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53–064 PDF 2010

S. HRG. 111–278 

HAWAII FIELD HEARINGS DURING 

THE 111TH CONGRESS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST AND SECOND SESSIONS 

AUGUST 25, 2009 AND JANUARY 7, 2010 

Printed for the use of the Committee on Veterans’ Affairs 

( 

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

(II) 

COMMITTEE ON VETERANS’ AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN D. ROCKEFELLER IV, West Virginia 

PATTY MURRAY, Washington 

BERNARD SANDERS, (I) Vermont 

SHERROD BROWN, Ohio 

JIM WEBB, Virginia 

JON TESTER, Montana 

MARK BEGICH, Alaska 

ROLAND W. BURRIS, Illinois 

ARLEN SPECTER, Pennsylvania 

RICHARD BURR, North Carolina, Ranking 

Member 

LINDSEY O. GRAHAM, South Carolina 

JOHNNY ISAKSON, Georgia 

ROGER F. WICKER, Mississippi 

MIKE JOHANNS, Nebraska 

SCOTT P. BROWN, Massachusetts1

WILLIAM E. BREW, Staff Director 

LUPE WISSEL, Republican Staff Director 

1 Hon. Scott P. Brown was recognized as a minority Member on March 24, 2010. 

(III) 

C O N T E N T S 

AUGUST 25, 2009 

FIELD HEARING ON VA OUTREACH TO RETURNING GUARD UNITS

SENATORS 

Page 

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

WITNESSES 

Tamayo, 1LT Tulsi Gabbard, Hawaii Army National Guard .............................. 3 

Prepared statement .......................................................................................... 5 

Tuimalealiifano, SFC Sualauvi, III, Hawaii .......................................................... 7 

Park, ‘‘Clay’’ William Clayton Sam, Veterans Program Director, Papa Ola 

Lokahi ................................................................................................................... 8 

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

Tuimalealiifano, Shannon, veteran and wife of SFC Sualauvi Tuimalealiifano 17 

Betts, Tracey, Honolulu Regional Office Director, Veterans Benefits Administration, U.S. Department of Veterans Affairs .................................................... 20 

Prepared statement .......................................................................................... 22 

Cullen, Sheila, Director, Veterans Integrated Service Network (VISN) 21, 

U.S. Department of Veterans Affairs; accompanied by James Hastings, 

M.D., Director, VA Pacific Islands Health Care System; and Adam W. 

Darkins, M.D., Chief Consultant for Care Coordination, Veterans Health 

Administration ..................................................................................................... 25 

Prepared statement .......................................................................................... 27 

Ishikawa, BG Gary M., Deputy Adjutant General, State of Hawaii ................... 33 

Prepared statement .......................................................................................... 35 

Jefferson, Raymond, Assistant Secretary, Veterans’ Employment and Training, U.S. Department of Labor ............................................................................ 36 

Prepared statement .......................................................................................... 37 

APPENDIX 

Moses, Mark S., Director, Office of Veterans Services, State of Hawaii; letter . 53 

JANUARY 7, 2010 

STATE OF VA SERVICES ON MAUI, HAWAII

SENATORS 

Akaka, Hon. Daniel K., Chairman, U.S. Senator from Hawaii ........................... 55 

WITNESSES 

Calleon, Karl, Vietnam Veteran and Commander, DAV, Chapter 2, Maiu, HI .... 56 

Evangelista, Rogelio G., Advisory Board Member, VA Pacific Islands Health 

Care System ......................................................................................................... 58 

Prepared statement .......................................................................................... 59 

Helm, CDR Larry, Molokai Veterans Caring for Veterans .................................. 61 

Kamai, Clarence, Jr., Molokai Representative, Veterans Caring for Veterans .. 63 

Kanahele, Danny, VA Advisory Council Member ................................................. 64 

Page

IV 

Laub, Paul, President, Maui County Veterans Council ....................................... 65 

Prepared statement .......................................................................................... 66 

Poaipuni, Terry, Wife of a Vietnam Veteran ......................................................... 67 

Prepared statement .......................................................................................... 68 

Skaggerberg, Mitch, President, Vietnam Veterans of Maui County ................... 69 

Prepared statement .......................................................................................... 70 

Sodetani, Lloyd K., Maui Representative, Hawaii Office of Veterans Services .. 71 

Prepared statement .......................................................................................... 72 

Attached Survey ........................................................................................ 73 

Addendums ................................................................................................ 78 

Betts, Tracey, Director, Honolulu VA Regional Office, U.S. Department of 

Veterans Affairs ................................................................................................... 94 

Prepared statement .......................................................................................... 96 

Response to request arising during the hearing by Hon. Daniel K. 

Akaka ......................................................................................................... 128, 130 

Cullen, Sheila, Director, VA Sierra Pacific Network (VISN 21), Veterans 

Health Administration, U.S. Department of Veterans Affairs ......................... 97 

Prepared statement .......................................................................................... 98 

Halliday, Linda, Deputy Assistant Inspector General for Audits and Evaluations, Office of Inspector General, U.S. Department of Veterans Affairs ........ 105 

Prepared statement .......................................................................................... 106 

Attachment ........................................................................................................ 109 

(1) 

FIELD HEARING ON VA OUTREACH TO 

RETURNING GUARD UNITS 

TUESDAY, AUGUST 25, 2009 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Honolulu, HI 

The Committee met, pursuant to notice, at 10:30 a.m., at the 

Oahu Vet Center, 1298 Kukila Street, Honolulu, Hawaii, Hon. 

Daniel K. Akaka, Chairman of the Committee, presiding. 

Present: Senator Akaka. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. Aloha. 

AUDIENCE. Aloha. 

Chairman AKAKA. A big welcome to all of you. Thank you very 

much for your patience. Welcome to today’s hearing of the Senate 

Committee on Veterans’ Affairs. 

This is the first of two field hearings that I am chairing here in 

the State this week. Today’s hearing will focus on the benefits and 

services provided to returning Guard units and related transition 

issues. We held several hearings on this and related topics in the 

State before, and most recently held a hearing on the same topic 

last year in Washington, DC. Much has improved in recent years, 

for which I am grateful. However, it is important for the Committee to understand the remaining challenges. 

I applaud the efforts of VA employees in Hawaii. These men and 

women work hard to help the veterans who seek assistance. There 

are many things that VA does well in Hawaii. However, there is 

always room for improvement. 

Indeed, our unique geography, our diversity, and our way of life 

require that VA develop a unique strategy to care for our islands’ 

veterans, including Hawaii veterans of the National Guard and Reserves. I want to hear what tools VA needs to make a difference 

in the lives of these men and women of the Hawaii National Guard 

and Reserves. 

Back in Washington, we have worked hard to ensure that VA 

has the resources to provide the best possible care. In my first 2 

years as Chairman—2007 and 2008—Congress provided recordbreaking funding increases to VA. This year we are working to get 

VA the funding it needs for next year. We are also hard at work 

fixing the broken way that VA’s health care system is funded. 

I introduced legislation to fund VA health care 1 year ahead of 

the current budget process, which will allow VA health care dollars 

2 

to go further for veterans and taxpayers. I am pleased to tell you 

that this bill, the Veterans Health Care Budget Reform and Transparency Act, passed the Senate just before the August break. 

We have also been focusing on finding ways to improve how VA 

and the Department of Defense work together to improve the transition process for servicemembers and veterans. We are working 

hard on seamless transition between active service and life as a civilian, which is part of our goal. Given the existing relationship between VA and Tripler Army Hospital, Hawaii should be on the 

forefront of national efforts to have the two Departments work 

more closely together. We will explore that issue today. 

Here in Hawaii, more than 5,000 members of the Guard and Reserve have been deployed. The Hawaii National Guard has recently 

returned from its second deployment and over 85 percent of those 

mobilized were already combat veterans. It is important that these 

soldiers, and indeed all of those who have been sent into harm’s 

way, know that VA will be there for them when they return home. 

After years of war, we appreciate that there are distinct challenges facing the reintegration of these citizen servicemembers. Unlike their active-duty counterparts, Guard veterans must transition 

from their civilian life and employment to active military service 

and back again. Despite VA’s best efforts to conduct outreach to 

this population, it seems clear that some are still unaware of all 

that VA has to offer and how to access those services and benefits; 

and this is something that we also need to work on, to provide the 

information that they need. More work needs to be done. 

I hope that both of our panels will shed some light on why we 

continue to hear from veterans that they just did not know about 

their eligibility for VA benefits and services. We need to know how 

VA and the Congress can help bridge this information gap. This is 

particularly important for those who suffer from the invisible 

wounds of war and need more help readjusting to their civilian 

lives. 

I appreciate the Department of Labor and Hawaii National 

Guard’s participation in today’s hearing, as they both have important roles in the transition process. 

Finally, I note that there are many veterans here today who 

would like to testify. While we cannot accommodate everyone’s request to speak, we do want to hear your views. The Committee is 

accepting written testimony, which will be reviewed and made part 

of the record of today’s hearing. If you have brought written testimony with you, please give it to the Committee staff who are located here in the room. And if you do not have written testimony 

but would like to submit something, Committee staff will assist 

you. In addition, the Committee staff is joined by VA staff, who can 

respond to the questions, concerns, and comments that you raise. 

At this point, let me ask my staff members to please raise your 

hand. If you want to talk to one of them, please do so. 

Let me ask the VA staff who are here to raise your hands. These 

are the folks that you can talk to if you have any questions and 

want to make any statements. 

I hope today’s witnesses will provide us with a real sense of what 

the next steps are so that no member of the Guard, or indeed any 

3 

servicemember is unaware of their eligibility and the benefits available to them. 

Thank you very much again, and now, I would like to introduce 

our first panel. We have First Lieutenant Tulsi Gabbard Tamayo, 

Hawaii Army National Guard; Sergeant First Class Sualauvi Tuimalealiifano III from the U.S. Army; and also Clay Park, who is 

Veterans Program Director from Papa Ola Lokahi. 

We are waiting for the Sergeant to return, but in the meantime, 

I am going to ask Lieutenant Tamayo to please proceed with her 

statement. Welcome. 

STATEMENT OF FIRST LIEUTENANT TULSI GABBARD TAMAYO, 

HAWAII ARMY NATIONAL GUARD 

Lieutenant TAMAYO. Thank you, Senator. Good morning, Chairman Akaka and everyone gathered here. Thank you for the opportunity to speak here today regarding the VA’s outreach and services to Guard and Reserve servicemembers. 

By way of introduction, I am a First Lieutenant, a Military Police 

Officer in the Hawaii Army National Guard. I enlisted in 2003, 

earned my commission in 2007, and have just returned from my 

second deployment overseas. My statement today reflects only my 

personal opinions and experiences as an individual. 

As you are well aware, since September 11, 2001, the VA has 

begun to see a new kind of clientele. Veterans are younger—a new 

generation who grew up in a different culture and face new challenges. The Reserve component of the military has taken a role 

front and center like never before. The VA is now faced with hundreds of thousands of customers who are young combat veterans, 

but who also still actively serve in the National Guard or Reserves. 

My underlying message to you today, the bottom line shared up 

front, is that the DOD and the VA need to work together to think 

outside the box and find comprehensive strategies to reach, educate, and serve Guard and Reserve veterans. 

The VA’s presence in our redeployment process, from point of reentry back to the U.S. to being released from active duty, has improved since 2006 when I returned from my first deployment. 

About a week and a half ago, as we went through demobilization 

at Fort Hood, TX, we received about a 2-hour briefing from the 

local VA rep on the various benefits available to us as veterans. He 

ensured that all 400 of us in the briefing tent filled out enrollment 

papers to join the VA or be registered in the VA and assisted and 

encouraged soldiers to fill out disability claims, applications, as 

well as talked about the VA Home Loan Guarantee. It was a lot 

of information packed into a short period of time, but it was informative and I walked away learning a few new things about the 

VA. However, this should not be the end of the story. 

I understand that the VA and DOD are two very separate agencies. However, for Guard and Reserve soldiers, the idea of a clean 

and complete transition between the DOD and VA is not a reality. 

The Reserve component has hundreds of thousands of servicemembers who are dual members of both agencies, eligible for benefits from both. It is highly likely, as you mentioned, that a servicemember will transition between Reserve and active status multiple 

times throughout his or her career. 

4 

A short personal example, which I know is not an isolated incident, is I was attempting to take advantage of my G.I. Bill benefits 

while deployed and took a few classes. It took 7 months, and I am 

still waiting for the VA to get confirmation from DOD that I am 

actually eligible for this G.I. Bill benefit. I called once a month, and 

every time I called was told that it takes a long time for the VA 

to get information from the DOD and to call back next month. I 

was also told that as a member of the National Guard, it takes 

even longer. 

As members of the Reserve component, there are specific limits 

to what benefits we are eligible for as well as special benefits that 

we are entitled to. However, in my experience the outreach and the 

education of Reservists and National Guard members has not been 

focused and comprehensive. Upon our redeployment, we don’t have 

the luxury of time, unlike the active component. Like I said, in 

Texas, we were there for 5 days and we received one briefing from 

the VA. 

Therefore, connecting with this group of veterans and ensuring 

education and access to all that the VA has to offer requires a different strategy. 

One thing I noticed is that under the VA Web site, there is not 

easily found a section that caters specifically to National Guard or 

Reservists. I have a lot of questions. Throughout my deployment I 

have talked to soldiers who I worked with and members of my command and there is neither knowledge nor understanding about 

what benefits are available to us. I know of a lot of things from my 

work with you, but this is not known by the mass Guard population. I think if there was an easy way on the Web site to find 

focused information about medical benefits and education benefits 

that target, specifically, the Reserve component, that would be 

helpful. 

Regarding VA outreach at the local level in each State, I think 

it is really about developing relationships between the local VA and 

the local Reserve units and commands. Because access to Guard 

and Reserve soldiers is sparse and spread out, the local VA developing a partnership with the local Guard and Reserve leadership 

so that they can coordinate and integrate the Guard schedule with 

VA outreach, would also provide a lot more access and direct access 

for the soldiers from to VA. To me, this partnership should not be 

short-term, but rather a continuous conversation. By doing this, 

the VA would provide faces and names to these soldiers and their 

families before, during, and after deployments—to include the 

break between deployments—which would greatly improve availability and access. It would take away the common view that the 

VA is a big bureaucratic organization that is not user friendly. 

The best counselors are veterans themselves. I have talked to 

soldiers during my deployment who would like to help other soldiers upon returning from deployments and feel that they have the 

gift and the need to help other soldiers, but they don’t have the 

training, the official training or the degree or the background to do 

so. If there is a way that the VA could channel those veterans interested into a training program where they could have the official 

training and certification, possibly along with a commitment from 

the veteran to work for the VA, both sides would be served well. 

5 

I also think there should be mandatory counseling, both one-onone and in groups, for returning Guard and Reserve veterans. As 

many of us know, soldiers may be too proud to seek assistance or 

seek help or know where to go to get it. These one-on-one counseling sessions would provide that opportunity for a soldier to 

speak freely. 

Also, these counselors should be trained to ask the right questions, be personable, develop a relationship, and know what the 

unique challenges that Reserve veterans face with reintegrating 

back into their civilian life. This would also provide the soldier the 

opportunity to enroll in the VA system, provide focused information, as well as a face, a name, and a phone number that the soldier can utilize to follow up for any additional care. 

There are other concerns and issues that exist, as well as those 

that we have not discovered yet. By working together and being 

creative in finding solutions, progress can be made. 

Thank you for the opportunity to share my experiences and 

thoughts. 

[The prepared statement of Lieutenant Tamayo follows:] 

PREPARED STATEMENT OF FIRST LIEUTENANT TULSI GABBARD TAMAYO, HAWAII ARMY NATIONAL GUARD

Chairman Akaka, and Members of the Committee, thank for the opportunity to 

speak here today regarding the VA’s outreach and services to Guard and Reserve 

Servicemembers. 

I am a First Lieutenant, Military Police officer, in the Hawaii Army National 

Guard. I enlisted in 2003, earned my commission in 2007, and have just returned 

from my second deployment overseas. My statement today reflects only my personal 

opinions and experiences as an individual. 

As you are well aware, since 9/11, the VA has begun to see a new kind of clientele. Veterans are younger, a new generation who grew up in a different culture, 

and face new challenges. Also, the reserve component of the military has taken a 

role front and center like never before. The VA is now faced with hundreds of thousands of customers who are young combat veterans, but who also still actively serve 

in the National Guard or Reserves. 

Between the period of September 2001 and November 2007, over 450,000 Reserve 

and National Guard Soldiers were deployed to either Iraq or Afghanistan. Thousands more have deployed since that time, many on their second and third tours. 

My underlying message to you, the bottom line up front, is that the DOD and the 

VA need to work together to think outside the box, and find comprehensive strategies to reach, educate, and serve Guard and Reserve veterans. 

The VA’s presence in our redeployment process (from point of re-entry back to the 

US, to being released from active duty) has improved since 2006, when I returned 

from my last deployment. About a week and a half ago, as we went through demobilization at Ft. Hood, TX, we received a roughly 2-hour briefing from the local Texas 

VA rep, on all the various benefits available to us as veterans. He ensured that all 

400 of us in the briefing tent filled out the enrollment papers, assisted those who 

wished to fill out disability claims applications, and passed out the application for 

VA Home Loan guaranty. It was informative, and I walked away learning a few new 

things. However, this should not be the end of the story. 

1. DOD and VA cross-talk & coordination 

I understand that the VA and DOD are two very separate agencies; however, for 

Guard and Reserve Soldiers, the idea of a clean and complete transition between 

the DOD and VA is no longer a reality. The Reserve component has hundreds of 

thousands of servicemembers who are dual members of both agencies, eligible for 

benefits from both. It is highly likely that a servicemember will transition between 

reserve and active status multiple times in his/her career. 

A short personal example, I have been waiting 7 months for the VA to get confirmation from the DOD that I am indeed eligible for the GI Bill (even though I 

was deployed and sent the VA a copy of my mobilization orders). I have called at 

least once a month for the last 7 months, provided all the documentation that was 

requested, but am still being told that nothing can be done. I was told by the VA 

6 

Case Manager that it takes a lot longer to get information from the DOD when dealing with a Guard servicemember. Perhaps with a better system of coordination between the DOD and the VA, Guard and Reserve Soldiers who go back and forth between active/reserve status, would not get caught in this gray area of ‘‘in-between.’’ 

2. Outreach to reserve component members 

As members of the Reserve component, there are some specific limits to what benefits we are eligible for, as well as specific benefits we are entitled to. However, the 

outreach and education of Reservists does not seem to be focused and comprehensive. 

Upon redeployment, the Guard/Reserve do not have the luxury of time, unlike the 

Active Component. Guard and Reservists have to take time off from civilian work 

to seek help. Therefore, connecting with this group of veterans, and ensuring education and access to all that VA has to offer requires a different strategy. 

a. I could not easily find under any tab on the va.gov web site, a section that 

catered solely to Reserve component members. There are many questions our 

benefits, especially in the areas of health care, home loans, and education that 

could be answered in a specific section, rather than trying to sift through all 

the information and figure out what applies to us and what doesn’t. 

b. VA offices in each state could develop a partnership with the local Guard/ 

Reserve leadership to coordinate and integrate VA outreach with the annual 

training/work schedule, and to find innovative ways to meet the needs of Guard 

and Reserve veterans. 

This partnership should not be short-term, but rather a continuous conversation. VA’s providing a face and continuous outreach to Soldiers and their families before, during, and after deployments, to include the break between deployments, would greatly improve availability and access. It would take away the 

common view that the VA is a big bureaucratic organization that is not userfriendly. 

3. The best counselors are veterans themselves. Those who have been through 

what we have been through can provide the best understanding and support. However, many veterans do not have a 4-year degree or are not certified counselors. VA 

could channel those who are interested into a program that would give them the 

additional training needed, along a commitment from them to work for the VA, so 

that these veterans can become counselors. 

4. There should be mandatory counseling—both one-on-one and in groups—for returning Guard/Reserve Veterans. If this is a DOD/VA mandate, local commands will 

find time for this to ensure it is executed properly. Soldiers may be too proud to 

seek assistance on their own. These one-on-one counselors should be trained to ask 

the right questions, encourage the Soldier to enroll in the VA system, provide focused information to the Soldier based on whatever benefits he/she find applicable, 

and then provide a name and phone number who the Soldier can follow-up with for 

any additional care that is required. 

After my last deployment, we were required to come in 6 months after returning 

home for the Post-Deployment Health Re-Assessment. The VA was present and provided counseling to those who needed, and also had a table set up to enroll any one 

had not yet enrolled in the VA. I don’t know if this has changed since then, but 

the VA should be front and center at these briefings, since at this time Soldiers 

have had a chance to get through the excitement of being at home, have settled in, 

and had more time to think about what kinds of benefits the VA has to offer them. 

5. A central 800 number for Guard/Reserves, which will automatically route the 

call directly to a local VA office, similar to how the phone company or Pizza Hut 

have their systems, will put a Soldier directly in touch with their local VA rep who 

is familiar with the Guard/Reserve. 

There are other concerns and issues that exist, as well as those we have not discovered yet. By working together and being creative in solutions, progress can be 

made. Thank you for the opportunity to share my experiences and thoughts. 

Chairman AKAKA. Mahalo and thank you very much, Lieutenant 

Tamayo. We certainly are grateful to hear you share your personal 

challenges. This will certainly help us to restructure our system so 

that we can provide services that are needed to our veterans. 

I would like to call now on Sergeant Sualauvi Tuimalealiifano. 

Thank you so much for being here. At this time, we would like to 

receive your statement. 

7 

STATEMENT OF SERGEANT FIRST CLASS SUALAUVI 

TUIMALEALIIFANO III, HAWAII 

Sergeant TUIMALEALIIFANO. Good morning, Senator Akaka. 

Chairman AKAKA. Good morning. 

Sergeant TUIMALEALIIFANO. I want to thank you for the privilege, 

honor, and opportunity to testify before you today. I am Sergeant 

First Class Sualauvi Malua Tuimalealiifano III of the 96th Civil 

Affairs Battalion, Airborne, Fort Bragg, North Carolina. I am processing through the Bravo Company Warrior Transition Unit of Tripler Army Medical Center. 

My 13-year career brought me to Fort Bragg, North Carolina, 

with two tours in Iraq, Operation Iraqi Freedom, and a third in Afghanistan, Operation Enduring Freedom, as part of the proud and 

legendary All-American 82nd Airborne Division and the USA Special Operations Command, Civil Affairs with Third and Seventh 

Special Forces Group, Airborne. The results of a mission in midJuly 2007 in South Afghanistan brought me here today and to my 

home of Hawaii. 

After 11 months as an inpatient through four different hospitals 

in three different States, I have come to know of many challenges 

related to injuries and recovery. Because of what happened on the 

day I was injured, I am here before you today. Just as a rock tossed 

into the water will have a ripple effect that continues on, the day 

that I was injured has caused ripple effects that still continue. I believe this is also true for others who are wounded in the service of 

their country. Today, I hope to represent not just myself, but other 

injured servicemembers, whether their injuries are physical, like 

mine, or within. 

My testimony will focus on what I can offer this Committee, honest answers based on the experiences I have had in the service of 

my country. I will not focus on studies, promises, or the ideas of 

others. My strength is that I can speak firsthand of what a wounded soldier has experienced and what I have seen others go through. 

Senator Akaka, I have with me additional points and issues that 

I wanted to bring before you and the Committee. 

A lack of confidence in therapists and limited time with therapy—not according to a group overall, but individual to that soldier’s will and his or her injury. 

Acupuncture, but not massages. We’ll allow skin-piercing needles 

with jolts of electricity but not manual body/muscle stimulation to 

body and nerves as well, according to a soldier or patient. 

I have a story of a National Guard Texas soldier who was left 

with no unit support while in the care of James Haley Veterans Affairs Hospital in Tampa, Florida. I was unaware of any soldier not 

having any connection or ties with their unit or the unit that they 

were mobilized with. With this individual soldier, he was 23 years 

old, just got married before he deployed, and is now a double amputee—both legs above the knee. We met at the Fisher House. 

After we spoke and got together, the wives and myself found out 

that he has had no connection with any of his unit members. I was 

very upset, very upset. I found out the unit’s information and discussed it with the person on the other side. But his wife and family 

were unaware of the way the military works. His wife was very bitter, and I understood why. She didn’t see any help. According to 

8 

them, they didn’t see any help in any way—maybe sending a soldier of the unit there periodically, maybe once a month to check up 

on them—but there were no ties of any kind. I was told they probably demobilized, and I don’t know what else became of that, but 

from what I could have done, I did. I just hope from being there 

that no other soldier, injured or not, returning home would have 

to go through that. 

I also have on my list here Special Operations. We have an organization that we call the Care Coalition, and throughout the time 

in the hospital the Care Coalition is very informative, very supportive to, it is sad, but it is to the Special Operations soldiers and 

families. 

There are things and events that are accessible, funded and 

looked after by this Care Coalition. I spoke with them in 2007, 

shortly after the War Transition Units were starting to stand up— 

and they are working their way in sharing the ideas and ways of 

standing up an organization or program to support all soldiers, regardless of National Guard, Reserves, or active duty. I think that 

there are citizen soldiers that were sent overseas to do what we 

can do to keep home safe, and when we return, I think we should 

all have a similar status of whatever care and help that we can get. 

The other notation I have here is regarding Fisher House. It provides a great service but could be more family friendly. It is a nice 

museum. Everything is beautiful—top-notch funds, I guess—but 

they are not friendly toward or prepared for children. I think the 

main purpose for that house is to house the wives and the husbands who come there with their children to support their loved 

ones. The Fisher House I have been through hasn’t been familyfriendly. They have a very nice parlor, but no child-friendly room 

to play in, unlike the Ronald McDonald House geared toward the 

family and the children. 

And the last one, sir, is the G.I. Bill. I believe it is earned and 

should be used as desired. The question is, for seminary or church 

classes—we are not allowed to use it toward theology without getting the State involved. The point I am trying to make is, I tried 

to take classes through my church school, but I am not allowed to 

use the G.I. Bill for any Christian courses and I just want to know 

why, or if we are looking into it. 

That is all, and I would like to thank you for your time, for hearing me out, and for letting me come by and testify. Thank you, sir. 

Chairman AKAKA. Thank you very much, Sergeant Tuimalealiifano, for our testimony. 

Now, we will hear from Clay Park, who is the Veterans Program 

Director, Papa Ola Lokahi. Clay, will you please proceed with your 

testimony. 

STATEMENT OF CLAY PARK, VETERANS PROGRAM DIRECTOR, 

PAPA OLA LOKAHI 

Mr. PARK. Good morning, Mr. Chairman and Members of the 

U.S. Senate Committee on Veterans’ Affairs. Thank you for the opportunity to address the Committee. My name is William Clayton 

Sam Park. I am of Native Hawaiian ancestry, a disabled veteran 

who served as a combat medic during the Vietnam War, and a retired Master Sergeant with 3 years active duty with the U.S. Army 

9 

and 21 years of service with the Hawaii Army National Guard. I 

am presently the Veterans Program Director with Papa Ola 

Lokahi. My comments today are based on my experiences in that 

role, and in particular with regard to situations faced by our returning OEF/OIF National Guard and Reserve troops as they transition from the military to veteran status and back to their lives 

in the community. 

Though the impact of this current war will be my focus, my work 

on a recent day in which veterans I served included an 88-year-old 

World War II veteran from Guam and a 19-year-old Oahu Iraqi 

war veteran reminds me to emphasize the message of General 

Shinseki during his confirmation hearing for the position of Secretary of the Department of Veterans Affairs. We must care for all 

of our veterans. We cannot allow those who have served their country at any time, in any role, to be neglected. 

Having worked with the community agencies for the past several 

years in outreach efforts to our veterans, it is evident to me that 

the challenges faced by our newest warriors and their families remain great. As I have done in testimony before this Committee in 

prior years, I would like to use the stories of those who come to 

me to provide you with the human side of the statistics reported 

to you by officials of the military or the VA. 

Let me start with the experience of a full-time National Guard 

soldier activated in Iraq and wounded during that deployment. 

This individual was medically boarded with a disability rating and 

then discharged from the National Guard. Since his full-time position with the Guard was his employment and being a member of 

the Guard is required for that employment, this veteran is now 

without a job, without adequate income to maintain his former 

standard of living, and without health benefits for his family. 

Next, consider the young man activated with his Reserve unit for 

a second tour in Iraq and sent to the mainland for training, despite 

the unit knowing he had a medical condition likely to limit his performance. He was returned to Hawaii because he was not able to 

complete assigned functions. His unit was deployed to Iraq without 

him. He is now in limbo. He hears from the VA that they cannot 

help him because he is still an active duty soldier. The military 

tells him he is not truly on active duty, since his unit is overseas 

and he is here. Consequently, he has no income and no access to 

health care. 

A young Reservist’s wife from a State on the mainland contacted 

me after reading an airplane article about the community outreach 

work in Hawaii. Her husband, a medic, was being deployed for the 

fourth time and she was fearful for his physical and emotional 

well-being but did not know where to turn for help. She believed 

if she spoke with anyone in his command about her fears or if word 

got to command from any other source she might share her fears 

with, this would reflect badly on her husband’s career. 

I hear from other wives of physical and verbal abuse by the returning husbands. They are fearful for their children, contemplating divorce, and yet knowing the person they loved before he 

was deployed is still there somewhere, desperate to find him again 

but not knowing how to do that or where to go for help. 

10 

In another situation, during a briefing with a Reserve unit about 

our community outreach efforts, I could see two young women soldiers in the audience, one with the 1,000-yard stare. After the 

briefing, she asked to speak with me off-line about her experience 

while deployed in Iraq. This young woman reminded me of one of 

my own daughters, and while she cried while telling me of being 

raped in Iraq by a fellow soldier, I knew I was limited in what I 

could do. She was fearful that she would be booted out of her unit 

and possibly even lose her full-time Federal job if she told anyone 

what happened. She felt she could certainly not trust that the 

other soldiers in her unit would be supportive and anticipated revenge instead of support. 

One can only wonder how many other women face this situation 

alone. I am so thankful that she had the courage to trust me and 

that I have a network of people and organizations in this community available as resources in such situations. In other situations 

where the individual is eligible for VA care, I do everything possible to bridge the trust and get the person to see one of our caring 

VA providers. 

Since I last testified to this Committee in 2007, I have seen 

changes in the VA, such as more emphasis on outreach, more visible service for women veterans. But as General Shinseki stated, we 

must care for all of our veterans. There are still those who do not 

reach the safety net of the VA through established channels or who 

are frustrated in attempts to seek help by bureaucratic obstacles. 

Transitioning home still is not easy. Senator Akaka’s comments in 

2007 still hold true. More can be done to assist veterans and their 

families in the reintegration of the wounded or injured veterans 

into their community. 

Mahalo nui loa for allowing me the time to share my mana’o 

with you today. Mr. Chairman, I will be pleased to answer questions you or your Members of your Committee have for me at this 

time. 

[The prepared statement of Mr. Park follows:] 

PREPARED STATEMENT OF CLAY PARK, VETERANS PROGRAM DIRECTOR, PAPA OLA LOKAHI

Mr. Chairman and Members of the U.S. Senate Committee on Veterans Affairs: 

My name is William Clayton Sam Park. I am of Native Hawaiian ancestry, a disabled veteran, who served as a combat medic during the Vietnam War, and a retired Master Sergeant with 3 years active duty with the U.S. Army and 21 years 

of service with the Hawai’i Army National Guard. I am presently the Veterans Program Director with Papa Ola Lokahi. Thank you for the opportunity to address the 

Senate Veterans’ Affairs Committee. 

My comments today are based on my experiences in that role, and in particular 

with regard to situations faced by our returning OEF/OIF National Guard and Reserve troops as they transition from military to veterans status, and back to their 

lives in the community. Though the impact of this current war will be my focus, 

my work on a recent day in which the veterans I served included an 88 year old 

WWII veteran from Guam and a 19 year old Oahu Iraq War veteran reminds me 

to emphasize the message of General Shinseki during his confirmation hearing for 

the position as Secretary of the Department of Veterans Affairs (VA)—we must care 

for all of our veterans. We cannot allow those who have served their country at any 

time, in any role, to be neglected. 

Having worked with community agencies for the past several years in outreach 

efforts to our veterans, it is evident to me that the challenges faced by our newest 

warriors and their families remain great. As I have done in testimony before this 

Committee in prior years, I would like to use the ‘‘stories’’ of those who come to me 

to provide you with the human side of the statistics reported to you by officials of 

11 

the military or the VA. Let me start with the experience of a full time, National 

Guard soldier, activated for duty in Iraq and wounded during that deployment. This 

individual was medically boarded with a disability rating and then discharged from 

the National Guard. Since his full time position with the Guard was his employment, and being a member of the Guard is required for that employment, this veteran is now without a job, without adequate income to maintain his former standard 

of living, and without health benefits for his family. 

Next, consider the young man activated with his Reserve Unit for his second tour 

in Iraq, and sent to the Mainland for training despite the Unit knowing he had a 

medical condition likely to limit his performance. He was returned to Hawaii because he was not able to complete assigned functions; his Unit was deployed to Iraq 

without him. He is now in limbo—he hears from the VA that they cannot help him 

because he is still an active duty soldier. The military tells him he is not truly on 

active duty since his unit is overseas and he is here. Consequently, he has no income and no access to health care. 

A young Reservist wife from a State on the Mainland contacted me after reading 

an airplane magazine article about the community outreach work in Hawaii. Her 

husband, a medic, was being deployed for the fourth time and she was fearful for 

his physical and emotional well-being, but did not know where to turn for help. She 

believed if she spoke with anyone in his Command about her fears, or if word got 

to Command from any other source she might share her fears with, this would reflect badly on her husband’s career. I hear from other wives of physical or verbal 

abuse by their returning husbands. They are fearful for their children, contemplating divorce, yet knowing that the person they loved before he was deployed is 

still there somewhere—desperate to find him again, but not knowing how to do that 

or where to go for help. 

In another situation, during a briefing with a Reserve Unit about our community 

outreach efforts, I could see two young women soldiers in the audience—one with 

that ‘‘thousand yard stare.’’ After the briefing she asked to speak with me ‘‘off-line’’ 

about her experience while deployed in Iraq. This young woman reminded me of one 

of my own daughters, and while she cried while telling me of being raped in Iraq 

by a fellow soldier, I knew I was limited in what I could do. She was fearful that 

she would be booted out of her unit and possibly even lose her full time Federal 

job if she told anyone what happened. She felt she certainly could not trust that 

the other soldiers in her unit would be supportive, and anticipated revenge instead 

of support. One can only wonder how many other women face this situation alone. 

I am so thankful that she had the courage to trust me, and that I have a network 

of people and organizations in this community available as resources in such situations. In other situations, when the individual is eligible for VA care, I do everything possible to bridge the trust and get the person to see one of our caring VA 

providers. 

Since I last testified to this Committee in 2007, I have seen changes in the VA, 

such as more emphasis on outreach and more visible services for our women veterans. But, as General Shinseki stated—we must care for all of our veterans. There 

are still those who do not reach the safety net of the VA through the established 

channels, or who are frustrated in attempts to seek help by bureaucratic obstacles. 

Transitioning home is still not easy. Senator Akaka’s comments in 2007 still hold 

true, ‘‘. . . more can be done to assist veterans and their families in the 

. . . reintegration of the wounded or injured veterans into their community.’’ 

Mahalo nui loa for allowing me the time to share my mana’o with you today. Mr. 

Chairman, I would be pleased to answer any questions that you or the Members 

of the Committee have for me at this time. Aloha. 

Chairman AKAKA. Thank you very much, Mr. Park, for your testimony, and I thank all of you for your testimonies. 

I have a question here for each of you, so I will call on you starting with Lieutenant Tamayo. This question is to all of you, because 

you each bring your unique perspectives to today’s discussion. It is 

clear that if we cannot reach veterans, their needs will go unmet. 

Over the years that I have been working with VA, one of the structuring goals is we want to change the structure from World War 

II to Iraq and Afghanistan, meaning to update what we are doing 

and to try to restructure VA so that we can deliver the necessary 

services to those veterans today. 

12 

So the question is, what can VA do to improve the effectiveness 

of its outreach efforts—our outreach efforts? Nothing is off the 

table. We are looking for creative solutions and you folks have been 

there. 

That said, let me call on Lieutenant Tamayo for your response. 

Lieutenant TAMAYO. I think the most important piece to answer 

that question is about building relationships and making veterans 

and servicemembers feel comfortable and feel that we have access 

to the local VA. I think it is easy—you know, the common perception is that the VA is just a big, huge government organization that 

is out there somewhere. Maybe we have access, maybe we don’t. 

We have to wait in long lines, wait forever to get benefits. 

But by the local VA office or representatives developing relationships with these Guard and Reserve commands and units and having that access and availability there where you have a name, you 

have a face, and you know that if you have any questions, you can 

talk to them, and making that level of comfort be present at all levels so that the leaders in the Guard, from the platoon leaders to 

the company commanders, the battalion commanders, they feel 

comfortable. So, they know when they have a soldier who they are 

concerned about or a soldier who is seeking help, that relationship 

is there where it is not just calling an 800 number and not knowing who you are going to get at the other end of the line. 

It is developing that relationship and comfort not only with the 

units, but I think that is where it starts, because from there, you 

have the families. And I know something that is changing now that 

is different from our last deployment is the Family Readiness 

Groups are trying to remain active and not shutting down now that 

we are home. They are trying to stay active for each other and continue the support between the family members, but also the support that they experienced while we were gone. So that is another 

way for the VA to also develop relationships with the spouses and 

with the families and see what kind of care they are looking for 

and concerns they may have about their returning servicemember. 

Another thing is, you know, a lot of times those of us in the military, we say, OK, you have to go to this briefing or that briefing. 

You have to go to a suicide prevention briefing or an anger management briefing, you know, getting ready to come home. Too often, 

these become kind of check-the-block. Here is a 30-slide PowerPoint 

presentation. OK, you saw it. Sign your name. You are good to go. 

There is a difference between that and actually talking to someone 

or hearing from someone who is able to reach us. 

We had a briefing from a Major from Wyoming in Kuwait right 

before we came back, and he just—he is a social worker in his civilian job. He is a National Guard soldier. And he said, you know, 

this is called an anger management briefing, but I am here to talk 

to you about basically how to deal with yourself, how to deal with 

the experiences you have had and how to deal with your family. He 

talked a lot about himself, and it was a personal conversation. 

There were about 150 of us in the room, but I know each of us felt 

touched by his message and what he had to tell us because it was 

practical. It was real. We weren’t just going through the motions. 

13 

So, I think the more we can try to push that, and again, it’s 

about developing relationships and having local support and local 

access. 

Chairman AKAKA. Thank you very much. 

Let me now call on Sergeant Tuimalealiifano. 

Sergeant TUIMALEALIIFANO. Thank you, Senator Akaka. I think, 

amongst many things and many ways, I think the best thing we 

could do is maybe, with the soldiers that have returned that are 

willing to help and assist those who are still there and still sitting 

in the same positions—depressions that they were in—if we can 

take those veterans, train them—whether it be by certifying them 

or not—but to train them maybe with people skills or talking from 

their own personal experience, we take those veterans, train them 

up if that is what they desire to do. 

Like myself, that is what I would love to do, is to get back into 

the field that I just left, which is the field of depression. There is 

a large field that comes with depression and a lot of things that 

different soldiers and injuries, whether they come back fully physically able, they might not be within themselves. 

I think if we take those soldiers that have recovered to a certain 

extent, that have the desire to go back into those areas, that way, 

I think, when they are talking to those soldiers and helping them 

out, they convey that they have been there. They have done that. 

They have shared that. They know how it feels. They know how it 

was. I think if we take those veterans and train them and put 

them back in that field, if that would be desired, they could better 

help those that are coming in. 

The VA, I think, like the Lieutenant said, is a lot about the relationship. There are soldiers like Mr. Clay here shared that had the 

courage to come up and speak about rape. And there are many others that probably turned away because the information is not out 

there, not sharing the opening up to everyone to see that the VA 

is available, that there are organizations and programs available. 

But I think relationships, as the Lieutenant mentioned, with soldiers that are coming and going, I think the VA can do that, and 

then just putting themselves out there and to reach them, whether 

they want to be heard or not, I think. 

That is all I have, sir. 

Chairman AKAKA. Thank you very much, Sergeant. 

Mr. Park? 

Mr. PARK. Thank you, Mr. Chairman. That is a tough question, 

you know. 

Chairman AKAKA. Yes. Your response to the question? 

Mr. PARK. One of the things when I look at this is the predeployment briefing. I have never heard of the VA doing a predeployment 

briefing. I have done a predeployment briefing with the Hawaii 

Army National Guard, the 29th Brigade; and what I tell these people is that when you become Title X, when you are activated, keep 

all your documents because documentation is the key. You know, 

if you are in country and you are standing next to a sign that says, 

‘‘Welcome to Iraq,’’ take a picture, because if the VA comes back 

and says, we have no evidence that you were in country, guess 

what, here it is. 

14 

Look for LODs. Make sure you get your LODs if you got hurt 

while you were in the military. And again, I go back to documentation is the key. So these young men and women need to understand 

that they need all these documents. They need their orders. They 

need to know that the people they go with in country can write a 

buddy letter for them when they come back. So they need to understand that they can work with these people to help them with their 

application process, as well. 

An open door policy. The VA has an open door policy that if a 

veteran is having difficulty with talking to someone, maybe he can 

go up the chain and talk to somebody else. 

You know, we do education and training. That is the key, education and training, as well. 

The biggest thing is connecting with the community, connecting 

with community organizations. Hawaii is very unique. The people 

in Hawaii, we are so diverse—different ethnic backgrounds, the different ways we think. When you go to a community—I am going 

to pick a place like Hana. If you go to Hana to talk to the people 

in Hana, the first thing you need to do is you need to seek out the 

elders out there. Go talk to the Kupuna, because they are the ones 

that can give you guidance on where all these people are, where 

they are in the bush. They are the ones that can help you. So make 

that connection with the community. Thank you. 

Chairman AKAKA. Mahalo. Thank you very much. As I said, we 

want to be creative in thinking of other ways that are not being 

used now to try to deal with the needs that our veterans have. 

Tulsi, as a veteran of several deployments, can you talk about 

improvements, improvements that have been made since your last 

assignment overseas? What challenges remain? 

Lieutenant TAMAYO. Like I mentioned before, my return from my 

last deployment in 2006, the outreach and the process just in that 

short demobilization period—from where we are returned to the 

U.S. and released from active duty—the VA had a bigger presence 

this time and it was more focused solely on benefits. 

I don’t know if this is how it is everywhere, but the VA rep who 

spoke to us was very encouraging and, I want to say, forceful in 

a good way in getting all soldiers to enroll in the VA and all soldiers to make sure they got a paper talking about the VA Home 

Guarantee. People were timid in the beginning. Like I said, there 

were over 400, 500 of us in the tent, but he made sure and he said, 

hey, you need to get one of these forms, or you need to fill this out. 

First, people weren’t raising their hands, and he got basically almost everyone in the whole tent to raise their hands saying that 

they were interested and made himself available afterwards. 

So that, to me, was a big improvement from the last time we returned, where I was not left with an impression of the VA. The bottom line is, I didn’t come back feeling that I had some big connection with the VA or something that I could take away. 

Six months after we returned home, we went through a post-deployment health reassessment, and at that time, the VA was also 

available to us and provided one-on-one counseling to those who requested it. It was not a front and center piece in that PDHRA process. We will see in 6 months and see how things have changed this 

time around. 

15 

Personally, I know that there has been a lot of development from 

the VA about benefits for Guard and Reserve soldiers and there is 

a lot more available to us now than there was previously. But 

again, it comes down to having that focused outreach to Guard and 

Reserves saying, this is what is available to you, this is what you 

are eligible for, rather than kind of getting a big, fat book of, hey, 

this is what the VA has to offer to everyone and trying to sift 

through it to find what actually applies to me or my family? 

Chairman AKAKA. Thank you very much. 

Sergeant, will you describe your experiences with the Warrior 

Transition Battalion? 

Sergeant TUIMALEALIIFANO. With the Warrior Transition Battalion, or War Transition Unit, my experience is not much. I have 

been through Fort Bragg’s WTU. They were just standing it up. It 

was fairly new. My interactions with WT there were not much. I 

was still an active duty soldier, so I was still returning back to the 

unit, to and from, because I was from Fort Bragg. 

I came here to Hawaii and have been with Tripler’s WTU. While 

the intentions are good, they still need more work. And there is a 

lot of—because the Guard, I believe they work with the active duty 

and I think with the Reserves, they don’t really hold the same authority over each other. I am still trying to figure out where in 

there I might be able to fit in if I was to go to COAD. 

But as far as the WTU, Senator Akaka, the way they are moving, 

I think the way they are moving is progressing. They are getting 

better in what they are supposed to be doing and in what they are 

doing. Like anything else, a new program that you stand up, you 

run into obstacles and you learn to adapt to overcome or change 

routes or routines. 

My experience with the one here—I have been with the WTU 

here since January. They have been very supportive out there to 

really get you involved in activities and events, going out for a 

walk type deals or going to the beach and stuff like that. I would 

rather be doing therapy myself, but they have a lot of good intentions, a lot of good events for soldiers in regards to their active 

duty, National Guard and Reserves. They provide a lot of events. 

They provide courses and classes for those who need help with depression, if they feel suicidal. 

I think they are going in the right way, the right route and direction with what they are trying to provide soldiers. But with the 

wars now, you have got a lot of us young guys, young gals, a lot 

of new and different ways of looking at things. Some guys, we got 

our chest out too high or too far and chin up so high that we forget 

that on the inside it is always turning and it needs to be checked 

up or checked out every once in a while. 

But I think that the WTU is doing a great job, still progressing, 

still young, still new. 

Chairman AKAKA. Thank you very much, Sergeant. 

Mr. Park, in your testimony, you state that trust must be established in order for servicemembers and veterans to be successfully 

served. My question to you is, how should VA go about building 

this trust? 

Mr. PARK. One of the things that we established is what we call 

our Uncles Program, and I am happy to say that I have a few of 

16 

my uncles in here right now. It is disabled veterans that help the 

veterans navigate the system in getting the application, going 

through the application process. 

And what happens with this is that when the veteran calls and 

needs somebody to talk to, these are the uncles that talk to these 

veterans. You know, in Hawaii, that is who you turn to. You turn 

to your uncle, and then your uncle helps you with whatever problems, whatever you have. Because the VA is a government organization and because the soldiers are asking if the command doesn’t 

take care of them, the NCOs don’t take care of them, they are looking at a government organization. They come right out and they go 

right back to another government organization. So the trust that 

you need to establish with the soldier is to be straight up front and 

tell them, this is how it is. This is what you have got. 

I will give you an example. My PHD tells me 10, 10, 30 adds up 

to 50, and my PHD is my public high school diploma. [Laughter.] 

Well, when a veteran comes up with 10, 10, 30 on his disability 

and they give him 40, he is going to start thinking, you know, my 

PHD tells me 10, 10, 30 is 50, it is not 40. You need to explain to 

these guys, we have a formula here. That is why you got 40, you 

didn’t get 50. So the VA needs to be up front in telling these young 

soldiers, these veterans, that this is what we have and they need 

to educate these people on how to get the information across to 

them, because local guys, if you tell them no, that is it. They are 

out the door. They give up. You can’t let them give up. We can’t. 

I have got no time to sit back and let these guys give up, and I 

don’t. And my uncles, they don’t let them give up, either. I have 

a young uncle right there in that uniform. He just started, came 

back from Iraq. 

I think what the VA needs to do is they need to make that connection. They need to get that trust from the veterans. They need 

to go to the National Guard units and the Reserve units and talk 

to the commander, talk to the First Sergeant, talk to the NCOs. 

That is where it all begins. Thank you. 

Chairman AKAKA. Thank you very much, Clay. When you say 

uncles, I am sure you also mean aunties. 

Mr. PARK. That, too. [Laughter.] 

There is a Dr. Kathleen M. McNamara who holds a women’s 

group in Maui. I think she is the only one that I know who does 

a women’s group in Maui, and she does it in the evenings. I think 

there is a women’s group here on Oahu. I am not sure there is, but 

I think there is one at the VA here on Oahu. But with my counterpart, Babette Galaang, standing there, we are trying to establish 

an aunties group, as well. 

Chairman AKAKA. Thank you. This is really about the relationship between two people, and in this particular case, veterans with 

VA, right? 

Mr. PARK. Yes, sir. 

Chairman AKAKA. Well, thank you very much. 

This question is for all members of the panel. In your experiences, how are families affected by the reintegration process? I 

know this is a very sensitive question. However, this Committee 

would appreciate your candor so we can gain insight into the nature of this happy and sometimes difficult process. 

17 

Let me first call on Sergeant Tuimalealiifano. 

Mrs. TUIMALEALIIFANO. Excuse me, Senator, for barging in here. 

Chairman AKAKA. Will you please identify yourself? 

STATEMENT OF SHANNON TUIMALEALIIFANO, VETERAN AND 

WIFE OF SERGEANT TUIMALEALIIFANO 

Mrs. TUIMALEALIIFANO. My name is Shannon Tuimalealiifano, 

and I am Sergeant Tui’s wife. Very briefly, before I speak on your 

question, let me say who I am. My mother was an active duty 

Army soldier in the Vietnam era. My father, as well, was a Vietnam veteran of 24 years. He retired. He spent the majority of his 

time at Fort Bragg, the mighty mighty Fort Bragg, NC. So, I am 

very familiar with the military historically and having also joined 

the military, I am a 10-year veteran myself. 

After 9/11, I was activated. My husband and I got married. I left 

active duty service after 6 years and was reactivated twice after 

9/11. So, I am familiar with the Reserve component and its difficulties, and the active-duty component and its novelties, and families 

of all types and sorts, growing up from a Vietnam veteran family, 

having been a member, and having not only dealt with deployment 

issues, but traumatic deployment issues. So, I just want to say that 

to let people know that when I speak, I am speaking from a broad 

array of experiences. I am so thankful, Senator, that you are asking for creative ideas on how to make a difference. I would like to 

say that the biggest reason that my husband and I came home 

after he was injured, was that the military gave us permission, because we knew without a shadow of a doubt that even though initially his neck was broken and he could not function from the neck 

down, we knew that God is good all the time and that the best 

healing comes at home. So we requested for a transfer. We were 

granted that transfer. 

The reason we came was because, as Mr. Park has said, Hawaii 

is different from the entire rest of the United States. Where the 

majority of the United States has had a breakdown in family components, there is still ohana here. You will still find uncles and 

aunties and grandmas and grandpas in the family, helping. In the 

mainland especially and in the military, you are disseminated 

throughout the United States. You are very far from any kind of 

support. And if your command is not strong and the wives of that 

command are not strong enough to understand that their role is to 

mentor the young wives coming in, then there is a lack of family 

connection at all. 

And the Lieutenant is very right. The main thing that we can 

do to help veterans, families, and all of the issues sprouting from 

the war and being military, period, is relationship. 

We have three children. The youngest was born when he deployed. He was injured 2 weeks before coming home, so the baby 

was one. The number 1 thing, sir, that I can say that would assist 

families, when people come home, they need to reconnect. When 

they come home different from the way they left—injured in any 

capacity—it is traumatizing. It is wonderful to focus on the outreach of the veterans to take care of them, but if the families are 

not cared for, then you are not caring for the veteran, because the 

brunt of the burden of the care will fall on that family. Because 

18 

after business hours when everybody shuts down, the therapist, the 

counselors, and the family will take over—weekends, holidays, et 

cetera. 

So, the thing that I would say, sir, would be that programs such 

as child care so that the couple can seek counseling, or even can 

simply get together and reconnect in an informal atmosphere, of 

going on a date and simply talking. We need programs with child 

care, programs in the VA that reach out to the community for the 

family. There were so many things that my husband could not 

speak to me on, but he could speak to fellow veterans, and I understood that. I gave them their time to connect and console each 

other so that healing could come. Even just talking is wonderful. 

I received so many helpful people who would give me Web sites 

and numbers to call, applications to fill out. With three small children, one an infant, and my husband unable to function, if you give 

me a Web site, you might as well not give me information. I don’t 

have the time. 

The VA would do well to have an organization, and I model this 

after the Care Coalition because they were our salvation when he 

was hurt. We were so overwhelmed with the future and the prospects of our entire lives. They banded around us. They poured love 

on us. They poured out information in pamphlets, but they also 

contacted organizations for us. They saw the need. They went to 

the community for us because I didn’t have time to leave the hospital to go ask these people for help. 

And they came back with gift cards and gas cards for me driving 

back and forth to hospitals. I think many people are aware of Hero 

Miles, where they give free tickets for the families to help—gas 

cards and food, grocery cards—because we were living out of the 

Fisher House. We needed groceries. We needed all these things 

that normally we would have at home. But it was an expense out 

of our pocket with a sudden loss of income because, of course, I 

could not continue working. 

So if the VA could form a group where their purpose is to reach 

out to the community for these families, connect them to these 

groups, connect them to the families of their local environment, get 

things like gas cards or grocery cards or free child care tickets or 

things that just would take the pressure off of the couple trying to 

juggle their lives in the middle of the chaos while they are still trying to plan their future. These are the kind of programs and groups 

needed. 

And as I said, the Care Coalition, I do believe, is working with 

active duty components to attempt to form some groups, and they 

are doing the same thing. They are trying to draft some of these 

young soldiers who do not feel that they can continue in the military so that they don’t have the bleak outlook of, I don’t have a future. They ask them, would you like to reach out to other soldiers? 

Join our organization, be on staff, come talk to other soldiers in the 

hospital so that they don’t give up on life because they don’t see 

what can happen after, if they lose limbs, if they lose families from 

the stress. 

And the children, most importantly—we were blessed because 

my family lived nearby, and being Vietnam veterans they understood. When he got hurt, my parents took the children. I went to 

19 

the hospital. My children didn’t have to experience the trauma of 

watching me break down and cry. They were allowed to remain 

children because there was an environment to care for them. But 

without relationship, without a trusting back-up plan, I would have 

had to take them and they would have had to see every sordid detail of him coming off the plane, being connected to wires, tubes, 

and a neck brace. That was not something I wished for my children. But had those programs not been in place, I wouldn’t have 

had a choice. 

So again, I say, it can be traumatic if there is not someone there 

to take the pressure off of the soldier and the spouse so that families can heal slowly instead of trying to put a pressure dressing immediately and keep it there while you are trying to figure out everything. So, thank you for letting me speak. 

Chairman AKAKA. Mahalo. Thank you so much for that. [Applause.] 

Lieutenant, do you have a response to that? 

Lieutenant TAMAYO. Just very briefly to touch on something you 

mentioned earlier and that you mentioned regarding soldiers not 

coming home the same way that they left. This comes in many 

shapes and forms. There is the physical aspect of it, and I know 

you have worked and you have talked a lot about the invisible 

wounds. My mom had actually asked me about PTSD the other day 

and asked me, how do they figure out who has PTSD and who 

doesn’t, and that is the thing. 

Coming back from these experiences, there is no cut-and-dry formula, you had this many bullets shot at you or you went through 

this many explosions, therefore, you qualify or whatever. I can only 

speak from a Guard-Reservist perspective, but the baseline of leaving home, putting life on pause, and being away from your family 

is a stress in and of itself on a good day, but when you put together 

all the things that happen to a majority of us—not only the 

stresses of the mission but also being aware of and knowing things 

that are going on at home, things that are not going on at home 

that should be, and knowing that you can’t do anything about it 

and you are powerless and have no control, you can’t go home and 

save the day, you can’t take care of things—there is a lot of stress 

in that and different people deal with it in different ways. 

The important thing is that when we come home, the support 

that was there for the families while we were gone continues for 

the families and us as we come home. I know for our unit—and 

this is, I think, a testament to the Guard leadership here—there 

was quite a bit of family support. Families had a lot of gatherings, 

they had a lot of meetings, they had a lot of information and things 

that were available. I think it is definitely important that support 

continues now that we are home while we are trying to put all the 

pieces back together. 

Chairman AKAKA. Thank you very much. 

Let me call on Clay Park for his response. 

Mr. PARK. Well, Senator, after four children, 13 grandchildren, 

and four great-grandchildren, I have come a long way. 

When I came back from Vietnam, I was angry. When I was told 

that I had PTSD, I said, no, I don’t. And they said, well, then why 

20 

do you sleep with a loaded pistol under your pillow? How do you 

know that? 

One day, my son got angry at me and he was going to throw 

something at me; and I still remember this in my mind right now. 

I was going to kill him, because I remembered that I had seen this 

young kid throw a grenade in the helicopter; and at that time I 

thought my son was a young VC. If my wife didn’t yell at me, I 

would have run him over. 

I see a lot of spouses that go through their husbands self-medicating. They are drinking, they are doing drugs, and the wives are 

getting hit at night. They don’t know what to do. The families are 

getting pretty much beat up, and the reason for that is because 

they aren’t getting help from nobody. They are doing it on their 

own. I know the VA is now trying to help the families, but that is 

my personal experience with PTSD. Maybe I have got a Traumatic 

Brain Injury, too, I don’t know, but I have come a long way. So, 

after 35 years married to my wife, I have got a long way to go yet. 

Thank you, Senator. 

Chairman AKAKA. Thank you for sharing your personal experience, Mr. Park. 

I want you to know that we have passed legislation on home care 

out of Committee. Hopefully we can pass it finally through the full 

Senate in September when we go back into Session. 

This comes down to helping the family help the soldier—which 

includes training the family member and providing stipends that 

will help the family. 

This has been a great panel. Thank you so much for sharing your 

personal experiences. And without question, your responses will 

help us be more creative in trying to find services that can help you 

and your families. Mahalo nui loa. [Applause.] 

I want to welcome our second panel. Our first witness is Tracey 

Betts. She is the Honolulu Regional Office Director. 

Also, Sheila Cullen, who is Director of the Veterans Integrated 

Service Network 21 at the Veterans Health Administration. She is 

accompanied by Dr. James Hastings, Director of the VA Pacific Islands Health Care System, and Dr. Adam Darkins, who is the 

Chief Consultant for Care Coordination in the Office of Patient 

Services. 

And we have Brigadier General Gary Ishikawa, Deputy Adjutant 

General for the State of Hawaii. 

Our final witness is the Honorable Ray Jefferson. I want to welcome Ray home. He has just been confirmed as Assistant Secretary 

of Veterans’ Employment and Training at the Department of 

Labor. 

I want to thank all of you on the second panel for being here this 

morning. Your full testimony will be, of course, printed in the 

record. 

Ms. Betts, will you please begin with your statement. 

STATEMENT OF TRACEY BETTS, HONOLULU REGIONAL OFFICE DIRECTOR, VETERANS BENEFITS ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. BETTS. Chairman Akaka, it is my pleasure to be here today 

to discuss our efforts to meet the needs of veterans residing in the 

21 

Pacific Region. The Honolulu Regional Office is responsible for delivering non-medical VA benefits and services to veterans and their 

families through the administration of comprehensive and diverse 

benefit programs. Today, I will specifically discuss important outreach and services provided to members of the National Guard and 

Reserves here in Hawaii. 

The Honolulu Regional Office serves the veteran population in 

Hawaii and the Pacific region, including Guam, American Samoa, 

and the Commonwealth of the Northern Mariana Islands. The 

Honolulu RO is also responsible for outreach to the veterans residing in the insular islands of the Republic of Palau, Federated 

States of Micronesia, and the Republic of the Marshall Islands. 

The Honolulu RO administers the following benefits and services: 

disability compensation, vocational rehabilitation and employment 

assistance, the Home Loan Guarantee Program, specially adaptive 

housing grants, and Native American direct home loan programs, 

outreach for all veterans, and survivor benefits. 

Over 118,000 veterans live in the jurisdiction served by the dedicated employees of the Honolulu RO. Of these veterans, approximately 19,200 currently receive disability compensation benefits. 

The Honolulu RO has two dedicated Military Service Coordinators who perform many of the outreach functions provided to returning servicemembers. The MSCs conduct regular briefings covering the full range of VA benefits as part of the Military Transition Assistance Program, referred to as TAP, at various military installations. Servicemembers are informed of the array of VA benefits and services available, instructed how to properly complete VA 

application forms, and advised of the evidence needed to support 

their claims. Since the beginning of the fiscal year, the Honolulu 

RO has conducted 171 TAP briefings to approximately 5,100 servicemembers in Hawaii. Claims submitted by seriously injured veterans of the Operation Enduring Freedom or Operation Iraqi Freedom receive priority processing through case management. 

The Honolulu RO has a Veterans Service Representative that 

travels throughout Hawaii to provide monthly benefit counseling to 

veterans residing in Kona, Hilo, Maui, Kauai, with bimonthly services to veterans on Molokai and semi-annual services to veterans 

on Lanai. Veterans Service Representatives travel to provide benefit briefings, answer questions, and accept the benefit claims. Outreach to the insular islands is scheduled to occur on a quarterly 

basis. 

In fiscal year 2009, the Honolulu Loan Guarantee Division closed 

47 Native American direct loans totaling $8.3 million. The success 

of this program is attributed to the Loan Guarantee staff’s promotion of the NADL program through weekly outreach with the 

Department of Hawaiian Homelands. 

We have expanded our outreach programs for National Guard 

and Reserve components, our participation in the OEF/OIF community events, and other information dissemination activities to ensure that benefit briefings are conducted when local National 

Guard and Reserve units return from deployment. 

In September 2009, the MSCs and our other Honolulu RO employees will be participating in the Hawaii Beyond the Yellow RibVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00025 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
22 

bon Exposition at the convention center, where it is expected that 

over 3,000 soldiers and their families will attend. 

The Honolulu RO is also working with the Department of Defense to expand its role in their military pre-separation process. 

Specifically, we are working to place our MSCs on the grounds of 

the military treatment facility to expedite the delivery of consistent 

service to the wounded, ill, and injured servicemembers and veterans. Relocation of the MSCs will enable servicemembers and 

members of the National Guard and Reserve to file pre-separation 

claims, receive benefit briefings, and participate in personal interviews. 

Our vocational rehabilitation and education counselors have a 

presence in the Wounded Warrior battalions located at the Schofield Barracks and the Kaneohe Marine Corps Base. In fiscal year 

2009 our counselors completed 20 briefings and provided education 

and vocational counseling to approximately 1,200 servicemembers. 

Claims with a known discharge date between 60 and 180 days 

can also be processed as benefits delivery at discharge. The Honolulu RO is a BDD intake site and is responsible for taking and developing claims received from the eight military installations within its jurisdiction, to include Camp Smith, Fort Shafter, Hickham 

Air Force Base, Marine Corps Base, Pearl Harbor, San Island 

Coast Guard, Schofield Barracks, and Tripler Army Medical Center. Upon receipt of an application, the Honolulu RO coordinates 

with the Honolulu VA medical center to provide the separating 

servicemember with a VA examination. 

When the claim is fully developed, the claim is sent to the Rating 

Activity Site, located in Salt Lake City, UT. The Honolulu RO refers an average of 14 BDD claims per week to the RAS, which prepares rating decisions for all VA BDD intake claims for veterans 

separating in Honolulu. On an average, claims are completed by 

the RAS in less than 90 days. 

Claims received from servicemembers with a known discharge 

date of less than 60 days are categorized as quick-start claims. At 

the time of filing a quick-start claim, the servicemember is advised 

of the full array of VA benefits, to include disability compensation, 

health care, insurance, vocational rehabilitation, loan guarantees, 

specially adaptive housing, and education benefits. The Honolulu 

RO receives an average of ten quick-start claims per week. Upon 

receipt, medical examinations are ordered and the claim is sent to 

San Diego for expedited processing. The San Diego Regional Office 

has 100 employees dedicated specifically to processing quick-start 

claims. 

The Honolulu Regional Office works diligently to provide services 

to the veteran population residing here in the Pacific region. 

Mr. Chairman, this concludes my testimony. 

[The prepared statement of Ms. Betts follows:] 

PREPARED STATEMENT OF TRACEY BETTS, DIRECTOR, HONOLULU REGIONAL OFFICE, 

VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Chairman Akaka, it is my pleasure to be here today to discuss our efforts to meet 

the needs of Veterans residing in the Pacific Region. 

The Honolulu Regional Office (RO) is responsible for delivering non-medical VA 

benefits and services to Veterans and their families through the administration of 

23 

comprehensive and diverse benefit programs. Our goal is to deliver these benefits 

and services in a timely, accurate, and compassionate manner. 

Today I will specifically discuss important outreach and services provided to members of the National Guard and Reserves in Hawaii. 

HONOLULU REGIONAL OFFICE

The Honolulu RO serves the Veteran population in Hawaii and the Pacific Region, 

including Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI). The Honolulu RO is also responsible for outreach to Veterans 

residing in the Insular Islands of the Republic of Palau, Federated States of Micronesia, and Republic of the Marshall Islands. 

The Honolulu RO administers the following benefits and services: 

• Disability Compensation • Vocational Rehabilitation and Employment Assistance • Home Loan Guaranty, Specially Adapted Housing Grants, and Native American 

Direct Home Loans • Outreach for all Veteran and survivor benefits 

Over 118,000 Veterans live in the jurisdiction served by the dedicated employees 

of the Honolulu RO. Of these Veterans, approximately 19,200 receive disability compensation benefits. 

OUTREACH

The Honolulu RO actively participates in various outreach activities. The Honolulu RO has two dedicated Military Service Coordinators (MSCs) who perform many 

of the outreach functions provided to returning servicemembers. The MSCs conduct 

regular briefings covering the full range of VA benefits as part of the military Transition Assistance Program (TAP) at various military installations in Hawaii. TAP 

briefings aim to prepare retiring and separating military personnel for return to civilian life. At these briefings, servicemembers are informed of the array of VA benefits and services available, instructed how to properly complete VA application 

forms, and advised of the evidence needed to support their claims. Following the 

general instruction segment, personal interviews are conducted with those servicemembers who request assistance in preparing and submitting their applications for 

compensation and/or vocational rehabilitation and employment benefits. Since the 

beginning of the fiscal year, the Honolulu RO has conducted 171 TAP briefings to 

approximately 5,177 servicemembers in Hawaii. 

Claims submitted by seriously injured Veterans of Operation Enduring Freedom 

or Operation Iraqi Freedom (OEF/OIF) receive priority processing through case 

management. The Honolulu RO OEF/OIF coordinator works with military medical 

facilities and VA medical centers to ensure these servicemembers and their families 

receive expedited delivery of all benefits. 

In addition, the Honolulu RO has a Veterans Service Representative (VSR) travel 

throughout Hawaii to provide benefit counseling to Veterans. The VSR travels and 

provides monthly benefit services to Veterans residing on Kona and Hilo, Hawaii; 

and on Maui and Kauai. Quarterly service is also provided to the Veterans residing 

on Molokai, and semi-annual service is provided to Veterans residing on Lanai. 

The Honolulu RO is committed to providing benefit information and access to VA 

programs to Veterans and their dependents living on Guam and in the Insular Islands, to include the Federated States of Micronesia, the Republic of the Marshall 

Islands, and the Republic of Palau through their increased outreach presence. Veterans Service Representatives travel to these remote locations to provide benefits 

briefings, answer questions, and accept benefit claims. Outreach to the Insular Islands is scheduled to occur on a quarterly basis. The Honolulu RO also distributes 

informational materials, such as VA pamphlets and DVDs, to Veterans residing on 

the Insular Islands. A dedicated telephone line was established for Insular Island 

Veterans to contact the Honolulu RO to inquire about their individual claims and 

to request general VA benefit information. 

Homeless claims are case managed and processed expeditiously. The Honolulu RO 

has a Homeless Coordinator who actively works with the Veterans Health Administration Homeless Coordinators to provide services to homeless Veterans such as living placement, clothing, and food. The Homeless Coordinator participates in various 

outreach activities to include Homeless Stand Down events in Hilo on April 17, 

2009, and Kauai July 4, 2009. 

The Native American Direct Loan (NADL) Program, established in 1992 and 

made permanent by Public Law 109–233, provides financing for homes for Native 

American Veterans and Veterans with Native American spouses. In fiscal year 2009, 

the Honolulu Loan Guaranty (LGY) Division closed 47 Native American Direct 

24 

Loans totaling $8,375,639. The success of this program is attributed to the Honolulu 

Loan Guaranty staff that regularly promotes the NADL Program through weekly 

outreach with the Department of Hawaiian Homelands. Quarterly outreach for the 

NADL Program is provided to Veterans in American Samoa, Guam, and CNMI. 

Continual training with lenders and realtors in the community is conducted. 

The RO staff and I regularly participate in various ceremonies and conventions, 

such as the Joint POW/MIA Accounting Command Repatriation Ceremony held at 

Hickam Air Force Base; the annual Vietnam Veterans Memorial Day Ceremony at 

the National Memorial Cemetery of the Pacific, also known as the Punchbowl; the 

annual State Governor’s Memorial Day Ceremony at the Hawaii State Veterans 

Cemetery; and most recently, the Disabled American Veterans State Conference 

held in June on the island of Kauai. Additionally, employees participate in the graduation ceremonies of Post Traumatic Stress Disorder Residential Rehabilitation participants held quarterly at Tripler Army Medical Center. 

OUTREACH SERVICES FOR MEMBERS OF THE RESERVE AND NATIONAL GUARD

We have expanded our outreach programs for National Guard and Reserve components and our participation in OEF/OIF community events and other information 

dissemination activities. The MSC ensures that benefit briefings are conducted 

when local National Guard and Reserve units return from deployment. During these 

briefings, the MSC provides a comprehensive briefing on VA benefits and assists 

with appropriate applications. All attendees receive a copy of VA pamphlet, A Summary of VA Benefits, as well as the VA Health Care and Benefit Information for Veterans wallet card. In addition, the MSC works in concert with the National Guard 

Yellow Ribbon Program to provide information and services to members of the National Guard. In September 2009, the MSCs and other Honolulu RO employees will 

be participating in ‘‘Hawaii Beyond the Yellow Ribbon’’ exposition. Over 3,000 soldiers and their families are expected to attend. 

The Honolulu RO is also working with the Department of Defense to expand its 

role in their military pre-separation process. Specifically, we are working to place 

our MSCs on the grounds of the military treatment facility to expedite the delivery 

of consistent service to the wounded, ill, and injured servicemembers and Veterans. 

Relocation of the MSCs will enable servicemembers and members of the National 

Guard and Reserve to file pre-separation claims, receive benefit briefings, and participate in personal interviews. 

Our Vocational Rehabilitation and Employment (VR&E) employees work closely 

with military facilities in Hawaii to ensure that outreach is extended to as many 

returning servicemembers as possible. The VR&E counselors have a presence in the 

Wounded Warrior Battalions located at Schofield Barracks and Kaneohe Marine 

Corp Base. They provide monthly briefings to these soldiers in addition to providing 

them education and employment counseling. In fiscal year 2009, VR&E completed 

20 briefings and provided education and vocational counseling to approximately 

1,200 servicemembers. 

The VR&E Employment Coordinator from the Honolulu RO works with the Tripler Army Medical Center’s Deployment Health Center to assist returning Reservists and National Guard members. In addition to providing information about VA 

services, the Employment Coordinator refers recuperating soldiers to the local Disabled Veterans Outreach Program for employment briefings offered by the Department of Labor. The Honolulu RO also has a VR&E counselor located at the Maui 

Community Based Outpatient Clinic full time providing VR&E services to Maui Veterans. He currently works with approximately 100 Veterans on Maui and has met 

with 1,200 Veterans this fiscal year. 

With the ongoing activation of Reserve and National Guard members in support 

of the military operations in Iraq and Afghanistan, servicemembers are becoming 

eligible for VA home loan benefits in greater numbers. Reserve and National Guard 

members are eligible for the Loan Guaranty and Native American Direct Loan Programs after 90 days or more of active wartime service. In general, Veterans may 

qualify for VA-guaranteed and direct loans in amounts equal to the Freddie Mac 

conforming loan limit. As a result of the Veterans’ Benefits Improvement Act of 

2008, the amount in Oahu, a high-cost area, can be as high as $783,750, with no 

down-payment. 

The Honolulu Loan Guaranty Office administers VA Home Loan Workshops at 

Hickam Air Force Base to active duty servicemembers to include National Guard 

and Reservists. In fiscal year 2009, the Loan Guaranty staff completed five workshops, participated in various outreach activities such as the Mortgage Class/Financial Fair held at Fort Shafter, and participated in the Personal Financial Expo held 

at the Blaisdell Center earlier this month. 

25 

BENEFITS DELIVERY AT DISCHARGE AND QUICK START CLAIMS

Any servicemember may file a pre-discharge claim for disability compensation if 

that individual is within 180 days of release from active service. This includes members of both active duty and full-time reserve components and those undergoing 

medical evaluation board/physical evaluation board proceedings. 

Those claims with a known discharge date between 60–180 days can be processed 

as a Benefits Delivery at Discharge (BDD) claim. The Honolulu RO is a Benefits 

Delivery at Discharge (BDD) intake site and is responsible for taking and developing claims received from the eight military installations within its jurisdiction 

(Camp Smith, Fort Shafter, Hickam Air Force Base, Marine Corp Base Hawaii, 

Pearl Harbor, San Island Coast Guard, Schofield Barracks, and Tripler Army Medical Center). Upon receipt of an application, the Honolulu RO coordinates with the 

Honolulu VA Medical Center to provide the separating servicemember with a VA 

examination. When the claim is fully developed to include completion of the VA examination, the claim is sent to the rating activity site (RAS) located at the Salt 

Lake City RO. The Honolulu RO refers an average of 14 BDD claims per week to 

the RAS, which prepares rating decisions for all VA BDD claims for Veterans separating in Honolulu. On average, claims are completed by the RAS in less than 90 

days. 

Claims received from servicemembers with a known discharge date of less than 

60 days are categorized as Quick Start pre-discharge disability claims. At the time 

of filing a Quick Start claim, the servicemember is advised of the full array of VA 

benefits to include disability compensation, health care, insurance, vocational rehabilitation, loan guaranty, specially adapted housing, and education benefits. The 

Honolulu RO receives an average of 10 Quick Start claims per week. Upon receipt, 

claims are immediately placed under control, have medical examinations ordered, 

and are then sent to the San Diego RO for expedited processing. The San Diego RO 

has 100 employees dedicated to the processing of Quick Start claims. 

CONCLUSION

The Honolulu Regional Office works diligently to provide services to the Veteran 

population residing in the Pacific Region and ensure members of the National 

Guard and Reserve are knowledgeable of the array of benefits and services available 

to them through VA. 

Mr. Chairman, this concludes my testimony. I greatly appreciate being here today 

and look forward to answering your questions. 

Chairman AKAKA. Thank you very much, Ms. Betts. 

Now, Sheila Cullen, will you please proceed with your statement. 

STATEMENT OF SHEILA CULLEN, DIRECTOR, VETERANS INTEGRATED SERVICE NETWORK 21 (VISN 21); ACCOMPANIED BY 

JAMES HASTINGS, M.D., DIRECTOR, VA PACIFIC ISLANDS 

HEALTH CARE SYSTEM; AND ADAM W. DARKINS, M.D., CHIEF 

CONSULTANT FOR CARE COORDINATION, VETERANS 

HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS 

AFFAIRS 

Ms. CULLEN. Mr. Chairman, mahalo for the opportunity to appear before you today to discuss the Department of Veterans Affairs health care in Hawaii and the Pacific region. It is a privilege 

to be here on Oahu to speak and to answer questions about VA 

health care issues that are important to veterans residing in 

Hawaii. 

First, Mr. Chairman, I would like to thank you for your leadership and advocacy on behalf of veterans. Your vision and support 

have led to an unprecedented level of health care services for veterans, construction of state-of-the-art facilities here in Honolulu, 

and remarkable improvements in access to health care services for 

veterans residing on the Hawaiian neighbor islands, American 

Samoa and Guam. 

26 

My written testimony, which I ask be submitted for the record, 

describes the VA Sierra Pacific Health Care Network. It provides 

an overview of the VA Pacific Islands Health Care System and the 

VA facilities here on Oahu. It discusses national and local telehealth programs, and it highlights outreach and seamless transition activities between the VA Pacific Islands Health Care System 

and the State of Hawaii National Guard. 

In the few minutes I have now, I would like to tell you about 

some recent expansions of care and services on the islands and to 

describe our outreach efforts to members of the Reserves and National Guard. 

VA Pacific Islands Health Care System currently provides care 

in ten locations, with two more soon to be added. The two planned 

facilities include a new interim community-based outpatient clinic 

to serve Leeward Oahu veterans with an expected opening in fiscal 

year 2010, and a new outreach clinic in Saipan set to open this fall. 

An inpatient Post Traumatic Stress Disorder residential rehabilitation unit is in its interim location on the Tripler campus, pending 

construction and activation of a new VA-funded facility during fiscal year 2011. 

VA Pacific Islands Health Care System also received approval for a VA-funded project, just under $7 million, to build a joint VA/DOD 

ambulatory surgery facility on the grounds of Tripler. The project 

is nearing design completion and is scheduled for construction and 

activation in fiscal year 2011. 

VA Pacific Islands Health Care System is also constructing a 

new replacement community-based outpatient clinic in Guam that 

will offer expanded capacity. It will be located along the perimeter 

of the Guam Naval Hospital, and is expected to open in March 

2010. 

VA Pacific Islands Health Care System has served the needs of 

almost 3,400 total Operation Enduring Freedom/Operation Iraqi 

Freedom—or as we more often refer to them, OEF/OIF veterans— 

through July 2009, including 1,089 Hawaii National Guard members. Our experience to-date has shown that about one in four 

OEF/OIF veterans avail themselves of VA enrollment and health 

care. 

VA Pacific Islands Health Care System has a dynamic OEF/OIF 

program led by a program manager who, along with three staff, 

which includes two care managers and one Transition Patient Advocate, partner effectively with the Hawaii National Guard, the 

Army Reserve, and active duty military to serve the veterans’ 

health care needs related to these organizations. 

These program staff members coordinate care and services for 

OEF/OIF veterans and their families throughout the VA Pacific Islands Health Care System by ensuring that comprehensive, preventive, mental and physical health examinations are performed. They 

also provide outreach services to veterans who are not currently 

VA users and assist in the case management of severely injured 

veterans who require complex care. 

VA Pacific Islands Health Care System OEF/OIF staff members 

meet and communicate frequently with Hawaii National Guard 

leadership and exchange data and information about troop status, 

including force deployment and return. VA is presently anticipating 

27 

the health care needs from an estimated 1,158 returning members 

of the Guard this month. The program is also decentralizing its 

staff and locating them on a full- and part-time basis, as appropriate, to work on military bases on Oahu, including Fort Shafter, 

Kaneohe Marine Air Station, Schofield Barracks, and with the 

Hawaii National Guard at Kalaeloa. We expect that integrating VA 

staff with these military units will increase the visibility and level 

of service VA provides to individuals within these units and 

supports continued seamless transition activities between the organizations. 

In addition, VA program staff members regularly attend and participate in Guard post-deployment health assessment screenings 

and Yellow Ribbon events organized for servicemembers and their 

families. 

In summary, because of the support of this Committee and the 

Hawaiian Congressional delegation, VA is providing an unprecedented level of health care services to veterans residing in Hawaii 

and the Pacific region. VA Pacific Islands Health Care System still 

faces several challenges, including timely access to health care 

services, an aging veteran population, and the special needs of our 

newest veterans. VA Pacific Islands Health Care System will meet 

these challenges by working with DOD and community partners, 

activating an ambulatory surgical center, utilizing telehealth technologies, and opening new clinics, as necessary. I am proud of what 

VA has accomplished in Hawaii and the Pacific Islands region and 

look forward to future endeavors on behalf of veterans. 

Again, Mr. Chairman, mahalo for the opportunity to testify at 

this hearing, and my colleagues and I would be delighted to address any questions you may have for us. 

[The prepared statement of Ms. Cullen follows:] 

PREPARED STATEMENT OF MS. SHEILA CULLEN, DIRECTOR, VA SIERRA PACIFIC NETWORK (VISN 21), VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Mr. Chairman and Members of the Committee, mahalo for the opportunity to appear before you today to discuss VA health care in Hawaii and the Pacific region. 

It is a privilege to be on Oahu to speak and answer questions about VA health care 

issues that are important to Veterans residing in Hawaii. I am accompanied today 

by Dr. James Hastings, Director of the VA Pacific Islands Health Care System 

(VAPIHCS), and Dr. Adam Darkins, Chief Consultant, Care Coordination, Office of 

Patient Care Services, Veterans Health Administration. 

First, Mr. Chairman, I would like to thank you for your leadership and advocacy 

on behalf of our Nation’s Veterans. During your tenure as Ranking Member and 

Chairman of this Committee, you have consistently demonstrated your commitment 

to Veterans by introducing legislation designed to meet the needs of Veterans. As 

I will highlight later, your vision and support have led to an unprecedented level 

of health care services for Veterans, construction of state-of-the-art facilities here in 

Honolulu, and remarkable improvements in access to health care services for Veterans residing on the Hawaiian neighbor islands, American Samoa and Guam. In 

addition, we appreciate your interest in and support of the Department of Veterans 

Affairs (VA). 

Today, I will briefly review the operations of the VA Sierra Pacific Network that 

includes Hawaii and the Pacific region; provide an overview of VAPIHCS and the 

VA facilities here on Oahu; provide national and local information regarding telehealth programs; and highlight outreach and seamless transition activities between 

VAPIHCS and the State of Hawaii National Guard. 

28 

VA SIERRA PACIFIC NETWORK (VISN 21)

The VA Sierra Pacific Network (Veterans Integrated Service Network [VISN] 21) 

is one of 21 integrated health care networks in the Veterans Health Administration 

(VHA). The VA Sierra Pacific Network provides services to Veterans residing in Hawaii and the Pacific region (including the Philippines, Guam, American Samoa and 

Commonwealth of the Northern Marianas Islands), northern Nevada, and central/ 

northern California. There were an estimated 1.1 million Veterans living within the 

boundaries of the VA Sierra Pacific Network in Fiscal Year (FY) 2008. 

The VA Sierra Pacific Network includes six major health care systems based in 

Honolulu, HI; Palo Alto, CA; San Francisco, CA; Sacramento, CA; Fresno, CA; and 

Reno, NV, as well as an Independent Outpatient Clinic in Manila, PI. In FY 2008, 

the Network provided services to 213,000 out of 350,000 enrolled Veterans. There 

were about 3.2 million clinic visits and 25,800 inpatient discharges. The cumulative 

full-time employment equivalents (FTEE) level was 9,607, and the operating budget 

was about $2.1 billion. 

The VA Sierra Pacific Network is committed to ensuring the care Veterans receive 

is of the highest quality. All six health care systems within the Network have major 

academic affiliations. The Network hosts a significant number of Centers of Excellence in VHA and supports a large and broad research portfolio. It also has expansive and collaborative relationships with the Department of Defense (DOD). The VA 

Sierra Pacific Network has not only exceeded patient satisfaction goals (inpatient 

and outpatient), but its employee satisfaction scores are among the top five Networks for overall job satisfaction in VHA. As reflected in the most recent employee 

satisfaction survey, the Network had the highest scores in VHA in several categories 

including leadership, supervisory support, customer service, conflict resolution, 

praise, and rewards. 

Given the large and diverse geographic nature (i.e. rural or frontier lands and remote islands) of VISN 21, access to care is a priority. In FY 2010, the Network will 

activate nine new sites of care in the Pacific (Hawaii and the Northern Mariana Islands), California, and Nevada. Finally, VISN 21 is proud to operate one of four 

Polytrauma Rehabilitation Centers in VHA dedicated to addressing the clinical 

needs of the most severely injured Veterans. 

VA PACIFIC ISLANDS HEALTH CARE SYSTEM (VAPIHCS)

As noted above, VAPIHCS is one of six major health care systems in VISN 21. 

Dr. James Hastings is the director and a practicing cardiologist at VAPIHCS. 

VAPIHCS is unique in several important aspects: its vast catchment area covers 2.6 

million square-miles (including Hawaii, Guam, American Samoa and Commonwealth of the Northern Marianas); its remote island locations create access challenges; and it enjoys the cultural richness of the Pacific Islands with an ethnically 

diverse patient and staff population. In FY 2008, there were an estimated 118,000 

Veterans living in Hawaii, and at least 10,000 additional Veterans located beyond 

Hawaii in the VAPIHCS catchment area. 

VAPIHCS currently provides care in ten locations, with two more soon to be 

added. Our current facilities include an Ambulatory Care Center (ACC) and a Community Living Center (CLC) on the campus of the Tripler Army Medical Center 

(TAMC) in Honolulu; community-based outpatient clinics (CBOC) in Lihue (Kauai), 

Kahului (Maui), Kailua-Kona (Hawaii), Hilo (Hawaii), Hagatna (Guam) and Pago 

Pago (American Samoa); and outreach clinics on Molokai and Lanai. The two 

planned facilities include a new interim CBOC to serve Leeward Oahu Veterans (approved in FY 2008 with an expected opening in early FY 2010) and a new outreach 

clinic in Saipan set to open this fall. The inpatient Post Traumatic Stress Disorder 

(PTSD) residential rehabilitation unit is in its interim location on the campus of 

TAMC, pending construction and activation of a new VA-funded facility ($9.56 million), also at TAMC, during FY 2011. VAPIHCS also received approval for a VAfunded project ($6.95 million) to build a Joint VA/DOD Ambulatory Surgery facility 

on the grounds of TAMC. The project is nearing design completion and is scheduled 

for construction and activation in FY 2011. 

VAPIHCS is also constructing a new replacement CBOC in Guam that will offer 

expanded capacity. It will be located along the perimeter of the Guam Naval Hospital, and we expect it to open in March 2010. VHA operates a total of six Vet Centers in Honolulu, Lihue, Wailuku, Kailua-Kona, Hilo and Guam. These facilities provide counseling, psychosocial support, and outreach. A Vet Center staff member was 

also added in American Samoa during FY 2008. 

In FY 2008, VAPIHCS provided services to nearly 24,000 Veterans, an increase 

of over seven percent from FY 2007. Of these Veterans, 19,000 reside in Hawaii. 

There were 162,000 clinic stops in Hawaii during FY 2008. The cumulative FTEE 

29 

in FY 2008 for the health care system was 540 employees. The operating budget 

for VAPIHCS (i.e., General Purpose allocation from appropriated funds) increased 

from $128.0 million in FY 2007 to $142 million in FY 2008, an increase of 11 

percent. 

VAPIHCS provides or contracts for a comprehensive array of health care services. 

VAPIHCS directly provides primary care, including preventive services and health 

screenings, and mental health services at all locations. VAPIHCS does not operate 

its own acute medical-surgical hospital and as a result faces some challenges in providing specialty services. VAPIHCS has hired specialists in orthopedics, ophthalmology, nephrology, infectious disease and inpatient medicine (‘‘hospitalist’’), and is 

providing selected specialty care in Honolulu and to a lesser extent at CBOCs. 

VAPIHCS also added a neurologist in FY 2008 to improve the treatment of Traumatic Brain Injury (TBI). VAPIHCS is actively recruiting additional specialists and 

expects to have a newly hired cardiologist and endocrinologist this fall. Veterans 

with spinal cord injuries receive care from VAPIHCS dedicated staff, which provides 

a multidisciplinary approach to care. The team, located on Oahu, is planning to 

travel and care for patients on the neighbor islands during FY 2010. Veterans 

requiring other specialty care continue to be referred to DOD and community 

facilities. 

Inpatient long-term and acute rehabilitation care is available at the Community 

Living Center (CLC). Inpatient mental health services are provided by VA staff on 

a 20 bed ward within TAMC and at the 16 bed Post Traumatic Stress Disorder 

(PTSD) Residential Rehabilitation Program (PRRP). VAPIHCS contracts for care 

with DOD (at TAMC and Guam Naval Hospital) and community facilities for inpatient medical-surgical care. 

NATIONAL AND LOCAL TELEHEALTH PROGRAMS

National Telehealth Programs 

Telehealth involves the use of information and telecommunication technologies as 

a tool in providing health care services when the patient and practitioner are separated by geographical distance. The benefits of telehealth to health care systems include: improving access to care, making specialist services available in rural and remote locations, and supporting patients to live independently in their own homes 

and local communities. Because of the support of telehealth by VA and Congressional leadership, more Veterans are able to realize these benefits. 

Over the past 6 years telehealth in VA has transitioned from use in a range of 

discrete local projects and programs toward a unified, enterprise level approach that 

provides routine telehealth services that are mission critical to the delivery of care 

to Veterans. In 2009 over 230,000 Veteran patients received care via VA’s telehealth 

programs. Telehealth takes many forms. VA’s enterprise telehealth programs deliver 

care to Veteran patients in their homes via home telehealth; telehealth care is also 

provided in VA medical centers (VAMCs), CBOCs and Vet Centers via clinical 

videoconferencing. In addition, VA routinely exchanges clinical images via storeand-forwards telehealth. 

I would like to briefly highlight some of the direct benefits these services are providing to Veterans. Almost 40,000 Veterans are receiving home-telehealth-based 

care that supports care delivery to them in their own homes. These care coordination/home telehealth (CCHT) services have reduced hospital admissions by 25 percent, hospital stays by 25 percent, and have high levels of patient satisfaction (86 

percent mean score). In 2008 almost 50,000 Veterans received care via clinical 

videoconferencing (CCGT), the majority receiving mental health care services that 

reduced hospital admissions by 20 percent. In 2008 over 100,000 Veterans were 

screened to prevent avoidable blindness by VA’s teleretinal imaging programs 

(CCSF). 

The successful implementation of robust and sustainable telehealth services that 

VA entrusts to provide care to Veteran patients must satisfy stringent clinical, technological and business requirements that ensure they are appropriate, effective and 

cost-effective. These requirements include acceptance by patients and practitioners 

as well as staff training and quality management systems. Mr. Chairman, you and 

the Committee understand how the geography of Hawaii and the Pacific region 

poses particular challenges in implementing telehealth that are not encountered on 

the U.S. mainland. Services to Guam and American Samoa not only need to bridge 

a physical distance of 3,820 and 2,300 miles respectively, they also need to bridge 

between patients and clinical communities that are distant and distinct from one 

another. Bridging these distances and linking these communities to enable them to 

integrate requires telecommunications bandwidth. VA is currently seeking to embrace Hawaii and the Pacific region within its clinical enterprise video conferencing 

30 

network (CEVN) and in doing simplify the linkage to specialist services from medical center assets on the U.S. mainland. 

VA recognizes the pioneering role that Hawaii and the Pacific region have played 

in the development of telehealth solutions that range from teleretinal imaging to 

home telehealth. These innovations have included partnerships with DOD and the 

University of Hawaii within the collaborative framework of the Pacific Telehealth 

and Technology Hui (partnership, or ‘‘Hui.’’). VA appreciates the support of Congress 

in the establishment of VA’s Office of Rural Health with sufficient resources that 

enable us to focus on extending current enterprise telehealth solutions as well as 

developing new telehealth solutions to serve Veterans, not only those in Hawaii and 

the Pacific region Islands, but also Veterans elsewhere in the Nation for whom geographical distance from VA’s physical health care assets presents a challenge to receiving care. In considering future innovation for local and enterprise portfolios of 

telehealth services, VA is looking toward new iterations of a familiar technology— 

the telephone. Currently the telephone has meant that eight patients a month from 

Hawaii and the Pacific region have been able to access VA’s suicide hotline and receive support from Canandaigua, New York. The transition of health applications 

onto mobile technologies such as cell phones promises to further revolutionize how 

telehealth can serve Veterans in areas such as Hawaii and the Pacific region. 

Mr. Chairman, I used the word Hui earlier. As you know, Hui describes a partnership, a union or a gathering. All health care is ultimately local, and my discussion 

so far has focused on the clinical, technological and business issues of implementing 

telehealth across the VA health care system. My attention will now turn to local 

telehealth initiatives that support Hawaiian Veterans and those living on other Pacific Islands. 

Local Telehealth Programs 

In partnership with DOD, specifically TAMC, VAPIHCS began to develop this capability in 2001 with the support of Senator Daniel K. Inouye. The Pacific Telehealth and Technology Hui formed in 1999 allows joint development of telemedicine 

technologies for both organizations in the Pacific. This partnership (known as ‘‘the 

Hui’’) fielded many demonstration projects that have enabled both Departments to 

develop ongoing telehealth activity for our beneficiaries. 

For VAPIHCS, this partnership allowed us to begin developing telemedicine capabilities in collaboration with the local information technology (IT) department that 

developed the telecommunications network infrastructure and supported the deployment of video teleconferencing to VA CBOCs on the islands of Hawaii, Maui, Kauai, 

Guam, and American Samoa. Connectivity to Molokai and Lanai is also available, 

and we are presently studying connectivity for our newly approved Outreach Clinic 

in Saipan. Additionally, this initial investment allowed the development of procedures, practices, and protocols to support video teleconference clinical visits for primary care, mental health, and subspecialty care. Funds were provided for purchasing telemedicine ‘‘carts,’’ that allow the use of peripheral medical equipment 

(stethoscopes, otoscopes, cameras and other attachments), as well as teleretinal imaging equipment to permit screening for diabetic eye disease. Automated Drug Dispensing System (ADDS) machines were installed in CBOCs in 2003 allowing pharmacists in Honolulu to dispense medications and, through the use of video conferencing, to provide medication counseling to Veterans at the time of their clinic visits. The VAPIHCS also began tele-home care projects in 2003 by deploying home 

telemedicine units. This partnership and initial funding has helped us establish a 

foundation of experience upon which we continue to build to enhance the medical 

care provided in our facilities throughout the Pacific Region. Additionally, this early 

experience has allowed our facilities to compete for research dollars to further develop telemedicine and tele-mental health activities. 

The Hui also provided support for TAMC projects, including support for store and 

forward telemedicine for adult and pediatric care to the Western Pacific, cardiac 

sonography from TAMC to Guam and Japan, intensive care unit telemetry and consultation from TAMC to Guam Naval Hospital and Korea, speech therapy and other 

projects. 

Beyond the Hui, VAPIHCS and TAMC are working together to develop joint telemedicine capabilities in American Samoa to support co-location of TAMC personnel 

at a VA CBOC. This arrangement would extend clinical expertise from TAMC to 

American Samoa to serve Veterans and active duty servicemembers, as well as 

members of the National Guard and Reserve who have experienced a Traumatic 

Brain Injury (TBI). 

Recently, VA expanded mental health programs, including significant growth in 

tele-mental health activities. VA recruited a clinical psychologist to fill a new position for a dedicated tele-mental health coordinator based in Maui. This new position 

31 

expanded tele-psychology services equitably throughout the CBOC. Additionally, VA 

has begun conducting tele-mental health Compensation and Pension (C&P) examinations to expedite the assessment of Veterans for appropriate benefits. 

During fiscal year (FY) 2009, telehealth has been extremely helpful in delivering 

mental health services and dispensing medications to Veterans. A snapshot of relevant data, current through July 2009, includes: 

• Over 2,000 telehealth patient encounters in VAPIHCS, 1,300 of which were for 

mental health and 52 of which were for mental health C&P evaluations for patients 

in Guam or the Commonwealth of the Northern Mariana Islands; and 

• Over 9,000 prescriptions filled at CBOCs on Kauai, Maui, Hilo, Kona, American 

Samoa and Guam using ADDS machines. 

VAPIHCS has other Telehealth services that are available to Veterans, including: 

• Care Coordinated General Telehealth clinics (CCGT), which offer 

• Individual and group psychology and psychiatry support; 

• PTSD group research clinic; 

• Individual and family nutrition information; 

• Mental health C&P examinations; 

• Geriatric psychiatry; 

• General surgery and neurosurgery through the San Francisco VAMC; 

• Treatment for spinal cord injury through the Palo Alto VAMC; 

• Wound care; 

• Nephrology care; and 

• Participation in VA’s ‘MOVE!’ (weight loss) program; 

• Care Coordinated Store Forward clinics (CCSF): 

• Teledermatology through the San Francisco VAMC; and 

• Teleretinal Imaging; 

• Care Coordination Home Telehealth, utilizing home telehealth devices to 

support the care of Veteran patients in their own homes on Oahu, Maui and 

Hilo. 

Our expanding and diverse experience with telehealth has provided many ‘‘lessons 

learned’’ to further shape the development of our VAPIHCS Telehealth Program. 

For example, numbers (i.e. encounters) alone do not tell the complete story of how 

technologies may be used to improve the health care of Veterans. In addition to increasing access to specialty services for Veterans, VAPIHCS has found telehealth 

technologies also allow CBOC providers to learn from telemedicine experiences (with 

distant providers), which can improve the skills of local physicians. VAPIHCS continually evaluates the use of telehealth services that are provided to Veterans within our service area and changes the program as necessary to meet the needs of the 

Veterans we serve. There is a new opportunity to expand the use of telehealth as 

we develop new outreach clinics to meet the needs of Veterans in highly rural areas. 

This increased ‘‘hands-on’’ care allows us to pursue new telehealth opportunities 

in even more remote locations to benefit Veterans. We are providing more care in 

the home, using VA’s Care Coordination Home Telehealth (CCHT) protocols. This 

will provide us with patient data and information from the home that can be used 

to maximize our ability to manage medically complex patients in conjunction with 

our chronic disease team to improve the quality of life for Veterans. 

There are some local challenges with telehealth. We are adding additional staff, 

including telehealth nurses, to our sites so our clinics can both provide direct patient care and staff telehealth clinics as well. We anticipate that by this fall, we will 

have sufficient support for telehealth activities at each CBOC in the area. 

This table provides data about telehealth usage in the following facilities: 

Number of Unique Patients by Site (VA Pacific Islands Health Care System) 

Facility FY 2006 FY 2007 FY 2008 FY 2009 (YTD) 

Honolulu ............................................................... 298 253 186 230 

Maui ..................................................................... 53 65 60 

(includes 

Molokai 5) 

272 

(includes 

Molokai 17) 

Kauai .................................................................... 70 71 73 100 

Hilo ....................................................................... 128 59 65 96 

Guam ................................................................... 0 18 40 117 

Kona ..................................................................... 6 1 14 33 

32 

Number of Unique Patients by Site (VA Pacific Islands Health Care System)—Continued 

Facility FY 2006 FY 2007 FY 2008 FY 2009 (YTD) 

Am Samoa ........................................................... 0 0 0 7 

TOTAL ................................................. 555 467 438 855 

The total numbers of VA’s patients using telehealth decreased in FY 2007 when 

VA received permission to begin sending patients to TAMC, rather than using telemedicine to support patient transfers to California. Some of this change can also be 

explained in part by additional staff hires, particularly in mental health, at some 

of these facilities. We anticipate a growth in telehealth in FY 2010 as dedicated telehealth nurses are added to our facilities this fall. 

OAHU FACILITIES

VA operates the Spark M. Matsunaga VA Medical Center in Oahu, located on the 

campus of TAMC at 459 Patterson Road, Honolulu, HI, 96815. The VAMC consists 

of the Ambulatory Care Center (ACC), a 60-bed Community Living Center (CLC) 

and administrative space (located in the E Wing of TAMC). Additionally VA operates both a 20-bed acute psychiatry inpatient unit and a 16-bed PRRP within 

TAMC. A Veterans Benefits Administration (VBA) Regional Office is co-located with 

VHA on this campus. The Honolulu Vet Center is located nearby at 1680 Kapiolani 

Boulevard in Honolulu. 

VA estimates the Veteran island population for Oahu in FY 2008 was 73,000. In 

FY 2008, 27,000 Veterans on Oahu were enrolled for care, and of these 14,070 received VA care (‘‘users’’). The market penetrations for enrollees and users are 37 

percent and 19 percent, respectively and compare favorably with rates within VISN 

21 and VHA. 

The average FTEE level on Oahu in FY 2008 is 468. With this staff, VAPIHCS 

provides a wide range of outpatient services, including primary care, several medical 

subspecialties (e.g., cardiology, gastroenterology, geriatrics, nephrology, orthopedics, 

pulmonary and women’s health), mental health, and dental care. In addition, 

VAPIHCS provides diagnostic services such as laboratory, echocardiography and radiology. If Veterans require services not available at the ACC or CLC, VAPIHCS 

arranges and pays for care at TAMC, local community providers, or VA facilities in 

California; for those referred to a facility in California, VA can cover the costs of 

transportation if the veteran is eligible for beneficiary travel. 

In FY 2008, VA facilities in Oahu recorded about 162,000 clinic stops. In the face 

of increasing demand for primary care services in Honolulu, VAPIHCS unexpectedly 

lost the services of two primary care physicians, resulting in a large number of Veterans being placed on our wait list. To address this need, we have identified potential replacements for our primary care provider vacancies and established several 

new primary care positions, including a physician solely dedicated to women’s 

health care and another for spinal cord injuries. We believe these steps will eliminate our primary care appointment wait list by October 1, 2009. In FY 2008, the 

combined average daily census (ADC) in the mental health ward was 11 and was 

53 at the CLC. VAPIHCS spent about $15 million for clinical services for Veterans 

at TAMC and another $30 million for non-VA care in the community. 

VA RESOURCES AVAILABLE TO THE HAWAII NATIONAL GUARD

VAPIHCS has served the needs of almost 3,400 total Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans through July 2009, including 

1,089 Hawaii National Guard members, 800 of whom reside on Oahu, with the rest 

residing throughout the Hawaiian neighbor islands. Experience to date has shown 

that about one in four OEF/OIF Veterans avail themselves of VA enrollment and 

health care. 

VAPIHCS has a dynamic OEF/OIF Program led by a Program Manager who, 

along with three staff including two Care Managers and one Transition Patient Advocate, partner effectively with the Hawaii National Guard, the Army Reserve, and 

active duty military to serve the Veterans’ health care needs related to these organizations. 

These program staff members coordinate care and services for OEF/OIF Veterans 

and their families throughout the VAPIHCS. Specifically, they ensure comprehensive preventive mental and physical health evaluations are performed, provide outreach services to Veterans who are not currently VA users, and assist in the case 

33 

management of severely injured Veterans who require complex care. VA program 

staff also work collaboratively with Army Wounded Warrior staff to coordinate care 

and services for these individuals. 

VAPIHCS OEF/OIF staff members meet and communicate frequently with Hawaii 

National Guard leadership and exchange data and information about troop status, 

including force deployment and return. VA is presently anticipating the health care 

needs from an estimated 1,158 returning members of the Guard during August 

2009. 

The program is also decentralizing its staff during this period of time, locating 

them on a full and part time basis as appropriate to work on military bases on 

Oahu including Ft. Shafter, Kaneohe Marine Air Station, Schofield Barracks, and 

with the Hawaii National Guard at Kalaeloa. We expect that integrating VA staff 

with these military units will increase the visibility and level of service VA provides 

to individuals within these units and supports continued seamless transition activities between the organizations. 

In addition, VA program staff members regularly attend and participate in Guard 

Post Deployment Health Assessment Screenings and Yellow Ribbon Events, organized for servicemembers and their families. 

As mentioned previously, VAPIHCS has the resources to provide members of the 

Hawaii National Guard quality primary and mental health care, and specialized 

medical care. The PRRP, TBI and SCI team capability further enhances the services 

available to all Veterans. 

CONCLUSION

In summary, with the support of the Senate Committee on Veterans’ Affairs and 

the Hawaiian Congressional delegation, VA is providing an unprecedented level of 

health care services to Veterans residing in Hawaii and the Pacific region. VA has 

state-of-the-art facilities and enhanced services in Honolulu, as well as robust staffing on the neighbor islands along with expanded or renovated clinics in many locations. VA continues to enhance its staff with added mental health providers and 

specialists to meet Veterans’ needs. These services are also available to Veterans 

who are Hawaii National Guard members 

VAPIHCS still faces several challenges including timely access to health care 

services (in part due to the topography of its catchment area and lack of an acute 

medical-surgical hospital), an aging Veteran population, and the special needs of our 

newest Veterans. VAPIHCS will meet these challenges by working with DOD and 

community partners, activating an ambulatory surgery center, utilizing telehealth 

technologies, and opening new clinics as necessary. I am proud of what VA has accomplished in Hawaii and the Pacific Islands region and look forward to our future 

endeavors on behalf of Veterans. 

Again, Mr. Chairman, mahalo for the opportunity to testify at this hearing. My 

colleagues and I would be delighted to address any questions you may have for us. 

Chairman AKAKA. Thank you very much, Ms. Cullen, for your 

testimony. 

And now, I will call on General Ishikawa for his statement. 

STATEMENT OF BRIGADIER GENERAL GARY M. ISHIKAWA, 

DEPUTY ADJUTANT GENERAL, STATE OF HAWAII 

General ISHIKAWA. Chairman Akaka, mahalo and aloha. 

Chairman AKAKA. Aloha. 

General ISHIKAWA. I appreciate this opportunity to testify. I am 

Brigadier General Gary Ishikawa, the Deputy Adjutant General for 

the State of Hawaii. I bring you greetings from Major General Bob 

Lee, of course. 

You should have my written testimony submitted earlier, so as 

such, I would just like to summarize and share with you an observation and an event that I just experienced, both of which I believe 

are relevant. 

Before I get into that, I would also like to enter into the record— 

I have here the testimony of Mark Moses, who is the Director of 

the State Office of Veterans Services. They are a very important 

partner with all the agencies in the outreach, as we have counVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00037 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
34 

selors in every county, including periodic visits to Molokai and 

Lanai. So, I think his testimony—I ask that it be entered into the 

record. 

Chairman AKAKA. Thank you very much. It will be included in 

the record, without objection. 

[The prepared statement of Mr. Moses is in the Appendix.] 

General ISHIKAWA. Mahalo. The first and most important are the 

services to our veterans, especially on the neighbor islands and our 

Pacific Island veterans from Tinian, Rota, and Saipan. I know that 

on August 14, Secretary Shinseki announced that 28 additional Vet 

Centers will be established next year. This is in addition to the existing 232 community-based centers across the 50 States. I further 

note that two of the additional centers will be in Western Oahu. 

I think they mean Leeward Coast and American Samoa. After listening to Secretary Shinseki during his most recent visit, I am extremely optimistic that we will be seeing marked improvements in 

care to our veterans. 

It is also a great pleasure of mine to share with a former fellow 

Deputy Director, the Secretary Ray Jefferson. And I welcome him 

back to Hawaii. 

The key, I feel, to a lot of these good things that are going on 

in what I call remote locations is collaboration and partnerships. 

All too often, we get into our silos. We are the State, so we only 

work with State. We are the Federal, so we only work with Federal. If we are going to really address the problem of remote locations for service to our veterans, then we really need to get together and sit down and have a good discussion how Federal, 

State, county, and even non-government organizations can somehow partner. We have got a lot of smart lawyers. I am certain that 

we can get there if that is what we are determined to do. 

Then an event I would like to share with you, Senator. Early this 

month—actually, I left on August 11—I had the opportunity to welcome back to the U.S. Hawaii’s own 29th Brigade Combat Team, 

including Lieutenant Tamayo. During my briefing about the demobilization, or what we call Reverse SRP, or Reverse Soldier Readiness Program, I was pleasantly surprised—and this is in Fort 

Hood, Texas—to learn that two new stations had been added to the 

demobilization. I am not sure this is occurring nationwide, but it 

did occur in Fort Hood. They were dental and hearing. 

When I asked the doctors there why they were doing this, they 

were very clear to me how difficult it was for Reserve soldiers in 

remote locations to get those type of services. I was really happy 

to hear that kind of thinking in the demobilization station. When 

I inquired how they defined remote locations, however, they answered, places like Saipan, Tinian, Rota, and American Samoa. 

While this is a giant step to addressing care to our veterans in remote locations, this type of thinking has to be extended, and we 

will figure out how to do this within the Department of Defense to 

all remote locations, because as we know, soldiers from locations 

like Molokai and Keaau on Hawaii Island fits what I would define 

as remote locations. 

So, I am pleased that the conversation has started. We will continue to push that conversation to all remote locations, even within 

the continental United States. I think this is very important. You 

35 

have to get to where the veterans are. It has to be grass roots. And 

I like these two things, hopefully as indicators that things are moving in the right direction. 

Senator, thank you again for your attention, and I will be available for questions after. 

[The prepared statement of General Ishikawa follows:] 

PREPARED STATEMENT OF BRIGADIER GENERAL GARY M. ISHIKAWA, DEPUTY

ADJUTANT GENERAL, STATE OF HAWAII

Chairman Akaka and members of the Senate Committee on Veterans’ Affairs, I 

am Brigadier General Gary Ishikawa, the Deputy Adjutant General for the State 

of Hawaii. 

Within the State Department of Defense, there are four major divisions: the Hawaii Army and Air National Guard, State Civil Defense, and the Office of Veterans’ 

Services. Mr. Mark Moses, a retired Marine and former state legislator, is our Director of the Office of Veterans’ Services. 

The Office of Veterans’ Services is responsible for the welfare of our veterans and 

their families. They also act as an intermediary between our veterans and the Department of Veterans’ Affairs. 

Hawaii veterans make up more than ten percent of our total population. The majority of them—about 72%—live on the island of Oahu. About 13% live on the island 

of Hawaii, 10% are on one of the three islands that comprise Maui County, and 5% 

live on the island of Kauai. However, our veteran population continues to grow as 

Hawaii continues to support our Nation’s war on terrorism. Since September 11, 

2001, call to active duty have involved nine out of every ten Hawaii Army National 

Guard and Army Reserve soldiers. They have served honorably in Iraq Afghanistan, 

and other locations; and have returned to Hawaii after their 12–15 month 

deployments. 

Members of the Hawaii Air National Guard have supported and continues to support Operations Iraqi Freedom and Enduring Freedom. 

It is important that these veterans return to their communities in good health. 

The Office of Veterans’ Services partners with the Veterans’ Administration here 

during the soldier’s demobilization process. This partnership works to ensure that 

no veteran or no benefit is forgotten. 

The United States government has an obligation to our military members from 

enlistment, through their years of service, and to veterans’ benefits. We must ensure 

that all veterans receive all entitled benefits now and tin the years to come. 

The National Guard Bureau recently authorized the Army and Air National 

Guard to release medical records to the Department of Veterans’ Affairs without the 

veteran’s signature. This new procedure speeds the Department of Veterans’ Affairs 

adjudication of veterans’ claims and provides medical care to National Guard 

members. 

I come to you with two concerns. First and most important is Veterans’ Affair 

services to all our veterans, especially on the neighbor islands and our Pacific Islander veterans form Tinian, Rota, and Saipan. In July 2007, a VA clinic opened 

in American Samoa that supports our veterans there. However, veterans from other 

Pacific islands must pay the high cost of airline and hotel accommodations to receive 

follow-on medical treatment. In Hawaii, a similar situation occurs when a neighbor 

island veteran must come to Tripler Army Medical Center/Matsunaga VA Hospital 

in Honolulu for treatment. We must find a solution to this situation. One thought 

would be to establish a partnership between the Department of Veterans’ Affairs 

and existing medical/health care facilities on the neighbor islands to provide medical 

treatment for our veterans. 

Second concern is the staffing at VA hospitals. For example, the Post Deployment 

Health Reassessment Program (PDHRA) requires an initial appointment with 30 

days for VA registration. 

On average, the VA hospital schedules initial appointments as much as 90 to 120 

days from the registration date. Our local VA hospital staff has been doing their 

best to provide services to all of our veterans. They have stretched their limited 

health care provider resources to support their mission requirements to all veterans 

in the Pacific Basin. 

In closing, I want to thank the Committee for their continuing support of our veterans. Thank you for coming to Hawaii to conduct these hearings. Are there any 

questions? 

Chairman AKAKA. Thank you very much, General Ishikawa. 

36 

Now, we will receive the statement of our friend, the Honorable 

Raymond Jefferson. 

STATEMENT OF RAYMOND JEFFERSON, ASSISTANT SECRETARY, VETERANS’ EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR 

Mr. JEFFERSON. Aloha. 

Chairman AKAKA. Aloha. 

Mr. JEFFERSON. Chairman Akaka, brethren, distinguished members in the room today who serve the veterans community, it is an 

honor and a pleasure to be back home. Let me just share a few 

thoughts. 

I am a veteran. I was injured in October 1995 with Special 

Forces, lost my hand in the line of duty. I was medevaced here to 

Tripler, Hawaii, and through the support of Hawaii, of the Department of Veterans Affairs, the Vocational Rehabilitation Program, 

all of those partnerships allowed me to get my life back, to move 

forward, and to ultimately today have the privilege of serving our 

veterans through the Department of Labor’s Veterans’ Employment 

and Training Service. 

Senator, we have the mission of helping veterans and transitioning servicemembers have the best possible services and resources 

to succeed in the 21st century workforce. We have five aspirations 

that we are aiming toward achieving that. 

The first is serving as a national focal point for veterans employment and training. That will involve increasing awareness, access, 

and participation in all of our programs, and improving the employment outcomes for those participants. 

Second, convening, collaborating, and communicating with all of 

our stakeholders so that we can work seamlessly together. 

And third, from that first aspiration is ensuring that we serve all 

of those populations with special needs, especially homeless veterans, women veterans, veterans in rural areas, and veterans who 

have been ill or injured. During this week here in Hawaii, we are 

also, Senator, going to be reaching out to Maui and the Big Island 

and spending time with the veteran populations there. 

We also want to further engage with the private sector, make 

sure they are involved with our programs and processes because 

they have the jobs. We want to work with them, and we are going 

to meet with private sector leaders tomorrow here on Oahu and on 

Thursday and Friday with private sector leaders on the Big Island 

and Maui. 

We also want to boost USERRA’s impact and the commitment to 

USERRA. We are very pleased that right now Hawaii has a very 

low rate of USERRA incidents—only four in 2007 and four in 2008. 

We also want to help transitioning servicemembers to transition 

seamlessly into meaningful employment and careers, and to have 

a particular emphasis on what we call green jobs and jobs of the 

future. 

And finally, we want to invest in our people. I believe that the 

rising tide lifts all boats. We want to help each of our team members achieve his or her potential and also improve their ability to 

better serve our veterans. 

Thank you, Senator, and we look forward to your questions. 

37 

[The prepared statement of Mr. Jefferson follows:] 

PREPARED STATEMENT OF HON. RAYMOND M. JEFFERSON, ASSISTANT SECRETARY, 

VETERANS’ EMPLOYMENT AND TRAINING, U.S. DEPARTMENT OF LABOR

Chairman Akaka, Ranking Member Burr and distinguished Members of the Committee: Aloha! Thank you for inviting us to appear before you today to discuss the 

employment assistance and outreach services provided to the National Guard and 

Reserve in Hawaii. 

The mission of the Veterans’ Employment and Training Service (VETS) is to provide Veterans and transitioning Service Members with the resources and services 

to succeed in the workforce by maximizing their employment opportunities, protecting their employment rights, and meeting labor market demands with qualified 

veterans. 

We accomplish our mission through three distinct functions: (1) conducting employment and training programs; (2) enforcing relevant Federal laws and regulations; and (3) providing transition assistance services. 

VETS administers two programs through formula grants to States that directly 

meet the goals of its mission: (1) the Disabled Veteran Outreach Program (DVOP) 

and (2) the Local Veterans Employment Representatives (LVER) program. DVOP 

specialists provide outreach services, and intensive employment assistance to meet 

the employment needs of eligible veterans. LVER staff conduct outreach to employers and engage in advocacy efforts with hiring executives to increase employment 

opportunities for veterans, encourage the hiring of disabled veterans, and generally 

assist veterans to gain and retain employment. To meet the needs of homeless veterans and help reintegrate them into the workforce, VETS administers the Homeless Veterans’ Reintegration Program. Veterans with significant barriers to employment or service-connected disabilities are also served through the Veterans’ Workforce Investment Program, a focused and innovative training program that coordinates services available through other VETS administered programs. Both the 

homeless and workforce investment veterans programs are funded through a competitive grant process. 

Our enforcement programs investigate complaints filed by Veterans and other 

protected individuals under the Uniformed Services Employment and Reemployment Rights Act (USERRA), assess complaints alleging violation of statutes requiring Veterans’ Preference in Federal hiring, and implement and collect information 

regarding Veteran employment by Federal contractors. 

VETS’ transition assistance services are offered through the Transition Assistance 

Program (TAP), which provides employment workshops and direct services for separating military members, including those who are seriously wounded and injured. 

TRANSITION ASSISTANCE PROGRAM

TAP is a Department of Defense (DOD) program that partners with the Department of Labor (DOL), the Department of Veterans Affairs (VA), and the Department 

of Homeland Security (DHS). TAP has four components: 

1. Pre-separation counseling—this is mandatory for all transitioning Service Members and is provided by the military services; 

2. TAP employment workshops—these are voluntary on the part of the 

transitioning Service Member and are administered through DOL and its state partners; 

3. VA benefits briefing—these briefings are also voluntary and administered by 

the VA; and 

4. Disabled Transition Assistance Program—also voluntary and administered by 

the VA. 

DOL EMPLOYMENT WORKSHOPS

Since 1991, when DOL began providing employment workshops pursuant to section 502 of the National Defense Authorization Act for Fiscal Year 1991 (P.L. 101– 

510), over one million separating and retiring military members and their spouses 

have been provided employment and job training assistance and other transitional 

services. DOL was further directed to provide these services at overseas locations 

by section 309 of the Veterans Benefits Act of 2003 (P.L. 108–183). 

VETS began facilitating TAP workshops at overseas military installations where, 

by previous interagency agreement, the DOD had provided TAP workshops since the 

program’s inception. We are currently conducting TAP employment workshops at 55 

sites overseas including Germany, Japan, Italy, Korea, Guam and the United KingVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
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dom. Our mission is to provide TAP at every location requested by the Armed Services or National Guard and Reserve Component. 

VETS provides employment search workshops based on projections made by each 

of the Armed Services and the DHS (for the U.S. Coast Guard). DVOPs and LVERs 

are the primary source for TAP Employment Workshop facilitation stateside. However, because of the distance between many state employment offices and the military installations, as well as the rapid increase in Workshop participants, contract 

facilitators were added in early FY 1992 and supplemented by Federal staff in FY 

1996. Hawaii currently uses contract facilitators. 

The Department of Defense recently set a goal for TAP Employment Workshop 

participation of 85 percent of separating servicemembers. Eighty-one percent of active-duty transitioning Service Members currently attend the DOL TAP employment 

workshops, a 30% increase in participation since 2001. TAP employment workshop 

participation is expected to increase over the next year, and we plan to target workshop delivery to spouses and family members of separating servicemembers, including those with limited English proficiency. . 

In an effort to provide the same high level of instruction to all servicemembers 

and spouses attending TAP Employment Workshops, VETS requires that all TAP 

facilitators receive training conducted by the National Veterans Training Institute 

(NVTI) at the University of Colorado in Denver. NVTI provides competency based 

training to further develop and enhance the professional skills of veterans’ employment and training service providers throughout the United States. 

The current course curriculum covers two and one-half days of classroom instruction and provides information on a variety of topics including: 

• Career exploration; 

• Resume preparation; 

• Strategies for an effective job search; 

• Interview techniques; 

• Reviewing job offers; 

• Prevention of homelessness; 

• Entrepreneurship information; and 

• Other available support and assistance. 

RESERVE COMPONENT AND NATIONAL GUARD EMPLOYMENT WORKSHOP

Global military commitments have necessitated a mobilization of Guard and Reserve members that is unprecedented in modern times. The longer mobilization periods result in these Service Members now being eligible for Veterans’ benefits, including TAP. The employment workshop is available for Guard or Reserve Members, 

along with all other Service Members, at one of the 215 transition offices located 

on military installations in the United States as well as overseas locations. 

However, Reserve and National Guard members usually transition at fewer locations, referred to as demobilization sites. Typically the demobilization process is 

rapid, taking a matter of days once the Service Members arrive back in the United 

States from overseas. During demobilization, Service Members may be expected to 

participate in many separate briefings and activities. This leaves little or no time 

for a full two and one-half day employment workshop. Nevertheless, we have found 

that many National Guard and Reserve Service Members would benefit from such 

transition assistance. Our State Directors have coordinated with each State Adjutant General and they work directly with the individual Reserve and National 

Guard commanders to make special arrangements following demobilization in order 

to present a modified TAP employment workshop to Guard and Reserve Service 

Members. Based on requests from Reserve Component Commanders or Adjutant 

Generals and through coordination with our VETS’ state directors and local VA 

staff, VETS has offered to tailor the workshops to the identified needs of the transitioning Reserve and National Guard members. 

In fact, since 2001 VETS has provided transition services to over 146,000 National 

Guard and Reservists. These transition services range in size and content from mobilization and demobilization briefings to the full scale TAP employment workshops. 

They are provided in 43 states and the District of Columbia. In some states, National Guardsmen and Reservists have been allowed to attend the regular TAP for 

Active Component Service Members. The services provided to the National Guard 

and Reserve are tailored to the needs and requests by the DOD. 

To meet the transition needs of the National Guard and Reserves, in FY 2007, 

DOL directed the NVTI to develop a modular version of the TAP employment workshop. The traditional TAP employment workshop was turned into a 15-module menu 

that Reserve and National Guard commanders may choose from in providing these 

services to their unit members. This training includes a mandatory module that covVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00042 Fmt 6633 Sfmt 6621 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
39 

ers local labor market information, USERRA, the One-Stop Career Center system, 

small business opportunities, and the risks of homelessness. The other 14 modules 

consist of the current TAP employment workshop curriculum broken down into logical and connected blocks of instruction. This is not a new or separate curriculum 

for the Reserves and National Guard; rather it has been packaged to better serve 

this community. 

PROGRAMS IN HAWAII

I have provided information on what is being done to assist those Service Members transitioning from the military to civilian life. I would now like to focus on 

what we are doing in the state of Hawaii. 

Hawaii averages more than 100 TAP workshops annually with nearly 4,000 

transitioning Service Members in attendance. There are five TAP sites, all on the 

island of Oahu, Honolulu County, encompassing all military service branches including the U.S. Coast Guard. 

A DVOP or LVER representative attends each workshop session to discuss their 

respective roles and responsibilities in providing job search assistance. Since most 

transitioning Service Members return to the mainland, this information is provided 

to help the Service Member contact the DVOP and LVER representative in their 

respective states to assist them directly with their re-integration into the local job 

market in their areas. 

Our VETS Director in Hawaii meets quarterly with all TAP site managers, a VA 

representative, and a representative from the State of Hawaii National Guard to 

discuss the TAP program and how it can be improved. Guest speakers have included 

the garrison commander at Schofield Barracks and the U.S. Attorney for Hawaii.

National Guard and Reserve personnel in Hawaii are informed that they can attend TAP for up to 180 days after completion of their active duty commitment. 

LVER and DVOP staff assigned to the counties of Honolulu, Maui, Kauai, and Hawaii have all been formally trained and can facilitate TAP employment workshops 

either individually or on a unit basis. 

Periodic USERRA briefings are conducted upon request and through outreach by 

VETS staff. State of Hawaii Army and Air National Guard units as well as Army 

Reserve have received briefings and USERRA outreach within the last six months. 

National Guard units on the neighboring islands of Hawaii (Big Island) and Maui 

have received briefings within the last 45 days. Briefings will be conducted in conjunction with the Operation Yellow Ribbon Reintegration Program for the return of 

the State of Hawaii Army National Guard’s 29th Brigade. These welcome home activities are planned for Oahu on September 20, 2009, followed by September 26, 

2009, in the counties of Hawaii and Kona, and October 3 and 4, 2009, for Maui and 

Kauai counties. 

CLOSING

In closing, I again thank you for allowing me to address you today on this very 

important issue. I would be pleased to respond to any questions you may have. 

Mahalo. 

Chairman AKAKA. Thank you very much, Ray. We are so happy 

to have you here. 

I have a question for all the members of the panel. How do you 

currently communicate at the local level with one another about 

how to meet the needs of returning servicemembers? Let me first 

call on Tracey Betts for her response. 

Ms. BETTS. Here in Honolulu, we meet—myself and Dr. Hastings, as well as other folks—on a regular basis or even sometimes 

on a case-by-case basis, but we meet to discuss issues. A lot of 

times, the discussion starts with what can we do or what can we 

improve upon. 

I meet with the folks in the community. We have our service organizations who are in the facility with us. We meet with them 

regularly. Basically, it is a revolving door, and as a need comes up, 

we address it, and on a regular basis. 

40 

We have a lot of what I would consider—we do a lot of collaboration. We meet with not only the medical side, we have the benefit 

side. We also work with the Vet Centers. 

One of the issues, of course, that is coming up here in this hearing today is outreach. We have created a coordinator in the VBA 

side who is starting to network and to develop communication with 

everyone out there in the community, to let us know when we are 

needed for outreach and where are we needed, and then we schedule. And what we do is we communicate internally with everyone 

to participate and to ensure that the presence of the VA is there 

during the session or event in which we attend. 

Chairman AKAKA. Is there a regular schedule for meetings on 

Lanai and other Neighbor Islands? 

Ms. BETTS. When dealing with outreach, currently, the State of 

Hawaii has representatives who are out there every month. Mark 

Moses’s group goes out and meets with veterans and does counseling. When I came out, the VA benefits, they were meeting twice 

a year, and we are looking at increasing that time element. On the 

medical side, they do—can I defer to Dr. Hastings? 

Chairman AKAKA. Yes, you may. Let me say that we are accompanied here by Dr. Hastings, as well, and we are glad to hear from 

you, Dr. Hastings. 

Dr. HASTINGS. Thank you, Senator. Again, I want to thank you 

very much for all the support you have given us and our veterans 

here over a many-year period of time. 

We have, I think, a very sophisticated informal communication 

system between the groups that support veterans here on Oahu 

and in the Pacific Islands. We are fortunate in being all co-located 

on the Tripler campus. Very importantly, we have developed many 

lines of communication between VA, VHA, and Tripler, and they 

provide us inpatient services and outpatient services. But we also 

are involved with any servicemen who are coming back who are 

going to go into the Warrior Transition Unit. As you heard, we now 

have representatives from our organization located in the Warrior 

Transition Unit, both at Schofield Barracks and at Kaneohe. So we 

have developed a very good communication system. 

Also very importantly, as Tracey mentioned, we work collaboratively, and Tracey is essentially a member of our staff and we are 

a member of her staff. That is the way it works. So she can work 

with me, but she also can work with other members of my staff if 

the issue is something that they are more conversant with. Also 

they can work with Mark Moses. He is right downstairs, and we 

also have open communication with him. 

We also are very fortunate in that the Veterans Service Organizations are also housed in our complex, so they have open communication with us, as well. 

So, I think we are doing very, very nicely. We have regular meetings together and we have a Veterans Advisory Council, and both 

Mark and Tracey sit on our Veterans Advisory Council. So we have 

a lot of open communication with them. 

Now, you asked specifically a question about the sort of meeting 

that you witnessed yesterday in Lanai. I have to tell you that we 

have not had an open forum meeting like that with them in some 

time. But it is clear as I listened to that meeting yesterday that 

41 

this is something we are going to have to start doing, and we do 

have plans to do regular town halls, open town halls on the other 

islands and we will include Lanai in that plan. So, we will open 

up communications with the veterans. That is where we sort of 

stand today. 

Chairman AKAKA. Thank you very much, Dr. Hastings. 

The other member I wanted to pose this to is Sheila Cullen. Do 

you have anything to add? 

Ms. CULLEN. Thank you, Senator. Just a few. There is not much 

to add to what you have already heard from Dr. Hastings and from 

Tracey Betts. 

I would reemphasize the enormous benefit of having VHA, VBA, 

and DOD co-located here in Honolulu. That affords them the opportunity not only to have formal meetings to discuss common issues, 

but to readily have informal sessions, as well. 

Dr. Hastings and Tracey Betts have resolved together that when 

the opportunity presents itself in the future, they will be looking 

to locate some component of VBA along with any expansions that 

we might have for any of our community-based outpatient clinics. 

I would also add that some of the outreach efforts that you have 

heard about are joint outreach efforts, and I had seen that firsthand last Friday at the convention center for the 50th commemoration of Statehood. One of the booths was an outreach effort manned 

by VHA and VBA staff and they worked together very, very well 

answering the questions that came from some people in the military as well as some civilians and were jointly able to pass out information about eligibility and to refer some questions each to the 

other whenever one might have more specialized knowledge. 

It is not just at that outreach effort, but at the many other Yellow Ribbon and Welcome Home events that we have joint participation from the VA to assure a common understanding of what the 

issues are that we face. 

Chairman AKAKA. Thank you very much, Sheila. 

Let me ask General Ishikawa to respond to that question. General Ishikawa? 

General ISHIKAWA. If I understand the question correctly, it is 

how we communicate with our veterans. Actually, we have a family 

support group and we have a full-timer. Any information that we 

need to move to the spouses or the family members, really, we pass 

it through them. 

Just because I was curious with a personal reason, I joined the 

Family Support Group for Bravo Troop First of the 299th. There 

was a commander, his name was Captain with the same last name 

as mine, Ishikawa, so I saw it from two sides. The witness that 

said we should try to maintain that Family Support Group Network, I think they have it spot-on. 

We put information on the top and I caught it coming back at 

me. There are a lot of volunteers out there, and a constant e-mail 

traffic flow. That is a very strong method of communications with 

the grassroots that I would like to say that we relied upon a lot. 

One of the things that was real clear to me, and that is why we 

are really pushing hard for what we call the Yellow Ribbon Reintegration, while it is not mandatory, it is a 30-, 60-, 90-day program where, again, we will talk to not so much the veterans themVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00045 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
42 

selves but the families. Because they demobilized in Fort Hood, 

Texas, the families were not with them. It is actually the families, 

the spouses and the grandpas, like that, they are the ones that are 

really curious. They are the ones that pick up all that information. 

Talking to the soldiers themselves, basically, no matter how much 

we tell them to pay attention, they just want to get back to L&L 

and have a plate lunch. [Laughter.] 

So, we found that getting to the families and using the Family 

Support Network is probably going to be the key to the future for 

us, anyway, for especially our veterans in remote locations. 

Thank you, sir, for the opportunity to respond. 

Chairman AKAKA. Thank you very much for that. Since our 

troops have been returning as of last week, this becomes very, very 

important. I do understand that when they do come home, they 

want to just rest and do what they want to do and not worry about 

whether they are having any problems at this time. You are correct 

that the family is the one that can really help them at this point. 

But we still need to develop these relationships between the different units of the National Guard and Reserves as well as the VA 

for services. 

Let me ask Ray for any comments he may have in this particular 

area. I know we just confirmed you a few weeks ago in your position and that you have been working hard to set up services for our 

veterans across the Nation. 

Mr. JEFFERSON. Yes, Senator. Well, thank you. So in terms of coordination at the local level, let me touch on a few of the areas 

there. I want to thank my friend here and colleague, General 

Ishikawa, from our time in service, because in the Transition Assistance Program, we meet quarterly with the Department of Defense representative, the Veterans Affairs representative, and also 

with the State of Hawaii National Guard representative, and so 

that is a very effective collaboration at the transition assistance 

and program level for that resource and service. 

Also, our State Director, who is here today—Tom Rosenswike— 

is co-located at the Department of Labor Industrial Relations on 

Punchbowl. We are very grateful for the support we get from 

DLIR—the Director and the Deputy Director there. So we have a 

very close relationship and that co-location is very helpful in that. 

We also partner, Senator, with the Department of Veterans Affairs in our Homeless Veterans Reintegration Program. I would 

like to talk more about that later, if it would be helpful, and also 

about the Vocational Rehabilitation Program. 

We additionally have a REAL Lifelines program, and we actually 

have a Disabled Veteran Outreach Program Specialist located right 

at Tripler Army Medical Center. That individual works with the 

veteran when he or she is on active duty and helps them develop 

a plan for their life and to have a seamless transition as they move 

from active duty to their status as a veteran, whether they remain 

in Hawaii or whether they were to go on to the mainland. 

Finally, our State director participates in a variety of forums and 

councils, such as the Oahu Veterans Council, and is very involved 

with the VSOs here. I am very thankful for the support that the 

Department of Labor’s Veterans Employment and Training Service 

43 

gets from the VSOs. I just want to particularly acknowledge the 

American Legion and the Navy League. 

So, there is a tremendous amount of cooperation and communication that takes place and that assures we provide the most effective 

service possible to veterans and transitioning servicemembers. At 

the same time, I am down here to look at how things can be further improved. 

Chairman AKAKA. Thank you very much for that, Ray. I would 

like for you to expound on what you just suggested, but let me ask 

this question to General Ishikawa. I am concerned that the efforts 

of commands to identify and help those who may be suffering from 

psychological trauma may not be entirely focused. The approach 

seems to be one of providing information to a large gathering rather than working to identify those in need so as to reach them in 

a more appropriate setting, which could be down to one-to-one. I 

would add that sometimes these sweeping approaches can hurt 

overall morale while still not reaching those in need. A unit’s 

tempo and elements of the military culture create a wall that is 

hard for servicemembers to breach. 

What can be done to create an open and private environment in 

which servicemembers will be able to ask for help? 

General ISHIKAWA. That is a very double-sided, double-edged 

question, because we work in a macho environment where we have 

to be strong. I think we have done a lot of work with education for 

our soldiers. I do see some breakthroughs. The last mission which 

the brigade just came back from, basically, two of the units, the 

100th and the First of the 299th, had convoy duty into Iraq. It was 

normal policy when any of the units encountered an IED or something like that, they would automatically send the whole group to 

a resident mental health specialist. 

I think those types of positive things which the 29th Brigade did, 

will play well into the future. So what happened was that it doesn’t 

become stigmatized. You had an IED. Your whole team goes there. 

It is to help you. If you catch it right after the incident occurs and 

follow it through—because we know who they are now—it should 

be easier to keep it from being stigmatized and easier for us to find 

it. 

Now, I think it starts right there on the battlefield. If we can 

start it there for all units, I think it will pay big dividends. I think 

it is going to be time before we can shift the cultural mindset, but 

we have just got to keep up our education programs. It is OK. It 

doesn’t show weakness. We can help you. 

I don’t have a magic bullet, Senator. These are just some ideas 

and techniques I think that possibly could lead down the road to 

the ultimate solution. Thank you. 

Chairman AKAKA. Thank you very much. What the General is referring to, as he said, you can talk to families, but when it comes 

to the troops, they are looking at when they are going to eat—— 

[Laughter.] 

Chairman AKAKA [continuing]. Which is true. I am glad to hear 

that—and you are correct. It starts where it happened, on the field. 

That will certainly make a difference to the troops. 

Ms. Betts and Ms. Cullen, access to health care and other benefits and services are ongoing challenges for veterans in Hawaii and 

44 

Guam. I am especially concerned that when our National Guard 

members turn to VA, that the appropriate services will not be easily accessible when needed. What advances have been made to reduce the burden on veterans as they seek VA health care and benefits in areas served by the Pacific Islands Health Care System and 

the Honolulu Regional Office? Ms. Betts? 

Ms. BETTS. Yes, Senator. In developing and improving access, 

one of the road maps that we developed—one is to increase our 

presence and attend more outreach, as well as to utilize the structure. Right now, as we had alluded to earlier or discussed earlier, 

was the placement of a benefit person where the medical assistance 

is in all of the CBOCs. The medical facilities are growing and they 

are relocating to have easier access to the veterans, and with that 

we have worked out, or they have committed to us to allow for 

space because that is always an issue—we can put people out 

there. Finding the space that they will occupy is a challenge, so, 

we have been looking toward that. 

The challenge for us is obviously the geography of the jurisdiction that we have, such as places in Guam, Tinian, Rota, American 

Samoa, and particularly here in the islands. All of the outer islands, we have those kind of challenges. 

The discussion came up yesterday of when do you—what are the 

requirements to have a full-time person sitting there in a chair 8 

hours a day? The reality of it is, when there is a need, when the 

veterans are present, and so the outreach approach is to try to get 

them to identify themselves and tell us where they are. Once we 

know where they are we can then provide those services and reach 

out to them, whether it is through periodic visits and/or if we need 

to be there on a more permanent basis. 

So, what we are doing right now is looking—we are working on 

a very collaborative effort in understanding where these veterans 

are, what their needs are, and how we can together provide full, 

comprehensive services for them both on the benefits as well as the 

medical side. 

As far as getting information out there, of course, everybody assumes that now that we are online, it is easier for people to apply 

for their benefits. The part that is missing is that veterans, or what 

we call the end users, don’t all have computers or access to them; 

so we are trying to look at that part of it—the technology side of 

how can we better improve access for them. Although we have the 

methodology, we need to look at the actual veterans, see where 

they are at and see how can we help them. Ideally, the non-government entities or the service organizations or other veterans and 

volunteer folks can help us to determine how can we get those people access to the structure that we placed out there. 

Chairman AKAKA. Thank you. 

Ms. Cullen? 

Ms. CULLEN. Thank you, Senator Akaka. What we have done, is 

made improvements in bringing health care to the veterans in remote areas such as American Samoa and Guam. In late 2007, we 

opened a new CBOC on American Samoa and that has been very 

well received by veterans. I don’t have the numbers in front of me 

of how many veterans we have seen there, but the numbers have 

45 

increased very dramatically from the numbers who had been seen 

when we had a part-time presence on the island. 

In Guam, we will be replacing the current CBOC with an expanded clinic and it will be located on the perimeter of the Naval 

Hospital in Guam, which we think will be an improvement for veterans. Right now, they need to go through the security process at 

the Naval Hospital in order to access the clinic, which is within the 

hospital there. So, in March of next year we will have an expansion 

of services in Guam. 

We have both primary care and mental health services available 

at both clinics. As Tracey Betts referenced, we are looking to accommodate benefits counselors in both locations, as well. With 

those great distances and the challenge it presents, we are hoping 

to expand our utilization of telehealth and tele-mental health services. We look forward to providing you with a demonstration of how 

we utilize that technical capability later on this week at the hearing on Friday. 

Chairman AKAKA. Thank you for that. 

Let me just ask Dr. Darkins whether he has any comments to 

make. 

Dr. DARKINS. Thank you, Mr. Chairman. Telehealth uses information communication technologies to make health care accessible. 

Certainly, the distances involved and the services required in Hawaii and the Pacific Islands lend themselves very much to the use 

of telehealth. The Pacific Islands Health Care System has been an 

innovator and a leader in developing telehealth in partnership with 

the military, and also with links across to the mainland. 

I think that the services here are really poised to take advantage 

of many new things in the future. The real challenge, I think, is 

to go from what are called point-to-point connections to develop a 

network of care; and to do that, there are various issues that need 

to be addressed. 

First, there are telecommunications issues to be able to ensure 

there is that connectivity. 

Second, it is necessary to have the culture. We heard earlier 

about the importance of relationships. Despite using technology, it 

doesn’t work unless it fosters those kind of relationships. So, visiting some of the clinics, which I have had the opportunity to do 

this week, shows just some of the ways in which that needs to take 

place. 

I certainly commend what is being done here and look forward 

to seeing the further growth of telemedicine as a way to deliver the 

kind of services which we are hearing are required. 

Chairman AKAKA. Thank you, Dr. Darkins. 

This name has been mentioned here, and I want to take the time 

to mention that Mark Moses is here. He is with the Office of Veterans Services, Department of Defense, for the State of Hawaii, 

and he is available to veterans for veterans services. He is another 

one that veterans can call on for help. 

Ray, I am delighted that you could be here on what must be one 

of your first engagements since becoming Assistant Secretary for 

Veterans’ Employment and Training at the Department of Labor. 

Mr. JEFFERSON. My first one. 

[Laughter.] 

46 

Chairman AKAKA. Very good. As a disabled veteran who has utilized VA services and who is now in a position to make positive 

contributions for those who have worn this Nation’s uniform, can 

you please share some areas in which you believe that transition 

services can be improved, as well as some things that DOD, VA, 

and Labor are doing right, and expand on what you had suggested 

you would do. 

Mr. JEFFERSON. Thank you. Senator, let me first just share 

maybe a picture of the journey of how the Department of Labor’s 

Veterans Employment and Training Service can help servicemembers and veterans. 

When the active-duty servicemember, to include National Guard 

and Reserve who were mobilized and now are being demobilized, 

when they are transitioning out, we have the Transition Assistance 

Program, which is conducted in collaboration with the Department 

of Defense, Department of Veterans Affairs, and the Department of 

Homeland Security. So, we provide a 21⁄2-day employment workshop through that Transition Assistance Program. So, that is the 

first service and resource that we can provide to servicemembers. 

Second, when they return, either when they have been mobilized 

and they are being demobilized, if they come back and realize that 

their job or employment has been given away as a result of that 

deployment, we have the USERRA program that helps guarantee 

their rights and we go ahead and work to ensure that those rights 

are maintained. And if there is a situation of employment discrimination, we investigate that and work to resolve that. So that is the 

second area and service that we can provide for servicemembers 

and veterans. 

Third, once a servicemember has transitioned to being a veteran, 

we have what we call our Disabled Veterans Outreach Program 

Specialists, or DVOPS. It is a long phrase, but a very important 

role. We also have our LVERS, Local Veterans Employment Representative Services. Here is the bottom line: these people work 

with veterans one-on-one to get them jobs. Our Disabled Veteran 

Outreach Program Specialists—we have one here on Oahu, one on 

the Big Island, and one on Maui—I will be meeting with them this 

week to get their insights on how things can be further improved. 

We also have four local Veterans Employment Representatives: 

three on Oahu, one on Kauai, and one of them on Oahu is co-located at Tripler to help the seriously disabled and injured veterans 

there. 

There are two more areas in which we can help veterans. One, 

we have a Homeless Veterans Reintegration Program. We have on 

this island a rural location that I visited yesterday, Kalaeloa; and 

we have an urban location where I will be this afternoon called 

Network Enterprises. Rene ́ Berthiaume is here today and I am 

very appreciative of his support, and we are looking forward to 

spending time together. We are getting very good feedback on the 

impact these programs are having to help homeless veterans get 

back on their feet and to get jobs. 

And finally, for those servicemembers who are seriously, seriously injured, we have a REAL Lifelines program where we help 

them develop a life map to move from being injured in the military 

to going through whatever retraining is necessary to create a 

47 

meaningful life and career. There are things which are working 

well. There are also things that can be improved, and if you would 

like me to comment on those, I would be very willing and eager to 

do so. 

Chairman AKAKA. Thank you very much, Ray, for that. It is good 

for Hawaii to know what you are doing here. Thank you. 

Mr. JEFFERSON. Thank you, Senator. 

Chairman AKAKA. Ms. Betts, your testimony touches on the Hawaii Beyond the Yellow Ribbon Exposition that the Military Services Coordinators and other Honolulu Regional Office employees 

will participate in during September. Can you expand on the information that will be provided at this exposition and detail any other 

efforts that are underway to inform Guard members of benefits and 

services for which they are eligible? 

Ms. BETTS. The function itself—what will happen is the Department of Veterans Affairs will have a booth there with representation from all of the components, and those components are from the 

medical staff, from the benefits staff, as well as the Vet Center 

staff. The expectation is that all information that we have for them 

will be available and will be provided at that time. We will have 

brochures for all the different benefit programs. We will have representatives from the different benefit programs, such as a loan 

guarantee representative, the voc rehab representative, as well as 

the compensation-pension program. What we plan to do is be there 

to answer questions, to take inquiries, and if necessary, to take 

claims. 

As far as what else we are doing out there: we have been involved with the Yellow Ribbon Program that the Guard and the Reserves have. As I had indicated earlier, we have an Outreach Program Coordinator, and their job is to get into the network of the 

needs of both veterans—those in the Guard as well as in the Reserve, and even in the active service, anyone out there who needs 

to know about benefits—about VA and what we have to offer. We 

have been trying to get the word out there, contact that individual 

and let them know and it will be on our schedule. 

Right now we participate in the Guard’s 30-, 60-, 90-day reintegration program. We have counselors who go in for every one 

of those. Of course, we have the normal TAP briefings, but right 

now, it is if you call, we will come. So, we have been trying to get 

out there to get the word out and to find out what information is 

needed and how to better improve our presence as well as access 

they have to benefits. 

Chairman AKAKA. Thank you very much, Ms. Betts. 

General Ishikawa and Ms. Betts, one issue that we hear of time 

and time again from VA and servicemembers is the difficulty VA 

has in gathering Guard and Reserve records. This is regarding 

records for the claims process. Obviously, this impedes the timeliness of receiving compensation. 

My question is, what can be done to improve this particular process? General Ishikawa, followed by Ms. Betts. 

General ISHIKAWA. I think right now, and even in the really difficult times that we are having in the State of Hawaii economically, 

Mark Moses and his folks are on the tip of the spear. They meet 

with the veterans out there, especially more so in our remote locaVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00051 Fmt 6633 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
48 

tions, and they actually help them fill out the forms. And Mark can 

probably talk a lot more about this, but I think when I talk about 

partnerships and collaborations, I think all the agencies need to get 

together—the VA clinics, the Vet Centers, and all of that—because 

we are servicing the same folks in these remote locations. 

So, I cannot see why we cannot take the meetings and communications we do here on that one campus to the neighbor islands 

where we have the services. I challenge Director Moses to start collaborating with the various agencies out there. I think if we start 

pushing that more and more, we will see a lot better input, and I 

think that is the key. A lot of times we see the records—applications—go in and they get returned, missing this, missing that, and 

that is where Mark and his great team steps in. They actually 

sit down with the veterans and help them fill out the forms. I think 

more work on collaboration and partnerships is the ultimate 

answer. 

Ms. BETTS. One thing I can say is here in Hawaii, we do not 

have the same or similar issues that you see in other stations, and 

that is access to the records. I do know that what we have started 

to do is we have started the conversation with the Guard in how 

to get better access or how to better secure this information. 

One of the things we found out in this conversation was that 

they do centralize their records here in Hawaii, which makes it a 

little bit easier for us. So, what we have done is one of my staff 

has entered into conversation with the records manager and discussed access to points of contact. So, we have set up a structure 

and we have managed—as he said, the collaboration of the agencies and finding the right people and continuing the conversation 

has improved the process, but it also is not as—this issue here is 

not as prevalent as it is other places because of this. And I think 

it will definitely improve just because we have started that conversation. 

Chairman AKAKA. Thank you very much, Ms. Betts. 

I want to ask Ray—— 

General ISHIKAWA. Senator, if I could, my apologies—— 

Chairman AKAKA. Oh, sorry. General Ishikawa? 

General ISHIKAWA. In my written testimony, and I apologize for 

not mentioning this, the National Guard Bureau recently authorized the Army and the Air National Guard to release medical 

records to the Department of Veterans Affairs without the veterans’ signature. So if that is the medical records we need, then we 

have that authority to do that now. 

Chairman AKAKA. Thank you, General. 

Ray, you understand the unique needs of Hawaii and Hawaii’s 

veterans. You did mention what you are doing now. I just want to 

give you an opportunity to expound on any other programs that 

you may have to provide to veterans as they return home to the 

islands, given Hawaii’s unique geographical challenges that we 

have. 

Mr. JEFFERSON. Sure. Well, Senator, let me first begin by thanking Lieutenant Tamayo for your comments and Sergeant First 

Class Tuimalealiifano, my fellow Special Forces man, because one 

of the things that was very important for me—and we discussed 

this at my confirmation hearing—is to get out of Washington, get 

49 

out into the field, out of the urban areas and into the rural areas 

to see what is really happening with the veterans. 

So, Senator, there are some things working very well. There is 

tremendous interagency cooperation among the Federal agencies 

and the State agencies. Everyone cares deeply and is tremendously 

committed. The TAP Council, where we meet four times a year, has 

a significant impact to improve that program for the participants. 

The Homeless Veterans Reintegration Program brings a lot of best 

practices to help homeless veterans make that journey to employment and to deal with the issues that can prevent employment, 

such as substance abuse and addiction. 

But there is additional room for improvement. I don’t have all 

the answers, and so one of the reasons I am here and one of the 

things we are going to do this week is to get out to the different 

islands to talk to the veterans and to talk to the Veterans Service 

Organizations to find out specifically what their needs are and how 

they would like to see the programs improved. 

But let me share two thoughts. First, we have the responsibility 

to provide coverage to all veterans throughout Asia Pacific—Guam, 

Saipan, Tinian, Palau, Federated States of Micronesia. We presently don’t have any Disabled Veterans Outreach Program Specialists or local veterans employment representatives in those areas. 

So, that is something I need to look at, to find how we provide adequate coverage for them. 

Senator, I also want to share briefly with you a story and ask 

for help from you and from the other members who are in the room 

today. Yesterday, I had the chance to go out to Kalaeloa. We have 

a Homeless Veterans Reintegration Program out there called U.S. 

Vets. They are doing fantastic work. They have about 98 veterans 

out there right now. I met with the veterans alone, without any 

staff around, and was really impressed by the tremendous feedback 

they had on how successful they felt the program was. It was helping them deal with addiction, break those cycles of dependency, 

helping them to create meaningful lives for themselves, and to find 

employment. 

But here is the challenge I learned about. There is a one-mile 

distance from where the site is located to the nearest city and 

county public transportation, and evidently the ridership level is 

not a significant amount to change that. I believe that if nonprofit, 

private sector leaders work creatively in Hawaii, we might be able 

to help those 45 to 50 veterans who are out there to find some kind 

of shuttle service to span that one-mile distance. 

I was really surprised to learn that this has been a challenge ongoing for about 5 years. Now, I know that we can send these men 

and women thousands of miles away to put themselves in danger 

for the benefit of our Nation. I believe that, collectively and creatively, we can find a way to span a distance of one mile and get 

them a shuttle so these 50 veterans who found jobs can actually 

get to their jobs. 

So, I am here asking for help. Tom, raise your hand, please. This 

is my State Director. If anyone has ideas, if anyone would like to 

be part of the solution, there are 50 veterans who found jobs and 

can’t get to them. More importantly, something that really annoyed 

me, Senator, some of these veterans have actually been attacked 

50 

and assaulted going or coming on that one-mile walk. So, I think 

that is something that we can do a much better job at and it is just 

one of those things that if I stayed in my office in Washington, DC, 

I wouldn’t have known about. But I have full confidence that with 

the aloha spirit here, we can find a solution to help those veterans. 

Thank you. 

Chairman AKAKA. Thank you very much, Ray. 

I want to thank the second panel. But before I close this hearing, 

I want to invite those on the panel to make any final comments 

about today’s hearing topic or what they have on their hearts. I 

will begin from that side of the room, since the microphone is 

there, and ask each of you to make any final statements you may 

want to make. 

Mr. JEFFERSON. Senator, I was reflecting this morning on a quote 

by a tremendous leader, an inspirational figure, Eleanor Roosevelt, 

and she said that the future belongs to those who believe in the 

beauty of their dreams. And when our servicemembers come back, 

each of them has unique dreams, unique aspirations, unique needs. 

I just believe that by working together, we can do everything we 

can to help Lieutenant Tamayo and Sergeant First Class Tuimalealiifano make sure that they achieve their dreams and their aspirations. And thank you for your service. 

[Applause.] 

Chairman AKAKA. General? 

General ISHIKAWA. In closing, I want to quote what I consider to 

be a great patriot—General Eric Shinseki—when he talked about 

the G.I. Bill—which I thank you so much for passing. He said, 

‘‘Lightning is about to strike twice.’’ I firmly believe that when I 

go and talk to our soldiers, our airmen, our Marines, I see the next 

great generation. So, thank you for all the work you do and thank 

you to all the veterans in the audience. 

Chairman AKAKA. Yes? 

Dr. DARKINS. Could I make a quick comment, which is also to 

quote General Shinseki. He mentioned a few days ago his belief in 

telehealth and telemedicine as part of the solution to the challenges. With his support and with the support of Congress, I see 

it as one of the solutions and look forward to a future in which we 

will provide solutions to the challenges we have heard today. 

Chairman AKAKA. Ms. Cullen? 

Ms. CULLEN. Thank you, Mr. Chairman. I would say that we in 

the VA appreciate your longstanding support for veterans and we 

count on your future support for veterans. We also thank you for 

coming out here and having this panel where you hold us personally accountable for taking care of the needs of, as Abraham Lincoln said, he who has borne the battle. So thank you for that and 

thank you for coming here with Secretary Shinseki last week to 

also hold us accountable. 

Chairman AKAKA. Thank you. 

Dr. Hastings? 

Dr. HASTINGS. Thank you, Mr. Chairman. It is very important, 

I think, for the VA to recognize the low-density populations that 

they have responsibility for, that we have responsibility for, in the 

islands and the Pacific. We have low density, so we don’t have the 

big numbers, and this is home. As we heard today, all of us want 

51 

to be taken care of as near home as we can; and certainly when 

we are stressed and have significant challenges in life, we want to 

be near our homes. That is where we can get the best cures, and 

we have ample evidence that that is the case. 

At the VA, we have heard now that the VA is changing its focus 

and putting resources into care in low-density, rural and very rural 

areas, so I think the VA is taking on a new role in its obligation 

to care for veterans, and that is the world that we live in. You saw 

some of it yesterday on Lanai. I can tell you that I have been to 

Tinian, I have sat with a veterans group in Tinian and talked to 

them about their frustrations with health care, and I have talked 

to the veterans in Saipan, and on our next trip, we are going to 

Rota, where the concentration is even smaller. 

But, I think these are veterans who have been underserved by 

the VA and I think I am very proud to be in an organization that 

is recognizing this obligation and building in a direction using all 

of the modern technology and all the modern science that we know. 

We have learned to deliver care to veterans who earned the care 

in their home. Thank you. 

Chairman AKAKA. Ms. Betts? 

Ms. BETTS. Yes, Senator. I would like to make a general statement on my behalf that I am committed with the position that I 

have here, to ensure that the employees that work under me start 

to look and take advantage of what we refer to as opportunities, 

and each opportunity that occurs every day is when a veteran 

walks into our door. The way I would like to see it develop over 

time is that they recognize it as an opportunity when a veteran 

comes to us—an opportunity to help to improve their life—to just 

experience and discuss or be a part of that moment in time that 

we are part of for them. 

What we are working on, as I know you had discussed with me 

when I first met you, what you had told me was you would like 

to see the VA have a motto, and I said, yes, sir, I will work on that 

motto, and I am still working on it. But I do know that one thing 

that comes to mind, and that is that every employee who works at 

the VA when a veteran walks in the door or when the veteran calls 

on the phone, is the first thing they should think about is what we 

can do, and that might be my motto if I work on it hard enough. 

But it is something that we need to get back to realizing—that 

the reason we are here is for the veteran—and we need to remember what we can do when they walk in that door and ask for our 

assistance and expect the services that they do. Because a lot of it 

has to do—in our outreach program right now, my goal and objective is to help change the perspective of the individuals we visit, 

meaning their perspective of what the VA is. 

As I heard the three witnesses earlier, their perspective of the 

VA out there as a servicemember—as a veteran, whether it is a 

Vietnam veteran, World War II, or even the latest OEF/OIF veteran—is not very good. It is not a very good picture that they paint 

of us. But I am sure that we can improve on it. Just as they said, 

the communications, developing those relationships, and here in 

Hawaii, being Hawaiian, I believe it is a place where it can start. 

The ohana is definitely a part of the daily relationships and the 

52 

building of those relationships to bring more grayness to those 

lines of the bureaucracy and the services that we provide. 

I want you to know that the commitment is here to help to improve and to develop that thought process of what we as VA employees can do for those veterans that we service, and I thank you 

very much for the time. 

Chairman AKAKA. Well, thank you. I think you have said much 

in closing. 

I want to thank all of our witnesses for being here, for your responses. No question, it is going to be helpful to what we are trying 

to do. We know there is much to be done in order to improve the 

effectiveness of VA’s outreach to servicemembers returning from 

overseas. Members of the Guard and Reserve that we are focusing 

on today face unique challenges. It is necessary that VA recognize 

and overcome those obstacles so that these veterans receive the 

highest quality of care. This is our challenge today. 

So, I want to thank all of you again for being here today. This 

hearing is adjourned. 

[Whereupon, at 1 p.m., the Committee was adjourned.] 

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A P P E N D I X 


5306401.eps
(55) 

STATE OF VA SERVICES ON MAUI, HAWAII 

THURSDAY, JANUARY 7, 2010 

U.S. SENATE, COMMITTEE ON VETERANS’ AFFAIRS, Maui, HI. 

The Committee met, pursuant to notice, at 2 p.m., in the Maui 

Arts and Cultural Center, Maui, Hawaii, Hon. Daniel K. Akaka, 

Chairman of the Committee, presiding. 

Present: Senator Akaka. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA, CHAIRMAN, 

U.S. SENATOR FROM HAWAII 

Chairman AKAKA. Well, I want to say again mahalo to Danny for 

leading the pledge and Mitch for offering the prayer, and now it is 

pono. We are ready to go. 

Let me tell you that we as a Committee have held similar hearings on Maui before, as you know. Much has improved in recent 

years, for which I am grateful, but it is important for us to understand the present challenges. I think you know what our country 

is going through at this time and we must be ready to come up 

with the kind of help that our country needs. Both the clinic and 

Vet Center on Maui are tremendously busy and must be available 

to those Maui veterans who rely on VA for their care and to veterans living on Lanai and Molokai as well. 

I applaud the efforts of the VA employees in Hawaii. These men 

and women work hard to help the veterans who seek their assistance, and there are many things that VA does well in Hawaii, as 

you know. Hawaii has done, I think, pretty well, but we need to 

continue to do better. There is always room for improvement. Indeed, our unique geography, diversity, and our kind of way of life 

require that VA develop a unique strategy to care for our island’s 

veterans and to care for it through our cultural activities as well. 

Ensuring timely access to mental health services for veterans living on Maui has been a challenge due to reported shortages of VA 

and community health providers on the island. However, VA has 

established new mental health positions at the Maui Clinic and has 

expanded telehealth capabilities to other islands. There has also 

been some indication of a desire to create a single location on the 

island for veterans’ services in lieu of the existing three locations. 

I hope to discuss these and other important issues with veterans 

and VA today. 

Back in Washington, we have worked hard to ensure that VA 

has the resources to provide the best possible care. In my years as 

Chairman, Congress provided record-breaking funding increases to 

56 

VA. Last year, I introduced the Veterans Health Care Budget Reform and Transparency Act to secure funding for veterans’ health 

care 1 year in advance of the regular appropriations process. And 

we have followed up that success with passage of our Caregivers 

bill, which would help wounded warriors and the families who care 

for them. This bill, which also improves care for women veterans, 

those who reside in rural areas, and those who are homeless, has 

been sent to the House of Representatives. I expect to finalize this 

bill in the coming months. 

Finally, I note that there are many veterans here today who 

would like to testify. While we cannot accommodate everyone’s request to speak, we do want to hear your views. The Committee is 

accepting written testimony which will be reviewed and made part 

of the record of today’s hearing. If you have brought written testimony with you, please give it to Committee staff who are located 

outside on the patio. If you do not have written testimony but 

would like to submit something, Committee staff will assist you in 

doing that. In addition, the Committee staff is joined by VA staff 

who can respond to the questions, concerns, and comments that 

you raise. 

A special mahalo nui to Dr. Hastings, Dr. JangDhari, and their 

team who are here to help us as well. Will you raise your hands, 

Dr. Hastings and Dr. JangDhari? [Applause.] 

Once again, mahalo nui loa. Mahalo to all of you who are in attendance today, and I look forward to hearing from today’s witnesses. 

I want to welcome members of our first panel; and I just want 

to pass this on: as far as feelings are concerned, I feel real cool. 

[Laughter.] 

I want to welcome members of the first panel. Our first witness 

is Karl Calleon. 

Our second is Rogelio Evangelista, Advisory Board Member for 

VA Pacific Islands Health Care System; followed by Larry Helm, 

the Commander of Molokai Veterans Caring for Veterans. 

After Mr. Helm will be Clarence Kamai, Jr., a VA Advisory 

Council Member, and his fellow Council Member Danny Kanahele. 

Next will be Paul Laub, the President of the Maui County Veterans Council; and Terry Poaipuni, the wife of a veteran. Ms. 

Poaipuni will be followed by Mitch Skaggerberg, who offered the 

prayer and who is President of the Vietnam Veterans of Maui 

County. 

Our final witness on the panel will be Lloyd Sodetani, the Maui 

Representative to the Hawaii Office of Veterans Services. 

I thank all of you for being here today on this panel. Your full 

testimony will, of course, appear in the record of this hearing. 

I would like to ask you to begin, Mr. Evangelista—oh, Mr. 

Calleon. E kala mai i’au. 

STATEMENT OF KARL CALLEON, VIETNAM VETERAN AND 

COMMANDER, CHAPTER 2, MAUI, DISABLED AMERICAN 

VETERANS 

Mr. CALLEON. My name is Karl Calleon. I am the Commander 

for DAV Chapter 2 in Maui. 

AUDIENCE MEMBERS. We can’t hear. 

57 

Chairman AKAKA. Oh. 

Mr. CALLEON. Can you hear me now? 

AUDIENCE MEMBERS. No. 

Chairman AKAKA. Pull the mic closer. 

Mr. CALLEON. My name is Karl Calleon. I am the Commander 

for DAV Chapter 2 in Maui. First of all, I want to thank you, Senator Akaka, on behalf of all the Hawaii veterans for being our most 

vocal and powerful voice for veterans ranked in our State. 

As part of the DAV here, I have most often heard the following 

complaints about VA services on Maui. 

First, we need your help to remedy the ongoing loss of so many 

of our best VA doctors and other key veteran service personnel. For 

example, it is extremely disruptive to quality and continuity of our 

veterans’ medical care to keep losing our primary care providers. 

They have to wait months then are scheduled to start all over 

again with a new doctor, by then they are already overwhelmed 

with the VA system. Related to this ongoing turnover is that we 

cannot rely on the Maui CBOC staff to schedule, reschedule, or set 

up referrals for outside medical appointments because they seem to 

always be so disorganized. As a result, we advise all those veterans 

getting services to follow up with the clinic to make sure they are 

doing what they are supposed to do. But that should not be our 

responsibility. 

The real cause of this ongoing VA staff turnover and clear disorganization is that the VA systems under which they work are so 

incredibly inefficient that they get fed up and leave. VA management are either not listening to them or they are completely ignoring them because they too often do not believe change is possible. 

This is why we strongly urge you and the VA Secretary, Eric 

Shinseki, to go and talk directly to our long-time front line professionals like Dr. Maurice Kramer, Kathleen McNamara, William 

McMichaels, James Lockyear, Richard McDonald, social worker 

Laurie Aoki and Tamicko Jackson in the State. If given the opportunity and support, they can tell you very clearly what changes 

need to be made. 

Another concern we have is that we have a lot of older vets here 

whose doctors are prescribing them grab bars and other safety devices. However, after receiving them, they are told they have to install them, and they cannot—many cannot. It should not be the 

veteran’s responsibility. 

Something also needs to be done about our veterans who seek 

emergency care on weekends or after hours at Maui Memorial 

Medical Center. Too often these veterans start receiving huge bills 

and threatening letters for the services they received. This is because the VA refuses to pay these bills since they were not preapproved, even though it was impossible for the veteran to do so at 

the time. While most of these veterans choosing to challenge these 

actions eventually do get them paid by the VA, this whole process 

is very distressing to these veterans, adds insult to injury, and 

seems so needless. This same problem also occurs too frequently 

with payments for outside medical referrals and consultations. 

The Independent Living Program here has helped hundreds of 

severely PTSD-disabled veterans like myself finally pull out of decades of ugliness, depression, and isolation to reconnect with our 

58 

families and communities. However, too many veterans are waiting 

too long to receive these services. I myself had to wait 2 years to 

get my independent living plan written and approved. The biggest 

problem is that only Hawaii veterans are required to have their 

independent living plans approved all the way to the VA’s Central 

Office. It just does not seem right that only Hawaii veterans are 

being singled out this way, especially when these services have 

proven to be so helpful to so many. 

The incredible workload demands faced by our Office of Veterans 

Services officers are enormous; however, the VA and the State cannot seem to come up with whatever is needed to secure two fulltime staff which are minimally needed to meet this demand. As a 

result, we already lost one long-time OVS officer. We just lost another part-time staff person, and the remaining officer, Tamicko 

Jackson, is impossibly overloaded. Again, it is our veterans’ services that are suffering because no one seems to have the power to 

remedy this matter. 

Maui veterans have been complaining about these related problems for some time—the ongoing burnout and loss of VA health 

care service providers and the resulting disruption means loss of effective care to our veterans—will not improve without significant 

changes in our VA system and management. Thankfully, we have 

really good VA staff serving us here on Maui; however, these remaining diehard professionals are still being severely hindered in 

their jobs to effectively and efficiently serve our veterans by unresponsive VA systems and management. 

In conclusion, on behalf of all Maui veterans, we sincerely thank 

you for your time and kokua. We also thank you for your efforts 

to make the VA more responsive to our veterans’ needs. 

[There is no prepared statement for Mr. Calleon.] 

Chairman AKAKA. Mahalo. Mahalo, Karl, for your testimony. 

And now we will hear from Rogelio Evangelista. 

STATEMENT OF ROGELIO G. EVANGELISTA, ADVISORY BOARD 

MEMBER, VA PACIFIC ISLANDS HEALTH CARE SYSTEM 

Mr. EVANGELISTA. Honorable Chairman, Distinguished Members 

of the Senate Veterans’ Affairs Committee, and fellow veterans, 

being on the Veterans Administration Pacific Islands Health Care 

System, I thank you for giving me the opportunity to testify, especially you, Senator, for all the personal sacrifices and unending 

time you have spent helping with our veterans. 

The uniqueness of the Hawaiian Islands, separated from the 

United States by miles of ocean, makes it hard to provide for more 

than 120,000 veterans living here. When I first testified back in the 

year 2007, and again in 2008, there have been great strides in 

health care with the leadership of James Hastings and his team of 

professionals, but a lot still needs to be done to assure the best 

health care to our veterans. 

Unfortunately, unlike the Mainland, there are no bridges or tunnels and we need to fly to Tripler. And because of disability and 

cost of the insurance, we incur all those expenses. Due to the illnesses and injuries that these veterans have received in wartime, 

many of these veterans have limited incomes. To choose between 

taking care of their families, themselves, and flying to Oahu for 

59 

health care is a choice that should not even be an issue for these 

veterans who have served so selflessly. 

I think it is only fair for the specialized services of each island 

to cover any and all the transportation costs that I receive that are 

offered by the Spark Matsunaga Clinic and Tripler on Oahu. The 

VA health care system should take care of us 100 percent because 

the problems that are happening in our later years are all part of 

the cost of war; and when we served in the military we did not give 

only a certain percent, but we gave our full 100 percent. In Hawaii, 

we need to think how we can geographically place the best delivery 

of care, or we will deny our veterans quality medical care which 

they rightfully deserve. 

As our WWII, Korean, and Vietnam veterans age, they are now 

faced with more ailments that affect their health, problems that 

were not visible when they were younger. Not only are they faced 

with their health concerns, but also the issues that cannot be corroborated due to red tape between the VA and the records. 

Senator Akaka, you also know that when a military person finishes, their problems are just beginning to start with their visible 

scars and invisible physical and mental scars. These issues have 

not been dealt with, and most of our veterans are at that time contemplating committing suicide. Part of the billions spent overseas 

in Iraq and Afghanistan need to be spent on the men and women 

who relive this war on a daily basis. 

Senator, we the veterans ask you, the Senate Veterans’ Affairs 

Committee, to right what is wrong and to say to the veterans, 

‘‘Thank you for your service to our country.’’ 

May God bless our Nation, those in uniform and our veterans, 

and in closing, we the veterans ask for our country to love us as 

we loved our country in keeping it the land of the free and the 

home of the brave. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Evangelista follows:] 

PREPARED STATEMENT OF ROGELIO G. EVANGELISTA, VAPIHCS ADVISORY BOARD

MEMBER AND PRESIDENT EMERITUS, MAUI COUNTY VETERANS COUNCIL

Honorable Chairman, Distinguished members of the Senate Veterans’ Affairs 

Committee, and Fellow veterans, being on the Veterans Administration Pacific Islands Health Care System Advisory Board, I thank you for giving me this opportunity to testify on behalf of the Veterans of Maui County. I would like to commend 

the Committee, especially Senator Akaka, for all the personal sacrifices and 

unending time spent on helping our veterans cope with their disabilities. 

The uniqueness of the Hawaiian Islands, separated from the United States by 

1500 miles of ocean makes it very extra ordinary to provide health care to the more 

than 120,000 veterans living here. When I first testified before this panel in 2007 

and again in 2008 there have been great strides done with our health care here in 

Hawaii with the leadership of Gen. James Hastings and his team of professionals 

BUT A LOT STILL NEEDS TO BE DONE TO ASSURE THE BEST HEALTH 

CARE TO OUR VETERANS. 

Unfortunately, unlike the mainland of the United States, these islands are not 

joined by bridges or tunnels, therefore to obtain the necessary medical services 

needed from Tripler, the veterans need to fly, and due to the lack of disability insurance, the veterans incur most of the cost of these flights to receive their rightful 

medical services. Due to the illness and injuries that these veterans have received 

during wartime, many of these veterans are on limited incomes. Having to choose 

between taking care of their families and themselves and flying to Oahu to receive 

healthcare, is a choice that should not even be an issue for these veterans who have 

served the United States so selflessly. The promises made by the military offer eduVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00063 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
60 

cation for the betterment of the soldier for life, the ability for home loans on the 

GI bill for the betterment of the soldier’s life, and medical care for the betterment 

of the soldier’s life. What we are asking for is that the medical services be available 

and not have to be a financial liability to the veteran in need of medical services. 

We ask that the transportation costs of those veterans who do not live on Oahu be 

covered fully. Until the time that there are specialized services available on each 

island, it is only fair and just to cover any and all the transportation costs to receive 

these medical services that are only offered at Tripler or the Spark Matsunaga Clinic on Oahu. If we use the VA health care system, the VA should take care of us 

100 per cent, cause the problems that are happening to us now in our later years 

in life are all part of the cost of war and also when we served in the military we 

did not give only a certain percent but we gave our full 100 per cent. In Hawaii 

we need to think how we can geographically place the best delivery of care or we 

will deny our veterans quality medical care that they so rightfully deserve. 

As our WWII, Korean, and Vietnam veterans age, they are now faced with more 

ailments that affect their health, problems that were not visible when they were 

younger, with the possibility of being service-connected. Not only are they faced with 

their health problems, but also the issues of getting to prove with collaborating evidence, records which the VA cannot provide due to all the red tape between the 

military records and the VA when you need copies of your records. 

As we deal with the incredible injuries and mental health needs of our veterans 

we simply have to do it right in taking care of those that borne the battle and we 

can start by reducing the number of backlog on claims, especially those on disability 

claims. If there is any probability that it could be service-connected, it should be 

approved. 

Senator Akaka, you also know that when a person finishes his military obligation 

and he goes home it does not end there, but their problems are just starting, in trying to get health care, getting a job, fitting in with the community, reuniting with 

the family and coping with visible and invisible physical and mental scars. 

Senator Akaka, another issue is the families of these veterans. For a lot of families the men or women who have left to serve their country have come back broken 

both mentally and physically and this is often traumatic to the families to not only 

welcome back a changed person, but to learn how to deal with their disabilities. 

These families need the support of the VA also to deal with needs of the veteran 

in the home situation. The veteran may have been exposed to situations to which 

the average family cannot even fathom much less give support to. What options do 

these families have on their home islands? For the families on the outer islands 

often the costs of transportation to receive these services are a deterrent to receiving 

these services. 

We have done our duty, so now we ask the Senate Veterans’ Affairs Committee 

along with the Veterans Administration to do their duty in helping the Veterans 

and their families. There are incredible issues that we have to face not only for our 

newer veterans but also those that have served in previous wars, be it World War 

II, Korea, Vietnam, Etc. Caring for our veterans means providing the best health 

care 24/7 and rehabilitation and compensating veterans for their injuries. 

We have to honor our returning troops, as you know what happens when we don’t. 

Like in the case of the Vietnam Veterans, due to the opposition against the war, 

the men and women who served were not honored on their return, they were 

disrespected. For these men and women to endure wartime and come home to be 

dishonored by society, caused tremendous psychological issues resulting in suicides, 

homelessness etc. These issues have not been dealt with and our veterans of this 

current war are committing suicide in large numbers. Dealing with these issues is 

very much part of the cost of war. Part of the billions spent overseas in Iraq and 

Afghanistan need to be spent on the men and women who relive this war on a daily 

basis. 

With hundreds of our troops returning home in dire need of health care let us 

show our appreciation and commitment to the men and women who have worn the 

military uniform in defense of this Nation, let us say thank you by asking for unlimited funding to deal with the crisis that we are facing to get the veteran soldiers 

back into society and their families, even in this hard economic times we need to 

know and show that the care for the veteran and their families are the continuing 

cost of war. 

The VA is a premier Health Care System, but here in Hawaii, specifically the 

outer islands, the healthcare services are limited. In fact, the VA does not have a 

hospital anywhere here in the Hawaiian islands. With the increasing population of 

veterans here in the islands, is it possible that there would be plans for a VA hospital in the near future. 

61 

Let me also mention that the Maui County Veterans Council and the more than 

20 veteran organizations it represents wholeheartedly support the aspect of the proposed facility in Kahului at Maui High School of which one of our panelists Col. 

Lloyd Sodetani Ret. will address. 

Last but not the least is the honors that veterans earned while serving in the 

military which is basically the last respect regarding the veterans service to his 

country during his burial rites. We are being faced with different issues in providing 

these various services—services that were earned and promised when we wore the 

uniform. Things like new memorandums for different branch of service, no available 

personnel, due to deployment for the war, economic hardship on travel for the full 

honor guard, time constraints, etc; WE, THE VETERANS, ask you and the Senate 

Veterans’ Affairs Committee TO RIGHT WHAT IS WRONG and say to the Veterans 

‘‘THANK YOU’’ for your service to our country. 

May God Bless Our Nation, those in uniform, our veterans and their families and 

in closing, WE, THE VETERANS, ASK, ‘‘FOR OUR COUNTRY TO LOVE US AS 

WE LOVED OUR COUNTRY’’, IN KEEPING IT THE LAND OF THE FREE AND 

THE HOME OF THE BRAVE. 

Chairman AKAKA. Thank you very much for your testimony. 

Now I would like to call on Larry Helm. 

Mr. HELM. Senator, if you do not mind, I would like to allocate 

three of my minutes to our Molokai representative. 

Chairman AKAKA. I do not mind. 

Mr. HELM. Because he is from out of island and we must be helpful to our guests. 

Chairman AKAKA. Thank you. Let me repeat that the full text of 

your testimony will be included in the record, but we do have a 

time limit for the presentation of this. So, Larry, you have an additional 3 minutes. 

STATEMENT OF LARRY HELM, COMMANDER, MOLOKAI 

VETERANS CARING FOR VETERANS 

Mr. HELM. Thank you, Senator. Before I start my testimony, I 

would like to give personal thanks to the Molokai vets who got up 

at 4 o’clock this morning, jumped on a boat—— 

[Applause.] 

Mr. HELM. I would just to say to you in advance, Senator, that 

when I get through testifying, because we have to get back on the 

ferry we’re going to hele on. 

Good afternoon, Chairman, Senator Daniel Akaka, staff, all the 

angels that work for the betterment of veterans and their families, 

fellow veterans and to the audience, aloha. 

PARTICIPANTS. Aloha. 

Mr. HELM. Mahalo, Senator Akaka, for your time to hear veterans testify on behalf of veterans. There are lots of advocates. You 

are our number 1 advocate. For that I say mahalo nui loa. 

[Applause.] 

Six years ago, an organization was formed on Molokai called 

Molokai Veterans Caring for Veterans. Today there are approximately 600 Molokai veterans. Three hundred veterans from all 

wars and conflicts have joined our organization called ‘‘Koa 

Kahiko’’—ancient warriors, wise warriors. Services to Molokai vets 

then were sparse and limited. Today, thanks to you, Dr. Hastings, 

Dr. Steve McBride, who helped to hire our own resident, Dr. 

Hefferman, regular visits from our VA angel Dr. McNamara, Dr. 

Springer, Benefit Counselor Joe Thompson, Ernie Matsukawa, and 

many others, beginning next week, we will have a home care nurse 

on-island to fulfill an overwhelming need. Today seven veterans 

62 

qualify for home care, and she is here today, and she starts next 

week. [Applause.] 

Molokai has had the highest percentage of Vietnam vets per capita in this country. Many of them have died. Many have been in 

the valleys, the bars, and the crevices of Molokai for a long time. 

Finally, many of these veterans are getting their due benefits. And 

because of the VA services and counselors, they are at least having 

some quality-of-life. Mahalo plenty. 

I come today, of course, with some honey, but also I have some 

lemonade that needs some sugar in it. 

Recently, a Molokai retired Navy lieutenant, Richard Smith, who 

served 33 years in the Korean and Vietnam conflicts and received 

many commendations, died. One of the benefits promised to vets 

like Richard is that they have a full military burial when they are 

on their last rite from Earth. Because his home was on Molokai, 

Richard had a watered-down detail of three and, in my opinion, if 

we cannot own up to our promises made to veterans, then how are 

we going to own up to the rest of the world? 

Some veteran organizations like the VFW, et cetera, provide burial details. This ought not to happen. It ought to be mandatory that 

all military branches honor these vets with full military burials as 

they promised. 

There are two crypts left in Molokai Veterans Cemetery. Mr. 

Mark Moses, Director of the State Veteran Services, is aware of 

this issue. However, he is constrained by State budget problems. 

Give the veterans on Molokai the materials, and we will build the 

needed addition. 

We acquired official property to build a Vet Center. We are in the 

process. It is a simple building. Needless to say, we have been 

jumping through hoops with the County of Maui to get our permit. 

It’s been a 3-year process. 

My suggestion is from the top down give priority status to all 

veteran groups in this country that are advocating and helping in 

the advancement and the betterment of all veterans and their families. Many times just going through this process, I still think I am 

in the woods in Vietnam. We are still fighting. 

Senator, if you can find it in a little piggy bank stashed away, 

we can use $20,000 to $30,000 to furnish our Vet Center. 

There are many veterans whose records have been lost from the 

Korean and Vietnam era for one reason or another. Some of them 

have legitimate service-connected claims. There ought to be a system to give them the benefit of the doubt. Because of State budget 

woes, there was a mental health counselor position cut on Molokai. 

The counselor had over 100 clients, and some are veterans. What 

can we do to help them? Because of privacy issues, the VA can find 

out from the State and get them enrolled in the system if not already enrolled. 

On Molokai, we have approximately 60 residents who have 

served in the Mideast conflicts. Some are still serving. Some are 

home now. There ought to be a method of issuing a heads-up that 

these soldiers are returning home so they can be identified to be 

provided needed service before they have major problems. I personally have had three different late-night calls from parents concerned about erratic, threatening behavior from young vets that 

63 

could have been very volatile. Mahalo to the VA, Dr. McNamara, 

and others who served these veterans immediately, and they are 

moving forward. 

Another personal issue. My nephew served three tours in Iraq, 

wanting to make a career in the army. His paternal grandmother, 

who raised him, died. He was denied to come home to her funeral. 

As the military says, ‘‘only immediate family.’’ Suggestion: VA, 

work with the military on exceptions. My nephew left the army. 

Molokai has 30 or more Native Hawaiian veterans. Many are disabled—service-connected—living on homestead land. There ought 

to be a more efficient process for Native Hawaiian veterans to refinance their homes through the VA or other loan people. The Department of Hawaiian Homes process is a hindrance. They ought 

not to be. Native Hawaiians served this country and deserve equal 

treatment. In my opinion, the system discriminates against qualified disabled Native Hawaiian veterans. 

Suggestion: The VA, first, in administering services to veterans, 

if the State is involved with the State counselors for veterans, that 

they be required to use the criteria of the Federal VA standards. 

Many times it is redundant, time-consuming, and not cost-effective. 

Veterans ought to have: a veteran credit union—easy to do, piggyback or a subsidiary like the Pentagon Credit Union; a veteran 

low fixed interest credit card, easy to do. Work with major credit 

cards—Visa, American Express, et cetera. Veterans set up the 

rules. 

Again, on behalf of the Molokai veterans, to Senator Daniel 

Akaka and staff, mahalo for your kokua and your continued advocacy for all veterans. Veterans are the soul of America. There are 

citizens and there are veterans. Without veterans, there would be 

no citizens. 

Akua bless you. Mahalo. 

[Applause.] 

Chairman AKAKA. Mahalo. Mahalo, Larry, for your testimony. 

And now I call on Clarence Kamai, Jr., for your testimony. 

STATEMENT OF CLARENCE KAMAI, JR., MOLOKAI 

REPRESENTATIVE, VETERANS CARING FOR VETERANS 

Mr. KAMAI. Thank you, Senator. Now let me turn this thing on. 

OK. There is no sound. Let’s change mics. 

OK. Can you hear me? 

PARTICIPANTS. Yes. 

Mr. KAMAI. Amen. Good morning, Senator, Honolulu VA executives, staff of the State Veterans Office, Maui CBOC staff, members 

of panels one and two, and, most important, aloha and mahalo to 

my fellow veterans and comrades. 

Chairman AKAKA. Aloha. 

PARTICIPANTS. Aloha. 

Mr. KAMAI. Senator, I do concur with my fellow constituents 

here, and I would just like to say thank you for being here and for 

bringing a second round to us. 

I would also like to make mention and really applaud Dr. Kathy 

McNamara for her dedication and work. [Applause.] 

I know Dr. McNamara is working with one of our veterans—this 

guy Rodney Ricken. He needs a lot of help. He has put in all of 

64 

his paperwork, and so far to this date and time, we have not heard 

anything from anyone regarding his status. And he is looking for 

his disability and whatnot. So, prayerfully, something can happen 

for Mr. Ricken. Hopefully, we can get something going for him. 

But I would like to thank each and every one of you for helping 

us, and my question right now to the Senator is: What can we do 

to help you? How can we help you to help us to get what we need? 

Because we are here. We have been training as soldiers, and we 

will continue being soldiers. We will fight for you and become your 

soldiers. Tell us what you want, because we are telling you what 

we need, not what we want. God bless each and every one of you. 

Aloha. Thanks. 

[Applause.] 

Chairman AKAKA. Mahalo. Thank you very much, Mr. Kamai, for 

your statement, and I want to thank you again for your offer for 

us to work together. That is the key. We have got to work together 

to try to get these things done. So, mahalo. 

And now we will hear from Mr. Kanahele for your testimony. 

Please proceed. 

STATEMENT OF DANNY KANAHELE, 

VA ADVISORY COUNCIL MEMBER 

Mr. KANAHELE. Thank you, Senator. Thanks to everybody for 

being here. 

My testimony is slightly different. My testimony is about thanking everybody for what they do. Senator, I want to thank you and 

your professional team for the hard work they do, the time they 

put in, the hours they sleep—which is not much. Senator, I also 

want to tell you about the staff at Spark Matsunaga Veterans Administration under the direction of Dr. Hastings. With his professional team, Dr. Hastings’ administration and his direction have 

helped Maui. They do the best they can, which I am one of them 

who makes sure they do the best they can because that is also my 

job. Thank you, General. 

Again, I would like to thank, Dr. Hastings. I want you to know 

your staff on Maui, under the hands of Kathy Hass and her professional team—again, doctors, nurses, administrators, and their directors—deserve thanks for everything they do, and share and put 

up with—headaches and sometimes hard times, which I am one of 

them at times. I am honest about that. 

I would also like to thank Dr. McNamara for the Education and 

Independent Living Program, which I think is very much needed, 

and I have been on it. I love it and I am still doing it. I like that. 

I enjoy that. 

Again, I would like to thank Mr. Ernie Matsukawa for everything he does with his counselors: family counseling, individual 

counseling, and group counseling. They have made advances over 

there, which I join in once in a while. He shares a lot of information with everybody and he shares it and more. But, again, you 

cannot please everybody. 

With this testimony, like I said, it is short, brief, and very direct. 

I thank you, Senator, Dr. Hastings, Kathy, Ernie, and Tamicko . 

I want to thank everybody who puts in time and helps us today. 

Thank you. 

65 

[Applause.] 

Chairman AKAKA. Mahalo nui loa, Danny, for your gracious 

mahalos to those who have been working hard. We really appreciate that. 

And now we will hear the testimony of Paul Laub. Please proceed. 

STATEMENT OF PAUL LAUB, PRESIDENT, 

MAUI COUNTY VETERANS COUNCIL 

Mr. LAUB. Aloha auinala and aloha kakou. 

Chairman AKAKA. Aloha. 

Mr. LAUB. I am Paul Laub and I have the honor of being the 

President of the Maui County Veterans Council. 

First, I would like to read a letter from County Council member 

Bill Kauakea Medeiros, who is or was here. It says: 

‘‘I am writing this letter to you as a concerned veteran 

and a Maui County council member that feels that we veterans are not receiving the most efficient and cost-effective 

facilities and services for the funds that the Veterans Administration spends on Maui. Our second proposal would 

be more efficient and cost-effective because it would bring 

all the veterans’ services to one location rather than having the services at three different locations as it exists 

today. Currently, insufficient parking at all three locations 

is a problem. Additionally, confusion and frustration results when a veteran goes to the wrong location and needs 

to drive 20 or 30 minutes to another location. In the long 

term, the costs for VA would be substantially less than the 

total amount the VA will have paid for these three—and 

will pay in the future.’’ 

‘‘The State of Hawaii’s Departments of Defense and Education are also providing fair-share contributions to make 

this a reality. The VA will continue to own its facilities 

and be able to upgrade its facilities as technology and 

operational needs change. Being rent-free will result in 

substantial savings to the VA. This complex will benefit all 

of our veterans and, with proper coordination, provide immeasurable benefits to our students and our neighboring 

communities. As a faithful constituent and member of our 

local government legislative body, I humbly ask that you 

favorably consider the proposal and to initiate funding for 

that purpose. Mahalo for your kokua. 

Bill Kauakea Medeiros.’’ 

I also happen to have a letter from Council member Jo Anne 

Johnson, who is the wife of a World War II veteran who is in difficult straits at this time. It says: 

‘‘As the wife of a veteran of World War II, as a member 

of the Aging with Aloha coalition, not to mention my public service as an elected official, I am acutely aware of the 

needs of our veterans here in Maui County. Partially due 

to our isolation, but also because of the increasing number 

of veterans who require services, we are facing a crisis 

here in our county. With funding being limited for proVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00069 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
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grams that help support our veterans and their families at 

both the State and county levels, we face diminished services at a time when demand is on the rise. Programs that 

provide for the needs of veterans such as medical care, 

dental treatment, and mental health counseling are critical to our community. Also, rehabilitation for our disabled 

veterans, caregiver support services, reimbursement for 

relatives who care for loved ones, and educational retraining must be considered as key components of any health 

care delivery system for those who have served our 

country.’’ 

‘‘Our veterans trusted that while they were caring for 

our country that their families and themselves would be 

cared for in return. That assumption has proven over time 

to fall short of expectations of our vets and family members. Many servicemen and women cannot get simple 

counseling to find out what services are available to them 

and their families or what the requirements are for eligibility. We need to provide a one-stop service center that is 

accessible, that is—and that is adequately staffed to support the needs of veterans and their loved ones.’’ 

Our members, our veterans, who were once strong, resourceful, 

and independent men—the heroes of yesteryear—have now found 

that they have aged. This aging has robbed them of their strength, 

and many of their abilities have been diminished. Now these men 

are stooped with age and need the great services that our Government can offer to these warriors of our history. 

The problem is that getting these services has been unnecessarily difficult due to the random locations of each service. It appears that this problem can be resolved by building a Veterans 

Campus on the 41⁄2 acres of land at Maui High School that has 

been offered to us by the State of Hawaii. Please give this possibility your soonest attention. 

We now have no burial facilities in West Maui. The very generous Ka’anapali Land Company has offered us 15 acres of land for 

this purpose. May I urge you to assist in whatever way possible to 

ensure that we receive and properly utilize this great gift. 

The Veterans Cemetery at Makawao is almost at full capacity. 

I understand that there is a proposal to expand it through purchase of neighboring property. May I also urge you to help effect 

this transaction. 

We, the veterans of Maui County, greatly appreciate and wish to 

thank you for your many, many assistances to us. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Laub follows:] 

PREPARED STATEMENT OF PAUL LAUB, PRESIDENT, MAUI COUNTY VETERANS

COUNCIL AND MEMBER, WEST MAUI VETERANS CLUB

Senator Akaka, thank you for coming home to Maui. As the youngest member of 

the West Maui Veterans club, of which you are listed as a member, and President 

of the Maui County Veterans Council, it has fallen to me to bring some issues to 

your kind attention. 

Our members, once strong resourceful and independent men, the heroes of yesteryear, have now found that they have aged. This aging has robbed them of their 

67 

strength and many of their abilities have been diminished. Now these men are 

stooped with age and need the great services that our Governments afford to these 

warriors of our history. The problem is that getting these services has been unnecessarily difficult due to the random locations of each service. It appears that this problem can be resolved by building a Veterans Campus on the 41⁄2 (four and one-half) 

acres of land at Maui High School that has been offered to us by the state of Hawaii. Please give this possibility your soonest attention. 

We now have no burial facilities in West Maui. The VERY generous Ka’anapali 

Land Company has offered us 15 (fifteen) acres of land for this purpose. May I urge 

you to assist in whatever way possible to ensure that we receive and properly utilize 

this great gift? 

The Veterans Cemetery at Makawao is almost at full capacity. I understand that 

there is a proposal to expand it through purchase of neighboring property. May I 

also urge you to help effect this transaction? 

We, the Veterans of Maui County greatly appreciate, and wish to thank you for 

your many assistances to us. 

If there is any way I can be of assistance to any Veteran endeavors please do not 

hesitate to ask. 

Thank you, again. 

Chairman AKAKA. Thank you. Thank you very much, Mr. Laub, 

for your testimony and your idea of consolidation. 

And now we will hear from Ms. Poaipuni. Terry, will you please 

proceed with your statement? 

STATEMENT OF TERRY POAIPUNI, 

WIFE OF A VIETNAM VETERAN 

Ms. POAIPUNI. Aloha, Senator Akaka and Members of the U.S. 

Senate Committee on Veterans’ Affairs. My name is Terry Lee 

Poaipuni, and I am the wife of a Vietnam veteran. I was born and 

raised on the east side of Maui in a place called Hana. I have 

worked for Maui’s Native Hawaiian Health Care System, Hui No 

Ke Ola Pono, for 19 years. I will refer to Hana as East Maui because the district encompasses a bigger area than Hana. The number of veterans in East Maui is 75-plus, and this is not counting 

the National Guard and Coast Guard veterans. I am sure there are 

more veterans out there that I have missed. 

Nearly 5 years ago, the State Office of Veterans Services would 

send William Staton to Hana once a month to assist the veterans 

living in East Maui. Ten years ago, a registered nurse from the 

Veteran Clinic used to come to Hana Medical Center to see veteran 

patients. Presently, the State Office of Veterans Services does not 

come to East Maui. I have spoken to our State representative, and 

due to the State economic constraints, services by the State Office 

of Veterans Services were cut. Tamicko Jackson, who has taken 

William Staton’s place, is the only person employed by the State 

who is able to assist veterans from Maui, Molokai, and Lanai. 

Tamicko Jackson sees several of our East Maui veterans who drive 

out to Central Maui for their appointments, and I am not sure how 

long Tamicko Jackson will be there. The unfortunate thing is the 

veterans become familiar—or ‘‘ma‘a,’’ as we say in Hawaiian—to 

someone like Tamicko, and then she or he gets replaced. This replacement only makes it harder and more frustrating for the veterans. 

The accessibility of services to East Maui veterans is a major 

problem. Counselors Ernie Matsukawa and Ipo Messmore have 

made the Vet Center in Lunalilo Building a safe place for veterans 

wanting to gather and share experiences. Ernie and Ipo do an aweVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00071 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
68 

some job of counseling our veterans, and we need more people like 

them. 

I find the veterans who gather there have a lot of knowledge and 

information that they are willing to share. This is what is missing 

in the system. That willingness to share with the veteran of his or 

her benefits without them guessing and feeling like they need to 

beg, maybe this is what the system is set up to do. 

Hui No Ke Ola Pono, the Native Hawaiian Health Care System 

with an office in Central Maui and a satellite office in East Maui, 

has recently begun working with veterans on the island of Maui. 

Hui No Ke Ola Pono have included on our organization intake form 

a portion for the veteran to fill in. This will identify the veteran 

and give us the opportunity to advocate for them. Clay Park, of 

Papa Ola Lokahi, has been instrumental for starting the veteran 

advocate services at Hui No Ke Ola Pono. Clay Park has been helping the veterans on Maui to explain how to fill out the Veterans 

Benefit Administration forms and applications, and Clay Park does 

come to Hana. 

In closing, I would like to know how East Maui can get assistance from the Veteran Benefits Administration. My understanding 

is that Joseph Thompson can assist veterans with the application 

process. Can Joseph Thompson come to East Maui? Is there a way 

that a telecommunications site can be set up so veterans can access 

services from East Maui? The veterans need to feel like they are 

part of the system that they fought for and not a burden to it. 

Mahalo and thank you for your time. 

[Applause.] 

[The prepared statement of Ms. Poaipuni follows:] 

PREPARED STATEMENT OF TERRY LEE POAIPUNI, WIFE OF A VIETNAM VETERAN

Aloha Mr. Chairman and Members of the U.S. Senate Committee on Veterans Affair, My name is Terry Lee Poaipuni and I am a wife of a Vietnam Veteran. I was 

born and raised on the East side of Maui, in a place call Hana. I have worked for 

Maui’s Native Hawaiian Healthcare System, Hui No Ke Ola Pono for 19 years. I 

will refer to Hana as east Maui because the district encompasses a bigger area than 

Hana. The number of Veterans in east Maui is seventy five plus and this is not 

counting the National and Coast Guard Veterans. I’m sure there are more Veterans 

out there that I’ve missed. 

Nearly five years ago the State, Office of Veteran Services would send William 

Staton to Hana once a month to assist the Veterans living in east Maui. Ten years 

ago, a Registered Nurse from the Veteran Clinic used to come to Hana Medical Center to see Veteran patients. Presently the State, Office of Veterans Services does not 

come to east Maui. I’ve spoken to our State representative and due to the State economic constraints services by the State Office of Veterans Services were cut. 

Tamicko Jackson, who has taken William Staton’s place is the only person employed 

by the State who is able to assist Veterans from Maui, Molokai, and Lanai. Tamicko 

Jackson sees several of our east Maui Veterans who drives out to Central Maui for 

their appointments and I’m not sure how long Tamicko Jackson will be there. The 

unfortunate thing is the Veterans become familiar (or ma‘a as we say in Hawaiian) 

to someone like Tamicko and then she gets replaced. This replacement only makes 

it harder and frustrating for the Veteran. The accessibility of services to east Maui 

Veterans is a major problem. 

Counselors Ernie Matsukawa and Ipo Messmore has made the Veteran Center in 

Lunalilo Building a safe place for Veterans wanting to gather and share experiences. Ernie and Ipo Messmore does an awesome job of counseling our Veterans and 

we need more people like them. I find the Veterans, who gather there, have a lot 

of knowledge and information they are willing to share. This is what is missing in 

the system. That willingness to share with the Veteran of his or her benefits without them guessing and feeling like they need to beg. Maybe this is what the system 

is set up to do. 

69 

Hui No Ke Ola Pono, the Native Hawaiian Healthcare System with an office in 

Central Maui and a satellite office in east Maui have recently began working with 

Veterans on the island of Maui. Hui No Ke Ola Pono, have included on our organization intake form a portion for the Veteran to fill. This will identify the Veteran 

and give us the opportunity to advocate for them. Clay Park, of Papa Ola Lokahi, 

has been instrumental for starting the Veteran advocate services at Hui No Ke Ola 

Pono. Clay Park has been helping the Veterans on Maui to explain how to fill out 

the Veterans Benefit Administration forms. 

In closing, I would like to know how East Maui can get assistance from the Veteran Benefits Administration. My understanding is that Joseph Thompson can assist Veterans with the application process. Can Joseph Thompson come to east 

Maui? Is there a way that a telecommunication site can be set up so Veterans can 

access services from east Maui? 

The Veterans need to feel like they are part of the system that they fought for 

and not a burden to it. Mahalo and thank you for your time. 

Chairman AKAKA. Mahalo nui, Terry, for your testimony. 

And now we will receive the testimony of Mitch Skaggerberg, 

President of the Vietnam Veterans Association. 

STATEMENT OF MITCH SKAGGERBERG, PRESIDENT, 

VIETNAM VETERANS OF MAUI COUNTY 

Mr. SKAGGERBERG. Daniel, thank you for coming. Your tireless 

work has really spawned a tremendous number of veterans here in 

Maui to step forward to represent the 12,000 veterans in Maui and 

Maui County. You continue to inspire us, and we are always 

amazed at the new benefits that you enact on our behalf and the 

budget increases for the VA to do their job more effectively. You 

are in our hearts always. 

The thing that I think has become apparent is how our families 

cherish what is going on in this community. They are probably— 

they have more benefit than we do because families are healing, 

children fall back in love with their fathers. So, truly you represent 

the ohana of so many veterans, and we want you to know that. We 

never want to stop telling you that, so thank you. 

Also, an overwhelming appreciation in the last 2 years since you 

held—we had a pretty tumultuous meeting 2 years ago here. I 

want to give you and your staff credit for giving us the extra 

money, especially in terms of mental health care and additional 

doctors. It has improved the ability of our staff here—our doctors 

and our nurses—to provide us with good care, very good care overall. Now, there are some improvements that I will address in a 

minute, but like Danny and Clarence, there are a lot of good things 

to report because of what you have done and what our VA director 

has done. They have rolled up their sleeves. It is not easy when 

you hear criticism and still broaden your horizons, and we hope 

that they could do that again today. 

There are three areas that I am going to briefly make recommendations on, and the first is voc rehab. I was privileged to be 

the first Voc Rehab Veteran of the Nation in 1995. I remember you 

sent me a letter, and that has continued to follow through all these 

years with me, so I have a fond heart for that. 

Why has D.C. reinstituted a policy to have all independent living 

programs go up to them for review? There has got to be a better 

way. It is hurting the veterans. I want them and I want you to 

really have them reevaluate that system. Many of the veterans are 

waiting 11⁄2 to 2 years. Now, these are veterans 60 years old. It is 

70 

not like they are 30 or 40 and they have the time, and their families are waiting, too. There has got to be a better way to get things 

done like when you were going through it in the 90’s—6 months 

to get it approved. They have also reduced the limit, I understand, 

to 15,000 from 25,000. I am not quite clear why that is, especially 

with the cost here. So that—I mean, I know the system can be improved. It was—for years, and I am not blaming those people from 

D.C. They probably had a good reason, but they have got to understand that they are hurting the veterans. They are not hurting any 

of the VA employees or whatever is going on. So, that is one recommendation, and I know we have heard that from other people 

before. It is a huge problem, maybe not only here, but across the 

State. Ms. Joy Gavigan would know that. 

The second area is the benefits counselor. We are recommending 

that the VA actually install a full-time benefits counselor in the 

Vet Center to do outreach to Hana and Molokai. Joe Thompson is 

fantastic, but he can only get here once or twice a month. The reason I am saying that is the State has refused over the last 10 years 

to add another counselor through the State Office of Veterans Services, and they have burned out about three of those people on the 

neighbor islands because of it. Pat Pavao, Bill Staton, and Manuel 

Brigadora on Kauai, they are not nurturing their people, they are 

wearing them out because we need more counselors on the neighbor islands. 

Sparky Matsunaga is the one that got the Governor in 1987 to 

start the Office of Veterans Services for Hawaii. He understood the 

critical need. They have done nothing since, and the workload has 

gone up tremendously. So, Maui sees the same number of veterans 

as Oahu. Oahu has three. We have been trying to get it through 

the State for 10 years. It falls on deaf ears. They give us less than 

$1 million a year to service 125,000. The best tip that the veteran 

leader said was let’s get a full-time benefits counselor in Maui 

County, and outreach especially for the Iraq and Afghanistan vets 

coming home. We have got 900 to 1,000 in Maui that are going to 

be leaving their units or be back for good in the next year. So, that 

is a high priority. 

[The recording got cut off and resumes with another speaker.] 

[The prepared statement of Mr. Skaggerberg follows:] 

PREPARED STATEMENT OF MITCH SKAGGERBERG, PRESIDENT, VIETNAM VETERANS OF

MAUI COUNTY

Dear Senator Daniel Akaka, Our Aloha to you, Senator Akaka, for coming back 

to Maui to listen to our current experiences and additional suggestions to improve 

about our VA Medical Clinic, Vet Center, and Vocational Rehab Programs and Services. 

We want to start with our Overwhelming Appreciation for the additional Nurses, 

Mental Health Doctor’s, and administrative staff at our Maui Clinic over the last 

18 months. Our veterans are very thankful for your support, Senator Akaka, in getting us the additional funding for these much needed personnel to serve the 2,000+ 

Maui Veterans using our VA Clinic. 

We have seen a big improvement in shorter wait times to access mental health 

support for our 1,000 Maui PTSD Veterans because the hiring of an additional mental health psychologist and a mental health clinical nurse. Again, thank you, Senator Akaka, for procuring and advocating for the funds to get these two additional 

Mental Health providers into the Maui clinic. 

A PTSD psychologist on Maui, Dr. Richard Sword, together with Professor 

Zimbardo of Stanford University, has been using another new PTSD treatment 

method to treat some Maui Veterans that effectively reduce PTSD symptoms and 

71 

treatment times. It’s called ‘‘Time Therapy.’’ We would encourage the VA mental 

health providers to look at this method for possible use in our VA PTSD programs. 

Our Vietnam Veterans also overwhelming support the current proposal to house 

all our VA Facilities at the Maui High School complex; being spearheaded by Our 

Maui County Veterans Council; and its Chairperson for this Proposal, Lloyd 

Sodetani. 

And our wounded Veterans seeking disability compensation need much more 

timely and consistent help in submitting and being provided with ongoing help to 

get their Claims adjudicated. We would like to recommend a Full Time Benefits 

Counselor be added to our VA Maui Vet Center. Currently we have a benefits counselor come twice a month from our Honolulu VA Regional headquarters; which 

slows the process and, in our experience, can cause unnecessary frustration with the 

Veteran. This could also help the VA reduce its Compensation Claims backlog, 

which is a top priority with our VA. 

Many of our combat veterans who have their disability claim still being adjudicated (called CV in the system) cannot get their travel to Honolulu paid for by 

the VA. For much needed medical care. This results in withholding critical medical 

care for them since the care is not available on Maui. We believe they are entitled 

to travel. Travel reimbursement is also being withheld for non service-connected veterans needing critical care only available at Honolulu VA or Tripler. These veterans 

cannot drive to Oahu and are entitled to care and the travel cost to get there! In 

both situations our doctors tell us these Veterans are needlessly suffering because 

of this policy. Can you get us travel for all these deserving Veterans Senator Akaka! 

We have also heard from Combat Disabled Veterans (many with ratings of 50– 

100%) that some of the medical treatment being recommended by our Maui VA Doctors is not being approved by our Honolulu VA/Utilization board. This has been an 

ongoing source of frustration with our Veterans care on Maui. Why have doctors if 

the Financial folks on Honolulu have the final SAY for our medical care. We would 

like our Doctors to have the Final Say on their Patients care. 

We need help also in getting our Guam Clinic a Mental Health Doctor. Because 

the budget for this position is 60% less than the pay in Las Vegas the VA cannot 

fill the position. Is there any way the VA can fix this wide pay difference to fill the 

position? We have already lost a highly qualified Applicant due to this pay issue! 

Last, Maui Veterans seeking vocational rehab, specifically, the Independent Living Program, are upset at the procedure set up by the Washington, DC, Voc Rehab 

Office to review and approve all Voc Rehab Program Applications by Maui Veterans. 

We find this policy has resulted in major delays in getting Maui Veterans their programs; many times up to two years. 

Again, Senator Akaka, we want to thank you for your Tireless and ongoing assistance in the overall improvement of our Maui VA health care in the last two years. 

Without your help this would not have been possible. 

STATEMENT OF LLOYD K. SODETANI, MAUI REPRESENTATIVE, 

HAWAII OFFICE OF VETERANS SERVICES 

Mr. SODETANI [In progress]. I would like to introduce individuals 

who were instrumental in assisting us as a team in planning, organizing, and directing this proposed project. I would like to begin 

with a person who represents the Department of Defense, State of 

Hawaii, Brigadier General Gary Ishikawa. If he would stand to be 

recognized, please. 

[Applause.] 

Chairman AKAKA. Welcome to our hearing, General. 

Mr. SODETANI. Representing the Department of Education is 

Maui High School Principal Randy Yamanuha. Randy. 

[Applause.] 

Chairman AKAKA. Thank you for being here, Randy. 

Mr. SODETANI. The architect who has done pro bono work 

throughout this period of time is Stanley Gima. 

[Applause.] 

Chairman AKAKA. Mahalo, Stanley. 

Mr. SODETANI. And through the generosity of Austin, Tsutsumi 

& Associates, Ken Kurokawa, who is a Vietnam veteran, an engiVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00075 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
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neer, and a cancer survivor, I would like to introduce the surveyor, 

Tim Lapp. 

[Applause.] 

Chairman AKAKA. Mahalo. 

Mr. SODETANI. This was all manuahi, OK? Above all, I would like 

to recognize the organizations within the community, including the 

veterans groups and veterans who are present here today, and I 

would like to thank all of them for all their kokua. 

My testimony. Regarding the proposed multi-service complex, 

submitted herewith is a copy of a survey—and I am submitting 

that also—that was conducted by the Hawaii Health Systems Corporation on the island of Hawaii. The results of the survey indicate 

similar problems and challenges appearing in East Hawaii. It has 

shown that systemic problems exist relative to Hawaii, as it was 

voiced during your visit with the Hawaii veterans last August 

2009, and this testimony is being presented today. In each geographical location, the consensus has been loud and clear that 

multi-service complexes as proposed are needed. It is the contention of the veteran advocates that continuing to provide services in 

the current manner would not be in the best interest of veterans, 

particularly since dissatisfaction continues to grow. Creating multiservice complexes would benefit all users, employees, and the community. By providing a user-friendly facility with ample parking in 

close proximity to all related services, it will be cost-effective, efficiently operated, and achieve greater satisfaction from veterans. 

It is with sincere appreciation that I express my gratitude to you 

for having this forum. You have provided an immense amount of 

projects and programs for Hawaii and Maui County. For those we 

are truly grateful. We continue to ask for your support in our endeavor to have a better quality-of-life for all veterans in Hawaii 

nei. 

Thank you. 

[Applause.] 

[The prepared statement of Mr. Sodetani follows:] 

PREPARED STATEMENT OF LLOYD K. SODETANI, COL, USA (RET.), CHAIRMAN, STATE

ADVISORY BOARD, OFFICE OF VETERANS SERVICES

Dear Senator Akaka: Submitted herewith is a copy of a survey that was conducted 

by the Hawaii Health Systems Corporation on the island of Hawaii. The results of 

the survey indicate similar problems and challenges experienced in East Hawaii. It 

confirms that systemic problems exist throughout the State of Hawaii as it was 

voiced during your visit with the Kauai veterans last August, 2009. 

It is the contention of the veteran advocates that multi-service complexes will benefit all users, employees and the community. To continue providing services in the 

current manner would not be in the best interest of veterans, particularly since dissatisfaction continues to grow. By providing a user friendly facility with ample parking, in close proximity to all related services, it will be cost-effective, efficiently operated and achieve greater satisfaction from the veterans. 

It is with sincere appreciation that I express my gratitude to you for having this 

forum. You have provided an immense amount of projects and programs for Hawaii 

and Maui County. For those, we are truly grateful. We continue to ask for your support in our endeavor to have a better quality of life for our veterans in Hawaii nei. 

73 

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Chairman AKAKA. Thank you very much, Lloyd, for your testimony and your concerns, as well as your offerings of how we can 

help to improve the system. 

And now, as you know, this is the time for questions. I have a 

question here for all of the witnesses, so what I will do—you all 


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do not have to answer. I will just go down the line. If you want 

to answer it, please do. And this has to do with the accessibility 

of service. Can you hear me? 

AUDIENCE. We cannot hear. 

Chairman AKAKA. OK. This question has to do with the accessibility of service, and this is for all the witnesses here, and here is 

the question: Do you feel that VA services on Maui are readily 

available to all veterans? And then if not, what improvements do 

you feel are necessary to ensure access to services for all of Maui’s 

veterans? That is the question. Maybe I will just open it to anyone 

who wants to start. Larry Helm? 

Mr. HELM. Mahalo, Senator Akaka. As far as here on Maui, 

there probably could be some improvement, but in my opinion, 10, 

15 years ago there was some. Today there is more. Molokai, 10, 15 

years ago, there was none. Today we have a lot thanks to you. 

Mahalo. 

Of course, there is a lot more to do to improve, and that is why 

we are here, to try to—and if I sound sharp sometimes, E kala mai, 

but I am trying to find the right way and a right day to make it 

better for the veterans. I think dialoguing with guys that use the 

services and being more efficient, more effective, less time-consuming, finding ways to do that would improve accessibility and 

service to the veterans. 

Chairman AKAKA. Mahalo. 

Anyone else? 

Ms. POAIPUNI. I think I would like to answer some of those—— 

Chairman AKAKA. Terry Poaipuni. 

Ms. POAIPUNI [continuing]. Those questions. As far as accessibility to East Maui—and I am saying East Maui because that encompasses Kanaio too. It seems like we are on the flip side of 

Molokai. We used to have services, and I do not mean a lot of services. We had services; now we don’t have any. We have been working—I have been talking with Dr. McNamara and we meet with 

Dr. McNamara and Clay Park, we have been talking about giving 

telecommunication a try to find a solution, anything, so we could 

begin to get more services—or get services into the community. Oftentimes, our veterans of many wars need to take off from their 

work time, and with the cutback of jobs and so forth, that is difficult. So what happens is they have got to come up to Central 

Maui for their appointments. So, it would be nice if someone would 

come to East Maui or Hana or Keanae, and if someone could come 

there it would be a lot easier. That way they could come in and do 

that for us, even via telecommunication. 

You know, we have been without for so long, oftentimes in East 

Maui we feel like we are like Molokai—out of sight, out of mind— 

and we’ve gotten ma‘a (used to it), but we do not want to be in that 

same state of mind. We want to be able to continue getting in because we have a lot of veterans and we need the services. 

Chairman AKAKA. Mahalo. 

Mr. SODETANI. Senator, may I comment on that, please? 

Chairman AKAKA. Yes, Mr. Sodetani. 

Mr. SODETANI. In my recent testimony to you, I addressed part 

of this. I believe that by combining services or jointly providing 

services through the public health clinic, for example—and I beVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00091 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
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lieve General Shinseki also spoke about telemedicine, using 

telemed facilities to be able to do communications, among other 

things. 

The Hana Clinic, for example, can be used as an initial examination station for veterans, and then rather than the veteran coming 

all the way out here to the clinic for initial visits or being sent to 

Tripler, for that matter. I believe that by having a veteran attend 

the facilities at Hana Clinic it would make it more convenient to 

the veteran and also probably make it more efficient and cost-effective as well. 

I believe the Wailuku Clinic that just opened would also be another alternative facility for veterans to attend in the event the VA 

clinic here would not be able to support all of the needs of the veterans. I am sure they have a lot of specialists at the community 

health clinic that can provide additional services to our veterans 

before our veterans are being transported to Tripler. I think we 

should try to avoid that transportation matter as much as possible 

or try to provide a more convenient environment for our veterans 

so that it will be less stressful for them. 

But these are some of the things that I suggested in there, and 

it brought to my mind when I served my last tour at Camp Smith 

in a joint level, that we worked together with Army, Navy, Air 

Force, Marine Corps, and we had to pool our resources in order to 

ensure that we had the best experts and the most cost-effective 

way of operating our mission requirements. 

So, I would like to suggest that Public Health Service clinics 

could be an option for us to consider, especially in these remote 

communities. Thank you. 

[Applause.] 

Chairman AKAKA. Thank you. 

Any other comments? Mitch? Mr. Skaggerberg? 

Mr. SKAGGERBERG. It is amazing how many calls the leaders got 

in the last few months, but one of the big things that we have been 

hearing is that many service-connected veterans are not getting the 

full range of services our VA doctors are prescribing, such as chiropractic and massage. There are a lot of inconsistencies. They are 

very frustrated. They need these services. And we do not know who 

it is, whether it is the Board of Utilization in Honolulu. I know I 

have gone through it before, and a lot of times they say, well, that 

is not really necessary. And they almost—I do not know if they use 

doctors there, but they take our doctors and they override us. I do 

not know if it is money or what, but I know one thing: a lot of service-connected veterans are suffering because of that and they are 

angry. And a lot of these veterans have been serving Maui for 40 

years. 

So, I would ask our VA reps and you to see if they can correct 

that because that denies them access to certain services their doctors want them to have—our doctors. Thank you. 

[Applause.] 

Chairman AKAKA. Mr. Laub? 

Mr. LAUB. Thank you. I want to read part of a letter here that 

came to me from Pastor Daniel Merritt, who is in the back with 

his father. He wrote a letter to the editor because he could not get 

the services that he needed for his father. 

89 

‘‘I want to just first say thank you for responding to my 

letter to the editor regarding care of my veteran father. It 

is very discouraging to have to write such letters, but it 

has become painfully apparent that things like this must 

be done. My name is Pastor Daniel Merritt. I am a pastor 

for the Salvation Army and the chaplain for Maui Community Correctional Center here on Maui. Over the past several months, I have noticed the lack of due care in the 

health practitioners for my father who did two tours in 

Vietnam in the U.S. Marine Corps. My Dad was diagnosed 

with Agent Orange exposure, and as a result, he has leukemia, non-Hodgkin’s lymphoma, and diabetes, along with 

several other crippling diseases.’’ 

‘‘I have called VA on several occasions with concerns regarding my Dad’s health only to get treated with anything 

but respect. I followed up with them for over a month for 

a walker as his feet have become so bad he can barely 

walk. Only after this letter to the editor was he offered a 

diabetes specialist which I have been requesting for 

months. I also asked for an increase of his pain medication, which has never been done. He had to go to a pain 

doctor as the VA would not supply him with adequate 

medication for his pain, which he had to pay for out of his 

pocket. He was prescribed pain patches, shower handles 

for his shower, and hand controls for his car, but I was 

told they were too expensive and the VA would not cover 

them. Can we put a price tag on the vets who fought to 

keep the country the United States of America? Have we 

lost the understanding that without them we would be 

speaking another language?’’ 

‘‘It saddens me to know that I have to call the VA and 

when I ask who I am speaking to, I am told ‘RP 64.’ As 

I was concerned with all these issues, I called the patient 

advocate, Alma, and asked her help regarding the situation and was told, ‘There is nothing to investigate.’ I then 

called the Inspector General, who would only identify himself as ‘RP 64,’ and was told that there was nothing to the 

claim and they refused to investigate.’’ 

‘‘Have we lost our system of checks and balances? These 

are the veterans of the United States military and need to 

be treated as such. On this day, my father is sitting at 

home, alone, in excruciating pain, with no pain pills because he cannot afford to keep purchasing them on his 

own and is waiting for another empty promise from the VA 

that his prescription is in the mail. Why can’t they fill 

them at the VA pharmacy or local drug store? I don’t understand. Today, as the son of a strong man who has been 

reduced to nothing for his country, I am humbly asking for 

your assistance. Pastor Daniel Merritt.’’ 

Chairman AKAKA. Thank you very much, Paul, for your response 

here to the question. 

Any other responses? Rogelio Evangelista. 

Mr. EVANGELISTA. Senator Akaka, due to the economic times, we 

need to honor the veteran because they went out there to do what 

90 

was needed. And if honoring the veteran is just a minute thing 

that we need, we need a VA hospital within the islands that will 

take some of the pressure off, not just with Spark Matsunaga but 

some hospital itself. And the part is we need to lift the restriction 

of the Millennium Act sending the veterans—although they are 

only 10 percent or whatever—send them to get specialized medical 

care also. 

Thank you. 

Chairman AKAKA. Thank you very much, Rogelio Evangelista. 

Are there any other further responses? Before we continue, I 

want to say mahalo to the veterans from Molokai. 

[Applause.] 

Mr. HELM. Thank you, Senator Daniel Akaka. This is a fine time 

for Maui, Molokai, Lanai, with President Paul Laub. The power is 

in the veterans. We form a coalition and get politically active. For 

those who are veteran-friendly get them in, and those who are not 

get them out. 

[Laughter.] 

AUDIENCE MEMBER. Imua! 

Mr. HELM. And that is the direction. I think we have got enough 

numbers there. We have got 12,000. And although we are aware, 

Senator Akaka, we’ll keep you posted. Thank you again. 

Chairman AKAKA. Mahalo. 

[Applause.] 

Mr. HELM. Thank you. I want to invite you guys over to Molokai 

when we have our building dedication, OK? 

Chairman AKAKA. Mahalo. Are there any other responses to that 

question? If not, let me go back particularly to Lloyd Sodetani, because you mentioned and there were some others who mentioned 

it, too. And let me say to Mr. Sodetani that I appreciate the efforts 

you have made to develop a plan to consolidate services for Maui 

veterans. [Applause.] 

And so my question to you, Lloyd, is: How would this improve 

efficiencies and services for veterans? 

Mr. SODETANI. Well, first of all, if you look at the current situation, the parking is inadequate at all three facilities. There is inadequate advertising or ability to locate the facilities. The signage is 

poor, and the locations are not in the best areas for and on behalf 

of veterans. So, physically it becomes a burden for the veterans. 

There are inadequate handicapped stalls in all three locations. 

If you look at the clinic, it is a walk-up or it requires elevator 

services. It is not conducive to serving veterans, especially those 

who are handicapped. The greater majority of them—a whole 

bunch of them are. And so we need to be aware that, you know, 

the ADA requirements should be even more pronounced. We need 

to be sure that our veterans are provided this type of care. 

By consolidating it to one location, we can have in the plan—our 

plan shows 200 parking stalls, and it is all mostly located through 

the buildings so that they will be easily accessible for the veterans. 

We have more than adequate handicapped stalls. It is on a 41⁄2- acre campus that Maui High School is willing to give up so that 

they can also start a program for the students, a health care, social 

services, and community service type of internship that would be 

more acceptable to the student programs there. 

91 

We would also have everything on one level. I am sure everyone—because it is so centralized, all of our veterans will be able 

to locate that facility easily. It can be easily identifiable. It can be 

advertised accordingly. But right now we advertise three different 

locations for veterans services. A guy goes to Wailuku, Ernie’s 

place, and Ernie tells him, No, you are at the wrong location. You 

have got to go down to Kahului. You know, that is demoralizing for 

the veteran. I think that having that one-stop service would eliminate that type of confusion. So these are some of the benefits that 

we would gain from having something like that. 

In addition to that, I know that I received a letter from you with 

regard to this matter early last year when I submitted it to you. 

The concern that you had was the ownership of the land. Well, the 

State owns the land here. The facility would be provided by VA, 

veterans’ facilities, the clinic, Vet Center, et cetera, things that 

would—areas that would be occupied by VA. On the other hand, 

OVS would pay for their own structure or improvements. 

In the National Guard, there is not a problem with ownership of 

land. The State owns the land. The Federal Government pays for 

the armory. And if I recall correctly, and if this system has not 

changed over the years, the building remains under the ownership 

of the National Guard Bureau for 27 years. Thereafter, if the National Guard Bureau wants to turn that building over, they say, 

‘‘We have no further need for this structure,’’ turns it over to the 

State, and just like here at Charlie Company Armory and Wailuku 

Armory, Wailuku Armory has been converted to part of a school. 

Charlie Company Armory is now being used by the Land and Natural Resources’ Enforcement Division. So these are continuous government uses. 

So, the concern that has been expressed—and I believe General 

Shinseki also expressed that—with regard to the ownership of the 

land with a Federal structure on it should not be really a concern 

because we have means of coming to an understanding. We have 

already submitted a draft between the Memorandum of Agreement 

between the Department of Defense, the State Office of Veterans 

Services, and the Department of Education to show that, you know, 

whatever VA needed—30-, 50-, 100-year use of the land—would be 

accommodated. And it would be rent free. There would be no rent 

whatsoever. 

I believe that we are prepared and committed to go forth with 

this project if we can receive the proper funding for it. And I believe that by what we have submitted so far to date, the phasing 

of it would be such that it would not require a total lump sum 

budgeted amount one time. It will be over a period of 3 or 4 years. 

I believe that we, the veterans, would be able to enjoy a facility 

more or better than what we have now. 

Thank you. 

Chairman AKAKA. Thank you very much for that. 

[Applause.] 

Mr. LAUB. May I answer that, sir? 

Chairman AKAKA. Paul Laub. 

Mr. LAUB. Sir, we also need long-term elder care, and this property would provide us with space for that. 

Chairman AKAKA. Thank you. 

92 

Any other comments on—Terry Poaipuni. 

Ms. POAIPUNI. Senator, we talked about accessibility, and another one is, like I mentioned, the ability to fill out the applications; and oftentimes our vets go out to Ernie’s thinking they can 

get the help. He just counsels and the only other one that we know 

of—I just found out—which is Tamicko . I just recently found out 

that Mr. Thompson does it, too. So we need that type of assistance 

for our vets to be helped through that process to understand the 

applications and work with them at that point, because right now 

they are lost and they are confused. They do not know, and then 

when they get the reply, they think that—you know, they stop. It 

is all right for the VA that they do stop, but I think the veterans 

just do not have to and should not give up because they do not understand the system—the process of the application system. 

Chairman AKAKA. Well, mahalo—oh, Mitch Skaggerberg. 

Mr. SKAGGERBERG. One of the things about having a centralized 

location for all the services is being able to attract a lot more veterans. It is going to give them a tremendous visibility in the community and a sense of confidence and comfort when they go there. 

One of the things I think is going to happen, it is going to make 

life a lot easier for them, the VA nurses and doctors, Dr. Hastings, 

the director, because when the veterans do want drugs, they leave 

the clinic denied, they feel, of services they are entitled to. With everything there, they have access to other people in there, like a 

counselor, to say, hey, I am never coming back to the VA. We hear 

this all the time. They can stay on the property and get other help. 

A patient advocate or a counselor solves their problem right there, 

where they go back to the family with some sense of comfort and 

peace. 

The other thing is that it would be a rallying point for all the 

veteran organizations. It will be a place of honor in our community 

and visible; and that will help us get more services from the county 

and other places where veterans are. 

Thank you. 

Chairman AKAKA. Well, mahalo. 

Mr. SODETANI. Senator, I would like to announce that—— 

Chairman AKAKA. Mr. Sodetani. 

Mr. SODETANI [continuing]. If anyone would like to see the site 

plan and aerial photo of what has been done so far, please do not 

hesitate to consult with Mr. Stanley Gima. He has a blown-up aerial photo, I believe, and also the site plan of the proposal. If any 

others would like to discuss it with him or with any of the people 

that I mentioned, including Paul or those who have been involved 

in this project for the longest period of time, I am sure they are 

well versed on what we would like to do. And, please, by all means, 

I am sure that they would welcome your request, Senator. 

Thank you. 

Chairman AKAKA. Thank you very much, Lloyd. 

Now I would like to move to the next question. This question is 

to Mitch Skaggerberg. I have heard from many veterans across Hawaii that there is a need for a full-time veterans counselor at each 

Vet Center to help with, among many issues, the filing of claims 

for compensation. Mitch, why do you feel a full-time benefits counselor at the Maui Vet Center is important? And if he answers that, 

93 

to the rest of the panel, do any of you have any thoughts or opinions on this issue after Mitch is finished with his response? Mitch. 

Mr. SKAGGERBERG. Many Maui veterans—and we have 12,000— 

never apply for compensation, disability, or even the medical benefits. A benefits counselor who has outreach capability will be able 

to adequately let all our veterans know what their entitlements are 

and encourage them to apply for them. 

I think the most important reason why we need a full-time benefits counselor is for years the State did that role, and they did it 

well. But we have quadrupled the number of veterans using veterans care now, which means we have quadrupled the number of 

people that have to fill out applications. They need counseling and 

they need coordination. Here is step one, step two, check into the 

clinic to see your doctor, step three. They cannot come close to 

doing that right now. Joe Thompson was a full-time member of our 

Vet Center for years, and he will be much more valuable, I think, 

in helping us—he comes over, I believe, once a month. And so that 

is the reason why I believe we need a full-time benefits counselor. 

Again, we tried to get another one through the State. Their attitude, by the way, is that that is the VA’s job. And they turned us 

down. I have heard that from the county Mayor. I have heard that 

from the Governor’s office, even the OVS, behind closed doors. 

Really, the VA needs to do that. So, we need tremendous support 

in reaching all those veterans that we need to reach. 

Thank you. 

Chairman AKAKA. Thank you very much. 

Are there any other responses from the panel? Yes, Terry 

Poaipuni. 

Ms. POAIPUNI. Let me say—because I think that is exactly what 

we are trying to mention to you, Senator, because there is a great 

need. I think when we say counselor, maybe there should be a 

counselor/application process officer; and I think a full-time person. 

Right now, as I am looking at Ernie, I see they are the ones that 

do the application work, and other ones do not. And so it is important because what we are doing right now is we are doing that job 

at home. So, I think it is very important that the VA comes to all 

areas and not only Central or Lahaina, but should travel the triisle of these islands. 

Chairman AKAKA. Are there any more responses to that question? 

Mr. SODETANI. Yes, Senator. I would like to respond. 

Chairman AKAKA. Yes, Lloyd Sodetani. 

Mr. SODETANI. You know, Tamicko has been a tireless worker, 

and it is a very thankless job, and she is overwhelmed. And we 

miss you, Terri. In any event, I wanted to state that, you know, one 

solution to this would be to fund it through VA, allocating the 

funds through another position to the State of Hawaii through the 

Department of Defense Office of Veterans Services, and mandating 

that that fund will be for another counselor here. And I think that 

might work. I am not sure how the whole politics of it would be, 

but I would think that if we could have that funding allocated specifically for that position, we would be able to create that position 

here. But it will be funded through the Federal Government providing assistance to Maui County. Hopefully that is the solution. 

94 

Chairman AKAKA. Fine. Well, mahalo nui loa. You know, I want 

to thank all of you on this panel very much for your testimony, for 

your responses, and without question, this is going to be helpful to 

what we are trying to do to improve the accessibility, services, and 

the quality of care for veterans. And this is the reason we are having this hearing. I have got to tell you at this point I am so glad 

we are having this hearing because we have learned a lot. 

So, I want to say mahalo nui loa to all on this panel for what 

you have added to our hearings and to the work that we need to 

do. But I want to take some suggestions from you folks, too, that 

this is something that we all have to work together to do, and I 

really, really appreciate what you have said. And this does not end. 

You can continue to express as we go along, as you have ideas 

about what we need to do. So I want to say mahalo nui loa to all 

of you again for being members of this panel. Thank you. [Applause.] 

And now I would like to invite those who are standing. There are 

seats that are available, or maybe the panelists will be moving— 

and then I would like to welcome the second panel. 

First is Tracey Betts, Honolulu Regional Office Director. 

Next is Sheila Cullen, Director of the Veterans Integrated Service Network 21. She is accompanied by Dr. James Hastings, Director of the VA Pacific Islands Health Care System, and Dr. Darkins 

from VA as well. 

Next we have Linda Halliday, Deputy Assistant Inspector General for Audits and Evaluations for VA’s Office of Inspector General. Ms. Halliday is accompanied by Walter Stucky, who is an 

audit manager in the Seattle Audit Division. 

I want to thank our panelists for being here today, and your full 

testimony will, of course, appear in the record. So, may I ask you, 

Ms. Betts, to proceed with your testimony. Welcome, Ms. Betts. 

STATEMENT OF TRACEY BETTS, DIRECTOR, HONOLULU VA 

REGIONAL OFFICE, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. BETTS. Thank you, Chairman. Chairman Akaka, it is my 

pleasure to be here today to discuss our efforts to meet the needs 

of veterans residing in the Pacific Region. Today I will specifically 

discuss important benefits and outreach services provided to veterans living on Maui. 

The Honolulu Regional Office serves the veteran population in 

Hawaii and the Pacific Region. The Honolulu facility also provides 

outreach to veterans residing in the Insular Islands of the Republic 

of Palau, Federated States of Micronesia, and Republic of the Marshall Islands. 

The Honolulu Regional Office administers the following benefits 

and services: disability compensation; vocational rehabilitation and 

employment assistance; home loan guaranty, specially adapted 

housing grants, and Native American direct home loans; and outreach for all veteran and survivor benefits. Our goal is to deliver 

these benefits and services in a timely, accurate, and compassionate manner. This is accomplished through the administration 

of comprehensive and diverse benefit programs. 

The Honolulu facility is responsible for delivering non-medical 

VA benefits and services to over 118,000 veterans and their famiVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00098 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
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lies. Approximately 19,000 of these veterans receive disability compensation benefits from the Honolulu facility. 

In fiscal year 2009, Honolulu provided more than 5,400 veterans 

with decisions on their disability claims. The Honolulu office conducts an average of 3,000 telephone interviews and 1,300 personal 

interviews per month. In addition, the Honolulu RO conducted 171 

Transitional Assistance Program briefings to approximately 5,000 

servicemembers in Hawaii in fiscal year 2009. 

The Maui Vet Center hosts a traveling veterans service representative from Honolulu to provide services to the veterans living 

on Maui. During fiscal year 2009, 132 veterans personally met with 

the traveling counselor to file claims and obtain information regarding benefits. 

In October 2009, we have implemented a program in which our 

decision review officer hearings are being conducted on all of the 

six Hawaiian Islands, which includes Maui. To date, the Honolulu 

facility has conducted two decision review officer hearings here in 

Maui, and as they are received, they will be conducting more in the 

future. 

The Honolulu Regional Office also has a vocational rehabilitation 

counselor collocated in the Maui Community Based Outpatient 

Clinic. The vocational rehabilitation counselor provides educational 

and vocational counseling to servicemembers, veterans, and eligible 

dependents. The counselor met with 1,276 veterans in fiscal year 

2009 and is currently working with over 100 veterans here on 

Maui. The counselor is also a member of the Maui Veterans Association and attends their regular meetings to provide general vocational rehabilitation and educational information. 

Veterans residing on Maui can receive assistance with their 

claims and benefits information through the nationwide toll-free 

number, which is answered by the Honolulu Regional Office employees. The Honolulu office and the State Office of Veterans Services here on Maui work as partners to ensure that the veterans on 

Maui receive access to all VA benefits for which they are eligible. 

The Native American Direct Loan Program administered by VA 

is very active on Maui, in part because of the temporary increase 

in the maximum guaranty amount, as enacted by Public Law 110– 

389. Another reason for this success is attributable to our ongoing 

partnership with the Department of Hawaiian Homelands. The Department of Hawaiian Homelands serves as our partner in assisting with loan packaging, appraisals, and construction-related inspections, as well as providing crucial communication links between our staff and the veterans that we serve. A Honolulu Regional Office employee in the Loan Guaranty Division travels to 

Maui on a regular basis to assist in servicing Maui loans, meet 

with the Department of Hawaiian Homelands, and conduct 

appraisals. 

I myself am a member of various advisory councils, such as the 

Advisory Board on Veterans Services chaired by the Director of the 

State of Hawaii Office of Veterans Services and the VA Pacific Island Health Care System Advisory Council. Board and council 

members are local veterans and advocates representing their communities from six of the Hawaiian Islands, to include Maui. During 

96 

these meetings, board and council members express concerns, discuss veteran issues and receive general information on VA benefits. 

The Honolulu Regional Office is and remains committed to providing timely benefits and services to the veteran population residing here on Maui. 

Mr. Chairman, this concludes my testimony. I greatly appreciate 

being here today and look forward to answering your questions. 

[The prepared statement of Ms. Betts follows:] 

PREPARED STATEMENT OF TRACEY BETTS, DIRECTOR, HONOLULU VA REGIONAL

OFFICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS

AFFAIRS

Chairman Akaka, it is my pleasure to be here today to discuss our efforts to meet 

the needs of Veterans residing in the Pacific Region. Today I will specifically discuss 

important benefits and outreach services provided to Veterans living on Maui. 

HONOLULU REGIONAL OFFICE

The Honolulu Regional Office (RO) serves the Veteran population in Hawaii and 

the Pacific Region. The Honolulu RO also provides outreach to Veterans residing in 

the Insular Islands of the Republic of Palau, Federated States of Micronesia, and 

Republic of the Marshall Islands. 

The Honolulu RO administers the following benefits and services: 

• Disability Compensation • Vocational Rehabilitation and Employment Assistance • Home Loan Guaranty, Specially Adapted Housing Grants, and Native American 

Direct Home Loans • Outreach for all Veteran and survivor benefits 

Our goal is to deliver these benefits and services in a timely, accurate, and compassionate manner. This is accomplished through the administration of comprehensive and diverse benefit programs. 

The Honolulu RO is responsible for delivering non-medical VA benefits and services to over 118,000 Veterans and their families. Approximately 19,000 of these Veterans receive disability compensation benefits from the Honolulu RO. In fiscal year 

2009, Honolulu provided more than 5,400 Veterans with decisions on their disability 

claims. The Honolulu RO employees conduct an average of 3,000 telephone interviews and 1,300 personal interviews per month. In addition, the Honolulu RO conducted 171 Transitional Assistance Program (TAP) briefings to approximately 5,000 

servicemembers in Hawaii in fiscal year 2009. 

SERVICES ON MAUI

The Maui Vet Center hosts a traveling Veterans Service Representative (VSR) 

from Honolulu to provide services to Veterans living on Maui. During fiscal year 

2009, 132 Veterans personally met with the VSR to file claims and obtain general 

benefit information. 

In October 2009, the Honolulu RO began conducting Decision Review Officer 

(DRO) hearings on six of the Hawaiian Islands, to include Maui. To date, the Honolulu RO has conducted two DRO hearings on Maui. 

The Honolulu RO also has a Vocational Rehabilitation Counselor (VRC) co-located 

in the Maui Community-Based Outpatient Clinic. The VRC provides educational 

and vocational counseling to servicemembers, Veterans, and eligible dependents. 

The VRC met with 1,276 Veterans in fiscal year 2009 and is currently working with 

over 100 Veterans on Maui. The VRC is also a member of the Maui Veterans Association and attends their regular meetings to provide general vocational rehabilitation and educational information. 

Veterans residing on Maui can receive assistance with their claims and benefits 

information through the nationwide toll-free number, which is answered by the 

Honolulu RO. The Honolulu RO and State Office of Veterans Services on Maui work 

as partners to ensure the Veterans on Maui receive access to all VA benefits for 

which they are eligible. 

The Native American Direct Loan Program administered by VA is very active on 

Maui, in part because of the temporary increase in the maximum guaranty amount, 

as enacted by Public Law 110–389. Another reason for this success is attributable 

to our ongoing partnership with the Department of Hawaiian Homelands. The Department of Hawaiian Homelands serves as our partner in assisting with loan packVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00100 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
97 

aging, appraisals, and construction-related inspections, as well as providing crucial 

communication links between our staff and the Veterans we serve. A Honolulu RO 

loan guaranty employee travels to Maui on a regular basis to assist in servicing 

Maui loans, meet with the Department of Hawaiian Homelands, and conduct 

appraisals. 

I participate on various advisory councils, such as the Advisory Board on Veterans 

Services chaired by the Director of the State of Hawaii Office of Veterans Services 

and the VA Pacific Island Healthcare System Advisory Council. Board and Council 

members are local Veterans and advocates representing their communities from six 

of the Hawaiian Islands, to include Maui. During these meetings, board and council 

members express concerns, discuss Veteran issues and receive general information 

on VA benefits. 

CONCLUSION

The Honolulu RO is and remains committed to providing timely benefits and services to the Veteran population residing on Maui. 

Mr. Chairman, this concludes my testimony. I greatly appreciate being here today 

and look forward to answering your questions. 

Chairman AKAKA. Thank you very much, Ms. Betts. 

And now we will receive the testimony of Sheila Cullen. 

STATEMENT OF SHEILA CULLEN, DIRECTOR, VA SIERRA PACIFIC NETWORK (VISN 21), VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. CULLEN. Mr. Chairman, mahalo for the opportunity to appear before you today to discuss the state of VA health care in 

Maui. 

Chairman AKAKA. Thank you for being here. 

Ms. CULLEN. It is a privilege to be here in Maui to speak and 

answer any questions you may have pertaining to the services we 

provide veterans in Maui County. 

First, Mr. Chairman, I would like to thank you for your leadership and advocacy on behalf of veterans. Your vision and support 

have led to an unprecedented level of health care services for veterans, construction of state-of-the-art facilities in Honolulu, and remarkable improvements in access to health care services for veterans residing on the Hawaiian neighbor islands, American Samoa 

and Guam. 

My written statement, which I request be submitted for the 

record, reviews the VA Sierra Pacific Network; provides an overview of the VA Pacific Islands Health Care System; offers information regarding telehealth programs; and discusses the VA clinic in 

Maui, as well as issues of interest to veterans residing in Maui 

County. During my time before you today, I would like to focus on 

what VA is doing to improve services and care for Maui veterans. 

VA operates a community-based outpatient clinic located in 

Kahului and expanded the clinic space by an additional 4,400 

square feet during fiscal year 2008 to a total today of 9,700 square 

feet. Since the hearing you held here 2 years ago, the Maui Clinic 

has recently increased its staffing and currently is authorized to 

have 28 staff at the clinic to provide a broad range of primary care 

and mental health services. 

In fiscal year 2008, the clinic implemented a home-based primary 

care program supported by a nurse practitioner and received over 

a quarter of a million dollars in VA rural health funding this fiscal 

year. 

98 

As you know, Mr. Chairman, Congress has provided several hundred million dollars to VA specifically to enhance mental health 

services. These funds have been used to hire about 35 new mental 

health staff in VA facilities across Hawaii and the Pacific Region, 

including seven staff here at the Maui Clinic. In addition, the Maui 

Vet Center also successfully recently recruited another psychologist. 

VA provides part-time outreach clinics on the islands of Molokai 

and Lanai, and VA Pacific Islands Health Care System is assessing 

options to increase and enhance services in both of those locations. 

The VA Clinic on Molokai is located in shared space near Molokai 

General Hospital and operates two half-day primary clinics per 

week. VA also sends mental health staff from the Maui Clinic to 

Molokai to provide care. 

In addition, VA purchases non-VA care in the community for eligible veterans there. Veterans residing in Molokai also are seen at 

DOD and VA facilities in other locations. 

Since June 2007, a VA primary care provider from Maui and 

more recently, since late fiscal year 2009, a mental health clinical 

nurse specialist travels to Lanai once a month to provide needed 

primary care and mental health services. VA has used space adjacent to the Lanai Community Hospital and last year finalized an 

agreement with the Straub Outpatient Clinic for visiting VA providers to use space and support the clinic there. In addition, VA 

purchases non-VA care in the community and pays beneficiary 

travel for eligible veterans. VA is exploring other options to improve access, including adding an automated pharmacy dispensing 

machine and increasing telehealth capabilities. 

In summary, with your support, Mr. Chairman, and with the 

support of other Members of Congress, VA is providing an unprecedented level of health care services to veterans residing in Hawaii 

and here in Maui. We look forward to a growth of new patients at 

the Maui Clinic, and we will meet the expectations of veterans for 

quality and timeliness of care. 

Again, Mr. Chairman, mahalo for the opportunity to testify at 

this hearing. My colleagues and I would be happy to address any 

questions that you may have for us. Thank you. 

[The prepared statement of Ms. Cullen follows:] 

PREPARED STATEMENT OF MS. SHEILA CULLEN, DIRECTOR, VA SIERRA PACIFIC NETWORK (VISN 21), VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Mr. Chairman and Members of the Committee, Mahalo for the opportunity to appear before you today to discuss the state of VA health care in Maui. It is a privilege 

to be here in Maui to speak and answer any questions you may have pertaining to 

the services we provide Veterans in Maui County. I am accompanied today by Dr. 

James Hastings, Director of the VA Pacific Islands Health Care System (VAPIHCS), 

and Dr. Adam Darkins, Chief Consultant, Care Coordination, Office of Patient Care 

Services, Veterans Health Administration. 

First, Mr. Chairman, I would like to thank you for your leadership and advocacy 

on behalf of our Nation’s Veterans. During your tenure as Ranking Member and 

Chairman of this Committee, you have consistently demonstrated your commitment 

to Veterans by introducing legislation designed to meet the needs of Veterans. As 

I will highlight later, your vision and support have led to an unprecedented level 

of health care services for Veterans, construction of state-of-the-art facilities here in 

Honolulu, and remarkable improvements in access to health care services for Veterans residing on the Hawaiian neighbor islands, American Samoa and Guam. In 

99 

addition, I appreciate your interest in and support of the Department of Veterans 

Affairs (VA). 

Today, I will briefly review the VA Sierra Pacific Network that includes Hawaii 

and the Pacific islands region; provide an overview of the VA Pacific Islands Health 

Care System (VAPIHCS); provide national and local information regarding telehealth programs; discuss the VA clinic in Maui; and highlight issues of particular 

interest to Veterans residing in Maui County, including capacity at the VA clinic 

in Maui and VA services on the nearby islands of Molokai and Lanai. 

VA SIERRA PACIFIC NETWORK (VISN 21)

The VA Sierra Pacific Network (Veterans Integrated Service Network [VISN] 21) 

is one of 21 integrated health care networks in the Veterans Health Administration 

(VHA). The VA Sierra Pacific Network provides services to Veterans residing in Hawaii and the Pacific region (including the Philippines, Guam, American Samoa and 

Commonwealth of the Northern Marianas Islands), northern Nevada, and central/ 

northern California. There were an estimated 1.1 million Veterans living within the 

boundaries of the VA Sierra Pacific Network in Fiscal Year (FY) 2009. 

The VA Sierra Pacific Network includes six major health care systems based in 

Honolulu, HI; Palo Alto, CA; San Francisco, CA; Sacramento, CA; Fresno, CA; and 

Reno, NV, as well as an Independent Outpatient Clinic in Manila, PI. In FY 2009 

the Network provided services to over 250,000 unique Veterans out of 350,000 enrolled Veterans. There were about 2.7 million clinic visits and 28,079 inpatient discharges. The cumulative full-time employment equivalents (FTEE) level was 9,740, 

and the operating budget was about $2.2 billion. 

The VA Sierra Pacific Network is committed to ensuring the care Veterans receive 

is of the highest quality. All six health care systems within the Network have major 

academic affiliations. The Network hosts a significant number of Centers of Excellence in VHA and supports a large and broad research portfolio. It also has expansive and collaborative relationships with the Department of Defense (DOD). The VA 

Sierra Pacific Network has not only exceeded patient satisfaction goals (inpatient 

and outpatient), but its employee satisfaction scores are among the top five Networks for overall job satisfaction in VHA. As reflected in the most recent employee 

satisfaction survey, the Network had the highest scores in VHA in several categories 

including leadership, supervisory support, customer service, conflict resolution, 

praise, and rewards. 

Given the large and diverse geographic nature (i.e. rural or frontier lands and remote islands) of VISN 21, access to care is a priority. In FY 2010, the Network will 

activate nine new sites of care including the Pacific (Hawaii and the Northern Mariana Islands), California, and Nevada. Finally, VISN 21 is proud to operate one of 

four Polytrauma Rehabilitation Centers in VHA dedicated to addressing the clinical 

needs of the most severely injured Veterans. 

VA PACIFIC ISLANDS HEALTH CARE SYSTEM (VAPIHCS)

As noted above, VAPIHCS is one of six major health care systems in VISN 21. 

Dr. James Hastings is the director and a practicing cardiologist at VAPIHCS. 

VAPIHCS is unique in several important aspects: its vast catchment area covers 2.6 

million square-miles (including Hawaii, Guam, American Samoa and Commonwealth of the Northern Marianas); its remote island locations create access challenges; and it enjoys the cultural richness of the Pacific Islands with an ethnically 

diverse patient and staff population. In FY 2009 there were an estimated 118,000 

Veterans living in Hawaii, and at least 10,000 additional Veterans located beyond 

Hawaii in the VAPIHCS catchment area. 

VAPIHCS currently provides care in ten locations, with two more soon to be 

added. Our current facilities include an Ambulatory Care Center (ACC) and a Community Living Center (CLC) on the campus of the Tripler Army Medical Center 

(TAMC) in Honolulu; community-based outpatient clinics (CBOCs) in Lihue (Kauai), 

Kahului (Maui), Kailua-Kona (Hawaii), Hilo (Hawaii), Hagatna (Guam) and Pago 

Pago (American Samoa); and outreach clinics in Molokai and Lanai. Two new facilities planned include a new CBOC to serve Leeward Oahu Veterans (approved in FY 

2008 with an expected opening in late FY 2010) and a new rural outreach clinic in 

Saipan set to open this winter. A mental health provider (psychologist) has begun 

seeing patients part-time in Saipan but the clinic has not yet been activated. The 

inpatient Post Traumatic Stress Disorder (PTSD) residential rehabilitation unit is 

in its interim location on the campus of TAMC, pending construction and activation 

of a new VA-funded facility ($9.56 million), also at TAMC, during FY 2011. 

VAPIHCS is also constructing a new replacement CBOC in Guam that will offer 

expanded capacity. It will be located along the perimeter of the Guam Naval HosVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00103 Fmt 6601 Sfmt 6621 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
100 

pital, and we expect it to open in May 2010. VHA operates a total of six Vet Centers 

in Honolulu, Lihue, Wailuku, Kailua-Kona, Hilo and Guam. These facilities provide 

counseling, psychosocial support, and outreach. A Vet Center staff member was also 

added in American Samoa during FY 2008. 

In FY 2009 VAPIHCS provided services to more than 24,000 Veterans, an increase of five percent from FY 2007. Of these Veterans, 19,000 reside in Hawaii. 

VAPIHCS provided 175,000 outpatient visits during FY 2009. The cumulative 

VAPIHCS FTEE in FY 2009 was 619 employees, with an operating budget increase 

from $139.1 million in FY 2008 to $155.1 million in FY 2009, an increase of 12 

percent. 

VAPIHCS provides or contracts for a comprehensive array of health care services. 

VAPIHCS directly provides primary care, including preventive services and health 

screenings, and mental health services at all locations. VAPIHCS does not operate 

its own acute medical-surgical hospital and as a result faces some challenges in providing specialty services. VAPIHCS has hired specialists in orthopedics, cardiology, 

endocrinology, ophthalmology, nephrology, infectious disease and inpatient medicine 

(‘‘hospitalist’’), and makes use of University of Hawaii faculty to provide specialty 

care services in pulmonary disease, rheumatology, allergy, and hematology in Honolulu and to a lesser extent at CBOCs. Veterans with spinal cord injuries receive care 

from VAPIHCS dedicated staff, which provides a multidisciplinary approach to care. 

The team, located on Oahu, is planning to travel and care for patients on the neighbor islands during FY 2010. Veterans requiring other specialty care continue to be 

referred to DOD and community facilities. 

Inpatient long-term and acute rehabilitation care is available at the Community 

Living Center (CLC). Inpatient mental health services are provided by VA staff on 

a 20 bed ward within TAMC and at the 16 bed Post Traumatic Stress Disorder 

(PTSD) Residential Rehabilitation Program (PRRP). VAPIHCS contracts for care 

with DOD (at TAMC and Guam Naval Hospital) and community facilities for inpatient medical-surgical care. 

NATIONAL AND LOCAL TELEHEALTH PROGRAMS

National Telehealth Programs 

Telehealth involves the use of information and telecommunication technologies as 

a tool in providing health care services when the patient and practitioner are separated by geographical distance. The benefits of telehealth to health care systems include: improving access to care, making specialist services available in rural and remote locations, and supporting patients to live independently in their own homes 

and local communities. Because of the support of telehealth by VA and Congressional leadership, more Veterans are able to realize these benefits. 

Over the past six years telehealth in VA has transitioned from use in a range of 

discrete local projects and programs toward a unified, enterprise level approach that 

provides routine telehealth services that are mission critical to the delivery of care 

to Veterans. In 2009 over 260,000 Veteran patients received care via VA’s telehealth 

programs. Telehealth takes many forms. VA’s enterprise telehealth programs deliver 

care to Veteran patients in their homes via home telehealth; telehealth care is also 

provided in VA medical centers (VAMCs), CBOCs and Vet Centers via clinical 

videoconferencing. In addition, VA routinely exchanges clinical images via ‘‘store 

and forward’’ telehealth. 

I would like to briefly highlight some of the direct benefits these services are providing to Veterans. More than 40,000 Veterans are receiving home-telehealth-based 

care that supports care delivery to them in their own homes. These care coordination/home telehealth (CCHT) services have reduced hospital admissions by 25 percent, hospital stays by 25 percent, and have high levels of patient satisfaction (86 

percent mean score). In 2009 more than 58,000 Veterans received care via clinical 

videoconferencing, the majority receiving mental health care services that reduced 

hospital admissions by 24 percent. In 2009 almost 150,000 Veterans were screened 

to prevent avoidable blindness by VA’s teleretinal imaging programs (CCSF). 

The successful implementation of robust and sustainable telehealth services that 

VA entrusts to provide care to Veteran patients must satisfy stringent clinical, technological and business requirements that ensure they are appropriate, effective and 

cost-effective. These requirements include acceptance by patients and practitioners 

as well as staff training and quality management systems. Mr. Chairman, you and 

the Committee understand how the geography of Hawaii and the Pacific region 

poses particular challenges in implementing telehealth that are not encountered on 

the U.S. mainland. Services to Guam and American Samoa not only need to bridge 

a physical distance of 3,820 and 2,300 miles respectively, they also need to bridge 

between patients and clinical communities that are distant and distinct from one 

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another. Bridging these distances and linking these communities to enable them to 

integrate requires telecommunications bandwidth. VA is currently seeking to embrace Hawaii and the Pacific region within its clinical enterprise video conferencing 

network (CEVN) and in doing simplify the linkage to specialist services from medical center assets on the U.S. mainland. 

VA recognizes the pioneering role that Hawaii and the Pacific region have played 

in the development of telehealth solutions that range from teleretinal imaging to 

home telehealth. These innovations have included partnerships with DOD and the 

University of Hawaii within the collaborative framework of the Pacific Telehealth 

and Technology Hui. VA appreciates the support of Congress in supporting rural 

health initiatives that enable us to focus on extending current enterprise telehealth 

solutions as well as developing new telehealth solutions to serve Veterans, not only 

those in Hawaii and the Pacific region Islands, but also Veterans elsewhere in the 

Nation for whom geographical distance from VA’s physical health care assets presents a challenge to receiving care. In considering future innovation for local and 

enterprise portfolios of telehealth services, VA is looking toward new iterations of 

a familiar technology—the telephone. Currently the telephone has meant that eight 

patients a month from Hawaii and the Pacific region have been able to access VA’s 

suicide hotline and receive support from Canandaigua, New York. The transition of 

health applications onto mobile technologies such as cell phones promises to further 

revolutionize how telehealth can serve Veterans in areas such as Hawaii and the 

Pacific region. 

Mr. Chairman, I used the word Hui earlier. As you know, Hui describes a partnership, a union or a gathering. All health care is ultimately local, and my discussion 

so far has focused on the clinical, technological and business issues of implementing 

telehealth across the VA health care system. My attention will now turn to local 

telehealth initiatives that support Hawaiian Veterans and those living on other Pacific Islands. 

Local Telehealth Programs 

In partnership with DOD, specifically TAMC, VAPIHCS began to develop this capability in 2001 with the support of Senator Daniel K. Inouye. The Hui allows joint 

development of telemedicine technologies for both organizations in the Pacific. This 

partnership has fielded many demonstration projects that have enabled both Departments to develop ongoing telehealth activity for our beneficiaries. 

For VAPIHCS, this partnership allowed us to begin developing telemedicine capabilities in collaboration with the local information technology (IT) department that 

developed the telecommunications network infrastructure and supported the deployment of video teleconferencing to VA CBOCs on the islands of Hawaii, Maui, Kauai, 

Guam, and American Samoa. Connectivity to Molokai and Lanai is also available, 

and we are presently studying connectivity for our newly approved Outreach Clinic 

in Saipan. Additionally, this initial investment allowed the development of procedures, practices, and protocols to support video teleconference clinical visits for primary care, mental health, and subspecialty care. Funds were provided for purchasing telemedicine ‘‘carts’’ that allow the use of peripheral medical equipment 

(stethoscopes, otoscopes, cameras and other attachments), as well as teleretinal imaging equipment to permit screening for diabetic eye disease. Automated Drug Dispensing System (ADDS) machines were installed in CBOCs in 2003 allowing pharmacists in Honolulu to dispense medications and, through the use of video conferencing, to provide medication counseling to Veterans at the time of their clinic visits. The VAPIHCS also began tele-home care projects in 2003 by deploying home 

telemedicine units. This partnership and initial funding has helped us establish a 

foundation of experience upon which we continue to build to enhance the medical 

care provided in our facilities throughout the Pacific Region. Additionally, this early 

experience has allowed our facilities to compete for research dollars to further develop telemedicine and tele-mental health activities. 

The Hui also provided support for TAMC projects, including support for ‘‘store and 

forward’’ telemedicine for adult and pediatric care to the Western Pacific, cardiac 

sonography from TAMC to Guam and Japan, intensive care unit telemetry and consultation from TAMC to Guam Naval Hospital and Korea, speech therapy and other 

projects. 

Beyond the Hui, VAPIHCS and TAMC are working together to develop joint telemedicine capabilities in American Samoa to support co-location of TAMC personnel 

at a VA CBOC. This arrangement would extend clinical expertise from TAMC to 

American Samoa to serve Veterans and active duty servicemembers, as well as 

members of the National Guard and Reserve who have experienced a Traumatic 

Brain Injury (TBI). 

102 

Recently, VA expanded mental health programs, including significant growth in 

tele-mental health activities. VA recruited a clinical psychologist to fill a new position for a dedicated tele-mental health coordinator based in Maui. This new position 

expanded tele-psychology services equitably throughout the CBOC. Additionally, VA 

has begun conducting tele-mental health Compensation and Pension (C&P) examinations to expedite the assessment of Veterans for appropriate benefits. 

During fiscal year (FY) 2009, telehealth has been extremely helpful in delivering 

mental health services and dispensing medications to Veterans. A snapshot of relevant data, current through September 2009, includes: 

• Over 2,500 telehealth patient encounters in VAPIHCS, 1,500 of which were for 

mental health and 52 of which were for mental health C&P evaluations for patients 

in Guam or the Commonwealth of the Northern Mariana Islands; and 

• Over 12,500 prescriptions filled at CBOCs on Kauai, Maui, Hilo, Kona, American Samoa and Guam using Automatic Drug Dispensing System (ADDS) machines. 

VAPIHCS has other Telehealth services that are available to Veterans, including: 

• Clinical Video Telehealth clinics (CVT), which offer 

o Individual and group psychology and psychiatry support; 

o PTSD group research clinic; 

o Individual and family nutrition information; 

o Mental health C&P examinations; 

o Geriatric psychiatry; 

o General surgery and neurosurgery through the San Francisco VAMC; 

o Treatment for spinal cord injury through the Palo Alto VAMC; 

o Wound care; 

o Nephrology care; and 

o Participation in VA’s ‘MOVE!’ (weight loss) program; 

• Care Coordinated Store Forward clinics (CCSF): 

o Teledermatology through the San Francisco VAMC; 

o Teleretinal Imaging; and 

o Care Coordination Home Telehealth, utilizing home telehealth devices to 

support the care of Veteran patients in their own homes on Oahu, Maui and 

Hilo. 

Our expanding and diverse experience with telehealth has provided many ‘‘lessons 

learned’’ to further shape the development of our VAPIHCS Telehealth Program. 

For example, numbers (i.e. encounters) alone do not tell the complete story of how 

technologies may be used to improve the health care of Veterans. In addition to increasing access to specialty services for Veterans, VAPIHCS has found telehealth 

technologies also allow CBOC providers to learn from telemedicine experiences (with 

distant providers), which can improve the skills of local physicians. VAPIHCS continually evaluates the use of telehealth services that are provided to Veterans within our service area and changes the program as necessary to meet the needs of the 

Veterans we serve. There is a new opportunity to expand the use of telehealth as 

we develop new outreach clinics to meet the needs of Veterans in highly rural areas. 

This increased ‘‘hands-on’’ care allows us to pursue new telehealth opportunities 

in even more remote locations to benefit Veterans. We are providing more care in 

the home, using VA’s Care Coordination Home Telehealth (CCHT) protocols. This 

will provide us with patient data and information from the home that can be used 

to maximize our ability to manage medically complex patients in conjunction with 

our chronic disease team to improve the quality of life for Veterans. 

There are some local challenges with telehealth. We are adding additional staff, 

including telehealth nurses, to our sites so our clinics can both provide direct patient care and staff telehealth clinics as well. We anticipate that by this fall, we will 

have sufficient support for telehealth activities at each CBOC in the area. 

This table provides data about telehealth usage in the following facilities: 

Number of Unique Patients by Site 

(VA Pacific Islands Health Care System) 

Facility FY 2008 FY 2009 

Honolulu ................................................................................................................ 74 159 

Maui ...................................................................................................................... 153 287 

Molokai .................................................................................................................. 6 17 

Kauai ..................................................................................................................... 96 124 

Hilo ........................................................................................................................ 66 62 

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Number of Unique Patients by Site 

(VA Pacific Islands Health Care System)—Continued 

Facility FY 2008 FY 2009 

Guam .................................................................................................................... 58 143 

Kona ...................................................................................................................... 17 43

American Samoa ................................................................................................... 14 8 

TOTAL .................................................................................................. 425 669 

The total numbers of VA’s patients using telehealth increased in FY 2009 over 

FY 2008. Some of this change is attributed to additional telehealth nurse positions 

added in FY 2009, and a telehealth Psychologist who serves veterans throughout the 

VA Pacific Islands locations. We anticipate further growth in telehealth in FY 2010 

as additional VA specialty care visits, such as Nephrology, make greater use of the 

capability. 

MAUI CBOC

VA operates a CBOC located in Kahului (203 Ho’ohana, Suite 303, Kahului, HI, 

96732) and expanded the clinic’s space by an additional 4,400 square feet during 

FY 2008 to a total of 9,700 square feet. The building that currently houses the Clinic cannot be certified as having met Federal seismic structural requirements. If the 

current building cannot be modified to meet these requirements, as required by the 

renewal lease process, we will need to identify a new location. VISN 21 and 

VAPIHCS have requested VA Central Office approval to seek an alternate location 

as a contingency should the modifications not be feasible. 

In addition to the CBOC, VA operates on Maui a Vet Center, which is located in 

nearby Wailuku. 

In FY 2009, the Maui CBOC served an estimated island Veteran population of 

9,900 Veterans. Approximately 2,400 Veterans residing on Maui were enrolled for 

care, and 1,749 Veterans received VA care. This is a 21 percent increase over FY 

2007. The market penetration rates for enrollees and users within the Veteran population are 24 percent and 17 percent, respectively. These rates are lower than rates 

elsewhere in Hawaii. In FY 2009 the Maui CBOC recorded 9,976 clinic visits, which 

represent an increasing trend largely attributed to increased capacity and enhanced 

services. 

At the time of the hearing here in August 2007, the Maui CBOC was authorized 

to have 15 FTEE; the Maui CBOC has recently increased its staffing and currently 

is authorized to have 25 staff at the clinic. This includes two full time primary care 

physicians, a physician assistant and a social worker to support primary care services, two psychiatrists, two psychologists (one of whom provides tele-mental health 

services to other CBOCs), one social worker, one clinical nurse specialist, one substance abuse counselor, and one telehealth technician and one administrative officer 

are also available to address Veterans’ mental health needs. This staff provides a 

broad range of primary care and mental health services. In FY 2008 the clinic also 

implemented a Home-Based Primary Care (HBPC) program supported by a nurse 

practitioner. During FY 2010, HBPC will be initiated this month on Molokai, and 

we expect to activate Lanai’s HBPC program later this year. 

The size of the Veteran population and the number of VA patients in Maui limit 

the feasibility of having a large number of medical and surgical specialists based 

in the Maui CBOC. Nonetheless, VA recognizes that some Veterans in Maui County 

have needs beyond primary care and mental health. VAPIHCS provides specialty 

care services at the clinic by sending VA staff from Honolulu and other VA facilities 

in California to the CBOC. Services provided by clinicians traveling to Maui include 

cardiology, gastroenterology, geriatrics, nephrology, neurology, orthopedics and 

rheumatology. If Veterans require services not available at the Ambulatory Care 

Center (ACC) or CLC, VAPIHCS arranges and pays for care at TAMC, local community providers, or VA facilities in California; for those referred to a facility in California, VA can cover the costs of transportation if the veteran is eligible for beneficiary travel. In FY 2009, VA spent over $4 million for non-VA care in the private 

sector (i.e. not including costs at other VA or DOD facilities) for residents of Maui. 

Treatment of many non service-connected Veterans requiring off island referrals 

continues to be a challenge, because VA Beneficiary Travel support is unavailable 

for these patients. The Maui CBOC also utilizes telehealth technologies to provide 

specialty services, as described above. 

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SPECIAL ISSUES

Capacity at Maui CBOC. As noted earlier, in FY 2009 VA provided health care 

services to 1,749 Veterans who reside in Maui. However, market penetration rates 

for enrollees and users suggest there is additional demand for VA health care. 

VAPIHCS has significantly increased the authorized staffing at the Maui CBOC to 

keep pace with the growth in numbers of Veterans seeking care, in particular Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. This population increased from 56 in FY 07 to a cumulative total of 270 unique Veterans at 

the close of FY 09. The Clinic’s two full time VA primary care physicians and one 

full time physician assistant, based upon VA primary care panel size criteria, gives 

the clinic a potential capacity for over 3,000 primary care patients (i.e. 1,200 patients for each full-time physician and 800 for each physician assistant). Even considering the special circumstances at the Maui CBOC (e.g., lack of VA inpatient facility and limited community health care resources on the island), the VA clinic will 

be able to provide high quality and accessible primary care to more than 2,000 patients. 

In addition, during FY 2008, the Maui CBOC began delivering HBPC services for 

Veterans residing in Maui. HBPC is also delivered by VA in Oahu, Kauai and the 

Big Island. HBPC is an important component of VA’s non-institutional long-term 

care program designed to provide care in the least restrictive setting for Veterans. 

Earlier this year, VAPIHCS was approved for $256,000 in rural health funding to 

expand the Maui HBPC program and to begin providing home care services on the 

islands of Lanai and Molokai. VA will add staff to serve these islands, with service 

delivery anticipated this month on Molokai and later this year in Lanai. 

There is also a significant demand for mental health services at the Maui CBOC. 

About 32 percent of all patients currently seen at the clinic have a documented mental health illness (compared to 19 percent for VHA). This includes a high prevalence 

of PTSD. In response to this need, VA has substantially increased its authorized 

mental health capacity at the Maui CBOC. As you know, Mr. Chairman, Congress 

has provided several hundred million dollars to VA to specifically enhance mental 

health services. Since FY 2006, and each subsequent year thereafter, VAPIHCS has 

received nearly $3 million of these funds. These funds have been used to hire about 

35 new mental health staff in VA facilities across Hawaii and the Pacific region, 

including seven staff here at the Maui CBOC. In addition, the Maui Vet Center also 

successfully recruited another psychologist. 

Molokai and Lanai. The islands of Molokai and Lanai are part of Maui County. 

VA provides limited services (i.e. part-time outreach clinics) on these islands with 

permanent staff (on Molokai) and visiting VA staff (to both islands). VAPIHCS is 

assessing options to enhance services in both locations. 

MOLOKAI. VA estimates the Veteran population on Molokai to be 649, with 203 

Veterans from Molokai enrolled for VA care and 150 Veterans receiving VA services. 

VA formally established an outreach clinic on Molokai in FY 2005 with the assistance of you and your staff, Mr. Chairman. The VA clinic on Molokai is located in 

shared space near Molokai General Hospital and operates two half-day primary care 

clinics per week. The clinic is staffed with a part-time VA physician and contract 

support staff. VA has access to videoconferencing equipment at this facility. VA also 

sends mental health staff from the Maui CBOC to Molokai to provide care. The 

Clinic’s psychologist travels twice a month and the psychiatrist once a month. In 

addition, VA purchases non-VA care in the community (e.g., Molokai General Hospital) for eligible Veterans residing in Molokai. Veterans residing in Molokai also 

are seen at DOD and VA facilities in other locations. VA pays for travel expenses 

for those Veterans eligible for beneficiary travel. 

LANAI. VA estimates the Veteran population on Lanai to be 229, with 57 Veterans 

enrolled for VA care, and 30 Veterans receiving VA services. Since June 2007, a VA 

primary care provider from Maui travels to Lanai once a month to provide needed 

primary care services. Additionally, in FY 2009 a Mental Health Clinical Nurse Specialist began accompanying the primary care provider. VA has used space adjacent 

to the Lanai Community Hospital, and most recently finalized an agreement with 

Straub Outpatient Clinic for visiting VA providers to use space and support the 

Clinic. In addition, VA purchases non-VA care in the community and pays beneficiary travel for eligible Veterans. VA is continually exploring other options to improve access. 

CONCLUSION

In summary, with your support, Mr. Chairman, and with the support of other 

Members of Congress, VA is providing an unprecedented level of health care services to Veterans residing in Hawaii and here in Maui. We look forward to a growth 

105 

of new patients at the Maui CBOC and will meet the expectations of Veterans for 

quality and timeliness. 

VAPIHCS still faces several challenges, in part due to the topography of its 

catchment area, the lack of an acute medical-surgical hospital, limited community 

resources in rural areas, and difficulties recruiting staff. VAPIHCS will meet these 

challenges by utilizing telehealth technologies, hiring specialists, working with community partners and developing new delivery models. I am proud of the improvements in VA services in Hawaii, but recognize that our job is not done. 

Again, Mr. Chairman, mahalo for the opportunity to testify at this hearing. My 

colleagues and I would be delighted to address any questions you may have for us. 

Chairman AKAKA. Thank you very much, Ms. Cullen. 

And now we will hear from Linda Halliday. Please proceed with 

your testimony. 

STATEMENT OF LINDA HALLIDAY, DEPUTY ASSISTANT INSPECTOR GENERAL FOR AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF VETERANS AFFAIRS 

Ms. HALLIDAY. Mr. Chairman, thank you for the opportunity to 

testify on the results of our report, ‘‘Review of Availability of Mental Health and Orthopedic Services at the VA Pacific Islands 

Health Care System.’’ Accompanying me today is Mr. Walter 

Stucky, Audit Manager in our Seattle Audit and Evaluations Office 

in the OIG. 

Veterans living on Maui and the other islands face similar issues 

as veterans living in rural communities in obtaining timely access 

to health care services, especially mental health services and specialty care such as orthopedics. Not only has the health care system faced difficulties in providing these services, they have also 

been limited by the short supply of community health providers. 

In early June 2009, we conducted on-site work at the health care 

system’s main ambulatory care center in Honolulu and the Maui 

CBOC. We found that since fiscal year 2006 the health care system 

has made significant strides in reducing wait times for elective orthopedic surgery procedures. Furthermore, although the health 

care system has experienced challenges in providing mental health 

services to veterans on Maui and other islands, it is effectively 

using VA’s Mental Health Enhancement Initiative funding to recruit additional staff and expand telehealth services. 

In 2006, the OIG assessed the timeliness of orthopedic surgeries 

at the health care system. We found that the average wait time for 

elective orthopedic procedures was 182 days with wait times for individual cases ranging between 14 to 379 days. I am happy to say 

our more recent work found significant improvement in elective 

surgery wait times. Both VA and Tripler orthopedic surgeons treat 

health care system patients who require orthopedic care, and the 

surgical procedures are performed at Tripler TAMC by VA and Tripler orthopedic surgeons under an interagency sharing agreement. 

We reviewed 15 elective orthopedic surgeries performed at Tripler in April and May 2009 and found that the time between the 

decision to operate and the surgery date ranged from 11 to 210 

days and averaged 82 days. We attribute the improvements in 

timeliness since 2006 to three factors: 

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Since February 2007, the health care system has hired two orthopedic surgeons. Prior to this, it relied on surgeons from Tripler and 

other VA facilities in the continental United States. 

Tripler dedicated one operating room day each week to VA orthopedic patients, in addition to its normal integrated scheduling of 

VA and Tripler patients for surgery. 

And, third, the health care system and Tripler have improved 

their coordination of orthopedic surgery care. 

In 2007, the State of Hawaii task force reported community 

health resources in Maui were stretched to meet mental health 

needs resulting from veterans returning from Iraq and Afghanistan, an aging population, and prevalent drug use. The health care 

system has also been stretched by the scarcity of mental health resources on Maui. Mental health staff at the Maui CBOC told us 

that they have been meeting emergency needs of patients, but they 

are challenged in ensuring the timely follow-up care due to staff 

shortages. For example, in May 2009, the psychiatrist reported that 

his earliest available follow-up appointment was 7 weeks away. 

Despite these challenges, we found that the health care system 

leadership has been proactive in securing funding through VA’s 

Mental Health Enhancement Initiative to hire additional staff at 

the Maui CBOC and to expand telehealth capabilities to assist 

other CBOCs. In the past year, the health care system has received 

approximately $4.7 million in Mental Health Enhancement Initiative funding and used a portion to hire additional staff. They expect to meet both the urgent and the follow-up mental health care 

needs of veterans served by the Maui Clinic. 

In summary, Mr. Chairman, our review found that the health 

care leadership continues to identify gaps and improve availability 

of orthopedic and mental health services to veterans on Maui and 

other islands. However, as with any rural health care system, VA 

Pacific Islands Health Care System leadership must make difficult 

choices as to how to best use the resources to most effectively meet 

the needs of veterans in a large, geographically diverse area, while 

also addressing difficulties in recruiting qualified health care professionals. 

Mr. Chairman, I thank you for the opportunity today. We would 

be pleased to answer any questions you have. 

[The prepared statement of Ms. Halliday follows:] 

PREPARED STATEMENT OF LINDA HALLIDAY, DEPUTY ASSISTANT INSPECTOR GENERAL, 

AUDITS AND EVALUATIONS, OFFICE OF INSPECTOR GENERAL, U.S. DEPARTMENT OF

VETERANS AFFAIRS

INTRODUCTION

Mr. Chairman and Members of the Committee, Thank you for the opportunity to 

testify today on the availability of mental health and orthopedic services for veterans served by the VA Pacific Islands Health Care System (VAPIHCS), with special emphasis on the Island of Maui. I will focus on the results of our recently issued 

report, Review of Availability of Mental Health and Orthopedic Services at the VA 

Pacific Islands Health Care System (attached). Accompanying me today is Mr. Walter Stucky, Audit Manager, Seattle Audit Operations Division, Office of Inspector 

General (OIG), Department of Veterans Affairs. 

BACKGROUND

Veterans living on Maui and the other Hawaiian islands face similar issues as 

veterans living in rural communities throughout the country obtaining timely access 

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to all services, especially mental health services and specialty care services such as 

orthopedics. Not only has VAPIHCS faced difficulties providing the services, they 

have also been limited by the short supply of community health providers. 

In May 2006, the OIG issued a report titled, Review of Access to Care in the Veterans Health Administration, which included an assessment of the timeliness of orthopedic surgeries at the VAPIHCS. Because no related Veterans Health Administration or other American medical timeliness standards were available at the time, 

the review used a foreign orthopedic surgery timeliness goal of 6 months. This 

standard was based on evidence that suggested that deterioration of patients’ health 

occurs when they wait more than 6 months for joint replacement surgeries. The 

OIG’s review found that the average wait for elective orthopedic procedures at the 

VAPIHCS was 182 days, with wait times for individual cases ranging from 14 to 

379 days. 

In November 2007, a task force commissioned by the State of Hawaii found that 

community mental health resources on Maui were stretched to meet increasing 

mental health needs resulting from veterans returning from Iraq and Afghanistan, 

an aging population, and prevalent drug use. VAPIHCS is also challenged in recruiting staff especially on the outer islands due to the high cost of living, both for 

housing and commodities; high relocation costs; and a cost of living adjustment that 

is not comparable to locality pay rates used in the continental United States and 

is not used in calculating Federal retirement benefits. 

RESULTS

In late May/early June 2009, we conducted onsite work in Honolulu and Maui at 

VAPIHCS, Veterans Integrated Service Network 21, Tripler Army Medical Center 

(TAMC), and the Maui Community Based Outpatient Clinic (CBOC). We interviewed managers and administrative and clinical staff and reviewed scheduling and 

workload data, recruitment information, and other pertinent documents related to 

patient complaints and wait times. We found that: 

• Since fiscal year (FY) 2006, VAPIHCS has made significant strides in reducing 

wait times for elective orthopedic surgery procedures, most notably by hiring two 

orthopedic surgeons. 

• Although VAPIHCS has experienced challenges in providing mental health 

services to veterans on Maui and the other outlying islands, it is effectively using 

VA’s Mental Health Initiative funding to recruit additional staff and expand telehealth services. 

Orthopedic Care 

Our recent work noted significant improvement in elective surgery wait times 

since FY 2006. Both VA and TAMC orthopedic surgeons evaluate and treat 

VAPIHCS patients requiring orthopedic care. Because VAPIHCS is not fully staffed 

or equipped to perform orthopedic surgeries, surgical procedures are performed at 

TAMC by VA and TAMC orthopedic surgeons under an interagency sharing agreement. If TAMC cannot accommodate a VA patient, VAPIHCS Utilization Management staff refers the patient to a community provider on a fee-for-service basis. 

Our discussions with VAPIHCS clinicians and TAMC managers indicated that 

TAMC has sufficient staff and resources to consistently accommodate VA patients 

without significant delays, but that some patients prefer later surgery dates or they 

are not medically ready to undergo surgery on the scheduled dates. Our review of 

15 elective orthopedic surgeries performed at TAMC in April and May 2009 found 

significant improvement in average wait times. The time between the decision to operate and date of surgery ranged from 11 to 210 days and averaged 82 days. We 

attribute the improvement in timeliness to three factors: 

• VAPIHCS officials hired two orthopedic surgeons—one in February 2007 and 

the other in October 2008. Prior to hiring these surgeons, VAPIHCS relied on orthopedic surgeons from TAMC and other VA facilities in the continental United States 

to provide services. With these recruitments, VAPIHCS has established its own orthopedic clinics at both the Ambulatory Care Center and CBOCs. Furthermore, one 

of the orthopedic surgeons also performs surgery at TAMC. 

• TAMC dedicated one operating room day each week to VA orthopedic patients, 

in addition to its normal integrated scheduling of VA and TAMC patients for surgery. 

• VAPIHCS and TAMC have improved their coordination of orthopedic surgery 

care. For example, TAMC provides VAPIHCS monthly reports on availability of 

services and holds monthly coordination meetings with VAPIHCS Utilization Management officials to resolve problems and improve services. In addition, a VAPIHCS 

108 

orthopedic surgery nurse tracks the status of VA patients scheduled for surgery at 

TAMC to ensure patients meet all pre-operative requirements. 

Mental Health 

Mental health staff at the Maui CBOC told us that they have been meeting the 

emergency needs of patients; yet, they continue to acknowledge challenges ensuring 

timely follow-up care due to staff shortages. For example, in May 2009, the psychiatrist reported that his earliest available follow-up appointment was 7 weeks away 

and that he often worked additional hours to see patients. 

Despite these challenges, we found that VAPIHCS leadership has been proactive 

about securing funding through VA’s Mental Health Enhancement Initiative to hire 

additional staff at the Maui CBOC and expand telehealth capabilities to assist other 

CBOCs. In the past year, VAPIHCS has received approximately $4.7 million in 

Mental Health Enhancement Initiative funding and has used a portion of this 

amount to improve the availability of services at the Maui CBOC by hiring additional staff. In February 2009, VAPIHCS officials hired a mental health social worker. In addition, a clinical nurse specialist and a second staff psychiatrist joined the 

CBOC in late July/early August of this year. VAPIHCS leadership and clinicians 

told us that, with this additional staff, they expect to meet both the urgent and follow-up mental health care needs of veterans served by the Maui CBOC. 

SUMMARY

Our review found that VAPIHCS leadership continues to identify gaps and improve availability of orthopedic and mental health services to veterans on Maui and 

the other islands. However, as with any rural health care system, VAPIHCS leadership must make difficult choices as to how best to use its resources to most effectively meet the needs of veterans in a large, geographically diverse area, while also 

addressing difficulties in recruiting qualified health care professionals. 

Mr. Chairman, thank you again for this opportunity. We would be pleased to answer any questions that you or other Members of the Committee may have. 

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Chairman AKAKA. Thank you. Thank you all very much for your 

testimony. Again, I want to thank this panel for bringing us up to 

date and especially what we are anticipating will happen, providing the supports come through. 

Dr. Hastings, I want to pose the first question to you. What is 

the status of the proposal to build a new veterans multi-use building on the campus of the Maui High School? And what is VA’s role 


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in this partnership? And have you heard from the State regarding 

this proposal? 

Dr. HASTINGS. Well, Mr. Chairman, first I want to thank you 

very much for coming out and having this hearing and providing 

all of us with an opportunity to review how we provide services to 

our veterans. This proposal that we heard so much about today we 

have heard of, and we have talked to several of the people that 

have worked on this proposal. The fundamental problem that we 

have is the issue of the Federal Government not being able to build 

on land that it does not own, and it seems that is the core issue 

that we are faced with. And we certainly have talked to the capital 

assets managers of the VA about this proposal. We have looked at 

it, and we have worked with the Vet Center that proposed this. But 

as we understand it right now, the issue is that the VA does not 

have the authority to build on land that it does not own. I think 

that is the fundamental problem. 

Chairman AKAKA. Well, thank you for that technicality. We, of 

course, need to look into that and see what we can do next on this. 

I thank you very much for what you have been trying to do and 

get done, and even to the point of maybe making other suggestions. 

Thank you for your response. 

Ms. Betts, how often does the traveling veterans service representative from Honolulu provide services to veterans living on 

Maui? How often does that happen? How would you characterize 

that representative’s schedule while on Maui? Do veterans seeking 

services from that representative receive them in a timely manner? 

Ms. BETTS. With regards to the traveling schedule of the counselor, currently we have a counselor who travels to every island 

once a month, and they do come on. It is a set schedule, the same 

day of the week every month. The Vet Center hosts the counselor, 

and they take—they actually take appointments, so they know who 

they are coming to see. And they usually come in the morning and 

then leave on the last flight out. And they see all of the people who 

are scheduled for appointments plus walk-ins. 

We also have a program in which the counselor—and it is not always the same one, but a benefit counselor also goes to Molokai 

every other month, and they go to Maui—I mean, to Lanai apparently once a quarter. The counselor is able to assist and provide as 

much information as they can while they are here, and they take 

the information back to Oahu. 

We are currently working on outreach to all of the islands in collaboration with Dr. Hastings and myself. We are working on an 

outreach program to visit each of the islands with an outreach 

team because one of the issues we have, and that is, what is the 

need and what is the veteran population in the areas. What we are 

trying to do in this program—we started this month, in January— 

is to start to get the veterans who are residing in all of these rural 

remote areas to register. We need them to register with the health 

care system so that we can document how many veterans are 

there, and, therefore, we can provide the services for the veteran 

population. Currently, the populations who are registered are a lot 

less than the numbers that people keep putting out to us. Although 

the State has a number of veterans on this island, the number that 

125 

are registered in the VA system are a lot less than what they are 

saying is actually residing. 

So what we are doing is, as far as access to a benefit counselor, 

I work collaboratively also with the State Office of Veterans Services, Mr. Moses, and we are looking at what is needed, and we are 

looking at the possibility of having a full-time counselor here on 

Maui, and that, again, is a collaborative effort with Dr. Hastings 

because he had worked on a program where he would provide the 

actual space, which would be in the CBOC. We are working toward, as we say, the one-stop shop where all of the VA services are 

provided in one area. So, right now we are working with the clinic 

to see when they come up with the space for us, then we will put 

a full-time counselor there. 

Currently, the Vet Center is hosting us. Again, it is an issue of 

space to put a permanent full-time person in. 

Chairman AKAKA. Ms. Betts, as you heard from the first panel, 

some veterans believe that Vet Centers should be staffed with a 

veterans service representative full-time. What is your opinion on 

this matter? 

Ms. BETTS. Currently, where the veteran counselor sits, I do not 

have an opinion on that at this time. My issue is that we get a veteran counselor, and they need to be full-time out here on Maui. At 

this time, just from my exposure to everything, I would say it appears that it would be more beneficial to put a counselor into a 

CBOC. But whether it goes into a Vet Center or a CBOC, I don’t 

have an opinion there. It is just getting the counselor out to—— 

Chairman AKAKA. Thank you very much. 

Ms. Cullen, I understand that some veterans are able to receive 

specialty care through a telehealth link with Palo Alto in California. Are you providing incentives to providers in Palo Alto to 

provide those services to veterans in Hawaii? And if so, what are 

they? 

Ms. CULLEN. Over the last 2 to 3 years, we have moved away 

from the reliance that we had at one point of utilizing clinical providers from both the VA medical centers in Palo Alto and in San 

Francisco. Dr. Hastings has made significant inroads in hiring 

some specialists to be on staff at VA Pacific Islands Health Care 

System. As you heard from part of the IG report, having brought 

on two orthopedists who are now in place in Honolulu, I believe 

that they are now able to provide a lot of the specialty services via 

telehealth. 

I would like to look to Dr. Hastings just to see if we still have 

any regular services via telehealth from California, but I think that 

they are all provided from providers out of Honolulu, a combination 

of telehealth as well as those clinical providers traveling to the 

other islands, though I would turn to Dr. Hastings. 

Chairman AKAKA. Dr. Hastings? 

Dr. HASTINGS. Senator, I would like to tell you that our contact 

with the other facilities in the VISN has been very, very supportive, and whenever we have needed something, they have been 

willing to come and help us. 

The two areas that we are using them extensively right now is— 

I guess there are three areas that we use them. One is spinal cord 

injury patients, paraplegic patients, and we are using facilities at 

126 

Palo Alto telemedicine support there. And then we are using teledermatology where we get dermatology consultations from providers in California, and this is very helpful to us. And then the 

third area that I would tell you about is in electrocardiograms for 

cardiac patients. We have been able to set up a relationship so that 

we have been able to get regions in California to help in that area. 

Now, we are not going to have to use that in the future because 

we have been successfully hiring our own cardiologists, so we will 

not use that one. But, as we identify areas that we feel there is 

something that they can help us with, they have always been very 

responsive to the needs that we identify. 

Thank you, Senator. 

Chairman AKAKA. Thank you. 

Ms. CULLEN. If I can perhaps add, I had a few more thoughts 

since Dr. Hastings began to elaborate. Just to tell you of two developments within VA that will certainly benefit veterans in the Pacific Islands and will benefit them nationally as well. 

One is that within VA there is now a greater incentive to provide 

health care services via telehealth. At one point within VA, its own 

internal reimbursement mechanism did not recognize a cost transfer for services provided by telehealth, and that has been changed 

effective this fiscal year, so I anticipate that will help increase telehealth services nationwide. 

A second development that may be of interest to you is VA’s National Teleradiology Program. That began in California, in Northern California, starting at the San Bruno Clinic, which is linked to 

the San Francisco VA medical center, and transitioning to a larger 

program at Palo Alto. They have now begun a second center here 

in Honolulu and have two to three radiologists on board who are 

available to read radiology films at the facilities that are experiencing either recruitment difficulty with radiologists or who might 

have a temporary problem. 

So, they have already touched based with Dr. Hastings, and I am 

assured that he will have first availability of any services that they 

can provide should he have any need, but I think both of those developments will greatly help provide services to veterans throughout the country. 

Chairman AKAKA. Thank you. 

Also, Dr. Darkins, this relates to you and your work in telemedicine. Please give us an update on how telemedicine is improving 

which might make getting on a plane less necessary. 

Dr. DARKINS. Aloha, Chairman. 

Chairman AKAKA. Aloha. Thank you for being here, Doctor. 

Dr. DARKINS. I would like again, like the others, thank you for 

the opportunity to be here. This meeting and also the one back in 

August really help highlight some of the importance of telehealth, 

so I thank you for that. 

VA really has shown over the last 7 or 8 years a sustained 

growth in telehealth, and we completed fiscal year 2009 with just 

over 260,000 cases nationally, which was up from just over 230,000 

the year before. Of those 260,000 cases, 58,000 were doing videoconferencing with VA medical centers and clinics, and 150,000 were 

providing teleretinal imaging, screening the eyes of veteran patients with diabetes and blindness. And as we sit here, some 41,000 

127 

veteran patients are currently managing to live in their own homes 

independently because of having telehealth devices in their homes. 

We have looked at the benefits of this in terms of the reductions 

of admissions to hospital where the reductions are on the order of 

about 25 percent reductions in the need to go to the hospital. And 

we look across the board at the satisfaction of veteran patients because we are obviously concerned that with changing the location 

of care, this is indeed their preference. We have found very high 

levels of patient satisfaction. So, I think it is good news to be able 

to report that we are seeing a systematic growth year on year, and 

we look forward to the same happening again. 

We have some new programs which we anticipate coming online 

this year. One particularly notable one is going to be the use of the 

weight reduction program, the MOVE program that VA has. It is 

now possible to provide that by telehealth devices. 

I was talking to Dr. Hastings before. This is something in preliminary discussions, but certainly it makes sense to be able to discuss its applicability out in the islands. We are looking at the use 

of Internet protocol video in the home to be able to reach out into 

the home more commonly to provide services. So, we are really seeing, as I said, this kind of sustained growth. 

We are piloting teledermatology. You have heard about its link 

between Northern California and Hawaii. We are looking toward— 

we have piloted it in seven VISNs and are looking toward rolling 

that out more widely. So, I hope to be able to report at the end of 

this next fiscal year further sustained growth. 

The issue very much for telehealth, particularly with regard to 

rural and remote areas, such as—I welcome the opportunity to be 

here and to see many of the issues evolve, though I have been here 

before as well. 

The issue of telehealth is not just about care in the remote areas 

that is important. It is also the access to care from urban areas—— 

I would just like to finish by saying in the end it really comes 

down to peoples and communities. My ability back in August with 

others to go around and see Hawaii, especially on the Big Island, 

and just over yesterday to be here on Maui to see the enthusiasm 

of the staff involved, which I think there are some exemplary services. Having seen Dr. Pierce and what is taking place in telemedical health I think is really something we can work elsewhere. 

So, I must say, I think one can certainly see improvements in 

growth here and seeing the effects of both yourself and Secretary 

Shinseki really focusing on the importance of telehealth. I have had 

some very good discussions with Ms. Cullen and also Dr. Hastings, 

and we look forward to being able to serve more veterans in more 

timely ways in the future. That is really why I am here, and I look 

forward to being able to bring forth some of the ideas we have for 

that benefit. 

Chairman AKAKA. Well, thank you very much, Dr. Darkins. 

Ms. Halliday, are other clinics in the health care system encountering the same challenges that the Maui Clinic has encountered 

serving veterans with mental health care needs? 

Ms. HALLIDAY. We did not specifically review the staffing issues 

outside of Maui. However, we did talk with the health care system 

clinicians and staff and believe that the other CBOCs are experiVerDate Nov 24 2008 20:36 Jun 16, 2010 Jkt 000000 PO 00000 Frm 00131 Fmt 6601 Sfmt 6601 H:\111TH HEARINGS\082509.TXT SVETS PsN: PAULIN
128 

encing similar issues. Some of the common problems include lack 

of community mental health resources, difficulty in recruiting medical providers, and the geographic separation from the main health 

care facility in Honolulu. 

Chairman AKAKA. Ms. Cullen, you are in charge of several large 

VA hospitals and clinics, mostly in California. Would it help if you 

had a Deputy Network Director here in Hawaii? 

Ms. CULLEN. Well, funny you should ask because we will be getting a new Deputy Network Director, but that person will be based 

in Northern California. She will be arriving the beginning of February. And one of the things that we are doing is setting—while 

we are setting some goals for all of our facilities during the course 

of this year, we are also setting some goals for our home office, and 

one that we are assigning to ourselves is to ensure that our VISN 

staff get out to each element of our organization; that is, not just 

the large medical center but to each CBOC, at least one VISN staff 

person would be at each VA site, a VHA site, within the VISN annually. It is not quite the same as having a Deputy Network Director based in Hawaii, but I believe that—but sometimes I think that 

our Hawaii colleagues think they perhaps see a little more of us 

than they would like. 

I come with Jeannie Daily, the quality manager who is with me 

and with our chief medical officer to have regular performance reviews with our facility in Hawaii. And thanks to your invitation in 

August to come to almost all of the islands, and the opportunity 

here today, we feel we see the value in having regular contact with 

each VA location. So while we do not have a staff person—a VISN 

staff person—based here, I think, though you will have to ask 

them, that they perhaps get to see at least as much of us as they 

might like. But, again, I will leave that for them to respond to perhaps after they are on the official record. 

Chairman AKAKA. Yes. [Laughter.] 

Well, thank you very much for that. We look forward and anticipate the best happening here. 

Ms. Betts, I am very pleased to hear that the Native American 

Direct Loan Program is very active on Maui. Will you please tell 

me approximately how many Maui veterans benefited from this 

program in 2009? 

Ms. BETTS. I do not have that number specifically for Maui. I do 

know that we had 121 Native American direct loans for the State 

of Hawaii. 

Chairman AKAKA. Well, you can provide that specific for the 

record. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. DANIEL K. AKAKA

TO TRACEY BETTS, DIRECTOR, HONOLULU VA REGIONAL OFFICE, U.S. DEPARTMENT

OF VETERANS AFFAIRS

Question. Of the 121 Native American direct loans for the State of Hawaii, how 

many are specifically for Maui? 

Response: Nine of the 121 Native American Direct Loans in Hawaii are in Maui. 

Chairman AKAKA. Dr. Hastings, what barriers do you see to expanding telehealth services on Maui? Do you see any barriers, including potentially connecting VA to the community health clinic in 

East Maui? 

129 

Dr. HASTINGS. Thank you, Senator. We have looked at the issue 

of East Maui and are trying to connect with them, and our staff 

people who view telehealth have been over to Maui, have been over 

to Hana, and they have surveyed the equipment and facilities that 

were available over there. At the moment we have—we are unable 

to connect VA equipment with the existing equipment there. 

On the other hand, as we are continuing to explore the expansion 

of this technology in the Pacific, I believe that we will be able to 

figure out how to end up really providing better services there. 

I can tell you that in the Pacific the challenges that we have had 

have been with connectivity growing. Look at American Samoa 

and, more recently, our expansion into Saipan. And, of course, the 

problem of getting into American Samoa was getting cable—getting 

bandwidth—there. It has been within the past year, I believe, that 

we were able to get cable into American Samoa. And what has happened is we now have wide bandwidth connectivity to our clinic 

there, and so we have been able to expand our telehealth connectivity to that area, and we are doing it to support the Department of 

Defense in their TBI evaluations on our Reservists that are in the 

area, as well as for supporting our veterans. 

I think that has not been a problem for us here in Hawaii. I 

think we have adequate bandwidth connectivity capabilities here in 

our clinics, but we have had some problems with equipment, and 

I think we are going to be able to have all of those soon. 

You asked about the things that prevent us from being able to 

exploit this technology. Part of it is just the very system that we 

work in. A lot of our providers—for instance in our fee-based system—they’re people from the university, practitioners in the community, specialists, and we can set up a telemedicine capability 

where we can transmit with an individual, but we also have to 

have—on the other end of the connection—we have to have a provider who is trained, experienced, and willing to use the technology. And if that person does not work full-time for VA, then it 

becomes a little bit of a challenge. 

So, I have been successful, we have been very successful in getting some of these people who are not as familiar with the technology to use it, but we are more successful when we have the specialists inside our own organization. 

Chairman AKAKA. Ms. Halliday, for elective orthopedic surgeries, 

you stated that the wait time was decreased to an average of 82 

days. This still seems excessive given that the time ranged from 11 

to 210 days. What challenges does the health care system continue 

to encounter to ensure timely orthopedic surgeries? 

Ms. HALLIDAY. The 82-day average in our sample included three 

surgeries that were delayed because patients were not healthy 

enough for surgery to be completed. When you factored those three 

instances that the auditors found, the average time would come 

down to 62 days. That is approximately 2 months. 

The main challenges that were brought to our attention were getting the patients ready for surgery, and sometimes their health 

issues—they have to have certain things cleared up before surgery. 

Now that they have a nurse, a VA nurse tracking the patients’ 

needs, it is improving dramatically. I think it is just a matter of 

timing to see an even more significant improvement. 

130 

Chairman AKAKA. Thank you. 

Mr. Stucky, would you like to share more information about the 

waiting times? 

Mr. STUCKY. Sure. There are no VHA or industry standards for 

timeliness of elective orthopedic surgeries. We found that the desired waiting time in scheduling the surgeries varies depending on 

the patient’s medical condition and the patient’s preferences, in addition to some cases where the surgery was scheduled within 60 

days it was delayed either because of the patient’s preference or because the patient was not ready for surgery. 

Chairman AKAKA. Ms. Betts, in his prepared testimony, Mitch 

Skaggerberg of the Vietnam Veterans of Maui County notes that 

requiring Central Office review and approval of applications for 

VA’s Independent Living Services Program results in ‘‘major 

delays, many times up to 2 years.’’ Would you please comment on 

this statement? 

Ms. BETTS. Apparently, there was a time period when the requirement for the Central Office review, as he stated, was an outcome of a site visit, and it was more of an oversight of the program 

itself. That was conducted here in Hawaii. 

Since then, that requirement is no longer in place. Currently, 

there are only four cases pending that have gone up into—and the 

normal process for the Independent Living Program—this is for everyone—is that the counselor once determined through the group 

assessment that the individual is eligible and was put into the 

Independent Living Program, all of that information does go up 

into the Washington office, and it is in our vocational rehabilitation 

and employment service, and they actually do the final approvals 

on all of the cases. 

So, the counselor would not—what was happening before, where 

his statement came from is based on this site visit and an audit 

that was done previously. We were asking him to look at the independent living cases prior to the actual application and the submission of requirement, and I think that is where there is a discrepancy in the understanding of what actually transpired. 

So, currently, there is no specific thing that we do any different 

from any other facility, and it does—and it is just the program 

itself. They do have an oversight, and that oversight does go up 

to—once the counselor puts their program together and everyone 

concurs, I also see it and concur. We do send them up because the 

program reserves the right—and that is at the Central Office 

level—to approve and to review all independent living programs. 

Chairman AKAKA. Would you be able to tell me the national average time to approval for an application for independent living 

services and the average time for approvals in Maui? 

Ms. BETTS. Not at this time. Could I send you that information? 

Chairman AKAKA. Yes, thank you. 

RESPONSE TO REQUEST ARISING DURING THE HEARING BY HON. DANIEL K. AKAKA

TO TRACEY BETTS, DIRECTOR, HONOLULU VA REGIONAL OFFICE, U.S. DEPARTMENT

OF VETERANS AFFAIRS

Question. What is the average time to approve an application for independent living services in Maui and nationwide? 

Response. The average number of days to enter an independent living (IL) program nationally, based on active workload, is 188 days. The average number of days 

131 

to enter an independent living (IL) program for the Honolulu Regional Office, based 

on cases that entered independent living status fiscal year to date, is 415 days. 

The Honolulu Regional Office (RO) faces the unique challenge of serving a vast 

geographic area, which impacts timeliness of VR&E services. The RO’s geographic 

jurisdiction encompasses the following areas: Asia, American Samoa, Guam, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, and 

the Commonwealth of the Northern Mariana Islands. The RO has implemented several initiatives to ensure that IL services are used appropriately and to improve 

timeliness of the development of IL plans. Specifically, the Honolulu VR&E division 

implemented a workload management plan with an emphasis to improve the 

timelines of IL claims. The VR&E division revised the local training program to 

focus on IL planning. In addition, there is a multi-level approval process for all IL 

plans. To that end, the VRC develops the plan, the VR&E Officer reviews the appropriateness of the plan, and then it is forwarded to the Director for final approval. 

The tiered approval process ensures that all plans are developed appropriately. Honolulu has improved timeliness by 24% so far in fiscal year 2010, as a result of these 

initiatives. 

Chairman AKAKA. Now, I have further questions, but I want to 

give each of you a chance to give a summary or a statement that 

you have got to give at this time about what you are doing. And 

I, of course, want to thank you for your responses that you have 

given. It will be helpful for the people of Maui to have heard from 

you what you have done already and what we can probably expect 

to be done. So, if you have a statement you would like to close 

with, I want to give you that opportunity now. 

Let me begin with Ms. Betts. 

Ms. BETTS. Thank you, Chairman. What I would like to say to 

the veterans of Maui is we do have—right now I am working on— 

basically I have three initiatives going. One of them is to increase 

the outreach. I have been hearing this across the State and across 

the Pacific Region because my responsibilities are to deal with the 

benefits. I have been working collaboratively with Dr. Hastings 

from the medical side, and we also work with the Vet Centers as 

well as the Office of Veterans Services from all of Hawaii, American Samoa, and Guam. And what we are looking at is one, to increase our outreach and appearances on every island. The objective 

there is to do just that: to let the veterans know that we are here; 

to hear what they need; and one of our focuses is going to be on 

getting them enrolled. It is very important and they need to understand that. 

I heard the conversation about Hana, and we do not have a benefit counselor who goes to Hana. Those are the kinds of things that 

I need to know about. Those are the kinds of things we need to look 

into, and we are going to start by doing outreach. 

From January to June of this year, we will take an outreach 

team to every island, and that is the kind of thing we are going 

to be looking to address their concerns and to determine if the population there requires not only the benefits but also the medical 

care. So, we need to get everyone to register. It is very important 

that they register with the VA, and the registration is with the VA 

medical centers and the medical clinics. Once we get that, we can 

then do our assessments and put our people out there. 

Another thing is that in working in collaboration with Dr. Hastings and the medical centers, they are planning in their—as they 

are growing, they are planning to have space for a benefit counselor. So, with that commitment, as he grows and as he starts to— 

because currently in the facility they have, there is no extra space 

132 

to put us. But once they do become available, we will be putting 

counselors in those areas. 

In the meantime, what I’m looking at is we have a current counselor who comes once a month, and if it is determined because 

there is a need to have him go out more than once a month, we 

will do that. Right now I am trying to do assessments of what the 

need is, and this is for all of the islands and for all of the Pacific 

Region that we are responsible for. So, that was one thing. 

Another thing is I know there is a lot of conversation about the 

vocational rehabilitation and employment, particularly the Independent Living Program. Just something for more of what is the 

program itself. The Vocational Rehabilitation and Employment Program offers benefits for vocationally rehabilitating veterans for employment. VA has what we call 5 Tracks, and independent living 

is just one of the five tracks available: to try to rehab the veteran 

for employment purposes. In some instances they are not employable; therefore, we work with them. Independent living is just that. 

It is a program that helps them become more independent in their 

daily life. So, it is a program out there. It has not gone away. I 

hear from time to time people asking why did it go away. It has 

not gone away. 

I heard a comment about the dollar value being changed, and 

that has not happened either. It is an entitlement. It is a benefit. 

The purpose of the vocational rehabilitation counselor, who works 

in conjunction with the medical folks, they make the determinations medically and psychologically, where does the veteran sit at 

that time, what is the best program for them. And, again, independent living is just one of many tracks that the rehab-to-employment program takes care of. 

The last thing I would like to say is, again, you know, we are 

out here to service veterans, and the important thing is we need 

to know what—we need to hear from them, but we also need to 

know what is it that we need to do better, and we are working on 

that. It does not happen overnight. Some things take time. Some 

things can happen instantaneously, but a lot of these particular 

issues we are working on. I am hearing them. I am committed to 

improve the services to the veterans. And, again, I must keep saying as we do outreach, they must register with the VA system. 

Chairman AKAKA. Thank you very much, Tracey. 

Dr. Darkins? 

Dr. DARKINS. Thank you very much, Mr. Chairman. It is a privilege to work for the VA and to be able to serve veterans, and that 

is not just as an entitlement, but also our way of life, and as we 

have heard, is dependent upon the service they have given to our 

country. Therefore, the ability to do that and to help serve veterans 

is a great privilege, not just for myself but everybody I work with. 

I look forward—having heard distinctly some of the issues in 

terms of access to care, in terms of how timely that care is, and 

the trouble that will be avoided by telehealth, I think we have one 

of the solutions to some of the problems. I would not suggest that 

telemedicine is going to do everything, but I think there are ways 

it can appreciably enhance services here in Maui. 

I look forward to working with Dr. Hastings, with his staff, and 

Ms. Cullen to see what we can do to be able to address some of 

133 

the issues that we have heard and to deal with those and to come 

back in the future with what we have achieved and solutions and 

to hear that we have met some of these challenges and helped 

them. 

Chairman AKAKA. Thank you very much. 

Ms. Cullen? 

Ms. CULLEN. Thank you, Mr. Chairman. I appreciate hearing 

today from veterans on the first panel their expression that they 

have seen improvements in the services available to the veterans 

in Maui County over the course of the last 2 years. I am very encouraged by their declarations to that effect. 

We have national programs in the VA that you are certainly very 

familiar with which will allow us to provide opportunities to further improve care for veterans in the Pacific Islands—the rural 

health initiative, the women’s health initiative, the telehealth initiative, and Native Hawaiian initiatives. They are all priorities 

that Secretary Shinseki has identified, and our VISN staff will be 

working very closely with Dr. Hastings’ staff to exploit—and I 

mean that in a very positive way—how those programs can further 

benefit veterans in the Pacific Islands. 

I am also very impressed, as I come to each of the communitybased outpatient clinics—and certainly here the last couple of days 

in Maui—with the dedication, the professionalism, the commitment, not to mention the enthusiasm of the VA staff here and their 

willingness to embrace more programs and more opportunities to 

serve the veterans that they have been caring for over the last few 

years. That dedication and enthusiasm is something that I think 

will help us further expand and include services. 

We look forward to the Saipan outreach clinic this fiscal year, 

also the new expanded replacement clinic in Guam, and our own 

collaborations that Dr. Darkins referred to while here have identified some other potential areas for improvement that we need to 

do a little bit more work on. But we certainly look forward to reporting back to you at some point in the future with what those 

improvements will be. 

So, once again, thank you for all of your support and your encouragement to all of us to not settle for improvements that we 

have made, but to realize that there is still a lot more to be done. 

Chairman AKAKA. Thank you. 

Let me call on Ms. Halliday and call on Mr. Stucky and finally 

Dr. Hastings. Ms. Halliday? 

Ms. HALLIDAY. Well, thank you, Senator Akaka, for being so 

proactive and asking the OIG to look at certain accessibility and 

gaps that are occurring out on Maui. 

One of our main concerns was with the performance measure of 

mental health services in wait times to the initial and follow-up appointments. We have found that both the ambulatory care center 

in Honolulu and Maui were meeting this VHA performance measure. What we did see, though, is that the Maui CBOC was experiencing slippage in ensuring timely follow-up for current care. 

VHA does not track this performance. We would encourage VHA 

to track and collect this data so we can see it really truly measure 

whether improvements are happening in the future. 

Chairman AKAKA. Thank you. 

134 

Mr. Stucky? 

Mr. STUCKY. Thank you, Senator. The main focus of our limited 

review of availability of services to the veterans in Hawaii was on 

mental health services. What was clear was that the mental health 

initiative funding has had a significant positive impact on the 

availability of services there. 

Chairman AKAKA. Thank you. 

Dr. Hastings? 

Dr. HASTINGS. Thank you, Senator. I think what you have all 

heard is that the VA has significantly improved its ability to deliver services to our veterans here on Maui, and indeed throughout 

our system. We are not finished. This is a journey that we are on. 

We have come a long ways. 

I have to say that in large part it is support from you and from 

your Committee and from our representatives that has allowed the 

VA to improve the quality of care and the access to our veterans. 

We have a lot of challenges. Developing a complex health care 

system in the isolated areas that we face out here in the Pacific 

is a challenge, and I think that we have a long way to go. I think 

we have some very, very dedicated individuals and have been able 

to recruit more. For us in isolated areas, we have been successful. 

Now, there are areas that we need to improve, clearly. One of the 

ones that you heard today, we all heard today, is the East Maui 

issue. East Maui represents a small pocket of veterans who are in 

a very isolated area with limited resources for health care. We have 

other areas like that, and we have been able to begin to address 

those areas. 

Now, I think we are doing it very successfully. I think you heard 

that today. We have been successful on Molokai. We have been successful on Lanai. We have been successful in American Samoa. We 

have been successful in Guam. We have been successful in Saipan. 

I think we can be successful in East Maui as well. 

It is not something we can do overnight. It is going to take us 

a while to work on the problem, but I think we can be successful. 

And we will use the technologies that we heard about. We will use 

telemedicine, and we will use partnerships with existing health 

care facilities. You know, those are the tools that we end up using. 

We need to use the tools and the people that we have. 

I think there are other areas that we are improving on that are 

not so available, they do not stand out. But we are improving the 

efficiency of our organization. One of them that I would mention 

is laboratory support. We have come a long way in being able to 

get laboratory support for our CBOCs throughout our system in our 

area, and we are going to continue to do that. That is going to improve the ability of our providers to make accurate and rapid decisions about our patients. 

That is not something you measure, but it is there. I saw it today 

in the clinic that I went to. I remember going through that clinic 

2 years ago, and we had a part-time person that was there one half 

or two half-days a week to draw blood, something like that. That 

was it. Today we have a full-time individual in nicely equipped, 

small laboratory, able to do some functions right when the patient 

came in. That improves the quality of care for our patients. They 

were doing that kind of thing. 

135 

We started improving women’s health. We have expanded our 

women’s health clinic. We have brought on some more subspecialists into our system, and we will continue to do that. We will continue to build up that kind of support system that would support 

our whole thing. 

So, I think with the continued support that you have given us 

and that we have gotten from the big VA and from our VISN, all 

the help that we have gotten—and we have gotten help when we 

have asked for it, when we identified problems. We have been able 

to get support. We will continue to be able to improve access and 

quality of care for the veterans in Maui County and throughout the 

Pacific. 

Chairman AKAKA. Thank you very much, Dr. Hastings. 

I want to thank our panelists. We know that there is much to 

be done in order to ensure that veterans on Maui receive VA benefits that they are entitled to. Given Hawaii’s unique features, VA 

must implement its method of delivery of these services in a unique 

way. As Chairman, I am committed to overseeing that all veterans, 

especially those in my home State of Hawaii, receive the highest 

quality of care, and this is also for the rest of our country. 

Again, to all of you, thank you for being here, and at this time 

I would like to adjourn this hearing. This hearing is adjourned. 

[Applause.] 

[Whereupon, at 4:30 p.m., the Committee was adjourned.] 

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