in various ceremonies and
conventions, such as the Joint POW/MIA Accounting Command Repatriation
Ceremony held at Hickam Air Force Base; the annual Vietnam Veterans
Memorial Day Ceremony at the National Memorial Cemetery of the Pacific,
also known as the Punchbowl; the annual State Governor's Memorial Day
Ceremony at the Hawaii State Veterans Cemetery; and most recently, the
Disabled American Veterans State Conference held in June on the island
of Kauai. Additionally, employees participate in the graduation
ceremonies of Post Traumatic Stress Disorder Residential Rehabilitation
participants held quarterly at Tripler Army Medical Center.
outreach services for members of the reserve and national guard
We have expanded our outreach programs for National Guard and
Reserve components and our participation in OEF/OIF community events
and other information dissemination activities. The MSC ensures that
benefit briefings are conducted when local National Guard and Reserve
units return from deployment. During these briefings, the MSC provides
a comprehensive briefing on VA benefits and assists with appropriate
applications. All attendees receive a copy of VA pamphlet, A Summary of
VA Benefits, as well as the VA Health Care and Benefit Information for
Veterans wallet card. In addition, the MSC works in concert with the
National Guard Yellow Ribbon Program to provide information and
services to members of the National Guard. In September 2009, the MSCs
and other Honolulu RO employees will be participating in ``Hawaii
Beyond the Yellow Ribbon'' exposition. Over 3,000 soldiers and their
families are expected to attend.
The Honolulu RO is also working with the Department of Defense to
expand its role in their military pre-separation process. Specifically,
we are working to place our MSCs on the grounds of the military
treatment facility to expedite the delivery of consistent service to
the wounded, ill, and injured servicemembers and Veterans. Relocation
of the MSCs will enable servicemembers and members of the National
Guard and Reserve to file pre-separation claims, receive benefit
briefings, and participate in personal interviews.
Our Vocational Rehabilitation and Employment (VR&E) employees work
closely with military facilities in Hawaii to ensure that outreach is
extended to as many returning servicemembers as possible. The VR&E
counselors have a presence in the Wounded Warrior Battalions located at
Schofield Barracks and Kaneohe Marine Corp Base. They provide monthly
briefings to these soldiers in addition to providing them education and
employment counseling. In fiscal year 2009, VR&E completed 20 briefings
and provided education and vocational counseling to approximately 1,200
servicemembers.
The VR&E Employment Coordinator from the Honolulu RO works with the
Tripler Army Medical Center's Deployment Health Center to assist
returning Reservists and National Guard members. In addition to
providing information about VA services, the Employment Coordinator
refers recuperating soldiers to the local Disabled Veterans Outreach
Program for employment briefings offered by the Department of Labor.
The Honolulu RO also has a VR&E counselor located at the Maui Community
Based Outpatient Clinic full time providing VR&E services to Maui
Veterans. He currently works with approximately 100 Veterans on Maui
and has met with 1,200 Veterans this fiscal year.
With the ongoing activation of Reserve and National Guard members
in support of the military operations in Iraq and Afghanistan,
servicemembers are becoming eligible for VA home loan benefits in
greater numbers. Reserve and National Guard members are eligible for
the Loan Guaranty and Native American Direct Loan Programs after 90
days or more of active wartime service. In general, Veterans may
qualify for VA-guaranteed and direct loans in amounts equal to the
Freddie Mac conforming loan limit. As a result of the Veterans'
Benefits Improvement Act of 2008, the amount in Oahu, a high-cost area,
can be as high as $783,750, with no down-payment.
The Honolulu Loan Guaranty Office administers VA Home Loan
Workshops at Hickam Air Force Base to active duty servicemembers to
include National Guard and Reservists. In fiscal year 2009, the Loan
Guaranty staff completed five workshops, participated in various
outreach activities such as the Mortgage Class/Financial Fair held at
Fort Shafter, and participated in the Personal Financial Expo held at
the Blaisdell Center earlier this month.
benefits delivery at discharge and quick start claims
Any servicemember may file a pre-discharge claim for disability
compensation if that individual is within 180 days of release from
active service. This includes members of both active duty and full-time
reserve components and those undergoing medical evaluation board/
physical evaluation board proceedings.
Those claims with a known discharge date between 60-180 days can be
processed as a Benefits Delivery at Discharge (BDD) claim. The Honolulu
RO is a Benefits Delivery at Discharge (BDD) intake site and is
responsible for taking and developing claims received from the eight
military installations within its jurisdiction (Camp Smith, Fort
Shafter, Hickam Air Force Base, Marine Corp Base Hawaii, Pearl Harbor,
San Island Coast Guard, Schofield Barracks, and Tripler Army Medical
Center). Upon receipt of an application, the Honolulu RO coordinates
with the Honolulu VA Medical Center to provide the separating
servicemember with a VA examination. When the claim is fully developed
to include completion of the VA examination, the claim is sent to the
rating activity site (RAS) located at the Salt Lake City RO. The
Honolulu RO refers an average of 14 BDD claims per week to the RAS,
which prepares rating decisions for all VA BDD claims for Veterans
separating in Honolulu. On average, claims are completed by the RAS in
less than 90 days.
Claims received from servicemembers with a known discharge date of
less than 60 days are categorized as Quick Start pre-discharge
disability claims. At the time of filing a Quick Start claim, the
servicemember is advised of the full array of VA benefits to include
disability compensation, health care, insurance, vocational
rehabilitation, loan guaranty, specially adapted housing, and education
benefits. The Honolulu RO receives an average of 10 Quick Start claims
per week. Upon receipt, claims are immediately placed under control,
have medical examinations ordered, and are then sent to the San Diego
RO for expedited processing. The San Diego RO has 100 employees
dedicated to the processing of Quick Start claims.
conclusion
The Honolulu Regional Office works diligently to provide services
to the Veteran population residing in the Pacific Region and ensure
members of the National Guard and Reserve are knowledgeable of the
array of benefits and services available to them through VA.
Mr. Chairman, this concludes my testimony. I greatly appreciate
being here today and look forward to answering your questions.
Chairman Akaka. Thank you very much, Ms. Betts.
Now, Sheila Cullen, will you please proceed with your
statement.
STATEMENT OF SHEILA CULLEN, DIRECTOR, VETERANS INTEGRATED
SERVICE NETWORK 21 (VISN 21); ACCOMPANIED BY JAMES HASTINGS,
M.D., DIRECTOR, VA PACIFIC ISLANDS HEALTH CARE SYSTEM; AND ADAM
W. DARKINS, M.D., CHIEF CONSULTANT FOR CARE COORDINATION,
VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS
AFFAIRS
Ms. Cullen. Mr. Chairman, mahalo for the opportunity to
appear before you today to discuss the Department of Veterans
Affairs health care in Hawaii and the Pacific region. It is a
privilege to be here on Oahu to speak and to answer questions
about VA health care issues that are important to veterans
residing in Hawaii.
First, Mr. Chairman, I would like to thank you for your
leadership and advocacy on behalf of veterans. Your vision and
support have led to an unprecedented level of health care
services for veterans, construction of state-of-the-art
facilities here in Honolulu, and remarkable improvements in
access to health care services for veterans residing on the
Hawaiian neighbor islands, American Samoa and Guam.
My written testimony, which I ask be submitted for the
record, describes the VA Sierra Pacific Health Care Network. It
provides an overview of the VA Pacific Islands Health Care
System and the VA facilities here on Oahu. It discusses
national and local telehealth programs, and it highlights
outreach and seamless transition activities between the VA
Pacific Islands Health Care System and the State of Hawaii
National Guard.
In the few minutes I have now, I would like to tell you
about some recent expansions of care and services on the
islands and to describe our outreach efforts to members of the
Reserves and National Guard.
VA Pacific Islands Health Care System currently provides
care in ten locations, with two more soon to be added. The two
planned facilities include a new interim community-based
outpatient clinic to serve Leeward Oahu veterans with an
expected opening in fiscal year 2010, and a new outreach clinic
in Saipan set to open this fall.
An inpatient Post Traumatic Stress Disorder residential
rehabilitation unit is in its interim location on the Tripler
campus, pending construction and activation of a new VA-funded
facility during fiscal year 2011.
VA Pacific Islands Health Care System also received
approval for a VA-funded project, just under $7 million, to
build a joint VA/DOD ambulatory surgery facility on the grounds
of Tripler. The project is nearing design completion and is
scheduled for construction and activation in fiscal year 2011.
VA Pacific Islands Health Care System is also constructing
a new replacement community-based outpatient clinic in Guam
that will offer expanded capacity. It will be located along the
perimeter of the Guam Naval Hospital, and is expected to open
in March 2010.
VA Pacific Islands Health Care System has served the needs
of almost 3,400 total Operation Enduring Freedom/Operation
Iraqi Freedom--or as we more often refer to them, OEF/OIF
veterans--through July 2009, including 1,089 Hawaii National
Guard members. Our experience to-date has shown that about one
in four OEF/OIF veterans avail themselves of VA enrollment and
health care.
VA Pacific Islands Health Care System has a dynamic OEF/OIF
program led by a program manager who, along with three staff,
which includes two care managers and one Transition Patient
Advocate, partner effectively with the Hawaii National Guard,
the Army Reserve, and active duty military to serve the
veterans' health care needs related to these organizations.
These program staff members coordinate care and services
for OEF/OIF veterans and their families throughout the VA
Pacific Islands Health Care System by ensuring that
comprehensive, preventive, mental and physical health
examinations are performed. They also provide outreach services
to veterans who are not currently VA users and assist in the
case management of severely injured veterans who require
complex care.
VA Pacific Islands Health Care System OEF/OIF staff members
meet and communicate frequently with Hawaii National Guard
leadership and exchange data and information about troop
status, including force deployment and return. VA is presently
anticipating the health care needs from an estimated 1,158
returning members of the Guard this month. The program is also
decentralizing its staff and locating them on a full- and part-
time basis, as appropriate, to work on military bases on Oahu,
including Fort Shafter, Kaneohe Marine Air Station, Schofield
Barracks, and with the Hawaii National Guard at Kalaeloa. We
expect that integrating VA staff with these military units will
increase the visibility and level of service VA provides to
individuals within these units and supports continued seamless
transition activities between the organizations.
In addition, VA program staff members regularly attend and
participate in Guard post-deployment health assessment
screenings and Yellow Ribbon events organized for
servicemembers and their families.
In summary, because of the support of this Committee and
the Hawaiian Congressional delegation, VA is providing an
unprecedented level of health care services to veterans
residing in Hawaii and the Pacific region. VA Pacific Islands
Health Care System still faces several challenges, including
timely access to health care services, an aging veteran
population, and the special needs of our newest veterans. VA
Pacific Islands Health Care System will meet these challenges
by working with DOD and community partners, activating an
ambulatory surgical center, utilizing telehealth technologies,
and opening new clinics, as necessary. I am proud of what VA
has accomplished in Hawaii and the Pacific Islands region and
look forward to future endeavors on behalf of veterans.
Again, Mr. Chairman, mahalo for the opportunity to testify
at this hearing, and my colleagues and I would be delighted to
address any questions you may have for us.
[The prepared statement of Ms. Cullen follows:]
Prepared Statement of Ms. Sheila Cullen, Director, VA Sierra Pacific
Network (VISN 21), Veterans Health Administration, U.S. Department of
Veterans Affairs
Mr. Chairman and Members of the Committee, mahalo for the
opportunity to appear before you today to discuss VA health care in
Hawaii and the Pacific region. It is a privilege to be on Oahu to speak
and answer questions about VA health care issues that are important to
Veterans residing in Hawaii. I am accompanied today by Dr. James
Hastings, Director of the VA Pacific Islands Health Care System
(VAPIHCS), and Dr. Adam Darkins, Chief Consultant, Care Coordination,
Office of Patient Care Services, Veterans Health Administration.
First, Mr. Chairman, I would like to thank you for your leadership
and advocacy on behalf of our Nation's Veterans. During your tenure as
Ranking Member and Chairman of this Committee, you have consistently
demonstrated your commitment to Veterans by introducing legislation
designed to meet the needs of Veterans. As I will highlight later, your
vision and support have led to an unprecedented level of health care
services for Veterans, construction of state-of-the-art facilities here
in Honolulu, and remarkable improvements in access to health care
services for Veterans residing on the Hawaiian neighbor islands,
American Samoa and Guam. In addition, we appreciate your interest in
and support of the Department of Veterans Affairs (VA).
Today, I will briefly review the operations of the VA Sierra
Pacific Network that includes Hawaii and the Pacific region; provide an
overview of VAPIHCS and the VA facilities here on Oahu; provide
national and local information regarding telehealth programs; and
highlight outreach and seamless transition activities between VAPIHCS
and the State of Hawaii National Guard.
va sierra pacific network (visn 21)
The VA Sierra Pacific Network (Veterans Integrated Service Network
[VISN] 21) is one of 21 integrated health care networks in the Veterans
Health Administration (VHA). The VA Sierra Pacific Network provides
services to Veterans residing in Hawaii and the Pacific region
(including the Philippines, Guam, American Samoa and Commonwealth of
the Northern Marianas Islands), northern Nevada, and central/northern
California. There were an estimated 1.1 million Veterans living within
the boundaries of the VA Sierra Pacific Network in Fiscal Year (FY)
2008.
The VA Sierra Pacific Network includes six major health care
systems based in Honolulu, HI; Palo Alto, CA; San Francisco, CA;
Sacramento, CA; Fresno, CA; and Reno, NV, as well as an Independent
Outpatient Clinic in Manila, PI. In FY 2008, the Network provided
services to 213,000 out of 350,000 enrolled Veterans. There were about
3.2 million clinic visits and 25,800 inpatient discharges. The
cumulative full-time employment equivalents (FTEE) level was 9,607, and
the operating budget was about $2.1 billion.
The VA Sierra Pacific Network is committed to ensuring the care
Veterans receive is of the highest quality. All six health care systems
within the Network have major academic affiliations. The Network hosts
a significant number of Centers of Excellence in VHA and supports a
large and broad research portfolio. It also has expansive and
collaborative relationships with the Department of Defense (DOD). The
VA Sierra Pacific Network has not only exceeded patient satisfaction
goals (inpatient and outpatient), but its employee satisfaction scores
are among the top five Networks for overall job satisfaction in VHA. As
reflected in the most recent employee satisfaction survey, the Network
had the highest scores in VHA in several categories including
leadership, supervisory support, customer service, conflict resolution,
praise, and rewards.
Given the large and diverse geographic nature (i.e. rural or
frontier lands and remote islands) of VISN 21, access to care is a
priority. In FY 2010, the Network will activate nine new sites of care
in the Pacific (Hawaii and the Northern Mariana Islands), California,
and Nevada. Finally, VISN 21 is proud to operate one of four Polytrauma
Rehabilitation Centers in VHA dedicated to addressing the clinical
needs of the most severely injured Veterans.
va pacific islands health care system (vapihcs)
As noted above, VAPIHCS is one of six major health care systems in
VISN 21. Dr. James Hastings is the director and a practicing
cardiologist at VAPIHCS. VAPIHCS is unique in several important
aspects: its vast catchment area covers 2.6 million square-miles
(including Hawaii, Guam, American Samoa and Commonwealth of the
Northern Marianas); its remote island locations create access
challenges; and it enjoys the cultural richness of the Pacific Islands
with an ethnically diverse patient and staff population. In FY 2008,
there were an estimated 118,000 Veterans living in Hawaii, and at least
10,000 additional Veterans located beyond Hawaii in the VAPIHCS
catchment area.
VAPIHCS currently provides care in ten locations, with two more
soon to be added. Our current facilities include an Ambulatory Care
Center (ACC) and a Community Living Center (CLC) on the campus of the
Tripler Army Medical Center (TAMC) in Honolulu; community-based
outpatient clinics (CBOC) in Lihue (Kauai), Kahului (Maui), Kailua-Kona
(Hawaii), Hilo (Hawaii), Hagatna (Guam) and Pago Pago (American Samoa);
and outreach clinics on Molokai and Lanai. The two planned facilities
include a new interim CBOC to serve Leeward Oahu Veterans (approved in
FY 2008 with an expected opening in early FY 2010) and a new outreach
clinic in Saipan set to open this fall. The inpatient Post Traumatic
Stress Disorder (PTSD) residential rehabilitation unit is in its
interim location on the campus of TAMC, pending construction and
activation of a new VA-funded facility ($9.56 million), also at TAMC,
during FY 2011. VAPIHCS also received approval for a VA-funded project
($6.95 million) to build a Joint VA/DOD Ambulatory Surgery facility on
the grounds of TAMC. The project is nearing design completion and is
scheduled for construction and activation in FY 2011.
VAPIHCS is also constructing a new replacement CBOC in Guam that
will offer expanded capacity. It will be located along the perimeter of
the Guam Naval Hospital, and we expect it to open in March 2010. VHA
operates a total of six Vet Centers in Honolulu, Lihue, Wailuku,
Kailua-Kona, Hilo and Guam. These facilities provide counseling,
psychosocial support, and outreach. A Vet Center staff member was also
added in American Samoa during FY 2008.
In FY 2008, VAPIHCS provided services to nearly 24,000 Veterans, an
increase of over seven percent from FY 2007. Of these Veterans, 19,000
reside in Hawaii. There were 162,000 clinic stops in Hawaii during FY
2008. The cumulative FTEE in FY 2008 for the health care system was 540
employees. The operating budget for VAPIHCS (i.e., General Purpose
allocation from appropriated funds) increased from $128.0 million in FY
2007 to $142 million in FY 2008, an increase of 11
percent.
VAPIHCS provides or contracts for a comprehensive array of health
care services. VAPIHCS directly provides primary care, including
preventive services and health screenings, and mental health services
at all locations. VAPIHCS does not operate its own acute medical-
surgical hospital and as a result faces some challenges in providing
specialty services. VAPIHCS has hired specialists in orthopedics,
ophthalmology, nephrology, infectious disease and inpatient medicine
(``hospitalist''), and is providing selected specialty care in Honolulu
and to a lesser extent at CBOCs. VAPIHCS also added a neurologist in FY
2008 to improve the treatment of Traumatic Brain Injury (TBI). VAPIHCS
is actively recruiting additional specialists and expects to have a
newly hired cardiologist and endocrinologist this fall. Veterans with
spinal cord injuries receive care from VAPIHCS dedicated staff, which
provides a multidisciplinary approach to care. The team, located on
Oahu, is planning to travel and care for patients on the neighbor
islands during FY 2010. Veterans
requiring other specialty care continue to be referred to DOD and
community
facilities.
Inpatient long-term and acute rehabilitation care is available at
the Community Living Center (CLC). Inpatient mental health services are
provided by VA staff on a 20 bed ward within TAMC and at the 16 bed
Post Traumatic Stress Disorder (PTSD) Residential Rehabilitation
Program (PRRP). VAPIHCS contracts for care with DOD (at TAMC and Guam
Naval Hospital) and community facilities for inpatient medical-surgical
care.
national and local telehealth programs
National Telehealth Programs
Telehealth involves the use of information and telecommunication
technologies as a tool in providing health care services when the
patient and practitioner are separated by geographical distance. The
benefits of telehealth to health care systems include: improving access
to care, making specialist services available in rural and remote
locations, and supporting patients to live independently in their own
homes and local communities. Because of the support of telehealth by VA
and Congressional leadership, more Veterans are able to realize these
benefits.
Over the past 6 years telehealth in VA has transitioned from use in
a range of discrete local projects and programs toward a unified,
enterprise level approach that provides routine telehealth services
that are mission critical to the delivery of care to Veterans. In 2009
over 230,000 Veteran patients received care via VA's telehealth
programs. Telehealth takes many forms. VA's enterprise telehealth
programs deliver care to Veteran patients in their homes via home
telehealth; telehealth care is also provided in VA medical centers
(VAMCs), CBOCs and Vet Centers via clinical videoconferencing. In
addition, VA routinely exchanges clinical images via store-and-forwards
telehealth.
I would like to briefly highlight some of the direct benefits these
services are providing to Veterans. Almost 40,000 Veterans are
receiving home-telehealth-based care that supports care delivery to
them in their own homes. These care coordination/home telehealth (CCHT)
services have reduced hospital admissions by 25 percent, hospital stays
by 25 percent, and have high levels of patient satisfaction (86 percent
mean score). In 2008 almost 50,000 Veterans received care via clinical
videoconferencing (CCGT), the majority receiving mental health care
services that reduced hospital admissions by 20 percent. In 2008 over
100,000 Veterans were screened to prevent avoidable blindness by VA's
teleretinal imaging programs (CCSF).
The successful implementation of robust and sustainable telehealth
services that VA entrusts to provide care to Veteran patients must
satisfy stringent clinical, technological and business requirements
that ensure they are appropriate, effective and cost-effective. These
requirements include acceptance by patients and practitioners as well
as staff training and quality management systems. Mr. Chairman, you and
the Committee understand how the geography of Hawaii and the Pacific
region poses particular challenges in implementing telehealth that are
not encountered on the U.S. mainland. Services to Guam and American
Samoa not only need to bridge a physical distance of 3,820 and 2,300
miles respectively, they also need to bridge between patients and
clinical communities that are distant and distinct from one another.
Bridging these distances and linking these communities to enable them
to integrate requires telecommunications bandwidth. VA is currently
seeking to embrace Hawaii and the Pacific region within its clinical
enterprise video conferencing network (CEVN) and in doing simplify the
linkage to specialist services from medical center assets on the U.S.
mainland.
VA recognizes the pioneering role that Hawaii and the Pacific
region have played in the development of telehealth solutions that
range from teleretinal imaging to home telehealth. These innovations
have included partnerships with DOD and the University of Hawaii within
the collaborative framework of the Pacific Telehealth and Technology
Hui (partnership, or ``Hui.''). VA appreciates the support of Congress
in the establishment of VA's Office of Rural Health with sufficient
resources that enable us to focus on extending current enterprise
telehealth solutions as well as developing new telehealth solutions to
serve Veterans, not only those in Hawaii and the Pacific region
Islands, but also Veterans elsewhere in the Nation for whom
geographical distance from VA's physical health care assets presents a
challenge to receiving care. In considering future innovation for local
and enterprise portfolios of telehealth services, VA is looking toward
new iterations of a familiar technology--the telephone. Currently the
telephone has meant that eight patients a month from Hawaii and the
Pacific region have been able to access VA's suicide hotline and
receive support from Canandaigua, New York. The transition of health
applications onto mobile technologies such as cell phones promises to
further revolutionize how telehealth can serve Veterans in areas such
as Hawaii and the Pacific region.
Mr. Chairman, I used the word Hui earlier. As you know, Hui
describes a partnership, a union or a gathering. All health care is
ultimately local, and my discussion so far has focused on the clinical,
technological and business issues of implementing telehealth across the
VA health care system. My attention will now turn to local telehealth
initiatives that support Hawaiian Veterans and those living on other
Pacific Islands.
Local Telehealth Programs
In partnership with DOD, specifically TAMC, VAPIHCS began to
develop this capability in 2001 with the support of Senator Daniel K.
Inouye. The Pacific Telehealth and Technology Hui formed in 1999 allows
joint development of telemedicine technologies for both organizations
in the Pacific. This partnership (known as ``the Hui'') fielded many
demonstration projects that have enabled both Departments to develop
ongoing telehealth activity for our beneficiaries.
For VAPIHCS, this partnership allowed us to begin developing
telemedicine capabilities in collaboration with the local information
technology (IT) department that developed the telecommunications
network infrastructure and supported the deployment of video
teleconferencing to VA CBOCs on the islands of Hawaii, Maui, Kauai,
Guam, and American Samoa. Connectivity to Molokai and Lanai is also
available, and we are presently studying connectivity for our newly
approved Outreach Clinic in Saipan. Additionally, this initial
investment allowed the development of procedures, practices, and
protocols to support video teleconference clinical visits for primary
care, mental health, and subspecialty care. Funds were provided for
purchasing telemedicine ``carts,'' that allow the use of peripheral
medical equipment (stethoscopes, otoscopes, cameras and other
attachments), as well as teleretinal imaging equipment to permit
screening for diabetic eye disease. Automated Drug Dispensing System
(ADDS) machines were installed in CBOCs in 2003 allowing pharmacists in
Honolulu to dispense medications and, through the use of video
conferencing, to provide medication counseling to Veterans at the time
of their clinic visits. The VAPIHCS also began tele-home care projects
in 2003 by deploying home telemedicine units. This partnership and
initial funding has helped us establish a foundation of experience upon
which we continue to build to enhance the medical care provided in our
facilities throughout the Pacific Region. Additionally, this early
experience has allowed our facilities to compete for research dollars
to further develop telemedicine and tele-mental health activities.
The Hui also provided support for TAMC projects, including support
for store and forward telemedicine for adult and pediatric care to the
Western Pacific, cardiac sonography from TAMC to Guam and Japan,
intensive care unit telemetry and consultation from TAMC to Guam Naval
Hospital and Korea, speech therapy and other projects.
Beyond the Hui, VAPIHCS and TAMC are working together to develop
joint telemedicine capabilities in American Samoa to support co-
location of TAMC personnel at a VA CBOC. This arrangement would extend
clinical expertise from TAMC to American Samoa to serve Veterans and
active duty servicemembers, as well as members of the National Guard
and Reserve who have experienced a Traumatic Brain Injury (TBI).
Recently, VA expanded mental health programs, including significant
growth in tele-mental health activities. VA recruited a clinical
psychologist to fill a new position for a dedicated tele-mental health
coordinator based in Maui. This new position expanded tele-psychology
services equitably throughout the CBOC. Additionally, VA has begun
conducting tele-mental health Compensation and Pension (C&P)
examinations to expedite the assessment of Veterans for appropriate
benefits.
During fiscal year (FY) 2009, telehealth has been extremely helpful
in delivering mental health services and dispensing medications to
Veterans. A snapshot of relevant data, current through July 2009,
includes:
Over 2,000 telehealth patient encounters in VAPIHCS, 1,300
of which were for mental health and 52 of which were for mental health
C&P evaluations for patients in Guam or the Commonwealth of the
Northern Mariana Islands; and
Over 9,000 prescriptions filled at CBOCs on Kauai, Maui,
Hilo, Kona, American Samoa and Guam using ADDS machines.
VAPIHCS has other Telehealth services that are available to
Veterans, including:
Care Coordinated General Telehealth clinics (CCGT), which
offer
Individual and group psychology and psychiatry
support;
PTSD group research clinic;
Individual and family nutrition information;
Mental health C&P examinations;
Geriatric psychiatry;
General surgery and neurosurgery through the San
Francisco VAMC;
Treatment for spinal cord injury through the Palo
Alto VAMC;
Wound care;
Nephrology care; and
Participation in VA's `MOVE!' (weight loss) program;
Care Coordinated Store Forward clinics (CCSF):
Teledermatology through the San Francisco VAMC; and
Teleretinal Imaging;
Care Coordination Home Telehealth, utilizing home
telehealth devices to support the care of Veteran patients in
their own homes on Oahu, Maui and Hilo.
Our expanding and diverse experience with telehealth has provided
many ``lessons learned'' to further shape the development of our
VAPIHCS Telehealth Program. For example, numbers (i.e. encounters)
alone do not tell the complete story of how technologies may be used to
improve the health care of Veterans. In addition to increasing access
to specialty services for Veterans, VAPIHCS has found telehealth
technologies also allow CBOC providers to learn from telemedicine
experiences (with distant providers), which can improve the skills of
local physicians. VAPIHCS continually evaluates the use of telehealth
services that are provided to Veterans within our service area and
changes the program as necessary to meet the needs of the Veterans we
serve. There is a new opportunity to expand the use of telehealth as we
develop new outreach clinics to meet the needs of Veterans in highly
rural areas.
This increased ``hands-on'' care allows us to pursue new telehealth
opportunities in even more remote locations to benefit Veterans. We are
providing more care in the home, using VA's Care Coordination Home
Telehealth (CCHT) protocols. This will provide us with patient data and
information from the home that can be used to maximize our ability to
manage medically complex patients in conjunction with our chronic
disease team to improve the quality of life for Veterans.
There are some local challenges with telehealth. We are adding
additional staff, including telehealth nurses, to our sites so our
clinics can both provide direct patient care and staff telehealth
clinics as well. We anticipate that by this fall, we will have
sufficient support for telehealth activities at each CBOC in the area.
This table provides data about telehealth usage in the following
facilities:
Number of Unique Patients by Site (VA Pacific Islands Health Care System)
----------------------------------------------------------------------------------------------------------------
Facility FY 2006 FY 2007 FY 2008 FY 2009 (YTD)
----------------------------------------------------------------------------------------------------------------
Honolulu.................................................. 298 253 186 230
Maui...................................................... 53 65 60 272
(includes (includes
Molokai 5) Molokai 17)
Kauai..................................................... 70 71 73 100
Hilo...................................................... 128 59 65 96
Guam...................................................... 0 18 40 117
Kona...................................................... 6 1 14 33
Am Samoa.................................................. 0 0 0 7
-----------------------------------------------------
TOTAL................................................. 555 467 438 855
----------------------------------------------------------------------------------------------------------------
The total numbers of VA's patients using telehealth decreased in FY
2007 when VA received permission to begin sending patients to TAMC,
rather than using telemedicine to support patient transfers to
California. Some of this change can also be explained in part by
additional staff hires, particularly in mental health, at some of these
facilities. We anticipate a growth in telehealth in FY 2010 as
dedicated telehealth nurses are added to our facilities this fall.
oahu facilities
VA operates the Spark M. Matsunaga VA Medical Center in Oahu,
located on the campus of TAMC at 459 Patterson Road, Honolulu, HI,
96815. The VAMC consists of the Ambulatory Care Center (ACC), a 60-bed
Community Living Center (CLC) and administrative space (located in the
E Wing of TAMC). Additionally VA operates both a 20-bed acute
psychiatry inpatient unit and a 16-bed PRRP within TAMC. A Veterans
Benefits Administration (VBA) Regional Office is co-located with VHA on
this campus. The Honolulu Vet Center is located nearby at 1680
Kapiolani Boulevard in Honolulu.
VA estimates the Veteran island population for Oahu in FY 2008 was
73,000. In FY 2008, 27,000 Veterans on Oahu were enrolled for care, and
of these 14,070 received VA care (``users''). The market penetrations
for enrollees and users are 37 percent and 19 percent, respectively and
compare favorably with rates within VISN 21 and VHA.
The average FTEE level on Oahu in FY 2008 is 468. With this staff,
VAPIHCS provides a wide range of outpatient services, including primary
care, several medical subspecialties (e.g., cardiology,
gastroenterology, geriatrics, nephrology, orthopedics, pulmonary and
women's health), mental health, and dental care. In addition, VAPIHCS
provides diagnostic services such as laboratory, echocardiography and
radiology. If Veterans require services not available at the ACC or
CLC, VAPIHCS arranges and pays for care at TAMC, local community
providers, or VA facilities in California; for those referred to a
facility in California, VA can cover the costs of transportation if the
veteran is eligible for beneficiary travel.
In FY 2008, VA facilities in Oahu recorded about 162,000 clinic
stops. In the face of increasing demand for primary care services in
Honolulu, VAPIHCS unexpectedly lost the services of two primary care
physicians, resulting in a large number of Veterans being placed on our
wait list. To address this need, we have identified potential
replacements for our primary care provider vacancies and established
several new primary care positions, including a physician solely
dedicated to women's health care and another for spinal cord injuries.
We believe these steps will eliminate our primary care appointment wait
list by October 1, 2009. In FY 2008, the combined average daily census
(ADC) in the mental health ward was 11 and was 53 at the CLC. VAPIHCS
spent about $15 million for clinical services for Veterans at TAMC and
another $30 million for non-VA care in the community.
va resources available to the hawaii national guard
VAPIHCS has served the needs of almost 3,400 total Operation
Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans through
July 2009, including 1,089 Hawaii National Guard members, 800 of whom
reside on Oahu, with the rest residing throughout the Hawaiian neighbor
islands. Experience to date has shown that about one in four OEF/OIF
Veterans avail themselves of VA enrollment and health care.
VAPIHCS has a dynamic OEF/OIF Program led by a Program Manager who,
along with three staff including two Care Managers and one Transition
Patient Advocate, partner effectively with the Hawaii National Guard,
the Army Reserve, and active duty military to serve the Veterans'
health care needs related to these organizations.
These program staff members coordinate care and services for OEF/
OIF Veterans and their families throughout the VAPIHCS. Specifically,
they ensure comprehensive preventive mental and physical health
evaluations are performed, provide outreach services to Veterans who
are not currently VA users, and assist in the case management of
severely injured Veterans who require complex care. VA program staff
also work collaboratively with Army Wounded Warrior staff to coordinate
care and services for these individuals.
VAPIHCS OEF/OIF staff members meet and communicate frequently with
Hawaii National Guard leadership and exchange data and information
about troop status, including force deployment and return. VA is
presently anticipating the health care needs from an estimated 1,158
returning members of the Guard during August 2009.
The program is also decentralizing its staff during this period of
time, locating them on a full and part time basis as appropriate to
work on military bases on Oahu including Ft. Shafter, Kaneohe Marine
Air Station, Schofield Barracks, and with the Hawaii National Guard at
Kalaeloa. We expect that integrating VA staff with these military units
will increase the visibility and level of service VA provides to
individuals within these units and supports continued seamless
transition activities between the organizations.
In addition, VA program staff members regularly attend and
participate in Guard Post Deployment Health Assessment Screenings and
Yellow Ribbon Events, organized for servicemembers and their families.
As mentioned previously, VAPIHCS has the resources to provide
members of the Hawaii National Guard quality primary and mental health
care, and specialized medical care. The PRRP, TBI and SCI team
capability further enhances the services available to all Veterans.
conclusion
In summary, with the support of the Senate Committee on Veterans'
Affairs and the Hawaiian Congressional delegation, VA is providing an
unprecedented level of health care services to Veterans residing in
Hawaii and the Pacific region. VA has state-of-the-art facilities and
enhanced services in Honolulu, as well as robust staffing on the
neighbor islands along with expanded or renovated clinics in many
locations. VA continues to enhance its staff with added mental health
providers and specialists to meet Veterans' needs. These services are
also available to Veterans who are Hawaii National Guard members
VAPIHCS still faces several challenges including timely access to
health care services (in part due to the topography of its catchment
area and lack of an acute medical-surgical hospital), an aging Veteran
population, and the special needs of our newest Veterans. VAPIHCS will
meet these challenges by working with DOD and community partners,
activating an ambulatory surgery center, utilizing telehealth
technologies, and opening new clinics as necessary. I am proud of what
VA has accomplished in Hawaii and the Pacific Islands region and look
forward to our future endeavors on behalf of Veterans.
Again, Mr. Chairman, mahalo for the opportunity to testify at this
hearing. My colleagues and I would be delighted to address any
questions you may have for us.
Chairman Akaka. Thank you very much, Ms. Cullen, for your
testimony.
And now, I will call on General Ishikawa for his statement.
STATEMENT OF BRIGADIER GENERAL GARY M. ISHIKAWA, DEPUTY
ADJUTANT GENERAL, STATE OF HAWAII
General Ishikawa. Chairman Akaka, mahalo and aloha.
Chairman Akaka. Aloha.
General Ishikawa. I appreciate this opportunity to testify.
I am Brigadier General Gary Ishikawa, the Deputy Adjutant
General for the State of Hawaii. I bring you greetings from
Major General Bob Lee, of course.
You should have my written testimony submitted earlier, so
as such, I would just like to summarize and share with you an
observation and an event that I just experienced, both of which
I believe are relevant.
Before I get into that, I would also like to enter into the
record--I have here the testimony of Mark Moses, who is the
Director of the State Office of Veterans Services. They are a
very important partner with all the agencies in the outreach,
as we have counselors in every county, including periodic
visits to Molokai and Lanai. So, I think his testimony--I ask
that it be entered into the record.
Chairman Akaka. Thank you very much. It will be included in
the record, without objection.
[The prepared statement of Mr. Moses is in the Appendix.]
General Ishikawa. Mahalo. The first and most important are
the services to our veterans, especially on the neighbor
islands and our Pacific Island veterans from Tinian, Rota, and
Saipan. I know that on August 14, Secretary Shinseki announced
that 28 additional Vet Centers will be established next year.
This is in addition to the existing 232 community-based centers
across the 50 States. I further note that two of the additional
centers will be in Western Oahu. I think they mean Leeward
Coast and American Samoa. After listening to Secretary Shinseki
during his most recent visit, I am extremely optimistic that we
will be seeing marked improvements in care to our veterans.
It is also a great pleasure of mine to share with a former
fellow Deputy Director, the Secretary Ray Jefferson. And I
welcome him back to Hawaii.
The key, I feel, to a lot of these good things that are
going on in what I call remote locations is collaboration and
partnerships. All too often, we get into our silos. We are the
State, so we only work with State. We are the Federal, so we
only work with Federal. If we are going to really address the
problem of remote locations for service to our veterans, then
we really need to get together and sit down and have a good
discussion how Federal, State, county, and even non-government
organizations can somehow partner. We have got a lot of smart
lawyers. I am certain that we can get there if that is what we
are determined to do.
Then an event I would like to share with you, Senator.
Early this month--actually, I left on August 11--I had the
opportunity to welcome back to the U.S. Hawaii's own 29th
Brigade Combat Team, including Lieutenant Tamayo. During my
briefing about the demobilization, or what we call Reverse SRP,
or Reverse Soldier Readiness Program, I was pleasantly
surprised--and this is in Fort Hood, Texas--to learn that two
new stations had been added to the demobilization. I am not
sure this is occurring nationwide, but it did occur in Fort
Hood. They were dental and hearing.
When I asked the doctors there why they were doing this,
they were very clear to me how difficult it was for Reserve
soldiers in remote locations to get those type of services. I
was really happy to hear that kind of thinking in the
demobilization station. When I inquired how they defined remote
locations, however, they answered, places like Saipan, Tinian,
Rota, and American Samoa. While this is a giant step to
addressing care to our veterans in remote locations, this type
of thinking has to be extended, and we will figure out how to
do this within the Department of Defense to all remote
locations, because as we know, soldiers from locations like
Molokai and Keaau on Hawaii Island fits what I would define as
remote locations.
So, I am pleased that the conversation has started. We will
continue to push that conversation to all remote locations,
even within the continental United States. I think this is very
important. You have to get to where the veterans are. It has to
be grass roots. And I like these two things, hopefully as
indicators that things are moving in the right direction.
Senator, thank you again for your attention, and I will be
available for questions after.
[The prepared statement of General Ishikawa follows:]
Prepared Statement of Brigadier General Gary M. Ishikawa, Deputy
Adjutant General, State of Hawaii
Chairman Akaka and members of the Senate Committee on Veterans'
Affairs, I am Brigadier General Gary Ishikawa, the Deputy Adjutant
General for the State of Hawaii.
Within the State Department of Defense, there are four major
divisions: the Hawaii Army and Air National Guard, State Civil Defense,
and the Office of Veterans' Services. Mr. Mark Moses, a retired Marine
and former state legislator, is our Director of the Office of Veterans'
Services.
The Office of Veterans' Services is responsible for the welfare of
our veterans and their families. They also act as an intermediary
between our veterans and the Department of Veterans' Affairs.
Hawaii veterans make up more than ten percent of our total
population. The majority of them--about 72%--live on the island of
Oahu. About 13% live on the island of Hawaii, 10% are on one of the
three islands that comprise Maui County, and 5% live on the island of
Kauai. However, our veteran population continues to grow as Hawaii
continues to support our Nation's war on terrorism. Since September 11,
2001, call to active duty have involved nine out of every ten Hawaii
Army National Guard and Army Reserve soldiers. They have served
honorably in Iraq Afghanistan, and other locations; and have returned
to Hawaii after their 12-15 month
deployments.
Members of the Hawaii Air National Guard have supported and
continues to support Operations Iraqi Freedom and Enduring Freedom.
It is important that these veterans return to their communities in
good health. The Office of Veterans' Services partners with the
Veterans' Administration here during the soldier's demobilization
process. This partnership works to ensure that no veteran or no benefit
is forgotten.
The United States government has an obligation to our military
members from enlistment, through their years of service, and to
veterans' benefits. We must ensure that all veterans receive all
entitled benefits now and tin the years to come.
The National Guard Bureau recently authorized the Army and Air
National Guard to release medical records to the Department of
Veterans' Affairs without the veteran's signature. This new procedure
speeds the Department of Veterans' Affairs adjudication of veterans'
claims and provides medical care to National Guard
members.
I come to you with two concerns. First and most important is
Veterans' Affair services to all our veterans, especially on the
neighbor islands and our Pacific Islander veterans form Tinian, Rota,
and Saipan. In July 2007, a VA clinic opened in American Samoa that
supports our veterans there. However, veterans from other Pacific
islands must pay the high cost of airline and hotel accommodations to
receive follow-on medical treatment. In Hawaii, a similar situation
occurs when a neighbor island veteran must come to Tripler Army Medical
Center/Matsunaga VA Hospital in Honolulu for treatment. We must find a
solution to this situation. One thought would be to establish a
partnership between the Department of Veterans' Affairs and existing
medical/health care facilities on the neighbor islands to provide
medical treatment for our veterans.
Second concern is the staffing at VA hospitals. For example, the
Post Deployment Health Reassessment Program (PDHRA) requires an initial
appointment with 30 days for VA registration.
On average, the VA hospital schedules initial appointments as much
as 90 to 120 days from the registration date. Our local VA hospital
staff has been doing their best to provide services to all of our
veterans. They have stretched their limited health care provider
resources to support their mission requirements to all veterans in the
Pacific Basin.
In closing, I want to thank the Committee for their continuing
support of our veterans. Thank you for coming to Hawaii to conduct
these hearings. Are there any questions?
Chairman Akaka. Thank you very much, General Ishikawa.
Now, we will receive the statement of our friend, the
Honorable Raymond Jefferson.
STATEMENT OF RAYMOND JEFFERSON, ASSISTANT SECRETARY, VETERANS'
EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR
Mr. Jefferson. Aloha.
Chairman Akaka. Aloha.
Mr. Jefferson. Chairman Akaka, brethren, distinguished
members in the room today who serve the veterans community, it
is an honor and a pleasure to be back home. Let me just share a
few thoughts.
I am a veteran. I was injured in October 1995 with Special
Forces, lost my hand in the line of duty. I was medevaced here
to Tripler, Hawaii, and through the support of Hawaii, of the
Department of Veterans Affairs, the Vocational Rehabilitation
Program, all of those partnerships allowed me to get my life
back, to move forward, and to ultimately today have the
privilege of serving our veterans through the Department of
Labor's Veterans' Employment and Training Service.
Senator, we have the mission of helping veterans and
transitioning servicemembers have the best possible services
and resources to succeed in the 21st century workforce. We have
five aspirations that we are aiming toward achieving that.
The first is serving as a national focal point for veterans
employment and training. That will involve increasing
awareness, access, and participation in all of our programs,
and improving the employment outcomes for those participants.
Second, convening, collaborating, and communicating with
all of our stakeholders so that we can work seamlessly
together.
And third, from that first aspiration is ensuring that we
serve all of those populations with special needs, especially
homeless veterans, women veterans, veterans in rural areas, and
veterans who have been ill or injured. During this week here in
Hawaii, we are also, Senator, going to be reaching out to Maui
and the Big Island and spending time with the veteran
populations there.
We also want to further engage with the private sector,
make sure they are involved with our programs and processes
because they have the jobs. We want to work with them, and we
are going to meet with private sector leaders tomorrow here on
Oahu and on Thursday and Friday with private sector leaders on
the Big Island and Maui.
We also want to boost USERRA's impact and the commitment to
USERRA. We are very pleased that right now Hawaii has a very
low rate of USERRA incidents--only four in 2007 and four in
2008.
We also want to help transitioning servicemembers to
transition seamlessly into meaningful employment and careers,
and to have a particular emphasis on what we call green jobs
and jobs of the future.
And finally, we want to invest in our people. I believe
that the rising tide lifts all boats. We want to help each of
our team members achieve his or her potential and also improve
their ability to better serve our veterans.
Thank you, Senator, and we look forward to your questions.
[The prepared statement of Mr. Jefferson follows:]
Prepared Statement of Hon. Raymond M. Jefferson, Assistant Secretary,
Veterans' Employment and Training, U.S. Department of Labor
Chairman Akaka, Ranking Member Burr and distinguished Members of
the Committee: Aloha! Thank you for inviting us to appear before you
today to discuss the employment assistance and outreach services
provided to the National Guard and Reserve in Hawaii.
The mission of the Veterans' Employment and Training Service (VETS)
is to provide Veterans and transitioning Service Members with the
resources and services to succeed in the workforce by maximizing their
employment opportunities, protecting their employment rights, and
meeting labor market demands with qualified veterans.
We accomplish our mission through three distinct functions: (1)
conducting employment and training programs; (2) enforcing relevant
Federal laws and regulations; and (3) providing transition assistance
services.
VETS administers two programs through formula grants to States that
directly meet the goals of its mission: (1) the Disabled Veteran
Outreach Program (DVOP) and (2) the Local Veterans Employment
Representatives (LVER) program. DVOP specialists provide outreach
services, and intensive employment assistance to meet the employment
needs of eligible veterans. LVER staff conduct outreach to employers
and engage in advocacy efforts with hiring executives to increase
employment opportunities for veterans, encourage the hiring of disabled
veterans, and generally assist veterans to gain and retain employment.
To meet the needs of homeless veterans and help reintegrate them into
the workforce, VETS administers the Homeless Veterans' Reintegration
Program. Veterans with significant barriers to employment or service-
connected disabilities are also served through the Veterans' Workforce
Investment Program, a focused and innovative training program that
coordinates services available through other VETS administered
programs. Both the homeless and workforce investment veterans programs
are funded through a competitive grant process.
Our enforcement programs investigate complaints filed by Veterans
and other protected individuals under the Uniformed Services Employment
and Reemployment Rights Act (USERRA), assess complaints alleging
violation of statutes requiring Veterans' Preference in Federal hiring,
and implement and collect information regarding Veteran employment by
Federal contractors.
VETS' transition assistance services are offered through the
Transition Assistance Program (TAP), which provides employment
workshops and direct services for separating military members,
including those who are seriously wounded and injured.
transition assistance program
TAP is a Department of Defense (DOD) program that partners with the
Department of Labor (DOL), the Department of Veterans Affairs (VA), and
the Department of Homeland Security (DHS). TAP has four components:
1. Pre-separation counseling--this is mandatory for all
transitioning Service Members and is provided by the military services;
2. TAP employment workshops--these are voluntary on the part of the
transitioning Service Member and are administered through DOL and its
state partners;
3. VA benefits briefing--these briefings are also voluntary and
administered by the VA; and
4. Disabled Transition Assistance Program--also voluntary and
administered by the VA.
dol employment workshops
Since 1991, when DOL began providing employment workshops pursuant
to section 502 of the National Defense Authorization Act for Fiscal
Year 1991 (P.L. 101-510), over one million separating and retiring
military members and their spouses have been provided employment and
job training assistance and other transitional services. DOL was
further directed to provide these services at overseas locations by
section 309 of the Veterans Benefits Act of 2003 (P.L. 108-183).
VETS began facilitating TAP workshops at overseas military
installations where, by previous interagency agreement, the DOD had
provided TAP workshops since the program's inception. We are currently
conducting TAP employment workshops at 55 sites overseas including
Germany, Japan, Italy, Korea, Guam and the United Kingdom. Our mission
is to provide TAP at every location requested by the Armed Services or
National Guard and Reserve Component.
VETS provides employment search workshops based on projections made
by each of the Armed Services and the DHS (for the U.S. Coast Guard).
DVOPs and LVERs are the primary source for TAP Employment Workshop
facilitation stateside. However, because of the distance between many
state employment offices and the military installations, as well as the
rapid increase in Workshop participants, contract facilitators were
added in early FY 1992 and supplemented by Federal staff in FY 1996.
Hawaii currently uses contract facilitators.
The Department of Defense recently set a goal for TAP Employment
Workshop participation of 85 percent of separating servicemembers.
Eighty-one percent of active-duty transitioning Service Members
currently attend the DOL TAP employment workshops, a 30% increase in
participation since 2001. TAP employment workshop participation is
expected to increase over the next year, and we plan to target workshop
delivery to spouses and family members of separating servicemembers,
including those with limited English proficiency. .
In an effort to provide the same high level of instruction to all
servicemembers and spouses attending TAP Employment Workshops, VETS
requires that all TAP facilitators receive training conducted by the
National Veterans Training Institute (NVTI) at the University of
Colorado in Denver. NVTI provides competency based training to further
develop and enhance the professional skills of veterans' employment and
training service providers throughout the United States.
The current course curriculum covers two and one-half days of
classroom instruction and provides information on a variety of topics
including:
Career exploration;
Resume preparation;
Strategies for an effective job search;
Interview techniques;
Reviewing job offers;
Prevention of homelessness;
Entrepreneurship information; and
Other available support and assistance.
reserve component and national guard employment workshop
Global military commitments have necessitated a mobilization of
Guard and Reserve members that is unprecedented in modern times. The
longer mobilization periods result in these Service Members now being
eligible for Veterans' benefits, including TAP. The employment workshop
is available for Guard or Reserve Members, along with all other Service
Members, at one of the 215 transition offices located on military
installations in the United States as well as overseas locations.
However, Reserve and National Guard members usually transition at
fewer locations, referred to as demobilization sites. Typically the
demobilization process is rapid, taking a matter of days once the
Service Members arrive back in the United States from overseas. During
demobilization, Service Members may be expected to participate in many
separate briefings and activities. This leaves little or no time for a
full two and one-half day employment workshop. Nevertheless, we have
found that many National Guard and Reserve Service Members would
benefit from such transition assistance. Our State Directors have
coordinated with each State Adjutant General and they work directly
with the individual Reserve and National Guard commanders to make
special arrangements following demobilization in order to present a
modified TAP employment workshop to Guard and Reserve Service Members.
Based on requests from Reserve Component Commanders or Adjutant
Generals and through coordination with our VETS' state directors and
local VA staff, VETS has offered to tailor the workshops to the
identified needs of the transitioning Reserve and National Guard
members.
In fact, since 2001 VETS has provided transition services to over
146,000 National Guard and Reservists. These transition services range
in size and content from mobilization and demobilization briefings to
the full scale TAP employment workshops. They are provided in 43 states
and the District of Columbia. In some states, National Guardsmen and
Reservists have been allowed to attend the regular TAP for Active
Component Service Members. The services provided to the National Guard
and Reserve are tailored to the needs and requests by the DOD.
To meet the transition needs of the National Guard and Reserves, in
FY 2007, DOL directed the NVTI to develop a modular version of the TAP
employment workshop. The traditional TAP employment workshop was turned
into a 15-module menu that Reserve and National Guard commanders may
choose from in providing these services to their unit members. This
training includes a mandatory module that covers local labor market
information, USERRA, the One-Stop Career Center system, small business
opportunities, and the risks of homelessness. The other 14 modules
consist of the current TAP employment workshop curriculum broken down
into logical and connected blocks of instruction. This is not a new or
separate curriculum for the Reserves and National Guard; rather it has
been packaged to better serve this community.
programs in hawaii
I have provided information on what is being done to assist those
Service Members transitioning from the military to civilian life. I
would now like to focus on what we are doing in the state of Hawaii.
Hawaii averages more than 100 TAP workshops annually with nearly
4,000 transitioning Service Members in attendance. There are five TAP
sites, all on the island of Oahu, Honolulu County, encompassing all
military service branches including the U.S. Coast Guard.
A DVOP or LVER representative attends each workshop session to
discuss their respective roles and responsibilities in providing job
search assistance. Since most transitioning Service Members return to
the mainland, this information is provided to help the Service Member
contact the DVOP and LVER representative in their respective states to
assist them directly with their re-integration into the local job
market in their areas.
Our VETS Director in Hawaii meets quarterly with all TAP site
managers, a VA representative, and a representative from the State of
Hawaii National Guard to discuss the TAP program and how it can be
improved. Guest speakers have included the garrison commander at
Schofield Barracks and the U.S. Attorney for Hawaii.
National Guard and Reserve personnel in Hawaii are informed that
they can attend TAP for up to 180 days after completion of their active
duty commitment. LVER and DVOP staff assigned to the counties of
Honolulu, Maui, Kauai, and Hawaii have all been formally trained and
can facilitate TAP employment workshops either individually or on a
unit basis.
Periodic USERRA briefings are conducted upon request and through
outreach by VETS staff. State of Hawaii Army and Air National Guard
units as well as Army Reserve have received briefings and USERRA
outreach within the last six months. National Guard units on the
neighboring islands of Hawaii (Big Island) and Maui have received
briefings within the last 45 days. Briefings will be conducted in
conjunction with the Operation Yellow Ribbon Reintegration Program for
the return of the State of Hawaii Army National Guard's 29th Brigade.
These welcome home activities are planned for Oahu on September 20,
2009, followed by September 26, 2009, in the counties of Hawaii and
Kona, and October 3 and 4, 2009, for Maui and Kauai counties.
closing
In closing, I again thank you for allowing me to address you today
on this very important issue. I would be pleased to respond to any
questions you may have. Mahalo.
Chairman Akaka. Thank you very much, Ray. We are so happy
to have you here.
I have a question for all the members of the panel. How do
you currently communicate at the local level with one another
about how to meet the needs of returning servicemembers? Let me
first call on Tracey Betts for her response.
Ms. Betts. Here in Honolulu, we meet--myself and Dr.
Hastings, as well as other folks--on a regular basis or even
sometimes on a case-by-case basis, but we meet to discuss
issues. A lot of times, the discussion starts with what can we
do or what can we improve upon.
I meet with the folks in the community. We have our service
organizations who are in the facility with us. We meet with
them regularly. Basically, it is a revolving door, and as a
need comes up, we address it, and on a regular basis.
We have a lot of what I would consider--we do a lot of
collaboration. We meet with not only the medical side, we have
the benefit side. We also work with the Vet Centers.
One of the issues, of course, that is coming up here in
this hearing today is outreach. We have created a coordinator
in the VBA side who is starting to network and to develop
communication with everyone out there in the community, to let
us know when we are needed for outreach and where are we
needed, and then we schedule. And what we do is we communicate
internally with everyone to participate and to ensure that the
presence of the VA is there during the session or event in
which we attend.
Chairman Akaka. Is there a regular schedule for meetings on
Lanai and other Neighbor Islands?
Ms. Betts. When dealing with outreach, currently, the State
of Hawaii has representatives who are out there every month.
Mark Moses's group goes out and meets with veterans and does
counseling. When I came out, the VA benefits, they were meeting
twice a year, and we are looking at increasing that time
element. On the medical side, they do--can I defer to Dr.
Hastings?
Chairman Akaka. Yes, you may. Let me say that we are
accompanied here by Dr. Hastings, as well, and we are glad to
hear from you, Dr. Hastings.
Dr. Hastings. Thank you, Senator. Again, I want to thank
you very much for all the support you have given us and our
veterans here over a many-year period of time.
We have, I think, a very sophisticated informal
communication system between the groups that support veterans
here on Oahu and in the Pacific Islands. We are fortunate in
being all co-located on the Tripler campus. Very importantly,
we have developed many lines of communication between VA, VHA,
and Tripler, and they provide us inpatient services and
outpatient services. But we also are involved with any
servicemen who are coming back who are going to go into the
Warrior Transition Unit. As you heard, we now have
representatives from our organization located in the Warrior
Transition Unit, both at Schofield Barracks and at Kaneohe. So
we have developed a very good communication system.
Also very importantly, as Tracey mentioned, we work
collaboratively, and Tracey is essentially a member of our
staff and we are a member of her staff. That is the way it
works. So she can work with me, but she also can work with
other members of my staff if the issue is something that they
are more conversant with. Also they can work with Mark Moses.
He is right downstairs, and we also have open communication
with him.
We also are very fortunate in that the Veterans Service
Organizations are also housed in our complex, so they have open
communication with us, as well.
So, I think we are doing very, very nicely. We have regular
meetings together and we have a Veterans Advisory Council, and
both Mark and Tracey sit on our Veterans Advisory Council. So
we have a lot of open communication with them.
Now, you asked specifically a question about the sort of
meeting that you witnessed yesterday in Lanai. I have to tell
you that we have not had an open forum meeting like that with
them in some time. But it is clear as I listened to that
meeting yesterday that this is something we are going to have
to start doing, and we do have plans to do regular town halls,
open town halls on the other islands and we will include Lanai
in that plan. So, we will open up communications with the
veterans. That is where we sort of stand today.
Chairman Akaka. Thank you very much, Dr. Hastings.
The other member I wanted to pose this to is Sheila Cullen.
Do you have anything to add?
Ms. Cullen. Thank you, Senator. Just a few. There is not
much to add to what you have already heard from Dr. Hastings
and from Tracey Betts.
I would reemphasize the enormous benefit of having VHA,
VBA, and DOD co-located here in Honolulu. That affords them the
opportunity not only to have formal meetings to discuss common
issues, but to readily have informal sessions, as well.
Dr. Hastings and Tracey Betts have resolved together that
when the opportunity presents itself in the future, they will
be looking to locate some component of VBA along with any
expansions that we might have for any of our community-based
outpatient clinics.
I would also add that some of the outreach efforts that you
have heard about are joint outreach efforts, and I had seen
that firsthand last Friday at the convention center for the
50th commemoration of Statehood. One of the booths was an
outreach effort manned by VHA and VBA staff and they worked
together very, very well answering the questions that came from
some people in the military as well as some civilians and were
jointly able to pass out information about eligibility and to
refer some questions each to the other whenever one might have
more specialized knowledge.
It is not just at that outreach effort, but at the many
other Yellow Ribbon and Welcome Home events that we have joint
participation from the VA to assure a common understanding of
what the issues are that we face.
Chairman Akaka. Thank you very much, Sheila.
Let me ask General Ishikawa to respond to that question.
General Ishikawa?
General Ishikawa. If I understand the question correctly,
it is how we communicate with our veterans. Actually, we have a
family support group and we have a full-timer. Any information
that we need to move to the spouses or the family members,
really, we pass it through them.
Just because I was curious with a personal reason, I joined
the Family Support Group for Bravo Troop First of the 299th.
There was a commander, his name was Captain with the same last
name as mine, Ishikawa, so I saw it from two sides. The witness
that said we should try to maintain that Family Support Group
Network, I think they have it spot-on.
We put information on the top and I caught it coming back
at me. There are a lot of volunteers out there, and a constant
e-mail traffic flow. That is a very strong method of
communications with the grassroots that I would like to say
that we relied upon a lot.
One of the things that was real clear to me, and that is
why we are really pushing hard for what we call the Yellow
Ribbon Reintegration, while it is not mandatory, it is a 30-,
60-, 90-day program where, again, we will talk to not so much
the veterans themselves but the families. Because they
demobilized in Fort Hood, Texas, the families were not with
them. It is actually the families, the spouses and the
grandpas, like that, they are the ones that are really curious.
They are the ones that pick up all that information. Talking to
the soldiers themselves, basically, no matter how much we tell
them to pay attention, they just want to get back to L&L and
have a plate lunch. [Laughter.]
So, we found that getting to the families and using the
Family Support Network is probably going to be the key to the
future for us, anyway, for especially our veterans in remote
locations.
Thank you, sir, for the opportunity to respond.
Chairman Akaka. Thank you very much for that. Since our
troops have been returning as of last week, this becomes very,
very important. I do understand that when they do come home,
they want to just rest and do what they want to do and not
worry about whether they are having any problems at this time.
You are correct that the family is the one that can really help
them at this point. But we still need to develop these
relationships between the different units of the National Guard
and Reserves as well as the VA for services.
Let me ask Ray for any comments he may have in this
particular area. I know we just confirmed you a few weeks ago
in your position and that you have been working hard to set up
services for our veterans across the Nation.
Mr. Jefferson. Yes, Senator. Well, thank you. So in terms
of coordination at the local level, let me touch on a few of
the areas there. I want to thank my friend here and colleague,
General Ishikawa, from our time in service, because in the
Transition Assistance Program, we meet quarterly with the
Department of Defense representative, the Veterans Affairs
representative, and also with the State of Hawaii National
Guard representative, and so that is a very effective
collaboration at the transition assistance and program level
for that resource and service.
Also, our State Director, who is here today--Tom
Rosenswike--is co-located at the Department of Labor Industrial
Relations on Punchbowl. We are very grateful for the support we
get from DLIR--the Director and the Deputy Director there. So
we have a very close relationship and that co-location is very
helpful in that.
We also partner, Senator, with the Department of Veterans
Affairs in our Homeless Veterans Reintegration Program. I would
like to talk more about that later, if it would be helpful, and
also about the Vocational Rehabilitation Program.
We additionally have a REAL Lifelines program, and we
actually have a Disabled Veteran Outreach Program Specialist
located right at Tripler Army Medical Center. That individual
works with the veteran when he or she is on active duty and
helps them develop a plan for their life and to have a seamless
transition as they move from active duty to their status as a
veteran, whether they remain in Hawaii or whether they were to
go on to the mainland.
Finally, our State director participates in a variety of
forums and councils, such as the Oahu Veterans Council, and is
very involved with the VSOs here. I am very thankful for the
support that the Department of Labor's Veterans Employment and
Training Service gets from the VSOs. I just want to
particularly acknowledge the American Legion and the Navy
League.
So, there is a tremendous amount of cooperation and
communication that takes place and that assures we provide the
most effective service possible to veterans and transitioning
servicemembers. At the same time, I am down here to look at how
things can be further improved.
Chairman Akaka. Thank you very much for that, Ray. I would
like for you to expound on what you just suggested, but let me
ask this question to General Ishikawa. I am concerned that the
efforts of commands to identify and help those who may be
suffering from psychological trauma may not be entirely
focused. The approach seems to be one of providing information
to a large gathering rather than working to identify those in
need so as to reach them in a more appropriate setting, which
could be down to one-to-one. I would add that sometimes these
sweeping approaches can hurt overall morale while still not
reaching those in need. A unit's tempo and elements of the
military culture create a wall that is hard for servicemembers
to breach.
What can be done to create an open and private environment
in which servicemembers will be able to ask for help?
General Ishikawa. That is a very double-sided, double-edged
question, because we work in a macho environment where we have
to be strong. I think we have done a lot of work with education
for our soldiers. I do see some breakthroughs. The last mission
which the brigade just came back from, basically, two of the
units, the 100th and the First of the 299th, had convoy duty
into Iraq. It was normal policy when any of the units
encountered an IED or something like that, they would
automatically send the whole group to a resident mental health
specialist.
I think those types of positive things which the 29th
Brigade did, will play well into the future. So what happened
was that it doesn't become stigmatized. You had an IED. Your
whole team goes there. It is to help you. If you catch it right
after the incident occurs and follow it through--because we
know who they are now--it should be easier to keep it from
being stigmatized and easier for us to find it.
Now, I think it starts right there on the battlefield. If
we can start it there for all units, I think it will pay big
dividends. I think it is going to be time before we can shift
the cultural mindset, but we have just got to keep up our
education programs. It is OK. It doesn't show weakness. We can
help you.
I don't have a magic bullet, Senator. These are just some
ideas and techniques I think that possibly could lead down the
road to the ultimate solution. Thank you.
Chairman Akaka. Thank you very much. What the General is
referring to, as he said, you can talk to families, but when it
comes to the troops, they are looking at when they are going to
eat----
[Laughter.]
Chairman Akaka [continuing]. Which is true. I am glad to
hear that--and you are correct. It starts where it happened, on
the field. That will certainly make a difference to the troops.
Ms. Betts and Ms. Cullen, access to health care and other
benefits and services are ongoing challenges for veterans in
Hawaii and Guam. I am especially concerned that when our
National Guard members turn to VA, that the appropriate
services will not be easily accessible when needed. What
advances have been made to reduce the burden on veterans as
they seek VA health care and benefits in areas served by the
Pacific Islands Health Care System and the Honolulu Regional
Office? Ms. Betts?
Ms. Betts. Yes, Senator. In developing and improving
access, one of the road maps that we developed--one is to
increase our presence and attend more outreach, as well as to
utilize the structure. Right now, as we had alluded to earlier
or discussed earlier, was the placement of a benefit person
where the medical assistance is in all of the CBOCs. The
medical facilities are growing and they are relocating to have
easier access to the veterans, and with that we have worked
out, or they have committed to us to allow for space because
that is always an issue--we can put people out there. Finding
the space that they will occupy is a challenge, so, we have
been looking toward that.
The challenge for us is obviously the geography of the
jurisdiction that we have, such as places in Guam, Tinian,
Rota, American Samoa, and particularly here in the islands. All
of the outer islands, we have those kind of challenges.
The discussion came up yesterday of when do you--what are
the requirements to have a full-time person sitting there in a
chair 8 hours a day? The reality of it is, when there is a
need, when the veterans are present, and so the outreach
approach is to try to get them to identify themselves and tell
us where they are. Once we know where they are we can then
provide those services and reach out to them, whether it is
through periodic visits and/or if we need to be there on a more
permanent basis.
So, what we are doing right now is looking--we are working
on a very collaborative effort in understanding where these
veterans are, what their needs are, and how we can together
provide full, comprehensive services for them both on the
benefits as well as the medical side.
As far as getting information out there, of course,
everybody assumes that now that we are online, it is easier for
people to apply for their benefits. The part that is missing is
that veterans, or what we call the end users, don't all have
computers or access to them; so we are trying to look at that
part of it--the technology side of how can we better improve
access for them. Although we have the methodology, we need to
look at the actual veterans, see where they are at and see how
can we help them. Ideally, the non-government entities or the
service organizations or other veterans and volunteer folks can
help us to determine how can we get those people access to the
structure that we placed out there.
Chairman Akaka. Thank you.
Ms. Cullen?
Ms. Cullen. Thank you, Senator Akaka. What we have done, is
made improvements in bringing health care to the veterans in
remote areas such as American Samoa and Guam. In late 2007, we
opened a new CBOC on American Samoa and that has been very well
received by veterans. I don't have the numbers in front of me
of how many veterans we have seen there, but the numbers have
increased very dramatically from the numbers who had been seen
when we had a part-time presence on the island.
In Guam, we will be replacing the current CBOC with an
expanded clinic and it will be located on the perimeter of the
Naval Hospital in Guam, which we think will be an improvement
for veterans. Right now, they need to go through the security
process at the Naval Hospital in order to access the clinic,
which is within the hospital there. So, in March of next year
we will have an expansion of services in Guam.
We have both primary care and mental health services
available at both clinics. As Tracey Betts referenced, we are
looking to accommodate benefits counselors in both locations,
as well. With those great distances and the challenge it
presents, we are hoping to expand our utilization of telehealth
and tele-mental health services. We look forward to providing
you with a demonstration of how we utilize that technical
capability later on this week at the hearing on Friday.
Chairman Akaka. Thank you for that.
Let me just ask Dr. Darkins whether he has any comments to
make.
Dr. Darkins. Thank you, Mr. Chairman. Telehealth uses
information communication technologies to make health care
accessible. Certainly, the distances involved and the services
required in Hawaii and the Pacific Islands lend themselves very
much to the use of telehealth. The Pacific Islands Health Care
System has been an innovator and a leader in developing
telehealth in partnership with the military, and also with
links across to the mainland.
I think that the services here are really poised to take
advantage of many new things in the future. The real challenge,
I think, is to go from what are called point-to-point
connections to develop a network of care; and to do that, there
are various issues that need to be addressed.
First, there are telecommunications issues to be able to
ensure there is that connectivity.
Second, it is necessary to have the culture. We heard
earlier about the importance of relationships. Despite using
technology, it doesn't work unless it fosters those kind of
relationships. So, visiting some of the clinics, which I have
had the opportunity to do this week, shows just some of the
ways in which that needs to take place.
I certainly commend what is being done here and look
forward to seeing the further growth of telemedicine as a way
to deliver the kind of services which we are hearing are
required.
Chairman Akaka. Thank you, Dr. Darkins.
This name has been mentioned here, and I want to take the
time to mention that Mark Moses is here. He is with the Office
of Veterans Services, Department of Defense, for the State of
Hawaii, and he is available to veterans for veterans services.
He is another one that veterans can call on for help.
Ray, I am delighted that you could be here on what must be
one of your first engagements since becoming Assistant
Secretary for Veterans' Employment and Training at the
Department of Labor.
Mr. Jefferson. My first one.
[Laughter.]
Chairman Akaka. Very good. As a disabled veteran who has
utilized VA services and who is now in a position to make
positive contributions for those who have worn this Nation's
uniform, can you please share some areas in which you believe
that transition services can be improved, as well as some
things that DOD, VA, and Labor are doing right, and expand on
what you had suggested you would do.
Mr. Jefferson. Thank you. Senator, let me first just share
maybe a picture of the journey of how the Department of Labor's
Veterans Employment and Training Service can help
servicemembers and veterans.
When the active-duty servicemember, to include National
Guard and Reserve who were mobilized and now are being
demobilized, when they are transitioning out, we have the
Transition Assistance Program, which is conducted in
collaboration with the Department of Defense, Department of
Veterans Affairs, and the Department of Homeland Security. So,
we provide a 2\1/2\-day employment workshop through that
Transition Assistance Program. So, that is the first service
and resource that we can provide to servicemembers.
Second, when they return, either when they have been
mobilized and they are being demobilized, if they come back and
realize that their job or employment has been given away as a
result of that deployment, we have the USERRA program that
helps guarantee their rights and we go ahead and work to ensure
that those rights are maintained. And if there is a situation
of employment discrimination, we investigate that and work to
resolve that. So that is the second area and service that we
can provide for servicemembers and veterans.
Third, once a servicemember has transitioned to being a
veteran, we have what we call our Disabled Veterans Outreach
Program Specialists, or DVOPS. It is a long phrase, but a very
important role. We also have our LVERS, Local Veterans
Employment Representative Services. Here is the bottom line:
these people work with veterans one-on-one to get them jobs.
Our Disabled Veteran Outreach Program Specialists--we have one
here on Oahu, one on the Big Island, and one on Maui--I will be
meeting with them this week to get their insights on how things
can be further improved.
We also have four local Veterans Employment
Representatives: three on Oahu, one on Kauai, and one of them
on Oahu is co-located at Tripler to help the seriously disabled
and injured veterans there.
There are two more areas in which we can help veterans.
One, we have a Homeless Veterans Reintegration Program. We have
on this island a rural location that I visited yesterday,
Kalaeloa; and we have an urban location where I will be this
afternoon called Network Enterprises. Rene Berthiaume is here
today and I am very appreciative of his support, and we are
looking forward to spending time together. We are getting very
good feedback on the impact these programs are having to help
homeless veterans get back on their feet and to get jobs.
And finally, for those servicemembers who are seriously,
seriously injured, we have a REAL Lifelines program where we
help them develop a life map to move from being injured in the
military to going through whatever retraining is necessary to
create a meaningful life and career. There are things which are
working well. There are also things that can be improved, and
if you would like me to comment on those, I would be very
willing and eager to do so.
Chairman Akaka. Thank you very much, Ray, for that. It is
good for Hawaii to know what you are doing here. Thank you.
Mr. Jefferson. Thank you, Senator.
Chairman Akaka. Ms. Betts, your testimony touches on the
Hawaii Beyond the Yellow Ribbon Exposition that the Military
Services Coordinators and other Honolulu Regional Office
employees will participate in during September. Can you expand
on the information that will be provided at this exposition and
detail any other efforts that are underway to inform Guard
members of benefits and services for which they are eligible?
Ms. Betts. The function itself--what will happen is the
Department of Veterans Affairs will have a booth there with
representation from all of the components, and those components
are from the medical staff, from the benefits staff, as well as
the Vet Center staff. The expectation is that all information
that we have for them will be available and will be provided at
that time. We will have brochures for all the different benefit
programs. We will have representatives from the different
benefit programs, such as a loan guarantee representative, the
voc rehab representative, as well as the compensation-pension
program. What we plan to do is be there to answer questions, to
take inquiries, and if necessary, to take claims.
As far as what else we are doing out there: we have been
involved with the Yellow Ribbon Program that the Guard and the
Reserves have. As I had indicated earlier, we have an Outreach
Program Coordinator, and their job is to get into the network
of the needs of both veterans--those in the Guard as well as in
the Reserve, and even in the active service, anyone out there
who needs to know about benefits--about VA and what we have to
offer. We have been trying to get the word out there, contact
that individual and let them know and it will be on our
schedule.
Right now we participate in the Guard's 30-, 60-, 90-day
reintegration program. We have counselors who go in for every
one of those. Of course, we have the normal TAP briefings, but
right now, it is if you call, we will come. So, we have been
trying to get out there to get the word out and to find out
what information is needed and how to better improve our
presence as well as access they have to benefits.
Chairman Akaka. Thank you very much, Ms. Betts.
General Ishikawa and Ms. Betts, one issue that we hear of
time and time again from VA and servicemembers is the
difficulty VA has in gathering Guard and Reserve records. This
is regarding records for the claims process. Obviously, this
impedes the timeliness of receiving compensation.
My question is, what can be done to improve this particular
process? General Ishikawa, followed by Ms. Betts.
General Ishikawa. I think right now, and even in the really
difficult times that we are having in the State of Hawaii
economically, Mark Moses and his folks are on the tip of the
spear. They meet with the veterans out there, especially more
so in our remote locations, and they actually help them fill
out the forms. And Mark can probably talk a lot more about
this, but I think when I talk about partnerships and
collaborations, I think all the agencies need to get together--
the VA clinics, the Vet Centers, and all of that--because we
are servicing the same folks in these remote locations.
So, I cannot see why we cannot take the meetings and
communications we do here on that one campus to the neighbor
islands where we have the services. I challenge Director Moses
to start collaborating with the various agencies out there. I
think if we start pushing that more and more, we will see a lot
better input, and I think that is the key. A lot of times we
see the records--applications--go in and they get returned,
missing this, missing that, and that is where Mark and his
great team steps in. They actually
sit down with the veterans and help them fill out the forms. I
think more work on collaboration and partnerships is the
ultimate answer.
Ms. Betts. One thing I can say is here in Hawaii, we do not
have the same or similar issues that you see in other stations,
and that is access to the records. I do know that what we have
started to do is we have started the conversation with the
Guard in how to get better access or how to better secure this
information.
One of the things we found out in this conversation was
that they do centralize their records here in Hawaii, which
makes it a little bit easier for us. So, what we have done is
one of my staff has entered into conversation with the records
manager and discussed access to points of contact. So, we have
set up a structure and we have managed--as he said, the
collaboration of the agencies and finding the right people and
continuing the conversation has improved the process, but it
also is not as--this issue here is not as prevalent as it is
other places because of this. And I think it will definitely
improve just because we have started that conversation.
Chairman Akaka. Thank you very much, Ms. Betts.
I want to ask Ray----
General Ishikawa. Senator, if I could, my apologies----
Chairman Akaka. Oh, sorry. General Ishikawa?
General Ishikawa. In my written testimony, and I apologize
for not mentioning this, the National Guard Bureau recently
authorized the Army and the Air National Guard to release
medical records to the Department of Veterans Affairs without
the veterans' signature. So if that is the medical records we
need, then we have that authority to do that now.
Chairman Akaka. Thank you, General.
Ray, you understand the unique needs of Hawaii and Hawaii's
veterans. You did mention what you are doing now. I just want
to give you an opportunity to expound on any other programs
that you may have to provide to veterans as they return home to
the islands, given Hawaii's unique geographical challenges that
we have.
Mr. Jefferson. Sure. Well, Senator, let me first begin by
thanking Lieutenant Tamayo for your comments and Sergeant First
Class Tuimalealiifano, my fellow Special Forces man, because
one of the things that was very important for me--and we
discussed this at my confirmation hearing--is to get out of
Washington, get out into the field, out of the urban areas and
into the rural areas to see what is really happening with the
veterans.
So, Senator, there are some things working very well. There
is tremendous interagency cooperation among the Federal
agencies and the State agencies. Everyone cares deeply and is
tremendously committed. The TAP Council, where we meet four
times a year, has a significant impact to improve that program
for the participants. The Homeless Veterans Reintegration
Program brings a lot of best practices to help homeless
veterans make that journey to employment and to deal with the
issues that can prevent employment, such as substance abuse and
addiction.
But there is additional room for improvement. I don't have
all the answers, and so one of the reasons I am here and one of
the things we are going to do this week is to get out to the
different islands to talk to the veterans and to talk to the
Veterans Service Organizations to find out specifically what
their needs are and how they would like to see the programs
improved.
But let me share two thoughts. First, we have the
responsibility to provide coverage to all veterans throughout
Asia Pacific--Guam, Saipan, Tinian, Palau, Federated States of
Micronesia. We presently don't have any Disabled Veterans
Outreach Program Specialists or local veterans employment
representatives in those areas. So, that is something I need to
look at, to find how we provide adequate coverage for them.
Senator, I also want to share briefly with you a story and
ask for help from you and from the other members who are in the
room today. Yesterday, I had the chance to go out to Kalaeloa.
We have a Homeless Veterans Reintegration Program out there
called U.S. Vets. They are doing fantastic work. They have
about 98 veterans out there right now. I met with the veterans
alone, without any staff around, and was really impressed by
the tremendous feedback they had on how successful they felt
the program was. It was helping them deal with addiction, break
those cycles of dependency, helping them to create meaningful
lives for themselves, and to find employment.
But here is the challenge I learned about. There is a one-
mile distance from where the site is located to the nearest
city and county public transportation, and evidently the
ridership level is not a significant amount to change that. I
believe that if nonprofit, private sector leaders work
creatively in Hawaii, we might be able to help those 45 to 50
veterans who are out there to find some kind of shuttle service
to span that one-mile distance.
I was really surprised to learn that this has been a
challenge ongoing for about 5 years. Now, I know that we can
send these men and women thousands of miles away to put
themselves in danger for the benefit of our Nation. I believe
that, collectively and creatively, we can find a way to span a
distance of one mile and get them a shuttle so these 50
veterans who found jobs can actually get to their jobs.
So, I am here asking for help. Tom, raise your hand,
please. This is my State Director. If anyone has ideas, if
anyone would like to be part of the solution, there are 50
veterans who found jobs and can't get to them. More
importantly, something that really annoyed me, Senator, some of
these veterans have actually been attacked and assaulted going
or coming on that one-mile walk. So, I think that is something
that we can do a much better job at and it is just one of those
things that if I stayed in my office in Washington, DC, I
wouldn't have known about. But I have full confidence that with
the aloha spirit here, we can find a solution to help those
veterans. Thank you.
Chairman Akaka. Thank you very much, Ray.
I want to thank the second panel. But before I close this
hearing, I want to invite those on the panel to make any final
comments about today's hearing topic or what they have on their
hearts. I will begin from that side of the room, since the
microphone is there, and ask each of you to make any final
statements you may want to make.
Mr. Jefferson. Senator, I was reflecting this morning on a
quote by a tremendous leader, an inspirational figure, Eleanor
Roosevelt, and she said that the future belongs to those who
believe in the beauty of their dreams. And when our
servicemembers come back, each of them has unique dreams,
unique aspirations, unique needs. I just believe that by
working together, we can do everything we can to help
Lieutenant Tamayo and Sergeant First Class Tuimalealiifano make
sure that they achieve their dreams and their aspirations. And
thank you for your service.
[Applause.]
Chairman Akaka. General?
General Ishikawa. In closing, I want to quote what I
consider to be a great patriot--General Eric Shinseki--when he
talked about the G.I. Bill--which I thank you so much for
passing. He said, ``Lightning is about to strike twice.'' I
firmly believe that when I go and talk to our soldiers, our
airmen, our Marines, I see the next great generation. So, thank
you for all the work you do and thank you to all the veterans
in the audience.
Chairman Akaka. Yes?
Dr. Darkins. Could I make a quick comment, which is also to
quote General Shinseki. He mentioned a few days ago his belief
in telehealth and telemedicine as part of the solution to the
challenges. With his support and with the support of Congress,
I see it as one of the solutions and look forward to a future
in which we will provide solutions to the challenges we have
heard today.
Chairman Akaka. Ms. Cullen?
Ms. Cullen. Thank you, Mr. Chairman. I would say that we in
the VA appreciate your longstanding support for veterans and we
count on your future support for veterans. We also thank you
for coming out here and having this panel where you hold us
personally accountable for taking care of the needs of, as
Abraham Lincoln said, he who has borne the battle. So thank you
for that and thank you for coming here with Secretary Shinseki
last week to also hold us accountable.
Chairman Akaka. Thank you.
Dr. Hastings?
Dr. Hastings. Thank you, Mr. Chairman. It is very
important, I think, for the VA to recognize the low-density
populations that they have responsibility for, that we have
responsibility for, in the islands and the Pacific. We have low
density, so we don't have the big numbers, and this is home. As
we heard today, all of us want to be taken care of as near home
as we can; and certainly when we are stressed and have
significant challenges in life, we want to be near our homes.
That is where we can get the best cures, and we have ample
evidence that that is the case.
At the VA, we have heard now that the VA is changing its
focus and putting resources into care in low-density, rural and
very rural areas, so I think the VA is taking on a new role in
its obligation to care for veterans, and that is the world that
we live in. You saw some of it yesterday on Lanai. I can tell
you that I have been to Tinian, I have sat with a veterans
group in Tinian and talked to them about their frustrations
with health care, and I have talked to the veterans in Saipan,
and on our next trip, we are going to Rota, where the
concentration is even smaller.
But, I think these are veterans who have been underserved
by the VA and I think I am very proud to be in an organization
that is recognizing this obligation and building in a direction
using all of the modern technology and all the modern science
that we know. We have learned to deliver care to veterans who
earned the care in their home. Thank you.
Chairman Akaka. Ms. Betts?
Ms. Betts. Yes, Senator. I would like to make a general
statement on my behalf that I am committed with the position
that I have here, to ensure that the employees that work under
me start to look and take advantage of what we refer to as
opportunities, and each opportunity that occurs every day is
when a veteran walks into our door. The way I would like to see
it develop over time is that they recognize it as an
opportunity when a veteran comes to us--an opportunity to help
to improve their life--to just experience and discuss or be a
part of that moment in time that we are part of for them.
What we are working on, as I know you had discussed with me
when I first met you, what you had told me was you would like
to see the VA have a motto, and I said, yes, sir, I will work
on that motto, and I am still working on it. But I do know that
one thing that comes to mind, and that is that every employee
who works at the VA when a veteran walks in the door or when
the veteran calls on the phone, is the first thing they should
think about is what we can do, and that might be my motto if I
work on it hard enough.
But it is something that we need to get back to realizing--
that the reason we are here is for the veteran--and we need to
remember what we can do when they walk in that door and ask for
our assistance and expect the services that they do. Because a
lot of it has to do--in our outreach program right now, my goal
and objective is to help change the perspective of the
individuals we visit, meaning their perspective of what the VA
is.
As I heard the three witnesses earlier, their perspective
of the VA out there as a servicemember--as a veteran, whether
it is a Vietnam veteran, World War II, or even the latest OEF/
OIF veteran--is not very good. It is not a very good picture
that they paint of us. But I am sure that we can improve on it.
Just as they said, the communications, developing those
relationships, and here in Hawaii, being Hawaiian, I believe it
is a place where it can start. The ohana is definitely a part
of the daily relationships and the building of those
relationships to bring more grayness to those lines of the
bureaucracy and the services that we provide.
I want you to know that the commitment is here to help to
improve and to develop that thought process of what we as VA
employees can do for those veterans that we service, and I
thank you very much for the time.
Chairman Akaka. Well, thank you. I think you have said much
in closing.
I want to thank all of our witnesses for being here, for
your responses. No question, it is going to be helpful to what
we are trying to do. We know there is much to be done in order
to improve the effectiveness of VA's outreach to servicemembers
returning from overseas. Members of the Guard and Reserve that
we are focusing on today face unique challenges. It is
necessary that VA recognize and overcome those obstacles so
that these veterans receive the highest quality of care. This
is our challenge today.
So, I want to thank all of you again for being here today.
This hearing is adjourned.
[Whereupon, at 1 p.m., the Committee was adjourned.]
A P P E N D I X
----------
STATE OF VA SERVICES ON MAUI, HAWAII
----------
THURSDAY, JANUARY 7, 2010
U.S. Senate,
Committee on Veterans' Affairs,
Maui, HI.
The Committee met, pursuant to notice, at 2 p.m., in the
Maui Arts and Cultural Center, Maui, Hawaii, Hon. Daniel K.
Akaka, Chairman of the Committee, presiding.
Present: Senator Akaka.
OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN,
U.S. SENATOR FROM HAWAII
Chairman Akaka. Well, I want to say again mahalo to Danny
for leading the pledge and Mitch for offering the prayer, and
now it is pono. We are ready to go.
Let me tell you that we as a Committee have held similar
hearings on Maui before, as you know. Much has improved in
recent years, for which I am grateful, but it is important for
us to understand the present challenges. I think you know what
our country is going through at this time and we must be ready
to come up with the kind of help that our country needs. Both
the clinic and Vet Center on Maui are tremendously busy and
must be available to those Maui veterans who rely on VA for
their care and to veterans living on Lanai and Molokai as well.
I applaud the efforts of the VA employees in Hawaii. These
men and women work hard to help the veterans who seek their
assistance, and there are many things that VA does well in
Hawaii, as you know. Hawaii has done, I think, pretty well, but
we need to continue to do better. There is always room for
improvement. Indeed, our unique geography, diversity, and our
kind of way of life require that VA develop a unique strategy
to care for our island's veterans and to care for it through
our cultural activities as well.
Ensuring timely access to mental health services for
veterans living on Maui has been a challenge due to reported
shortages of VA and community health providers on the island.
However, VA has established new mental health positions at the
Maui Clinic and has expanded telehealth capabilities to other
islands. There has also been some indication of a desire to
create a single location on the island for veterans' services
in lieu of the existing three locations. I hope to discuss
these and other important issues with veterans and VA today.
Back in Washington, we have worked hard to ensure that VA
has the resources to provide the best possible care. In my
years as Chairman, Congress provided record-breaking funding
increases to VA. Last year, I introduced the Veterans Health
Care Budget Reform and Transparency Act to secure funding for
veterans' health care 1 year in advance of the regular
appropriations process. And we have followed up that success
with passage of our Caregivers bill, which would help wounded
warriors and the families who care for them. This bill, which
also improves care for women veterans, those who reside in
rural areas, and those who are homeless, has been sent to the
House of Representatives. I expect to finalize this bill in the
coming months.
Finally, I note that there are many veterans here today who
would like to testify. While we cannot accommodate everyone's
request to speak, we do want to hear your views. The Committee
is accepting written testimony which will be reviewed and made
part of the record of today's hearing. If you have brought
written testimony with you, please give it to Committee staff
who are located outside on the patio. If you do not have
written testimony but would like to submit something, Committee
staff will assist you in doing that. In addition, the Committee
staff is joined by VA staff who can respond to the questions,
concerns, and comments that you raise.
A special mahalo nui to Dr. Hastings, Dr. JangDhari, and
their team who are here to help us as well. Will you raise your
hands, Dr. Hastings and Dr. JangDhari? [Applause.]
Once again, mahalo nui loa. Mahalo to all of you who are in
attendance today, and I look forward to hearing from today's
witnesses.
I want to welcome members of our first panel; and I just
want to pass this on: as far as feelings are concerned, I feel
real cool. [Laughter.]
I want to welcome members of the first panel. Our first
witness is Karl Calleon.
Our second is Rogelio Evangelista, Advisory Board Member
for VA Pacific Islands Health Care System; followed by Larry
Helm, the Commander of Molokai Veterans Caring for Veterans.
After Mr. Helm will be Clarence Kamai, Jr., a VA Advisory
Council Member, and his fellow Council Member Danny Kanahele.
Next will be Paul Laub, the President of the Maui County
Veterans Council; and Terry Poaipuni, the wife of a veteran.
Ms. Poaipuni will be followed by Mitch Skaggerberg, who offered
the prayer and who is President of the Vietnam Veterans of Maui
County.
Our final witness on the panel will be Lloyd Sodetani, the
Maui Representative to the Hawaii Office of Veterans Services.
I thank all of you for being here today on this panel. Your
full testimony will, of course, appear in the record of this
hearing.
I would like to ask you to begin, Mr. Evangelista--oh, Mr.
Calleon. E kala mai i'au.
STATEMENT OF KARL CALLEON, VIETNAM VETERAN AND COMMANDER,
C H A P T E R 2, M A U I, D I S A B L E D A M E R I C AN
VETERANS
Mr. Calleon. My name is Karl Calleon. I am the Commander
for DAV Chapter 2 in Maui.
Audience Members. We can't hear.
Chairman Akaka. Oh.
Mr. Calleon. Can you hear me now?
Audience Members. No.
Chairman Akaka. Pull the mic closer.
Mr. Calleon. My name is Karl Calleon. I am the Commander
for DAV Chapter 2 in Maui. First of all, I want to thank you,
Senator Akaka, on behalf of all the Hawaii veterans for being
our most vocal and powerful voice for veterans ranked in our
State.
As part of the DAV here, I have most often heard the
following complaints about VA services on Maui.
First, we need your help to remedy the ongoing loss of so
many of our best VA doctors and other key veteran service
personnel. For example, it is extremely disruptive to quality
and continuity of our veterans' medical care to keep losing our
primary care providers. They have to wait months then are
scheduled to start all over again with a new doctor, by then
they are already overwhelmed with the VA system. Related to
this ongoing turnover is that we cannot rely on the Maui CBOC
staff to schedule, reschedule, or set up referrals for outside
medical appointments because they seem to always be so
disorganized. As a result, we advise all those veterans getting
services to follow up with the clinic to make sure they are
doing what they are supposed to do. But that should not be our
responsibility.
The real cause of this ongoing VA staff turnover and clear
disorganization is that the VA systems under which they work
are so incredibly inefficient that they get fed up and leave.
VA management are either not listening to them or they are
completely ignoring them because they too often do not believe
change is possible.
This is why we strongly urge you and the VA Secretary, Eric
Shinseki, to go and talk directly to our long-time front line
professionals like Dr. Maurice Kramer, Kathleen McNamara,
William McMichaels, James Lockyear, Richard McDonald, social
worker Laurie Aoki and Tamicko Jackson in the State. If given
the opportunity and support, they can tell you very clearly
what changes need to be made.
Another concern we have is that we have a lot of older vets
here whose doctors are prescribing them grab bars and other
safety devices. However, after receiving them, they are told
they have to install them, and they cannot--many cannot. It
should not be the veteran's responsibility.
Something also needs to be done about our veterans who seek
emergency care on weekends or after hours at Maui Memorial
Medical Center. Too often these veterans start receiving huge
bills and threatening letters for the services they received.
This is because the VA refuses to pay these bills since they
were not preapproved, even though it was impossible for the
veteran to do so at the time. While most of these veterans
choosing to challenge these actions eventually do get them paid
by the VA, this whole process is very distressing to these
veterans, adds insult to injury, and seems so needless. This
same problem also occurs too frequently with payments for
outside medical referrals and consultations.
The Independent Living Program here has helped hundreds of
severely PTSD-disabled veterans like myself finally pull out of
decades of ugliness, depression, and isolation to reconnect
with our families and communities. However, too many veterans
are waiting too long to receive these services. I myself had to
wait 2 years to get my independent living plan written and
approved. The biggest problem is that only Hawaii veterans are
required to have their independent living plans approved all
the way to the VA's Central Office. It just does not seem right
that only Hawaii veterans are being singled out this way,
especially when these services have proven to be so helpful to
so many.
The incredible workload demands faced by our Office of
Veterans Services officers are enormous; however, the VA and
the State cannot seem to come up with whatever is needed to
secure two full-time staff which are minimally needed to meet
this demand. As a result, we already lost one long-time OVS
officer. We just lost another part-time staff person, and the
remaining officer, Tamicko Jackson, is impossibly overloaded.
Again, it is our veterans' services that are suffering because
no one seems to have the power to remedy this matter.
Maui veterans have been complaining about these related
problems for some time--the ongoing burnout and loss of VA
health care service providers and the resulting disruption
means loss of effective care to our veterans--will not improve
without significant changes in our VA system and management.
Thankfully, we have really good VA staff serving us here on
Maui; however, these remaining diehard professionals are still
being severely hindered in their jobs to effectively and
efficiently serve our veterans by unresponsive VA systems and
management.
In conclusion, on behalf of all Maui veterans, we sincerely
thank you for your time and kokua. We also thank you for your
efforts to make the VA more responsive to our veterans' needs.
[There is no prepared statement for Mr. Calleon.]
Chairman Akaka. Mahalo. Mahalo, Karl, for your testimony.
And now we will hear from Rogelio Evangelista.
STATEMENT OF ROGELIO G. EVANGELISTA, ADVISORY BOARD MEMBER, VA
PACIFIC ISLANDS HEALTH CARE SYSTEM
Mr. Evangelista. Honorable Chairman, Distinguished Members
of the Senate Veterans' Affairs Committee, and fellow veterans,
being on the Veterans Administration Pacific Islands Health
Care System, I thank you for giving me the opportunity to
testify, especially you, Senator, for all the personal
sacrifices and unending time you have spent helping with our
veterans.
The uniqueness of the Hawaiian Islands, separated from the
United States by miles of ocean, makes it hard to provide for
more than 120,000 veterans living here. When I first testified
back in the year 2007, and again in 2008, there have been great
strides in health care with the leadership of James Hastings
and his team of professionals, but a lot still needs to be done
to assure the best health care to our veterans.
Unfortunately, unlike the Mainland, there are no bridges or
tunnels and we need to fly to Tripler. And because of
disability and cost of the insurance, we incur all those
expenses. Due to the illnesses and injuries that these veterans
have received in wartime, many of these veterans have limited
incomes. To choose between taking care of their families,
themselves, and flying to Oahu for health care is a choice that
should not even be an issue for these veterans who have served
so selflessly.
I think it is only fair for the specialized services of
each island to cover any and all the transportation costs that
I receive that are offered by the Spark Matsunaga Clinic and
Tripler on Oahu. The VA health care system should take care of
us 100 percent because the problems that are happening in our
later years are all part of the cost of war; and when we served
in the military we did not give only a certain percent, but we
gave our full 100 percent. In Hawaii, we need to think how we
can geographically place the best delivery of care, or we will
deny our veterans quality medical care which they rightfully
deserve.
As our WWII, Korean, and Vietnam veterans age, they are now
faced with more ailments that affect their health, problems
that were not visible when they were younger. Not only are they
faced with their health concerns, but also the issues that
cannot be corroborated due to red tape between the VA and the
records.
Senator Akaka, you also know that when a military person
finishes, their problems are just beginning to start with their
visible scars and invisible physical and mental scars. These
issues have not been dealt with, and most of our veterans are
at that time contemplating committing suicide. Part of the
billions spent overseas in Iraq and Afghanistan need to be
spent on the men and women who relive this war on a daily
basis.
Senator, we the veterans ask you, the Senate Veterans'
Affairs Committee, to right what is wrong and to say to the
veterans, ``Thank you for your service to our country.''
May God bless our Nation, those in uniform and our
veterans, and in closing, we the veterans ask for our country
to love us as we loved our country in keeping it the land of
the free and the home of the brave.
Thank you.
[Applause.]
[The prepared statement of Mr. Evangelista follows:]
Prepared Statement of Rogelio G. Evangelista, VAPIHCS Advisory Board
Member and President Emeritus, Maui County Veterans Council
Honorable Chairman, Distinguished members of the Senate Veterans'
Affairs Committee, and Fellow veterans, being on the Veterans
Administration Pacific Islands Health Care System Advisory Board, I
thank you for giving me this opportunity to testify on behalf of the
Veterans of Maui County. I would like to commend the Committee,
especially Senator Akaka, for all the personal sacrifices and unending
time spent on helping our veterans cope with their disabilities.
The uniqueness of the Hawaiian Islands, separated from the United
States by 1500 miles of ocean makes it very extra ordinary to provide
health care to the more than 120,000 veterans living here. When I first
testified before this panel in 2007 and again in 2008 there have been
great strides done with our health care here in Hawaii with the
leadership of Gen. James Hastings and his team of professionals BUT A
LOT STILL NEEDS TO BE DONE TO ASSURE THE BEST HEALTH CARE TO OUR
VETERANS.
Unfortunately, unlike the mainland of the United States, these
islands are not joined by bridges or tunnels, therefore to obtain the
necessary medical services needed from Tripler, the veterans need to
fly, and due to the lack of disability insurance, the veterans incur
most of the cost of these flights to receive their rightful medical
services. Due to the illness and injuries that these veterans have
received during wartime, many of these veterans are on limited incomes.
Having to choose between taking care of their families and themselves
and flying to Oahu to receive healthcare, is a choice that should not
even be an issue for these veterans who have served the United States
so selflessly. The promises made by the military offer education for
the betterment of the soldier for life, the ability for home loans on
the GI bill for the betterment of the soldier's life, and medical care
for the betterment of the soldier's life. What we are asking for is
that the medical services be available and not have to be a financial
liability to the veteran in need of medical services. We ask that the
transportation costs of those veterans who do not live on Oahu be
covered fully. Until the time that there are specialized services
available on each island, it is only fair and just to cover any and all
the transportation costs to receive these medical services that are
only offered at Tripler or the Spark Matsunaga Clinic on Oahu. If we
use the VA health care system, the VA should take care of us 100 per
cent, cause the problems that are happening to us now in our later
years in life are all part of the cost of war and also when we served
in the military we did not give only a certain percent but we gave our
full 100 per cent. In Hawaii we need to think how we can geographically
place the best delivery of care or we will deny our veterans quality
medical care that they so rightfully deserve.
As our WWII, Korean, and Vietnam veterans age, they are now faced
with more ailments that affect their health, problems that were not
visible when they were younger, with the possibility of being service-
connected. Not only are they faced with their health problems, but also
the issues of getting to prove with collaborating evidence, records
which the VA cannot provide due to all the red tape between the
military records and the VA when you need copies of your records.
As we deal with the incredible injuries and mental health needs of
our veterans we simply have to do it right in taking care of those that
borne the battle and we can start by reducing the number of backlog on
claims, especially those on disability claims. If there is any
probability that it could be service-connected, it should be approved.
Senator Akaka, you also know that when a person finishes his
military obligation and he goes home it does not end there, but their
problems are just starting, in trying to get health care, getting a
job, fitting in with the community, reuniting with the family and
coping with visible and invisible physical and mental scars.
Senator Akaka, another issue is the families of these veterans. For
a lot of families the men or women who have left to serve their country
have come back broken both mentally and physically and this is often
traumatic to the families to not only welcome back a changed person,
but to learn how to deal with their disabilities. These families need
the support of the VA also to deal with needs of the veteran in the
home situation. The veteran may have been exposed to situations to
which the average family cannot even fathom much less give support to.
What options do these families have on their home islands? For the
families on the outer islands often the costs of transportation to
receive these services are a deterrent to receiving these services.
We have done our duty, so now we ask the Senate Veterans' Affairs
Committee along with the Veterans Administration to do their duty in
helping the Veterans and their families. There are incredible issues
that we have to face not only for our newer veterans but also those
that have served in previous wars, be it World War II, Korea, Vietnam,
Etc. Caring for our veterans means providing the best health care 24/7
and rehabilitation and compensating veterans for their injuries.
We have to honor our returning troops, as you know what happens
when we don't. Like in the case of the Vietnam Veterans, due to the
opposition against the war, the men and women who served were not
honored on their return, they were disrespected. For these men and
women to endure wartime and come home to be dishonored by society,
caused tremendous psychological issues resulting in suicides,
homelessness etc. These issues have not been dealt with and our
veterans of this current war are committing suicide in large numbers.
Dealing with these issues is very much part of the cost of war. Part of
the billions spent overseas in Iraq and Afghanistan need to be spent on
the men and women who relive this war on a daily basis.
With hundreds of our troops returning home in dire need of health
care let us show our appreciation and commitment to the men and women
who have worn the military uniform in defense of this Nation, let us
say thank you by asking for unlimited funding to deal with the crisis
that we are facing to get the veteran soldiers back into society and
their families, even in this hard economic times we need to know and
show that the care for the veteran and their families are the
continuing cost of war.
The VA is a premier Health Care System, but here in Hawaii,
specifically the outer islands, the healthcare services are limited. In
fact, the VA does not have a hospital anywhere here in the Hawaiian
islands. With the increasing population of veterans here in the
islands, is it possible that there would be plans for a VA hospital in
the near future.
Let me also mention that the Maui County Veterans Council and the
more than 20 veteran organizations it represents wholeheartedly support
the aspect of the proposed facility in Kahului at Maui High School of
which one of our panelists Col. Lloyd Sodetani Ret. will address.
Last but not the least is the honors that veterans earned while
serving in the military which is basically the last respect regarding
the veterans service to his country during his burial rites. We are
being faced with different issues in providing these various services--
services that were earned and promised when we wore the uniform. Things
like new memorandums for different branch of service, no available
personnel, due to deployment for the war, economic hardship on travel
for the full honor guard, time constraints, etc; WE, THE VETERANS, ask
you and the Senate Veterans' Affairs Committee TO RIGHT WHAT IS WRONG
and say to the Veterans ``THANK YOU'' for your service to our country.
May God Bless Our Nation, those in uniform, our veterans and their
families and in closing, WE, THE VETERANS, ASK, ``FOR OUR COUNTRY TO
LOVE US AS WE LOVED OUR COUNTRY'', IN KEEPING IT THE LAND OF THE FREE
AND THE HOME OF THE BRAVE.
Chairman Akaka. Thank you very much for your testimony.
Now I would like to call on Larry Helm.
Mr. Helm. Senator, if you do not mind, I would like to
allocate three of my minutes to our Molokai representative.
Chairman Akaka. I do not mind.
Mr. Helm. Because he is from out of island and we must be
helpful to our guests.
Chairman Akaka. Thank you. Let me repeat that the full text
of your testimony will be included in the record, but we do
have a time limit for the presentation of this. So, Larry, you
have an additional 3 minutes.
STATEMENT OF LARRY HELM, COMMANDER, MOLOKAI VETERANS CARING FOR
VETERANS
Mr. Helm. Thank you, Senator. Before I start my testimony,
I would like to give personal thanks to the Molokai vets who
got up at 4 o'clock this morning, jumped on a boat----
[Applause.]
Mr. Helm. I would just to say to you in advance, Senator,
that when I get through testifying, because we have to get back
on the ferry we're going to hele on.
Good afternoon, Chairman, Senator Daniel Akaka, staff, all
the angels that work for the betterment of veterans and their
families, fellow veterans and to the audience, aloha.
Participants. Aloha.
Mr. Helm. Mahalo, Senator Akaka, for your time to hear
veterans testify on behalf of veterans. There are lots of
advocates. You are our number 1 advocate. For that I say mahalo
nui loa. [Applause.]
Six years ago, an organization was formed on Molokai called
Molokai Veterans Caring for Veterans. Today there are
approximately 600 Molokai veterans. Three hundred veterans from
all wars and conflicts have joined our organization called
``Koa Kahiko''--ancient warriors, wise warriors. Services to
Molokai vets then were sparse and limited. Today, thanks to
you, Dr. Hastings, Dr. Steve McBride, who helped to hire our
own resident, Dr. Hefferman, regular visits from our VA angel
Dr. McNamara, Dr. Springer, Benefit Counselor Joe Thompson,
Ernie Matsukawa, and many others, beginning next week, we will
have a home care nurse on-island to fulfill an overwhelming
need. Today seven veterans qualify for home care, and she is
here today, and she starts next week. [Applause.]
Molokai has had the highest percentage of Vietnam vets per
capita in this country. Many of them have died. Many have been
in the valleys, the bars, and the crevices of Molokai for a
long time. Finally, many of these veterans are getting their
due benefits. And because of the VA services and counselors,
they are at least having some quality-of-life. Mahalo plenty.
I come today, of course, with some honey, but also I have
some lemonade that needs some sugar in it.
Recently, a Molokai retired Navy lieutenant, Richard Smith,
who served 33 years in the Korean and Vietnam conflicts and
received many commendations, died. One of the benefits promised
to vets like Richard is that they have a full military burial
when they are on their last rite from Earth. Because his home
was on Molokai, Richard had a watered-down detail of three and,
in my opinion, if we cannot own up to our promises made to
veterans, then how are we going to own up to the rest of the
world?
Some veteran organizations like the VFW, et cetera, provide
burial details. This ought not to happen. It ought to be
mandatory that all military branches honor these vets with full
military burials as they promised.
There are two crypts left in Molokai Veterans Cemetery. Mr.
Mark Moses, Director of the State Veteran Services, is aware of
this issue. However, he is constrained by State budget
problems. Give the veterans on Molokai the materials, and we
will build the needed addition.
We acquired official property to build a Vet Center. We are
in the process. It is a simple building. Needless to say, we
have been jumping through hoops with the County of Maui to get
our permit. It's been a 3-year process.
My suggestion is from the top down give priority status to
all veteran groups in this country that are advocating and
helping in the advancement and the betterment of all veterans
and their families. Many times just going through this process,
I still think I am in the woods in Vietnam. We are still
fighting.
Senator, if you can find it in a little piggy bank stashed
away, we can use $20,000 to $30,000 to furnish our Vet Center.
There are many veterans whose records have been lost from
the Korean and Vietnam era for one reason or another. Some of
them have legitimate service-connected claims. There ought to
be a system to give them the benefit of the doubt. Because of
State budget woes, there was a mental health counselor position
cut on Molokai. The counselor had over 100 clients, and some
are veterans. What can we do to help them? Because of privacy
issues, the VA can find out from the State and get them
enrolled in the system if not already enrolled.
On Molokai, we have approximately 60 residents who have
served in the Mideast conflicts. Some are still serving. Some
are home now. There ought to be a method of issuing a heads-up
that these soldiers are returning home so they can be
identified to be provided needed service before they have major
problems. I personally have had three different late-night
calls from parents concerned about erratic, threatening
behavior from young vets that could have been very volatile.
Mahalo to the VA, Dr. McNamara, and others who served these
veterans immediately, and they are moving forward.
Another personal issue. My nephew served three tours in
Iraq, wanting to make a career in the army. His paternal
grandmother, who raised him, died. He was denied to come home
to her funeral. As the military says, ``only immediate
family.'' Suggestion: VA, work with the military on exceptions.
My nephew left the army.
Molokai has 30 or more Native Hawaiian veterans. Many are
disabled--service-connected--living on homestead land. There
ought to be a more efficient process for Native Hawaiian
veterans to refinance their homes through the VA or other loan
people. The Department of Hawaiian Homes process is a
hindrance. They ought not to be. Native Hawaiians served this
country and deserve equal treatment. In my opinion, the system
discriminates against qualified disabled Native Hawaiian
veterans.
Suggestion: The VA, first, in administering services to
veterans, if the State is involved with the State counselors
for veterans, that they be required to use the criteria of the
Federal VA standards. Many times it is redundant, time-
consuming, and not cost-effective.
Veterans ought to have: a veteran credit union--easy to do,
piggyback or a subsidiary like the Pentagon Credit Union; a
veteran low fixed interest credit card, easy to do. Work with
major credit cards--Visa, American Express, et cetera. Veterans
set up the rules.
Again, on behalf of the Molokai veterans, to Senator Daniel
Akaka and staff, mahalo for your kokua and your continued
advocacy for all veterans. Veterans are the soul of America.
There are citizens and there are veterans. Without veterans,
there would be no citizens.
Akua bless you. Mahalo.
[Applause.]
Chairman Akaka. Mahalo. Mahalo, Larry, for your testimony.
And now I call on Clarence Kamai, Jr., for your testimony.
STATEMENT OF CLARENCE KAMAI, JR., MOLOKAI REPRESENTATIVE,
VETERANS CARING FOR VETERANS
Mr. Kamai. Thank you, Senator. Now let me turn this thing
on.
OK. There is no sound. Let's change mics.
OK. Can you hear me?
Participants. Yes.
Mr. Kamai. Amen. Good morning, Senator, Honolulu VA
executives, staff of the State Veterans Office, Maui CBOC
staff, members of panels one and two, and, most important,
aloha and mahalo to my fellow veterans and comrades.
Chairman Akaka. Aloha.
Participants. Aloha.
Mr. Kamai. Senator, I do concur with my fellow constituents
here, and I would just like to say thank you for being here and
for bringing a second round to us.
I would also like to make mention and really applaud Dr.
Kathy McNamara for her dedication and work. [Applause.]
I know Dr. McNamara is working with one of our veterans--
this guy Rodney Ricken. He needs a lot of help. He has put in
all of his paperwork, and so far to this date and time, we have
not heard anything from anyone regarding his status. And he is
looking for his disability and whatnot. So, prayerfully,
something can happen for Mr. Ricken. Hopefully, we can get
something going for him.
But I would like to thank each and every one of you for
helping us, and my question right now to the Senator is: What
can we do to help you? How can we help you to help us to get
what we need? Because we are here. We have been training as
soldiers, and we will continue being soldiers. We will fight
for you and become your soldiers. Tell us what you want,
because we are telling you what we need, not what we want. God
bless each and every one of you. Aloha. Thanks.
[Applause.]
Chairman Akaka. Mahalo. Thank you very much, Mr. Kamai, for
your statement, and I want to thank you again for your offer
for us to work together. That is the key. We have got to work
together to try to get these things done. So, mahalo.
And now we will hear from Mr. Kanahele for your testimony.
Please proceed.
STATEMENT OF DANNY KANAHELE,
VA ADVISORY COUNCIL MEMBER
Mr. Kanahele. Thank you, Senator. Thanks to everybody for
being here.
My testimony is slightly different. My testimony is about
thanking everybody for what they do. Senator, I want to thank
you and your professional team for the hard work they do, the
time they put in, the hours they sleep--which is not much.
Senator, I also want to tell you about the staff at Spark
Matsunaga Veterans Administration under the direction of Dr.
Hastings. With his professional team, Dr. Hastings'
administration and his direction have helped Maui. They do the
best they can, which I am one of them who makes sure they do
the best they can because that is also my job. Thank you,
General.
Again, I would like to thank, Dr. Hastings. I want you to
know your staff on Maui, under the hands of Kathy Hass and her
professional team--again, doctors, nurses, administrators, and
their directors--deserve thanks for everything they do, and
share and put up with--headaches and sometimes hard times,
which I am one of them at times. I am honest about that.
I would also like to thank Dr. McNamara for the Education
and Independent Living Program, which I think is very much
needed, and I have been on it. I love it and I am still doing
it. I like that. I enjoy that.
Again, I would like to thank Mr. Ernie Matsukawa for
everything he does with his counselors: family counseling,
individual counseling, and group counseling. They have made
advances over there, which I join in once in a while. He shares
a lot of information with everybody and he shares it and more.
But, again, you cannot please everybody.
With this testimony, like I said, it is short, brief, and
very direct. I thank you, Senator, Dr. Hastings, Kathy, Ernie,
and Tamicko . I want to thank everybody who puts in time and
helps us today.
Thank you.
[Applause.]
Chairman Akaka. Mahalo nui loa, Danny, for your gracious
mahalos to those who have been working hard. We really
appreciate that.
And now we will hear the testimony of Paul Laub. Please
proceed.
STATEMENT OF PAUL LAUB, PRESIDENT,
MAUI COUNTY VETERANS COUNCIL
Mr. Laub. Aloha auinala and aloha kakou.
Chairman Akaka. Aloha.
Mr. Laub. I am Paul Laub and I have the honor of being the
President of the Maui County Veterans Council.
First, I would like to read a letter from County Council
member Bill Kauakea Medeiros, who is or was here. It says:
``I am writing this letter to you as a concerned
veteran and a Maui County council member that feels
that we veterans are not receiving the most efficient
and cost-effective facilities and services for the
funds that the Veterans Administration spends on Maui.
Our second proposal would be more efficient and cost-
effective because it would bring all the veterans'
services to one location rather than having the
services at three different locations as it exists
today. Currently, insufficient parking at all three
locations is a problem. Additionally, confusion and
frustration results when a veteran goes to the wrong
location and needs to drive 20 or 30 minutes to another
location. In the long term, the costs for VA would be
substantially less than the total amount the VA will
have paid for these three--and will pay in the
future.''
``The State of Hawaii's Departments of Defense and
Education are also providing fair-share contributions
to make this a reality. The VA will continue to own its
facilities and be able to upgrade its facilities as
technology and operational needs change. Being rent-
free will result in substantial savings to the VA. This
complex will benefit all of our veterans and, with
proper coordination, provide immeasurable benefits to
our students and our neighboring communities. As a
faithful constituent and member of our local government
legislative body, I humbly ask that you favorably
consider the proposal and to initiate funding for that
purpose. Mahalo for your kokua.
Bill Kauakea Medeiros.''
I also happen to have a letter from Council member Jo Anne
Johnson, who is the wife of a World War II veteran who is in
difficult straits at this time. It says:
``As the wife of a veteran of World War II, as a
member of the Aging with Aloha coalition, not to
mention my public service as an elected official, I am
acutely aware of the needs of our veterans here in Maui
County. Partially due to our isolation, but also
because of the increasing number of veterans who
require services, we are facing a crisis here in our
county. With funding being limited for programs that
help support our veterans and their families at both
the State and county levels, we face diminished
services at a time when demand is on the rise. Programs
that provide for the needs of veterans such as medical
care, dental treatment, and mental health counseling
are critical to our community. Also, rehabilitation for
our disabled veterans, caregiver support services,
reimbursement for relatives who care for loved ones,
and educational retraining must be considered as key
components of any health care delivery system for those
who have served our country.''
``Our veterans trusted that while they were caring
for our country that their families and themselves
would be cared for in return. That assumption has
proven over time to fall short of expectations of our
vets and family members. Many servicemen and women
cannot get simple counseling to find out what services
are available to them and their families or what the
requirements are for eligibility. We need to provide a
one-stop service center that is accessible, that is--
and that is adequately staffed to support the needs of
veterans and their loved ones.''
Our members, our veterans, who were once strong,
resourceful, and independent men--the heroes of yesteryear--
have now found that they have aged. This aging has robbed them
of their strength, and many of their abilities have been
diminished. Now these men are stooped with age and need the
great services that our Government can offer to these warriors
of our history.
The problem is that getting these services has been
unnecessarily difficult due to the random locations of each
service. It appears that this problem can be resolved by
building a Veterans Campus on the 4\1/2\ acres of land at Maui
High School that has been offered to us by the State of Hawaii.
Please give this possibility your soonest attention.
We now have no burial facilities in West Maui. The very
generous Ka'anapali Land Company has offered us 15 acres of
land for this purpose. May I urge you to assist in whatever way
possible to ensure that we receive and properly utilize this
great gift.
The Veterans Cemetery at Makawao is almost at full
capacity. I understand that there is a proposal to expand it
through purchase of neighboring property. May I also urge you
to help effect this transaction.
We, the veterans of Maui County, greatly appreciate and
wish to thank you for your many, many assistances to us.
Thank you.
[Applause.]
[The prepared statement of Mr. Laub follows:]
Prepared Statement of Paul Laub, President, Maui County Veterans
Council and Member, West Maui Veterans Club
Senator Akaka, thank you for coming home to Maui. As the youngest
member of the West Maui Veterans club, of which you are listed as a
member, and President of the Maui County Veterans Council, it has
fallen to me to bring some issues to your kind attention.
Our members, once strong resourceful and independent men, the
heroes of yesteryear, have now found that they have aged. This aging
has robbed them of their strength and many of their abilities have been
diminished. Now these men are stooped with age and need the great
services that our Governments afford to these warriors of our history.
The problem is that getting these services has been unnecessarily
difficult due to the random locations of each service. It appears that
this problem can be resolved by building a Veterans Campus on the 4\1/
2\ (four and one-half) acres of land at Maui High School that has been
offered to us by the state of Hawaii. Please give this possibility your
soonest attention.
We now have no burial facilities in West Maui. The VERY generous
Ka'anapali Land Company has offered us 15 (fifteen) acres of land for
this purpose. May I urge you to assist in whatever way possible to
ensure that we receive and properly utilize this great gift?
The Veterans Cemetery at Makawao is almost at full capacity. I
understand that there is a proposal to expand it through purchase of
neighboring property. May I also urge you to help effect this
transaction?
We, the Veterans of Maui County greatly appreciate, and wish to
thank you for your many assistances to us.
If there is any way I can be of assistance to any Veteran endeavors
please do not hesitate to ask.
Thank you, again.
Chairman Akaka. Thank you. Thank you very much, Mr. Laub,
for your testimony and your idea of consolidation.
And now we will hear from Ms. Poaipuni. Terry, will you
please proceed with your statement?
STATEMENT OF TERRY POAIPUNI,
WIFE OF A VIETNAM VETERAN
Ms. Poaipuni. Aloha, Senator Akaka and Members of the U.S.
Senate Committee on Veterans' Affairs. My name is Terry Lee
Poaipuni, and I am the wife of a Vietnam veteran. I was born
and raised on the east side of Maui in a place called Hana. I
have worked for Maui's Native Hawaiian Health Care System, Hui
No Ke Ola Pono, for 19 years. I will refer to Hana as East Maui
because the district encompasses a bigger area than Hana. The
number of veterans in East Maui is 75-plus, and this is not
counting the National Guard and Coast Guard veterans. I am sure
there are more veterans out there that I have missed.
Nearly 5 years ago, the State Office of Veterans Services
would send William Staton to Hana once a month to assist the
veterans living in East Maui. Ten years ago, a registered nurse
from the Veteran Clinic used to come to Hana Medical Center to
see veteran patients. Presently, the State Office of Veterans
Services does not come to East Maui. I have spoken to our State
representative, and due to the State economic constraints,
services by the State Office of Veterans Services were cut.
Tamicko Jackson, who has taken William Staton's place, is the
only person employed by the State who is able to assist
veterans from Maui, Molokai, and Lanai. Tamicko Jackson sees
several of our East Maui veterans who drive out to Central Maui
for their appointments, and I am not sure how long Tamicko
Jackson will be there. The unfortunate thing is the veterans
become familiar--or ``ma`a,'' as we say in Hawaiian--to someone
like Tamicko, and then she or he gets replaced. This
replacement only makes it harder and more frustrating for the
veterans.
The accessibility of services to East Maui veterans is a
major problem. Counselors Ernie Matsukawa and Ipo Messmore have
made the Vet Center in Lunalilo Building a safe place for
veterans wanting to gather and share experiences. Ernie and Ipo
do an awesome job of counseling our veterans, and we need more
people like them.
I find the veterans who gather there have a lot of
knowledge and information that they are willing to share. This
is what is missing in the system. That willingness to share
with the veteran of his or her benefits without them guessing
and feeling like they need to beg, maybe this is what the
system is set up to do.
Hui No Ke Ola Pono, the Native Hawaiian Health Care System
with an office in Central Maui and a satellite office in East
Maui, has recently begun working with veterans on the island of
Maui. Hui No Ke Ola Pono have included on our organization
intake form a portion for the veteran to fill in. This will
identify the veteran and give us the opportunity to advocate
for them. Clay Park, of Papa Ola Lokahi, has been instrumental
for starting the veteran advocate services at Hui No Ke Ola
Pono. Clay Park has been helping the veterans on Maui to
explain how to fill out the Veterans Benefit Administration
forms and applications, and Clay Park does come to Hana.
In closing, I would like to know how East Maui can get
assistance from the Veteran Benefits Administration. My
understanding is that Joseph Thompson can assist veterans with
the application process. Can Joseph Thompson come to East Maui?
Is there a way that a telecommunications site can be set up so
veterans can access services from East Maui? The veterans need
to feel like they are part of the system that they fought for
and not a burden to it.
Mahalo and thank you for your time.
[Applause.]
[The prepared statement of Ms. Poaipuni follows:]
Prepared Statement of Terry Lee Poaipuni, Wife of a Vietnam Veteran
Aloha Mr. Chairman and Members of the U.S. Senate Committee on
Veterans Affair, My name is Terry Lee Poaipuni and I am a wife of a
Vietnam Veteran. I was born and raised on the East side of Maui, in a
place call Hana. I have worked for Maui's Native Hawaiian Healthcare
System, Hui No Ke Ola Pono for 19 years. I will refer to Hana as east
Maui because the district encompasses a bigger area than Hana. The
number of Veterans in east Maui is seventy five plus and this is not
counting the National and Coast Guard Veterans. I'm sure there are more
Veterans out there that I've missed.
Nearly five years ago the State, Office of Veteran Services would
send William Staton to Hana once a month to assist the Veterans living
in east Maui. Ten years ago, a Registered Nurse from the Veteran Clinic
used to come to Hana Medical Center to see Veteran patients. Presently
the State, Office of Veterans Services does not come to east Maui. I've
spoken to our State representative and due to the State economic
constraints services by the State Office of Veterans Services were cut.
Tamicko Jackson, who has taken William Staton's place is the only
person employed by the State who is able to assist Veterans from Maui,
Molokai, and Lanai. Tamicko Jackson sees several of our east Maui
Veterans who drives out to Central Maui for their appointments and I'm
not sure how long Tamicko Jackson will be there. The unfortunate thing
is the Veterans become familiar (or ma`a as we say in Hawaiian) to
someone like Tamicko and then she gets replaced. This replacement only
makes it harder and frustrating for the Veteran. The accessibility of
services to east Maui Veterans is a major problem.
Counselors Ernie Matsukawa and Ipo Messmore has made the Veteran
Center in Lunalilo Building a safe place for Veterans wanting to gather
and share experiences. Ernie and Ipo Messmore does an awesome job of
counseling our Veterans and we need more people like them. I find the
Veterans, who gather there, have a lot of knowledge and information
they are willing to share. This is what is missing in the system. That
willingness to share with the Veteran of his or her benefits without
them guessing and feeling like they need to beg. Maybe this is what the
system is set up to do.
Hui No Ke Ola Pono, the Native Hawaiian Healthcare System with an
office in Central Maui and a satellite office in east Maui have
recently began working with Veterans on the island of Maui. Hui No Ke
Ola Pono, have included on our organization intake form a portion for
the Veteran to fill. This will identify the Veteran and give us the
opportunity to advocate for them. Clay Park, of Papa Ola Lokahi, has
been instrumental for starting the Veteran advocate services at Hui No
Ke Ola Pono. Clay Park has been helping the Veterans on Maui to explain
how to fill out the Veterans Benefit Administration forms.
In closing, I would like to know how East Maui can get assistance
from the Veteran Benefits Administration. My understanding is that
Joseph Thompson can assist Veterans with the application process. Can
Joseph Thompson come to east Maui? Is there a way that a
telecommunication site can be set up so Veterans can access services
from east Maui?
The Veterans need to feel like they are part of the system that
they fought for and not a burden to it. Mahalo and thank you for your
time.
Chairman Akaka. Mahalo nui, Terry, for your testimony.
And now we will receive the testimony of Mitch Skaggerberg,
President of the Vietnam Veterans Association.
STATEMENT OF MITCH SKAGGERBERG, PRESIDENT,
VIETNAM VETERANS OF MAUI COUNTY
Mr. Skaggerberg. Daniel, thank you for coming. Your
tireless work has really spawned a tremendous number of
veterans here in Maui to step forward to represent the 12,000
veterans in Maui and Maui County. You continue to inspire us,
and we are always amazed at the new benefits that you enact on
our behalf and the budget increases for the VA to do their job
more effectively. You are in our hearts always.
The thing that I think has become apparent is how our
families cherish what is going on in this community. They are
probably--they have more benefit than we do because families
are healing, children fall back in love with their fathers. So,
truly you represent the ohana of so many veterans, and we want
you to know that. We never want to stop telling you that, so
thank you.
Also, an overwhelming appreciation in the last 2 years
since you held--we had a pretty tumultuous meeting 2 years ago
here. I want to give you and your staff credit for giving us
the extra money, especially in terms of mental health care and
additional doctors. It has improved the ability of our staff
here--our doctors and our nurses--to provide us with good care,
very good care overall. Now, there are some improvements that I
will address in a minute, but like Danny and Clarence, there
are a lot of good things to report because of what you have
done and what our VA director has done. They have rolled up
their sleeves. It is not easy when you hear criticism and still
broaden your horizons, and we hope that they could do that
again today.
There are three areas that I am going to briefly make
recommendations on, and the first is voc rehab. I was
privileged to be the first Voc Rehab Veteran of the Nation in
1995. I remember you sent me a letter, and that has continued
to follow through all these years with me, so I have a fond
heart for that.
Why has D.C. reinstituted a policy to have all independent
living programs go up to them for review? There has got to be a
better way. It is hurting the veterans. I want them and I want
you to really have them reevaluate that system. Many of the
veterans are waiting 1\1/2\ to 2 years. Now, these are veterans
60 years old. It is not like they are 30 or 40 and they have
the time, and their families are waiting, too. There has got to
be a better way to get things done like when you were going
through it in the 90's--6 months to get it approved. They have
also reduced the limit, I understand, to 15,000 from 25,000. I
am not quite clear why that is, especially with the cost here.
So that--I mean, I know the system can be improved. It was--for
years, and I am not blaming those people from D.C. They
probably had a good reason, but they have got to understand
that they are hurting the veterans. They are not hurting any of
the VA employees or whatever is going on. So, that is one
recommendation, and I know we have heard that from other people
before. It is a huge problem, maybe not only here, but across
the State. Ms. Joy Gavigan would know that.
The second area is the benefits counselor. We are
recommending that the VA actually install a full-time benefits
counselor in the Vet Center to do outreach to Hana and Molokai.
Joe Thompson is fantastic, but he can only get here once or
twice a month. The reason I am saying that is the State has
refused over the last 10 years to add another counselor through
the State Office of Veterans Services, and they have burned out
about three of those people on the neighbor islands because of
it. Pat Pavao, Bill Staton, and Manuel Brigadora on Kauai, they
are not nurturing their people, they are wearing them out
because we need more counselors on the neighbor islands.
Sparky Matsunaga is the one that got the Governor in 1987
to start the Office of Veterans Services for Hawaii. He
understood the critical need. They have done nothing since, and
the workload has gone up tremendously. So, Maui sees the same
number of veterans as Oahu. Oahu has three. We have been trying
to get it through the State for 10 years. It falls on deaf
ears. They give us less than $1 million a year to service
125,000. The best tip that the veteran leader said was let's
get a full-time benefits counselor in Maui County, and outreach
especially for the Iraq and Afghanistan vets coming home. We
have got 900 to 1,000 in Maui that are going to be leaving
their units or be back for good in the next year. So, that is a
high priority.
[The recording got cut off and resumes with another
speaker.]
[The prepared statement of Mr. Skaggerberg follows:]
Prepared Statement of Mitch Skaggerberg, President, Vietnam Veterans of
Maui County
Dear Senator Daniel Akaka, Our Aloha to you, Senator Akaka, for
coming back to Maui to listen to our current experiences and additional
suggestions to improve about our VA Medical Clinic, Vet Center, and
Vocational Rehab Programs and Services.
We want to start with our Overwhelming Appreciation for the
additional Nurses, Mental Health Doctor's, and administrative staff at
our Maui Clinic over the last 18 months. Our veterans are very thankful
for your support, Senator Akaka, in getting us the additional funding
for these much needed personnel to serve the 2,000+ Maui Veterans using
our VA Clinic.
We have seen a big improvement in shorter wait times to access
mental health support for our 1,000 Maui PTSD Veterans because the
hiring of an additional mental health psychologist and a mental health
clinical nurse. Again, thank you, Senator Akaka, for procuring and
advocating for the funds to get these two additional Mental Health
providers into the Maui clinic.
A PTSD psychologist on Maui, Dr. Richard Sword, together with
Professor Zimbardo of Stanford University, has been using another new
PTSD treatment method to treat some Maui Veterans that effectively
reduce PTSD symptoms and treatment times. It's called ``Time Therapy.''
We would encourage the VA mental health providers to look at this
method for possible use in our VA PTSD programs.
Our Vietnam Veterans also overwhelming support the current proposal
to house all our VA Facilities at the Maui High School complex; being
spearheaded by Our Maui County Veterans Council; and its Chairperson
for this Proposal, Lloyd Sodetani.
And our wounded Veterans seeking disability compensation need much
more timely and consistent help in submitting and being provided with
ongoing help to get their Claims adjudicated. We would like to
recommend a Full Time Benefits Counselor be added to our VA Maui Vet
Center. Currently we have a benefits counselor come twice a month from
our Honolulu VA Regional headquarters; which slows the process and, in
our experience, can cause unnecessary frustration with the Veteran.
This could also help the VA reduce its Compensation Claims backlog,
which is a top priority with our VA.
Many of our combat veterans who have their disability claim still
being adjudicated (called CV in the system) cannot get their travel to
Honolulu paid for by the VA. For much needed medical care. This results
in withholding critical medical care for them since the care is not
available on Maui. We believe they are entitled to travel. Travel
reimbursement is also being withheld for non service-connected veterans
needing critical care only available at Honolulu VA or Tripler. These
veterans cannot drive to Oahu and are entitled to care and the travel
cost to get there! In both situations our doctors tell us these
Veterans are needlessly suffering because of this policy. Can you get
us travel for all these deserving Veterans Senator Akaka!
We have also heard from Combat Disabled Veterans (many with ratings
of 50-100%) that some of the medical treatment being recommended by our
Maui VA Doctors is not being approved by our Honolulu VA/Utilization
board. This has been an ongoing source of frustration with our Veterans
care on Maui. Why have doctors if the Financial folks on Honolulu have
the final SAY for our medical care. We would like our Doctors to have
the Final Say on their Patients care.
We need help also in getting our Guam Clinic a Mental Health
Doctor. Because the budget for this position is 60% less than the pay
in Las Vegas the VA cannot fill the position. Is there any way the VA
can fix this wide pay difference to fill the position? We have already
lost a highly qualified Applicant due to this pay issue!
Last, Maui Veterans seeking vocational rehab, specifically, the
Independent Living Program, are upset at the procedure set up by the
Washington, DC, Voc Rehab Office to review and approve all Voc Rehab
Program Applications by Maui Veterans. We find this policy has resulted
in major delays in getting Maui Veterans their programs; many times up
to two years.
Again, Senator Akaka, we want to thank you for your Tireless and
ongoing assistance in the overall improvement of our Maui VA health
care in the last two years. Without your help this would not have been
possible.
STATEMENT OF LLOYD K. SODETANI, MAUI REPRESENTATIVE, HAWAII
OFFICE OF VETERANS SERVICES
Mr. Sodetani [In progress]. I would like to introduce
individuals who were instrumental in assisting us as a team in
planning, organizing, and directing this proposed project. I
would like to begin with a person who represents the Department
of Defense, State of Hawaii, Brigadier General Gary Ishikawa.
If he would stand to be recognized, please.
[Applause.]
Chairman Akaka. Welcome to our hearing, General.
Mr. Sodetani. Representing the Department of Education is
Maui High School Principal Randy Yamanuha. Randy.
[Applause.]
Chairman Akaka. Thank you for being here, Randy.
Mr. Sodetani. The architect who has done pro bono work
throughout this period of time is Stanley Gima.
[Applause.]
Chairman Akaka. Mahalo, Stanley.
Mr. Sodetani. And through the generosity of Austin,
Tsutsumi & Associates, Ken Kurokawa, who is a Vietnam veteran,
an engineer, and a cancer survivor, I would like to introduce
the surveyor, Tim Lapp.
[Applause.]
Chairman Akaka. Mahalo.
Mr. Sodetani. This was all manuahi, OK? Above all, I would
like to recognize the organizations within the community,
including the veterans groups and veterans who are present here
today, and I would like to thank all of them for all their
kokua.
My testimony. Regarding the proposed multi-service complex,
submitted herewith is a copy of a survey--and I am submitting
that also--that was conducted by the Hawaii Health Systems
Corporation on the island of Hawaii. The results of the survey
indicate similar problems and challenges appearing in East
Hawaii. It has shown that systemic problems exist relative to
Hawaii, as it was voiced during your visit with the Hawaii
veterans last August 2009, and this testimony is being
presented today. In each geographical location, the consensus
has been loud and clear that multi-service complexes as
proposed are needed. It is the contention of the veteran
advocates that continuing to provide services in the current
manner would not be in the best interest of veterans,
particularly since dissatisfaction continues to grow. Creating
multi-service complexes would benefit all users, employees, and
the community. By providing a user-friendly facility with ample
parking in close proximity to all related services, it will be
cost-effective, efficiently operated, and achieve greater
satisfaction from veterans.
It is with sincere appreciation that I express my gratitude
to you for having this forum. You have provided an immense
amount of projects and programs for Hawaii and Maui County. For
those we are truly grateful. We continue to ask for your
support in our endeavor to have a better quality-of-life for
all veterans in Hawaii nei.
Thank you.
[Applause.]
[The prepared statement of Mr. Sodetani follows:]
Prepared Statement of Lloyd K. Sodetani, COL, USA (Ret.), Chairman,
State Advisory Board, Office of Veterans Services
Dear Senator Akaka: Submitted herewith is a copy of a survey that
was conducted by the Hawaii Health Systems Corporation on the island of
Hawaii. The results of the survey indicate similar problems and
challenges experienced in East Hawaii. It confirms that systemic
problems exist throughout the State of Hawaii as it was voiced during
your visit with the Kauai veterans last August, 2009.
It is the contention of the veteran advocates that multi-service
complexes will benefit all users, employees and the community. To
continue providing services in the current manner would not be in the
best interest of veterans, particularly since dissatisfaction continues
to grow. By providing a user friendly facility with ample parking, in
close proximity to all related services, it will be cost-effective,
efficiently operated and achieve greater satisfaction from the
veterans.
It is with sincere appreciation that I express my gratitude to you
for having this forum. You have provided an immense amount of projects
and programs for Hawaii and Maui County. For those, we are truly
grateful. We continue to ask for your support in our endeavor to have a
better quality of life for our veterans in Hawaii nei.
______
Attachment
Chairman Akaka. Thank you very much, Lloyd, for your
testimony and your concerns, as well as your offerings of how
we can help to improve the system.
And now, as you know, this is the time for questions. I
have a question here for all of the witnesses, so what I will
do--you all do not have to answer. I will just go down the
line. If you want to answer it, please do. And this has to do
with the accessibility of service. Can you hear me?
Audience. We cannot hear.
Chairman Akaka. OK. This question has to do with the
accessibility of service, and this is for all the witnesses
here, and here is the question: Do you feel that VA services on
Maui are readily available to all veterans? And then if not,
what improvements do you feel are necessary to ensure access to
services for all of Maui's veterans? That is the question.
Maybe I will just open it to anyone who wants to start. Larry
Helm?
Mr. Helm. Mahalo, Senator Akaka. As far as here on Maui,
there probably could be some improvement, but in my opinion,
10, 15 years ago there was some. Today there is more. Molokai,
10, 15 years ago, there was none. Today we have a lot thanks to
you. Mahalo.
Of course, there is a lot more to do to improve, and that
is why we are here, to try to--and if I sound sharp sometimes,
E kala mai, but I am trying to find the right way and a right
day to make it better for the veterans. I think dialoguing with
guys that use the services and being more efficient, more
effective, less time-consuming, finding ways to do that would
improve accessibility and service to the veterans.
Chairman Akaka. Mahalo.
Anyone else?
Ms. Poaipuni. I think I would like to answer some of
those----
Chairman Akaka. Terry Poaipuni.
Ms. Poaipuni [continuing]. Those questions. As far as
accessibility to East Maui--and I am saying East Maui because
that encompasses Kanaio too. It seems like we are on the flip
side of Molokai. We used to have services, and I do not mean a
lot of services. We had services; now we don't have any. We
have been working--I have been talking with Dr. McNamara and we
meet with Dr. McNamara and Clay Park, we have been talking
about giving telecommunication a try to find a solution,
anything, so we could begin to get more services--or get
services into the community. Oftentimes, our veterans of many
wars need to take off from their work time, and with the
cutback of jobs and so forth, that is difficult. So what
happens is they have got to come up to Central Maui for their
appointments. So, it would be nice if someone would come to
East Maui or Hana or Keanae, and if someone could come there it
would be a lot easier. That way they could come in and do that
for us, even via telecommunication.
You know, we have been without for so long, oftentimes in
East Maui we feel like we are like Molokai--out of sight, out
of mind--and we've gotten ma`a (used to it), but we do not want
to be in that same state of mind. We want to be able to
continue getting in because we have a lot of veterans and we
need the services.
Chairman Akaka. Mahalo.
Mr. Sodetani. Senator, may I comment on that, please?
Chairman Akaka. Yes, Mr. Sodetani.
Mr. Sodetani. In my recent testimony to you, I addressed
part of this. I believe that by combining services or jointly
providing services through the public health clinic, for
example--and I believe General Shinseki also spoke about
telemedicine, using telemed facilities to be able to do
communications, among other things.
The Hana Clinic, for example, can be used as an initial
examination station for veterans, and then rather than the
veteran coming all the way out here to the clinic for initial
visits or being sent to Tripler, for that matter. I believe
that by having a veteran attend the facilities at Hana Clinic
it would make it more convenient to the veteran and also
probably make it more efficient and cost-effective as well.
I believe the Wailuku Clinic that just opened would also be
another alternative facility for veterans to attend in the
event the VA clinic here would not be able to support all of
the needs of the veterans. I am sure they have a lot of
specialists at the community health clinic that can provide
additional services to our veterans before our veterans are
being transported to Tripler. I think we should try to avoid
that transportation matter as much as possible or try to
provide a more convenient environment for our veterans so that
it will be less stressful for them.
But these are some of the things that I suggested in there,
and it brought to my mind when I served my last tour at Camp
Smith in a joint level, that we worked together with Army,
Navy, Air Force, Marine Corps, and we had to pool our resources
in order to ensure that we had the best experts and the most
cost-effective way of operating our mission requirements.
So, I would like to suggest that Public Health Service
clinics could be an option for us to consider, especially in
these remote communities. Thank you.
[Applause.]
Chairman Akaka. Thank you.
Any other comments? Mitch? Mr. Skaggerberg?
Mr. Skaggerberg. It is amazing how many calls the leaders
got in the last few months, but one of the big things that we
have been hearing is that many service-connected veterans are
not getting the full range of services our VA doctors are
prescribing, such as chiropractic and massage. There are a lot
of inconsistencies. They are very frustrated. They need these
services. And we do not know who it is, whether it is the Board
of Utilization in Honolulu. I know I have gone through it
before, and a lot of times they say, well, that is not really
necessary. And they almost--I do not know if they use doctors
there, but they take our doctors and they override us. I do not
know if it is money or what, but I know one thing: a lot of
service-connected veterans are suffering because of that and
they are angry. And a lot of these veterans have been serving
Maui for 40 years.
So, I would ask our VA reps and you to see if they can
correct that because that denies them access to certain
services their doctors want them to have--our doctors. Thank
you.
[Applause.]
Chairman Akaka. Mr. Laub?
Mr. Laub. Thank you. I want to read part of a letter here
that came to me from Pastor Daniel Merritt, who is in the back
with his father. He wrote a letter to the editor because he
could not get the services that he needed for his father.
``I want to just first say thank you for responding
to my letter to the editor regarding care of my veteran
father. It is very discouraging to have to write such
letters, but it has become painfully apparent that
things like this must be done. My name is Pastor Daniel
Merritt. I am a pastor for the Salvation Army and the
chaplain for Maui Community Correctional Center here on
Maui. Over the past several months, I have noticed the
lack of due care in the health practitioners for my
father who did two tours in Vietnam in the U.S. Marine
Corps. My Dad was diagnosed with Agent Orange exposure,
and as a result, he has leukemia, non-Hodgkin's
lymphoma, and diabetes, along with several other
crippling diseases.''
``I have called VA on several occasions with concerns
regarding my Dad's health only to get treated with
anything but respect. I followed up with them for over
a month for a walker as his feet have become so bad he
can barely walk. Only after this letter to the editor
was he offered a diabetes specialist which I have been
requesting for months. I also asked for an increase of
his pain medication, which has never been done. He had
to go to a pain doctor as the VA would not supply him
with adequate medication for his pain, which he had to
pay for out of his pocket. He was prescribed pain
patches, shower handles for his shower, and hand
controls for his car, but I was told they were too
expensive and the VA would not cover them. Can we put a
price tag on the vets who fought to keep the country
the United States of America? Have we lost the
understanding that without them we would be speaking
another language?''
``It saddens me to know that I have to call the VA
and when I ask who I am speaking to, I am told `RP 64.'
As I was concerned with all these issues, I called the
patient advocate, Alma, and asked her help regarding
the situation and was told, `There is nothing to
investigate.' I then called the Inspector General, who
would only identify himself as `RP 64,' and was told
that there was nothing to the claim and they refused to
investigate.''
``Have we lost our system of checks and balances?
These are the veterans of the United States military
and need to be treated as such. On this day, my father
is sitting at home, alone, in excruciating pain, with
no pain pills because he cannot afford to keep
purchasing them on his own and is waiting for another
empty promise from the VA that his prescription is in
the mail. Why can't they fill them at the VA pharmacy
or local drug store? I don't understand. Today, as the
son of a strong man who has been reduced to nothing for
his country, I am humbly asking for your assistance.
Pastor Daniel Merritt.''
Chairman Akaka. Thank you very much, Paul, for your
response here to the question.
Any other responses? Rogelio Evangelista.
Mr. Evangelista. Senator Akaka, due to the economic times,
we need to honor the veteran because they went out there to do
what was needed. And if honoring the veteran is just a minute
thing that we need, we need a VA hospital within the islands
that will take some of the pressure off, not just with Spark
Matsunaga but some hospital itself. And the part is we need to
lift the restriction of the Millennium Act sending the
veterans--although they are only 10 percent or whatever--send
them to get specialized medical care also.
Thank you.
Chairman Akaka. Thank you very much, Rogelio Evangelista.
Are there any other further responses? Before we continue,
I want to say mahalo to the veterans from Molokai.
[Applause.]
Mr. Helm. Thank you, Senator Daniel Akaka. This is a fine
time for Maui, Molokai, Lanai, with President Paul Laub. The
power is in the veterans. We form a coalition and get
politically active. For those who are veteran-friendly get them
in, and those who are not get them out.
[Laughter.]
Audience Member. Imua!
Mr. Helm. And that is the direction. I think we have got
enough numbers there. We have got 12,000. And although we are
aware, Senator Akaka, we'll keep you posted. Thank you again.
Chairman Akaka. Mahalo.
[Applause.]
Mr. Helm. Thank you. I want to invite you guys over to
Molokai when we have our building dedication, OK?
Chairman Akaka. Mahalo. Are there any other responses to
that question? If not, let me go back particularly to Lloyd
Sodetani, because you mentioned and there were some others who
mentioned it, too. And let me say to Mr. Sodetani that I
appreciate the efforts you have made to develop a plan to
consolidate services for Maui veterans. [Applause.]
And so my question to you, Lloyd, is: How would this
improve efficiencies and services for veterans?
Mr. Sodetani. Well, first of all, if you look at the
current situation, the parking is inadequate at all three
facilities. There is inadequate advertising or ability to
locate the facilities. The signage is poor, and the locations
are not in the best areas for and on behalf of veterans. So,
physically it becomes a burden for the veterans. There are
inadequate handicapped stalls in all three locations.
If you look at the clinic, it is a walk-up or it requires
elevator services. It is not conducive to serving veterans,
especially those who are handicapped. The greater majority of
them--a whole bunch of them are. And so we need to be aware
that, you know, the ADA requirements should be even more
pronounced. We need to be sure that our veterans are provided
this type of care.
By consolidating it to one location, we can have in the
plan--our plan shows 200 parking stalls, and it is all mostly
located through the buildings so that they will be easily
accessible for the veterans. We have more than adequate
handicapped stalls. It is on a 4\1/2\-acre campus that Maui
High School is willing to give up so that they can also start a
program for the students, a health care, social services, and
community service type of internship that would be more
acceptable to the student programs there.
We would also have everything on one level. I am sure
everyone--because it is so centralized, all of our veterans
will be able to locate that facility easily. It can be easily
identifiable. It can be advertised accordingly. But right now
we advertise three different locations for veterans services. A
guy goes to Wailuku, Ernie's place, and Ernie tells him, No,
you are at the wrong location. You have got to go down to
Kahului. You know, that is demoralizing for the veteran. I
think that having that one-stop service would eliminate that
type of confusion. So these are some of the benefits that we
would gain from having something like that.
In addition to that, I know that I received a letter from
you with regard to this matter early last year when I submitted
it to you. The concern that you had was the ownership of the
land. Well, the State owns the land here. The facility would be
provided by VA, veterans' facilities, the clinic, Vet Center,
et cetera, things that would--areas that would be occupied by
VA. On the other hand, OVS would pay for their own structure or
improvements.
In the National Guard, there is not a problem with
ownership of land. The State owns the land. The Federal
Government pays for the armory. And if I recall correctly, and
if this system has not changed over the years, the building
remains under the ownership of the National Guard Bureau for 27
years. Thereafter, if the National Guard Bureau wants to turn
that building over, they say, ``We have no further need for
this structure,'' turns it over to the State, and just like
here at Charlie Company Armory and Wailuku Armory, Wailuku
Armory has been converted to part of a school. Charlie Company
Armory is now being used by the Land and Natural Resources'
Enforcement Division. So these are continuous government uses.
So, the concern that has been expressed--and I believe
General Shinseki also expressed that--with regard to the
ownership of the land with a Federal structure on it should not
be really a concern because we have means of coming to an
understanding. We have already submitted a draft between the
Memorandum of Agreement between the Department of Defense, the
State Office of Veterans Services, and the Department of
Education to show that, you know, whatever VA needed--30-, 50-,
100-year use of the land--would be accommodated. And it would
be rent free. There would be no rent whatsoever.
I believe that we are prepared and committed to go forth
with this project if we can receive the proper funding for it.
And I believe that by what we have submitted so far to date,
the phasing of it would be such that it would not require a
total lump sum budgeted amount one time. It will be over a
period of 3 or 4 years. I believe that we, the veterans, would
be able to enjoy a facility more or better than what we have
now.
Thank you.
Chairman Akaka. Thank you very much for that.
[Applause.]
Mr. Laub. May I answer that, sir?
Chairman Akaka. Paul Laub.
Mr. Laub. Sir, we also need long-term elder care, and this
property would provide us with space for that.
Chairman Akaka. Thank you.
Any other comments on--Terry Poaipuni.
Ms. Poaipuni. Senator, we talked about accessibility, and
another one is, like I mentioned, the ability to fill out the
applications; and oftentimes our vets go out to Ernie's
thinking they can get the help. He just counsels and the only
other one that we know of--I just found out--which is Tamicko .
I just recently found out that Mr. Thompson does it, too. So we
need that type of assistance for our vets to be helped through
that process to understand the applications and work with them
at that point, because right now they are lost and they are
confused. They do not know, and then when they get the reply,
they think that--you know, they stop. It is all right for the
VA that they do stop, but I think the veterans just do not have
to and should not give up because they do not understand the
system--the process of the application system.
Chairman Akaka. Well, mahalo--oh, Mitch Skaggerberg.
Mr. Skaggerberg. One of the things about having a
centralized location for all the services is being able to
attract a lot more veterans. It is going to give them a
tremendous visibility in the community and a sense of
confidence and comfort when they go there.
One of the things I think is going to happen, it is going
to make life a lot easier for them, the VA nurses and doctors,
Dr. Hastings, the director, because when the veterans do want
drugs, they leave the clinic denied, they feel, of services
they are entitled to. With everything there, they have access
to other people in there, like a counselor, to say, hey, I am
never coming back to the VA. We hear this all the time. They
can stay on the property and get other help. A patient advocate
or a counselor solves their problem right there, where they go
back to the family with some sense of comfort and peace.
The other thing is that it would be a rallying point for
all the veteran organizations. It will be a place of honor in
our community and visible; and that will help us get more
services from the county and other places where veterans are.
Thank you.
Chairman Akaka. Well, mahalo.
Mr. Sodetani. Senator, I would like to announce that----
Chairman Akaka. Mr. Sodetani.
Mr. Sodetani [continuing]. If anyone would like to see the
site plan and aerial photo of what has been done so far, please
do not hesitate to consult with Mr. Stanley Gima. He has a
blown-up aerial photo, I believe, and also the site plan of the
proposal. If any others would like to discuss it with him or
with any of the people that I mentioned, including Paul or
those who have been involved in this project for the longest
period of time, I am sure they are well versed on what we would
like to do. And, please, by all means, I am sure that they
would welcome your request, Senator.
Thank you.
Chairman Akaka. Thank you very much, Lloyd.
Now I would like to move to the next question. This
question is to Mitch Skaggerberg. I have heard from many
veterans across Hawaii that there is a need for a full-time
veterans counselor at each Vet Center to help with, among many
issues, the filing of claims for compensation. Mitch, why do
you feel a full-time benefits counselor at the Maui Vet Center
is important? And if he answers that, to the rest of the panel,
do any of you have any thoughts or opinions on this issue after
Mitch is finished with his response? Mitch.
Mr. Skaggerberg. Many Maui veterans--and we have 12,000--
never apply for compensation, disability, or even the medical
benefits. A benefits counselor who has outreach capability will
be able to adequately let all our veterans know what their
entitlements are and encourage them to apply for them.
I think the most important reason why we need a full-time
benefits counselor is for years the State did that role, and
they did it well. But we have quadrupled the number of veterans
using veterans care now, which means we have quadrupled the
number of people that have to fill out applications. They need
counseling and they need coordination. Here is step one, step
two, check into the clinic to see your doctor, step three. They
cannot come close to doing that right now. Joe Thompson was a
full-time member of our Vet Center for years, and he will be
much more valuable, I think, in helping us--he comes over, I
believe, once a month. And so that is the reason why I believe
we need a full-time benefits counselor. Again, we tried to get
another one through the State. Their attitude, by the way, is
that that is the VA's job. And they turned us down. I have
heard that from the county Mayor. I have heard that from the
Governor's office, even the OVS, behind closed doors. Really,
the VA needs to do that. So, we need tremendous support in
reaching all those veterans that we need to reach.
Thank you.
Chairman Akaka. Thank you very much.
Are there any other responses from the panel? Yes, Terry
Poaipuni.
Ms. Poaipuni. Let me say--because I think that is exactly
what we are trying to mention to you, Senator, because there is
a great need. I think when we say counselor, maybe there should
be a counselor/application process officer; and I think a full-
time person. Right now, as I am looking at Ernie, I see they
are the ones that do the application work, and other ones do
not. And so it is important because what we are doing right now
is we are doing that job at home. So, I think it is very
important that the VA comes to all areas and not only Central
or Lahaina, but should travel the tri-isle of these islands.
Chairman Akaka. Are there any more responses to that
question?
Mr. Sodetani. Yes, Senator. I would like to respond.
Chairman Akaka. Yes, Lloyd Sodetani.
Mr. Sodetani. You know, Tamicko has been a tireless worker,
and it is a very thankless job, and she is overwhelmed. And we
miss you, Terri. In any event, I wanted to state that, you
know, one solution to this would be to fund it through VA,
allocating the funds through another position to the State of
Hawaii through the Department of Defense Office of Veterans
Services, and mandating that that fund will be for another
counselor here. And I think that might work. I am not sure how
the whole politics of it would be, but I would think that if we
could have that funding allocated specifically for that
position, we would be able to create that position here. But it
will be funded through the Federal Government providing
assistance to Maui County. Hopefully that is the solution.
Chairman Akaka. Fine. Well, mahalo nui loa. You know, I
want to thank all of you on this panel very much for your
testimony, for your responses, and without question, this is
going to be helpful to what we are trying to do to improve the
accessibility, services, and the quality of care for veterans.
And this is the reason we are having this hearing. I have got
to tell you at this point I am so glad we are having this
hearing because we have learned a lot.
So, I want to say mahalo nui loa to all on this panel for
what you have added to our hearings and to the work that we
need to do. But I want to take some suggestions from you folks,
too, that this is something that we all have to work together
to do, and I really, really appreciate what you have said. And
this does not end. You can continue to express as we go along,
as you have ideas about what we need to do. So I want to say
mahalo nui loa to all of you again for being members of this
panel. Thank you. [Applause.]
And now I would like to invite those who are standing.
There are seats that are available, or maybe the panelists will
be moving--and then I would like to welcome the second panel.
First is Tracey Betts, Honolulu Regional Office Director.
Next is Sheila Cullen, Director of the Veterans Integrated
Service Network 21. She is accompanied by Dr. James Hastings,
Director of the VA Pacific Islands Health Care System, and Dr.
Darkins from VA as well.
Next we have Linda Halliday, Deputy Assistant Inspector
General for Audits and Evaluations for VA's Office of Inspector
General. Ms. Halliday is accompanied by Walter Stucky, who is
an audit manager in the Seattle Audit Division.
I want to thank our panelists for being here today, and
your full testimony will, of course, appear in the record. So,
may I ask you, Ms. Betts, to proceed with your testimony.
Welcome, Ms. Betts.
STATEMENT OF TRACEY BETTS, DIRECTOR, HONOLULU VA REGIONAL
OFFICE, U.S. DEPARTMENT OF VETERANS AFFAIRS
Ms. Betts. Thank you, Chairman. Chairman Akaka, it is my
pleasure to be here today to discuss our efforts to meet the
needs of veterans residing in the Pacific Region. Today I will
specifically discuss important benefits and outreach services
provided to veterans living on Maui.
The Honolulu Regional Office serves the veteran population
in Hawaii and the Pacific Region. The Honolulu facility also
provides outreach to veterans residing in the Insular Islands
of the Republic of Palau, Federated States of Micronesia, and
Republic of the Marshall Islands.
The Honolulu Regional Office administers the following
benefits and services: disability compensation; vocational
rehabilitation and employment assistance; home loan guaranty,
specially adapted housing grants, and Native American direct
home loans; and outreach for all veteran and survivor benefits.
Our goal is to deliver these benefits and services in a timely,
accurate, and compassionate manner. This is accomplished
through the administration of comprehensive and diverse benefit
programs.
The Honolulu facility is responsible for delivering non-
medical VA benefits and services to over 118,000 veterans and
their families. Approximately 19,000 of these veterans receive
disability compensation benefits from the Honolulu facility.
In fiscal year 2009, Honolulu provided more than 5,400
veterans with decisions on their disability claims. The
Honolulu office conducts an average of 3,000 telephone
interviews and 1,300 personal interviews per month. In
addition, the Honolulu RO conducted 171 Transitional Assistance
Program briefings to approximately 5,000 servicemembers in
Hawaii in fiscal year 2009.
The Maui Vet Center hosts a traveling veterans service
representative from Honolulu to provide services to the
veterans living on Maui. During fiscal year 2009, 132 veterans
personally met with the traveling counselor to file claims and
obtain information regarding benefits.
In October 2009, we have implemented a program in which our
decision review officer hearings are being conducted on all of
the six Hawaiian Islands, which includes Maui. To date, the
Honolulu facility has conducted two decision review officer
hearings here in Maui, and as they are received, they will be
conducting more in the future.
The Honolulu Regional Office also has a vocational
rehabilitation counselor collocated in the Maui Community Based
Outpatient Clinic. The vocational rehabilitation counselor
provides educational and vocational counseling to
servicemembers, veterans, and eligible dependents. The
counselor met with 1,276 veterans in fiscal year 2009 and is
currently working with over 100 veterans here on Maui. The
counselor is also a member of the Maui Veterans Association and
attends their regular meetings to provide general vocational
rehabilitation and educational information.
Veterans residing on Maui can receive assistance with their
claims and benefits information through the nationwide toll-
free number, which is answered by the Honolulu Regional Office
employees. The Honolulu office and the State Office of Veterans
Services here on Maui work as partners to ensure that the
veterans on Maui receive access to all VA benefits for which
they are eligible.
The Native American Direct Loan Program administered by VA
is very active on Maui, in part because of the temporary
increase in the maximum guaranty amount, as enacted by Public
Law 110-389. Another reason for this success is attributable to
our ongoing partnership with the Department of Hawaiian
Homelands. The Department of Hawaiian Homelands serves as our
partner in assisting with loan packaging, appraisals, and
construction-related inspections, as well as providing crucial
communication links between our staff and the veterans that we
serve. A Honolulu Regional Office employee in the Loan Guaranty
Division travels to Maui on a regular basis to assist in
servicing Maui loans, meet with the Department of Hawaiian
Homelands, and conduct appraisals.
I myself am a member of various advisory councils, such as
the Advisory Board on Veterans Services chaired by the Director
of the State of Hawaii Office of Veterans Services and the VA
Pacific Island Health Care System Advisory Council. Board and
council members are local veterans and advocates representing
their communities from six of the Hawaiian Islands, to include
Maui. During these meetings, board and council members express
concerns, discuss veteran issues and receive general
information on VA benefits.
The Honolulu Regional Office is and remains committed to
providing timely benefits and services to the veteran
population residing here on Maui.
Mr. Chairman, this concludes my testimony. I greatly
appreciate being here today and look forward to answering your
questions.
[The prepared statement of Ms. Betts follows:]
P r e p a r e d S t a t e m e n t o f T r a c e y B e t t s ,
D i r e c t o r , H o n o l u l u VA R e g i o n a l Office, Veterans
Benefits Administration, U.S. Department of Veterans Affairs
Chairman Akaka, it is my pleasure to be here today to discuss our
efforts to meet the needs of Veterans residing in the Pacific Region.
Today I will specifically discuss important benefits and outreach
services provided to Veterans living on Maui.
honolulu regional office
The Honolulu Regional Office (RO) serves the Veteran population in
Hawaii and the Pacific Region. The Honolulu RO also provides outreach
to Veterans residing in the Insular Islands of the Republic of Palau,
Federated States of Micronesia, and Republic of the Marshall Islands.
The Honolulu RO administers the following benefits and services:
Disability Compensation
Vocational Rehabilitation and Employment Assistance
Home Loan Guaranty, Specially Adapted Housing Grants, and
Native American Direct Home Loans
Outreach for all Veteran and survivor benefits
Our goal is to deliver these benefits and services in a timely,
accurate, and compassionate manner. This is accomplished through the
administration of comprehensive and diverse benefit programs.
The Honolulu RO is responsible for delivering non-medical VA
benefits and services to over 118,000 Veterans and their families.
Approximately 19,000 of these Veterans receive disability compensation
benefits from the Honolulu RO. In fiscal year 2009, Honolulu provided
more than 5,400 Veterans with decisions on their disability claims. The
Honolulu RO employees conduct an average of 3,000 telephone interviews
and 1,300 personal interviews per month. In addition, the Honolulu RO
conducted 171 Transitional Assistance Program (TAP) briefings to
approximately 5,000 servicemembers in Hawaii in fiscal year 2009.
services on maui
The Maui Vet Center hosts a traveling Veterans Service
Representative (VSR) from Honolulu to provide services to Veterans
living on Maui. During fiscal year 2009, 132 Veterans personally met
with the VSR to file claims and obtain general benefit information.
In October 2009, the Honolulu RO began conducting Decision Review
Officer (DRO) hearings on six of the Hawaiian Islands, to include Maui.
To date, the Honolulu RO has conducted two DRO hearings on Maui.
The Honolulu RO also has a Vocational Rehabilitation Counselor
(VRC) co-located in the Maui Community-Based Outpatient Clinic. The VRC
provides educational and vocational counseling to servicemembers,
Veterans, and eligible dependents. The VRC met with 1,276 Veterans in
fiscal year 2009 and is currently working with over 100 Veterans on
Maui. The VRC is also a member of the Maui Veterans Association and
attends their regular meetings to provide general vocational
rehabilitation and educational information.
Veterans residing on Maui can receive assistance with their claims
and benefits information through the nationwide toll-free number, which
is answered by the Honolulu RO. The Honolulu RO and State Office of
Veterans Services on Maui work as partners to ensure the Veterans on
Maui receive access to all VA benefits for which they are eligible.
The Native American Direct Loan Program administered by VA is very
active on Maui, in part because of the temporary increase in the
maximum guaranty amount, as enacted by Public Law 110-389. Another
reason for this success is attributable to our ongoing partnership with
the Department of Hawaiian Homelands. The Department of Hawaiian
Homelands serves as our partner in assisting with loan packaging,
appraisals, and construction-related inspections, as well as providing
crucial communication links between our staff and the Veterans we
serve. A Honolulu RO loan guaranty employee travels to Maui on a
regular basis to assist in servicing Maui loans, meet with the
Department of Hawaiian Homelands, and conduct appraisals.
I participate on various advisory councils, such as the Advisory
Board on Veterans Services chaired by the Director of the State of
Hawaii Office of Veterans Services and the VA Pacific Island Healthcare
System Advisory Council. Board and Council members are local Veterans
and advocates representing their communities from six of the Hawaiian
Islands, to include Maui. During these meetings, board and council
members express concerns, discuss Veteran issues and receive general
information on VA benefits.
conclusion
The Honolulu RO is and remains committed to providing timely
benefits and services to the Veteran population residing on Maui.
Mr. Chairman, this concludes my testimony. I greatly appreciate
being here today and look forward to answering your questions.
Chairman Akaka. Thank you very much, Ms. Betts.
And now we will receive the testimony of Sheila Cullen.
STATEMENT OF SHEILA CULLEN, DIRECTOR, VA SIERRA PACIFIC NETWORK
(VISN 21), VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF
VETERANS AFFAIRS
Ms. Cullen. Mr. Chairman, mahalo for the opportunity to
appear before you today to discuss the state of VA health care
in Maui.
Chairman Akaka. Thank you for being here.
Ms. Cullen. It is a privilege to be here in Maui to speak
and answer any questions you may have pertaining to the
services we provide veterans in Maui County.
First, Mr. Chairman, I would like to thank you for your
leadership and advocacy on behalf of veterans. Your vision and
support have led to an unprecedented level of health care
services for veterans, construction of state-of-the-art
facilities in Honolulu, and remarkable improvements in access
to health care services for veterans residing on the Hawaiian
neighbor islands, American Samoa and Guam.
My written statement, which I request be submitted for the
record, reviews the VA Sierra Pacific Network; provides an
overview of the VA Pacific Islands Health Care System; offers
information regarding telehealth programs; and discusses the VA
clinic in Maui, as well as issues of interest to veterans
residing in Maui County. During my time before you today, I
would like to focus on what VA is doing to improve services and
care for Maui veterans.
VA operates a community-based outpatient clinic located in
Kahului and expanded the clinic space by an additional 4,400
square feet during fiscal year 2008 to a total today of 9,700
square feet. Since the hearing you held here 2 years ago, the
Maui Clinic has recently increased its staffing and currently
is authorized to have 28 staff at the clinic to provide a broad
range of primary care and mental health services.
In fiscal year 2008, the clinic implemented a home-based
primary care program supported by a nurse practitioner and
received over a quarter of a million dollars in VA rural health
funding this fiscal year.
As you know, Mr. Chairman, Congress has provided several
hundred million dollars to VA specifically to enhance mental
health services. These funds have been used to hire about 35
new mental health staff in VA facilities across Hawaii and the
Pacific Region, including seven staff here at the Maui Clinic.
In addition, the Maui Vet Center also successfully recently
recruited another psychologist.
VA provides part-time outreach clinics on the islands of
Molokai and Lanai, and VA Pacific Islands Health Care System is
assessing options to increase and enhance services in both of
those locations. The VA Clinic on Molokai is located in shared
space near Molokai General Hospital and operates two half-day
primary clinics per week. VA also sends mental health staff
from the Maui Clinic to Molokai to provide care.
In addition, VA purchases non-VA care in the community for
eligible veterans there. Veterans residing in Molokai also are
seen at DOD and VA facilities in other locations.
Since June 2007, a VA primary care provider from Maui and
more recently, since late fiscal year 2009, a mental health
clinical nurse specialist travels to Lanai once a month to
provide needed primary care and mental health services. VA has
used space adjacent to the Lanai Community Hospital and last
year finalized an agreement with the Straub Outpatient Clinic
for visiting VA providers to use space and support the clinic
there. In addition, VA purchases non-VA care in the community
and pays beneficiary travel for eligible veterans. VA is
exploring other options to improve access, including adding an
automated pharmacy dispensing machine and increasing telehealth
capabilities.
In summary, with your support, Mr. Chairman, and with the
support of other Members of Congress, VA is providing an
unprecedented level of health care services to veterans
residing in Hawaii and here in Maui. We look forward to a
growth of new patients at the Maui Clinic, and we will meet the
expectations of veterans for quality and timeliness of care.
Again, Mr. Chairman, mahalo for the opportunity to testify
at this hearing. My colleagues and I would be happy to address
any questions that you may have for us. Thank you.
[The prepared statement of Ms. Cullen follows:]
Prepared Statement of Ms. Sheila Cullen, Director, VA Sierra Pacific
Network (VISN 21), Veterans Health Administration, U.S. Department of
Veterans Affairs
Mr. Chairman and Members of the Committee, Mahalo for the
opportunity to appear before you today to discuss the state of VA
health care in Maui. It is a privilege to be here in Maui to speak and
answer any questions you may have pertaining to the services we provide
Veterans in Maui County. I am accompanied today by Dr. James Hastings,
Director of the VA Pacific Islands Health Care System (VAPIHCS), and
Dr. Adam Darkins, Chief Consultant, Care Coordination, Office of
Patient Care Services, Veterans Health Administration.
First, Mr. Chairman, I would like to thank you for your leadership
and advocacy on behalf of our Nation's Veterans. During your tenure as
Ranking Member and Chairman of this Committee, you have consistently
demonstrated your commitment to Veterans by introducing legislation
designed to meet the needs of Veterans. As I will highlight later, your
vision and support have led to an unprecedented level of health care
services for Veterans, construction of state-of-the-art facilities here
in Honolulu, and remarkable improvements in access to health care
services for Veterans residing on the Hawaiian neighbor islands,
American Samoa and Guam. In addition, I appreciate your interest in and
support of the Department of Veterans Affairs (VA).
Today, I will briefly review the VA Sierra Pacific Network that
includes Hawaii and the Pacific islands region; provide an overview of
the VA Pacific Islands Health Care System (VAPIHCS); provide national
and local information regarding telehealth programs; discuss the VA
clinic in Maui; and highlight issues of particular interest to Veterans
residing in Maui County, including capacity at the VA clinic in Maui
and VA services on the nearby islands of Molokai and Lanai.
va sierra pacific network (visn 21)
The VA Sierra Pacific Network (Veterans Integrated Service Network
[VISN] 21) is one of 21 integrated health care networks in the Veterans
Health Administration (VHA). The VA Sierra Pacific Network provides
services to Veterans residing in Hawaii and the Pacific region
(including the Philippines, Guam, American Samoa and Commonwealth of
the Northern Marianas Islands), northern Nevada, and central/northern
California. There were an estimated 1.1 million Veterans living within
the boundaries of the VA Sierra Pacific Network in Fiscal Year (FY)
2009.
The VA Sierra Pacific Network includes six major health care
systems based in Honolulu, HI; Palo Alto, CA; San Francisco, CA;
Sacramento, CA; Fresno, CA; and Reno, NV, as well as an Independent
Outpatient Clinic in Manila, PI. In FY 2009 the Network provided
services to over 250,000 unique Veterans out of 350,000 enrolled
Veterans. There were about 2.7 million clinic visits and 28,079
inpatient discharges. The cumulative full-time employment equivalents
(FTEE) level was 9,740, and the operating budget was about $2.2
billion.
The VA Sierra Pacific Network is committed to ensuring the care
Veterans receive is of the highest quality. All six health care systems
within the Network have major academic affiliations. The Network hosts
a significant number of Centers of Excellence in VHA and supports a
large and broad research portfolio. It also has expansive and
collaborative relationships with the Department of Defense (DOD). The
VA Sierra Pacific Network has not only exceeded patient satisfaction
goals (inpatient and outpatient), but its employee satisfaction scores
are among the top five Networks for overall job satisfaction in VHA. As
reflected in the most recent employee satisfaction survey, the Network
had the highest scores in VHA in several categories including
leadership, supervisory support, customer service, conflict resolution,
praise, and rewards.
Given the large and diverse geographic nature (i.e. rural or
frontier lands and remote islands) of VISN 21, access to care is a
priority. In FY 2010, the Network will activate nine new sites of care
including the Pacific (Hawaii and the Northern Mariana Islands),
California, and Nevada. Finally, VISN 21 is proud to operate one of
four Polytrauma Rehabilitation Centers in VHA dedicated to addressing
the clinical needs of the most severely injured Veterans.
va pacific islands health care system (vapihcs)
As noted above, VAPIHCS is one of six major health care systems in
VISN 21. Dr. James Hastings is the director and a practicing
cardiologist at VAPIHCS. VAPIHCS is unique in several important
aspects: its vast catchment area covers 2.6 million square-miles
(including Hawaii, Guam, American Samoa and Commonwealth of the
Northern Marianas); its remote island locations create access
challenges; and it enjoys the cultural richness of the Pacific Islands
with an ethnically diverse patient and staff population. In FY 2009
there were an estimated 118,000 Veterans living in Hawaii, and at least
10,000 additional Veterans located beyond Hawaii in the VAPIHCS
catchment area.
VAPIHCS currently provides care in ten locations, with two more
soon to be added. Our current facilities include an Ambulatory Care
Center (ACC) and a Community Living Center (CLC) on the campus of the
Tripler Army Medical Center (TAMC) in Honolulu; community-based
outpatient clinics (CBOCs) in Lihue (Kauai), Kahului (Maui), Kailua-
Kona (Hawaii), Hilo (Hawaii), Hagatna (Guam) and Pago Pago (American
Samoa); and outreach clinics in Molokai and Lanai. Two new facilities
planned include a new CBOC to serve Leeward Oahu Veterans (approved in
FY 2008 with an expected opening in late FY 2010) and a new rural
outreach clinic in Saipan set to open this winter. A mental health
provider (psychologist) has begun seeing patients part-time in Saipan
but the clinic has not yet been activated. The inpatient Post Traumatic
Stress Disorder (PTSD) residential rehabilitation unit is in its
interim location on the campus of TAMC, pending construction and
activation of a new VA-funded facility ($9.56 million), also at TAMC,
during FY 2011.
VAPIHCS is also constructing a new replacement CBOC in Guam that
will offer expanded capacity. It will be located along the perimeter of
the Guam Naval Hospital, and we expect it to open in May 2010. VHA
operates a total of six Vet Centers in Honolulu, Lihue, Wailuku,
Kailua-Kona, Hilo and Guam. These facilities provide counseling,
psychosocial support, and outreach. A Vet Center staff member was also
added in American Samoa during FY 2008.
In FY 2009 VAPIHCS provided services to more than 24,000 Veterans,
an increase of five percent from FY 2007. Of these Veterans, 19,000
reside in Hawaii. VAPIHCS provided 175,000 outpatient visits during FY
2009. The cumulative VAPIHCS FTEE in FY 2009 was 619 employees, with an
operating budget increase from $139.1 million in FY 2008 to $155.1
million in FY 2009, an increase of 12 percent.
VAPIHCS provides or contracts for a comprehensive array of health
care services. VAPIHCS directly provides primary care, including
preventive services and health screenings, and mental health services
at all locations. VAPIHCS does not operate its own acute medical-
surgical hospital and as a result faces some challenges in providing
specialty services. VAPIHCS has hired specialists in orthopedics,
cardiology, endocrinology, ophthalmology, nephrology, infectious
disease and inpatient medicine (``hospitalist''), and makes use of
University of Hawaii faculty to provide specialty care services in
pulmonary disease, rheumatology, allergy, and hematology in Honolulu
and to a lesser extent at CBOCs. Veterans with spinal cord injuries
receive care from VAPIHCS dedicated staff, which provides a
multidisciplinary approach to care. The team, located on Oahu, is
planning to travel and care for patients on the neighbor islands during
FY 2010. Veterans requiring other specialty care continue to be
referred to DOD and community facilities.
Inpatient long-term and acute rehabilitation care is available at
the Community Living Center (CLC). Inpatient mental health services are
provided by VA staff on a 20 bed ward within TAMC and at the 16 bed
Post Traumatic Stress Disorder (PTSD) Residential Rehabilitation
Program (PRRP). VAPIHCS contracts for care with DOD (at TAMC and Guam
Naval Hospital) and community facilities for inpatient medical-surgical
care.
national and local telehealth programs
National Telehealth Programs
Telehealth involves the use of information and telecommunication
technologies as a tool in providing health care services when the
patient and practitioner are separated by geographical distance. The
benefits of telehealth to health care systems include: improving access
to care, making specialist services available in rural and remote
locations, and supporting patients to live independently in their own
homes and local communities. Because of the support of telehealth by VA
and Congressional leadership, more Veterans are able to realize these
benefits.
Over the past six years telehealth in VA has transitioned from use
in a range of discrete local projects and programs toward a unified,
enterprise level approach that provides routine telehealth services
that are mission critical to the delivery of care to Veterans. In 2009
over 260,000 Veteran patients received care via VA's telehealth
programs. Telehealth takes many forms. VA's enterprise telehealth
programs deliver care to Veteran patients in their homes via home
telehealth; telehealth care is also provided in VA medical centers
(VAMCs), CBOCs and Vet Centers via clinical videoconferencing. In
addition, VA routinely exchanges clinical images via ``store and
forward'' telehealth.
I would like to briefly highlight some of the direct benefits these
services are providing to Veterans. More than 40,000 Veterans are
receiving home-telehealth-based care that supports care delivery to
them in their own homes. These care coordination/home telehealth (CCHT)
services have reduced hospital admissions by 25 percent, hospital stays
by 25 percent, and have high levels of patient satisfaction (86 percent
mean score). In 2009 more than 58,000 Veterans received care via
clinical videoconferencing, the majority receiving mental health care
services that reduced hospital admissions by 24 percent. In 2009 almost
150,000 Veterans were screened to prevent avoidable blindness by VA's
teleretinal imaging programs (CCSF).
The successful implementation of robust and sustainable telehealth
services that VA entrusts to provide care to Veteran patients must
satisfy stringent clinical, technological and business requirements
that ensure they are appropriate, effective and cost-effective. These
requirements include acceptance by patients and practitioners as well
as staff training and quality management systems. Mr. Chairman, you and
the Committee understand how the geography of Hawaii and the Pacific
region poses particular challenges in implementing telehealth that are
not encountered on the U.S. mainland. Services to Guam and American
Samoa not only need to bridge a physical distance of 3,820 and 2,300
miles respectively, they also need to bridge between patients and
clinical communities that are distant and distinct from one another.
Bridging these distances and linking these communities to enable them
to integrate requires telecommunications bandwidth. VA is currently
seeking to embrace Hawaii and the Pacific region within its clinical
enterprise video conferencing network (CEVN) and in doing simplify the
linkage to specialist services from medical center assets on the U.S.
mainland.
VA recognizes the pioneering role that Hawaii and the Pacific
region have played in the development of telehealth solutions that
range from teleretinal imaging to home telehealth. These innovations
have included partnerships with DOD and the University of Hawaii within
the collaborative framework of the Pacific Telehealth and Technology
Hui. VA appreciates the support of Congress in supporting rural health
initiatives that enable us to focus on extending current enterprise
telehealth solutions as well as developing new telehealth solutions to
serve Veterans, not only those in Hawaii and the Pacific region
Islands, but also Veterans elsewhere in the Nation for whom
geographical distance from VA's physical health care assets presents a
challenge to receiving care. In considering future innovation for local
and enterprise portfolios of telehealth services, VA is looking toward
new iterations of a familiar technology--the telephone. Currently the
telephone has meant that eight patients a month from Hawaii and the
Pacific region have been able to access VA's suicide hotline and
receive support from Canandaigua, New York. The transition of health
applications onto mobile technologies such as cell phones promises to
further revolutionize how telehealth can serve Veterans in areas such
as Hawaii and the Pacific region.
Mr. Chairman, I used the word Hui earlier. As you know, Hui
describes a partnership, a union or a gathering. All health care is
ultimately local, and my discussion so far has focused on the clinical,
technological and business issues of implementing telehealth across the
VA health care system. My attention will now turn to local telehealth
initiatives that support Hawaiian Veterans and those living on other
Pacific Islands.
Local Telehealth Programs
In partnership with DOD, specifically TAMC, VAPIHCS began to
develop this capability in 2001 with the support of Senator Daniel K.
Inouye. The Hui allows joint development of telemedicine technologies
for both organizations in the Pacific. This partnership has fielded
many demonstration projects that have enabled both Departments to
develop ongoing telehealth activity for our beneficiaries.
For VAPIHCS, this partnership allowed us to begin developing
telemedicine capabilities in collaboration with the local information
technology (IT) department that developed the telecommunications
network infrastructure and supported the deployment of video
teleconferencing to VA CBOCs on the islands of Hawaii, Maui, Kauai,
Guam, and American Samoa. Connectivity to Molokai and Lanai is also
available, and we are presently studying connectivity for our newly
approved Outreach Clinic in Saipan. Additionally, this initial
investment allowed the development of procedures, practices, and
protocols to support video teleconference clinical visits for primary
care, mental health, and subspecialty care. Funds were provided for
purchasing telemedicine ``carts'' that allow the use of peripheral
medical equipment (stethoscopes, otoscopes, cameras and other
attachments), as well as teleretinal imaging equipment to permit
screening for diabetic eye disease. Automated Drug Dispensing System
(ADDS) machines were installed in CBOCs in 2003 allowing pharmacists in
Honolulu to dispense medications and, through the use of video
conferencing, to provide medication counseling to Veterans at the time
of their clinic visits. The VAPIHCS also began tele-home care projects
in 2003 by deploying home telemedicine units. This partnership and
initial funding has helped us establish a foundation of experience upon
which we continue to build to enhance the medical care provided in our
facilities throughout the Pacific Region. Additionally, this early
experience has allowed our facilities to compete for research dollars
to further develop telemedicine and tele-mental health activities.
The Hui also provided support for TAMC projects, including support
for ``store and forward'' telemedicine for adult and pediatric care to
the Western Pacific, cardiac sonography from TAMC to Guam and Japan,
intensive care unit telemetry and consultation from TAMC to Guam Naval
Hospital and Korea, speech therapy and other projects.
Beyond the Hui, VAPIHCS and TAMC are working together to develop
joint telemedicine capabilities in American Samoa to support co-
location of TAMC personnel at a VA CBOC. This arrangement would extend
clinical expertise from TAMC to American Samoa to serve Veterans and
active duty servicemembers, as well as members of the National Guard
and Reserve who have experienced a Traumatic Brain Injury (TBI).
Recently, VA expanded mental health programs, including significant
growth in tele-mental health activities. VA recruited a clinical
psychologist to fill a new position for a dedicated tele-mental health
coordinator based in Maui. This new position expanded tele-psychology
services equitably throughout the CBOC. Additionally, VA has begun
conducting tele-mental health Compensation and Pension (C&P)
examinations to expedite the assessment of Veterans for appropriate
benefits.
During fiscal year (FY) 2009, telehealth has been extremely helpful
in delivering mental health services and dispensing medications to
Veterans. A snapshot of relevant data, current through September 2009,
includes:
Over 2,500 telehealth patient encounters in VAPIHCS, 1,500
of which were for mental health and 52 of which were for mental health
C&P evaluations for patients in Guam or the Commonwealth of the
Northern Mariana Islands; and
Over 12,500 prescriptions filled at CBOCs on Kauai, Maui,
Hilo, Kona, American Samoa and Guam using Automatic Drug Dispensing
System (ADDS) machines.
VAPIHCS has other Telehealth services that are available to
Veterans, including:
Clinical Video Telehealth clinics (CVT), which offer
o Individual and group psychology and psychiatry support;
o PTSD group research clinic;
o Individual and family nutrition information;
o Mental health C&P examinations;
o Geriatric psychiatry;
o General surgery and neurosurgery through the San Francisco
VAMC;
o Treatment for spinal cord injury through the Palo Alto
VAMC;
o Wound care;
o Nephrology care; and
o Participation in VA's `MOVE!' (weight loss) program;
Care Coordinated Store Forward clinics (CCSF):
o Teledermatology through the San Francisco VAMC;
o Teleretinal Imaging; and
o Care Coordination Home Telehealth, utilizing home
telehealth devices to support the care of Veteran patients in
their own homes on Oahu, Maui and Hilo.
Our expanding and diverse experience with telehealth has provided
many ``lessons learned'' to further shape the development of our
VAPIHCS Telehealth Program. For example, numbers (i.e. encounters)
alone do not tell the complete story of how technologies may be used to
improve the health care of Veterans. In addition to increasing access
to specialty services for Veterans, VAPIHCS has found telehealth
technologies also allow CBOC providers to learn from telemedicine
experiences (with distant providers), which can improve the skills of
local physicians. VAPIHCS continually evaluates the use of telehealth
services that are provided to Veterans within our service area and
changes the program as necessary to meet the needs of the Veterans we
serve. There is a new opportunity to expand the use of telehealth as we
develop new outreach clinics to meet the needs of Veterans in highly
rural areas.
This increased ``hands-on'' care allows us to pursue new telehealth
opportunities in even more remote locations to benefit Veterans. We are
providing more care in the home, using VA's Care Coordination Home
Telehealth (CCHT) protocols. This will provide us with patient data and
information from the home that can be used to maximize our ability to
manage medically complex patients in conjunction with our chronic
disease team to improve the quality of life for Veterans.
There are some local challenges with telehealth. We are adding
additional staff, including telehealth nurses, to our sites so our
clinics can both provide direct patient care and staff telehealth
clinics as well. We anticipate that by this fall, we will have
sufficient support for telehealth activities at each CBOC in the area.
This table provides data about telehealth usage in the following
facilities:
Number of Unique Patients by Site (VA Pacific Islands Health Care
System)
------------------------------------------------------------------------
Facility FY 2008 FY 2009
------------------------------------------------------------------------
Honolulu............................................ 74 159
Maui................................................ 153 287
Molokai............................................. 6 17
Kauai............................................... 96 124
Hilo................................................ 66 62
Guam................................................ 58 143
Kona................................................ 17 43
American Samoa...................................... 14 8
-------------------
TOTAL........................................... 425 669
------------------------------------------------------------------------
The total numbers of VA's patients using telehealth increased in FY
2009 over FY 2008. Some of this change is attributed to additional
telehealth nurse positions added in FY 2009, and a telehealth
Psychologist who serves veterans throughout the VA Pacific Islands
locations. We anticipate further growth in telehealth in FY 2010 as
additional VA specialty care visits, such as Nephrology, make greater
use of the capability.
maui cboc
VA operates a CBOC located in Kahului (203 Ho'ohana, Suite 303,
Kahului, HI, 96732) and expanded the clinic's space by an additional
4,400 square feet during FY 2008 to a total of 9,700 square feet. The
building that currently houses the Clinic cannot be certified as having
met Federal seismic structural requirements. If the current building
cannot be modified to meet these requirements, as required by the
renewal lease process, we will need to identify a new location. VISN 21
and VAPIHCS have requested VA Central Office approval to seek an
alternate location as a contingency should the modifications not be
feasible.
In addition to the CBOC, VA operates on Maui a Vet Center, which is
located in nearby Wailuku.
In FY 2009, the Maui CBOC served an estimated island Veteran
population of 9,900 Veterans. Approximately 2,400 Veterans residing on
Maui were enrolled for care, and 1,749 Veterans received VA care. This
is a 21 percent increase over FY 2007. The market penetration rates for
enrollees and users within the Veteran population are 24 percent and 17
percent, respectively. These rates are lower than rates elsewhere in
Hawaii. In FY 2009 the Maui CBOC recorded 9,976 clinic visits, which
represent an increasing trend largely attributed to increased capacity
and enhanced services.
At the time of the hearing here in August 2007, the Maui CBOC was
authorized to have 15 FTEE; the Maui CBOC has recently increased its
staffing and currently is authorized to have 25 staff at the clinic.
This includes two full time primary care physicians, a physician
assistant and a social worker to support primary care services, two
psychiatrists, two psychologists (one of whom provides tele-mental
health services to other CBOCs), one social worker, one clinical nurse
specialist, one substance abuse counselor, and one telehealth
technician and one administrative officer are also available to address
Veterans' mental health needs. This staff provides a broad range of
primary care and mental health services. In FY 2008 the clinic also
implemented a Home-Based Primary Care (HBPC) program supported by a
nurse practitioner. During FY 2010, HBPC will be initiated this month
on Molokai, and we expect to activate Lanai's HBPC program later this
year.
The size of the Veteran population and the number of VA patients in
Maui limit the feasibility of having a large number of medical and
surgical specialists based in the Maui CBOC. Nonetheless, VA recognizes
that some Veterans in Maui County have needs beyond primary care and
mental health. VAPIHCS provides specialty care services at the clinic
by sending VA staff from Honolulu and other VA facilities in California
to the CBOC. Services provided by clinicians traveling to Maui include
cardiology, gastroenterology, geriatrics, nephrology, neurology,
orthopedics and rheumatology. If Veterans require services not
available at the Ambulatory Care Center (ACC) or CLC, VAPIHCS arranges
and pays for care at TAMC, local community providers, or VA facilities
in California; for those referred to a facility in California, VA can
cover the costs of transportation if the veteran is eligible for
beneficiary travel. In FY 2009, VA spent over $4 million for non-VA
care in the private sector (i.e. not including costs at other VA or DOD
facilities) for residents of Maui. Treatment of many non service-
connected Veterans requiring off island referrals continues to be a
challenge, because VA Beneficiary Travel support is unavailable for
these patients. The Maui CBOC also utilizes telehealth technologies to
provide specialty services, as described above.
special issues
Capacity at Maui CBOC. As noted earlier, in FY 2009 VA provided
health care services to 1,749 Veterans who reside in Maui. However,
market penetration rates for enrollees and users suggest there is
additional demand for VA health care. VAPIHCS has significantly
increased the authorized staffing at the Maui CBOC to keep pace with
the growth in numbers of Veterans seeking care, in particular Operation
Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. This
population increased from 56 in FY 07 to a cumulative total of 270
unique Veterans at the close of FY 09. The Clinic's two full time VA
primary care physicians and one full time physician assistant, based
upon VA primary care panel size criteria, gives the clinic a potential
capacity for over 3,000 primary care patients (i.e. 1,200 patients for
each full-time physician and 800 for each physician assistant). Even
considering the special circumstances at the Maui CBOC (e.g., lack of
VA inpatient facility and limited community health care resources on
the island), the VA clinic will be able to provide high quality and
accessible primary care to more than 2,000 patients.
In addition, during FY 2008, the Maui CBOC began delivering HBPC
services for Veterans residing in Maui. HBPC is also delivered by VA in
Oahu, Kauai and the Big Island. HBPC is an important component of VA's
non-institutional long-term care program designed to provide care in
the least restrictive setting for Veterans. Earlier this year, VAPIHCS
was approved for $256,000 in rural health funding to expand the Maui
HBPC program and to begin providing home care services on the islands
of Lanai and Molokai. VA will add staff to serve these islands, with
service delivery anticipated this month on Molokai and later this year
in Lanai.
There is also a significant demand for mental health services at
the Maui CBOC. About 32 percent of all patients currently seen at the
clinic have a documented mental health illness (compared to 19 percent
for VHA). This includes a high prevalence of PTSD. In response to this
need, VA has substantially increased its authorized mental health
capacity at the Maui CBOC. As you know, Mr. Chairman, Congress has
provided several hundred million dollars to VA to specifically enhance
mental health services. Since FY 2006, and each subsequent year
thereafter, VAPIHCS has received nearly $3 million of these funds.
These funds have been used to hire about 35 new mental health staff in
VA facilities across Hawaii and the Pacific region, including seven
staff here at the Maui CBOC. In addition, the Maui Vet Center also
successfully recruited another psychologist.
Molokai and Lanai. The islands of Molokai and Lanai are part of
Maui County. VA provides limited services (i.e. part-time outreach
clinics) on these islands with permanent staff (on Molokai) and
visiting VA staff (to both islands). VAPIHCS is assessing options to
enhance services in both locations.
Molokai. VA estimates the Veteran population on Molokai to be 649,
with 203 Veterans from Molokai enrolled for VA care and 150 Veterans
receiving VA services. VA formally established an outreach clinic on
Molokai in FY 2005 with the assistance of you and your staff, Mr.
Chairman. The VA clinic on Molokai is located in shared space near
Molokai General Hospital and operates two half-day primary care clinics
per week. The clinic is staffed with a part-time VA physician and
contract support staff. VA has access to videoconferencing equipment at
this facility. VA also sends mental health staff from the Maui CBOC to
Molokai to provide care. The Clinic's psychologist travels twice a
month and the psychiatrist once a month. In addition, VA purchases non-
VA care in the community (e.g., Molokai General Hospital) for eligible
Veterans residing in Molokai. Veterans residing in Molokai also are
seen at DOD and VA facilities in other locations. VA pays for travel
expenses for those Veterans eligible for beneficiary travel.
Lanai. VA estimates the Veteran population on Lanai to be 229, with
57 Veterans enrolled for VA care, and 30 Veterans receiving VA
services. Since June 2007, a VA primary care provider from Maui travels
to Lanai once a month to provide needed primary care services.
Additionally, in FY 2009 a Mental Health Clinical Nurse Specialist
began accompanying the primary care provider. VA has used space
adjacent to the Lanai Community Hospital, and most recently finalized
an agreement with Straub Outpatient Clinic for visiting VA providers to
use space and support the Clinic. In addition, VA purchases non-VA care
in the community and pays beneficiary travel for eligible Veterans. VA
is continually exploring other options to improve access.
conclusion
In summary, with your support, Mr. Chairman, and with the support
of other Members of Congress, VA is providing an unprecedented level of
health care services to Veterans residing in Hawaii and here in Maui.
We look forward to a growth of new patients at the Maui CBOC and will
meet the expectations of Veterans for quality and timeliness.
VAPIHCS still faces several challenges, in part due to the
topography of its catchment area, the lack of an acute medical-surgical
hospital, limited community resources in rural areas, and difficulties
recruiting staff. VAPIHCS will meet these challenges by utilizing
telehealth technologies, hiring specialists, working with community
partners and developing new delivery models. I am proud of the
improvements in VA services in Hawaii, but recognize that our job is
not done.
Again, Mr. Chairman, mahalo for the opportunity to testify at this
hearing. My colleagues and I would be delighted to address any
questions you may have for us.
Chairman Akaka. Thank you very much, Ms. Cullen.
And now we will hear from Linda Halliday. Please proceed
with your testimony.
STATEMENT OF LINDA HALLIDAY, DEPUTY ASSISTANT INSPECTOR GENERAL
FOR AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S.
DEPARTMENT OF VETERANS AFFAIRS
Ms. Halliday. Mr. Chairman, thank you for the opportunity
to testify on the results of our report, ``Review of
Availability of Mental Health and Orthopedic Services at the VA
Pacific Islands Health Care System.'' Accompanying me today is
Mr. Walter Stucky, Audit Manager in our Seattle Audit and
Evaluations Office in the OIG.
Veterans living on Maui and the other islands face similar
issues as veterans living in rural communities in obtaining
timely access to health care services, especially mental health
services and specialty care such as orthopedics. Not only has
the health care system faced difficulties in providing these
services, they have also been limited by the short supply of
community health providers.
In early June 2009, we conducted on-site work at the health
care system's main ambulatory care center in Honolulu and the
Maui CBOC. We found that since fiscal year 2006 the health care
system has made significant strides in reducing wait times for
elective orthopedic surgery procedures. Furthermore, although
the health care system has experienced challenges in providing
mental health services to veterans on Maui and other islands,
it is effectively using VA's Mental Health Enhancement
Initiative funding to recruit additional staff and expand
telehealth services.
In 2006, the OIG assessed the timeliness of orthopedic
surgeries at the health care system. We found that the average
wait time for elective orthopedic procedures was 182 days with
wait times for individual cases ranging between 14 to 379 days.
I am happy to say our more recent work found significant
improvement in elective surgery wait times. Both VA and Tripler
orthopedic surgeons treat health care system patients who
require orthopedic care, and the surgical procedures are
performed at Tripler TAMC by VA and Tripler orthopedic surgeons
under an interagency sharing agreement.
We reviewed 15 elective orthopedic surgeries performed at
Tripler in April and May 2009 and found that the time between
the decision to operate and the surgery date ranged from 11 to
210 days and averaged 82 days. We attribute the improvements in
timeliness since 2006 to three factors:
Since February 2007, the health care system has hired two
orthopedic surgeons. Prior to this, it relied on surgeons from
Tripler and other VA facilities in the continental United
States.
Tripler dedicated one operating room day each week to VA
orthopedic patients, in addition to its normal integrated
scheduling of VA and Tripler patients for surgery.
And, third, the health care system and Tripler have
improved their coordination of orthopedic surgery care.
In 2007, the State of Hawaii task force reported community
health resources in Maui were stretched to meet mental health
needs resulting from veterans returning from Iraq and
Afghanistan, an aging population, and prevalent drug use. The
health care system has also been stretched by the scarcity of
mental health resources on Maui. Mental health staff at the
Maui CBOC told us that they have been meeting emergency needs
of patients, but they are challenged in ensuring the timely
follow-up care due to staff shortages. For example, in May
2009, the psychiatrist reported that his earliest available
follow-up appointment was 7 weeks away.
Despite these challenges, we found that the health care
system leadership has been proactive in securing funding
through VA's Mental Health Enhancement Initiative to hire
additional staff at the Maui CBOC and to expand telehealth
capabilities to assist other CBOCs. In the past year, the
health care system has received approximately $4.7 million in
Mental Health Enhancement Initiative funding and used a portion
to hire additional staff. They expect to meet both the urgent
and the follow-up mental health care needs of veterans served
by the Maui Clinic.
In summary, Mr. Chairman, our review found that the health
care leadership continues to identify gaps and improve
availability of orthopedic and mental health services to
veterans on Maui and other islands. However, as with any rural
health care system, VA Pacific Islands Health Care System
leadership must make difficult choices as to how to best use
the resources to most effectively meet the needs of veterans in
a large, geographically diverse area, while also addressing
difficulties in recruiting qualified health care professionals.
Mr. Chairman, I thank you for the opportunity today. We
would be pleased to answer any questions you have.
[The prepared statement of Ms. Halliday follows:]
Prepared Statement of Linda Halliday, Deputy Assistant Inspector
General, Audits and Evaluations, Office of Inspector General, U.S.
Department of Veterans Affairs
introduction
Mr. Chairman and Members of the Committee, Thank you for the
opportunity to testify today on the availability of mental health and
orthopedic services for veterans served by the VA Pacific Islands
Health Care System (VAPIHCS), with special emphasis on the Island of
Maui. I will focus on the results of our recently issued report, Review
of Availability of Mental Health and Orthopedic Services at the VA
Pacific Islands Health Care System (attached). Accompanying me today is
Mr. Walter Stucky, Audit Manager, Seattle Audit Operations Division,
Office of Inspector General (OIG), Department of Veterans Affairs.
background
Veterans living on Maui and the other Hawaiian islands face similar
issues as veterans living in rural communities throughout the country
obtaining timely access to all services, especially mental health
services and specialty care services such as orthopedics. Not only has
VAPIHCS faced difficulties providing the services, they have also been
limited by the short supply of community health providers.
In May 2006, the OIG issued a report titled, Review of Access to
Care in the Veterans Health Administration, which included an
assessment of the timeliness of orthopedic surgeries at the VAPIHCS.
Because no related Veterans Health Administration or other American
medical timeliness standards were available at the time, the review
used a foreign orthopedic surgery timeliness goal of 6 months. This
standard was based on evidence that suggested that deterioration of
patients' health occurs when they wait more than 6 months for joint
replacement surgeries. The OIG's review found that the average wait for
elective orthopedic procedures at the VAPIHCS was 182 days, with wait
times for individual cases ranging from 14 to 379 days.
In November 2007, a task force commissioned by the State of Hawaii
found that community mental health resources on Maui were stretched to
meet increasing mental health needs resulting from veterans returning
from Iraq and Afghanistan, an aging population, and prevalent drug use.
VAPIHCS is also challenged in recruiting staff especially on the outer
islands due to the high cost of living, both for housing and
commodities; high relocation costs; and a cost of living adjustment
that is not comparable to locality pay rates used in the continental
United States and is not used in calculating Federal retirement
benefits.
results
In late May/early June 2009, we conducted onsite work in Honolulu
and Maui at VAPIHCS, Veterans Integrated Service Network 21, Tripler
Army Medical Center (TAMC), and the Maui Community Based Outpatient
Clinic (CBOC). We interviewed managers and administrative and clinical
staff and reviewed scheduling and workload data, recruitment
information, and other pertinent documents related to patient
complaints and wait times. We found that:
Since fiscal year (FY) 2006, VAPIHCS has made significant
strides in reducing wait times for elective orthopedic surgery
procedures, most notably by hiring two orthopedic surgeons.
Although VAPIHCS has experienced challenges in providing
mental health services to veterans on Maui and the other outlying
islands, it is effectively using VA's Mental Health Initiative funding
to recruit additional staff and expand telehealth services.
Orthopedic Care
Our recent work noted significant improvement in elective surgery
wait times since FY 2006. Both VA and TAMC orthopedic surgeons evaluate
and treat VAPIHCS patients requiring orthopedic care. Because VAPIHCS
is not fully staffed or equipped to perform orthopedic surgeries,
surgical procedures are performed at TAMC by VA and TAMC orthopedic
surgeons under an interagency sharing agreement. If TAMC cannot
accommodate a VA patient, VAPIHCS Utilization Management staff refers
the patient to a community provider on a fee-for-service basis.
Our discussions with VAPIHCS clinicians and TAMC managers indicated
that TAMC has sufficient staff and resources to consistently
accommodate VA patients without significant delays, but that some
patients prefer later surgery dates or they are not medically ready to
undergo surgery on the scheduled dates. Our review of 15 elective
orthopedic surgeries performed at TAMC in April and May 2009 found
significant improvement in average wait times. The time between the
decision to operate and date of surgery ranged from 11 to 210 days and
averaged 82 days. We attribute the improvement in timeliness to three
factors:
VAPIHCS officials hired two orthopedic surgeons--one in
February 2007 and the other in October 2008. Prior to hiring these
surgeons, VAPIHCS relied on orthopedic surgeons from TAMC and other VA
facilities in the continental United States to provide services. With
these recruitments, VAPIHCS has established its own orthopedic clinics
at both the Ambulatory Care Center and CBOCs. Furthermore, one of the
orthopedic surgeons also performs surgery at TAMC.
TAMC dedicated one operating room day each week to VA
orthopedic patients, in addition to its normal integrated scheduling of
VA and TAMC patients for surgery.
VAPIHCS and TAMC have improved their coordination of
orthopedic surgery care. For example, TAMC provides VAPIHCS monthly
reports on availability of services and holds monthly coordination
meetings with VAPIHCS Utilization Management officials to resolve
problems and improve services. In addition, a VAPIHCS orthopedic
surgery nurse tracks the status of VA patients scheduled for surgery at
TAMC to ensure patients meet all pre-operative requirements.
Mental Health
Mental health staff at the Maui CBOC told us that they have been
meeting the emergency needs of patients; yet, they continue to
acknowledge challenges ensuring timely follow-up care due to staff
shortages. For example, in May 2009, the psychiatrist reported that his
earliest available follow-up appointment was 7 weeks away and that he
often worked additional hours to see patients.
Despite these challenges, we found that VAPIHCS leadership has been
proactive about securing funding through VA's Mental Health Enhancement
Initiative to hire additional staff at the Maui CBOC and expand
telehealth capabilities to assist other CBOCs. In the past year,
VAPIHCS has received approximately $4.7 million in Mental Health
Enhancement Initiative funding and has used a portion of this amount to
improve the availability of services at the Maui CBOC by hiring
additional staff. In February 2009, VAPIHCS officials hired a mental
health social worker. In addition, a clinical nurse specialist and a
second staff psychiatrist joined the CBOC in late July/early August of
this year. VAPIHCS leadership and clinicians told us that, with this
additional staff, they expect to meet both the urgent and follow-up
mental health care needs of veterans served by the Maui CBOC.
summary
Our review found that VAPIHCS leadership continues to identify gaps
and improve availability of orthopedic and mental health services to
veterans on Maui and the other islands. However, as with any rural
health care system, VAPIHCS leadership must make difficult choices as
to how best to use its resources to most effectively meet the needs of
veterans in a large, geographically diverse area, while also addressing
difficulties in recruiting qualified health care professionals.
Mr. Chairman, thank you again for this opportunity. We would be
pleased to answer any questions that you or other Members of the
Committee may have.
Attachment
Chairman Akaka. Thank you. Thank you all very much for your
testimony. Again, I want to thank this panel for bringing us up
to date and especially what we are anticipating will happen,
providing the supports come through.
Dr. Hastings, I want to pose the first question to you.
What is the status of the proposal to build a new veterans
multi-use building on the campus of the Maui High School? And
what is VA's role in this partnership? And have you heard from
the State regarding this proposal?
Dr. Hastings. Well, Mr. Chairman, first I want to thank you
very much for coming out and having this hearing and providing
all of us with an opportunity to review how we provide services
to our veterans. This proposal that we heard so much about
today we have heard of, and we have talked to several of the
people that have worked on this proposal. The fundamental
problem that we have is the issue of the Federal Government not
being able to build on land that it does not own, and it seems
that is the core issue that we are faced with. And we certainly
have talked to the capital assets managers of the VA about this
proposal. We have looked at it, and we have worked with the Vet
Center that proposed this. But as we understand it right now,
the issue is that the VA does not have the authority to build
on land that it does not own. I think that is the fundamental
problem.
Chairman Akaka. Well, thank you for that technicality. We,
of course, need to look into that and see what we can do next
on this. I thank you very much for what you have been trying to
do and get done, and even to the point of maybe making other
suggestions. Thank you for your response.
Ms. Betts, how often does the traveling veterans service
representative from Honolulu provide services to veterans
living on Maui? How often does that happen? How would you
characterize that representative's schedule while on Maui? Do
veterans seeking services from that representative receive them
in a timely manner?
Ms. Betts. With regards to the traveling schedule of the
counselor, currently we have a counselor who travels to every
island once a month, and they do come on. It is a set schedule,
the same day of the week every month. The Vet Center hosts the
counselor, and they take--they actually take appointments, so
they know who they are coming to see. And they usually come in
the morning and then leave on the last flight out. And they see
all of the people who are scheduled for appointments plus walk-
ins.
We also have a program in which the counselor--and it is
not always the same one, but a benefit counselor also goes to
Molokai every other month, and they go to Maui--I mean, to
Lanai apparently once a quarter. The counselor is able to
assist and provide as much information as they can while they
are here, and they take the information back to Oahu.
We are currently working on outreach to all of the islands
in collaboration with Dr. Hastings and myself. We are working
on an outreach program to visit each of the islands with an
outreach team because one of the issues we have, and that is,
what is the need and what is the veteran population in the
areas. What we are trying to do in this program--we started
this month, in January--is to start to get the veterans who are
residing in all of these rural remote areas to register. We
need them to register with the health care system so that we
can document how many veterans are there, and, therefore, we
can provide the services for the veteran population. Currently,
the populations who are registered are a lot less than the
numbers that people keep putting out to us. Although the State
has a number of veterans on this island, the number that are
registered in the VA system are a lot less than what they are
saying is actually residing.
So what we are doing is, as far as access to a benefit
counselor, I work collaboratively also with the State Office of
Veterans Services, Mr. Moses, and we are looking at what is
needed, and we are looking at the possibility of having a full-
time counselor here on Maui, and that, again, is a
collaborative effort with Dr. Hastings because he had worked on
a program where he would provide the actual space, which would
be in the CBOC. We are working toward, as we say, the one-stop
shop where all of the VA services are provided in one area. So,
right now we are working with the clinic to see when they come
up with the space for us, then we will put a full-time
counselor there.
Currently, the Vet Center is hosting us. Again, it is an
issue of space to put a permanent full-time person in.
Chairman Akaka. Ms. Betts, as you heard from the first
panel, some veterans believe that Vet Centers should be staffed
with a veterans service representative full-time. What is your
opinion on this matter?
Ms. Betts. Currently, where the veteran counselor sits, I
do not have an opinion on that at this time. My issue is that
we get a veteran counselor, and they need to be full-time out
here on Maui. At this time, just from my exposure to
everything, I would say it appears that it would be more
beneficial to put a counselor into a CBOC. But whether it goes
into a Vet Center or a CBOC, I don't have an opinion there. It
is just getting the counselor out to----
Chairman Akaka. Thank you very much.
Ms. Cullen, I understand that some veterans are able to
receive specialty care through a telehealth link with Palo Alto
in California. Are you providing incentives to providers in
Palo Alto to provide those services to veterans in Hawaii? And
if so, what are they?
Ms. Cullen. Over the last 2 to 3 years, we have moved away
from the reliance that we had at one point of utilizing
clinical providers from both the VA medical centers in Palo
Alto and in San Francisco. Dr. Hastings has made significant
inroads in hiring some specialists to be on staff at VA Pacific
Islands Health Care System. As you heard from part of the IG
report, having brought on two orthopedists who are now in place
in Honolulu, I believe that they are now able to provide a lot
of the specialty services via telehealth.
I would like to look to Dr. Hastings just to see if we
still have any regular services via telehealth from California,
but I think that they are all provided from providers out of
Honolulu, a combination of telehealth as well as those clinical
providers traveling to the other islands, though I would turn
to Dr. Hastings.
Chairman Akaka. Dr. Hastings?
Dr. Hastings. Senator, I would like to tell you that our
contact with the other facilities in the VISN has been very,
very supportive, and whenever we have needed something, they
have been willing to come and help us.
The two areas that we are using them extensively right now
is--I guess there are three areas that we use them. One is
spinal cord injury patients, paraplegic patients, and we are
using facilities at Palo Alto telemedicine support there. And
then we are using teledermatology where we get dermatology
consultations from providers in California, and this is very
helpful to us. And then the third area that I would tell you
about is in electrocardiograms for cardiac patients. We have
been able to set up a relationship so that we have been able to
get regions in California to help in that area.
Now, we are not going to have to use that in the future
because we have been successfully hiring our own cardiologists,
so we will not use that one. But, as we identify areas that we
feel there is something that they can help us with, they have
always been very responsive to the needs that we identify.
Thank you, Senator.
Chairman Akaka. Thank you.
Ms. Cullen. If I can perhaps add, I had a few more thoughts
since Dr. Hastings began to elaborate. Just to tell you of two
developments within VA that will certainly benefit veterans in
the Pacific Islands and will benefit them nationally as well.
One is that within VA there is now a greater incentive to
provide health care services via telehealth. At one point
within VA, its own internal reimbursement mechanism did not
recognize a cost transfer for services provided by telehealth,
and that has been changed effective this fiscal year, so I
anticipate that will help increase telehealth services
nationwide.
A second development that may be of interest to you is VA's
National Teleradiology Program. That began in California, in
Northern California, starting at the San Bruno Clinic, which is
linked to the San Francisco VA medical center, and
transitioning to a larger program at Palo Alto. They have now
begun a second center here in Honolulu and have two to three
radiologists on board who are available to read radiology films
at the facilities that are experiencing either recruitment
difficulty with radiologists or who might have a temporary
problem.
So, they have already touched based with Dr. Hastings, and
I am assured that he will have first availability of any
services that they can provide should he have any need, but I
think both of those developments will greatly help provide
services to veterans throughout the country.
Chairman Akaka. Thank you.
Also, Dr. Darkins, this relates to you and your work in
telemedicine. Please give us an update on how telemedicine is
improving which might make getting on a plane less necessary.
Dr. Darkins. Aloha, Chairman.
Chairman Akaka. Aloha. Thank you for being here, Doctor.
Dr. Darkins. I would like again, like the others, thank you
for the opportunity to be here. This meeting and also the one
back in August really help highlight some of the importance of
telehealth, so I thank you for that.
VA really has shown over the last 7 or 8 years a sustained
growth in telehealth, and we completed fiscal year 2009 with
just over 260,000 cases nationally, which was up from just over
230,000 the year before. Of those 260,000 cases, 58,000 were
doing videoconferencing with VA medical centers and clinics,
and 150,000 were providing teleretinal imaging, screening the
eyes of veteran patients with diabetes and blindness. And as we
sit here, some 41,000 veteran patients are currently managing
to live in their own homes independently because of having
telehealth devices in their homes.
We have looked at the benefits of this in terms of the
reductions of admissions to hospital where the reductions are
on the order of about 25 percent reductions in the need to go
to the hospital. And we look across the board at the
satisfaction of veteran patients because we are obviously
concerned that with changing the location of care, this is
indeed their preference. We have found very high levels of
patient satisfaction. So, I think it is good news to be able to
report that we are seeing a systematic growth year on year, and
we look forward to the same happening again.
We have some new programs which we anticipate coming online
this year. One particularly notable one is going to be the use
of the weight reduction program, the MOVE program that VA has.
It is now possible to provide that by telehealth devices.
I was talking to Dr. Hastings before. This is something in
preliminary discussions, but certainly it makes sense to be
able to discuss its applicability out in the islands. We are
looking at the use of Internet protocol video in the home to be
able to reach out into the home more commonly to provide
services. So, we are really seeing, as I said, this kind of
sustained growth.
We are piloting teledermatology. You have heard about its
link between Northern California and Hawaii. We are looking
toward--we have piloted it in seven VISNs and are looking
toward rolling that out more widely. So, I hope to be able to
report at the end of this next fiscal year further sustained
growth.
The issue very much for telehealth, particularly with
regard to rural and remote areas, such as--I welcome the
opportunity to be here and to see many of the issues evolve,
though I have been here before as well.
The issue of telehealth is not just about care in the
remote areas that is important. It is also the access to care
from urban areas----
I would just like to finish by saying in the end it really
comes down to peoples and communities. My ability back in
August with others to go around and see Hawaii, especially on
the Big Island, and just over yesterday to be here on Maui to
see the enthusiasm of the staff involved, which I think there
are some exemplary services. Having seen Dr. Pierce and what is
taking place in telemedical health I think is really something
we can work elsewhere.
So, I must say, I think one can certainly see improvements
in growth here and seeing the effects of both yourself and
Secretary Shinseki really focusing on the importance of
telehealth. I have had some very good discussions with Ms.
Cullen and also Dr. Hastings, and we look forward to being able
to serve more veterans in more timely ways in the future. That
is really why I am here, and I look forward to being able to
bring forth some of the ideas we have for that benefit.
Chairman Akaka. Well, thank you very much, Dr. Darkins.
Ms. Halliday, are other clinics in the health care system
encountering the same challenges that the Maui Clinic has
encountered serving veterans with mental health care needs?
Ms. Halliday. We did not specifically review the staffing
issues outside of Maui. However, we did talk with the health
care system clinicians and staff and believe that the other
CBOCs are experiencing similar issues. Some of the common
problems include lack of community mental health resources,
difficulty in recruiting medical providers, and the geographic
separation from the main health care facility in Honolulu.
Chairman Akaka. Ms. Cullen, you are in charge of several
large VA hospitals and clinics, mostly in California. Would it
help if you had a Deputy Network Director here in Hawaii?
Ms. Cullen. Well, funny you should ask because we will be
getting a new Deputy Network Director, but that person will be
based in Northern California. She will be arriving the
beginning of February. And one of the things that we are doing
is setting--while we are setting some goals for all of our
facilities during the course of this year, we are also setting
some goals for our home office, and one that we are assigning
to ourselves is to ensure that our VISN staff get out to each
element of our organization; that is, not just the large
medical center but to each CBOC, at least one VISN staff person
would be at each VA site, a VHA site, within the VISN annually.
It is not quite the same as having a Deputy Network Director
based in Hawaii, but I believe that--but sometimes I think that
our Hawaii colleagues think they perhaps see a little more of
us than they would like.
I come with Jeannie Daily, the quality manager who is with
me and with our chief medical officer to have regular
performance reviews with our facility in Hawaii. And thanks to
your invitation in August to come to almost all of the islands,
and the opportunity here today, we feel we see the value in
having regular contact with each VA location. So while we do
not have a staff person--a VISN staff person--based here, I
think, though you will have to ask them, that they perhaps get
to see at least as much of us as they might like. But, again, I
will leave that for them to respond to perhaps after they are
on the official record.
Chairman Akaka. Yes. [Laughter.]
Well, thank you very much for that. We look forward and
anticipate the best happening here.
Ms. Betts, I am very pleased to hear that the Native
American Direct Loan Program is very active on Maui. Will you
please tell me approximately how many Maui veterans benefited
from this program in 2009?
Ms. Betts. I do not have that number specifically for Maui.
I do know that we had 121 Native American direct loans for the
State of Hawaii.
Chairman Akaka. Well, you can provide that specific for the
record.
Response to Request Arising During the Hearing by Hon. Daniel K. Akaka
to Tracey Betts, Director, Honolulu VA Regional Office, U.S. Department
of Veterans Affairs
Question. Of the 121 Native American direct loans for the State of
Hawaii, how many are specifically for Maui?
Response: Nine of the 121 Native American Direct Loans in Hawaii
are in Maui.
Chairman Akaka. Dr. Hastings, what barriers do you see to
expanding telehealth services on Maui? Do you see any barriers,
including potentially connecting VA to the community health
clinic in East Maui?
Dr. Hastings. Thank you, Senator. We have looked at the
issue of East Maui and are trying to connect with them, and our
staff people who view telehealth have been over to Maui, have
been over to Hana, and they have surveyed the equipment and
facilities that were available over there. At the moment we
have--we are unable to connect VA equipment with the existing
equipment there.
On the other hand, as we are continuing to explore the
expansion of this technology in the Pacific, I believe that we
will be able to figure out how to end up really providing
better services there.
I can tell you that in the Pacific the challenges that we
have had have been with connectivity growing. Look at American
Samoa and, more recently, our expansion into Saipan. And, of
course, the problem of getting into American Samoa was getting
cable--getting bandwidth--there. It has been within the past
year, I believe, that we were able to get cable into American
Samoa. And what has happened is we now have wide bandwidth
connectivity to our clinic there, and so we have been able to
expand our telehealth connectivity to that area, and we are
doing it to support the Department of Defense in their TBI
evaluations on our Reservists that are in the area, as well as
for supporting our veterans.
I think that has not been a problem for us here in Hawaii.
I think we have adequate bandwidth connectivity capabilities
here in our clinics, but we have had some problems with
equipment, and I think we are going to be able to have all of
those soon.
You asked about the things that prevent us from being able
to exploit this technology. Part of it is just the very system
that we work in. A lot of our providers--for instance in our
fee-based system--they're people from the university,
practitioners in the community, specialists, and we can set up
a telemedicine capability where we can transmit with an
individual, but we also have to have--on the other end of the
connection--we have to have a provider who is trained,
experienced, and willing to use the technology. And if that
person does not work full-time for VA, then it becomes a little
bit of a challenge.
So, I have been successful, we have been very successful in
getting some of these people who are not as familiar with the
technology to use it, but we are more successful when we have
the specialists inside our own organization.
Chairman Akaka. Ms. Halliday, for elective orthopedic
surgeries, you stated that the wait time was decreased to an
average of 82 days. This still seems excessive given that the
time ranged from 11 to 210 days. What challenges does the
health care system continue to encounter to ensure timely
orthopedic surgeries?
Ms. Halliday. The 82-day average in our sample included
three surgeries that were delayed because patients were not
healthy enough for surgery to be completed. When you factored
those three instances that the auditors found, the average time
would come down to 62 days. That is approximately 2 months.
The main challenges that were brought to our attention were
getting the patients ready for surgery, and sometimes their
health issues--they have to have certain things cleared up
before surgery. Now that they have a nurse, a VA nurse tracking
the patients' needs, it is improving dramatically. I think it
is just a matter of timing to see an even more significant
improvement.
Chairman Akaka. Thank you.
Mr. Stucky, would you like to share more information about
the waiting times?
Mr. Stucky. Sure. There are no VHA or industry standards
for timeliness of elective orthopedic surgeries. We found that
the desired waiting time in scheduling the surgeries varies
depending on the patient's medical condition and the patient's
preferences, in addition to some cases where the surgery was
scheduled within 60 days it was delayed either because of the
patient's preference or because the patient was not ready for
surgery.
Chairman Akaka. Ms. Betts, in his prepared testimony, Mitch
Skaggerberg of the Vietnam Veterans of Maui County notes that
requiring Central Office review and approval of applications
for VA's Independent Living Services Program results in ``major
delays, many times up to 2 years.'' Would you please comment on
this statement?
Ms. Betts. Apparently, there was a time period when the
requirement for the Central Office review, as he stated, was an
outcome of a site visit, and it was more of an oversight of the
program itself. That was conducted here in Hawaii.
Since then, that requirement is no longer in place.
Currently, there are only four cases pending that have gone up
into--and the normal process for the Independent Living
Program--this is for everyone--is that the counselor once
determined through the group assessment that the individual is
eligible and was put into the Independent Living Program, all
of that information does go up into the Washington office, and
it is in our vocational rehabilitation and employment service,
and they actually do the final approvals on all of the cases.
So, the counselor would not--what was happening before,
where his statement came from is based on this site visit and
an audit that was done previously. We were asking him to look
at the independent living cases prior to the actual application
and the submission of requirement, and I think that is where
there is a discrepancy in the understanding of what actually
transpired.
So, currently, there is no specific thing that we do any
different from any other facility, and it does--and it is just
the program itself. They do have an oversight, and that
oversight does go up to--once the counselor puts their program
together and everyone concurs, I also see it and concur. We do
send them up because the program reserves the right--and that
is at the Central Office level--to approve and to review all
independent living programs.
Chairman Akaka. Would you be able to tell me the national
average time to approval for an application for independent
living services and the average time for approvals in Maui?
Ms. Betts. Not at this time. Could I send you that
information?
Chairman Akaka. Yes, thank you.
Response to Request Arising During the Hearing by Hon. Daniel K. Akaka
to Tracey Betts, Director, Honolulu VA Regional Office, U.S. Department
of Veterans Affairs
Question. What is the average time to approve an application for
independent living services in Maui and nationwide?
Response. The average number of days to enter an independent living
(IL) program nationally, based on active workload, is 188 days. The
average number of days to enter an independent living (IL) program for
the Honolulu Regional Office, based on cases that entered independent
living status fiscal year to date, is 415 days.
The Honolulu Regional Office (RO) faces the unique challenge of
serving a vast geographic area, which impacts timeliness of VR&E
services. The RO's geographic jurisdiction encompasses the following
areas: Asia, American Samoa, Guam, Republic of Palau, Republic of the
Marshall Islands, Federated States of Micronesia, and the Commonwealth
of the Northern Mariana Islands. The RO has implemented several
initiatives to ensure that IL services are used appropriately and to
improve timeliness of the development of IL plans. Specifically, the
Honolulu VR&E division implemented a workload management plan with an
emphasis to improve the timelines of IL claims. The VR&E division
revised the local training program to focus on IL planning. In
addition, there is a multi-level approval process for all IL plans. To
that end, the VRC develops the plan, the VR&E Officer reviews the
appropriateness of the plan, and then it is forwarded to the Director
for final approval. The tiered approval process ensures that all plans
are developed appropriately. Honolulu has improved timeliness by 24% so
far in fiscal year 2010, as a result of these initiatives.
Chairman Akaka. Now, I have further questions, but I want
to give each of you a chance to give a summary or a statement
that you have got to give at this time about what you are
doing. And I, of course, want to thank you for your responses
that you have given. It will be helpful for the people of Maui
to have heard from you what you have done already and what we
can probably expect to be done. So, if you have a statement you
would like to close with, I want to give you that opportunity
now.
Let me begin with Ms. Betts.
Ms. Betts. Thank you, Chairman. What I would like to say to
the veterans of Maui is we do have--right now I am working on--
basically I have three initiatives going. One of them is to
increase the outreach. I have been hearing this across the
State and across the Pacific Region because my responsibilities
are to deal with the benefits. I have been working
collaboratively with Dr. Hastings from the medical side, and we
also work with the Vet Centers as well as the Office of
Veterans Services from all of Hawaii, American Samoa, and Guam.
And what we are looking at is one, to increase our outreach and
appearances on every island. The objective there is to do just
that: to let the veterans know that we are here; to hear what
they need; and one of our focuses is going to be on getting
them enrolled. It is very important and they need to understand
that.
I heard the conversation about Hana, and we do not have a
benefit counselor who goes to Hana. Those are the kinds of
things that I need to know about. Those are the kinds of things
we need to look into, and we are going to start by doing
outreach.
From January to June of this year, we will take an outreach
team to every island, and that is the kind of thing we are
going to be looking to address their concerns and to determine
if the population there requires not only the benefits but also
the medical care. So, we need to get everyone to register. It
is very important that they register with the VA, and the
registration is with the VA medical centers and the medical
clinics. Once we get that, we can then do our assessments and
put our people out there.
Another thing is that in working in collaboration with Dr.
Hastings and the medical centers, they are planning in their--
as they are growing, they are planning to have space for a
benefit counselor. So, with that commitment, as he grows and as
he starts to--because currently in the facility they have,
there is no extra space to put us. But once they do become
available, we will be putting counselors in those areas.
In the meantime, what I'm looking at is we have a current
counselor who comes once a month, and if it is determined
because there is a need to have him go out more than once a
month, we will do that. Right now I am trying to do assessments
of what the need is, and this is for all of the islands and for
all of the Pacific Region that we are responsible for. So, that
was one thing.
Another thing is I know there is a lot of conversation
about the vocational rehabilitation and employment,
particularly the Independent Living Program. Just something for
more of what is the program itself. The Vocational
Rehabilitation and Employment Program offers benefits for
vocationally rehabilitating veterans for employment. VA has
what we call 5 Tracks, and independent living is just one of
the five tracks available: to try to rehab the veteran for
employment purposes. In some instances they are not employable;
therefore, we work with them. Independent living is just that.
It is a program that helps them become more independent in
their daily life. So, it is a program out there. It has not
gone away. I hear from time to time people asking why did it go
away. It has not gone away.
I heard a comment about the dollar value being changed, and
that has not happened either. It is an entitlement. It is a
benefit. The purpose of the vocational rehabilitation
counselor, who works in conjunction with the medical folks,
they make the determinations medically and psychologically,
where does the veteran sit at that time, what is the best
program for them. And, again, independent living is just one of
many tracks that the rehab-to-employment program takes care of.
The last thing I would like to say is, again, you know, we
are out here to service veterans, and the important thing is we
need to know what--we need to hear from them, but we also need
to know what is it that we need to do better, and we are
working on that. It does not happen overnight. Some things take
time. Some things can happen instantaneously, but a lot of
these particular issues we are working on. I am hearing them. I
am committed to improve the services to the veterans. And,
again, I must keep saying as we do outreach, they must register
with the VA system.
Chairman Akaka. Thank you very much, Tracey.
Dr. Darkins?
Dr. Darkins. Thank you very much, Mr. Chairman. It is a
privilege to work for the VA and to be able to serve veterans,
and that is not just as an entitlement, but also our way of
life, and as we have heard, is dependent upon the service they
have given to our country. Therefore, the ability to do that
and to help serve veterans is a great privilege, not just for
myself but everybody I work with.
I look forward--having heard distinctly some of the issues
in terms of access to care, in terms of how timely that care
is, and the trouble that will be avoided by telehealth, I think
we have one of the solutions to some of the problems. I would
not suggest that telemedicine is going to do everything, but I
think there are ways it can appreciably enhance services here
in Maui.
I look forward to working with Dr. Hastings, with his
staff, and Ms. Cullen to see what we can do to be able to
address some of the issues that we have heard and to deal with
those and to come back in the future with what we have achieved
and solutions and to hear that we have met some of these
challenges and helped them.
Chairman Akaka. Thank you very much.
Ms. Cullen?
Ms. Cullen. Thank you, Mr. Chairman. I appreciate hearing
today from veterans on the first panel their expression that
they have seen improvements in the services available to the
veterans in Maui County over the course of the last 2 years. I
am very encouraged by their declarations to that effect.
We have national programs in the VA that you are certainly
very familiar with which will allow us to provide opportunities
to further improve care for veterans in the Pacific Islands--
the rural health initiative, the women's health initiative, the
telehealth initiative, and Native Hawaiian initiatives. They
are all priorities that Secretary Shinseki has identified, and
our VISN staff will be working very closely with Dr. Hastings'
staff to exploit--and I mean that in a very positive way--how
those programs can further benefit veterans in the Pacific
Islands.
I am also very impressed, as I come to each of the
community-based outpatient clinics--and certainly here the last
couple of days in Maui--with the dedication, the
professionalism, the commitment, not to mention the enthusiasm
of the VA staff here and their willingness to embrace more
programs and more opportunities to serve the veterans that they
have been caring for over the last few years. That dedication
and enthusiasm is something that I think will help us further
expand and include services.
We look forward to the Saipan outreach clinic this fiscal
year, also the new expanded replacement clinic in Guam, and our
own collaborations that Dr. Darkins referred to while here have
identified some other potential areas for improvement that we
need to do a little bit more work on. But we certainly look
forward to reporting back to you at some point in the future
with what those improvements will be.
So, once again, thank you for all of your support and your
encouragement to all of us to not settle for improvements that
we have made, but to realize that there is still a lot more to
be done.
Chairman Akaka. Thank you.
Let me call on Ms. Halliday and call on Mr. Stucky and
finally Dr. Hastings. Ms. Halliday?
Ms. Halliday. Well, thank you, Senator Akaka, for being so
proactive and asking the OIG to look at certain accessibility
and gaps that are occurring out on Maui.
One of our main concerns was with the performance measure
of mental health services in wait times to the initial and
follow-up appointments. We have found that both the ambulatory
care center in Honolulu and Maui were meeting this VHA
performance measure. What we did see, though, is that the Maui
CBOC was experiencing slippage in ensuring timely follow-up for
current care.
VHA does not track this performance. We would encourage VHA
to track and collect this data so we can see it really truly
measure whether improvements are happening in the future.
Chairman Akaka. Thank you.
Mr. Stucky?
Mr. Stucky. Thank you, Senator. The main focus of our
limited review of availability of services to the veterans in
Hawaii was on mental health services. What was clear was that
the mental health initiative funding has had a significant
positive impact on the availability of services there.
Chairman Akaka. Thank you.
Dr. Hastings?
Dr. Hastings. Thank you, Senator. I think what you have all
heard is that the VA has significantly improved its ability to
deliver services to our veterans here on Maui, and indeed
throughout our system. We are not finished. This is a journey
that we are on. We have come a long ways.
I have to say that in large part it is support from you and
from your Committee and from our representatives that has
allowed the VA to improve the quality of care and the access to
our veterans. We have a lot of challenges. Developing a complex
health care system in the isolated areas that we face out here
in the Pacific is a challenge, and I think that we have a long
way to go. I think we have some very, very dedicated
individuals and have been able to recruit more. For us in
isolated areas, we have been successful.
Now, there are areas that we need to improve, clearly. One
of the ones that you heard today, we all heard today, is the
East Maui issue. East Maui represents a small pocket of
veterans who are in a very isolated area with limited resources
for health care. We have other areas like that, and we have
been able to begin to address those areas.
Now, I think we are doing it very successfully. I think you
heard that today. We have been successful on Molokai. We have
been successful on Lanai. We have been successful in American
Samoa. We have been successful in Guam. We have been successful
in Saipan. I think we can be successful in East Maui as well.
It is not something we can do overnight. It is going to
take us a while to work on the problem, but I think we can be
successful. And we will use the technologies that we heard
about. We will use telemedicine, and we will use partnerships
with existing health care facilities. You know, those are the
tools that we end up using. We need to use the tools and the
people that we have.
I think there are other areas that we are improving on that
are not so available, they do not stand out. But we are
improving the efficiency of our organization. One of them that
I would mention is laboratory support. We have come a long way
in being able to get laboratory support for our CBOCs
throughout our system in our area, and we are going to continue
to do that. That is going to improve the ability of our
providers to make accurate and rapid decisions about our
patients.
That is not something you measure, but it is there. I saw
it today in the clinic that I went to. I remember going through
that clinic 2 years ago, and we had a part-time person that was
there one half or two half-days a week to draw blood, something
like that. That was it. Today we have a full-time individual in
nicely equipped, small laboratory, able to do some functions
right when the patient came in. That improves the quality of
care for our patients. They were doing that kind of thing.
We started improving women's health. We have expanded our
women's health clinic. We have brought on some more
subspecialists into our system, and we will continue to do
that. We will continue to build up that kind of support system
that would support our whole thing.
So, I think with the continued support that you have given
us and that we have gotten from the big VA and from our VISN,
all the help that we have gotten--and we have gotten help when
we have asked for it, when we identified problems. We have been
able to get support. We will continue to be able to improve
access and quality of care for the veterans in Maui County and
throughout the Pacific.
Chairman Akaka. Thank you very much, Dr. Hastings.
I want to thank our panelists. We know that there is much
to be done in order to ensure that veterans on Maui receive VA
benefits that they are entitled to. Given Hawaii's unique
features, VA must implement its method of delivery of these
services in a unique way. As Chairman, I am committed to
overseeing that all veterans, especially those in my home State
of Hawaii, receive the highest quality of care, and this is
also for the rest of our country.
Again, to all of you, thank you for being here, and at this
time I would like to adjourn this hearing. This hearing is
adjourned.
[Applause.]
[Whereupon, at 4:30 p.m., the Committee was adjourned.]