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FIELD HEARING ON THE STATE OF VA CARE

IN HAWAII: PART II

HEARING

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

SECOND SESSION

JANUARY 11, 2006

Printed for the use of the Committee on Veterans’ Affairs

(

Available via the World Wide Web: http://www.access.gpo.gov/congress/senate 

(II)

COMMITTEE ON VETERANS’ AFFAIRS 

LARRY CRAIG, Idaho, Chairman 

ARLEN SPECTER, Pennsylvania 

KAY BAILEY HUTCHISON, Texas 

LINDSEY O. GRAHAM, South Carolina 

RICHARD M. BURR, North Carolina 

JOHN ENSIGN, Nevada 

JOHN THUNE, South Dakota 

JOHNNY ISAKSON, Georgia 

DANIEL K. AKAKA, Ranking Member, Hawaii 

JOHN D. ROCKEFELLER IV, West Virginia 

JAMES M. JEFFORDS, (I) Vermont 

PATTY MURRAY, Washington 

BARACK OBAMA, Illinois 

KEN SALAZAR, Colorado 

LUPE WISSEL, Majority Staff Director 

D. NOELANI KALIPI, Minority Staff Director 

(III)

C O N T E N T S 

JANUARY 11, 2006

SENATORS 

Page 

Akaka, Hon. Daniel K., U.S. Senator from Hawaii .............................................. 1

Abercrombie, Hon. Neil, U.S. Representative from Hawaii, 1st District, prepared statement ................................................................................................... 2

Case, Hon. Ed, U.S. Representative from Hawaii, 2nd District .......................... 4

Prepared statement .......................................................................................... 10

WITNESSES 

Daves, William, President, Oahu Veterans Council ............................................. 15

McCloskey, Michael, Member, National Executive Committee, The American 

Legion, Department of Hawaii ............................................................................ 15

Prepared statement .......................................................................................... 16

Hough, Master Chief Petty Officer Gil (Ret.), U.S. Navy; Member, Veterans 

Advisory Council .................................................................................................. 18

Prepared statement .......................................................................................... 19

Rienzi, Lieutenant General Thomas (Ret.), Chairman, Veterans Advisory 

Council .................................................................................................................. 20

Prepared statement .......................................................................................... 21

Ross, Caz, Veteran Service Officer, The Military Order of the Purple Heart .... 21

Cruickshank, Colonel Edward (Ret.), Director, Officer of Veterans Services ..... 22

Prepared statement .......................................................................................... 23

Rubens, Diana M., Director, Western Area Office, Veterans Benefits Administration; accompanied by James Carilli, Acting Director, Honolulu Regional 

Office ..................................................................................................................... 31

Prepared statement .......................................................................................... 33

Molnar, Stephen T., M.S.W., Team Leader, Honolulu Vet Center ...................... 35

Prepared statement .......................................................................................... 38

Gusman, Fred, M.S.W., Chief Operating Officer, Pacific Islands Division, 

National Center for PTSD ................................................................................... 40

Prepared statement .......................................................................................... 41

Wylie, Alfred, Public Relations, Coordinator, Vietnam Veterans of America ..... 46

Prepared statement .......................................................................................... 48

Shomaker, T. Samuel, M.D., J.D., Interim Dean, John A. Burns School of 

Medicine, University of Hawaii at Manoa ......................................................... 49

Prepared statement .......................................................................................... 50

Kahoano, Haku, 4th-year Medical Student, John A. Burns School of Medicine, 

University of Hawaii ............................................................................................ 50

Prepared statement .......................................................................................... 51

Perlin, Hon. Jonathan B., M.D., Ph.D., Under Secretary for Health, Department of Veterans Affairs; accompanied by Robert Wiebe, M.D., VA Network 

Director, VISN 21, Sierra Pacific Network; James Hastings, M.D., Director, 

VA Pacific Islands Health Care System; and Steven A. MacBride, M.D., 

Chief of Staff, VA Pacific Islands Health Care System .................................... 57

Prepared statement .......................................................................................... 60

Pollock, Major General Gale S., Commander, Tripler Army Medical Center ..... 65

Prepared statement .......................................................................................... 67

APPENDIX 

Combs, Travis, prepared statement ....................................................................... 75

Giblin, Malcolm M., prepared statement ............................................................... 79

Page

IV

Holi, Wilma, President, Papa Ola Lokahi, prepared statement .......................... 80

Kauhi, Henry, prepared statement ........................................................................ 80

Luke, Dr. Stanley, Helping Hands Hawaii, prepared statement ........................ 78

Park, Master Sergeant William C. S. (Ret.), prepared statement ....................... 82

Tsuneyoshi, Randall, prepared statement ............................................................. 85

Turner, Charles H., prepared statement ............................................................... 75

Wessel, Lori and Paul, prepared statement .......................................................... 85

Article, Camp McCain Units to Receive Honors ................................................... 76

Memorandum, Department of VA Regulation ....................................................... 83

News Release, Department of Veterans Affairs .................................................... 77

(1)

FIELD HEARING ON THE STATE OF VA CARE 

IN HAWAII: PART II 

WEDNESDAY, JANUARY 11, 2006

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Washington, DC. 

The Committee met, pursuant to notice, at 10:10 a.m., in the 

DAV Hall at Keehi Lagoon, Honolulu, Hawaii, Hon. Daniel Akaka 

presiding. 

Present: Senator Akaka. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA,

U.S. SENATOR FROM HAWAII 

Senator AKAKA. The hearing of the Veterans’ Affairs Committee 

will come to order. Aloha. 

AUDIENCE. Aloha. 

Senator AKAKA. It’s great to be here with you. Normally, we’re 

on a stage, but today we’re on the same level. I’m delighted to be 

here. I want to welcome all of you to the third day of the Senate 

Committee on Veterans’ Affairs field hearings in Hawaii. 

It is not often that Senate hearings are held outside Washington. 

For us, it’s really great to have this Committee hearing here in Hawaii. So let’s give the Committee a great hand. 

[Applause.] 

Senator AKAKA. I’d like to thank Pat Weiland and Fred Ballard 

of the Spark M. Matsunaga VA Ambulatory Care Center as well as 

the Vietnam Veterans of America for their assistance in coordinating today’s hearing. We greatly appreciate all of your hard 

work. 

Today and over this entire week, the Committee will assess VA 

care in Hawaii. That’s the reason most of you are here. Due to its 

geography, Hawaii is unlike any other State in the Union. As such, 

VA must tailor its services to reach all of Hawaii’s veterans. 

I applaud the efforts of every VA employee in Hawaii. These men 

and women work hard trying to help our veterans. There are many 

things that VA does well. However, there’s always room for improvement. I want to hear about how we can help VA help Hawaii’s 

veterans. 

Many brave young servicemen and women are returning from 

duty in Iraq as we speak. We in Congress work with VA to address 

our newest veterans’ needs, along with our oldest. Services such as 

readjustment, transition assistance, PTSD-related counseling, are 

at the forefront of our priorities. We must continue to ensure a 

smooth transition of service from DOD to VA. 

2

Sadly, some believe that reducing veterans’ compensation for 

PTSD is a good way to save money. I think you remember last year 

VA planned to conduct a review that would have examined 72,000 

claims that were previously awarded compensation over a 5-year 

period. Compensation should not be viewed as a welfare program. 

Our veterans have earned their compensation through selfless service to their country. I want to say when I mentioned that review 

of 72,000 cases that thankfully, VA set aside its plan to conduct the 

review last year. 

Travel for veterans living on Oahu is relatively inexpensive. 

Traveling from other islands can be costly, and we heard, especially 

in Maui County, how costly it is for them. It’s costly because of 

inter-island airfare, which can be over $200. 

Veterans often have difficulty getting reimbursed—that’s another 

problem—for such expenses. Adding various other travel costs, 

such as rental cars and lodging expenses, and a veteran may 

choose to forgo care rather than pay sizable out-of-pocket costs. 

We are privileged to have our witnesses with us this morning 

and to have all of you here present. I must tell you, I’m so delighted to have our National VA officials who are here with us, and 

you will hear them, and also our regional officials, our State officials here, and all of our veterans organizations here as well as 

families. We look forward to being informed so that we can help 

you have better services. 

We are happy to have our congressional people here. I should tell 

you that Senator Inouye is not able to be here this morning, but 

sends his warmest aloha. Also, Congressman Abercrombie was not 

able to be here, but he has submitted testimony for this Committee. We have here two of us. With me to testify at this time is 

our young representative, Representative Ed Case. 

[Applause.] 

[The prepared statement of Mr. Abercrombie follows:]

PREPARED STATEMENT OF HON. NEIL ABERCROMBIE, U.S. REPRESENTATIVE

FROM HAWAII, 1ST DISTRICT

Senator Craig and Senator Akaka, thank you for this opportunity to discuss with 

you and the other distinguished Members of the Senate Veterans’ Affairs Committee 

my thoughts on both the current status and future of Federal veterans programs 

in Hawaii. 

Before going into specifics, I want to thank all of America’s veterans, and especially those in Hawaii, for their service to the Nation. When the Nation called, they 

answered ‘‘send me.’’ We all appreciate the courage and sacrifice of those who leave 

their friends and families behind and go to fight on our behalf. 

Of course, when they get home, the Department of Veterans Affairs is responsible 

for providing our veterans’ assistance and healthcare. As Members of this Senate 

Committee, you know how important a mission that is. Caring for our veterans is 

a sacred duty, but it can also be a challenge given the size and diversity of needs 

within the veteran population. 

On that note, I’d like to also publicly thank the men and women of the Department of Veterans Affairs. They work hard every day with limited resources to meet 

the needs of the Nation’s veterans, and I don’t think they always get the credit they 

deserve. 

I also want to commend both Senators Craig and Akaka for running the Senate 

Veterans’ Affairs Committee in a bipartisan manner. We could use some of that 

spirit of working together to help our veterans in the House Veterans’ Affairs Committee, but seeing the two of you work so well together reminds me that accommodation and compromise are possible, and in the end, our veterans will get better 

service as a result. 

3

As you know, Hawaii has more than 100,000 veterans. In many aspects, this large 

population of veterans shares the same concerns that veterans around the country 

have about VA operations. These concerns include improving access to VA 

healthcare, better and more efficient delivery of veterans’ benefits, and an overall 

shortfall in VA funding, particularly for VA healthcare. 

I share all of those concerns. Over the past 5 years I have been especially troubled 

by the tone the Bush Administration has unfortunately taken regarding veterans’ 

benefits and healthcare. The general goal of the Department of Veterans Affairs 

under its current Washington leadership sometimes seems to be to minimize the 

amount of money spent on our veterans, and exclude as many veterans as possible 

from using the VA system created to take care of them. 

This general trend has manifested itself in many ways, as you know as Members 

of this Committee, but let me give a few examples that have troubled me. The first 

is how the Bush Administration chose to deal with the long waiting times that 

many veterans are experiencing trying to use or get into the VA healthcare system. 

Rather than trying to improve or expand services to accommodate the increased demand, the solutions provided to Congress consisted of both shutting out certain veterans and increasing co-payments on veterans already in the system. Of course, 

both of these proposals have met serious opposition in Congress, but the very fact 

that they were offered up as solution says a great deal. 

A second example is this past year’s controversy regarding a multi-billion dollar 

shortfall in VA healthcare funding. While I’m glad that the Administration finally 

owned up to the fact that they needed $1 billion more healthcare funding in 2005 

and $2 billion more in 2006, it would have been better for our veterans if the Administration had simply been honest in the first place. I just cannot understand why 

these shortfalls were not identified earlier in the budget process. 

I am especially troubled by this trend in under-funding because of what it says 

for the future. The wars in Iraq and Afghanistan are producing thousands more future veterans every day. Many of these troops are coming back with serious wounds, 

both physical and mental. If the current VA system cannot provide a consistent 

level of service to today’s veteran population, how is it going to be able to handle 

the hundreds of thousands of new veterans entering the system over the next decade? 

Overall, I would like to see a change in direction from the Bush Administration, 

one that lets our veterans know that they are not viewed as ‘‘wards of the state’’ 

who are simply seeking additional entitlement spending, but instead that they are 

valued and honored for their service. 

Will improving veterans care be expensive? Of course it will. However, I think 

most Americans would be willing to provide the resources if they knew that it would 

help make sure that our veterans get the care and benefits they deserve and have 

earned. Unfortunately, over the past 5 years the Bush Administration has not even 

asked the American people—outside of our military—for any level of sacrifice to 

fund the wars in Iraq or Afghanistan, let alone the increased burden on our veterans care system caused by these conflicts. I sincerely hope that changes, and soon. 

We owe our veterans more. 

Looking more at local concerns, it is clear that Hawaii faces many issues when 

it comes to veteran’s care, and I’m sure you have heard about these at great length 

during your series of hearings. The unique characteristics of Hawaii’s geography 

and population distribution make delivering veterans’ benefits and care here especially challenging. 

Rather than reiterate those same concerns, all of which are very important and 

need serious attention, I want to focus my testimony today on two groups of veterans with whom I have had the privilege of working with over the past few years, 

and on whose behalf I support legislation in the House. 

The first group of veterans—many of whom live in Hawaii—are known as ‘‘Atomic 

Veterans’’ because of their participation in nuclear weapons testing and other nuclear weapon activities. 

These veterans, while small in number, are paying a large price for doing their 

duty and not asking questions when ordered to participate in nuclear weapons testing between 1945 and 1965. In short, they did what they were told, and while at 

the time of these tests the military did not understand all of the health dangers 

involved, that does not absolve the military, the Congress, or the Nation from providing these veterans with the appropriate care and compensation. 

Today, the major barrier faced by veterans seeking care for health problems associated with their participation in these atomic activities is the ‘‘dose reconstruction’’ 

system. This system, while well-intentioned, is simply not working. The primary 

reason for that is that it relies upon service records that are either not detailed 

enough or not in existence to ‘‘reconstruct’’ how much radiation a veteran was exVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00007 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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posed to and thus how likely it is that their health problems resulted from this service. This is not just my opinion. Both the Government Accountability Office and the 

National Academy of Sciences have studied this issue and have concluded that the 

current dose reconstruction methodology does not work due to a lack of appropriate 

records. 

The result of this dysfunctional system is that very few atomic veterans are able 

to get access to the VA healthcare system. The National Academy of Sciences 2003 

study showed that just 2 percent of veterans who went through the ‘‘dose reconstruction’’ review had their medical conditions validated as ‘‘service connected.’’ The 

other 98 percent of the approximately 2,500 veterans who had applied for serviceconnected status were told ‘‘too bad.’’ While not all claims will have merit, I think 

this approval rating is disgraceful. It is clear to me that the current approach to 

evaluating the service of atomic veterans is skewed toward denying them servicerelated status. This must change. These ‘‘Atomic Veterans’’ are dying every day from 

diseases caused at least in part by their service in atomic tests and other nuclear 

weapon-related activities. 

To fix this problem I have introduced legislation to eliminate the ineffective dosereconstruction system. My bill, H.R. 2962—The Atomic Veterans Relief Act, would 

still require veterans to prove that they participated in an atomic test or served in 

an atomic occupation area, such as Nagasaki, and that they suffer from a radiogenic 

disease. That is, a disease related to exposure to ionizing radiation. This legislation 

would also expand the definition of ‘‘radiation risk-activity’’ to include those veterans who were exposed to ionizing radiation from residual contamination at nuclear test sites, which is now widely understood to be a serious health risk. This 

legislation now has 40 cosponsors, including Congressman Evans, the senior democrat on the House Veterans’ Affairs Committee. 

I ask for your support for this much-needed legislation. I think it is a basic issue 

of fairness that the Department of Veterans Affairs and the Congress must address. 

I look forward to working with the Committee on this issue in the future, and I will 

do anything you ask of me to help move this legislation forward. 

The second group of veterans whose cause I strongly support is the Filipino veterans of World War II that served alongside U.S. military forces as members of the 

Commonwealth Army of the Philippines and the Philippine Scouts. As you know, 

thousands of these veterans who fought under our flag in World War II were denied 

veterans benefits and healthcare for decades. While I appreciate the progress in 

2003 toward getting this group the benefits and care it deserves, I do not believe 

that those incremental steps are where Congress should stop. 

I am a cosponsor of House legislation, The Filipino Veterans Equity Act, which 

would finally erase all the inequities that this group of brave veterans has endured. 

This bill has 67 bipartisan cosponsors in the House. The goal of this legislation is 

full equity for Filipino veterans. They fought shoulder to shoulder with their American comrades in arms, suffered the same hardships, and sacrificed in the same 

cause. Simple justice demands that we recognize their equal contributions with 

equal veterans benefits. 

As a Member of Congress from Hawaii, I represent a large number of these veterans. Many are now in their seventies or eighties, so time is running out for the 

United States Government to finally fulfill the promises it made to these veterans 

during World War II. I look forward to working with your Committee in the future 

to make this legislation a reality. 

I want to again thank you for coming to Hawaii and holding these hearings. I 

know that you have many demands on your time, as all Members of Congress do, 

so your willingness to take the time to come and hear from Hawaii’s veterans is 

greatly appreciated.

STATEMENT OF HON. ED CASE,

U.S. REPRESENTATIVE FROM HAWAII, 2ND DISTRICT 

Mr. CASE. Thank you very much, Senator. I was young a few 

years ago when I took this job. I’m getting older rapidly. 

[Laughter.] 

Mr. CASE. Chairman Craig, Ranking Member Akaka, Members of 

the Senate Veterans’ Affairs Committee, guests, especially our veterans that are here with us today, good morning to all of you. I 

thank the Committee from the bottom of my heart, on behalf of all 

of Hawaii’s people, for joining in addressing this most important of 

issues for our Hawaii and country: how we fully and honorably disVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00008 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
5

charge our obligation to our Nation’s veterans and to those that 

they leave behind. 

I thank our Hawaii’s 120,000 and increasing—as a matter of fact, 

every day that another plane arrives home—increasing number of 

veterans for your service, and for the honor and privilege, and I do 

mean that very sincerely, of representing you in your U.S. Congress. 

I thank you for the partnership, Senator Akaka, between our 

congressional delegation and veterans. I think as we look back over 

the last decades and look at a delegation, as it has changed, it has 

still been committed every day to the needs of veterans, and we’ve 

enjoyed a fantastic relationship with our veterans, a partnership, 

really. It’s been a distinct pleasure to come into that part of my job. 

I thank you, Senator, personally for your efforts not only in 

bringing this Committee here, but, as the representative of the 2nd 

Congressional District, which I like to define as every part of the 

State of Hawaii except for that small sliver that lies in downtown 

Honolulu, for taking the Committee outside of Honolulu. Because 

of course I think we all know, and we will soon see revealed fully 

and furthermore today, that differences between the 1st and 2nd 

districts do exist. I thank you for taking the Committee to the 

other islands where the needs of the veterans communities are 

sometimes unique, as this Committee has already seen. 

Finally, I think it is vital as we start any one of these hearings, 

in this and other hearings and meetings and actions, that we pause 

and remember what we’re all about here. We pause to remember 

the joy that we feel in welcoming home our newest veterans, including members of the 29th Brigade Combat Team. We also pause 

and remember the great tragedy of the goodbyes that we are saying 

to our best and brightest that won’t be coming home, people like 

Sergeant Myla Maravillosa. 

I don’t want to take too much time today because I’ve seen the 

panel and it’s a fantastic panel. You have excellent and qualified 

people to inform the Committee. I’m looking forward to hearing 

them as well. I simply want to offer a couple of perspectives, 

I offer these perspectives as a Member engaged in a difficult and 

crucial national debate over whether we as a country will honor 

those commitments that I made reference to earlier. 

As a Member representing vets individually and collectively who 

have the same concerns as vets elsewhere, as Senator Akaka has 

already mentioned, whether it be student loans and other means 

of advancement; whether it be veterans preferences in small business set-asides for Federal procurement opportunities, which is a 

major issue right here; whether it be retirement and survivor benefits; or whether it be basic healthcare, which I think we all know 

and realize is really where the attention needs to be devoted. 

I also do it, as I mentioned earlier, as a Member representing a 

district that is a rural district, a suburban district. In that way, 

like a lot of other such districts throughout the country, we’re particularly unique in terms of the geographic complications. 

I do it as a Member that has met personally with so many of 

your organizations and individual vets, and finally, as a Member 

like every other Member of Congress, or I hope every other MemVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00009 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
6

ber of Congress, who has a very active casework component of the 

service that they provide, individual casework services. 

I can tell you what I think that we all should know and you 

know, and that is, when we talk about individual services, the individual connection between our constituents and the Federal Government, veterans issues are at the very top of that list. So that’s 

a unique and very direct and personal way of understanding how 

our Nation’s veterans are being impacted. 

In the big picture, let me first say—and I think we need to lay 

this out because it comes back more and more and repeatedly as 

a theme—that I completely share the legitimate concerns of veterans nationally, and many Members of Congress over what I think 

we have to fairly recognize as a lagging commitment by our Federal Government to veterans’ needs. 

The needs are simply not being kept up with by available resources. Despite the efforts of well-meaning, well-intentioned people, there is an increasing gap between what we need to do and 

what we are doing. That’s a national issue. We’ve seen it. I’ve seen 

it in my budget committee, where we fought major budget battles 

over the allocation of available resources to veterans. 

We have certainly seen it over reports of limitations in terms of 

outreach and the concerns of extending the net too far out as we 

look to the needs of veterans today and down the road. We have 

seen it in shortfalls mid-year in appropriations bills, where we’ve 

had to come back on major shortfalls and do emergency appropriations because the projections of need turned out to be dead wrong. 

We’ve even seen it in some of the procedural aspects of Congress 

where, for example, inexplicably, we stopped doing joint hearings 

with veterans organizations at the outset of this current Congress. 

I hope that changes. 

I don’t want to dwell too much on this national debate here because this hearing is really about trying to understand what our 

particular challenges are here in Hawaii, other than to make this 

basic observation—and I think this is a truth that we have to keep 

in mind—and that is that we can provide the most seamless and 

complete delivery system of veterans benefits throughout Hawaii, 

solving every single one of the challenges and problems logistically 

and on paper and otherwise that we are going to hear about today, 

have already heard about, and will be hearing about. 

Are we going to have that system in place? But if we don’t have 

that national commitment, the national resources, we’re not going 

to get the job done. So this does start at the national level. We 

need to talk about it locally, but it does start nationally. 

Now, let’s just turn to Hawaii specifically, some specific observations. I hope the witnesses will go into these. I’m sure they will. 

I want to report to you just on what I’ve observed in the last 3 

years of representing our veterans community. 

By the way, the veterans community in Hawaii is split pretty 

much evenly between 1st and 2nd Congressional districts, 60,000 

in each. I don’t know who has the lead there, but it doesn’t really 

matter. I think it’s fair to say that each and every one of your congressional delegation doesn’t distinguish on the basis of districts. 

I’m sure Congressman Abercrombie and I certainly don’t do that. 

7

But I will report on some of the observations that I have. I want 

to take off, really, on a veterans survey that I just completed. I 

have for the last 3 years sent out a veterans newsletter to the organizations and to the veterans themselves, trying to reach out first 

of all, to try to give you a sense of what’s happening nationally. 

I have that report here. I have a limited ability to distribute it; 

I can’t give it to all the veterans. But the VA does give it to me 

in terms of who is actually getting benefits today. So I miss the 

majority of veterans out there that are not actually receiving benefits, but those that are, who are those that we’re really trying to 

take care of, are responding, are getting my report and are responding to my survey. 

I think that what is coming back in that survey is relatively reflective of what I have also felt just through casework and talking 

anecdotally and walking around my district. I think the first thing 

I need to say, and this is good news, is that in many areas, veterans do feel relatively satisfied with the scope of the services that 

they are getting. 

This is not a picture in which this is a veterans community nor 

a broader community that believes that the entire system is collapsing around us and there’s no care being given to our veterans. 

I think it’s important for us to recognize both individually and institutionally where veterans services are in fact being provided, 

and the information I have and the feeling that I have is that what 

we are talking about is a structure that is generally accepted and 

has generally been committed to improvement, but does have problems, challenges, individual missed opportunities. 

So the first thing I want to say is something that Senator Akaka 

said as well, and that is, we thank our Federal Government. We 

thank our veterans entities on the Federal level for the commitment that they have. We know from the fact that the people from 

Washington are here today that they are committed to Hawaii. 

I think we have been blessed here in Hawaii by well-meaning 

and dedicated people in all aspects of the veterans services part of 

our Government, whether it be Federal, State, or local. So we say 

thank you to you, first of all, and thank you for a job that is well 

done in general. 

Let’s talk about the problem areas. Clearly, the problem areas 

are isolated in some of the areas that I talked about earlier. I think 

the number one I would note other than healthcare would be access 

to Federal procurement, where I certainly have seen a real deficiency. That’s not a veterans-driven issue; that’s a Federal procurement-driven issue. We simply have to provide those opportunities 

to our veterans. It’s a little bit of a complication on the neighbor 

islands, but nothing that is significantly different from urban Honolulu. 

Healthcare is clearly, as I said earlier, where we need to worry 

about things. I think there are a couple of areas that are of particular note. 

I think access to healthcare throughout Hawaii, and especially on 

the non-Oahu, non-Honolulu—because this applies to rural Oahu 

as well—is a little more spotty, obviously, than in downtown Honolulu. That’s understandable. You can get to medical facilities a little easier here. You have a greater diversity and range of medical 

8

professionals operating. You don’t suffer from some of the problems 

that go beyond the veterans issue on the neighbor islands, such as 

the fact that the only ear, nose, and throat specialist in West Hawaii just quit and is leaving. So what does that do to the safety 

net in West Hawaii? These are problems throughout the islands 

other than Oahu. 

But it’s very clear that one of the things that we have to be very 

vigilant about and work on is just simple availability of medical 

services to our veterans on the islands other than Oahu. 

We have had some concerns in terms of consolidation of veterans 

services. In some of the islands, the Committee will discover and 

already knows, the services have in fact been consolidated, so it’s 

kind of a one-stop shop. You can come in there and get services for 

your benefits, whether they be medical benefits, whether they be 

clinical benefits, whether they be benefits on economic preferences 

or otherwise. In other areas, you frankly have to go clear across 

town or sometimes across island to get them. So I think the concern there is to try to effect consolidation for efficiency of delivery, 

and also just to service the customer, who is you. 

In some of the islands, we do not have adequate centers for veterans to come together, really, to try to focus on the needs of veterans and to provide that camaraderie that is not only part of the 

veterans community, but is particularly important to recovery from 

various of the areas in which veterans still suffer. That’s been a 

crucial aspect, I know, for PTSD treatment in a number of our committees throughout Hawaii. So the adequacy of centers is inconsistent. 

Veterans cemeteries have been a persistent problem, especially 

on some of the neighbor islands. Good, solid efforts by Federal, 

State, and local, county Governments, State government, and Federal Government to provide the full range of the obligation that we 

have to provide for the final resting place of our veterans and relatives. 

But I think the fact of the matter is that although it’s relatively 

available here on Oahu, it is not relatively available, at least that 

simply, on the neighbor islands. So one of the bills that I have 

pending in Congress is a proposal to allow for an increase in the 

burial allowance which is given to the State to assume of the responsibility of the Federal Government in situations in which a 

cemetery is not available on island. 

Now, if you’re in the middle of New Jersey, that might not be a 

problem. But if you’re on the island of Hawaii and a veteran, you 

want to be buried on the island of Hawaii, just to take an example, 

or Molokai. So if there’s not an availability of, or it’s too expensive, 

and you’ve got to come to another island, well, I think that defeats 

the basic purpose of what we’re trying to accomplish. 

I think outreach remains a crucial thing for us all to focus on. 

There are veterans out there that are not being reached. In general, the veterans that are not being reached are the veterans that 

most need to be reached. I think that’s a truism. I think that we 

will find, and the Committee will observe and has already observed, that this is true on islands such as Molokai, in which I kind 

of fear that there is just not enough penetration, if I can put it that 

way, into the community that needs to be served. 

9

I think this has nothing to do with the efforts and intentions of 

people that are involved. The veterans councils have done a great 

job of trying to put together consolidated outreach efforts with Federal, State, and local Government and the veterans groups, and to 

reach people that need to be reached. 

Nonetheless, I think it has not been enough in some areas, and 

I think we all have to focus on a renewed effort to deliver to veterans, to take to their doors, in some cases, the benefits that the 

veterans structure does provide and does make available to them. 

We can’t get caught up in the thinking that because we tried, 

somehow if they’re not utilizing it that’s their problem. It’s not. It’s 

our problem. We want to reach these veterans. So one of the things 

that I think we need to do is redouble outreach efforts, especially 

to the more rural and remote parts of Hawaii. 

So where does this all leave us? Well, I just give you a couple 

of basic points, Senator Akaka, for consideration by the Committee. 

I think, first of all, I want to reiterate this all starts with a national priority to our veterans and a national commitment to our 

veterans and we have to focus there because nothing else is going 

to matter if we don’t get that straight. 

It is in danger right now, and we are having this debate as we 

speak, in Washington. It is being fought very hard for the veterans 

by your national veterans organizations, who are doing a masterful, great job of advocating. But that’s not going to be enough. 

We’re all going to have to hang in there. 

Again, the challenges of veterans nationally are the same challenges that we have here in Hawaii in a number of areas. 

Healthcare is number one. Access to Federal Government contracts 

I would put number two, and then basic outreach. I think that 

that’s important. If I were to say what the three priorities are, 

those would be them. 

We have challenges in Hawaii that affect Hawaii as a rural area, 

just as they affect any other rural area of our country. Access to 

medical care. The application of telemedicine, which is an amazing 

possibility, not possibility, actuality. I certainly encourage our National Government to redouble its areas in the area of telemedicine. 

That can eliminate distance problems right away, and all the 

issues that we have about getting veterans from Lanai to adequate, 

affordable healthcare on Oahu or Maui. We can do a lot of that just 

by basic telemedicine. We’re doing that in other areas of health 

provision in the neighbor islands. 

We have specific challenges for Hawaii as an island State. It is 

not as simple as just jumping in your car and driving 200 miles 

down the road, even though that’s a problem for many veterans. It 

costs a lot of money to get from Lanai nowadays to Tripler or wherever else you might go. We have to accommodate that. We’re trying 

to accommodate that. But I think we’ve got work to do. 

Other concerns are a little more individual. I talked about the 

cemetery situation. We have particular personnel issues that come 

up every once in a while in terms of the provision of broader veteran services. This is a hard job to provide. There’s some burnout 

involved, especially in some parts of it. We’ve got good, solid people 

that have been doing yeoman’s service out there. I think you all 

10

know somebody like that who’s in the system right now, who’s 

going above and beyond the call. 

But we’ve got to take care of the personnel that are working in 

the veterans area on behalf of all of our veterans. I think we’ve got 

to pay attention when those situations arise on an isolated basis. 

Again, I don’t think it’s something that’s pervasive. But I do think 

it’s something that has to be watched over. 

So those are some overall observations, so overall conclusions, 

some overall recommendations, and certainly some overall courses 

of action that I certainly intend to continue to pursue and which 

I want to pursue with you. 

I thank you again, Senator Akaka, for bringing the Committee 

here, and I thank all the participants here today. We all need to 

return to D.C., as you will next week and as I will later in the 

month, to redouble our efforts on behalf of veterans. We’re going 

into a new Federal budget. We’re going to get the new Federal 

budget in early February, and I fear for what it’s going to say 

about the priorities of veterans. I think we’re going to have to fight 

this fight all over again, so we’ve all got to be ready to do it. 

I certainly am there myself, and look forward to working with 

each and all of you. Thank you very much. 

[Applause.] 

[The prepared statement of Mr. Case follows:]

PREPARED STATEMENT OF HON. ED CASE, U.S. REPRESENTATIVE

FROM HAWAII, 2ND DISTRICT

I am proud and humbled to represent you and our Hawaii’s almost 120,000 fellow 

veterans in our U.S. Congress. 

Fully 14 percent of Hawaii’s adult population are veterans, one of the highest percentages in our Nation. Fully 5 percent of all Hawaii citizens 18 to 64 years old are 

currently serving in our armed forces, the highest percentage in our country. These 

numbers prove what we all know: that our Hawaii has been, is and will remain 

deeply committed to contributing to our Nation’s defense; and that we must all be 

especially dedicated to meeting our obligations to not only today’s veterans, but tomorrow’s as well. 

In my 2004 Veterans Report last June, I reported that the prior 108th Congress 

(2003–2004) was most difficult for our Nation’s veterans due to concerted efforts 

within our Federal Government to reduce benefits earned by current veterans and 

to underestimate the needs of future veterans. Unfortunately, that trend has continued in the current 109th Congress (2005–2006), where we have seen great resistance to funding especially crucial health needs and to recognizing the special needs 

of our troops returning from Iraq, Afghanistan and elsewhere. 

In this report, I summarize just some of many national veterans issues my Congressional colleagues and I have pursued to fully meet our country’s obligations to 

you and yours. I also summarize some of my efforts in our Hawaii, where I have 

been especially fortunate to ‘‘talk story’’ with so many veterans throughout our 

state. As you well know, here at home veterans needs are often different than on 

the mainland (for example, the difficulty in getting from island to island for 

healthcare or of maintaining veterans cemeteries on different islands). In addition, 

I tell you about my congressional office and how we can and want to help you, 

whether veterans-related or otherwise. 

Finally, especially important for me is a quick survey of your views and needs as 

one of our Hawaii’s veterans. This is invaluable to my continued efforts on your behalf, just as my June 2004 veterans survey proved indispensable, and I appreciate 

your response. 

It is my great privilege to serve you and yours in our Congress. I truly look forward to continuing to work with you on not only the needs of our veterans, but our 

other efforts toward a better Hawaii, country and world. 

With aloha. 

11

SELECTED VETERANS ISSUES IN THE 109TH CONGRESS (2005–2006)

1. Veterans Budget 

By far the most all-encompassing challenge continuing to face all current and future veterans nationwide is the ongoing effort in Washington, D.C. to limit funding 

of veterans benefits. 

As you know, the U.S. Department of Veterans Affairs (VA) administers promised 

benefits to eligible veterans, ranging from disability compensation and pensions to 

hospital and medical care. VA provides these benefits to veterans through three 

major operating units: the Veterans Health Administration (VHA), the Veterans 

Benefits Administration (VBA) and the National Cemetery Administration (NCA). 

VHA is mainly a direct service provider of primary care, specialized care, and related medical and social support services to veterans through an integrated health 

care system. Veterans are enrolled in priority groups that determine payments for 

service and non-service connected medical conditions. 

It is veterans healthcare generally and VHA specifically where we have seen both 

the greatest needs for our veterans and the most concentrated efforts to curtail 

funding. The current Administration’s budget request for fiscal year 2006 (which 

began on October 1, 2005) would have significantly shortfunded adequate veterans 

health care in fiscal year 2006 (as was demonstrated when the VHA ran out of 

money in June and came to Congress for a $1.5 billion supplemental appropriation 

just to get through fiscal year 2005.) 

As a Member of the House Budget Committee, I worked with colleagues on both 

sides of the aisle to craft a fiscal year 2006 budget that reined in our country’s spiraling debt and deficit while adequately funding our Nation’s highest priorities, including veterans benefits. When the fiscal year 2006 Budget Resolution, setting the 

overall framework for the Federal Government’s 2006 fiscal year, failed to do this, 

I voted against it. 

This basic debate continued throughout Congress’s consideration of H.R. 2528, 

making actual appropriations for VHA and other military/veterans programs for fiscal year 2006, with many national veterans groups joining us in advocating forcefully for adequate veterans funding. In mid-November, Congress approved a final 

version of this bill which funds VHA at more than what the Administration requested but less than what is necessary to keep up with true need. Obviously, this 

effort must continue and is, in my mind, the single most important veterans issue 

facing us all. 

2. Congressional Consideration of Veterans Issue 

Perhaps what has happened in Congress on veterans issues is not surprising 

given that the basic and time-honored legislative process in this area has eroded. 

Things didn’t get off to a good start in the current 109th Congress when the Chair 

of the U.S. House Committee on Veterans’ Affairs was replaced by House leadership 

because he was viewed as too sympathetic to veterans needs. 

More difficult to understand is the recent announcement by the current Committee Chair that the decades-old tradition of conducting annual joint hearings of 

the House and Senate Veterans’ Affairs committees will be discontinued. These 

hearings have provided an invaluable forum for Congress collectively to review the 

legislative priorities of veterans and military service organizations like AMVETS, 

the American Legion, Disabled American Veterans, Paralyzed Veterans of America, 

and Veterans of Foreign Wars of the United States, and to dialog directly with these 

invaluable representatives of America’s veterans. I joined many of my colleagues in 

a letter to the House Speaker decrying this decision and urging that it be reversed; 

at this writing that has not occurred. 

3. New GI Bill of Rights for the 21st Century Act 

Clearly, in the big picture, we must not only maintain the basic fabric of our prior 

undertakings to our veterans, but also adjust and update them to today’s and tomorrow’s needs. The best overall formulation of where we need to go is contained in 

H.R. 2131, the proposed New GI Bill of Rights for the 21st Century Act, which was 

introduced by my colleague, Representative Chet Edwards of Texas. I am an original cosponsor of the measure which, to date, has the support of 171 Members of 

Congress. 

H.R. 2131 seeks a wide-ranging update in our basic deal with our veterans. 

Among its many provisions, H.R. 2131 would (1) mandate adequate funding for veterans medical care, (2) prohibit until the end of fiscal year 2006 medication co-payments and imposition of a health care system enrollment fee, (3) extend until 2010 

Vietnam veterans eligibility for readjustment counseling services, (4) collect and 

process data from pre- and post-deployment health assessments, and conduct preVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00015 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
12

ventive post-deployment intervention, (5) seek early detection and treatment of posttraumatic stress disorder (PTSD) for returning troops, (6) establish a Department 

of Defense/Department of Veterans Affairs Council on Post-Deployment Mental 

Health, (7) increase survivors’ dependency and indemnity compensation (DIC), (8) 

provide certain pay increases and bonuses for active-duty members, (9) expand benefits under both active-duty and reserve Montgomery GI Bill programs, (10) provide 

employment assistance for homeless veterans, and (11) expand reserve member eligibility under the TRICARE program. This bill would also repeal the DIC offset 

from the Survivor Benefit Plan surviving spouse annuities. 

4. Concurrent Receipt 

Until 2004, Federal law required that military retired pay be reduced by the 

amount of any VA disability compensation received. For many years, some military 

retirees had sought a change in law to permit receipt of all or some of both, and 

legislation to allow this has been introduced during the past several Congresses, frequently with cosponsors, including myself, numbering well over half of both the 

House and the Senate. This is known as ‘‘concurrent receipt’’ because it authorizes 

the simultaneous receipt of two types of benefits. 

The fiscal year 2003 National Defense Authorization Act (NDAA), enacted in 

2002, created a benefit known as ‘‘combat-related special compensation,’’ or CRSC. 

CRSC provides, for certain seriously disabled retirees, a cash benefit financially 

identical to what concurrent receipt would provide them. The fiscal year 2004 NDAA 

authorized, for the first time, actual concurrent receipt, as well as a greatly expanded CRSC program. The fiscal year 2005 NDAA further liberalized the concurrent receipt rules contained in the fiscal year 2004 NDAA. 

While these initiatives, which I supported, addressed some of this longstanding 

injustice, I asked the House Committee on Government Reform to evaluate the extent to which Hawaii veterans in my Second District are still affected by the nonconcurrent receipt penalty. The Committee reported that over 2,100 veterans in our 

district—and over 4,500 veterans throughout the state—still lose benefits due to the 

disabled veterans tax. 

There have been a number of bills introduced this Congress seeking full concurrent receipt. The one with the greatest support is H.R. 303. This bill would (1) allow 

immediate concurrent receipt, rather than phasing it in between now and 2014, and 

(2) repeal the requirement that only military retirees with a 50 percent disability 

rating can qualify for concurrent receipt, allowing it for any retiree with a serviceconnected disability. 

I am a cosponsor of this bill. Also, because of current leadership’s refusal to bring 

this bill to the floor for a vote, I, along with over 200 of my colleagues, have signed 

a ‘‘discharge petition’’ which would mandate an up-or-down vote of the full House. 

As it takes a majority of House Members (218) to successfully force such a vote 

under this procedure, we have been working closely with national veterans groups 

toward achieving this goal. 

5. Survivor Benefit Plan (SBPI) 

Our country’s obligation to its veterans extends to your families. However, under 

previous law, surviving spouses who reach the age of 62 had their retirement benefits reduced from 55 percent of the deceased servicemember’s benefit to 35 percent 

of the deceased servicemember’s benefit. This unfair reduction—sometimes referred 

to as the ‘‘widow’s tax’’—caused a substantial hardship on the surviving spouse. 

Prior efforts, in which I joined, to eliminate the penalty were met with resistance. 

However, last year, sensing growing support, congressional leadership added a provision to the fiscal year 2005 defense authorization bill to phaseout the SBP penalty. 

Now, however, the issue, like concurrent receipt, is whether surviving spouses receiving survivor benefits should continue to be penalized by not being entitled to receive the combined total of such benefits and dependent and indemnity compensation (DIC). I and many other colleagues believe this is also unfair, and so have introduced H.R. 808 to eliminate the military families tax. 

6. Equity for Filipino Veterans 

Our Filipino veterans communities both in Hawaii and throughout our Nation 

continue to pursue the critical support needed to restore to our Filipino veterans the 

full benefits unfairly withdrawn by Congress in 1946. During the 108th Congress, 

we had partial success when Congress passed and the President signed into law 

H.R. 2297, which I had cosponsored, to increase VA benefits for U.S. Filipino WWII 

veterans and allow former Philippine Scouts living in the U.S. to be buried in VA 

cemeteries. 

This long overdue effort must be continued until full justice is provided to our now 

elderly Filipino veterans. To this end, I am a cosponsor of H.R. 302, the Filipino VetVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
13

erans Equity Act, to deem certain service performed before July 1, 1946, in the organized military forces of the Philippines and the Philippine Scouts, as active military 

service for purposes of eligibility for U.S. veterans benefits, and to repeal certain 

provisions discounting such service as qualifying service. We don’t have much time 

left to do the right thing here, and we are working toward doing just that. 

7. Federal Budget 

There should be no doubt that, in the big picture, the reason for the pervasive 

resistance in D.C. to full and fair funding of existing requirements and needs, much 

less long-denied needs and other initiatives necessary to provide basic fairness to 

our existing and soon-to-be veterans and to encourage enlistment in our armed 

forces, is largely the rapid deterioration over the last half-decade in our Nation’s 

overall finances. In a nutshell, we have not properly (1) balanced revenues and expenses, resulting in the largest annual deficits and fastest increases in our Nation’s 

total debt (now over $8 trillion, up $2 trillion just since I began representing you 

here in 2002) in our Nation’s history, (2) prioritized spending, and (3) addressed ongoing government inefficiency and waste. Until we correct these all-encompassing 

deficiencies, too many here will continue, in one form of another, to shortchange our 

Nation’s veterans. 

SELECTED HAWAII ACTIVITIES

1. Keeping In Touch 

Staying in touch with you and our Hawaii’s veterans is essential not only to recognizing your invaluable contributions, but to representing you in Congress and to assisting with Hawaii-specific challenges. I have been fortunate now to join you and 

speak at many Memorial Day, Veterans Day and other ceremonies throughout our 

state, in addition to many other events like the groundbreaking for the new Oahu 

Veterans Center and the annual cleanup at the Kauai Veterans Cemetery. I have 

also spent time just dropping by veterans centers on Molokai, Maui and Hawaii Island. 

My Talk Story community meetings district wide have been especially invaluable 

to keeping up on veterans issues, not just nationally but locally. I’ve done 50 in 2005 

throughout Hawaii as well as with Hawaii’s own 29th Brigade Combat Team in Fort 

Polk, Louisiana and Balad, Iraq. From these Talk Stories I learned, for example, 

of a crucial challenge facing Maui’s veterans, on which we are working, and of the 

Lanai veterans’ request for a U.S. flag flown over our Capitol, which I was able to 

provide. 

My point here is that we can accomplish more together and I can focus on your 

needs better if and as we stay in touch. I am always willing to try to work into my 

schedule a meeting with Hawaii’s veterans or attendance at an important event, 

and encourage you to call on me for such needs and opportunities. 

2. Visiting Our Troops 

Today’s active military forces are tomorrow’s veterans. Especially in this extremely difficult time, when we have hundreds of thousands of our own fighting for 

us overseas, I believe it is crucial for people like me to spend time with our troops 

where they are, not only to show our support and solidarity, but to understand and 

address current and future challenges. I’ve done this through visits throughout our 

Hawaii and overseas. I’ve now visited our troops in Iraq in 2003 and 2005, and in 

Afghanistan in 2004. My discussions and observations during those trips have 

played a major role in my own thinking on our obligations to our current and future 

veterans, including our guard and reserve component. 

3. Funding 

Many of our veterans issues in Hawaii involve funding of local needs, from cemeteries to centers and other facilities to specific programs. My efforts in this area 

have been to seek financial assistance from our Federal Government through existing programs or annual congressional allocations, and to support funding requests 

from individual veterans and your organizations and Federal, state and county government veterans representatives. As we move into the Federal Government’s 2006 

fiscal year, and look already toward the fiscal year 2007 congressional appropriations process which starts up in the remainder of this year and early next year, I 

especially need to hear from you on specific Hawaii needs so I can assist in the best 

manner available. 

4. Benefits Workshops 

Over my last 3 years of representing Hawaii veterans, both individually and collectively, it has become increasingly clear that in too many instances our veterans 

14

are simply not fully aware of their benefit and other rights and entitlements under 

law. I discussed this challenge most recently with Dr. James Hastings, the new director of the VA’s Pacific Health Care System, and will be working with him and 

your other veterans agencies to sponsor a series of outreach benefits workshops 

throughout my district. I am aiming to conduct these workshops in the first quarter 

of 2006, and welcome your input on how best to do so and how my office may otherwise assist in educating our veterans on the basics of our veterans system.

Senator AKAKA. Mahalo. Mahalo nui loa, Representative Case. I 

thank you very much for what we call in Hawaii mana’o, and it 

starts about veterans here and across the country. Thank you, Representative Case, so much for taking the time to be with us this 

morning. Mahalo nui loa. I want to thank him for being here. 

I’m pleased also to tell you that we were joined by Chairman 

Larry Craig for the past 2 days. We’re very fortunate to have him 

because he has other schedules. But he certainly really contributed 

to the hearings and the success of the hearings that we’ve already 

had. But he reluctantly had to go back to his snowy State because 

he had other responsibilities there. 

I want you to know that this is bipartisan effort. We work very 

closely together and very well together, and look forward to continuing to do that to help our veterans here in Hawaii. I’m also 

pleased to announce that the VA at the national level and the regional level and the State level on Maui and Kauai did make statements that they’ll help our veterans on Molokai and Lanai as well. 

I think they have unique problems, too. 

But this has been very fruitful for all of us. I want to again mention that it made a difference. I want to thank Representative 

Case. I know he has a busy schedule. 

I also want to mention that in the back of the room, uniquely, 

we have a desk of staff, VA staff as well as our staff in the Senate, 

who are there to help anyone here who has a concern or needs 

some help. You can go back there and talk with them. 

In case you have a letter, please present it to them. I think you 

know that letters are very important to us because if we do any 

inquiry, you know, it’s a privacy issue that we have to be careful 

of, and receiving a letter from you does take care of that for us. 

I just wanted you to know that they’re back there. So please feel 

free to stand and seek that help. 

My purpose in holding these hearings is to find out, as the Ranking Member of the Veterans’ Affairs Committee, how we can help 

VA provide the best care and services to Hawaii’s veterans. That’s 

what we’re here to do. 

So I’d like to call forward our first—our panel here, which is now 

our second one. William Daves, who’s President of Oahu Veterans 

Council. Mike McCloskey, who’s a member of the National Executive Committee of the American Legion, Department of Hawaii. 

Caz Roswell, service officer, military, awarded the Purple Heart. 

Lieutenant General (Ret.) Tom Rienzi, Veterans Advisory Council. 

Gil Hough, member of the Veterans Advisory Council. Colonel 

(Ret.) Edward Cruickshank, Director, Office of Veterans Services. 

We’re delighted to have all of you here. I would like to ask you 

to give your testimony in the order that I introduced you. So the 

first will be William Daves, and here’s your mike. 

15

STATEMENT OF WILLIAM DAVES, PRESIDENT,

OAHU VETERANS COUNCIL 

Mr. DAVES. Thank you and mahalo. 

I want to talk this morning about a program that the VA have. 

It’s called CHAMPVA. CHAMPVA is given out to people on DIC, 

and there are no doctors. There are two on Oahu, I think. 

I happen to know of a widow that’s getting DIC with two children. There are no doctors. There are no pediatricians. I can’t ask 

anybody in the VA. They give me the telephone number of the 

place in Denver, and that’s as far as you get. That’s all I wanted 

to talk about this morning. 

STATEMENT OF MICHAEL MCCLOSKEY, MEMBER, NATIONAL 

EXECUTIVE COMMITTEE, THE AMERICAN LEGION, DEPARTMENT OF HAWAII 

Mr. MCCLOSKEY. Good morning. I’d like to thank Congressman 

Case, Senator Akaka, the VA staffers that are here, and of course 

all the wonderful veterans and their families that we’ve got turned 

out. Mahalo for coming, and aloha. We provided our written testimony from the American Legion’s perspective. There are just a couple of things that I’d like to cover. 

The American Legion’s position on medical care for veterans is 

mandatory funding. Mandatory funding is needed so that every 

veteran is adequately taken care of whenever they go to a VA clinic. We are at war, ladies and gentlemen. This is not the time to 

be arguing over veterans benefits or trying to nickel and dime folks 

that are shedding their blood and their sweat for this country. We 

simply need mandatory medical care. 

Congressman Case spoke very briefly about the battle that’s 

going to come in Congress over funding for the VA. I know that the 

VA sitting over here is going to work hard to get as much money 

as they can to do the best they can for you. 

It’s not going to be enough. Right now, only about 20 percent of 

the veterans in this State seek and receive VA medical care. Many 

of them do not seek care simply because it’s so hard to access. As 

Congressman Case pointed out, geographical separation, cost of 

travel, lack of specialists, these all contribute. The bottom line is 

always money. We rely on our congressional delegation, led by Senator Inouye and Senator Akaka, to help us with this issue. It is our 

major issue. 

The American Legion also has some major concerns about the reassessment of PTSD claims. We are very pleased that those claims 

were not reviewed, the 75,000 cases. We believe that would have 

been counterproductive not only for the VA, but extremely harmful 

to those involved in the process. 

Lastly, I’d like to talk a little bit about readjustment counseling. 

We have a great readjustment counseling service led by Steve Molnar here on Oahu. It’s not big enough. We need two Vet Centers 

on this island. Ideally, we would have a Vet Center located somewhere in Kapolei. Population growth on the leeward coast mandates some VA services be placed in that area. I believe that that’s 

something we could do. 

The clinics on the outer islands are doing a great job. The Vet 

Centers on the outer islands are doing a great job. But they need 

16

help. People, some people, do not go to access those services because they don’t want to wait in line. 

In conclusion, I’d like to say a couple of real good things about 

the VA. The voc rehab program under Ed Gavigan [ph] is excellent. 

They’re doing a great job. But he needs help, too. The loan guarantee program is also doing an excellent job. They just lost one of 

the best in the business when Tom Sirocca [ph] retired last year. 

But I believe the young lady that they’ve selected to replace Tom 

is going to do a great job. 

We ask that Senator Akaka and Congressman Case fight hard so 

that we can get the Native Hawaiian program—the Native American loan program, thank you—passed and make it permanent. 

That would be really a great deal. 

I see Jim Carilli sitting out here, and most of you know Jim. He 

used to be my boss. There were some at the VA that probably 

thought that the claims process and the workload might improve 

after I retired a year or so ago. Sadly, it didn’t. Jim needs help. 

He needs more people to do this very complex medical and legal job 

that he’s got. We need to encourage our congressional delegation to 

give these folks all the help they can get. 

Thank you very much, Senator Akaka. I appreciate this opportunity to speak. We hope that you’ll carry this back and continue 

to help our veterans in Hawaii. Mahalo. 

[The prepared statement of Mr. McCloskey follows:]

PREPARED STATEMENT OF MICHAEL MCCLOSKEY, MEMBER, NATIONAL EXECUTIVE

COMMITTEE, THE AMERICAN LEGION, DEPARTMENT OF HAWAII

Senator Akaka, Thank you for the opportunity to participate in this forum. Our 

purpose is to bring to your attention various issues and concerns related to the quality and availability of Department of Veterans Affairs health care for veterans who 

reside in Hawai’i. 

As the largest war time veterans organization in the State, we believe we are 

uniquely qualified to speak on these issues. 

1. As National Commander Bock stated in his September 20, 2005 before a joint 

session of the Congressional Veterans Affairs Committees, there have been recent 

attempts by some in the 109th Congress to create an artificial distinction among 

veterans; the so-called ‘‘core constituency’’ of veterans eligible for VA Medical Care. 

There have been characterizations of deserving versus undeserving. Veterans who 

Congress granted eligibility for medical care were accused of seeking a ‘‘free ride’’ 

and causing ‘‘real’’ veterans to wait for care. Honorable military service, whether for 

a single enlistment, a 30-year career or National Guardsmen and Reservists called 

to active duty for shorter periods due to war time operations is not comparable to 

civilian employment. It is not just another job! Now who answer the call to arms 

are entitled by law to very specific individual legal status and entitlements that 

must not be denigrated regardless of whether or not their service involved participation in direct combat operations or in support roles. There is no draft or otherwise 

involuntary military service in the United States. We as a Nation rely upon the willingness of the population at large to serve. Consequently, debate regarding whether 

or not one group or another is more or less deserving is not only hurtful to the individuals concerned but damages our ability to recruit and retain capable individuals 

at a time when we most need them. Consider, what would have become of this 

Country if such debate and controversy had existed in some of the most critical 

times in our history, e.g., the Revolution, the Civil War, or World War II. It is with 

this in mind that we support MANDATORY funding of medical care for all honorably discharged veterans. This is the minimum that should be provided to those who 

raise their right hands and swear to uphold and defend our way of life. Medical care 

for those who we should not be an annual political ballgame with the only losers 

those who shed their blood and sweat to insure the continued existence of our Country. It is time to stop balancing the National Budget on the backs of those who defend us. 

17

2. Approximately 110,000 veterans reside in the State of Hawai’i. In recent years, 

this population has been decreasing due to the demise of aging World War II and 

Korea Veterans. However, the current war which must be assumed will continue for 

some years to come will undoubtedly keep this number either stable or increasing. 

Department of Veterans Affairs data indicates that only about 20 percent of the veteran population receives care from VA medical facilities in Hawai’i. Input from our 

membership indicates that many more would do so but for the difficulties veterans 

experience in getting to and from VA those facilities. There are a number of factors 

that contribute to this problem. One of the most significant is the fact that we are 

an island State. One cannot drive from Molokai to O’ahu. In recognition of this the 

Department of Veterans Affairs has established outpatient clinics on the major 

neighbor islands of Hawai’i, Kaua’i, and Mau’i. new Clinics have generally provided 

excellent service to those who are able to access them. However, it is our position 

that too few veterans are We to access that care simply because of limited clinic 

staffing and limited dollars in the VA budget. Nearly 75 percent of our veteran population resides on the Island of O’ahu. Even on O’ahu which has the largest and 

most sophisticated VA clinic in the State, most veterans do not seek VA medical 

care unless they have no other option. Again, limited staffing and limited budget 

dollars restrict many who need and deserve VA care. Put simply, we need more doctors, more nurses, and more and better equipped facilities. Now, neighbor island patients are often flown to O’ahu for medical care and examinations that cannot be 

conducted locally due to limited or non-existent facilities. Many debilitated or aged 

veterans required to make these trips need the assistance of an attendant to travel. 

The cost of the travel makes this a difficult budget issue for the VA but oftentimes, 

the lack of local specialists or simply the prohibitive cost of private sector treatment 

mandates it. Larger, more comprehensive facilities on each major island would 

eradicate this problem. The argument that many veterans have a wide range of 

medical care alternatives outside the VA does not negate the Nation’s obligation to 

those who served VA is in effect rationing medical care. This rationing causes many 

aging veterans to pay high insurance premiums and to make difficult and ultimately 

unhealthy choices, e.g., do I pay for the medication I need or do I buy food and pay 

my rent? now who served should not be asked to make sacrifices of this nature. 

3. Another problem of increasing concern is the lack of adequate long-term medical services and facilities in the State. The VA’s Center for Aging is a 60-bed facility located on the Tripler Army Medical Center. It provides excellent service from 

a highly trained staff of dedicated medical professionals. However, it is totally inadequate to meet the needs of our aging veteran population. Consequently, it is used 

to care primarily for patients requiring short-term inpatient care as in surgery recovery. It is not intended for long-term care. To meet the needs of our veterans, 

similar facilities should be constructed on each of the major neighbor islands. In this 

same regard, a State Veterans Hospital intended for long-term care is in the works 

on the Island of Hawai’i at Hilo. This is a great start but again is totally inadequate 

to meet the needs of the aging veteran population of this State. Our Congressional 

Delegation is asked to support the development of similar facilities on each of the 

major neighbor islands. 

4. We have a number of concerns regarding the care and treatment of veterans 

suffering from post traumatic stress disorder (PTSD). The number of veterans filing 

claims for service connection and treatment for this condition has risen dramatically 

over the past 10 years. As we are engaged in a global war of unknown duration it 

is likely that the number of these cases will continue to increase. Consequently, the 

cost of compensation and treatment is also likely to escalate. This issue and the collateral issue of awarding Individual Unemployability (IU) benefits to many veterans 

disabled by symptoms of PTSD apparently prompted the Department of Veterans 

Affairs last year to begin questioning whether some of these claims were appropriate. A review of several thousand cases was conducted, and a review of all such 

cases granted was announced. As you can imagine, the impact of this announcement 

on those who suffer from PTSD and rely totally on VA compensation as their only 

income was enormous. Many patients symptoms were exacerbated because of fear 

that VA would stop their compensation payments and/or interfere with their ongoing clinical psychiatric care. Many of these veterans had fought for years to obtain 

the benefits and it was seen as a setback by not only veterans but mental health 

care professionals as well. Subsequently, the VA announced that the review had 

been canceled and we applaud that decision. However, we have been recently advised that another move is being made by VA to perhaps restructure the Rating 

Schedule or to change the criteria for a PTSD diagnosis. Obviously, fewer diagnoses 

of PTSD or fewer grants of compensation based on PTSD would save lots of money. 

This appears to be another attempt to balance the budget on the backs of those who 

served. It is a particularly malignant scheme that presumes that lawyers and bean 

18

counters know more about mental health and the impact of trauma than mental 

health professionals. The DMSN which provides the basis and requirements for diagnosis of mental illness is predicated on input from the best qualified mental 

health professionals in the Nation. We oppose any effort to restrict or change the 

application of criteria currently established by law for the diagnosis of PTSD or the 

award of compensation benefits based on such diagnosis. We believe that this is particularly unconscionable in light of large numbers of troops returning from the war 

zone and in need of help for symptoms of PTSD. 

5. There are currently five Vet Centers in the State. These facilities provide outreach efforts for readjustment counseling and family counseling for all war time veterans. They have proven to be particularly effective and cost efficient. We currently 

have two on the Island of Hawai’i (Hilo and Kailua—Kona), one on Kaua’i, one on 

Mau’i, and one O’ahu. All of these facilities provide excellent and easy to access 

services to literally hundreds of veterans and their families. However, the Honolulu 

office is not adequate to meet the needs of our island community. A second facility 

is needed to meet the increasing need and permit easier access from O’ahu communities outside Honolulu proper particularly the rapidly growing population of the 

Leeward Coast. We solicit your support in acquiring the necessary funding for additional staffing and a new facility somewhere in the Kapolei area. 

6. Until last year, the VA maintained an inpatient facility for treatment of PTSD 

on the Island of Hawai’i. That facility was closed with the stated intention of moving it to the Island of O’ahu. The new facility has not opened. Put simply, this is 

an important tool in dealing with our growing PTSD patient population. This facility 

combined with our VA mental health clinics and Vet Centers has been an extremely 

effective tool for dealing with what we perceive to be a growing problem. Please insure that adequate funding is provided to make the new inpatient facility a reality. 

In closing, Senator Akaka, Members of the Commission, and fellow veterans, we 

greatly appreciate this opportunity to present testimony regarding VA healthcare in 

Hawaii. We hope that the information we have presented will be valuable and useful to you in making good decisions for veterans when you return to Washington. 

As you can see, the VA in Hawai’i has unique problems because of the geographic 

separation of our islands and distance from the continental United States. Our VA 

facilities also face the burden of caring for many veterans who reside in Guam, Micronesia, and Samoa. With all this in mind, we hope that your actions will reflect 

the needs of our veterans and provide us with the tools to meet the challenges of 

the 21st Century. On behalf of all veterans and especially members of the American 

Legion Department of Hawai’i, we thank you sincerely for allowing us to participate 

in this vital endeavor.

STATEMENT OF MASTER CHIEF PETTY OFFICER GIL HOUGH 

(RET.), U.S. NAVY; MEMBER, VETERANS ADVISORY COUNCIL 

Master Chief HOUGH. Senator Akaka, distinguished guests, and 

fellow disabled veterans, good morning and aloha. My name is Gil 

Hough. I’m a retired Master Chief Petty Officer in the United 

States Navy who served 30 years. I am also a member of the Pacific Healthcare Advisory Board of the Department of Veterans Affairs. 

First, I’d like to say thank you, VA. The VA to me and my family 

have been there for everything we’ve needed. When I first came to 

Hawaii on my 35th birthday, they gave me a GI loan to buy my 

first house. They paid for me to get an associate, bachelor’s, and 

master’s degree. They gave me veterans preference and disability 

when I returned, veterans preference in hiring so I could become 

the Director of the U.S. Department of Labor here for veterans employment and training. 

They put me in the hospital as a patient. I received medicine 

from them in the mail, direct, very promptly. Something I don’t 

want to—well, I will. But my son recently passed away in the VA 

hospital in Portland, and the VA provided extraordinary care for 

him. He was too sick to survive. He’s also buried at the Willamette 

National Cemetery in Oregon. So I’m going to say that we are a 

consumer of the VA in my family. 

19

Is there something wrong with the VA? Well, sure. Somebody as 

large as the VA, there’s always going to be problems. I’m very 

pleased that General Hastings was appointed to be the new Director because I know with he and General Pollock, they can help us 

maximize our resources and services to provide even better services 

for our veterans. 

I know right now there’s a concept of building a joint hospital in 

Great Lakes, Illinois, a Navy/VA joint hospital. That would be 

great. Hawaii is simply one of two States in the Nation that doesn’t 

have a VA hospital. Yes, Senator, we need more money if we don’t 

have a hospital, so we need better services. 

I want to say the Center for Aging is a real class organization. 

Just terrific. I’ve seen doctors up there cooking hamburgers and hot 

dogs for their patients. It’s just great. I’d like to see some more 

beds because we have a lot of veterans that are old and need the 

services, especially on the neighbor islands. 

I’m going to just talk about a couple of things. They’re not real 

negatives, but they could be fixed. One of them, Norbert Enos [ph], 

our past state commander for the VFW, told me that he recently 

picked up a veteran that came from the neighbor islands to bring 

up to the VA for an EKG test. Well, I’m sure that we can give an 

EKG in Maui. I mean, it’s not rocket science. 

Another case that was shared with me by a member here in this 

room is a veteran came over from a neighbor island to his appointment. He got tied up with the security processing, was 20 minutes 

late, and they canceled his appointment. He had to make a new appointment and come back 2 months later. Now, that is just really 

not right. We’ve got to figure out something to do to improve that. 

A third item that concerns me is the orthopedic care that our veterans get. We have veterans that are very aged, 75, 80 years old, 

and we want to send them to Palo Alto for a hip replacement or 

a knee replacement? That’s unacceptable. They have a hard time 

getting back on their own. 

We need to figure out here in Hawaii how to get that done. I 

mean, we can do it. We’re a great State. We’re the 50th State. 

We’ve got the power and the genius to get all these things accomplished. 

My fellow veterans, that’s all I have to say, but thank you very 

much. 

[Applause.] 

[The prepared statement of Mr. Hough follows:]

PREPARED STATEMENT OF MASTER CHIEF PETTY OFFICER GIL HOUGH (RET.),

UNITED STATES NAVY; MEMBER, VETERANS ADVISORY COUNCIL

I have the distinct honor of residing in Hawaii since February 3, 1978. I arrived 

here on that date to serve on the staff of the Commander in Chief, United States 

Pacific Fleet. I retired from the United States Navy on July 1, 1989 and made Hawaii our family home. 

The services provided by the Department of Veterans Affairs in Hawaii are outstanding. I personally have received benefits/services from them to include: home 

loan guaranty; education benefits; disability payments; preference in Federal hiring; 

hospitalization, dental treatment; pharmacy services and general health care. My 

shipmates and I are very proud of them and lucky to have the great services that 

the VA provides us. However, this is mainly because we live on Oahu! 

The consolidation of VA services with the United States Army in Hawaii (Tripler) 

was an absolute stroke of genius and provides a catalyst for future consolidation of 

20

services which will serve to maximize and leverage Government funding and services. 

I retired as the Director, Veterans’ Employment and Training Service, United 

States Department of Labor on March 31, 2004. I had the opportunity to provide 

services to veterans in the State of Hawaii, Guam, and Asia. During my tenure the 

only negative areas that were personally encountered are services to our Neighbor 

Island veterans by all Agencies because services and facilities are limited. 

It would be my fondest wish that you and your colleagues do everything in your 

power to ensure the necessary stream of funding to ensure services to veterans on 

our Neighbor Islands are increased, services improved, and new facilities created. 

I know my fellow veterans on our Neighbor Islands will provide you with their 

issues regarding services to them. 

I wish to thank you for your outstanding contribution(s) to our great State and 

Nation. Please continue to do everything possible to ensure that our veterans continue to receive that which they so richly deserve.

STATEMENT OF LIEUTENANT GENERAL THOMAS RIENZI 

(RET.), CHAIRMAN, VETERANS ADVISORY COUNCIL 

General RIENZI. Sir, my name is Tom Rienzi. I’m Chairman of 

the Veterans Council here. I take a little bit different view, having 

stumbled around here for the last 50 years. I’ve been Chairman of 

the Retirement Council, and now the Veterans Council. I think I 

reasonably have seen and know what goes on and this is what I 

have to say. 

As Chairman of the Hawaii Veterans Council for the Pacific 

Ocean area, I state that the veterans/military hospital in Tripler, 

and the CBOCs, the clinics, are the best in the world. 

[Applause.] 

General RIENZI. It serves more than 120,000 vets, as Congressman Case said, about 60K in his area and 60K in the other congressman’s area. It serves these 120,000 in a superior manner. I 

worked there as a chaplain for 22 years, so a chaplain knows an 

awful lot of what goes on in a hospital. 

Additionally, the VA staff, in my opinion—and I’m just a dumb 

little Italian from Philadelphia—the VA staff is well-organized, capable, to serve our veterans promptly and effectively. I didn’t say 

efficiently; I said effectively. 

[Laughter.] 

General RIENZI. I think a thing you should know, with the help 

of Max Cleland, Senator Max Cleland, who was my first aide, up 

on that hill now we have a VA hospital and a military hospital in 

the same place for the old fellows at one end and the young fellows 

at the other end. That’s quite an accomplishment. 

Finally, if you would look at what we had 2 years ago in the 

outer islands, it was next to nothing. Today, except for Molokai, we 

have a veterans facility, a CBOC, a clinic with a nurse or a PTSD 

person. The only one we’ve missed so far is Molokai, and we’ll get 

there. 

We’re a hell of an organization doing a hell of a job. Are there 

mistakes being made? Yes. Are there cases in this room here that 

are awful? Well, I say bring them to me or bring them to Dr. 

Hastings and we’ll solve them. 

God bless America, and God bless our veterans. 

[Applause.] 

[The prepared statement of Lieutenant General Rienzi follows:]

21

PREPARED STATEMENT OF LIEUTENANT GENERAL THOMAS RIENZI (RET.),

CHAIRMAN, VETERANS ADVISORY COUNCIL

As the Chairman of the ‘‘Hawaii VA Council’’ for the Pacific Ocean area, I state 

that the VA/military hospitals on Tripler Hill is the best in the world. It serves our 

100,000 veterans in a superior manner. Additionally, the VA staff is well-organized 

to capably serve our veterans promptly and effectively. 

With the help of Secretary Max Cleland, we combined the VA and military hospitals to be like one in caring for our personnel.

STATEMENT OF CAZ ROSS, VETERAN SERVICE OFFICER,

THE MILITARY ORDER OF THE PURPLE HEART 

Mr. ROSS. Very difficult to follow General Hastings [sic]. I really 

appreciate your sentiment. 

General RIENZI. That’s General Rienzi. 

[Laughter.] 

Mr. ROSS. That’s right. Excuse me. Lieutenant General Thomas 

Patrick Rienzi. Yes, we’ve talked a lot. 

Chairman Akaka, Senator—Representative Case—I’ve promoted 

him already—and veterans who are here in attendance as well as 

members of the VA staff and senatorial staff, my name is Caz Ross 

and I’m the Veteran Service Officer for the Military Order of the 

Purple Heart as well as the Veteran Services Coordinator with the 

Office of Veterans Services. I also work with those members who 

are really in the Pacific, those people who are in Guam and in 

American Samoa. 

I’d just like to share just a small bit about of the excellent services that we get here on Oahu. We do get the best of medical care, 

and we have in fact had numerous awards that show that the VA 

medical care that we get on here in Oahu is in fact fantastic. 

Can we do more? Yes, through telemedicine, Oahu will be the 

center and we’ll be able to get more services not only to our neighbor island individuals but also to those individuals in Guam as well 

as in American Samoa. It’s just taking a lot of time, and many of 

those individuals are extremely frustrated with the amount of time 

that it’s taking. 

We also have the same problem in terms of getting more medical 

care to our neighbor island people. That’s what we’re advocating 

for. We’ve got a very good system. We just need more of that system focused to those individuals in our rural areas, whether it be 

on Oahu or in our neighbor islands such as Molokai; Lanai, which 

we have 300 veterans on; Kalaupapa, where we have 5 veterans on. 

These individuals also need to be able to receive adequate medical 

services. 

A little message in terms of just talking about the services that 

we get from our benefits section. To date, service is slow due to the 

number of FTE not meeting the station’s needs. I’ve been asked 

also to talk about another issue, and that issue is what we call 

1151. This refers to individuals who in fact have medical conditions 

that become a problem because some medical problem occurred 

while those individuals were in a medical facility; a non-VA medical facility. 

As long as these individuals go to VA facilities, it’s fantastic. 

However, in the State of Hawaii, we only have one VA clinic. The 

vast majority of individuals are sent out, either to Palo Alto or 

someplace else in California, and receive medical care. 

22

When they receive that medical care under the direction of the 

Department of Veterans Affairs in a VA facility, they are able to 

be compensated for any injury that is unintended. For example, if 

somebody loses an arm or a finger because of something that happened that’s not intended to happen but it does, then these individuals are able to claim for a service-connected disability. 

However, for those individuals who go to Straub, St. Francis, or 

Tripler Medical Center, they are not able to get the same type of 

benefit. They are not protected. We need to ensure that the Legislature, meaning the Congress, changes 1,151, especially Section 38 

U.S.C. 1701(3), which states that only those facilities under the direct control of the Department of Veterans Affairs are eligible to 

receive this type of protection. We need to include all veterans in 

Hawaii who go to non-VA medical facilities and who are not able 

to travel to the mainland, and make them comparable to the services that they will get at any other VA facility. 

Another thing that I would like to touch upon is that Hawaii is 

an island State. Everyone here noticed that. But when we have 

consolidation of services in terms of benefits, sometimes we lose 

out. 

Right now, we have a consolidation where we in Hawaii have to 

call to either Muskogee, Oklahoma or to St. Louis or to Minneapolis-St. Paul for certain types of benefits. People in Hawaii 

only have a 2-hour window to get in a 1–800 telephone call, and 

it doesn’t happen. It’s just very difficult in terms of accessing these 

services because the services have been consolidated to a mainland 

facility. 

Part of the solution, of course, is money. We’ve talked about this. 

We need to have an adequate number of raters here in the State 

of Hawaii so that we can handle ratings for those individuals. We 

don’t have to send off so many of our claims to the mainland to be 

worked. 

I want to thank the VA for the services that they do provide. I 

want to thank the healthcare staff particularly because you’ve 

come a long way from where we first started. VA Benefits Staff are 

struggling, but I know that your people are working really hard to 

make this one of the better units in the United States. 

Again, thank you so much for allowing me to testify. 

[Applause.] 

STATEMENT OF COLONEL EDWARD CRUICKSHANK (RET.), 

DIRECTOR, OFFICE OF VETERANS SERVICES 

Colonel CRUICKSHANK. Senator Akaka, Members of the Senate 

Committee on Veterans’ Affairs, my name is Ed Cruickshank. I’m 

the Director of Veterans Services for the State of Hawaii. Based on 

everything you heard so far, I’m going to change my testimony because I just don’t want to repeat myself. 

But before I get started, I’d like to recognize the Wessel [ph] family back there in the room. They lost their son fighting in Iraq. Will 

the Wessels please stand up? Let’s give them a hand. 

[Applause.] 

Colonel CRUICKSHANK. Thank you. 

Before I discuss some of the challenges that we all face here—

and it’s primarily because we’re an island State—as Senator Akaka 

23

said, getting the services to our outer islands to provide services for 

veterans is a real problem. Getting the services here, we’re very 

lucky. But we need to find ways to get services out to the other islands. 

But before I mention the challenges, I want to let all of you 

know, as everyone else has said so far, the VA healthcare has been 

excellent. The way the VA staffs treat their veterans—they treat 

their veterans with dignity and respect, and they do everything 

they possibly can to show the veterans they really do care. To you, 

General Hastings, I’d like to say your group and General Pollock 

do a wonderful job. With our returning 2,900 soldiers coming back 

this week, let me tell you, we’re going to be counting on you to provide that service to them. 

On the island of Oahu, we have 70 percent of the veterans here. 

Two concerns that they have—well, not for those that are here but 

for those that are located on the other islands—is what they get 

assigned to mainland VA medical centers for surgical services. For 

neighbor island veterans, this can be very traumatic. They’re saying, please let us fly out if at all possible from the neighboring islands. Especially since our veterans are quite elderly, many times 

it’s a lot easier for them to do that. 

The other part that they keep mentioning a lot to me continually 

is on specialty care. I know when I spoke to General Hastings on 

this telemedicine, what is happening and what his goals are in the 

future, being just recently appointed, he’s mentioned that we’ve got 

to get this telemedicine to the other islands so that we can take 

care of our veterans. I hope on his behalf, that really will be an 

integral part and something that happens very, very quickly. 

I’d like to just—we’re a little bit separate from what we said 

here, and that is I think all of us have to continually address the 

issues of veterans and what care they’re getting. For all of you 

here, you know exactly what we’re talking about. But to you, Senator Akaka, it always comes down to a matter of money. If we can 

get the money or if VA can get the money, they can do their job. 

There’s only so much they can do based on the amount of money 

that they have. That becomes the issue. 

So for all of you here, thank you very much for supporting the 

veterans. That completes my testimony, Senator Akaka. 

[The prepared statement of Colonel Cruickshank follows:]

PREPARED STATEMENT OF COLONEL EDWARD CRUICKSHANK (RET.), DIRECTOR, 

OFFICE OF VETERANS SERVICES

Chairman Craig, Senator Akaka and Members of the Senate Committee on Veterans’ Affairs, I am Edward Cruickshank, Director of the Office of Veterans Services, this office serves as the single office within the State Government responsible 

for the welfare of Veterans and their family members. We act as a liaison between 

the Governor and veterans groups and organizations and serve as an intermediary 

between the Department of Veterans Affairs and Hawaii’s veterans. Based upon veteran’s population estimates as of September 30, 2004, data from the Office of the 

Actuary, Department of Veterans Affairs, there are 107,310 veterans in Hawaii. The 

majority or 72 percent live on Oahu, 13 percent reside on the island of Hawaii, 10 

percent live on one of the three islands which comprise Maui County, and approximately 5 percent live on Kauai. We are an island state located in the middle of the 

Pacific Ocean and Hawaii presents unique challenges for the Department of Veterans Affairs. 

Before I discuss some of these challenges, I want to share with you comments that 

my staff and I hear about VA health care very frequently. These comments speak 

24

to the excellence of VA care, how VA’s staff treat our veterans with dignity and respect, and that the services rendered by the dedicated health care professionals is 

superior to the care they received on the mainland (that is the continental United 

States). These comments are shared with us by local veterans as well as by veterans 

who visit Hawaii and have a need to interact with Spark M. Matsunaga Medical 

staff. When you speak of an organization that supports our troops, the VA exemplifies that phrase by supporting our troops at home, when they return and after conclusion of their military service. I am delighted with the services that VA offers to 

Hawaii’s veterans, to include the health care, benefits, and services provided at the 

National Memorial Cemetery of the Pacific; locally known as the Punchbowl Cemetery. 

As mentioned earlier Hawaii presents challenges to the VA. We are an island 

state with one large population center on Oahu and 30 percent of veterans living 

on the neighbor islands. Presently many of our veterans are referred for surgical 

services to mainland VA medical centers. For neighbor island veterans this can be 

very traumatic. They are booked on flights, sent to a city on the mainland, find the 

VA facility, operated on and sent back to Hawaii. We ask that: those who reside 

on neighbor islands that have direct flights to the mainland be offered, at a minimum, return flights that do not require a stop in Honolulu but fly directly to their 

island of residence. Individuals who are recovering from surgery are further inconvenienced by a delay in route because they were not booked on a direct flight. This 

delay increases the time these individuals endure pain and discomfort. Direct booking is available, we ask the VA to make this option a standard. 

Another issue that affects Hawaii and Alaska involves changes that were made 

to 38 U.S.C. 1151, Benefits for persons disabled by treatment of vocational rehabilitation. With the change the only facilities covered by the law are those over which 

the Secretary of Veterans Affairs has direct jurisdiction or Government Facilities 

contracted by the Secretary. Tripler Army Medical Center and other medical facilities in Hawaii, such as Straub, Queens and St Francis do not qualify. This means 

that in the unlikely event that a veteran is disabled or their death is caused by hospital care, medical or surgical treatment, or examination in any medical facility that 

VA refers the veteran to in Hawaii, he or she will not be covered under 38 U.S.C. 

1151. The definition as listed in 38 U.S.C. 1701 (3), of who is covered by the law 

should be changed so that veterans in Hawaii are afforded the same protection as 

veterans who receive VA medical care in VA facilities on the mainland. Hawaii’s 

veterans must have the same right of redress as veterans treated at mainland VA 

facilities. They too must be able to apply for and be granted compensation for injuries and not forced to pursue legal action against the facility. Only a modification 

of the law can address this issue. We ask the Committee to consider including VA 

referrals to medical facilities that provide surgical and medical treatment in Hawaii 

and Alaska under 38 U.S.C. 1701(3). 

Hawaii’s neighbor islands must be offered the same level of medical care and services as veterans located on Oahu. Presently neighbor island veterans wait long periods to be scheduled for specialty medical care. With the use of Tel-a-medicine, this 

problem is being addressed, never the less, implementation has been slow. Veterans 

have been known to wait several months before they see a specialist. We can and 

must do better in supporting these veterans. Additionally, VA should consider contracting dental care on the neighbor islands. With rising airline fairs, contract dentist may save veterans time and the VA much needed dollars that can be reallocated 

to other needed medical services, such as orthopedic or mental health services. 

As you are aware, Hawaii will be receiving thousands of its returning National 

Guardsmen and Reservist. As Director of the Office of Veterans Services and a Vietnam combat veteran I want these returning military members to be able to access 

medical and benefit services in a timely manner. We ask that VA Health and Benefits Administration be adequately staffed to provide medical care and benefit services to all veterans who make Hawaii their home. I know this involves dollars, however, as an organization that supports our veterans, we must acquire funds to complete the job. We must take care of our veterans. We must continue to support our 

troops, our veterans, and our citizens—after all they are our most Patriotic Americans. 

I thank the Committee for this opportunity to speak on this matter and I will respond to any questions that you may have.

Senator AKAKA. Thank you. Thank you very much for your testimony. We just heard from our VSOs, and I have some questions 

for you. 

25

This first question is to the whole group. I’m very concerned 

about VA’s inquiry to post-traumatic stress disorder claims, and I 

mentioned that. I personally saw the level of aggravation that this 

review caused our veterans, and I heard from you, many of you 

from Hawaii. 

I ask all the members, and we’ll go down the line again, members of the panel, whether you’re familiar with the PTSD review 

that was recently called off by the Department of Veterans Affairs, 

and for you to tell me about the impact the review had on you and 

any fellow members that you may be in contact with. 

Let’s begin with William Daves. 

Mr. DAVES. I’m also a service officer for the Fleet Reserve Association, and I help veterans with their claims. It would have had 

a deep impact on all of us service officers because it put the claims 

process back a ways. 

Right now I think most of the claims are done within 200 days 

or less. If they had to review all of those cases, it would have put 

the claims that are now going into the mill back. We don’t need 

that, sir. 

Mr. MCCLOSKEY. Thank you, Senator. I’m a little bit more of a 

unique bird here than most of you. I actually did the job of doing 

claims at the VA for many years. My boss will sit up here and tell 

you how bad or how good I was. 

But I can tell you that if I was sitting in my old job as a decision 

review officer and I was faced with these reviews, it would be a 

nightmare. It would be an absolute nightmare because I know that 

almost every one of these cases we would lose subsequently in 

court. It would be all done for naught. The VA generally does a 

very good job rating cases. If they’re given the facts, they’re going 

to rate the case properly in most cases. 

My big problem with this, though, really, is the impact that it 

had on every veteran who suffers from PTSD in this country. When 

that word went out, I got literally hundreds of phone calls in my 

capacity as an American Legion service officer. I had people coming 

to my office: What are they doing to me? I won’t be able to feed 

my family. I won’t be able to do this. I won’t be able to make my 

mortgage payments. 

I left concerned. But then I got real concerned when mental 

health care professionals that work for the VA, and I won’t name 

them, started calling me saying, Hey, what’s going on? Do you 

know anything about this? Because my patients are coming in really freaked out. 

Then, slowly, people started coming in to me saying, You know, 

if this happens, what do I do? It tripled my workload for about 3 

months. I’m sure that it created nightmares for many of the folks 

over here at the VA also. 

To me, especially during a time of war, Senator Akaka, it is absolutely unconscionable that we would try to do something like this. 

I’m a Vietnam veteran. My father was a World War II veteran. I 

have a son who’s a combat infantryman in the 100th Battalion. 

He’s coming home this week. If they treated me like that, I can 

imagine how I would feel, or some member of my family. 

We appreciate whatever pressure you put on the VA. I know it 

wasn’t the folks sitting here that were trying to do it. It was some 

26

bean-counter in Washington that was trying to save some money. 

It’s sad, and it hurt, and we can’t let it happen again. Thank you 

very much. 

[Applause.] 

Master Chief HOUGH. I concur with my good friend there, Mike 

McCloskey. These are traumatized war veterans. These people, 

men and women who served our country, did their very best for us. 

We rated them and adjudicated their claim. The VA Inspector General did not find any fraud. So if there’s any fault, it lies with the 

system itself. 

Perhaps the internal controls of the VA in the rating of compensation needs to be strengthened at the national level. But it’s 

certainly not the fault of our veteran. Our veteran got the rating, 

and to take somebody away from somebody, as Mike said, would 

cause not only an emotional breakdown, but human tragedy. We 

just don’t want to see that. 

There’s another thing that I’m little concerned with, Senator, is 

that there’s a study the VA has a big panel going on now for a year 

studying compensation. One of the recommendations was to give a 

lump sum payment to those veterans with a lesser degree of disability, such as 10 to 30 percent. 

This too is unconscionable because as we know, as we grow older 

we’re going to have problems. This is essentially saying, hey, here’s 

a wad of money, and don’t come back and bother us. 

I know that the veterans organizations are adamantly opposed to 

this, and I hope that you could do your best for us to make sure 

that our veterans are treated with the dignity and respect they deserve for their efforts. Thank you. 

[Applause.] 

Colonel CRUICKSHANK. I’m just going to simply say I’m glad that 

issue is not being readdressed again. I go along with Mike that it’s 

been done. Let’s just move on. 

Mr. ROSS. I have two perspectives on that. The first one is that 

really it’s not over. The Institute of Medicine, as we know, has been 

contracted by the Department of Veterans Affairs—not the people 

sitting here, their bosses—to go ahead and look at the vet condition 

of post-traumatic stress disorder and determine whether or not 

that particular definition that is medically looked at right now as 

the standard—because it’s in the Diagnostic and Statistical Manual 

No. IV–R—and determine whether or not they should have a new 

definition for our veterans so that we can in fact not grant so many 

of these benefits. 

Now, we’re talking money here. This is the problem. We’re talking money. We don’t talk money when I ask you—because many of 

us were—asked to go off to fight in a war. We were picked up and 

they said, now, of course, it’s very different because you get a 

chance to volunteer. But I’m holding up where I wasn’t asked. It 

was a question of saying, when are you going to go fight or join the 

military? Because it’s coming up and your draft number is coming 

up and you need to go in sooner or later. 

Now the question is that since we never talk about, when we 

start these wars, how much it’s going to cost, we do start talking 

about what is it costing us now that we’ve started it. 

27

Well, it’s going to cost us some damages. We’ve got people who 

come back with broken arms, shot arms, damages not only to their 

physical self but also to their bodies. Why is it that because someone who has a mangled hand that is so evident for everybody to 

see should be treated so much differently from an individual who 

has a mangled brain and because it’s not so noticeable? 

I have another question for people who are considering this. We 

have individuals in the military who have come from all walks of 

life. Some of them have been choirboys. Some of them have served 

in the church. Then we sent them off to war. They’ve seen the horrors of war, and then they come home and they have post-traumatic stress disorder. 

What kind of country would we have if we could send our people 

off and have them see the horrors of war and come back and have 

no problems? Wouldn’t we be a little bit more concerned with those 

kinds of individuals because of what they have done and seen, and 

now are able to just walk off and have no feelings or emotions 

about what they saw? 

I say that we are in fact extremely lucky to have a country that’s 

concerned about those individuals that we ask to do our bidding, 

and that we need to in fact continue what the VA says: Care for 

him or her who has borne the battle. Thank you very much. 

[Applause.] 

General RIENZI. Tom Rienzi again. I served in eight wars in 37 

years in the Army, and no shell-shock. It’s been around, and we’re 

going to have a lot more of it. I don’t think, Senator Akaka, that 

what we all talked about, and Secretary Nicholson talked about 

and before him—I don’t think we—I have not seen any strategic 

plan or major plan that’s going to care for these many, many, 

many, many people that will have the head problems. 

I think we can all know here that because of these shellshocked—and that’s a better term for me—coming back, we’re 

going to have a lot of problems. So we need the money. But the VA 

should be prepared for an awful lot of head problems. 

May I suggest that somehow, in your strategic plans, you think 

it through better than just this group here because I don’t think 

you have. Not that you’re indifferent to it or not that—but it’s 

going to be one hell of a big problem for these shell-shocked folks 

that are coming back. I hope we can put it in your strategic plans 

how to care for this head problem, which is a big one. 

Thank you very much, Senator Akaka. Thank you. 

[Applause.] 

Senator AKAKA. Thank you very much, General. I want to thank 

this panel for their mana’o and their responses. I want to say at 

this point that the VA did withdraw the review that we’re all talking about, and it has made such a big difference. But I wanted to 

know how our folks felt about that, and you’ve heard them do that. 

My next question to all of you again, in order, is what are some 

of the unique problems that veterans face in Hawaii? There are so 

many different ways. 

I want to thank the panel for mentioning how well they feel the 

VA is doing. They are, you know, trying their best to do it whatever limits they have. But they are serving our veterans. 

28

I’d like to hear from you about what unique problems veterans 

face in Hawaii. Second part—where do you see room for improvement, for improvement in services for veterans? So I don’t want 

you to tell me only your problems, but also to tell me how we can 

fix it. We look forward to that. 

Mr. DAVES. I think the VA needs to have more people, more raters, more DROs, more veterans in positions that understand what 

veterans go through in battle and et cetera. That’s exactly what we 

need, is more people. 

Mr. MCCLOSKEY. Thank you, Senator Akaka. To mention a 

unique problem, we have a couple. Our geographical separation, of 

course, from the mainland and the separation of our islands and 

how our veteran population is spread out are rather unique. 

I think somebody mentioned a guy in Utah may have to drive 

200 miles. But most folks can get that 200 miles. Even if you’re 

pretty old, you can usually get your kids or somebody to drive you. 

You can’t drive to Molokai from here. You just can’t do that. It’s 

a real problem. Money will help. 

Another unique problem we have here, I believe, and I think 

most of the VA folks that work here will agree, it’s very difficult 

for us to access specialists. Specialist care for veterans themselves, 

specialists to do specialist exams that are required for certain cases 

that are before the Board and the DROs. It boils down again, I 

think, to money and time. 

When we ask these doctors to do this, especially for an exam for 

a claim, typically that doctor has to spend a couple of hours reviewing a case, then do an examination, provide a report to the VA—

in a timely basis, by the way, I might add—but the VA doesn’t pay 

them very much for this. I’m trying to—off the top of my head, 

$150, I think we used to pay the specialist for an exam. That may 

have gone up some. That is one of our big problems, I think, here. 

If we had a better way of handling specialists—maybe it’s getting 

our own specialists here to do these things. I remember we had big 

cardiovascular problems, cardiovascular examination problems, 

ophthalmologists. Some of these may have been helped in the last 

year or resolved in the last year or so because I know we’ve added 

some specialties in the clinic. But I’m certain that it’s still a problem. 

Bill Daves brought up the issue of CHAMPVA. I don’t think 

again we really understood what he was talking about. CHAMPVA 

is a program that the VA has that’s intended for indigent people 

who are DIC recipients. These are men or women who are receiving dependency indemnity compensation benefits. They have no 

other access to healthcare through any other source. 

So the CHAMPVA provides them a system kind of similar to 

TRICARE to get their medical care. Here in Hawaii, we have, that 

I know of, two doctors and no pediatricians. There are a number 

of people here in Hawaii who are eligible for this program. 

If they’re eligible for CHAMPVA, they cannot get QUEST. So it 

really locks those people out. I know it’s not a large population. 

We’re only talking about maybe a dozen people, 20 people, on 

Oahu. But for those 10 or 20 people, this is a major problem because they can’t get medical care for their children and they can’t 

get medical care for themselves on a timely basis. I think, again, 

29

this is a matter of how much are we willing to pay these doctors 

to get involved with the CHAMPVA program. 

That’s all I have, Senator. Again, thank you very much. 

Master Chief HOUGH. Senator Akaka, it’s my feeling that Hawaii 

and Alaska are being penalized because we don’t have a full-scale 

Department of Veterans Affairs hospital here. I saw the workings 

of a VA hospital when my son was in Oregon, and they are teamed 

with the Oregon Health Sciences University, and it’s amazing to 

see the resources available and the teamwork. 

I know we’re teamed with the Army. But again, if we team up 

a lot with the Army, then that means that probably retirees and 

soldiers are going to be penalized because there’s not room for everything. 

We simply need a steady stream of funding to come up with innovative new ways to provide the healthcare that our veterans 

need here in the State. If you look at this State and compare it to 

like Wyoming or Vermont, they have a full-scale VA hospital. But 

we don’t, and Alaska doesn’t. 

I think that if anybody was to make an analysis of the money 

spent in Hawaii on VA projects as opposed to some of these other 

States, you will see that we’re not getting our fair share. Thank 

you very much. 

Colonel CRUICKSHANK. You know, we’re going around the panel 

but we all feel the same way. For me, again, it’s the geographical 

distance, the specialty care. I know for my office, to get off the 

track a little bit, my office has been inundated with veterans because VA can’t take care of the workload. 

Because of that, I’m going to the Legislature this year to request 

for another counselor for my office to better service our veterans. 

When our troops return, and they’ll be coming back this week, it’s 

not going to be a matter of overtime to service them. What we’re 

going to do is to ensure that our troops are serviced properly. 

Our additional counselor will be flying to the neighbor islands 

whenever the counselor on that island is out of the office on sick 

or vacation leave. 

When the 100th Battalion returns and gets ready to fly back to 

American Samoa, Guam and Saipan, we are going to make sure we 

fully service them before they leave for their homes. 

Mr. ROSS. Thank you very much, Senator Akaka. Unique problems. One of the unique problems that we have in Hawaii is that 

we have cultural differences. We kind of talk in America about cultural differences. Since I’m the only guy up here who looks different, I can talk about this. 

[Laughter.] 

Mr. ROSS. Everybody in America is not the same. That means 

when we start sitting around and talking to the psychologist about 

things like post-traumatic stress disorder, that’s really good for 

those individuals that grew up in a culture that allows you to talk 

about mental health problems. 

In Hawaii, we have many cultures that do not talk about mental 

health problems. What happens? Those individuals are short-shifted because someone says, ‘‘Well, how do you feel about that?’’ The 

therapists looks at them straight in their eyes and the person kind 

of puts their head down because that’s culturally correct in their 

30

culture. Of course, someone else misinterprets it, and the guy says, 

‘‘I’m all right.’’

They’re not all right, and they’re telling you that by their body 

language, which shows that they’re not all right. But we have a 

talk culture. So those individuals who receive mental health care 

do in fact have an extra barrier because of the cultural differences 

that exist. 

Another thing, is the access. When we have individuals who are 

located on a neighbor island, in rural areas, who cannot receive the 

same quality of care, we do have access problems. We need to address that, and I’m happy that the VA is spending a lot of money 

on telemed and other kinds of things to address that. 

We also need, you know, additional staffing to make sure that 

those individuals who are rating the cases that come through our 

VA facilities here are culturally sensitive to what they’re rating. 

When we send cases off to other places and they read and they see 

what the person is saying, or, even worse, when they look at the 

transcript and they can’t read the transcript because the guy’s 

speaking pidgin, we really do have an issue. 

We need to make sure that we do have people in Hawaii—because we all grew up speaking pidgin—who can understand some 

of the differences that we have and be willing to address those differences through appropriate care. Thank you. 

[Applause.] 

General RIENZI. I’ll just take up the specific, and I hope you 

write a note, Senator Akaka. Two years ago, there weren’t any clinics at all on the outer islands for veterans. Through a big fight—

or not fight, lots of hard work—we now have CBOCs, clinics, except 

Molokai. Probably some of the biggest PTSD problems are on 

Molokai. 

I would hope you’d write a note there: Molokai CBOC clinic within—by 1907. I mean, some of the worst problems are there. The 

rules sort of keep us from getting there, and they have to go Lanai 

or Maui or come over here. We should get a storefront and a nurse, 

and we have one doctor there that we’ve been able to hire that does 

it out of his office. But Molokai needs some specific help. I hope you 

write down: Molokai CBOC. Thank you very much. 

[Applause.] 

Senator AKAKA. Thank you. I want to thank all of you for your 

input. That was my final question. I have other questions for this 

panel, but I’m going to submit the questions for the record to all 

of you. 

I want to thank you for your testimonies here. You have highlighted, as we wanted, some key issues that we will look at with 

VA. I especially appreciate the insight provided regarding the need 

to address culture because culture in Hawaii in particular is very, 

very important. This is why I’m so happy that we’re paying attention to culture in Hawaii in trying to help our veterans here. 

General Rienzi, we’re working on a satellite clinic for Molokai 

and Lanai. Thank you very much. 

[Applause.] 

Senator AKAKA. We are working on that, and we hear you, all of 

you. I thank you again so much. I thank you for your testimony 

today. Thank you. 

31

I’d like to call up the next panel. Diana M. Rubens, Director, 

Western Area Office, Veterans Benefits Administration. She will be 

accompanied by James Carilli, Acting Director of the Honolulu regional office. Stephen Molnar, M.S.W., Team Leader, Honolulu Vet 

Center. 

Fred Gusman, M.S.W., Chief Operating Officer, Pacific Islands 

Division, National Center for PTSD. Alfred Wylie, Public Relations 

Coordinator, Vietnam Veterans of America. T. Samuel Shomaker, 

M.D., J.D., Interim Dean, John A. Burns School of Medicine, University of Hawaii at Manoa. Dr. Shomaker will be accompanied by 

Haku Kahoano, a 4th-year medical student at the John A. Burns 

School of Medicine, University of Hawaii. 

I look forward to your testimony on some of these issues that are 

pressing for all of us. So I’d like to begin this panel with Diana 

Rubens. 

STATEMENT OF DIANA M. RUBENS, DIRECTOR, WESTERN 

AREA OFFICE, VETERANS BENEFITS ADMINISTRATION;

ACCOMPANIED BY JAMES CARILLI, ACTING DIRECTOR,

HONOLULU REGIONAL OFFICE 

Ms. RUBENS. Thank you, Senator Akaka. I appreciate the participation of all the veterans and the service organizations today, and 

the opportunity to appear here on behalf of the Veterans Benefits 

Administration to provide you some information on the response to 

the needs of veterans returning from Operation Enduring Freedom 

and Operation Iraqi Freedom. I am accompanied today by Mr. Jim 

Carilli, the Acting Director of the Honolulu regional office. 

Veterans returning from Iraq and Afghanistan are eligible for an 

array of benefits offered through VBA. These include disability 

compensation and related benefits; educational and training benefits; vocational rehabilitation and employment benefits and services; home loan guarantees; life insurance; burial benefits; and the 

dependents and survivor benefits. 

The VA Honolulu regional office serves an estimated veteran 

population of more than 107,000 veterans in the State of Hawaii. 

Of the 21,842 veterans, surviving spouses, and surviving children 

who receive VA benefits each month, 16,754 are service-disabled 

veterans. In addition, the regional office effectively participates in 

numerous outreach activities to inform and assist returning 

servicemembers who are soon to be released from active duty. 

For those separating servicemembers, the Honolulu regional office Veterans Service Center has a designated Military Services coordinator who performed many of the outreach functions to those 

returning servicemembers. 

The service coordinator conducts regular briefings covering the 

full range of VA benefits as part of the military Transition Assistance Program at various military installations in Hawaii. A Veterans Service Representative is also outbased in Guam to provide 

those same TAP briefings there. 

Each month there are 4 TAP briefings at Schofield, 3 at Pearl 

Harbor, 2 to 3 at the Marine Base in Hawaii, and once a month 

at Hickam, Anderson Air Force Base in Guam, and the Guam 

Naval Station. There’s also a briefing every 3 months at the Coast 

Guard facility at Sand Island, Hawaii. 

32

In addition, the military service coordinator conducts briefings 

for members of the Army or Navy being discharged for medical disabilities. This briefings, which are part of the Physical Evaluation 

Board orientations, are conducted three or four times each month 

at Pearl Harbor Naval Regional Medical Center and at the Tripler 

Army Medical Center. 

During the past fiscal year, in 2005, the Honolulu regional office 

conducted 219 separate briefings, reaching over 4,500 active duty 

servicemembers and spouses in Hawaii and Guam. A total of 623 

servicemembers were interviewed following these briefings for personnel information. Activity was especially heavy during this past 

January through June of 2005, when a large contingent of the 25th 

Infantry Division returned from deployment. Already in fiscal year 

2006, the Honolulu regional office has conducted 48 military briefings for over 1,200 servicemembers and conducted 98 post-briefing 

interviews with active duty servicemembers. 

For our National Guard and Reserve members, the regional office 

here provides the veteran benefits briefings to those as part of the 

Army Deployment Cycle Support program to reorient 

servicemembers returning from Iraq and Afghanistan. All 

attendees receive a copy of our pamphlet, ‘‘A Summary of VA Benefits,’’ as well as a VA Health Care and Benefit Information for Veterans wallet card. 

Briefings are scheduled on demand based on the dates of return 

of the various units. The Honolulu regional office anticipates conducting numerous briefings in January and February of this year 

when an estimated 2,100 servicemembers are expected to return to 

Hawaii. 

In addition, Veteran Service Center staff provide individual case 

management for our seriously disabled OIF/OEF veterans. The 

Honolulu regional office receives periodic referrals from Tripler social workers about the seriously disabled OIF/OEF servicemembers 

and assists with the appropriate applications. Acting Director 

Carilli personally meets with all the OIF/OEF soldiers who visit 

the regional office to assure them that VA will provide them the 

best possible service. Each month, the Honolulu regional office follows up by calling each servicemember to ensure that their claims 

are being processed expeditiously. 

Additionally, the regional office gets immediate information 

about returning disabled soldiers who are likely to be eligible for 

compensation or other benefits, and the veteran service staff either 

visit these servicemembers at the Deployment Health Center or 

during medical hold or medical board briefings. 

Our Vocational Rehabilitation and Employment Division at the 

regional office works closely with the Tripler Army Medical Center 

inpatients, National Guard members, and Reservists to make sure 

the patients receive information about the vocational rehabilitation 

and employment program. When appropriate, they also refer patients to the Honolulu regional office for assistance with their disability claims. 

The Tripler Army Medical Center has created a special Deployment Health Center to assist returning Reservists and Guard 

members. It is staffed by professional treatment providers and 

caregivers, as well as a VA Employment specialist from the HonoVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00036 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
33

lulu regional office. The VA Employment specialist sees 3 or 4 

servicemembers a week at the Deployment Health Center and 

makes referrals accordingly. Some recuperating soldiers have been 

referred to the local Disabled Veteran Outreach Program for employment briefings as part of the Department of Labor ReaLifelines 

Program. 

The VR&E program provides ongoing monthly briefings at Disabled Transition Assistance Program sessions at Pearl Harbor 

Naval Base and Schofield Army Barracks. 

The VA’s liaison to the Department of Labor’s Disabled Veteran 

Outreach Program, who is co-located in the regional office VR&E 

Division, regularly meets with all medical hold servicemembers 

and special services liaisons to provide job-finding assistance. 

The Schofield Barracks Army Base established a Soldier and 

Family Assistance Center to provide one-stop service for returning 

servicemembers and their families. Our VR&E personnel, along 

with VA Mental Health Clinic personnel, participate in this program. 

Our home loan guarantees activities here in Hawaii. With the increasing activation of those Reservists and National Guard, these 

servicemembers are becoming eligible for VA home loans faster and 

in greater numbers than they would have had they not been activated. Instead of the time-in-service requirements of 6 years as a 

member of the Reserves or National Guard, these active duty personnel and veterans become eligible for benefits under the Loan 

Guaranty and Native American Direct Loan programs after having 

90 days or more of active wartime service. As a result, VBA anticipates there will be an increase in eligible veterans applying for VA 

loan guaranty benefits through both the Loan Guaranty Program 

and the Native American Direct Loan Program. 

Further, as a result of Public Law 108–454, veterans will be eligible for VA guaranteed loans equal to the Freddie Mac conforming 

loan limit. As of January 1, 2006, that rate increased to $625,500 

for the high cost areas such as Hawaii and Guam. We anticipate 

that this will make VA guaranteed home loans much more attractive to the veterans here. 

Moreover, assuming that pending legislation is passed making 

the Native American Direct Loan Program permanent, the very important housing benefit will be continued for many returning minority veterans in Hawaii and the Pacific U.S. Territories. 

Ranking Member Akaka, I hope this testimony has given you 

and the Members of the Committee a better understanding of the 

benefits, services, and outreach that VA is providing to veterans of 

the OIF/OEF conflicts. I assure you that the Honolulu regional office is ready and eager to serve the men and women coming home 

to Hawaii and the Pacific. 

This concludes my testimony. Mr. Carilli and I will be pleased 

to answer any questions you might have. 

[The prepared statement of Ms. Rubens follows:]

PREPARED STATEMENT OF DIANA M. RUBENS, DIRECTOR, WESTERN AREA OFFICE, 

VETERANS BENEFITS ADMINISTRATION

Senator Akaka, I appreciate this opportunity to testify today on the Veterans Benefits Administration’s (VBA) response to the needs of veterans returning from OperVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
34

ation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). I am accompanied today by James Carilli, Acting Director of the Honolulu Regional Office. 

Veterans returning from Iraq and Afghanistan are eligible for a full array of benefits offered through VBA. These include: 

• Disability Compensation and Related Benefits; 

• Education and Training Benefits; 

• Vocational Rehabilitation and Employment Benefits and Services; 

• Home Loan Guaranties; 

• Life Insurance; 

• Burial Benefits; and 

• Dependents’ and Survivors’ Benefits. 

The VA Honolulu Regional Office serves an estimated veteran population of more 

than 107,000 veterans in the State of Hawaii. Of the 21,842 veterans, surviving 

spouses, and surviving children who receive VA benefits each month, 16,754 are 

service-disabled veterans. In addition, the Regional Office effectively participates in 

numerous outreach activities to inform and assist returning servicemembers who 

are soon to be released from active duty. 

SEPARATING SERVICEMEMBERS

The Honolulu RO’s Veterans Service Center has a designated Military Services 

Coordinator (MSC) who performs many of the outreach functions provided to returning servicemembers. The Military Services Coordinator conducts regular briefings 

covering the full range of VA benefits as part of the military Transition Assistance 

Program (TAP) at various military installations in Hawaii. A Veterans Service Representative is also outbased in Guam to provide TAP briefings there. Each month 

there are four TAP briefings at Schofield Barracks; three at Pearl Harbor Naval 

Base; two or three at Marine Base Hawaii; and one a month at Hickam Air Force 

Base in Hawaii, Anderson Air Force Base in Guam, and Guam Naval Station. There 

is also a briefing every 3 months at the Coast Guard facility at Sand Island, Hawaii. 

In addition, the military service coordinator conducts briefings for members of the 

Army or Navy being discharged for medical disabilities. These briefings, which are 

part of the Physical Evaluation Board orientations, are conducted three or four 

times each month at Pearl Harbor Naval Regional Medical Center and Tripler Army 

Medical Center. 

During fiscal year 2005, the Honolulu Regional Office conducted 219 separate 

briefings reaching over 4,500 active duty members and spouses, in Hawaii and 

Guam. A total of 623 servicemembers were interviewed following these briefings. Activity was especially heavy during January through June 2005, when a large contingent of the 25th Infantry Division returned from deployment. Already in fiscal year 

2006, the Honolulu Regional Office conducted 32 military briefings for 845 

servicemembers and conducted 98 post-briefing interviews with active duty 

servicemembers. 

MEMBERS OF THE NATIONAL GUARD AND RESERVES

Honolulu’s Veterans Service Center staff provide VA benefit briefings to National 

Guard members and Reservists, as part of the Army Deployment Cycle Support program to reorient servicemembers returning from Iraq and Afghanistan. All 

attendees receive a copy of the VA pamphlet, A Summary of VA Benefits, as well 

as the VA Health Care and Benefit Information for Veterans Wallet Card. Briefings 

are scheduled on demand based upon the dates of return of the various units. The 

Honolulu Regional Office anticipates conducting numerous briefings in January and 

February 2006 when an estimated 2,100 servicemembers are expected to return to 

Hawaii. 

In addition, Veteran Service Center staff provides individual case management for 

seriously disabled OEF/OIF veterans. The Honolulu Regional Office receives periodic 

referrals from Tripler Army Medical Center social workers about seriously disabled 

OEF/OIF servicemembers. The Military Services Coordinator provides a comprehensive briefing on VA benefits and assists with appropriate applications. Acting Director Carilli personally meets with all OEF/OIF soldiers who visit the Regional Office 

to assure them that VA will provide them the best possible service. Each month, 

the Honolulu Regional Office follows up by calling each servicemember to ensure 

them that their claims are being processed expeditiously. 

In addition, the Regional Office gets immediate information about returning disabled soldiers who are likely to be eligible for VA compensation or other benefits. 

Veteran Service Center staff either visit these servicemembers at the Deployment 

Health Center or during ‘‘Medical Hold’’ or ‘‘Medical Board’’ briefings. 

35

VOCATIONAL REHABILITATION & EMPLOYMENT ACTIVITIES

The Vocational Rehabilitation and Employment (VR&E) Division at the Honolulu 

Regional Office is working closely with Tripler Medical Army Center inpatients, National Guard members, and Reservists to make sure patients receive information 

about the Vocational Rehabilitation and Employment Program. When appropriate, 

they also refer patients to the Honolulu Regional Office for assistance with their disability claims. 

The Tripler Army Medical Center has created a special Deployment Health Center to assist returning Reservists and National Guard members. It is staffed by professional treatment providers and caregivers, as well as a VA Employment Specialist from the Honolulu Regional Office. The VA Employment Specialist sees three 

or four servicemembers a week at the Deployment Health Center and makes referrals accordingly. Some recuperating soldiers have been referred to the local Disabled 

Veteran Outreach Program (DVOP) for employment briefings as part of the Department of Labor’s Recovery & Employment Assistance Lifelines (ReaLifelines) Program. 

The VR&E Division provides ongoing monthly briefings at Disabled Transition Assistance Program (DTAP) sessions at Pearl Harbor Naval Base and Schofield Army 

Barracks. 

VA’s liaison to the Department of Labor’s Disabled Veteran Outreach Program, 

who is co-located in the Regional Office VR&E Division, regularly meets with all 

‘‘Medical Hold’’ servicemembers and special services liaisons to provide job finding 

assistance. 

The Schofield Barracks Army Base established a Solider and Family Assistance 

Center to provide one-stop service for returning servicemembers and their families. 

VR&E personnel, along with VA Mental Health clinic personnel, participate in this 

program. 

HOME LOAN GUARANTY ACTIVITIES

With the increasing activation of Reservists and National Guard, these 

servicemembers are becoming eligible for VA home loan benefits faster and in greater numbers than they would have had they not been activated. Instead of the timein-service requirement of 6 years as a member of the Reserves or National Guard, 

these active duty personnel and veterans become eligible for benefits under the 

Loan Guaranty and Native American Veteran Direct Loan Programs after having 

90 days or more of active wartime service. As a result, VBA anticipates that there 

will be an increase in eligible veterans applying for VA loan guaranty benefits 

through both the Loan Guaranty Program and Native American Direct Loan Program. 

Further, as a result of P.L. 108–454, veterans will be eligible for VA guaranteed 

loans equal to the Freddie Mac conforming loan limit. As of January 1, 2006, that 

rate increased to $625,500 for high cost areas such as Hawaii and Guam. VA anticipates that this will make VA guaranteed home loans much more attractive to veterans. 

Ranking Member Akaka, I hope this testimony has given you and the Members 

of the Committee a better understanding of the benefits, services, and outreach that 

VA is providing to veterans of the OEF/OIF conflicts. I assure you that the Honolulu 

Regional Office is ready and eager to serve the men and women coming home to 

Hawaii and the Pacific. This concludes my testimony. Mr. Carilli and I will be 

pleased to answer any questions you might have.

Senator AKAKA. Thank you very much. 

Stephen Molnar. 

STATEMENT OF STEPHEN T. MOLNAR, M.S.W., TEAM LEADER, 

HONOLULU VET CENTER 

Mr. MOLNAR. Aloha, Senator Akaka, fellow veterans, families. It 

is an honor to have this opportunity today to testify at these important congressional hearings on ‘‘The State of VA Care in Hawaii.’’ 

I still vividly recall when I had testified before you at the Senate 

Veterans’ Affairs Committee hearings in Washington, DC back in 

1993 to address the concerns about VA mental health programs. 

As a result of those hearings, much changed in Hawaii. Public 

Law 104–262 was passed in 1996, thereby expanding eligibility for 

36

Vet Centers and authorizing the extension of readjustment counseling to all combat veterans and their families. This landmark legislation made it possible for combat veterans and their families to 

receive free counseling in convenient locations at 207 Vet Centers 

nationwide. 

More importantly, though, it helped to eliminate the stigma that 

is often associated with seeking help for mental health care. This 

law was a critical step toward the development of seamless and 

comprehensive care for our returning war veterans and their families. 

At Vet Centers, veterans receive counseling for war-related 

issues, including post-traumatic stress disorder, in a comfortable 

community-based setting that is confidential, private, and, as I’ve 

said, without stigma or embarrassment. The law authorized the 

Vet Centers to provide family therapy as a core component of readjustment counseling. 

As provided at Vet Centers, family counseling is available as necessary in connection with any psychological, social, or other military-related readjustment problem, whether service-connected or 

not. As a special authority in the law, veterans eligibility for readjustment counseling is determined solely by military service in a 

combat theater and does not require the veteran to go through any 

enrollment procedure. 

Additionally, providing family services at Vet Centers is not 

time-limited but rather is available as necessary for the veteran’s 

readjustment throughout the life of the veteran. The veteran’s family members are included in the counseling process as necessary to 

address the whole range of family adjustment issues stemming 

from the military experience and post-military readjustment. 

Early intervention by way of outreach and preventive family 

counseling services help returning veterans stabilize their postmilitary family and work lives, thereby reducing the risk of subsequently developing more chronic forms of PTSD and associated 

family problems. 

As you know, Senator, I am one of the original hire in the Vet 

Center program. For over 25 years, I have had the honor and 

unique privilege of serving Hawaii’s combat veterans and their 

families in the sometimes difficult readjustment process. The Honolulu Vet Center has served over 10,000 veterans and their families 

since opening in 1980. Our clients range in ages from 19 to 90, and 

reflect that diversity that distinguishes Hawaii from any other 

place in the world. 

In addition to readjustment counseling for combat-related issues, 

the Vet Center provides assessment and counseling for PTSD, sexual trauma, family counseling, and employment. We provide services and referral to homeless veterans and do extensive outreach, 

education, and networking to ensure that veterans have access to 

comprehensive care and assistance within their community. 

In 2003, the Secretary directed that Vet Centers be the focal 

point for delivery of bereavement counseling to families who lost a 

servicemember while on active duty. To date, we have provided 11 

families with bereavement counseling and support. As you can 

imagine, these have been amongst our most difficult cases. The 

37

pain of these families often runs deep. However, I know that our 

efforts have made a difference. 

With the anticipated return of soldiers from Iraq and Afghanistan and the recent hiring of our OIF/OEF outreach worker, we expect our proportion of OIF/OEF clients to rise accordingly. 

I would like at this point just to introduce our OIF/OEF counselor, Matthew Handelsford [ph]. He’s in the back there. 

[Applause.] 

Mr. MOLNAR. He served in Iraq and he also served in Kosovo. We 

brought him on in November, and we’re happy that he is back to 

outreaching and working with our returning soldiers. 

While all clients are offered individual counseling at the Vet Center, we also provide group counseling. Group counseling is important. It’s extremely effective therapeutically as well as it’s an efficient way to deliver services. At present, we offer 10 different 

groups. Many of our groups are held in the evenings to better accommodate our veterans and their families. 

As you know, Senator, Vet Centers are community-based counseling centers with a small core staff of only three or four employees. At the Honolulu Vet Center, we have four full-time staff: myself, the team leader; two counselors; and an office manager. In addition, we have a part-time sexual trauma social worker. 

As I mentioned, in November we hired our recently returned 

Iraqi veteran to serve as our outreach specialist. His role will be 

to be the bridge, the conduct, for our returned OIF/OEF veterans 

and their access not only to Vet Centers but the VA and other community resources. In addition, we have augmented our Vet Center 

with a comprehensive employment program courtesy of the State 

of Hawaii Department of Labor Disabled Veteran Outreach Program. We have a full-time DVOP onsite. He provides veterans with 

immediate access to a full range of computerized job listings and 

placement services that are geared to the needs of our veterans. 

I am deeply proud of our dedicated and committed staff, Senator. 

Through their efforts in serving Hawaii’s veterans, our Vet Center 

has received both local and national recognition, and two of our 

counselors have been awarded the VA Secretary’s prestigious 

‘‘Hands and Heart’’ award for what they have done with veterans. 

I have no doubt that the staff will continue to provide the same 

level of dedication and commitment to ensuring that our returning 

OIF and OEF veterans receive the best possible care and support. 

As you know, the 1996 legislation which I referred to expanded 

eligibility from a single group of war veterans to now all war zone 

veterans. This has resulted in a significant increase in eligible veterans without increased staffing. However, I’m glad to say recently 

VHA authorized 100 additional outreach specialists like Matthew, 

themselves veterans of OIF/OEF, to enhance the Vet Center program’s ability to extend timely services to this new era of war veterans. 

The dedication and can do attitude of the Vet Center staff will 

continue to ensure that combat veterans of all wars receive complete and comprehensive care and services. Similarly, the recent 

addition of bereavement services required a deep commitment of 

the staff to ensure that families were provided with immediate and 

38

sensitive assistance as well as a full range of comprehensive services and care, which the staff undertook willingly. 

The additional number of veterans who we anticipate may reside 

in Hawaii after discharge from OIF/OEF service will add to the Vet 

Center’s demand. As a result, the role of the Vet Center will likely 

continue to be significant in providing for their readjustment needs. 

In closing, I would like to again thank you, Senator, for this opportunity to be able to address those issues facing Hawaii’s veterans, particularly those who have served in combat, as well as 

those still deployed in combat. Your willingness to identify the 

problems facing our veterans and their families, and your commitment to finding appropriate solutions, is deeply appreciated by all 

here. 

Senator Akaka, this concludes my statement. I’ll be glad to answer any questions that you may have. Thank you. 

[The prepared statement of Mr. Molnar follows:]

PREPARED STATEMENT OF STEPHEN T. MOLNAR, M.S.W., TEAM LEADER,

HONOLULU VET CENTER

Aloha Senator Akaka and other Members of Congress. It is an honor to have this 

opportunity today to testify at these important congressional hearings on ‘‘The State 

of VA Care in Hawaii.’’ I still vividly recall when I had testified before you at the 

Senate Veterans’ Affairs Committee hearings in Washington, DC in 1993 to address 

concerns about ‘‘VA Mental Health Programs.’’ As a result of those hearings, Public 

Law 104–262 was passed in 1996, thereby expanding eligibility for Vet Centers and 

authorizing the extension of readjustment counseling to all combat veterans and 

their families. This landmark legislation made it possible for combat veterans, and 

their families, to receive free counseling in convenient locations at 207 Vet Centers 

nationwide. More importantly though, it helped to eliminate the stigma often associated with mental health care. Public Law 104–262 was a critical step toward the 

development of seamless and comprehensive care for our returned war veterans. 

At Vet Centers, veterans receive counseling for war-related issues, including Posttraumatic Stress Disorder (PTSD), in a comfortable community-based setting that 

is confidential, private, and without stigma or embarrassment. The law authorized 

the Vet Centers to provide family therapy as a core component of readjustment 

counseling. As provided at Vet Centers, family counseling is available as necessary 

in connection with any psychological, social, or other military-related readjustment 

problem, whether service-connected or not. As a special authority in the law, veterans eligibility for readjustment counseling is determined by military service in a 

combat theater and does not require the veteran to go through the enrollment procedure. Additionally, providing family services at Vet Centers is not time limited, but 

rather available as necessary for the veteran’s readjustment throughout the life of 

the veteran. Veterans’ family members are included in the counseling process as 

necessary to address the whole range of family adjustment issues stemming from 

the veteran’s military experience and post-military readjustment. Early intervention 

via outreach and preventive family counseling services help returning veterans stabilize their post-military family and work lives, thereby reducing the risk of subsequently developing more chronic forms of PTSD and associated family problems. 

As you know Senator, I am one of the original hires in the Vet Center program. 

For over 25 years, I have had the opportunity and unique privilege of serving Hawaii’s combat veterans, and their families, in the sometime difficult readjustment 

process. The Honolulu Vet Center has served over 10,000 veterans and their families since opening in 1980. Our clients range in ages from 19 to 90 and reflect the 

diversity that distinguishes Hawaii from any other place in the world. For example, 

47 percent of our caseload is composed of Asian Pacific Islander veterans and a full 

two-thirds of our caseload lists their ethnicity as ‘‘other than Caucasian.’’

In addition to readjustment counseling for combat-related issues, the Honolulu 

Vet Center provides assessment and counseling for PTSD, sexual trauma, family 

counseling and employment. The Vet Center provides services and referral to homeless veterans and does extensive outreach, education and networking to ensure that 

veterans have access to comprehensive care and assistance within their community. 

In 2003, the Secretary directed that Vet Centers be the focal point for delivery of 

bereavement counseling to families who lost a servicemember while on active duty. 

39

To date, we have provided 11 families with bereavement counseling and support. As 

you can imagine, these have been amongst our most difficult cases. The pain of 

these families runs deep. However, I know that our efforts have made a difference. 

Our most recent annual workload data reflects that we have served 628 unique 

veterans, recorded 5,500 visits and opened 250 new cases. At present, the approximate breakdown of new clients who have served in a combat theater are 40 percent 

for Vietnam, 30 percent for WWII, 15 percent for OIF/OEF and 15 percent for Other 

Combat Ops. With the anticipated return of soldiers from Iraq and Afghanistan, and 

the recent hiring of our OIF/OEF outreach worker, we expect our proportion of OIF/

OEF clients to rise accordingly. 

While all clients are offered individual counseling, we also provide group counseling. Group counseling is an extremely effective therapeutic modality as well as 

an efficient one. At present, the Honolulu Vet Center offers 10 different groups. 

These include groups focusing on combat, sexual trauma, bereavement, family members, life skills, meditation, and POWs. Many of these groups are held in the evenings to better accommodate our veterans and their families. 

As you know Senator, Vet Centers are community-based counseling centers with 

a small core staff of 3 or 4 employees. At the Honolulu Vet Center, we have four 

full-time staff: a team leader, two counselors (a social worker and psychologist) and 

an office manager. In addition, we have a part-time sexual trauma social worker. 

In November we hired a recently returned Iraqi veteran to serve as our outreach 

worker. His role is to be the bridge for our returned OIF/OEF veterans and their 

access to Vet Centers, the VA and other community resources. In addition, we have 

augmented our Vet Center with a comprehensive employment program through the 

State of Hawaii Department of Labor Disabled Veteran Outreach Program (DVOP). 

A full-time DVOP counselor out stationed onsite provides veterans with immediate 

access to a full-range of computerized job listings and placement services geared to 

the needs of veterans. 

I am deeply proud of our dedicated and committed staff, Senator. Through their 

efforts in serving Hawaii’s veterans, the Honolulu Vet Center has received both local 

and national recognition. Two of our counselors have been awarded the VA Secretary’s prestigious ‘‘Hands and Heart Award’’ that is presented annually to an employee involved in direct patient care who does the most to exercise professional expertise, to provide emotional support, help and guidance to patients. I have no doubt 

that the staff will continue to provide the same level of dedication and commitment 

to ensuring that our returning OIF/OEF veterans receive the best possible care and 

support. 

As you know, the 1996 legislation (Public Law 104–262) expanded eligibility from 

a single group of war veterans (Vietnam) to all war zone veterans. This resulted in 

a significant increase in eligible veterans without increasing staffing, and, recently, 

VHA authorized 100 additional outreach specialists, themselves veterans of OEF/

OIF, to enhance the Vet Center program’s ability to extend timely services to this 

new era of war veterans. The dedication and can do attitude of the Vet Center staff 

ensured that combat veterans of all wars received complete and comprehensive care 

and services. Similarly, the recent addition of bereavement services required a deep 

commitment of the staff to ensure that families were provided with immediate and 

sensitive assistance as well as a full-range of comprehensive services and care which 

the staff undertook willingly in a professional and compassionate manner. As already noted, with the increased success of our OIF/OEF outreach worker, we anticipate added demands will be placed upon our current counseling staff. 

The additional number of veterans who we anticipate may reside in Hawaii after 

discharge from their OIF/OEF service will add to the Vet Center’s demand. As a 

result, the role of the Vet Center will likely continue to be significant in providing 

for their readjustment needs. 

In closing, I would like to thank you for this opportunity, Senator Akaka, to be 

able to address those issues facing Hawaii’s veterans; particularly those who have 

served in combat, as well as those still deployed in combat areas. Your willingness 

to identify the problems facing our veterans, and your commitment to finding appropriate solutions is deeply appreciated. 

Senator Akaka, this concludes my statement. I will be glad to answer any questions that you or other Members of the Committee may have.

Senator AKAKA. Thank you very much. 

Mr. Gusman. 

40

STATEMENT OF FRED GUSMAN, M.S.W., CHIEF OPERATING

OFFICER, PACIFIC ISLANDS DIVISION, NATIONAL CENTER

FOR PTSD 

Mr. GUSMAN. Thank you, Senator Akaka. 

Mr. Chairman, Senator Akaka, distinguished Members of the 

Senate Veterans’ Affairs Committee, thank you for providing me 

the opportunity to come before you today to share with you insights 

and lessons learned from three decades of working with veterans 

and active duty personnel from all areas, and more recently those 

serving in OIF and OEF. 

I am the Chief Operating Officer of the VA’s National Center for 

PTSD, Pacific Islands Division, Hawaii, and the Director of the National Center for PTSD’s Education Division in Palo Alto, California. It has been my privilege as a clinician, a clinical program 

developer, and a veteran to be part of the VA’s primary effort to 

understand and treat combat-related stress and other medical and 

psychological co-morbidities affecting the men and women who 

have bravely served in our country’s military. I have submitted my 

written testimony for the record. 

I would like to now highlight some of the lessons learned from 

providing treatment to veterans who suffer from combat-related 

stress, and share with you some examples of how education can 

play an integral part in supporting the VA’s mission to provide the 

best quality care to our Nation’s veterans. 

The VA is very familiar treating combat veterans from prior 

wars. As a result, the VA has been instrumental in developing a 

variety of therapies, assessment measures, treatment models, educational tools, and research related to combat-related stress and 

PTSD. 

However, our servicemembers fighting in the wars in Iraq and 

Afghanistan present other unique factors that we need to incorporate into our current knowledge base. For example, their age 

range is 18 to 60 years. Women are a sizable segment of the force. 

Many more servicemembers are married with children. 

In addition, a majority of the men and women in today’s military 

have grown up in an age of great technological advances. This data 

would suggest that the current fighting force may be very different 

demographically from previous combat cohorts. As such, it may be 

necessary to deliver existing treatments using innovative formats 

that are easily accessible for both VA and DOD healthcare providers as well as the new warrior veterans and their families. 

An example of such innovation is the VA’s National Center for 

PTSD’s Iraq War Clinicians Guide. Originally developed for VA 

providers, the guide was later revised by the National Center and 

the Army in order to make this information more relevant and 

user-friendly to military providers. In order to maximize accessibility, the guide was then distributed via CD–ROM and the internet. 

The Marine Corps is also currently working with the National 

Center for PTSD to tailor a guide for the Navy and the Marine 

Corps personnel. This is another example of using technology that 

has been recent in application of tele-mental health care for the 

treatment of combat stress and PTSD by VA providers located in 

Honolulu and to neighboring islands. 

41

The VA’s National Center for PTSD’s mission continued not only 

to develop a state-of-the-art in clinical treatments, but also to employ innovative platforms to widely disseminate and deliver their 

care. I think that for the VA in particular, providers education is 

a critical tool that can be employed to help bridge the gap between 

servicemembers in need and providers who can assess and address 

these needs. 

In order to best serve our new warriors, we must further develop 

and provide ongoing state-of-the-art training and continuing education to VA personnel. This is a critical call because approximately 

40 percent of the VA providers are nearly retirement age in this 

decade. This translates into current personnel who need to be updated with training specific to this new cohort and, perhaps even 

more importantly, new hires that will new to the VA, new to veterans, and certainly new to the provisions of services to our men 

and women of today’s military. 

It is possible that the future educational clinical treatment materials can be made available via files easily downloadable onto 

handheld devices such as iPods or MP3 players as a technology familiar to many of the new warriors. An example would be an Iraq 

veteran who receives an audio file on stress management to listen 

to on his MP3 player as part of the veteran’s ongoing self-care program. 

This type of innovative approach would make education materials available 24 hours a day, 7 days a week, to augment the existing therapies and be made widely accessible to treatment providers, veterans, soldiers, and their families. 

In summary, I believe that the VA and the VA’s National Center 

for PTSD have provided outstanding clinical care for veterans from 

previous wars as well from current conflicts in Iraq and Afghanistan. We look forward to continuing to collaborate with the Department of Defense as well as other Federal, State, and local community agencies to care for our veterans. 

A fine example of this type of collaboration is the conference, 

Senator Akaka, that you have so willingly cosponsored last year 

and this year. The conference title, ‘‘Stress, Violence and Trauma: 

Providing Resiliency in Hawaii 2006.’’ This is an example of collaboration between the VA, the State, and the community at large, 

and your office, and other supporters. It’s a great example of how 

we can bridge the gap for our many returnees. 

Senator Akaka, that concludes the remarks that I have today. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Gusman follows:]

PREPARED STATEMENT OF FRED GUSMAN, M.S.W., CHIEF OPERATING OFFICER,

PACIFIC ISLANDS DIVISION, NATIONAL CENTER FOR PTSD 

Thank you, Mr. Chairman and Members of the Committee. I wish to applaud the 

efforts by Members of the Congress and the Department of Veterans Affairs (VA) 

to address the healthcare needs of those service Members currently engaged in combat operations. Moreover, recent legislation to support additional mental health care 

programs throughout VA demonstrates leadership’s support for quality care for the 

men and women who bravely serve in the United States military. 

Thank you for the opportunity to appear before you today to discuss the role of 

the Department of Veterans Affairs and the National Center for Post-traumatic 

Stress Disorder (NCPTSD) in meeting the mental health care needs of veterans and 

42

servicemembers returning from Operation Iraqi Freedom and Operation Enduring 

Freedom (OIF/OEF). VA has performed a tremendous service to our country’s soldiers and veterans through outreach programs designed to provide unprecedented 

access to care for those who have served. 

My testimony today will focus on a number of topics, including (1) comparisons 

between veterans from previous combat and peacekeeping missions and the current 

cohort of OIF/OEF veterans; (2) lessons learned from working with veterans from 

these previous combat and peacekeeping missions; (3) an overview of collaborative 

educational and clinical initiatives between NCPTSD and DoD to support OIF/OEF 

servicemembers, veterans and their families; and efforts to provide education and 

training to the mental health community located on the Hawaiian Islands concerning stress, violence and traumatic stress. (4) anticipation of educational and 

clinical training needs to augment VA/DOD seamless transition process. 

I. COMPARISONS BETWEEN VIETNAM VETERANS AND OIF/OEF VETERANS

During the last 30 plus years, VA and the National Center for PTSD have performed an outstanding service to this country’s veterans by developing the best possible assessment and treatment protocols for combat related Post-traumatic Stress 

Disorder (PTSD). VA has provided outstanding and quality healthcare to thousands 

of veterans who bravely served their country in overseas wars for their emotional 

and psychological difficulties. As a result of this long standing commitment, accurate assessment tools and evidenced-based guidelines are now readily available for 

VA and DoD providers. As we move forward in this tradition to provide quality 

healthcare to our Nation’s servicemembers and veterans, we need to recognize the 

importance to update and refine VA’s models of care in order to best serve the next 

generation of American Veterans. 

Most of what we know about the effects of traumatic stress, we learned from veterans from previous wars and peacekeeping missions (e.g., Vietnam, Somalia). We 

now face both a great challenge and opportunity as we translate our knowledge and 

clinical expertise, learned over the past 30 years, into evidenced based treatment 

for this current cohort of OIF/OEF veterans. We must appreciate both the differences and similarities between the previous generations of warriors with those 

serving in today’s military. 

PAST PERSPECTIVES: THE VETERANS OF THE VIETNAM WAR

Veterans of the Vietnam era cohort were a relatively homogeneous group: largely 

young males between the ages of 18–22 years old, single, drafted-active duty, and 

therefore in the relatively early stages of life development, and education, work, and 

career goals. Typically, they served a single 12–13 month deployment in country. 

Unlike those veterans of prior wars, those who returned from Vietnam faced a divided, and at times, hostile public. Unlike the experience of veterans of prior wars, 

few large scale homecoming ceremonies were offered to show support. In fact, veterans were often publicly scorned and society’s negative stereotyping/stigmatizing 

often foretold a difficult and problematic readjustment/reintegration into society. 

At first, a small percentage of Vietnam veterans accessed VA care. This may have 

been due, in part, to the lack of knowledge about the effects of combat stress on 

psychological adjustment following military service. Also, these veterans returned to 

a hostile and divided U.S. public who cast blame on the veterans as well as the government for the war. At that time, veterans may have avoided VA due to a fear 

of being labeled ‘‘crazy’’ or ‘‘mentally imbalanced.’’

CURRENT PERSPECTIVES: VETERANS/RETURNEES OF THE OPERATION IRAQI

FREEDOM/OPERATION ENDURING FREEDOM (OIF/OEF)

Veterans and returnees of OIF/OEF and the Global War on Terror (GWOT) often 

return to supportive communities who express appreciation for their sacrifices—despite political divisions in our country about the meaning and purpose of these wars. 

The age range of these combatants is 18–60 years. Many servicemembers are married with children. Most of the Reserve and National Guard have jobs and careers 

at home. Currently, women constitute a significant segment of the combined forces 

approximately 10 percent, many of whom serve in leadership roles. Unlike those 

who served in previous combat theaters, those deployed in OIF/OEF are likely to 

have experienced deployments lasting longer than 12–13 months and significant 

numbers may have experienced repeated deployments. 

In terms of assessment, diagnosis, and treatment, the field of PTSD is no longer 

in its infancy. We now have a body of knowledge that is replete with a variety of 

theories, assessment measures, treatment models, practical interventions, educational tools, and research findings in physiological, medical, psychological, and beVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00046 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
43

havioral domains. Studies suggest that the great majority of current returnees, like 

those veterans of prior wars, experience the normal range of post-deployment adjustment reactions. Similarly, a smaller percentage develops PTSD as a result of 

their combat experiences. A recent study (Hoge, et al., 2004) in a sample of Army 

and Marines (n = 3,671) who served in Iraq and Afghanistan, indicates that postdeployment, approximately 12 percent met criteria for PTSD. Pre-deployment assessment found the rates for PTSD were very similar to those of the general population: 5 percent and 3–4 percent respectively. Collectively, 17 percent met criteria 

for PTSD, Depression, or Generalized Anxiety Disorder (GAD). Of those whose responses were positive for a mental disorder, 38–45 percent were actually interested 

in receiving help and 23–40 percent actually received help. 

II. LESSONS LEARNED FROM RESEARCH AND TREATMENT OF PREVIOUS VETERANS

Important lessons from clinical research and treatment interventions to thousands 

of veterans in the past 30 years provide us with a solid foundation of treatment experience that should enable us to respond appropriately and effectively to the needs 

of veterans and servicemembers from OIF/OEF. Through our work with active duty, 

National Guard and military reserve units, we have learned to integrate such experience with recent scientific and clinical advances in the field. The following are lessons learned to be considered for OIF/OEF servicemembers and veterans: 

1. Greater implementation of early intervention strategies for servicemembers recently exposed to highly stressful events provides an opportunity to apply primary 

prevention to offset the psychological trauma of combat operations. The importance 

of early intervention strategies, such as psycho-education to servicemembers, veterans, and families, can not be over-emphasized. Early intervention may provide the 

best opportunity to prevent more chronic forms of PTSD in the months and years 

following combat operations. 

2. Associated with early intervention strategies is the concept of ‘‘stage of transition.’’ We now recognize that many individuals who experience traumatic stress go 

through a normal transitional period which may be marked by mild clinical features 

(e.g., insomnia, sadness). However, it is important to recognize that this phase is 

an absolutely normal response to loss or stress. We encourage providers not to immediately label these responses with psychiatric labels. In addition, we recommend 

to providers to watch for potential ‘‘red flags’’ such as substance abuse, anger, concentration deficits, which may be signs that the individual requires additional professional interventions. 

3. Further, we have been promoting a population-based approach to screening for 

combat stress within the military and VA. Both agencies are now routinely using 

the NCPTSD Primary Care PTSD Screen. This screen is a brief, four-item tool that 

can accurately and efficiently identify individuals who warrant further assessment 

for possible PTSD. In addition, NCPTSD has produced many gold-standard assessment instruments, such as the Clinicians Administered PTSD Scale (CAPS). 

4. We have learned that in addition to addressing issues of traumatic stress, that 

it is important to address resilience and growth. Instead of a narrow focus on PTSD 

symptoms and related difficulties, we have promoted resilience, or ‘‘psychological 

armor’’ to both active duty and veterans from OIF/OEF. This approach has the effect 

of increasing positive, active coping and maintaining one’s life goals and plans both 

during and after military experience. 

5. Veterans and servicemembers do not always seek out behavioral health care, 

even when they suffer from combat stress/PTSD or other psychiatric conditions. For 

example, many veterans will seek mental healthcare from their primary care providers. In response, we now provide greater education to primary care providers 

about the effects of combat stress on the physical and psychological status of their 

patients. Further, we now provide more onsite mental health staff in primary care 

settings in order to address these psychological issues, such as combat stress/PTSD, 

within the medical setting and during the primary care appointment. 

6. Veterans from each combat era develop a unique lexicon, or language to describe their own unique combat experiences. In addition to appreciating the unique 

aspects of their war zone experiences, it is also important that clinicians learn the 

lexicon that veterans speak to describe these experiences. By having a shared language, clinicians can deliver treatment interventions that more accurately capture 

the veterans experience. 

7. Polytrauma and blast related injuries are complex medical conditions that require focused, coordinated and comprehensive medical interventions. These conditions may consist of trauma to the head, eyes, ears, and spinal cord, as well as multiple injuries to internal organs, musculoskeletal and connective tissue systems. 

Closely related to the physical injuries are potential mental health conditions, such 

44

as posttraumatic stress disorder (PTSD), major depression, and anxiety disorders, 

which may interact with the physical injury to decrease overall health status and 

adherence to medical regimens. Such complex medical injuries require coordination 

with mental health to treat the psychological wounds associated with these physical 

injuries. 

III. OVERVIEW OF COLLABORATIVE EDUCATIONAL AND CLINICAL RESEARCH INITIATIVES

BETWEEN NCPTSD AND DOD

The National Center for PTSD is a consortium composed of the following seven 

divisions: Executive, Women’s Health Sciences, Behavioral Science, Clinical Neurosciences, Evaluation, Education, and Pacific Islands. Our world renowned website 

is www.ncptsd.va.gov. I would like to highlight some of the National Center’s recent 

educational and clinical research initiatives. For clarity of discussion, I have divided 

these into two main groups: (i) those that are primarily the purview of personnel 

of the NCPTSD Education, VA Palo Alto Healthcare System and the Pacific Islands 

Divisions (VAPIHCS), and (ii) those related to the entire NCPTSD consortium. 

NCPTSD EDUCATION AND THE PACIFIC ISLANDS DIVISIONS

NCPTSD personnel have been engaged in multiple collaborative educational and 

clinical research activities with the Department of Defense. 

In January 2005, the Navy Bureau of Medicine (BUMED) asked NCPTSD/

VAPAHCS staff to coordinate a leadership summit of Navy, Marine and VA leadership in Southern California. The summit was attended by military and VA mental 

health, medicine, and chaplains, and line officers from Marine Corp Headquarters, 

BUMED, Camp Pendleton, Camp Lejuene, San Diego Naval Hospital, National Center for PTSD, and VA Central Office. The focus of the meeting was coordination between services, across hospital settings, and transition to VA treatment facilities. 

In May 2005, the NCPTSD organized a 2-day combat stress clinical training program for Navy and Marine mental health and primary care military staff located 

throughout the western states (i.e., Camp Pendleton, Naval Hospital San Diego, 

Miramar Air Station, Twenty-nine Palms). 

In June 2005, based on trainings provided to staff at Camp Pendleton, Marine 

Corp Headquarters requested that NCPTSD/VAPAHCS staff provide clinical training related to identification and interventions for combat related stress to all Marine 

Corp Community Services (MCCS) staff at major Marine Corp bases in the U.S. 

NCPTSD/VAPAHCS has created an internet web-based clinical training curriculum entitled PTSD 101. The goal is to provide enhanced training for all VA and 

DoD field clinicians who provide services to veterans, reservists, and active duty returnees with PTSD, adjustment disorders, or other combat stress reactions. This 

web-based curriculum of over 20 courses provides practitioners with a convenient, 

practical, and user-friendly means to access a range of continuing education materials that focus on the diagnosis, assessment, and treatment for PTSD and other 

combat stress reactions. This new web-based curriculum will allow practitioners to 

access training materials 24-hours a day/7 days a week, from any computer terminal. 

Since the Congressional mandate for VA/NCPTSD includes developing and providing education and trainings about cultural issues affecting the Pacific Islands, I 

sought out partnerships with leadership from community mental health agencies 

and DoD. Further, VA/NCPTSD reached out to partner with local, state, and private 

agencies to provide educational and clinical trainings about combat stress/PTSD. 

One outcome of partnering with the larger communities on the islands has been 

the establishment of what will become an annual conference entitled ‘‘Stress, Violence, and Trauma: Promoting Hawaii’s Resilience.’’ This conference is organized by 

a planning committee comprised of a consortium of multiple Federal, state and local 

governmental and non-profit agencies. Also, after Senator Akaka’s staff learned 

about the conference, they expressed enthusiastic support and joined the planning 

efforts. Our first conference was held in April 2005 and was attended by a very receptive audience of over 250 people. Our next conference is being held January 11 

and 12, 2006 at the Hale Koa Hotel. (A description of the conference, at which the 

Under Secretary for Veterans Health Administration, Dr. Jonathan Perlin, will be 

presenting, is located at our website at (http://stressconference.com/). This educational event has increased the visibility for the Pacific Island Division. This collaboration has already had many positive outcomes as we have provided important 

clinical trainings for both Army and Marines in Hawaii who have been deployed and 

redeployed from Iraq and Afghanistan. We want to take the opportunity to thank 

Senator Akaka and his staff for their support to make this annual conference a success. 

45

Staff from NCPTSD’s Pacific Island Division (VAPIHCS) collaborates closely with 

the Army personnel stationed at Schofield Barracks’ Soldier Assistance Center and 

the Family Assistance Center. NCPTSD staff consult the Directors of the Solider Assistance Center and the Director of the Family Assistance Center who oversee the 

collection of needs assessment/clinical intake data for soldiers who screen positive 

for combat-related stress. In 2004, we provided a series of monthly trainings to DoD 

mental health providers at the Soldier Assistance Center on treatment for OIF/OEF 

returnees suffering from combat stress. Since that time, we have continued to provide ongoing trainings for newly hired therapists and residents on evidenced based 

treatment guidelines for the treatment of PTSD, assessment of combat stress-related disorders, early intervention for combat stress, intervention for sexual assault, 

and alcohol abuse treatment. Additionally, NCPTSD staff members co-lead group 

educational interventions with military personnel at the Soldier Assistance Center 

for returnees and their spouses. 

In February 2005, members of the NCPTSD Educational and Clinical Laboratory 

(VAPAHCS) and Pacific Island Divisions (VAPIHCS) provided a 5-day conference at 

Tripler Army Medical Center and Schofield Barracks titled ‘‘War-Zone Related 

Issues for Active Duty Personnel: Pre-, Post-, and Redeployment.’’ Audience members were over 100 Tri-service mental health professionals, including Family Service 

Workers, Social Workers, Psychiatrists, Psychologists, Chaplains, and Primary Care 

Providers. Members of the NCPTSD/VAPIHCS and U.S. Army, Schofield Barracks 

also developed a ‘‘Building Resilience Coping Skills Group,’’ with a manual and 

workbook that address post-deployment stressors uniquely reported by OIF/OEF returnees. Tri-service military providers were trained in implementing the group 

intervention, and several groups have been successfully conducted at Schofield Barracks and at Pearl Harbor. 

Personnel from the NCPTSD (VAPAHCS/VAPIHCS) were requested to provide a 

series of outreach and educational trainings to the 3,000 deploying members of the 

Hawaii’s 29th Infantry Brigade (National Guard) and their families in March 2005. 

We conducted lectures addressing the impact of deployment stress upon families, 

and provided educational materials, created by the NCPTSD, that were specifically 

geared to their needs. The National Guard has requested that VA/NCPTSD provide 

follow-up educational trainings to families prior to their spouses return and again 

upon the servicemember’s return in March 2006. 

Similarly, the Marine Corps requested ongoing educational trainings to spouses 

of the 800 returning Marines at Kaneohe Marine Base. Members of the VA/

NCPTSD are also conducting presentations that address deployment and post-deployment stress on families and provide accompanying VA/NCPTSD educational materials specifically geared to families. 

VA/DOD EDUCATION AND THE NCPTSD CONSORTIUM

Due to the successful collaboration to create an Army version of the Iraq War Clinician’s Guide, a Marine Corps version is also currently being created. The Marine 

Corps version is a collaboration between USMC/VAPAHCS/VAPIHCS and will provide the most current relevant clinical information about combat stress and PTSD 

for both military and VA personnel. 

Returning from the War Zone: A Guide for Military Personnel: This pamphlet was 

created to assist active duty, National Guard, military reserve, and veteran military 

servicemembers to positively cope with adjustment during their transition back to 

civilian life. Returning from the War Zone: A Guide for Families of Military Personnel: This pamphlet was created to help military families understand and assist 

their loved ones following a homecoming. 

IV. RECOMMENDATIONS FOR EDUCATIONAL AND CLINICAL TRAINING NEEDS TO AUGMENT

VA/DOD HEALTHCARE

In the months and years ahead, VA nationwide and VA/NCPTSD will continue 

to serve as a tremendous resource for servicemembers and veterans. VA’s task is 

to continually refine and improve the processes of care in order to apply evidencedbased treatment models for those servicemembers injured or psychologically affected 

during combat operations. Further, the collective goal of the VA and DoD healthcare 

is to support and facilitate the seamless transition and reintegration of the veteran 

into his or her family, work, and community settings. VA/NCPTSD is well positioned to support this mission. 

Here are four suggested recommendations for continued enhancements to quality 

care within VA system: 

46

Implementation of Innovative Treatment Delivery Systems 

Compared to the Vietnam era veterans, the current cohort of veterans display a 

wider diversity in age, racial, cultural, and educational backgrounds. They tend to 

be more comfortable using advanced technology. Many in the current generation of 

warriors have grown up with instant access technology, such as the internet, digital 

imagery and communication and other electronically advanced public and military 

technologies. These servicemembers and veterans may be more comfortable with 

technology than any other previous generation of warriors and veterans. Thus developing innovative treatment delivery systems employing technology based systems 

(internet-based, virtual reality) may provide a relevant platform that suits these individuals’ preferences for treatment. VA/NCPTSD’s Pacific Islands Division continues to promote PTSD telemental health as a way of providing specialty PTSD 

services to veterans residing in remote locations. In addition, NCPTSD provides ongoing education and supervision to national programs interested in developing 

PTSD telemental health for current veterans and returning OIF/OEF veterans. 

Continued Education and Clinical Training for VA Providers 

Many treatment providers in VA have tremendous expertise working with older 

generations of veterans. According to VA estimates, 40 percent of these providers 

will be nearing retirement age in the next 5 years. We can expect a new influx of 

younger treatment providers to enter VA’s workforce during this time as well. These 

younger treatment providers will not share the first hand knowledge of lessons 

learned from the work over the past 30 years. 

For these reasons, education and clinical training have become the primary foundation to support the mission and goals of VA and DoD health care. In order to best 

serve the unique health care needs of the OIF/OEF veterans, a wide educational net 

must be cast to clinical service providers, including mental health and primary care 

providers. In addition, veterans will seek out health care from spiritual leaders or 

others in the community. Education and clinical training will play an integral role 

in determining whether a veteran’s combat stress reactions resolve early, or develop 

into a more chronic form of PTSD. 

In summary, continued education and training are important foundations as VA 

continues to provide quality care to veterans from OIF/OEF, as well as previous 

wars. Further, it is imperative that the VA continues to develop innovative strategies to disseminate education not only to the veterans who come to VA but also the 

veterans who will access other community based healthcare. VA’s NCPTSD is 

uniquely positioned, as VA’s leader in the field of combat-related stress, to support 

VA to meet this objective. The VA/NCPTSD is staffed with highly talented clinicians, researchers, and educators who are devoted to development and dissemination of empirically based treatment protocols, assessment instruments, and guidelines for addressing combat stress and PTSD.

Senator AKAKA. Thank you very much. I just want to say we’ll 

include your full testimony in the record. 

Mr. Wylie. 

STATEMENT OF ALFRED WYLIE, PUBLIC RELATIONS, 

COORDINATOR, VIETNAM VETERANS OF AMERICA 

Mr. WYLIE. Senator, thanks. I’ve been asked to speak about my 

experience with veterans with PTSD and my own experience with 

PTSD. 

First, I wish to clarify that PTSD is essentially an emotional 

wound that is just as crippling as physical wounds, especially in 

personal and social relationships. In fact, there is neurological 

damage from the traumatizing events of war. 

This damage is exemplified by the veteran who hits the ground 

when he hears a car backfire 30 years after the stressor occurred. 

What happens to those of us who are emotionally wounded is that 

certain stimuli will trigger a flashback that is in essence a short 

circuit or a hardwired response that will be with the veteran until 

death. 

This hardwiring of our neural circuits will never be resolved. It 

is with us for the rest of our life. We can be improved in our emoVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00050 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
47

tional reaction to these specific triggering stimuli. The reduction of 

our emotional reactions is a long-term process called psychotherapy. 

The issue of psychotherapy is a double one. First, there is the 

emotionally wounded veteran, and then there are those who develop secondary PTSD, which is primarily the children of the veteran. This issue of secondary PTSD can be resolved if the veteran 

is treated prior to the conception of the children. 

This issue of veterans can be resolved by the VA developing procedures to identify those veterans with PTSD at the time of discharge and then integrating them into a mandatory therapy program immediately upon separation. This would save the Government an enormous amount of money in costs of future treatment 

and care. 

The Government needs to truly understand that intensive psychotherapy programs such as the VA intensive program in Hilo, 

Hawaii and its follow-up procedures are effective for the older veteran and would be doubly effective for the newly released veterans 

with PTSD. 

Again, I must emphasize that this neurological hardwiring from 

the chronic death threats will never go away. But with psychotherapy that focuses on processing the repressed death threat emotions, the veteran’s experiences will diminish in time. 

Going through the shakes of fear and letting out the tears of 

grief are necessary for the healing process. Unfortunately, the veteran with PTSD is usually unconscious of his emotional wounds 

since the environment that caused them required that he or she 

numb out to such feelings. This numbing-out process to emotional 

feelings is a natural process that occurs in humans and non-human 

primates as well as numerous mammals exposed to high levels of 

stress. 

So here we have veterans fresh from the high stress zone who 

can be treated of for his emotional wounds in a immediate manner, 

or they can be released into society where they will become a liability for many years. Most veterans don’t become conscious of the actual cause of their disability until they are older, when they can 

no longer produce enough epinephrine, which is also known as 

adrenalin, to suppress the emotions. 

Depending on the individual veteran, this occurs around 45 to 65 

years of age. This, by no means, means that the veteran is symptom-free, but just that he will start having reality level flashbacks 

when he can no longer produce enough adrenalin to suppress conscious memory of traumatic events and lifestyle. 

The second issue concerning veterans is the secondary PTSD 

they cause their children. Being a parent who has caused emotional wounding to my own children from my own PTSD, I speak 

with authority on the subject as well as speaking for other veteran 

fathers. Please get us into therapy before we have our children. 

Of course, there is the moral issue of the Government’s responsibility to its emotionally wounded veterans. However, after 65 years 

of life, I conclude that the real moral issue is money. Therefore, 

from this point of view, it is much more cost-effective for the Government to provide emotional therapy soon after separation from 

service, thus avoiding the cost to the social system of years of vetVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
48

erans who are emotionally wounded and the subsequent burden to 

the social welfare system involving their families. 

Secondarily, getting the young emotionally wounded veteran into 

emotional therapy will prevent a generational cost inasmuch as the 

emotionally wounded veteran produces emotionally wounded children. 

In conclusion, the Government in the long run will save money 

if veterans with PTSD are identified and entered into emotional 

third-party programs upon separation from service. Another benefit 

of entering young veterans into therapy soon after separation is 

stopping the secondary PTSD that develops in children of PTSD 

parents, which in turn becomes an economic drain to society. 

[The prepared statement of Mr. Wylie follows:]

PREPARED STATEMENT OF ALFRED WYLIE, PUBLIC RELATIONS COORDINATOR, VIETNAM VETERANS OF AMERICA

I have been asked to speak to you about my experience with veterans who have 

PTSD. 

First I wish to clarify that PTSD is in essence emotional wounds that are just 

as crippling as physical wounds, especially in personal and social relationships. In 

fact there is neurological damage from the traumatizing events of war. This damage 

is exemplified by the veteran who hits the ground when he hears a car backfire 30 

years after the stressor occurred. What happens to those of us who are emotionally 

wounded is that certain stimuli will trigger a flash back that is in essence a short 

circuit or a hardwired response that will be with the veteran unto death. This hard 

wiring of our neural circuits will never be resolved. It is with those of us who have 

PTSD for life. What can be improved is our emotional reaction to these specific triggering stimuli. The reduction of our emotional reactions is a long term process 

called psychotherapy. 

The issue of psychotherapy is a double one. First, there is the emotionally wounded veteran and then there are those who develop secondary PTSD which is primarily the children of the veteran. 

The issue of secondary PTSD can be resolved if the veteran him/herself is treated 

prior to the conception of the children. 

The issue of the veteran can be resolved by the VA developing procedures to identify those veterans with PTSD at the time of discharge and then integrating them 

into a mandatory therapy program immediately upon separation. This would save 

the government an enormous amount of money in costs of future treatments and 

care. 

The government needs to truly understand that intensive psychotherapy programs such as the VA intensive program in Hilo, Hawaii and its follow up procedures are effective for the older veterans and would be double effective for newly 

released veterans with PTSD. 

Again, I must emphasis that the neurological hardwiring from the chronic death 

threats will never go away. But with psychotherapy that focuses on processing the 

repressed death threats the emotions the veteran experiences will diminish in time. 

Going through the shakes of fear and letting out the tears of grief are necessary 

for the healing process. Unfortunately, the veteran with PTSD is usually unconscious of his emotional wounds since the environment that caused them required 

that he/she numb out to such feelings. This numbing out process to emotional feeling is a natural process that occurs in human and non human primates as well as 

numerous mammals exposed to high levels of stress. 

So here we have a veteran fresh from the high stress zone who can be taken care 

for his emotional wounds (PTSD) in an immediate manner or he can be released 

into society where he will become a liability for many years. Most veterans don’t 

become conscious of the actual cause of their disability until they are older when 

they can no longer produce enough ephiphrine (adreline) to suppress the emotions. 

Depending on the individual veteran this occurs around 45–65 years old. This by 

no means, means that the veteran is symptom free but just that he will start having 

reality level flash backs when he can no longer produce enough adreline to suppress 

conscious memory of traumatic events and lifestyle. 

The second issue concerning veterans is the secondary PTSD they cause their children. Being a parent who has caused emotional wounding to my own children from 

my own emotional wounds (PTSD) I speak with authority on the subject as well as 

49

speaking for other veteran fathers. Please get us into therapy before we have our 

children. 

Of course there is the moral issue of the government’s responsibility to its emotionally wounded veterans. However, after 65 years of life I conclude that the real 

moral issue is money. Therefore, from this point it is much more cost effective for 

government to provide emotional therapy soon after separation from service thus 

avoiding the cost to the social system of years of veterans who are emotionally 

wounded and the subsequent burden to the social welfare system. Secondarily, getting the young emotionally wounded veteran into emotional therapy will prevent 

generational cost in as much as the emotionally wounded veteran produces emotionally wounded children. 

In conclusion the government in the long run will save money if veterans with 

PTSD are identified and entered into emotional therapy programs upon separation 

from service. Another benefit of entering young veterans into therapy soon after separation is stopping the secondary PTSD that develops in children of PTSD parents, 

which in turn become an economic drain on the economy.

Senator AKAKA. Thank you. Thank you very much, Mr. Wylie. 

Dr. Shomaker. 

STATEMENT OF T. SAMUEL SHOMAKER, M.D., J.D., INTERIM 

DEAN, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY 

OF HAWAII AT MANOA 

Dr. SHOMAKER. Good morning, everyone. I want to thank Senators Craig and Akaka and the Committee staff for holding these 

important and historic hearings here in Hawaii. I particularly want 

to thank Senator Akaka for his longstanding support of the School 

of Medicine. We’re proud to count several members of his immediate family amongst our graduates, including a son, a grandson, 

and a nephew, I believe. 

I also want to take a moment, as an ordinary citizen, to thank 

all the veterans in the audience for the service that you render us. 

I am deeply grateful, and I think we all owe you a debt of gratitude. Thank you very much for all you’ve done for our country. 

[Applause.] 

Dr. SHOMAKER. I’m joined today by Haku Kahoano, who’s a 4thyear medical student. You’ll hear from him in just a second. 

The John A. Burns School of Medicine is the only medical school 

in the State. We provide a culturally appropriate medical education 

program for the State’s citizens. Our partnership with the VA dates 

back over many years. We share a common mission of clinical care, 

medical education, and biomedical research. 

We’re very, very excited with the appointment of Dr. Hastings, 

who’s a former Chair of the Department of Internal Medicine at 

our school, as the VA Director here. We feel that that will open up 

all sorts of new partnership opportunities for us. 

Our partnership in medical education is already very strong. 

Twenty-six members of the VA medical staff have faculty appointments at the John A. Burns School of Medicine, and they teach our 

students and residents at the Spark Matsunaga Center, which is 

an active teaching site for the John A. Burns School of Medicine. 

The VA also funds 16 residency training slots in residency programs in specialties like geriatrics, internal medicine, and psychiatry. We also have a very strong and burgeoning partnership in 

biomedical research in areas like dementia, movement disorders, 

kidney disease, and telemedicine. So we’re excited about developing 

that partnership further. We’re very supportive of the VA’s commitment to funding education and research programs. 

50

I’m joined today by Haku Kahoano, who’s a perfect example of 

the partnership that we have at the VA. He is both a future physician and a future veteran. He’s a member of the United States 

Army. He’s just been accepted to do his residency at Tripler, and 

recently completed a clinical rotation at the VA. So I’d like Haku 

to say a few words today. 

[The prepared statement of Mr. Shomaker follows:]

PREPARED STATEMENT OF T. SAMUEL SHOMAKER, M.D., J.D., INTERIM DEAN, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY OF HAWAII AT MANOA

Chairman Craig, Senator Akaka, and Members of the Committee on Veterans’ Affairs, thank you for this opportunity to testify on the relationship between the VA 

and the University of Hawaii’s John A. Burns School of Medicine. I am Sam 

Shomaker, currently serving as interim Dean, and I am accompanied by a 4th-year 

medical student, Haku Kahoano. 

I am pleased to report that our Medical School enjoys a very strong relationship 

with the VA in Hawaii—one that is mutually beneficial to our state’s veterans and 

medical education programs. Residents in Hawaii enjoy the longest average life 

span of any state in the Nation. For that reason, our Medical School has developed 

especially strong programs in geriatric medicine. 

The Hawaii VA hosts medical residents in internal medicine, transitional, psychiatry and geriatric psychiatry programs. At any given time, there are about 16 medical residents and fellows serving in VA facilities here. 

Areas of active collaboration between our Medical School and VA include dementia, movement disorders, aging, kidney disease, epidemiology, and telemedicine. 

More than two dozen members of the VA staff hold appointments as faculty of the 

John A. Burns School of Medicine. 

As Hawaii’s only medical school, we bear a special responsibility to prepare students to meet the health needs of our residents—among them our aging military 

veterans. At this time I would like to introduce one of our students who is both a 

future physician and a future veteran—Lt. Haku Kahoano is a member of the U.S. 

Army and a 4th-year medical student.

STATEMENT OF HAKU KAHOANO, 4TH-YEAR MEDICAL STUDENT, JOHN A. BURNS SCHOOL OF MEDICINE, UNIVERSITY 

OF HAWAII 

Mr. KAHOANO. Thank you, Dean Shomaker. Aloha, Senator 

Akaka, Committee Members, and veterans. 

I’m a lifelong resident of Hawaii and will graduate from the John 

A. Burns School of Medicine this May. You’ve heard Dean 

Shomaker describe the many ways the VA helps our medical school 

fulfill its mission in creating fully functioning residents and primary care physicians. 

I might also add that as the baby boomers enter their senior 

years, they can be expected to once again redefine the needs of society, redefine the needs of the VA. The need to create a cadre of 

physicians who will be able to address issues like polypharmacy, 

loss of cognitive and physical function, dementia, delirium, assisted 

living, long-term care, palliative management, has never been 

greater. 

In addition to its nationally recognized geriatric fellowship, John 

A. Burns School of Medicine now requires all 4th-year students to 

undergo a monthlong geriatric elective. JABSOM offers this program in partnership with the VA and provides tutelage of attending physicians with expertise in geriatrics. Students gain invaluable firsthand exposure to the care of geriatric ex-military members, both in the long-term care and outpatient arenas. 

I am one of the fortunate members of the class of 2006 to benefit 

from this program, and I come before you to day to attest to the 

51

truly valuable lessons learned from my geriatric experience at the 

VA. My 4th-year geriatric elective ambulatory block was conducted 

at the VA’s Spark M. Matsunaga Clinic located on the grounds of 

Tripler Army Medical Center. 

It is said that the saving grace of medicine is repetition. If that 

is true, then continuity should be seen as an integral part of any 

sound medical education. During my internal medicine rotations at 

Tripler, I had the distinct privilege of servicing veterans that I 

would later see during my outpatient geriatric experience. I can 

honestly say that it is difficult to forget a given pathology or a mix 

of pathologies when you see them in the same patient over and 

over again. 

Case in point: I recall the 87-year-old Mr. H, who was admitted 

to Tripler’s inpatient medicine wards for management of his ural 

sepsis and concomitant aspiration pneumonia. He was a pleasantly 

demented gentleman who had suffered a stroke 2 years prior that 

left him with significant left-sided weakness and an inability to 

take food orally. 

During his inpatient stay, I learned a great deal about the management of ural sepsis and aspiration pneumonia, all of which 

came in very handy when, 3 weeks later, I saw the same gentleman again, this time in the outpatient setting. Already familiar 

with the patient’s history and the pertinent issues, I was able to 

quickly generate a management plan for Mr. H’s new onset shortness of breath and cough. 

I was also able to get social work involved to help set up some 

respite time for the patient’s care provider. Both the patient and 

his caregiver also seemed to appreciate dealing with a familiar 

face, a face who had already put in the time to learn their story 

and earn their trust. 

Continuity of care in the clinical arena is a win-win situation for 

everyone involved. Through its alliance with the VA, the Tripler 

Army Medical Center, and the various private healthcare institutions in the State of Hawaii, the John A. Burns School of Medicine 

works hard to provide for its students experiences rich with this 

kind of continuity. 

In closing, gentlemen, every VA patient who is cared for here in 

the State of Hawaii is yet another patient whom JABSOM students 

can interact with, service, and learn from. Every patient that is 

sent away to another State for healthcare becomes another lost opportunity for our physicians-to-be. 

Senator Akaka, Committee Members, veterans, good people. I 

thank you for giving me the opportunity to discuss the tremendous 

relationship enjoyed by the VA and the John A. Burns School of 

Medicine. Aloha kakahiaka. 

[Applause.] 

[The prepared statement of Mr. Kahoano follows:]

PREPARED TESTIMONY BY HAKU KAHOANO, 4TH-YEAR STUDENT, JOHN A. BURNS

SCHOOL OF MEDICINE

Chairman Craig, Senator Akaka and other Committee Members, my name is 

Haku Kahoano and I am a lifelong resident of Hawaii as well as a graduate of the 

University of Hawaii. I had the privilege of playing on the UH football team from 

1987 to 1991 and received an MBA in 1996. 

52

I am on track to graduate from the John A. Burns School of Medicine (JABSOM) 

next year, and I have accepted a residency in internal medicine at the Tripler Army 

Medical Center. 

You’ve heard Dean Shomaker describe the many ways the VA helps our Medical 

School fulfill its mission to create fully functional residents and primary care physicians. 

Allow me to add that there is a national health care crisis on the horizon; The 

reality of the baby-boomers turning 80 and the need to create physicians who are 

‘‘geriatric’’ savvy. As the baby-boomers enter this demographic they can be expected 

to once again redefine the needs of society. The need to create a cadre of physicians 

who will be able to address issues like (polypharmacy, loss of cognitive and physical 

function, dementia, delirium, assisted living, long term care, palliative management, 

etc.) has never been greater. 

In addition to its nationally recognized geriatric fellowship, JABSOM now requires all 4th-year students to undergo a month-long geriatric elective. JABSOM offers this program in partnership with the VA, and provides tutelage of attending 

physicians with expertise in geriatrics. Students gain invaluable first-hand exposure 

to the care of geriatric ex-military members both in the long term care and outpatient arenas. 

I am one of the fortunate members of the Class of 2006 to benefit from this program, and I come before you today to attest, to the truly valuable lessons learned 

from my geriatric experience at the VA. 

My 4th-year geriatric elective ambulatory block (outpatient clinic) was conducted 

at the VA’s Spark Matsunaga Clinic located on the grounds of Tripler Army Medical 

Center. Senators, thank you for giving me the opportunity to discuss the tremendous relationship enjoyed by the VA and Hawaii’s medical school, from a medical 

student’s perspective.

Senator AKAKA. Mahalo nui loa. Mahalo, Haku Kahoano, and Dr. 

Shomaker. 

Dr. Shomaker, I know you have another event to attend, too, so 

I plan to ask you a question first. I want you to feel free to depart 

after you’ve answered the question. 

Dr. SHOMAKER. Thank you, sir. I appreciate it. 

Senator AKAKA. Dr. Shomaker, I noted in your testimony that 

you have collaborated with VA on telemedicine issues. What advances do you think that VA can make in the area of telemedicine 

in Hawaii? 

Dr. SHOMAKER. I think it’s a wonderful adjunct to providing onsite care. There obviously are going to be situations in which it’s 

not possible to have a specialist such as a cardiologist present at 

every VA clinic on neighbor islands. 

However, providing access to those services via telemedicine is a 

viable alternative to stationing specialists in neighbor island clinics 

on a regular basis. So I think it’s a tremendous adjunct to the care 

that serves the role of extending the capabilities of the VA, and it’s 

something that is probably well worth the investment. 

Senator AKAKA. Thank you for your testimony. I want you to 

know that our Washington level VA folks here, led by Dr. Perlin, 

have been looking forward to the future and the use of high tech 

to get services to veterans. This certainly fits in that future. 

So I want to thank you and Haku Kahoano for being here and 

for adding to this, and would wish you well. 

Dr. SHOMAKER. Thank you, Senator. 

[Applause.] 

Senator AKAKA. I have questions for the rest of the panel. I 

would like for each of you to comment on this. 

The spiraling costs of post-traumatic stress disorder have intensified a debate in Washington, adding fears of my fellow veterans. 

53

I believe that this debate is unfounded, as the cost of post-traumatic stress disorder should be viewed as a cost of war. 

Some have suggested that a veteran’s PTSD compensation 

should be reduced if the veteran’s decision is deemed to be improved. Some have also said that this move would be politically 

courageous. 

My question to each of you, first, on this side, and we’ll move to 

my right: Do you believe this to be a wise move? 

Ms. RUBENS. Well, the Veterans Benefits Administration is in 

place to enact and administer the laws that have been passed by 

Congress. The issue of cost savings is not one that we, quite honestly, trouble ourselves with because we feel as though the laws 

that are on the books are the ones that we are here to implement, 

and we can only make the assumption that you put the laws in 

place in Congress and you will find money to ensure that our veterans are being paid the benefits to which they are entitled. 

Mr. MOLNAR. Thank you, Senator. I will try to answer that question from a clinical point of view. 

When the decision was made to look at the 72,000 cases, I can 

tell you that, as others who have testified in the panel before, there 

was a great deal of concern about what it meant for the veteran 

we were serving. 

A couple of examples. One is, many of our World War II veterans 

never came forward after the war. They didn’t deal with their 

issues of trauma. There are some good reasons for that. We didn’t 

even recognize PTSD officially in the psychiatric diagnosis until 

1980. We didn’t have the kind of mental health care that we have 

today. For many cultural reasons, people did not want to be identified as a mental health provider. 

Nevertheless, after many years, some of them applied for compensation. Most of our World War II veterans are in their later 

years, the autumn of their life. Their concern is taking care of their 

families. This was an added stress, an added aggravation. They 

asked me, what do you think is going to happen? Do you think I 

might lose my PTSD, my compensation? What will happen to my 

wife? Those kinds of questions certainly came up. 

Clinically, was there an impact on that discussion? Yes. 

Mr. GUSMAN. Thank you, Senator Akaka. I think I would add 

that I’d like to also speak to that from a clinical perspective, that 

our understanding of now what we term combat-related stress and 

post-traumatic stress disorder are really different from 30 years 

ago. There’s so much more information. 

I believe it’s really important, without any intent to do harm, to 

look at how we do our assessments and how we make determinations on what’s best for our veterans. I think that there was a lot 

of concern by many, many veterans. I got calls from veterans that 

I had seen, you know, 20 years ago asking me what did this really 

mean. 

I believe that we have to find a happy medium somewhere, that 

we have to work with where science is taking us today. We have 

to look at what the impact is, and in some ways I personally—this 

is not the VA’s policy—is that sometimes we institutionalize people 

unintentionally. We create situations that allow for a dependency 

that in many instances is not healthy. 

54

I can personally tell you there are many veterans that come to 

me that say, I want to be in treatment but I don’t want to have 

this label. I don’t want to be compensated that way. I want a job. 

I want a place to live. I want to be able to raise my family in a 

healthy way. 

So I think that, yes, we need to look at things. But I think we 

need to clear this with the veterans, and we don’t do this with the 

intent to do harm, but to look at where science today is taking us. 

Senator AKAKA. Mr. Gusman, let me ask you a question here. Is 

there a time frame for PTSD symptoms to appear? How long does 

it take for this disorder to reveal itself? 

Mr. GUSMAN. Well, I’d like to say, as my colleague to the right 

had mentioned, that there really isn’t a timeline. You try to narrow 

that down scientifically, and we really haven’t been able to because 

what we’ve seen is that for some people, they can come home and 

manage the stress levels. They reintegrate to the community well. 

But then it might be many years later, if they’re having a loss in 

the family, that many of the old memories can trigger. Then some 

of the issues for that will come roaring in and overwhelm him. 

I think that what we do know is that we not have tools to help 

people. I think the issue really is about how we deliver those tools. 

How do we make them more accessible and user-friendly? 

I think some of the things that we’re starting to do, and including here in Hawaii, is working with the community at large because we know many of these veterans do not go to the VA, as they 

don’t in most of the country. I believe it’s a little above 7 percent 

of veterans who go to the VA on a national level. 

So it’s important that we share our knowledge with the community providers because they interface with the majority of veterans 

more frequently. I think that knowledge is the key here. Veterans 

who understand, as I’ve had the benefit of working with many Marines who are active duty, and what I find is that when they have 

knowledge about what they’re feeling and experiencing and understand that this is normal, that they do much better. 

Senator AKAKA. Thank you, Mr. Gusman. 

I want to finish the panel with Mr. Wylie’s answer on that question that I asked the panel. 

Mr. WYLIE. Well, I believe the question was, should compensation be lowered for the veteran if he gets better. I think for us older 

veterans, there is nothing that can be done for us. We’re getting 

too old. We had years and years of adding on pain due to the 

PTSD. Consequently we have to spend years working on emotional 

healings, whereas the young veteran only has to heal with the military trauma once they come out of service. They should be able to 

achieve a better adjustment. However, if the Government doesn’t 

accept that responsibility, I don’t see much progress to be made beyond that. 

Senator AKAKA. Thank you very much. 

Mr. Molnar and Mr. Gusman, we have seen in the past that substance abuse can become a secondary condition to another serviceconnected condition such as PTSD. How do you feel we can prevent 

our veterans from becoming users of illegal substances? 

Mr. MOLNAR. Well, I think it’s also both illegal and legal substances when you talk about substance abuse. I can speak to that 

55

question, Senator, both from a professional perspective and also 

from a personal one. My father was a World War II Marine, fought 

on Saipan and Tinian, was wounded there, and struggled most of 

his life with PTSD. He often went down to the VFW Hall and 

drank with his buddies, and developed an alcohol problem over the 

years. 

I think that quite often, since time immemorial, people seek to 

numb their pain, whether it be physical or whether it be emotional. 

That’s not unusual. Our doctors prescribe medication when we 

have pain. 

Many people, though, who are suffering from post-traumatic 

stress symptoms often will not present to the mental health clinic. 

They have fear, whether it be cultural, they have fear job-wise, 

that they do not want to be labeled or stigmatized with a mental 

health issue. 

So they can fall between the cracks. That’s why, as a number of 

folks have mentioned, outreach is important. Networking is important. Liaison is important. When our OIF/OEF person goes out 

there, Matthew, I want him to do one thing, to tell veterans, remember our phone number, 973–VETS. Call us. Perhaps if we can’t 

help you, we can put you in touch with someone who can. 

Because the important thing is that people have a readjustment 

period where they can begin to talk about these issues that they 

will carry the rest of their lives. The friend they lost, the day they 

lost that friend, the mistake that was made, the error, these things 

will live with them for the rest of their lives. 

If we can assist them in that readjustment process, we hopefully 

can minimize issues of substance abuse. 

Senator AKAKA. Thank you. 

Mr. Gusman. 

Mr. GUSMAN. Thank you, Senator. Substance abuse is becoming 

more of a problem, as I understand from my——

Senator AKAKA. Excuse me. Would you please pull up the mike? 

Mr. GUSMAN. Yes. As I said, Senator Akaka, as I understand 

from my DOD colleagues and working with them, that substance 

abuse is becoming more of a problem in the sense that our young 

men and women use this as a way of avoiding having some of the 

recall, some of the flashbacks, as we call them, some of the 

uncomfortableness. 

I think that DOD and the VA is making every effort, and we 

need to continue to do so to do some early intervention in this regard. We didn’t understand that 30 years ago, and many—by the 

time Vietnam veterans came to the VA, many then had chronic 

substance abuse problems. Then there was a constant debate within the VA: Do we treat the substance abuse or do we treat the socalled PTSD? 

I think we’re not going to go down that road this time, thank 

God, and what we understand is that PTSD does not discriminate. 

It doesn’t matter what ethnic group you are, your education or 

background; that if you’re exposed to enough events, you’re going 

to have some issues to deal with. 

It’s only natural that if you’re away from home, whether it’s 7 

months or multiple tours of being redeployed, that there is going 

56

to be some difficulty in transitioning back. You might possibly see 

people using substances of different sorts. 

As Dr. [sic] Molnar just said, it’s not only alcohol or dugs, but 

there are other kinds of problems—eating disorders, compulsive behavior, spending. I could tell you that when the first cadre of Marines came back to Camp Pendleton, the Harley dealers heard that 

these Marines needed to buy Harleys, and they just lined up everywhere you can go from San Diego up to Camp Pendleton to sell 

these Harleys. What was that about? Well, this is about the rush 

that many of these Marines felt more akin to. 

So there are many different ways that people so-called self-medicate. I think it’s important for us in the VA and for the community 

healthcare providers that we look for those flags, that we don’t only 

look for traditional drugs and alcohol but other kinds of behaviors 

that are addictive. 

Senator AKAKA. Mr. Gusman, in your opinion, how can VA better 

help the families of veterans with PTSD cope with the situation 

and take care of our veterans? 

Mr. GUSMAN. One of the ways actually is happening today, Senator, which I mentioned earlier that I’m very happy and thankful 

that you’re a supporter of, and that’s the community conference 

that’s happening at Hale Koa dealing with resiliency and stress 

and bonds in the community. 

These kinds of partnerships with the VA and other State and 

county agencies and nonprofits is essential. I think right now one 

of the things the VA has been doing, and again I’m proud to say 

that we have been part of this, including the Pacific Islands Division in Hawaii, is to develop materials that are easily accessible to 

families so that they can get the kind of education that they need 

to understand what their family members are dealing with. 

That’s the key, I think, you know. When people understand what 

to do, the mystery is taken away and things become sort of at least 

somewhat acceptable. Then the veteran, the returnee, doesn’t also 

feel like maybe they’re going crazy or something when in fact 

they’re not. They’re having normal reactions to some very terrifying 

experiences. 

I think that the VA is on the right track right now working with 

families and Vet Centers, doing a lot of that. Groups like the National Center’s PTSD section are working hand-in-hand with employee education in the VA to develop all kinds of materials, is the 

way to go. 

More outreach, sir. That’s what we have to do. 

Senator AKAKA. Thank you very much, Mr. Gusman. 

I want to thank this panel very much for your testimonies, and 

I’ll dismiss you at this time. 

Folks, we have another panel. This is the panel that are at the 

head of our VA. I would like to call them forward at this time. 

Dr. Perlin, who’s Under Secretary of Health, Department of Veterans Affairs; Robert Wiebe, who is the VA Network Director, 

VISN 21, Sierra Pacific Network; James Hastings, Doctor, and Director of VA Pacific Islands Health Care System; Steven MacBride, 

Chief of Staff, VA Pacific Islands Health Care System; and Major 

General Gale S. Pollock, Commander, Tripler Army Medical Center. 

57

General Pollock and Dr. Perlin, I appreciate your patience. I ask 

for the witness order to be adjusted today so that I could hear from 

you in response to all that has been shared. I greatly value your 

input and response, and I look forward to your testimony. 

I know, hearing from you already, that you’re making huge efforts to try to deal with the concerns of Hawaii’s veterans. I want 

you to know that I’m so grateful to you. Let me step back and say 

I’m grateful to Chairman Larry Craig of this Committee who did 

come out and did add so much to the hearings here. He, too, as we 

work together so well, will be looking forward to dealing with these 

issues. 

So let me ask Dr. Perlin to proceed with your testimony. 

STATEMENT OF HON. JONATHAN B. PERLIN, M.D., PH.D., 

UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS, ACCOMPANIED BY ROBERT WIEBE, M.D., VA 

NETWORK DIRECTOR, VISN 21, SIERRA PACIFIC NETWORK; 

JAMES HASTINGS, M.D., DIRECTOR, VA PACIFIC ISLANDS 

HEALTH CARE SYSTEM; AND STEVEN A. MACBRIDE, M.D., 

CHIEF OF STAFF, VA PACIFIC ISLANDS HEALTH CARE SYSTEM 

Dr. PERLIN. Aloha kakahiaka, Senator. 

Senator AKAKA. Aloha. 

Dr. PERLIN. Mahalo nui loa for the opportunity to appear before 

you today to discuss VA care. 

Senator AKAKA. I want to say, Dr. Perlin, in the short time that 

he’s been here, see how eloquent he is in Hawaiian? Thank you so 

much. 

[Applause.] 

Dr. PERLIN. Mahalo nui loa. 

Senator AKAKA. You’re getting better. 

[Laughter.] 

Dr. PERLIN. Senator, it’s really a delight to be here with you. 

Thank you, Senator Akaka, for your incredible leadership, your 

passion, your advocacy for veterans, and your support of VA and 

Department of Defense, the men and women who support and 

serve America in uniform. 

I’m pleased to be able to discuss with you VA care, especially 

care related to post-traumatic stress disorder. I have found care 

throughout all of the islands of Hawaii, and the access to that care. 

In fact, I’ve had the opportunity these last couple of days to move 

around the islands—we’ve had some hearings—and to see that care 

firsthand. 

We’ve had some good discussions in those hearings. We’ve identified some of the issues that we’re working on to make improvements to our, in fact, already very robust services for veterans in 

the State. Especially, the area of the greatest improvement is extending greater access to veterans on the neighbor islands, especially reaching out even more strongly to Lanai and Molokai. 

Improving access will take a number of shapes and forms. But 

let me assure you that the care is already very, very robust. For 

example, I’m proud of how [inaudible] CBOCs, such as those on 

Kauai and Molokai. The CBOCs are an element with one to two 

physicians, primary care physicians, one nurse practitioner, one 

58

psychiatrist, and generally a psychologist, with a panel about 1,000 

to 1,500 patients. This compares favorably to services on the mainland, where one primary care provider has a panel of 1,200 patients themselves. 

I realize that there are unique logistical issues. But these are the 

ways that we want to make sure that we transcend some of those 

logistical issues and continue to improve care. 

A number of issues have been identified this morning, and we 

look forward to sharing with you what emerged from some of the 

discussions, the hearings yesterday on Maui and the previous day 

on Kauai. Through hiring additional care providers, particularly in 

specialties that were identified as being in short supply—orthopedics and ophthalmology, for example. 

Through better scheduling of traveling doctors and nurses and 

psychologists to the neighbor islands to make sure that those specialty services are available more regularly and more timely. 

Through the use of advance technologies such as those Senator 

Akaka has championed in terms of telehealth and extending the 

care, and something I’ve had an opportunity to discuss during the 

questions in even more detail, some of the additional advances in 

telehealth supporting tele-mental health and all of the mental 

health services. 

In fact, which General Hastings later showed, the improvements 

in scheduling of services so when the veteran does travel from one 

of the neighbor islands, that the clinics, that services that are 

needed, are scheduled on the same day. 

But in fact my best observation is that it’s not just about the 

quality of care, which is excellent, nor about the access to service, 

but about the compassion with which that care is delivered. 

The thing that I learned in listening to the clinics that we visited 

together and the Vet Centers, that it’s not just about patients. It’s 

about community. It’s about family. That is absolutely remarkable 

and as good as if not better than I’ve seen anywhere else in this 

country. I commend the men of VA Pacific Islands Health Care 

System, who give not only of their technical skills but in their 

hearts in serving individuals who are not just their patients but 

their family. 

Here on Oahu we operate one of the Department’s finest and 

most innovative facilities. The Spark M. Matsunaga VA Medical 

Center is located, as I think you all know, on the campus of the 

Tripler Army Medical Center. Care here on the islands is provided 

through our VA Pacific Islands Health Care System, which is part 

of our Sierra Pacific Health Care Network, one of our 21 Veterans 

Integrated Service Networks. Dr. Robert Wiebe is the Director of 

that very, very large network. 

We’re joined also today by Dr. James Hastings, who is the new 

Director of the VA Pacific Islands Health Care System and also a 

card-carrying cardiologist who goes around still, despite his administrative duties, to the other islands providing cardiac care. 

The compassion and the sense of community and family is never 

better exemplified than anyone other than our Chief of Staff of that 

facility, Dr. Steven MacBride, who has, in his words and action, 

shown the absolute love and commitment he feels for the veterans 

that we serve. 

59

The Medical Center provides primary care services in its ambulatory care center. This includes mental health, specialty services, radiology, optometry, all in a state-of-the-art facility that was dedicated in May 2000. It houses also the Center for Aging, which is 

a 60-bed facility that provides outstanding convalescent and endof-life care, rehabilitation services, geriatric, and geripsychiatric assessments for veterans, all with the goal, if possible, of improving 

veterans’ functions so they can return to their homes and their 

families. 

I have to tell you that I would be remiss if I didn’t acknowledge Senator Akaka’s leadership in securing $83 million for the ambulatory care center and for the Center for Aging. This clearly is a demonstration of that support and leadership and compassion in caring 

for veterans. 

VA’s partnership here with Tripler Army Medical Center is one 

of the largest and most important of all the VA and DOD partnerships. I appreciate the great leadership and partnership that Major 

General Gale Pollock, Commander at Tripler Army Medical Center, 

provides. We’re pleased also, as I mentioned, to welcome the former 

commander of Tripler Army Medical Center as director. I know 

that these two individuals can form an unprecedented level of effectiveness in their partnership in serving both servicemembers and 

their dependents as well as our veterans. 

We heard also from Dr. Shomaker, who is the Dean of the John 

A. Burns School of Medicine. That relationship is not only so important, but was so well demonstrated by the presence of the medical student who will carry the torch on even beyond our times caring for the citizens and veterans and servicemembers here in Hawaii. 

That partnership provides a number of services, including emergency room care and acute medical/surgical inpatient care, outpatient specialty care, and ancillary services, and we greatly appreciate the leadership that Tripler Army Medical Center provides in 

allowing VA to use those services to provide the state-of-the-art 

care for veterans. 

That care extends. VA and DOD have secured $1.25 billion in 

funding for projects related to such things as computer-aided design and manufacturing and prosthetic devices, and for the construction of a chronic dialysis center, something that will help the 

servicemembers and veterans, and for the development of a chronic 

pain management program. 

We also work together on a single separation health examination 

for active duty personnel who will be leaving military service so 

they don’t have to go through two examinations with the same information required. 

One more piece of good news, particularly for the residents on 

Oahu, on that relates to the topic of today’s hearing, and that’s 

that we’re relocating our Post-Traumatic Stress Residential Rehabilitation Program from Hilo to here. It’s a program that provides 

intensive residential rehabilitation for veterans suffering from 

PTSD. 

The PTSD residential rehab problem was established about 10 

years ago to meet the needs of veterans with chronic post-traumatic stress disorder who would benefit from a specialized residenVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00063 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
60

tial program. Over the years, approximately 830 veterans, mostly 

Vietnam era, have been treated at the center, and many of these 

patients, nearly 75 percent, were not in fact from the Big Island 

but from right here in Oahu. 

Now, clearly the discussion indicates, and we fully expect, that 

there will be veterans of the Global War on Terror with PTSD or 

combat stress reactions. We hope to provide them—plan to provide 

them—with the very best of services at the center in the next few 

years. 

Most of these veterans reside in Oahu, and the best treatment 

for them is outpatient care that integrates their formal treatment 

with the service and support to their families and community. Consequently, we’re moving that program to Honolulu over the next 

few months. 

PTSD, as we’ve heard, is a major concern for our Department because of the activities and exposures inherent to military service. 

We’ve found that up to one-third of the veterans treated in the VA 

Pacific Islands Health Care System who are provided service for 

mental health issues also carry a diagnosis of PTSD. 

Besides the Residential Rehabilitation Program, we will provide 

a broad spectrum of mental health services on the island for veterans with PTSD and all mental health disorders, especially outpatient PTSDs that are now provided in Oahu by a traumatic 

stress recovery program, which is interdisciplinary. 

It includes a team of psychiatrists, psychologists, social workers, 

nurses. Readjustment counseling staff from the Vet Centers, as 

you’ve heard, are also so important. That work, that close relationship, extends not just on this island but over all of the islands. 

Each of our five community-based outpatient clinics in Hawaii 

are staffed by full-time psychiatrists, and our post-traumatic stress 

recovery program helps to provide care for those veterans who require a fair level of service. 

In fiscal year 2005, the VA treated 2,006 island veterans with 

PTSD, and we expect that there will be additional veterans to care 

for in the year to come. But we’ll meet those needs of all island veterans in this important area. 

Senator Akaka, with your help and the help and leadership provided by Chairman Craig, who’s equally passionate in terms of supporting the VA and veterans, and the support of all Members of 

Congress, we feel the VA is providing an unprecedented level of 

care in health services to all veterans residing on Oahu and 

throughout all of Hawaii. Thank you very, very much for that, and 

thank you for the opportunity to testify today. 

[Applause.] 

[The prepared statement of Mr. Perlin follows:]

PREPARED STATEMENT OF HON. JONATHAN B. PERLIN, M.D., PH.D.,

UNDER SECRETARY FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS

Senator Akaka, mahalo nui loa for the opportunity to appear before you today to 

discuss the state of VA care in Hawaii. It is a privilege to be here on Oahu—The 

Gathering Place—to speak and answer questions about issues important to veterans 

residing in Hawaii. 

First, I would like to express my appreciation and respect for how much you have 

done, along with your colleague, Senator Inouye, for the veterans residing in Hawaii 

and other islands in the Pacific region. As I will highlight later, your vision, guidance and assistance have directly led to an unprecedented level of health care servVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00064 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
61

ices for veterans, construction of state-of-the-art facilities in Honolulu and remarkable improvements in access to health care services for veterans residing on neighbor islands. 

Also, I would like to commend Chairman Craig for his outstanding leadership and 

advocacy on behalf of our Nation’s veterans. During his tenure as Chairman of this 

Committee, he has clearly demonstrated his commitment to veterans by acting decisively to ensure the needs of veterans are met. In addition, I appreciate his 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 region; provide an overview of the VA Pacific Islands Health Care 

System (VAPIHCS) and the VA facilities here in Oahu; and highlight issues of particular interest to veterans residing in Hawaii, including post-traumatic stress disorder (PTSD), VA-Department of Defense (DoD) joint venture in Honolulu and access to specialty services. 

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 Basin (including the Philippines, Guam, American Samoa and 

Commonwealth of the Northern Marianas Islands), northern Nevada and central/

northern California. There are an estimated 1.25 million veterans living within the 

boundaries of the VA Sierra Pacific Network. 

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. Dr. Robert Wiebe serves as director and oversees clinical and administrative operations throughout the Network. In fiscal year 2005 (fiscal year 2005), the 

Network provided services to 227,000 veterans. There were about 2.8 million clinic 

stops and 24,000 inpatient admissions. The cumulative full-time employment 

equivalents (FTEE) level was 8,200 and the operating budget was about $1.3 billion, 

which is an increase of $378 million since 2001. 

The VA Sierra Pacific Network is remarkable in several ways. In fiscal year 2005, 

the Network was the only VISN in VHA to meet the performance targets for all six 

Clinical Interventions that directly address adherence to evidence-based clinical 

practice. The Network hosts 11 (out of 65) VHA Centers of Excellence—the most in 

VHA. The VA Sierra Pacific Network also has the highest funded research programs 

in VHA. Finally, VISN 21 operates one of four Polytrauma units that are dedicated 

to addressing the clinical needs of the most severely wounded Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans. 

VA PACIFIC ISLANDS HEALTH CARE SYSTEM (VAPIHCS)

As noted above, VAPIHCS is one of six major health care systems in VISN 21. 

VAPIHCS is unique in several important aspects: its vast catchment area covering 

2.6 million square-miles (including Hawaii, Guam, American Samoa and Commonwealth of the Northern Marianas); island topography and the challenges to access 

it creates; richness of the culture of Pacific Islanders; and the ethnic diversity of patients and staff. In fiscal year 2005, there were an estimated 113,000 veterans living 

in Hawaii (9 percent of Network total). 

VAPIHCS provides care in six locations: Ambulatory Care Center (ACC) and Center for Aging (CFA) on the campus of the Tripler Army Medical Center (AMC) in 

Honolulu; and community-based outpatient clinics (CBOCs) in Lihue (Kauai), 

Kahului (Maui), Kailua-Kona (Hawaii), Hilo (Hawaii) and Agana (Guam). VAPIHCS 

also sends clinicians and support staff from these locations to provide services on 

Lanai, Molokai and American Samoa. The inpatient post-traumatic stress disorder 

(PTSD) unit formerly in Hilo is in the process of relocating to Honolulu at the Tripler AMC. In addition to VAPIHCS, VHA operates five Readjustment Counseling 

Centers (Vet Centers) in Honolulu, Lihue, Wailuku, Kailua-Kona and Hilo that provide counseling, psychosocial support and outreach. 

Dr. James Hastings was recently appointed Director, VAPIHCS. Dr. Hastings has 

impressive credentials, including tenure as Chair, Department of Medicine, John A. 

Burns School of Medicine, University of Hawaii, and Commanding General at Walter Reed AMC and Tripler AMC. I am excited about the possibilities that his tenure 

as Director at VAPIHCS brings. 

In fiscal year 2005, VAPIHCS provided services to 18,300 veterans in Hawaii (8 

percent of Network total). There were 194,000 clinic stops in Hawaii during fiscal 

year 2005 (7 percent of Network total), an increase of 36 percent since fiscal year 

2000. The cumulative FTEE for the health care system was 478 employees. The 

62

budget for VAPIHCS (including General Purpose, Specific Purpose and Medical 

Care Cost Funds [MCCF]) has increased from $53 million in fiscal year 1999 to $102 

million in fiscal year 2005 (about 8 percent of Network total). In addition, VISN 21 

provided over $20 million in supplemental funds to VAPIHCS over the past two fiscal years to ensure VAPIHCS met its financial obligations. 

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. Selected specialty services 

are also currently provided at the Honolulu campus and to a lesser extent, at 

CBOCs. VAPIHCS recently hired specialists in gero-psychiatry, gastroenterology, 

ophthalmology and radiology. VAPIHCS is actively recruiting additional specialists 

in cardiology, orthopedic surgery and urology. Inpatient long-term care is available 

at the Center for Aging. Inpatient mental health services are provided by VA staff 

on a 20-bed ward within Tripler AMC and at the PTSD Residential Rehabilitation 

Program (PRRP) that was formerly in Hilo (now relocating to Honolulu). VAPIHCS 

contracts for care with DoD (at Tripler AMC and Guam Naval Hospital) and community facilities for inpatient medical-surgical care. 

The current constellation of VA facilities and services represents a remarkable 

transformation over the past several years. Previously, the VAPIHCS (formerly 

known as the VA Medical and Regional Office Center [VAMROC] Honolulu) operated primary care and mental health clinics based in the Prince Kuhio Federal 

Building in downtown Honolulu and CBOCs on the neighbor islands that were 

staffed primarily with nurse practitioners. Senator Akaka and his colleagues in Congress approved $83 million in Major Construction funds to build a state-of-the-art 

ambulatory care center and nursing home care unit on the Tripler AMC campus and 

these facilities were activated in 2000 and 1997, respectively. VISN 21 allocated 

nearly $17 million from fiscal year 1998 to fiscal year 2000 to activate these 

projects. VISN 21 also provided dedicated funds (e.g., $2 million in fiscal year 2001) 

to enhance care on the neighbor islands by expanding/renovating clinic space and 

adding additional staff to ensure there are primary care physicians and psychiatrists at all CBOCs. 

OAHU FACILITIES

VA operates the Spark M. Matsunaga VA Medical Center in Oahu, located on the 

campus of Tripler AMC at 459 Patterson Road, Honolulu, HI, 96815. The medical 

center primarily consists of the Ambulatory Care Center (ACC) and Center for 

Aging (CFA). Congress appropriated $25.1 million Major Construction funds during 

fiscal years 1993–1994 to build the CFA; $14.9 million in fiscal year 1995 to construct the parking garage; and $43.0 million in fiscal years 1994/1995/1997 to build 

the ACC and renovate the E Wing of Tripler AMC for VA administrative use. Veterans Benefits Administration (VBA) is co-located with VHA on this campus. The 

Honolulu Vet Center is located nearby at 1680 Kapiolani Boulevard. 

The VA facilities in Oahu serve an estimated island veteran population in fiscal 

year 2005 of 80,118. In fiscal year 2005, 25,222 veterans were enrolled for care and 

12,739 veterans received care (‘‘users’’) in Oahu. The market penetrations for enrollees and ‘‘users’’ are 31 percent and 16 percent, respectively and compare favorably 

with rates within VISN 21 and VHA. 

The current authorized full-time employment equivalents (FTEE) level in Oahu 

is 425. With this staff, VAPIHCS provides a wide range of outpatient services, including primary care, several medical subspecialties (e.g., cardiology, gastroenterology, nephrology, pulmonary and women’s health), mental health and dental 

care. In addition, VAPIHCS provides diagnostic services such as laboratory, echocardiography and radiology. As noted earlier, VA staffs a 20-bed inpatient mental 

health unit within Tripler AMC and a 60-bed nursing home care unit (i.e., CFA). 

If veterans need services not available at the ACC or CFA, VAPIHCS arranges and 

pays for care at Tripler AMC, local community or VA facilities in California. 

In fiscal year 2005, VA facilities in Oahu recorded about 156,000 clinic stops, representing a 35 percent increase from fiscal year 2000 (i.e., 116,000 stops). The clinic 

has short waiting times for new patients with few veterans waiting more than 30 

days for their first primary care appointment. In fiscal year 2005, the combined average daily census (ADC) was 19 in the mental health ward and PRRP (52 percent 

occupancy rate) and 56 at the CFA (94 percent occupancy rate). VAPIHCS spent 

about $14.0 million for care at Tripler AMC and another $9.2 million for non-VA 

care in the community for residents in Oahu. 

63

SPECIAL ISSUES

Post-traumatic stress disorder (PTSD). PTSD is a psychiatric disorder that can 

occur after the experience of a life-threatening event. This is a major concern for 

VA because of the activities and exposures inherent to military service. PTSD has 

been observed in veterans from all conflicts, including Vietnam and Gulf theaters. 

VA has very active PTSD programs nationally. In fiscal year 2005, a significant 

portion of the $2.4 billion spent on mental health programs was used to treat veterans with PTSD. In fiscal year 2006, more than $40 million will be earmarked to 

establish new PTSD and Returning Veterans Outreach Education and Care 

(RVOEC) programs. VA is also enhancing staffing levels at many Vet Centers. 

There is a high prevalence of PTSD in veterans served by VAPIHCS (e.g., up to 

one-third of veterans treated in VAPIHCS mental health clinics carry the diagnosis 

of PTSD). Consequently, VAPIHCS provides a broad spectrum of mental health 

services for veterans with PTSD at the main facilities here in Honolulu (i.e., ACC 

and inpatient mental health ward in Tripler AMC), neighbor island CBOCs and the 

PTSD Residential Rehabilitation Program (PRRP) now in transition. Specialty outpatient PTSD services are provided in Oahu by the Traumatic Stress Recovery Program (TSRP), which is an interdisciplinary team of psychiatry, psychology, social 

work, nursing and readjustment counseling staff. The TSRP team also collaborates 

with the Honolulu Vet Center. 

On the neighbor islands, outpatient PTSD services are provided by full-time psychiatrists located at all CBOCs. The PRRP has also been available to veterans with 

chronic PTSD who need a higher level of care. In fiscal year 2005, VAPIHCS treated 

2,006 veterans with PTSD throughout the system and provided PTSD care during 

8,401 clinic stops. This represents increases of 39 percent and 16 percent, respectively, compared to fiscal year 2002. 

In addition to VAPIHCS, the VHA National Center for PTSD in Honolulu is an 

important resource for veterans. Mr. Fred Gusman, operations officer at the National Center for PTSD, Pacific Islands Division, is also testifying today and will 

highlight the activities of the Center, including its collaboration with DoD. 

Although VAPIHCS is currently very active in PTSD treatment, we expect additional patients from Operation Iraqi Freedom and Operation Enduring Freedom 

(OIF/OEF) will present to our facilities for evaluation of possible mental disorders. 

VA estimates up to 15,000 residents of Hawaii have been deployed to Afghanistan 

and Iraq as active duty personnel, Reservists or Hawaii National Guard personnel. 

Major General Lee, Adjutant General, State of Hawaii, Department of Defense 

(DoD), reports there are 2,200 Reservists and National Guard serving in Iraq and 

Afghanistan. 

VAPIHCS estimates that 10–20 percent of OIF/OEF veterans may present to its 

facilities for evaluation of possible PTSD or other adjustment disorders. In fiscal 

year 2005, VAPIHCS evaluated 393 OIF/OEF veterans and 30 of these patients 

were diagnosed with PTSD. For planning purposes, VAPIHCS projects an increased 

demand from OIF/OEF veterans presenting for care at its mental health clinics in 

the next several years. 

VAPIHCS will meet the needs of our newest veterans. Currently, VAPIHCS has 

9.0 psychiatry FTEE. This equates to 43 mental health physicians per 100,000 

unique patients, which is higher than the national VHA average (i.e., 35 FTEE per 

100,000). VAPIHCS will use these and other staff to assist those veterans who have 

either acute PTSD, also known as Acute Stress Disorder (ASD), and chronic PTSD. 

The goals are outreach, early identification, standardized assessment, individualized 

treatment plans and emphasis on recovery. 

To accomplish these goals, VAPIHCS will make several changes in its care delivery model, including the relocation of the PRRP unit from Hilo to Honolulu. The 

new outpatient program will be built on the successful foundation of the Hilo program. A Vietnam veteran who returned from combat with serious physical and emotional wounds, graduated from the PRRP last year. ‘‘I had lost 10 years of my life 

to drugs and chaotic living,’’ he said. ‘‘Healing takes a long time, but I carry note 

cards as reminders of the most important lessons I learned from VA. I’m clean and 

sober and my wife and I have love and happiness.’’ The veteran summarized his experience by saying, ‘‘I will be eternally indebted to the VA for turning my life 

around.’’

VAPIHCS is also developing new programs (e.g., VAPIHCS submitted several proposals related to the $100 million set aside in fiscal year 2006 by VHA for new mental health initiatives) and hiring additional staff as needed (e.g., Hilo CBOC). In 

these endeavors, VA will continue to closely collaborate with our DoD partners, including Tripler AMC. 

64

VA-DoD Joint ventures. VAPIHCS participates in one of the largest and most complex VA-DoD partnerships. The partnership with Tripler AMC accelerated when VA 

began to move clinical and administrative functions from the Prince Kuhio Federal 

Building to the Tripler AMC campus in 1997. The co-location of VAPIHCS and Tripler AMC allows functional integration and opportunities to provide high quality 

care to Federal beneficiaries residing in Hawaii and the Pacific region. VAPIHCS 

relies on Tripler AMC for emergency room care, acute medical-surgical inpatient 

care (including intensive care unit), outpatient specialty care and ancillary services. 

VAPIHCS also partners with Tripler AMC for nutritional services (e.g., inpatient 

meals at Tripler AMC and CFA), housekeeping, security and medical maintenance. 

In fiscal year 2005, VAPIHCS purchased about $14 million of services for veterans 

at Tripler AMC. 

VAPIHCS and Tripler AMC also collaborate in several other important endeavors. 

The joint venture in Honolulu has successfully competed for several Joint Incentive 

Fund (JIF) projects. JIF was established by Congress in the National Defense Authorization Act (NDAA) in fiscal year 2003 to encourage ongoing collaboration. The 

VA-DoD joint venture in Honolulu has secured $4 million in funding for projects related to computer-aided design and manufacturing of prosthetic devices; chronic dialysis center; and chronic pain management program. The venture was also selected 

as one of eight formal VA-DoD Joint Venture Demonstration Sites and will review 

budget and financial management systems. We are also collaborating on a single 

separation health examination for active duty personnel who will be leaving military 

service. 

VA appreciates the leadership of Major General (MG) Gale Pollock and the responsiveness her staff to VA concerns. The joint venture has made great strides in 

both clinical and administrative areas. Admittedly, some systemic barriers still 

exist, such as conflicting mission priorities, lack of computer interoperability, ambiguities regarding dual-eligible beneficiaries and differences in financial systems. 

Some of these barriers can be overcome at the local level, but many will require a 

solution at the national level. In any case, I am confident that our new Director, 

Dr. Hastings, and MG Pollock will continue the growth and accomplishments of this 

very important joint venture. 

Specialty services. VAPIHCS does not operate its own acute medical-surgical inpatient unit and has a limited number of specialists on staff. Historically, VAPIHCS 

has relied on its DoD partners and community facilities to provide these and specialty outpatient services to veterans. Over the past several years, VAPIHCS has 

significantly increased its recruitment of specialists to improve the access and continuity of care for veterans. Since fiscal year 2004, VAPIHCS has hired physicians 

in gero-psychiatry, gastroenterology, ophthalmology and radiology. VAPIHCS is actively recruiting additional specialists in cardiology, orthopedic surgery and urology. 

VAPIHCS has also hired hospitalists to provide care for veterans admitted to Tripler AMC. 

Although these specialists will be based in Oahu, most will travel regularly to 

CBOCs on neighbor islands and will be able to conduct telehealth clinics. The topography of the Pacific region makes telehealth one of VA’s most valuable programs—

not only for our older veterans from World War II, but also for our newest veterans 

from Iraq and Afghanistan. For example, a veteran came to VAPIHCS after surviving severe injuries from a rocket grenade attack in June 2004 that left him as 

a triple amputee (both legs and one arm). The veteran lives in Pohnpei, Federated 

States of Micronesia (FSM). After his return home to FSM, VA staff in Hawaii followed him weekly with telehealth visits to monitor his progress. 

CONCLUSION

In summary, with your support and the support of other Members of Congress, 

VA is providing an unprecedented level of health care services to veterans residing 

in Hawaii and the Pacific Region. VA now has state-of-the-art facilities and enhanced services in Honolulu, as well as robust staffing on the neighbor islands and 

has expanded or renovated clinics in many locations. VA is bringing more specialists 

on board and preparing for the newest generation of veterans—those who bravely 

served in southwest Asia. 

VAPIHCS still faces several challenges, in part due to the topography of its 

catchment area. VAPIHCS will meet these challenges by utilizing telehealth technologies, sharing specialists, developing new delivery models and opening new clinics as demographics suggest and resources allow. I am proud of the improvements 

in VA services in Hawaii, but recognize that our job is not done. 

65

Again, Senator Akaka, mahalo nui loa for the opportunity to testify at this hearing. I would be delighted to address any questions you may have for me or other 

members of the panel.

Senator AKAKA. Thank you very much, Dr. Perlin. I want to 

thank Dr. Perlin, who is Under Secretary for Health for VA. I want 

to tell you that whenever we have high level hearings and we have 

the Secretary of VA at the hearing, usually Dr. Perlin is there with 

him. So we are hearing from a person who is really at a high level 

in VA across the country. 

At this moment, this is a personal break. I’m going to ask for 

about a minute or so, and I’ll be right back. I’m going to call a recess. I’ve had the permission from the General. So we’ll just recess 

for a couple of minutes. Thank you. I’ll be back. Please don’t leave. 

We aren’t done. We are going to hear from the General about Tripler and the partnership that’s really working out. So we’ll see you 

in a few minutes. 

[Recess.] 

Senator AKAKA. The hearing will come to order. 

I’d like to call from testimony of Major General Gale Pollock. 

She’s the Commander of Tripler Army Medical Center. 

STATEMENT OF MAJOR GENERAL GALE S. POLLOCK, 

COMMANDER, TRIPLER ARMY MEDICAL CENTER 

General POLLOCK. Senator Akaka, aloha and mahalo for the opportunity to share information about the collaborative relationship 

and initiatives under the auspices of Department of Defense and 

the Department of Veterans Affairs joint ventures here in Hawaii. 

I’ve submitted my written testimony for the record. 

Senator AKAKA. It will be included in the record. 

General POLLOCK. Thank you, sir. 

As the commanding general at Tripler Army Medical Center, I 

represent the largest military medical treatment facility in the entire Pacific basin. Tripler’s area of responsibility spans more than 

52 percent of the earth’s surface and provides medical support to 

nearly 400,000 beneficiaries, including active duty members of all 

branches, their eligible families, military retirees and their families, veterans, and many Pacific island residents. 

In 1991, what leaders initially conceived as a small veterans hospital adjacent to our medical center is now a vast $20 million sharing agreement spanning inpatient and outpatient services and nonmedical support such as security, meals, and housekeeping. This 

collaboration has increased patient care at both Tripler and for the 

VA. 

On a daily basis, VA patients represent a large part of our workload. For example, during the last month, my average hospital census was 131 patients. Approximately 30 percent of those patients 

were veterans. An average 3 of the 12 daily admissions from my 

emergency room are veterans. The VA-operated psychiatric ward 

averages 9 patients each day. 

Over the years, we’ve hired additional clinical staff to accommodate the growing VA workload, forming a reliance on the input reimbursement from the VA. While other medical treatment facilities 

may have excess capacity and can accommodate additional workVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00069 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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load without a need to hire, that is not the situation at Tripler. The 

additional workload requires that we add staff. 

While reimbursement is essential to a successful DOD/VA partnership, it is not the primary motivation. Veteran access to specialized care in Oahu and their satisfaction is improved due to our 

joint venture. Another dimension of caring for the veteran is that 

the illnesses and surgeries associated with aging are very relevant 

to keeping our active duty military personnel trained and ready for 

our battlefield mission. 

We stay competent by caring for acutely ill patients. At Tripler, 

we have a robust graduate medical education program spanning 10 

different medical specialties and training 220 residents per year. 

Our anesthesia nursing graduate program, recognized as the number two program in the Nation, also depends upon these complex 

patients. All of our patients, graduate health education programs, 

and our staff benefit from serving the veteran population. 

One major recent initiative was already mentioned, and that’s 

our joint separation process and examination. The separation physical performed while the servicemember is still on active duty is 

convenient for the military member. It eliminates duplicative physical exams, and ideally completes the disability determination prior 

to discharge from the active duty. This process is very much appreciate by the beneficiaries, and is cost-effective for both DOD and 

the VA. 

Recently, we developed several joint initiative fund proposals, 

and three of them were approved and funded, computer-aided design and manufacturing for orthotics and prosthetics, a chronic dialysis center, and a pain management project. All three of these 

initiatives will improve access to care for our joint beneficiaries and 

decrease their waiting time. 

We continue to explore opportunities and initiatives that allow 

the services and VA to share staffing, ensuring that we are both 

effective fiduciary stewards of the Government’s resources. In the 

past month, we’ve signed two new sharing agreements. 

The first agreement relocates the post-traumatic stress disorder 

program from Hilo to Tripler. This facility currently provides residential PTSD services to veterans. Once relocated to Tripler, the 

program will also treat military active duty members. 

The second agreement is in support of a clinical investigation 

study titled, ‘‘Women’s Deployment Stress and Health: A Pilot 

Study.’’ The principal investigators are the providers from Tripler 

and the VA. We have also undertaken a joint approach in planning 

our response to a pandemic avian flu. 

In terms of DOD/VA joint venture development, we are clearly 

ahead of most other locations in that we are already one of the 

most functionally integrated joint ventures. Instead of two freestanding medical centers, we have one emergency room, one inpatient medical, surgical, and psychiatric service, and essentially one 

major specialty outpatient service. We have integrated our clinical 

services for psychiatric on-call support, hospitalists, nephrology, 

and psychology services. 

There are still opportunities for continued development of our 

joint venture. There’s top DOD leadership support to make Tripler 

a model joint venture site. The two key determinants for additional 

67

progress are expansion of our patient care services and elimination 

of redundant overhead. 

As with most merger activities, there are barriers that impede 

unfettered, efficient coordination. I believe, though, that most of 

our joint venture barriers are systemic in nature. In order to perpetuate sharing between VA and DOD entities, national initiatives 

applicable to all types of sharing must continue. 

Information systems require evaluation for applicability for sharing, and solutions for any systemic issues must be identified and 

shared expeditiously. We must address and resolve all barriers to 

achieve our ultimate goal—high quality care for our beneficiaries 

in a seamless healthcare system. The men and women currently 

serving in America’s military and those who have already completed their service to our Nation deserve no less. 

Senator, thank you for the opportunity to appear before you 

today and for your support of the military and veterans. I look forward to your questions. 

[Applause.] 

[The prepared statement of Major General Pollock follows:]

PREPARED STATEMENT OF MAJOR GENERAL S. POLLOCK, COMMANDER,

TRIPLER ARMY MEDICAL CENTER

Mr. Chairman and distinguished Members of the Committee, thank you for the 

opportunity to share information about the collaborative relationship and initiatives 

under the auspices of the Department of Defense (DoD)—Department of Veterans 

Affairs (VA) Joint Venture in Hawaii. As Commanding General, Tripler Army Medical Center (TAMC), I represent the largest military medical treatment facility in 

the entire Pacific Basin. TAMC’s area of responsibility spans more than 52 percent 

of the entire Earth’s surface and provides medical support to nearly 400,000 beneficiaries, including active duty servicemembers of all branches of service; their eligible families; military retirees and their families; veterans; and many Pacific Island 

nation residents. 

In 1991, Under Secretary of the Army and the Deputy Secretary of Veterans Affairs approved the basic concept of a Joint Venture for Hawaii. What was initially 

conceived as a small veteran’s hospital adjunct to the medical center, now is a vast 

twenty million dollar sharing agreement spanning inpatient and outpatient services 

and non-medical support, such as security, meals and housekeeping. Beginning in 

1997, the VA began to relocate administrative and health care services to the TAMC 

campus. Construction and renovation to portions of the medical center infrastructure have resulted in both new and relocated veteran services on the Tripler campus. By 1997, both the parking structure and the Center for Aging were completed. 

In 2000, the renovation of the E-Wing of TAMC and the Ambulatory Care Clinic 

were completed and operational. The relocation resulted in increased workload for 

both TAMC and the VA Pacific Islands Healthcare System (VAPIHCS). 

A collaborative of this magnitude requires diligent planning and oversight. Both 

the VA and TAMC have dedicated staff to ensure the exploration and development 

of collaborative efforts. On a daily basis, VA patients represent a large part of our 

workload. For example, during the last month my hospital census was 131 patients. 

Approximately 30 percent of those patients are veterans. Additionally, an average 

three of 12 daily admissions from the emergency room are veterans. The VA operated psychiatric ward averages nine psychiatric patients a day. 

Over the years, additional clinical staff has been hired to accommodate the growing VA workload, forming a reliance on the inpatient reimbursement from the VA. 

While there are Medical Treatment Facilities (MTFs) with excess capacity that can 

accommodate some workload within their minimum staffing requirements without 

adding significantly to their costs, that is not the situation at Tripler. 

While reimbursement is essential to a successful DOD/VA partnership, it is not 

the primary motivation. For the military, caring for veterans represents a continuation of the services we provided when they were active duty. In fact, when I talk 

to audiences regarding the relationship between the active duty and the veteran 

populations I say the active duty are ‘‘veterans in training’’. Our ultimate status will 

be as veterans. Another dimension of caring for the veteran is that the illnesses and 

68

surgeries associated with aging are very relevant to keeping active duty medical 

personnel trained and ready for our battlefield mission. We need to stay competent 

caring for acutely ill patients. At Tripler we have a robust graduate medical education program spanning 10 different medical specialties and training 220 physicians per year. Our graduate medical education occurs in Orthopedics, Radiology, 

Urology, Medicine, Obstetrics & Gynecology, Psychiatry, ENT, Pediatrics, Family 

Practice and General Surgery. We have found that these programs benefit from caring for the veterans population. 

Our current DoD/VA sharing agreements cover a wide variety of patient care services including inpatient care, outpatient specialty services and ancillary support. We 

also partner for facility support for housekeeping, security and medical maintenance. I am particularly proud that the medical center’s Nutrition Care Division 

prepares all the meals and nourishments for the 50-bed VA Center for Aging facility. We continuously receive positive feedback on our meals from the VA beneficiaries residing there. 

One major initiative is the Cooperative Separation Process/Examination Memorandum of Understanding (MOU) of June 2005, designed to create a coordinated effort between DoD and the VA on Oahu for a single separation physical exam 

through the VA with specialized services primarily performed through the MTFs. 

The separation physical, performed while the servicemember is on active duty, is 

not only convenient to the military member, it eliminates duplicative physical 

exams for servicemembers who leave the military and file disability claims with the 

VA. Thus it is cost effective to both the VA and the DoD. 

This year, there have been approximately 90 claims filed with 44 physicals completed. Currently, we are working through some minor disconnects with the VA on 

the process of returning the physical paperwork to the proper points of contact as 

well as the process of informing the member of the benefit eligibility and how to 

receive it. TAMC, along with the other MTFs on Oahu are working with the VA 

to refine the process and ensure the physical return of the paperwork allowing the 

active duty servicemember to separate from the military in a timely manner. 

Recently several new initiatives have been undertaken under the Joint Incentive 

Program and the Joint Demonstration Project. Development of several Joint Incentive Fund proposals totaling $4 million have been completed and funded including 

computer-aided design/computer-aided manufacturing for orthotics and prosthetics, 

a chronic dialysis center for veterans and a joint pain management improvement 

project. All three of these initiatives will improve access to care to our joint beneficiaries and decrease wait times. The Hawaii Collaborative was also selected as one 

of eight sites to serve as a demonstration project. Our Collaborative proposes to 

meet the need of establishing a structure and process to jointly assess, execute, and 

evaluate improvements in the following: Health Care Forecasting and Demand; Referral Management and Fee Authorization; Joint Charge Master Based Billing development; and Knowledge and Document Management. The collaborative expects 

to garner benefits from these demonstration studies including improved planning 

and programming for resource sharing (e.g. facility construction, joint staffing, joint 

purchase of services in the community, etc); improved budget forecasting; improved 

monitoring of access, workload, and budget execution for the Collaborative; improved access to documents for information exchange within the Collaborative; improved continuity of patient care; and improved fiscal resource management. 

We have also undertaken a joint approach in planning for pandemic flu response. 

We continue to explore opportunities and initiatives that allow the Services and VA 

to share staffing representing effective fiduciary stewards of our government resources. In the past month, we’ve signed two new sharing agreements. The first 

agreement relocates the Post Traumatic Stress Disorders (PTSD) Residential Rehabilitation Program (PRRP) from Hilo to TAMC. This facility currently provides residential PTSD services to veterans with chronic PTSD. However, once relocated to 

TAMC, the PRRP will be able to treat active duty members too. The current PRRP 

program admits patients as a cohort group, and provides a 7-week program of integrated treatment, including but not limited to PTSD symptom management, communication skills, anger management, relaxation training, behavior therapy, trauma 

focus therapy, adjustment counseling, substance abuse and relapse prevention treatment, and general health education. The second agreement is in support of a Clinical Investigation study titled ‘‘Women’s Deployment Stress and Health: A Pilot 

Study’’. The principal investigators include providers from both TAMC and 

VAPIHCS. The primary objective of the study is to explore the relationship between 

deployment stress and women’s health in a population of women returning to Oahu 

from deployment to Iraq or Afghanistan. We have also undertaken a joint approach 

in planning for pandemic flu response. We continue to explore opportunities and iniVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00072 Fmt 6633 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
69

tiatives that allow the Services and VA to share staffing, and remain effective fiduciary stewards of our government resources. 

As with most merger type activities, there are barriers that impede unfettered, 

efficient coordination. I believe, however, most of our Joint Venture barriers are systemic in nature. 

Despite the barriers we confront, we continue to work together diligently to devise 

local solutions. The Pacific Telehealth & Technology Hui is an agency that represents a partnership between TAMC and the VA. The DoD/VA Interoperability 

Project is a healthcare systems interchange initiative focused in three distinct 

areas—Pharmacy Bi-Directional Data Interchange, Common Data View (Janus) and 

Laboratory Interoperability. The Pharmacy Bi-Directional Data Interchange allows 

providers on both the DoD and VA sides to order and receive prescriptions from either information system. The common data view presents patient data (demographics, lab, pharmacy, etc) to be viewed on a common screen. Finally, the laboratory interoperability allows lab orders and results to be communicated between both 

systems. The common goal of these initiatives is to improve patient care by developing interfaces to allow the electronic sharing of pertinent patient information between the VA, DoD and other clinical data providers. 

In terms of DoD VA/joint venture development, our future is now. We are ahead 

of most localities in that we are already one of the most functionally integrated joint 

ventures. Instead of two freestanding medical centers, we have only one emergency 

room; one inpatient medical, surgical, and psychiatric service; and essentially one 

major specialty outpatient service. We have integrated clinical services for psychiatric on-call support, hospitalist support, nephrology support and psychology 

services. However, this functional integration is just the beginning. 

While we are ahead of most of the other joint venture sites in the Nation in developing our sharing agreements and establishing policies and procedures, there are 

still opportunities for continued development of our Joint Venture. The two key determinants when developing opportunities for improved coordination are expansion 

of our patient care services to care for more patients and elimination of redundant 

overhead. We have worked diligently to develop initiatives for VA Chronic Dialysis, 

shared pain management resources and expanded orthotic/prosthetic support to veteran patients through the Joint Incentive Fund. However, additional opportunities 

for improved coordination and cooperation are numerous. 

There is local VA and DoD top management support to make Tripler a model joint 

venture site. In this respect, countless hours have been invested by both activities 

to improve our joint venture. In order to perpetuate sharing between VA and DoD 

entities, national initiatives applicable to all types of sharing should continue to be 

developed. 

Information systems are evaluated for applicability to sharing, and solutions to 

systemic issues should be identified and resolved expeditiously. We must address 

and resolve the barriers to achieve our ultimate goal—high quality care for our respective beneficiaries in a seamless healthcare system.

Senator AKAKA. Thank you. Thank you very much, General Pollock, for your testimony. I really appreciate what you’re doing there 

for our active duty servicemembers as well as our veterans. I want 

to tell you that with Tripler, we have a great model of services 

there for our active duty servicemembers as well as our veteran 

members, the situation there on the hill. 

I have some questions for this panel. Dr. Perlin, I want to commend your efforts to expand the delivery of mental health services 

in fiscal year 2006. I note the excellent way in which you are distributing $100 million for mental health services, allowing the networks to develop their own creative proposals. 

I wish to call your attention to Hawaii’s proposal to meet the 

needs of all veterans residing on remote Pacific islands as well. The 

cornerstone of one enhancement is the use of telemedicine capabilities to address existing gaps. Another proposed enhancement would 

improve PTSD and substance abuse treatment as well as staffing 

levels at Hilo on Hawaii, on Maui, and Oahu. 

With a relatively minimal investment in equipment and staff, we 

believe we will see tremendous improvements in outreach and outVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00073 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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comes with each of these enhancements. I hope you find their proposals meritorious. 

Moving on to a related issue, it is my understanding that the relocation of the Hilo PRRP has yet to be completed. Dr. Perlin, has 

a suitable location been found on the Tripler campus for these 

much needed services yet? Where are we with regards to the relocation and restoration of the service? 

Dr. PERLIN. Thank you, Senator Akaka. If I may address the two questions first, the telemedicine and the $100 million for mental 

health care, first let me thank Chairman Craig and you for your 

leadership in making $100 million available to make sure that 

mental health needs are not only met, but met in the best possible 

way. 

Part of that, I think you’ll find, will help services here in Hawaii in some very unique ways. My goal when these $100 million were 

distributed were to make sure that those dollars got to the very 

front lines of care. I think in Hawaii, the ability to use telemedicine 

for tele-mental health is a unique opportunity to reach veterans 

across all the neighbor islands. 

What I’d like to do is have Dr. Robert Wiebe, who directs our VA 

Pacific—I’m sorry, the Sierra Pacific Health Care Network, VISN 

21, describe the proposal that, under his leadership, his excellent 

leadership, aimed for. I think you’ll find the answer to how those 

funds are coming right here to Hawaii to be very, very satisfactory. 

Dr. Wiebe. 

Dr. WIEBE. Thank you, Dr. Perlin and Senator Akaka. Thanks to 

the generous acts of you and your colleagues in Congress as well 

as the outstanding leadership of Dr. Perlin, VA did indeed make 

$100 million available this year to support the implementation of 

the VA Strategic Health Plan for Mental Health. 

Facilities across the country were given the opportunity to apply 

for funds and submit proposals that would describe how those 

funds would be used to directly benefit veterans. The VA Pacific Islands Health Care System submitted four such proposals that received strong support from the network office as well as the program office in VA headquarters, and ultimately, the approval of Dr. 

Perlin. 

All four proposals submitted by the Pacific Islands Health Care 

System are being funded, so there will be more than $1 million 

coming directly to Pacific Islands Health Care System this year to 

support improvements in mental health. 

They will come in four areas: Substance abuse; tele-mental 

health; enhancement of mental health services on two neighbor island clinics; and also funds for direct support of OIF/OEF care, and 

specifically the creation of an intensive outpatient program so that 

we can serve the veterans returning from Iraq and Afghanistan 

with the full range of adjustment disorders, including PTSD. 

As you noted in your question, Senator Akaka, indeed this will 

be a great benefit to the veterans in Hawaii, and I look forward to 

the implementation of those programs later this year. Thank you. 

Senator AKAKA. Thank you very much, Dr. Wiebe. 

[Applause.] 

Senator AKAKA. We’ve heard from the Director and the Regional 

Director of the VA. 

71

Dr. PERLIN. If I may address your second question, you asked 

about finding a suitable location for the PTSD Residential Rehabilitation Program. I’ll ask our new director of the Matsunaga Medical 

Center, Dr. James Hastings, to address that, along with Dr. 

MacBride, the Chief of Staff. 

Senator AKAKA. Dr. Hastings. 

Dr. Hastings. Thank you very much, Dr. Perlin. 

Senator Akaka, I have come into this system and become aware 

of this changing philosophy of how we are going to address the 

problem of PTSD for our new generation of veterans, and this is 

embodied in the move that we’re currently undertaking. 

As of, I think, 2 weeks ago, we were able to take possession of 

space in Tripler, which is currently being formatted so that we can 

continue the treatment of our PTSD patients, but on this island instead of in Hilo. 

So we have the space. We have moved some of the employees 

over. We are currently in the process of acquiring a few more employees. We hope that in the near future, we’ll be able to begin to 

open our new class. 

Senator AKAKA. Thank you very much. 

Dr. MacBride. 

Dr. MACBRIDE. Thank you, Senator Akaka. 

I would just like to add that because I was there before Dr. 

Hastings joined us, I remember vividly the day that the VA asked 

General Pollock and her staff for help in relocating the PRRP, and 

General Pollock graciously made this a very high priority for her 

staff to help us locate space within Tripler. That has, as testified 

by Dr. Hastings, become a reality. We’re very grateful again for 

that partnership with Tripler. 

Senator Akaka, thank you so much for supporting the formation 

of the PRRP initially for us 10 years ago. Now, we take the next 

step forward and move into the 5C–1 unit at Tripler—and by the 

way, I learned on the way over here from our ACOS for Mental 

Health, Dr. David Bernstein, that the furniture has now been installed and that we have three staff that are busy putting things 

in place. As General Hastings mentioned, we are recruiting new 

staff. 

But that vision to begin for Hawaii a post-traumatic stress residential rehabilitation program was yours, Sir. Again, we thank you 

for that leadership. 

Senator AKAKA. Thank you very much. You’ve just heard from 

Dr. Hastings, who’s the Director, and also the Chief of Staff, Dr. 

MacBride, their testimony. I want to thank you folks for being 

here. You’ve heard what they’re trying to do here, and it’s really 

great for Hawaii. 

I have a question for General Pollock. In your written statement, 

you mention systemic barriers to joint ventures. Could you elaborate and provide examples of these barriers? 

General POLLOCK. Thank you for that question, sir, because it 

really relates to the needs of the patients. It’s very, very confusing 

for the patients when they’re dual eligible. They’re not clear about 

what their benefit really is and which of us it’s best to go to receive 

that benefit. Then as we coordinate it, just that additional coordiVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00075 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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nation can be frustrating for the patients as we work that. That 

would be one example, that dual eligibility. 

The other that I would talk about is we really need a standard 

methodology throughout DOD and VA for billing and reimbursement because I would much rather that we spend our staff money 

on people who can assist the patients and do patient education and 

patient support than have them doing stubby pencil pushing pieces 

of paper back and forth in order to accomplish that billing mission. 

They would be two examples. 

Sir, if you would indulge me for just 1 second, you asked the 

question about the status of the residential treatment facility. 

We’ve signed together a document that has gone down to the installation management activity, Colonel Howard, who’s down at 

Schofield Barracks. 

He’s promised us that we will have expedited review and evaluation. So we’ll know exactly where on the campus we’ll be able to 

break ground for that new building. 

Senator AKAKA. That’s great news. Thank you so much for that. 

General Pollock, talking about paperwork and all of that, how do 

you handle dual-eligible beneficiaries? 

General POLLOCK. We spend a significant amount of time trying 

to educate them. Both sides of the building, whether they go in to 

the VA for advice or if they come to us for advice, there’s a significant amount of time, just because the benefits are different. So it’s 

very complex. 

We both have staff that are dedicated to resolving those issues, 

to coordinating that care, to make sure that we’re able to go as 

quickly as possible. But one of the other concerns that I have as 

one of the healthcare providers is that when they can go from one 

organization to the other, we have concerns about, well, who’s really managing their care? Who’s their primary care manager? How 

can we ensure that everything is in line so they’re getting the best 

care possible? 

So that would be one I would really like see us resolve. 

Senator AKAKA. Thank you for your response. 

Dr. Hastings, from your vantage point as the former commander 

and now a director at VA Hawaii, where do you see the most opportunities for increased sharing here in Hawaii? 

Dr. HASTINGS. Senator, I think I want to start off by answering 

that and thanking you and your Committee for all the efforts that 

you have put forward over the years in helping us. I’ve had the opportunity for 30 years to look at how the veterans are taken care 

of at Tripler, and I am absolutely astounded at the improved care, 

quantity of care, in a very high performance organization that I 

see. 

I have to agree with General Pollock in one of the comments that 

she made, that the sharing that is going on today between these 

two organizations, these two very high quality healthcare organizations, is as good as it gets anywhere in our country. 

I’ve heard a lot of the problems of sharing across the country, 

and you have heard some of the examples here. But I can tell you 

from firsthand experience, we’re sharing in many, many other ways 

and are running a seamless system in spite of a number of frustrations. 

73

Now, that’s not to say that, you know, we’re finished. We have, 

I think, a lot of opportunities to develop over the next few years. 

One of the ones that I would mention has been addressed today, 

and that’s specialty care. 

A number of years ago, the Veterans Administration in Hawaii 

was not terribly involved with specialty care. The philosophy has 

changed enormously, and we are now getting much more involved 

in specialty care. 

At the same time, Tripler, which has been a tertiary care institution with significant specialty care for many years, is under significant stress because of the war that we’re in. I see a significant opportunity for us to augment the specialty care that Tripler is providing at this time. I think that’s one example. 

As was mentioned earlier, the VA has already put in motion hiring some sub-specialists who will improve care to our veterans on 

the outer islands, but at the same time will do it right here on the 

Tripler campus. 

I think another example that I would bring out is the same-day 

surgery. An opportunity that we have—when I talk to the surgeons 

at Tripler, they’re maxed out in their operating room. They are 

stretched as far as they can stretch them. I’m sure you’ve heard 

problems from our veterans of having to go out into the community 

to get procedures done that we would like to have been done at Tripler. 

I think a win-win situation for both the Veterans’ Administration 

and for the Department of Defense is to come up with some solutions that would increase the availability of same-day surgery and, 

indeed, endoscopy for our veterans. So I think this is another area 

where we clearly can make some very significant headway. 

Another area that has struck me as I have been with the VA in 

the past couple of years, and that is we have very well developed 

community-based clinics on the other islands. That has been addressed today. These clinics deliver a very high quality of care. 

I’m sure that there are members of the active duty and dependents who have needs for healthcare and exist on our outer islands. 

The density is not high enough to make it possible for General Pollock to provide care. This is an area where we can share, we can 

develop sharing, where we can help out Tripler just because we are 

distributed in a different kind of way. 

These are all areas that I think are areas where working together, we can come up with much better access and quality and 

quantity healthcare for both our veterans and our active duty personnel and their dependents. 

Senator AKAKA. Thank you, Dr. Hastings. 

Before I end the hearing, I want to recognize a special person in 

the audience, Claire Wiebe. Is Claire here? Just stand. Claire is in 

the third grade, up front here, and she is attending her first Senate 

hearing. 

[Applause.] 

Senator AKAKA. I’m sure you are proud of your dad. You can see 

how hard he works here. 

I also want to recognize the Committee, the Committee staff, who 

have worked hard over months and during the days that we’re here 

at these hearings. They have worked to put these hearings toVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00077 Fmt 6633 Sfmt 6601 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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gether, and it’s a tremendous job because I see it being done. I 

want to thank Pat Driscoll, Rob Mann, and Kim Lipsky, who were 

primarily responsible for today’s hearing. 

I also want to thank—and again, I want to say I have much 

aloha for Chairman Larry Craig and for what he has been to this 

Committee and what he has done. And it’s tremendous. 

And of course, I’m saying that so I can say mahalo to his staff, 

too, who are here. I want you to know Lupe Wissel and Billy Cahill 

are here from Chairman Craig’s staff. They’ve been here working 

with us and are here today. 

I also thank Tom Harvey, who’s executive assistant to Secretary 

Nicholson, for joining us here in Hawaii. 

I also want to recognize Michelle Moreno, Ted Pusey, Dahlia 

Melendrez, Alex Sardegna, Donalyn Dela Cruz, and Jim Yoshimura 

on my staff who are here. I want to thank them for all they’ve 

done. 

Of course, before I forget, Noe Kalipi. We have two staff directors. Lupe is Senator Craig’s staff director, and Noe is my staff director. 

[Applause.] 

Senator AKAKA. Finally, I want to thank our veterans in Hawaii. 

I thank God for you for our great country and for all of our boys 

and girls who are in service right now in Iraq and Afghanistan and 

in other places, who are serving to keep our country free and with 

liberty. That’s a great effort, and they sacrifice themselves for it. 

We’re grateful. This is why Larry Craig and I are trying our best 

to help out. VA is also doing it. We all are here, trying to help give 

the best service to our veterans when they come off of active duty. 

But we have ideas, and you’ll hear about it in the future, and we’ll 

let you know about that. But this Committee will continue to strive 

to do all of these things. 

I want to thank the veterans in Hawaii for all you and your families have done to make our State and our Nation so great. Mahalo 

nui loa, and aloha. 

[Applause.] 

Senator AKAKA. This hearing is adjourned. 

[Whereupon, at 1:03 p.m., the Committee was adjourned.] 

(75)

A P P E N D I X 

PREPARED STATEMENT OF TRAVIS COMBS

Mahalo, Senator Akaka for bringing the Senate Committee on Veterans’ Affairs 

hearings to our DAV Hall recently. I found the historic event very interesting and 

the ecumenical spirit alive and well amongst the various veterans groups. 

I look forward to your re-election and thank you and your staff for all your support and hard work. 

PREPARED STATEMENT OF CHARLES H. TURNER

I have had claims filed with the VA for nearly 15 years for injuries suffered from 

mustard gas during my service in World War II. My first claim was denied on the 

basis of lack of evidence. I could not provide such evidence because the Army conducted a secret operation on me and my fellow servicemen while we were on maneuvers in Mississippi. We were sprayed with phosgene to test the efficiency of new gas 

masks that were supposedly impervious to any gas the enemy had. 

These new gas masks also were used in field operations while we were engaged 

in qualifying tests for the Expert Infantryman’s Badge that involved chemical warfare tactics. I qualified and was awarded the Badge and a pay boost of $5 a month. 

I still have that treasured Badge. But the Army refuses to admit that I earned it! 

It has stonewalled my application for correction of my Honorable Discharge since 

1991 when I also filed a VA claim. The VA apparently could not proceed without 

verification of the award and thus I have been frustrated. 

I now feel that I should come forward and disclose something I have never revealed before: While I was engaged in preparations for overseas duty in Mississippi 

in 1944 I was detached from my unit—Company I, 376th Infantry—and assigned 

to a special unit that was preparing our 201 Files for shipment. My MOS was as 

a BARman but because I could type I was assigned to the Company Clerk, Cpl. D. 

Nelson Russ. 

While working at headquarters, I noticed something strange. Information about 

the Expert Infantryman’s Badge was being deleted. Furthermore, no General Orders 

had been cut, as was normal procedure. I questioned the company clerk and he told 

me not to worry about it. 

But I did worry about it . . . so much that I secretly began making a list of everyone in my company—name, rank, serial number and hometown address. I still have 

that list. I never got a chance to complete it. 

I was summarily dismissed from my special assignment and sent back to do BAR 

training. 

I have irrefutable evidence that I received the Expert Infantryman’s Badge. I submit with this letter an enlarged photo of me while I was in Company Formation 

at Camp McCain, Miss., shortly before we went overseas. One can plainly see that 

I am wearing the Expert Infantryman’s Badge. I can make the full photo (it shows 

200 men) available if necessary. Would anyone dare wear such a badge in formation 

unless he earned it? The Army, in attempt to cover up the abuses in our training, 

has done a terrible thing. Most of those 200 men in the picture are long dead. Even 

Corporal Russ, our Company Clerk, no longer is among the living. Even if I finally 

win my case, it will be a hollow victory. 

But I am determined that the truth shall come out. I want the Army to end the 

charade once and for all. I would hope that in a sense of decency it would finally 

correct my Honorable Discharge to show that I received the Expert Infantryman’s 

Badge as well as the other awards omitted from the document because I took the 

word of a clerk at the Mustering Out facility at Ft. Dix, N.J., that ‘‘No one wants 

to hire a killer!’’

I have submitted medical evidence to support my latest claim with the VA and 

am awaiting a decision. 

76

Meantime, I hope I can survive to see this matter to a final conclusion. At age 

82, fighting cancer and heart trouble, the Diagnosis is not good. 

[From the Memphis Commercial Appeal, July 9, 1944] 

CAMP MCCAIN UNITS TO RECEIVE HONORS 

EXPERT INFANTRY REGIMENT AWARDS PLANNED TODAY—PUBLIC WILL ATTEND

CAMP MCCAIN, MISS.—The three infantry regiments of the 94th Division will receive the highest award of the Army Ground Forces—that of Expert Infantry Regiment—in elaborate ceremonies at the division parade grounds Monday morning. 

The event will mark the first award of the Expert Infantry Regiment streamer 

to any regiment in the Army, which at present count is more than 8,000,000 troops. 

The honor of being the first regiment to qualify for the streamer goes to the 376th 

Regiment, commanded by Col. Harold H. McClune, who has progressed from a private in World War I to his present position. 

376TH REGIMENT WINS

Three days after the 376th became the first in the Army to deserve the streamer, 

the 302nd Regiment, commanded by Col. Earl A. Johnson, and the 301st, led by Col. 

Roy N. Hagerty, qualified. The last two outfits, however, are still shy of the record 

set by the 376th, which has every company in the regiment qualified for the Expert 

Infantry company streamer. 

This latest recognition is a continuation of a long string of honors which have 

come to the 94th Division, commanded by Maj. Gen. Harry J. Malony. 

Among the distinguished general officers who will be present for the ceremonies 

are Maj. Gen. John P. Lucas, who led the Army corps which initiated the Anzio 

beachhead south of Rome and now is commander of the Fourth Army, and Maj. 

Gen. Frank M. Milburn, commander of the XXI Corps, of which the 94th is a part. 

Also ranking officers from the Army Ground Forces headquarters in Washington are 

expected to be on hand. 

MEANS PAY BOOST

The Expert Infantry awards, created by the War Department to partially give the 

Doughboys credit for the unsung work they do in winning wars, require a high degree of efficiency from the soldier in every phase of training—from military discipline to bayonet skill to chemical warfare. 

A company, battalion or regiment must qualify 65 percent of its personnel to be 

eligible for the award. As further recognition of the work of the Doughboy, Congress 

recently passed a bill granting pay raises of $5 per month to holders of the Expert 

Infantry Badge, which means practically an en masse pay raise for the 94th foot 

troops. 

In the parade Monday Brig. Gen. Louis, division artillery commander, will serve 

as commander of troops, forming the division for review by Generals Lucas, Milburn 

and Malony. The public is invited to attend at 10 a.m.

77


27351.001
78

PREPARED STATEMENT OF DR. STANLEY LUKE, HELPING HANDS HAWAII

We are writing to you regarding the VA services in the State of Hawaii. The focus 

of the below issues is on gaps and barriers to care for the local veterans. Please 

allow us to review these problems from the perspective of a mental health provider 

in the community. 

1. On Oahu, veterans have much difficulty obtaining an appointment at the VA. 

Our understanding is that the NCQA standard for a Routine appointment is 5 working days. The VA system clearly does not meet this community standard for Access 

to care. 

2. There has been a strained relationship between our agency and the Mental 

Health department at the VAMROC. Specifically, we had a VA client, S.A., who was 

denied services at the mental health clinic by Drs. Bernstein and Batzer. In my letters to Senators Inouye and Akaka, I filed a formal complaint regarding the quality 

of care problems associated with the denial of services for this 100 percent Service 

Connected veteran, who is now deceased. 

3. Regarding PTSD treatment, as a psychologist, I have worked twice for the 

PRRPHilo program, which was closed in December 2005. I understand that there 

is a plan to build an expensive inpatient PTSD facility at TAMC. I would recommend that a comprehensive study be conducted to determine if this is an efficient 

and effective manner to provide PTSD services to veterans in Hawaii. In general, 

I believe that an intensive outpatient PTSD program and supported housing program would be an alternative to inpatient treatment. Such a treatment program 

would be possible for All locations, including the neighbor islands. 

4. On Oahu, the C and P process has often been a burden and even a traumatic 

process for the local veterans. They have had to wait for their disability evaluations 

and have been disrespected by some of the mental health professionals who have 

conducted the PTSD evaluations. Specifically, I had a veteran express rage and resentment after being told that he was a ‘‘faker,’’ who was exaggerating his PTSD 

symptoms. 

5. There has been no on call coverage for mental health services. Veterans are 

simply told to go to the Tripler ER after business hours. Psychiatrists are not providing 24-hour coverage for their patients. 

6. We understand that mental health professionals have no office space now at 

the psychiatric unit at Tripler’s 3B2. This has affected morale and wasted time for 

the mental health staff assigned to treat inpatients. 

7. We also have observed that the staff at the benefits department have been burdened by large caseloads. This has affected morale and effectiveness in this department. We have noticed burn out and conflicts between staff members as well. 

8. Dr. Bernstein, who is chief of mental health services, has not been able to answer our questions regarding denial of services for veterans. He has even produced 

a rather flawed policy and procedure regarding veterans who are on a Conditional 

Release from the Hawaii State Hospital. In short, we have been told that the State 

of Hawaii’s Adult Mental Health Division, not the VA, is responsible for the mental 

health needs of the veterans, even if he/she is 100 percent Service Connected for 

a disability. I am not clear why Dr. Bernstein has not addressed this issue regarding dual eligibility for services. 

9. We have not been impressed with the utilization of the telemedicine resources. 

On Oahu, there are rural areas such as the Leeward side and North Shore which 

could benefit from telemedicine. There are many homeless veterans in these areas 

of Oahu, and they could benefit from outreach services as well. 

10. There has been a lack of resources in the VA’s mental health system. For example, there has been no hiring of clinical psychologists when replacements are 

needed. Positions have either been frozen or eliminated. No psychologists have been 

hired to work in Primary Care settings. Only a Maui psychologist has been hired 

for this kind of integration of mental health with Primary Care. 

11. There has been no replacement hired for the chief psychologist position after 

Dr. Rodney Torigoe retired many years ago. This has weakened the Psychology 

Service. 

12. In the past, cultural issues have been given both emphasis and money to improve VA services. Cultural competence is considered to be essential in any health 

care system, but the local VA has decreased its resources for this area. Many of the 

veterans are Native Hawaiians, and it concerns us that the VA has allowed an erosion in the trainings and education on cultural competence. 

13. The National Center for PTSD (Pac Center) has located its offices in downtown Honolulu. It has been on Bishop Street for many years, and veterans have had 

to go to this location for services and also research projects. We recommend an audit 

of this office location to determine if this is efficient and effective. We wonder if the 

79

National Center office should be located at TAMC rather than in an expensive location in downtown. 

14. The VA services have been affected by poor leadership and management. In 

Honolulu, the VA upper management have been insensitive to mental health services, usually using money and resources for other areas. In addition, there has been 

poor morale for staff members at VAMROC. There has even been infighting between 

staff at the VA. 

15. The Vet Centers have been extremely busy. They are providing mental health 

services with a small staff model. Therefore, we recommend that the Vet Centers 

hire additional staff to improve their capacity for services. 

16. Finally, we have been concerned about the lack of outreach services to veterans on Oahu. Generally the mental health services have been office or facility 

based, rather than community based. Essentially, veterans have avoided going to 

the VA because mental health outreach services have not attempted to engage them. 

They also perceive the services to be poor in quality. Thus, other health systems 

in Oahu have had to provide mental health services for veterans. For example, they 

have opted out and gone to private sector providers or even state-funded programs 

to receive their care. 

PREPARED STATEMENT OF MALCOLM M. GIBLIN

Thank you for taking the time to update the veterans on the state of VA care in 

Hawaii. 

The status of coordination health care resource between the Department of Veterans Affairs (DVA) and the Department of Defense (Tripler Army Medical Center) 

(TAMC) delivery of adequate medical care is grossly inadequate. 

I want to express the fact that the DVA lack a strong commitment to support the 

activities and deliberation of health care. Collaboration between the VA and DOD 

has to be improved in order to provide adequate services to our veterans. For example, the DVA prefers to send veterans to Palo Alto, California for surgery when the 

same services are available at Tripler Army Medical Center. We desperately need 

to improve coordination between the two departments in order to achieve enhanced 

and much needed benefits for our deserving veteran population. 

It is important to note that the VA and DOD leadership in Hawaii has not worked 

jointly for several years to address improvement or expansion of health care to our 

veterans. 

I recently had a conversation with an Orthopedic Surgeon at Tripler Army Medical Center. He informed me that the DVA prefers to fly a patient to Palo Alto for 

surgical procedures. The surgery is performed and then the patient is flown back 

to Hawaii. The primary doctor is in Palo Alto and the patient is in Hawaii. The 

same procedure could have been performed at TAMC with the doctor located here 

in Hawaii, instead of the mainland. Follow-up treatment can be performed locally. 

Additionally, the DVA prefers to farm the veteran out to local doctors for specialty 

care vs. using TAMC. 

A new Orthopedic Surgeon will be assigned to DVA at TAMC in the near future. 

What is the value of a surgeon who will not have operation room privileges at Tripler? Between the two, we need to explore collaboration to improve delivery of care 

at patient level. The VA Leadership needs to explore the potential of sharing with 

TAMC. As a matter of fact, health care officials need to declare that health care 

is local. Therefore making facility-level between coordination the VA efforts extremely important, in order to improve health care delivery to our beneficiary collaboration and Tripler. 

In addition, under TRICARE, the nature of interagency sharing health care has 

shifted from direct sharing of Federal Complicated partners to VA, primarily functioning in a subcontractor role and making sharing even more complex and complicated. 

In conclusion, I believe that in order to improve ‘‘The State of Health Care in Hawaii’’, the VA and TAMC need to work at all levels to expand and improve our sharing relationship. In addition to those specifically issues discussed, we need to continue to ensure that both our departments work together as effectively as possible.

80

PREPARED STATEMENT OF HENRY KAUHI

Subject: Assistance With the Following Pertinent Veteran Benefits and Health Related Issues:

(1) Priority: Direct Hawaiian Home Lands to allow my 71-year-old mom to reinstate her lease of 40-plus years, so that the Regional VA Office can assist me in 

completing my VA Home Mortgage Loan to a Veteran who currently is collecting 

100 percent Social Security Benefits and at least 50 percent total VA Disability Benefits which has been in appeals for over 6 years and demands closure; 

(2) To Assist me and future Veterans Who are still in the Appeals Stage by either 

expediting or having a process that is more easy to understand and easier for the 

Veteran to follow as currently it seems that we are locked in many red tape issues 

or/and catch 22 issues; 

(3) Currently I received a diagnosis and half treatment for the following conditions: 

(a) Thyroid Cancer Glands surgery performed late August 2005 by Dr. Francis, 

Tripler Medical Personnel and have yet to perform the follow up Iodine Treatment 

to ensure total removal of all cancerous cells; 

(b) Received confirmation by Dr. Bahrenberg of same facility that I have Multiple 

My Loma, another Cancerous Diagnosis in late Sept. 2005 which has resulted in 

current treatment making my body weak, and susceptible to current Pneumonia 

Conditions and also in dealing with my current service connected injuries which are 

pain to the middle lower back and also PTSD, which Social Security has recognized, 

however VA has yet to acknowledge that is connected regardless of currently being 

treated by my Prim Nakatsu and also Dr. Wong from Psychiatry at the Clinic at 

Tripler. 

(4) I have maxed out the Voc. Rehab Program (to include Completing Independent 

Living); 

(5) My current health requirement is an assistant immediately, as my mom is currently helping but have health limitations of her own, and I have been bed ridden 

for over 2 weeks! 

(6) In addition, I could use a way to get around, like a bed that can assist me 

to stand and also one of those carts that can transport me to and from shopping 

as I have been unable to work since 1997. 

PREPARED STATEMENT OF WILMA HOLI, PRESIDENT, PAPA OLA LOKAHI

Good morning Chairman Craig and Members of the U.S. Senate Committee on 

Veterans’ Affairs and a special Aloha to Senator Akaka, Ranking Member. Papa Ola 

Lokahi (POL) wishes to express its deep gratitude to Senator Akaka for bringing 

the Committee to Hawai’i to review ‘‘The State of VA Care in Hawai’i.’’ My name 

is Wilma Holi, president of Papa Ola Lokahi. 

Papa Ola Lokahi is the Native Hawaiian Health Board that was established in 

1988 to plan and implement programs, coordinate projects and programs, define policy, and educate about and advocate for the improved health and wellbeing of Native Hawaiians. This was done in conjunction with the U.S. Congress establishing 

its policy ‘‘to raise the health status of Native Hawaiians to the highest possible 

level and to provide existing Native Hawaiian health care programs with all the resources necessary to effectuate this policy (P.L. 100–579/P.L. 102–396). 

Native Hawaiians have served in the military services of the United States almost 

from the very beginning of the Nation. Young Prince George Kaumuali’i enlisted in 

the U.S. Navy and fought in the War of 1812 in the Mediterranean. In following 

conflicts including the American Civil War, the Spanish-American War, World Wars 

I and II, Korea, Vietnam, Iraq, and now Afghanistan and again Iraq, Native Hawaiians have continued to serve and serve with distinction. As a side note, a number 

of Native Hawaiians have also served historically in the military services of other 

countries including England and Canada. 

Current U.S. Census data indicate that there are about 30,000 Native Hawaiian 

and Pacific Islander veterans in the United States. A large proportion of this number is resident in Hawaii; thus, the great importance of the local VA offices. 

In 1997, when the VA released the results of the Hawaii’s late Senator Spark 

Matsunaga-initiated study on the impacts of exposure to war zones on Native Hawaiian and Asian veterans, it became clear that along with American Indians and 

Alaska Natives, Native Hawaiians have borne a higher burden of battle-related 

stress and trauma. More than one in two Native Hawaiian veterans experienced 

war-related trauma in Vietnam. The report goes on . . . Upon returning home after 

one or more tours in Vietnam many Native Hawaiian veterans struggle with exVerDate 0ct 09 2002 11:44 Oct 31, 2006 Jkt 000000 PO 00000 Frm 00084 Fmt 6601 Sfmt 6621 H:\RD41451\DOCS\27351.TXT SENVETS PsN: ROWENA
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tremely severe problems that neither they nor their families, friends, or communities know how to understand or cope with: depression, shame, guilt, isolation and 

emotional emptiness, alienation, unable to relax, addiction. One in three Native Hawaiians have full or partial PTSD currently . . . More than one in two Native Hawaiians have had full or partial PTSD sometime since Vietnam. 

With conflicts in the 1990s in Iraq and now ongoing conflicts in Iraq and Afghanistan, and with Reserve and National Guard units being heavily utilized along with 

regular military and the particularly brutal nature of the current warfare, these 

PTSD episodes will only greatly increase. An additional factor in these conflicts is 

the full participation of women now integrated with formally almost all male forces. 

Native Hawaiians have been actively engaged with the Hawai’i Office of the VA 

(Veterans Affairs) for more than 10 years. 

In 1993, the Office of Hawaiian Affairs under Babette Galang and working with 

Native Hawaiian kupuna (elders) developed for VA staff statewide a cultural sensitivity program entitled ‘‘Project Ho’olauna’’. POL became involved with health and 

wellness issues surrounding Native Hawaiian veterans shortly thereafter. It actively 

participated with the Department of Veterans Affairs and Director Barry Raff in the 

holding of its landmark Symposium on Healing Alternatives in October 1995, ‘‘An 

Interdisciplinary Orientation to Healing from Native Hawaiian, Native American, 

and Asian Perspectives.’’

Later, in March 1998, with Director David Burge and Thomas Kaulukukui, POL 

hosted a special section in its Native Hawaiian Health Summit on the health and 

wellness issues and concerns of Native Hawaiian veterans. Later, in 1999, both Director Burge and Mr. Kaulukukui were part of a POL team that visited the Navajo 

Nation to discuss with its veteran leadership how it was dealing with PTSD and 

other health issues surrounding Navajo veterans. 

Also, in 1999 Federal legislation established the Hawai’i Federal Healthcare Partnership which brought together Hawaii’s federally designated health entities—the 

Native Hawaiian Health Care Systems and Papa Ola Lokahi and the community 

health centers and the Hawai’i Primary Care Association—with the VA and TAMC 

(Tripler Army Medical Center) to focus on collaborative efforts around Native Hawaiian health. This partnership has developed into an increasingly effective mechanism to address Native Hawaiian health concerns including those of Hawaii’s veterans. 

In 2001, POL initiated with the VA a symposium for VA personnel and for others 

working with Native Hawaiian veterans. Noted psychologist Dr. Kekuni Minton presented a number of sessions on cultural trauma and its impacts. Also in 2003 and 

2004, POL provided Native Hawaiian cultural competency sessions for VA and 

TAMC professional staff. These sessions clearly indicated the importance sensitivity 

to culture is in treating Native peoples. 

Most recently in 2005, POL launched an effort with Dr. Bud Cook of Ka Maluhia 

Learning Center to begin to develop a program for Native Hawaiians, their families, 

and others which would look at building on the strengths of the Hawaiian culture 

to help mitigate veteran health and wellness issues. Work is just beginning on this 

initiative but it hopefully will enhance the work of the VA as well as bring together 

those entities working in the Hawaiian community in health such as the Native Hawaiian Health Care Systems to better address the on-going needs of our returning 

Native Hawaiian veterans-men and women-from the Afghanistan and Iraq theatres. 

Despite these efforts, there is so much more to be accomplished as the needs of 

many Native Hawaiian veterans remain unaddressed. Reports of Hawaiian veterans 

living in caves and in rural forested areas continue to be heard. Health care access 

for them and their families is non-existent. Somehow we need to find ways of reaching out to these ‘lost warriors.’ This remains our challenge for the future. 

Finally, before making the following recommendations, POL would like to acknowledge the appointment of Dr. Hastings as the new VA Director. POL looks forward to continuing to work with him and his staff. POL makes the following recommendations for your Committee’s consideration: 

1. Good health is integral to wellness and in the Hawaiian context, it incorporates 

mind, body, and spirit. POL strongly recommends that VA programs need to be 

mindful of and support cultural approaches which enhance wellness as well as address physical health needs; 

2. Native organizations have an important role to play in the healing process for 

Native peoples. POL recommends that the VA work closely with and collaborate 

with such groups as the now being chartered National American Indian Veterans, 

Inc.; the Native Hawaiian Health Care Systems; the Hawai’i Federal Healthcare 

Partnership and others to include sharing resources and expertise to better address 

the health and wellness issues of Native Hawaiian veterans and others; 

82

3. Culture serves as the foundation for healing for Native peoples. POL strongly 

recommends that the VA incorporate cultural competency sessions for its professional staff working with Native Hawaiian veterans; 

4. The concept of ‘place’ has great significance in Native Hawaiian culture as it 

does in American Indian and Alaska Native cultures. POL recommends that the VA 

study this concept as a means to enhancing its ability to provide services to Native 

Hawaiians; and 

5. Finally, on-going research into the needs and concerns of current Native Hawaiian veterans returning from war zones is crucial to saving lives. POL strongly 

recommends that the VA increase its research capacity to investigate what the 

health and wellness issues are for returning Native Hawaiian men and women veterans from today’s war zones. It is hoped that many of these studies could be undertaken by Native Hawaiian health researchers themselves. 

Thank you for giving POL an opportunity to provide testimony on this important 

issue. 

PREPARED STATEMENT OF WILLIAM C. S. PARK, RETIRED MASTER SERGEANT

Mr. Chairman and Members of the U.S. Senate Committee on Veterans’ Affairs: 

I offer all honor and respect to the Great Spirit who brings us together today, to 

the spirits of this sacred land, the sky above, the earth below, the streams which 

run to the sea and the sea itself. I pay all honor and respect to our ancestors who 

watch over us, to the kupuna who have passed, to the kupuna who yet live to guide 

us with their wisdom; and to the chiefs, dignitaries, Senators, and other leaders 

present, to the Department of Veterans Affairs, its Chair, to all veterans and to all 

others present. 

I thank you for taking the time to be here today and providing us the opportunity 

to discuss with you our concerns regarding veterans care here in Hawaii. 

I am a disabled veteran employed with a non-profit organization that works with 

adult mental health clients and the homeless, many of which are disabled veterans. 

Through my position, I am not only a witness to the care disabled veterans receive 

(or don’t receive), I am also faced with the challenge of helping them to find ways 

to overcome all the obstacles that are placed before them. 

Through the teachings of our elders and Papa Auwae, we were taught that Hawaiian tradition and culture believed that warriors returning from battle needed to 

be ‘‘re-born’’. Special rituals were performed to help the warriors through this process. In today’s society, we also must address and meet our warrior’s needs. 

Although it appears that this Committee is addressing many issues that directly 

affect veterans care, it doesn’t seem as if the long-standing, underlying issues are 

getting the attention they should. I would like to stress that as a veteran receiving 

care at the VA and working with veterans, my complaint does not lie with staff. 

I have nothing but great respect and gratitude for the doctors and staff at the VA. 

They are committed and dedicated to the veterans and their care. They are also 

overworked, intimidated by management, and disillusioned with leadership at all 

levels. It is a ripple affect and it starts at the top with poor leadership, low staff 

morale, distrust of management by staff, no open door policies, no adequate resolution of complaints, misuse of VA funds, but most important, a severe lack of care 

for veterans. 

Here locally, the VA has what it terms a ‘‘hands off’’ policy. This means that when 

a veteran is incarcerated or becomes a patient at one of the State’s facilities, the 

VA considers him/her a ‘‘ward of the State’’, and thereby relinquishes all contact, 

communication and care of the veteran. (Enclosed is a Facility Policy Memorandum 

No. 136–01–030.) Although this policy does provide for a possible collaboration of 

a veteran’s care once deemed to be a ward of the State or other government agencies, the local VA does not participate in such agreements for the care and wellbeing of the veteran. Working with these types of clients, living in the State of Hawaii, and given the lack of care provided by the VA, it seems only logical that at 

some point in time, a veteran will likely require the services of the State. 

It has been my experience that when this happens there is absolutely no communication between the doctors and/or staff at the VA, the detention facilities, or the 

hospitals. I personally know of veterans who have for one reason or another (whether it be difficulty in getting appointments with VA doctors, lack of transportation, 

lack of understanding, misinterpretation of procedures, among a few) have failed to 

take their medications and in an attempt to seek help, ended up being referred to 

a State Agency. It is a well known fact among the veterans requiring mental health 

care, that the VA has NO case management services for its veterans. NONE. When 

a veteran is in a mental health crisis and calls the VA for help, they are told to 

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call the State Access line. I ask you, when you are in a health crisis, do you want 

to talk with a stranger who knows absolutely nothing of you or your circumstances, 

and who has no access to your files and records to refer to if you are unable to communicate your needs to them? And the story gets even better, because the veteran 

is the pawn, the State’s hands are tied, and the VA has an uncooperative and uncommunicative spirit. 

What is a veteran’s alternative then? He/she seeks services on a fee basis which 

is approved by the VA. Unfortunately, more often than not, the vendor fails to get 

paid by the VA and the veteran receives the bill. Unable to pay the bill, it ends 

up with a collection agency. Now the veteran faces an additional challenge, when 

all he/she wanted and deserved was to get the care they are entitled to, a small 

compensation for the great sacrifice they have made in service of our country. 

I implore you, each of you on this Committee, to listen well to all that is being 

said, not only today, but at all of your meetings with the public. 

Go beyond what leadership and management are telling you. 

Listen carefully to staff who care and are brave enough to speak regarding their 

needs and concerns, and please, please pay heed to what the veterans themselves 

are telling you. 

He ‘onipa’a ka ‘oia’i’o. Truth is not changeable. 

I firmly believe that the brave warriors of this country deserve the best health 

care services its government has to offer. 

In closing, I once again thank you for holding these meetings and giving us the 

opportunity to voice our concerns. My thanks to you who cared enough to be here 

today, to those who were instrumental in arranging these meetings, and to you, the 

Committee, for seeking to ensure better care for veterans. 

My heartfelt thanks to each and every veteran throughout this Nation, who have 

served our country so well. May the Great Spirit that watches over all, bless and 

keep each of us. 

DEPARTMENT OF VA REGULATION—DEPARTMENT OF VETERANS AFFAIRS MEDICAL & 

REGIONAL OFFICE CENTER, HONOLULU, HI 96819, FACILITY POLICY MEMORANDUM, NO. 136–01–030, SEPTEMBER 30, 2001 

EXCLUSION FROM TREATMENT OF VETERANS WHO ARE ALSO WARDS OF THE STATE OF

HAWAII OR OTHER GOVERNMENT AGENCY

1. Purpose 

To establish policy and procedures that expressly exclude hospital and outpatient 

care for a veteran who is a patient or inmate in an institution of another government agency. 

2. Policy 

(a) In October 1999, VA promulgated regulations, establishing the enrollment system and a medical benefits package describing the services VA furnishes to veterans 

enrolled in the VA health care system. In developing the benefits package, VHA decided to change its long standing policy and expressly exclude from the benefits 

package, by regulation, hospital and outpatient care for a veteran who is a patient 

or inmate in. an institution of another government agency if that agency has a duty 

to give the care or service. 

(b) Under the Eight Amendment, a State or local government has a duty to provide adequate medical care and services to those whom it has incarcerated. To be 

adequate, the care must be reasonably designed to meet the routine and emergency 

health care needs of prisoners, including medical treatment for physical ills, dental 

care and mental health care. The medical care also must be at a level reasonably 

commensurate with modern medical science and of a quality acceptable within prudent professional standards. That standard arguably applies to virtually all care 

that VA might furnish to a veteran. 

(c) Emergency services will be provided to stabilize any veteran brought in. However, inpatient treatment will be considered only on a case-by-case basis. 

3. Definitions 

(a) 38 U.S.C., 1710(g). In 1986, Congress amended 38 U.S.C., 1710 (formerly 610) 

providing that VA ‘‘shall’’ furnish certain veterans with hospital care. To ensure that 

State and local officials did not use the new statute to argue that VA must provide 

care for incarcerated veterans, Congress added language providing that the statute 

does not require VA to furnish care to a veteran to whom another agency of Federal, 

State, or local government has a duty under law to provide care in an institution 

of such government. Subsection (g) does not prohibit VA from caring for incarcerated 

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veterans, thus from 1986 until late 1999, VA did provide such care. Rather, subsection (g) provides VA with legal authority for refusing to furnish such care to incarcerated veterans if it so chooses. VA did just that when it chose to exclude care 

for incarcerated veterans in the regulations establishing the benefits package, as 

discussed above. 

(b) Sharing Agreement: The policy on providing care to incarcerated veterans does 

not prohibit VA facilities from entering into sharing agreements with prison or other 

state officials to furnish care to incarcerated veterans. 

(c) Ward of the State: Any person who is forensically committed to an institution 

or is under conditional release. Patients on parole or probation are not considered 

wards of the state. 

(d) Conditional release: A person who is forensically committed by the State of Hawaii Courts, but who is allowed community treatment based on their meeting a specific set of conditions approved by the court. These patients are considered active 

patients in Hawaii State Hospital (HSH) or other institution and are still a ‘‘ward 

of the State’’. A violation of any condition is considered grounds for revocation of 

the release. 

(e) Voluntary vs. Involuntary: Voluntary assumes treatment that is with explicit 

permission of the patient, involuntary assumes legal involvement. There are involuntary admissions, which are based on medical opinion of danger to self or other 

while awaiting court ruling. 

4. Procedure 

(a) All patients meeting the ward of the state criteria are excluded from obtaining 

VA hospital or outpatient care. 

(b) The VA reserves the right to enter or not enter into sharing agreements with 

other government agencies for the provision of care to veterans who are wards of 

the state. 

(c) All patients on probation or parole are expected to have signed release of information agreements with the Hawaii State agency (either parole or probation officer, 

or HSH) and the VA, to afford free communication between the treating clinicians 

and the State officials. 

(d) Treatment, other than emergency care, will not be provided when it is required as a result of a breach in conditions of release. Subject to signed releases 

of information, the VA will notify the proper State officials, such as parole officers 

or HSH staff, to assume their responsibility in care of the patient. 

(e) Voluntary treatment as an inpatient or outpatient may be provided within VA 

or TAMC facilities for decompensation due to the veteran’s medical or psychiatric 

illness. VA will not be responsible for care in other facilities. 

(f) Involuntary inpatient or outpatient treatment will not be provided unless part 

of sharing agreement or if patient arrives at VA facility in need of emergent care. 

If a decision is made not to provide inpatient or outpatient care or treatment to a 

ward of the State, the appropriate State officials will be notified to act on the legal 

conditions. 

5. Responsibilities 

Compliance with this policy is the responsibility of all VA clinical staff. The ACOS 

of Mental Health Service, the Chief of the inpatient service, Fee Service, or attending physician is responsible for contacting the appropriate authorities. 

6. Reference 

(a) Title 38 U.S. Code Section 1710(g) 

7. Rescission 

Facility Policy Memorandum No. 116–99–001, dated July 30, 1999. 

8. Attachments 

None. 

9. Review Dates 

September 30, 2002 and September 30, 2003. 

10. Re-issue Date 

September 30, 2004. 

11. Follow-up Responsibility 

Chief, Health Administration Service, H. David Burge, Director. 

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PREPARED STATEMENT OF RANDALL TSUNEYOSHI

1. Health Care is excellent when you get it. 

2. It took 18 months to get an Agent Orange review. 

3. Takes 6 months to get an appointment. 

4. Why does VA send out letter requesting proof that a veteran served in RUN, 

when the DD 214 clearly states they were there. 

5. VA staff is overworked and under budgeted. 

6. VA benefits should be tied in with the annual Defense Budget. A quarter of 

the budget should be for Vet care. 

7. It takes 1 Combat Tour (we months) to develop PTSD. VA care should be funded of the level of 24 hours x 365 days = minimum time required for mental health 

care. 

8. On Agent Orange diseases: Why does VA not used EPA Standards on Chemical 

affects. Agent Orange problems take years to affect the veteran. A CIB or Purple 

Heart is not the only justification for disability. 

PREPARED STATEMENT OF LORI AND PAUL WESSEL

The support, therapy and guidance that they continue to provide for us (and our 

sons) have been excellent and very helpful throughout this awfully painful time in 

our lives. Bereavement Counseling provided by those who are knowledgeable about 

the military as well as being trained as counselors makes a difference. Sitting in 

the waiting area has also allowed me to witness first hand what they (the center, 

facilities and staff) provide to the veterans who walk in for information, support, 

advise and the work info center is a great asset and well utilized. We’ve seen vets 

come in for a bite of respite. 

As non-military, without access to the VA benefits or really, information, this center has proven to be a life saver for us in dealing with the loss of our son.

Æ