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S. HRG. 112–656

PROGRAMS AND SERVICES FOR NATIVE VETERANS

HEARING

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED TWELFTH CONGRESS

SECOND SESSION

MAY 24, 2012

Printed for the use of the Committee on Indian Affairs

(

(II)

COMMITTEE ON INDIAN AFFAIRS 

DANIEL K. AKAKA, Hawaii, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

DANIEL K. INOUYE, Hawaii 

KENT CONRAD, North Dakota 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

JON TESTER, Montana 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JOHN HOEVEN, North Dakota 

MIKE CRAPO, Idaho 

MIKE JOHANNS, Nebraska 

LORETTA A. TUELL, Majority Staff Director and Chief Counsel 

DAVID A. MULLON JR., Minority Staff Director and Chief Counsel 

(III)

C O N T E N T S 

Page 

Hearing held on May 24, 2012 ............................................................................... 1

Statement of Senator Akaka ................................................................................... 1 

Statement of Senator Barrasso ............................................................................... 2

Statement of Senator Franken ............................................................................... 3

WITNESSES

Birdwell, Stephanie, Director, Office of Tribal Government Relations, U.S. 

Department of Veterans Affairs .......................................................................... 4

Prepared statement .......................................................................................... 6

Burke, Hon. Wayne, Chairman, Pyramid Lake Paiute Tribe .............................. 21

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

Causley, Cheryl A., Chairwoman, National American Indian Housing Council 29

Prepared statement .......................................................................................... 31

Gover, Kevin, Director, National Museum of the American Indian .................... 15

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

Grinnell, Randy, Deputy Director, Indian Health Service, U.S. Department 

of Health and Human Services; accompanied by Dr. Susan Karol, Chief 

Medical Officer ..................................................................................................... 9

Yvette Roubideaux, M.D., M.P.H., Director, Indian Health Service, prepared statement ............................................................................................ 11

Kalipi, D. Noelani, President, TiLeaf Group ......................................................... 33

Prepared statement .......................................................................................... 34

McKaughan, Lt. Col. Kelly, Director, Veterans Advocacy, Choctaw Nation; 

accompanied by Maj. Nathaniel Cox, Director, Choctaw Global Staffing, 

Choctaw Nation .................................................................................................... 26

Prepared statement .......................................................................................... 28

APPENDIX

Adame, Richard Allen, Sergeant First Class, Retired U.S. Army, Prairie Band 

Potawatomi Nation Veteran, prepared statement ............................................. 51

Keel, Jefferson, President, National Congress of American Indians, prepared 

statement .............................................................................................................. 42

Murkowski, Hon. Lisa, U.S. Senator from Alaska, prepared statement ............. 41

Papa Ola Lokahi Native Hawaiian Health Board, prepared statement ............. 47

Response to Written Questions Submitted by Hon. Daniel K. Akaka to: 

Stephanie Birdwell ........................................................................................... 54

Cheryl A. Causley ............................................................................................. 57

Randy Grinnell ................................................................................................. 59

Response to Written Questions Submitted by Hon. John Barrasso to: 

Stephanie Birdwell ........................................................................................... 55

Cheryl A. Causley ............................................................................................. 58

Randy Grinnell ................................................................................................. 59

(1)

PROGRAMS AND SERVICES FOR NATIVE 

VETERANS 

THURSDAY, MAY 24, 2012

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 12:45 p.m. in room 

628, Dirksen Senate Office Building, Hon. Daniel K. Akaka,

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. DANIEL K. AKAKA,

U.S. SENATOR FROM HAWAII 

The CHAIRMAN. I call this hearing of the Committee on Indian 

Affairs to order. 

Aloha and thank you so much for being with us today. 

Before we begin our oversight hearing on the Programs and 

Services for Native Veterans, I would like to ask everyone to please 

for the presentation of the colors and veterans song by Dennis 

Zotigh, Cultural Specialist, at the National Museum of Indians. 

[Presentation.] 

The CHAIRMAN. Thank you very much. 

Carrying the colors today are members of the Lumbee Warriors 

Association, commanded by Staff Sergeant Harold Hunt, U.S. 

Army, Vietnam veteran; carrying the United States flag, Specialist 

Fourth Class James Edward Thomas, U.S. Army, Vietnam-era veteran; and carrying the Lumbee flag, Specialist James Taft Smith, 

U.S. Army, Vietnam veteran. 

Please present the colors. 

[Colors are presented.] 

The CHAIRMAN. Color guards, please proceed to the well and Mr. 

Zotigh will sing the veterans song. 

Mr. ZOTIGH. Thank you very much. 

Preceding this, I would like to say that American Indians have 

always been defenders of our lands, our lives, our families and our 

way of life. We honor our warriors with our songs. At this time, I 

would like to sing the veterans flag song which is analogous to our 

national anthem. 

[Presentation of flag song.] 

The CHAIRMAN. Please retire the colors. 

Please be seated. 

Thank you very much, Dennis Sotigh and the Lumbee Warriors 

Association for that wonderful opening. 

2

It is fitting that we conduct this hearing before Memorial Day in 

remembrance of the service of Native veterans to our country. It 

is important that we as a Nation are meeting our dual responsibility to them as veterans and as indigenous people. 

Native Americans, including American Indians, Alaskan Natives 

and Native Hawaiians, have served in the United States Armed 

Forces with honor for more than 200 years, fighting in the Revolutionary War, the Civil War and the Spanish American War long before they were acknowledged as American Citizens. It is a well 

known fact in this committee that Native Americans have the highest rate of service per capita of any group in the Nation. 

As a Native Hawaiian World War II veteran, I know the great 

sacrifice of leaving your family, your community and your home to 

fight for your country. As you look around this room, you can see 

the faces of the service and the sacrifice and I am humbled to be 

among them. 

The work of the Code Talkers in Wars I and II may well have 

meant the difference between victory and defeat and for many 

years, their contributions went unacknowledged. Still, the bravery 

and dedication of Native servicemen cannot go unnoticed forever. 

Over two dozen American Indians, Alaskan Natives and Native 

Hawaiians have received the Medal of Honor. 

As Chairman of this Committee, it has been my goal to conduct 

oversight in a way that ensures that the United States is meeting 

its unique responsibilities to Native Americans. As a former chairman and a current member of the Veterans Affairs Committee, my 

commitment to the veterans is the same. 

The CHAIRMAN. I am happy that my partner, friend and brother 

here from Wyoming, Vice Chairman Barrasso and I are able to 

work together on this Committee. Vice Chairman Barrasso, would 

you like to make an opening statement? 

STATEMENT OF HON. JOHN BARRASSO,

U.S. SENATOR FROM WYOMING 

Senator BARRASSO. I would, Mr. Chairman. 

Good afternoon and thank you, Mr. Chairman, for holding this 

hearing on Programs and Services for Native American Veterans. 

I especially want to thank you, Mr. Chairman, for your service 

to this country as we head up to Memorial Day. Mr. Chairman, you 

served in the U.S. Army from 1945 to 1947, and you continue to 

serve this country honorably as one of only three U.S. Senators 

today who are World War II veterans, you along with your colleague from your home State, Senator Inouye, as well as Senator 

Lautenberg. Thank you for your service. Thank you for your leadership on veterans’ issues. 

Native Americans have long played a very important role in protecting and preserving our freedoms. As many of you know and the 

Chairman referenced, the Native American Code Talkers, I believe, 

were instrumental. You said it could have been the difference between victory and defeat. I believe they were instrumental during 

both World Wars I and II in defeating the enemy. Indian Code 

Talkers communicated messages across enemy lines. They did it 

using secret codes derived from their Native languages and these 

were never, never deciphered by enemy forces. 

3

American Indians served in every one of our Nation’s wars since 

the Revolutionary War. Many fought for our country before even 

being granted citizenship in 1924. They served in Vietnam, in Iraq, 

in Afghanistan and have sacrificed much for the freedoms of all 

Americans. Indian veterans deserve our gratitude, our respect and 

full access to the services afforded to all other veterans. 

It appears there have been some longstanding challenges with 

Native veterans accessing the benefits they are entitled to. We are 

going to hear more about that today, particularly in regard to 

health services for Native veterans. I would like to hear what the 

Federal agencies are doing to overcome these problems. 

I want to thank all of our witnesses for being here today. I appreciate your accommodating the schedule with a number of Senate 

votes scheduled for later this afternoon and allowing us to move up 

the hearing. I appreciate your providing the Committee with 

thoughtful testimony. 

Thank you again, Mr. Chairman, for your service to this body 

and to our Nation. 

The CHAIRMAN. Thank you very much, Vice Chairman Barrasso. 

Senator Franken, do you have any opening remarks? 

STATEMENT OF HON. AL FRANKEN,

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. Yes. Thank you, Chairman Akaka, for holding 

this very important hearing and for all the work you have done 

over the years on behalf of Native veterans. You are a true leader 

in this Congress’ efforts to improve the lives of Native veterans. 

We owe so much to every veteran who has served our Nation. 

When they return home, they should have at a minimum, a job, a 

home and health care they need. That is equally true for Native 

veterans who serve in our Armed Forces in greater numbers than 

any other group of Americans and have served bravely as the Vice 

Chairman said in every conflict since the Revolutionary War. 

The Native veterans not only share the challenges that other veterans face in getting all they deserve, they also face unique challenges. That is certainly true for the thousands of Native veterans 

in Minnesota. Many of them, all of them live in rural areas which 

makes access to VA’s excellent health care a real challenge. 

I have a bill called the Rural Veterans Health Care Improvement 

Act that I have introduced with Senator Boozman of Arkansas to 

help VA improve access to health care for all rural veterans, including, of course, Native veterans. The bill, which calls on VA’s 

Office of Rural Health to develop a strategic plan so that it better 

uses the substantial resources that Congress has appropriated for 

that office, would have the strategic plan include a solution for better provision of care for Native veterans. 

I have also heard from Minnesotans that Indian veterans suffer 

from a lack of trust in the VA because of a history of poor treatment. I know VA, as well as our outstanding county and Tribal veteran service officers in Minnesota making mighty efforts to overcome that lack of trust, both through consultation, outreach, and 

through practical improvement in provision of services. 

I am looking forward to the hearing today. I don’t want to get 

my first pow wow in Minnesota. The first thing Ms. Jibway, an adVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00007 Fmt 6633 Sfmt 6633 S:\DOCS\76708.TXT JACK
4

visor on my staff, said the opening procession will be led by veterans, by the warriors. I know the honored place that warriors 

have in our Native communities. I honor you as well. Thank you. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you very much, Senator Franken, for your 

opening remarks. 

As Chairman, it is my goal to ensure that we hear from all who 

want to contribute to the discussion. Therefore, the hearing record 

will be open for two weeks from today and I encourage everyone 

to submit your comments and written testimony. 

I want to remind the witnesses to please limit your oral testimony to five minutes. 

Today, serving on our first panel is Ms. Stephanie Birdwell, Director, Office of Tribal Government Relations, U.S. Department of 

Veterans Affairs in Washington, D.C.; Mr. Randy Grinnell, Deputy 

Director, Indian Health Service, U.S. Department of Health and 

Human Services in Rockville, MD, accompanied by Dr. Susan 

Karol, Chief Medical Officer, Indian Health Service; and Mr. Kevin 

Gover, Director, National Museum of the American Indian located 

in Washington, D.C. Welcome to every one of you. 

Ms. Birdwell, please proceed with your testimony. 

STATEMENT OF STEPHANIE BIRDWELL, DIRECTOR, OFFICE 

OF TRIBAL GOVERNMENT RELATIONS, U.S. DEPARTMENT OF 

VETERANS AFFAIRS 

Ms. BIRDWELL. Good afternoon, Chairman Akaka, Vice Chairman 

Barrasso and members of the Committee. 

Thank you for inviting me to discuss the Department of Veterans 

Affairs programs and services for Native American veterans. 

On November 5, 2009, President Obama signed a memorandum 

on Tribal consultation pronouncing Tribal consultation a critical ingredient of a sound and productive Federal/Tribal relationship. As 

part of the strategy to realize the President’s vision of regular and 

meaningful consultation and collaboration with Tribal officials, VA 

created the Office of Tribal Government Relations and I was appointed as the Director of this new office last year. 

Guided by the Tribal Consultation Policy signed by Secretary 

Shinseki in February of 2011, our office has been charged with developing partnerships with American Indian and Alaskan Native 

Tribal governments for the purpose of enhancing access to services 

and benefits for Native veterans. 

Meaningful consultation is vital if we are to effectively address 

the unique needs of Native American veterans. Trust is the 

singlemost important aspect in our relationship with the Tribes 

and Native American veterans. VA’s goal is to earn the trust of 

Tribal leaders and Native American veterans through consistent 

outreach and an open door policy. 

As an enrolled member of the Cherokee Nation of Oklahoma with 

over 15 years of experience in Indian affairs, I know it will take 

time but I believe it is a goal we can achieve. Serving both Indian 

country and our Nation’s heroes is both a professional and deeply 

personal calling. 

With an estimated 383,000 Native American veterans and 556 

federally-recognized Tribal entities, there is much work to be done. 

5

VA is embarking on a robust outreach and consultation effort that 

will focus on listening, aiding and advocating. Listening includes 

receiving communications through email, phone and social media 

tools but we believe the best way to create lasting bonds of trust 

is to meet with Tribal leaders in their communities. VA has held 

listening sessions in Alaska, Montana, North Dakota and New 

Mexico. 

While we area in the communities, we are aiding and training 

Native American veterans. For example, VA staff have trained 

Tribal veteran representatives in Montana and Alaska and provided technical assistance to Native Americans seeking home loans 

during recent gatherings of northwest Tribal leaders and veterans 

in Spokane, Washington; Washington, D.C.; Minneapolis, Minnesota; and Albuquerque, New Mexico. 

Outreach and consultation is a vital tool that provides opportunities to increase Native American veteran enrollment in VA’s health 

care system, educate veterans about benefits for which they may 

be eligible and connect them with online resources such as 

eBenefits and MyHealtheVet. 

We are working with the Veterans Health Administration to enhance access to health care in several ways. First, we facilitate 

technical assistance and assure best practices with the Indian 

Health Service as part of our effort to implement the Memorandum 

of Understanding between the VA and IHS. My office’s role is to 

ensure Tribal concerns are heard and considered. To this end, we 

will hold annual listening sessions in addition to formal consultation to obtain recommendations, hear local priorities and advocate 

the Tribe’s perspectives on practices that will improve access to 

care. 

Additionally, we have entered agreements with Tribal health 

programs in Alaska under which VA will reimburse Alaska Tribal 

health programs for direct services provided to eligible veterans. 

These agreements will strength both the VA and Tribal health program systems to increase access to care for Native and non-Native 

veterans, particularly those in remote and rural areas served by 

Alaska Tribal health programs. Special recognition goes to our 

partners at IHS and Tribal leaders in our ongoing work to establish a national agreement with IHS and the efforts in Alaska. 

The VA also offers a wide range of benefits for eligible veterans 

such as compensation and pension, employment services and the 

post-9/11 GI bill, to name a few. VA can and will do more to increase access to and utilization of established benefits that veterans have earned. 

For example, recent changes to the post-9/11 GI bill program illustrate the need for a direct link to Indian country. We are using 

every avenue available to ensure that veterans know how changes 

to this program will directly affect them and my office will be a 

vital resource for Tribal leaders and a conduit for feedback to VA. 

I am hopeful that our efforts will increase utilization rates for 

the Native American Direct Loan Program, a vital tool in VA’s efforts to provide housing options for Native American veterans. 

We are committed to building a relationship with Tribal leaders 

built on a culture of trust and respect to increase to care and utiliVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00009 Fmt 6633 Sfmt 6633 S:\DOCS\76708.TXT JACK
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zation of benefits. We see a bright future but there is still much 

to be done. 

I look forward to answering any questions you may have. 

[The prepared statement of Ms. Birdwell follows:]

PREPARED STATEMENT OF STEPHANIE BIRDWELL, DIRECTOR, OFFICE OF TRIBAL

GOVERNMENT RELATIONS, U.S. DEPARTMENT OF VETERANS AFFAIRS

Introduction 

Good afternoon, Chairman Akaka and members of the committee, I appreciate the 

opportunity to discuss the Department of Veterans Affairs’ (VA) programs and services for Native Veterans. 

On November 5, 2009, President Obama signed a Presidential Memorandum directing all U.S. Government agencies to develop detailed plans to fully implement 

the Executive Order 13175, ‘‘Consultation and Coordination With Indian Tribal Governments.’’ The President described tribal consultation as ‘‘a critical ingredient of 

a sound and productive Federal-Tribal relationship.’’

In signing the Presidential Memorandum, the President set a standard of action 

to which he expects his Administration to be held, and we are being challenged to 

meet that standard. As such, VA created the Office of Tribal Government Relations 

(OTGR) and I was hired as the Director of the Office last year. In August 2011, VA 

hired four Tribal Government Relations Specialists to manage a portfolio of relationships with tribal governments within specific regions across the country. These specialists serve as a resource to tribal governments seeking to engage in productive 

relationships with VA. 

Guided by the VA’s Tribal Consultation Policy, signed by Secretary Shinseki in 

February 2011, OTGR has been charged to develop partnerships with American Indian and Alaska Native Tribal governments to enhance access to services and benefits for Native Veterans. VA must build and maintain lasting bonds with Tribal 

leaders and Native American Veterans. Toward this end, meaningful consultation 

is absolutely vital if we are to effectively address the unique needs of Native American Veterans. 

Trust is the single most important aspect in our relationship with the Tribes and 

Native American Veterans. VA is working to earn the trust of Tribal leaders and 

Native American Veterans through consistent outreach and an open door policy. As 

an enrolled member of the Cherokee Nation of Oklahoma with over 15 years experience in Indian Affairs, I know it will take time, but I believe it is a goal VA will 

achieve. Serving both Indian Country and our Nation’s heroes is both a professional 

and deeply personal calling. 

Outreach and Consultation 

Within VA, OTGR serves as an entry point for American Indian and Alaskan Native Tribal Government concerns. With an estimated 383,000 Native American Veterans and 566 federally-recognized tribal governments, there is much work to be 

done. VA is embarking on a robust outreach and consultation effort that consists 

of three pillars: listening, aiding, and advocating. 

While listening includes receiving communications from Tribal leaders through email, phone, and social media tools, we believe the best way to create lasting bonds 

of trust is to meet with Tribal leaders and Native American Veterans in their communities. VA held listening sessions in Bethel, Alaska; Billings, Montana; Bismarck, 

North Dakota; and Albuquerque, New Mexico. OTGR has participated in conferences in Arizona, Montana, Idaho, Texas, Wisconsin, Oklahoma, and Washington. 

During April 2012, OTGR held four regional meetings throughout Indian Country 

with Tribes in an effort to facilitate discussions about increasing access to 

healthcare and benefits through informative presentations and interactive discussions about VA’s efforts to reach Veterans in Indian Country. VA has also conducted 

site visits to key locations that deliver services to Native American Veterans, including the Consolidated Mail Outpatient Pharmacy in Leavenworth, Kansas, and Tribal courts in Navajo Nation, Hopi and Laguna Pueblo Tribes, and Tribal communities 

in South Dakota. OTGR is very grateful for the vast cooperation each of these 

Tribes has provided. Without this support, it would be difficult for OTGR to understand the challenges Native American Veterans are facing. Maintaining an aggressive outreach schedule to increase the number of American Indian and Alaska Native Tribal governments with which we are building relationships remains paramount. 

VA also provides training and assistance to Native American Veterans. For example, VA provided technical assistance to Native American Veterans seeking home 

7

loans during the recent meeting held in April. Our outreach provides a unique opportunity to deliver technical information to Native American Veterans. OTGR has 

sponsored outreach booths at the National Congress of American Indians annual 

convention, Gathering of Nations Pow-Wow, and Indian Health Service Self-Governance Conference, and will host a booth at the upcoming National Indian Health 

Board annual consumer conference. Officials can leverage these opportunities to increase Native American Veteran enrollment in VA’s health care system, educate 

Veterans about benefits for which they may be eligible, and connect them with online resources such as eBenefits and My HealtheVet. Every encounter with Tribal 

leaders and Veterans in Indian Country is an opportunity to make a difference in 

a Veteran’s life. 

OTGR is also advocating for Tribal governments. The Secretary of VA is committed to conducting meaningful consultation with Tribes; this means transforming 

words into action. VA conducted its first Tribal consultation in April 2012 in Washington, DC. Three more Tribal consultation sessions are scheduled in fiscal year 

(FY) 2012 for Alaska, Nebraska and Colorado. Tribal leaders will have an opportunity to voice their concerns on issues that affect the well being of Veterans and 

their families. With a direct link to the Tribes through OTGR, we will be able to 

address their concerns before new policies and procedures are implemented. OTGR 

is already serving as a vital intergovernmental link for VA’s health, benefits, and 

memorial programs. 

Sustainable Economic Opportunities 

The VA mission to ‘‘care for him who shall have borne the battle, and for his 

widow, and his orphan’’ extends to all Veterans, but VA officials understand that 

Veterans in Indian Country face unique challenges. My office works closely with the 

Veterans Benefits Administration (VBA) to address systemic economic issues within 

Tribal communities. VA can and will do more to increase access to and utilization 

of established benefits such as compensation and pension, vocational rehabilitation 

and employment services, and Post-9/11 GI Bill and other education benefits. Recent 

changes to the Post-9/11 GI Bill program illustrate the need for a direct link to Indian Country. We are using every avenue available to us to ensure that Veterans 

know how changes to that program will directly affect them, and OTGR will be a 

vital resource for Tribal leaders and a conduit for feedback. 

One area that VA believes deserves special attention is the Native American Direct Loan Program (NADL), a vital tool in VA’s efforts to provide housing options 

for Native American Veterans. NADL is available for Native American Veterans, 

and for qualified non-Native American Veterans who are married to Native American spouses, to purchase, construct or improve a home on trust land or to refinance 

an existing NADL at a lower interest rate. OTGR is working with VBA to increase 

VA’s efforts in Indian Country and Alaska to educate eligible Veterans about this 

important program. Our goal is to make sure every eligible Veteran understands the 

value of the NADL benefit as a long-term housing solution. 

OTGR will also work with Tribal leaders to address burial and memorial issues. 

On August 15, 2011, the Secretary approved the VA’s first grant to establish a Veterans cemetery on Tribal trust land, as authorized in Public Law No. 109–461 (Dec. 

22, 206). In FY 2011, VA made the first three Tribal Veterans cemetery grants. The 

Rosebud Sioux Tribe was awarded $6.9 million and the Yurok Tribe was awarded 

$3.3 million to establish new Tribal Veterans’ cemeteries, and the Pascua Yaqui 

Tribe was awarded $323 thousand to complete renovations to an existing cemetery. 

VA must measure our progress and hold ourselves to a high standard of achievement if we are to accomplish our goals. This starts with compiling recommendations 

from Tribal leaders and tracking these action items to completion. VA does not 

promise that every recommendation received will be adopted, but we do commit to 

ensuring Tribal leaders’ and Veterans’ voices are heard and considered. A stronger 

relationship between the Tribes and VA will lead to better results and outcomes for 

Native American Veterans. 

Collaboration with Indian Health Service (IHS) 

On October 1, 2010, VA and IHS signed an updated Memorandum of Understanding (MOU). The Memorandum’s principal goals are for VA and IHS to promote 

patient-centered collaborations in consultation with Tribes. Although national in 

scope, the MOU provides the necessary flexibility to tailor programs through local 

implementation. VA leadership believes that by bringing together the strengths and 

resources of each organization, we will improve the health status of American Indian and Alaska Native Veterans. 

VA and IHS staff have been working together to develop specific recommendations 

and action items related to the MOU. This work has been focused on areas such 

8

as services and benefits, coordination of care, health information technology, implementation of new technologies, payment and reimbursement, sharing of services, 

cultural competency and awareness, training and recruitment, and others. VA and 

IHS have made progress in many of these areas, and will continue to monitor 

progress through periodic meetings and quarterly updates to VA and IHS leadership. 

Most recently, VA and IHS produced a proposed draft agreement that sets forth 

the underlying terms and conditions for reimbursement by VA to IHS and Tribal 

health facilities for direct care services provided by IHS and tribal health facilities 

to eligible American Indian and Alaska Native Veterans. The proposed draft agreement, which was released for tribal consultation in April 2012, calls for demonstration sites; defines the eligible service populations and reimbursable services; discusses quality, payment methodologies, and claims submission; and includes appeals 

processes, confidentiality of health information, and information security. After tribal consultation, VA and IHS will make any needed revisions to the proposed draft 

agreement and design an implementation plan that will allow all parties to move 

forward expeditiously while having an opportunity to work through issues that may 

arise. 

Collaboration with American Indian and Alaska Native Tribes 

On a separate but parallel track, and consistent with the Administration’s goal 

to increase access to care for Veterans, the Alaska VA Healthcare System negotiated 

and entered into agreements with Tribal Health Programs in Alaska under which 

Alaska VA will reimburse Alaska Tribal Health Programs (ATHP) for direct care 

services provided to eligible Veterans. These agreements will strengthen both the 

VA and Alaska Tribal Health Program systems to increase access to care for Native 

and non-Native Veterans particularly those in remote and rural areas served by 

Alaska Tribal Health Programs. 

The effort to establish this agreement began one year ago following Secretary 

Shinseki’s visit to Alaska. Since that time, the Alaska VA and the Alaska Tribal 

Health Program organizations have met on a regular basis to craft the agreement. 

We are now scheduling briefings to Tribal Leaders about VA health care eligibility 

and enrollment requirements. Additionally, the Alaska VA is coordinating training 

sessions for Alaska Tribal Health Program staff on VA benefits and eligibility and 

enrollment processes to encourage and facilitate enrollment of eligible Veterans into 

VA’s system. Special recognition goes out to our partners at IHS and Tribal Leaders 

as our ongoing work to establish a national underlying agreement with IHS informed the efforts in Alaska. 

To address substance abuse and mental health issues among Veterans, VA has 

worked with Veterans Treatment Courts across the country. These Courts identify 

treatment options for many of our Veterans with substance use disorders or mental 

health conditions. OTGR is working with VHA to create a Veterans Treatment 

Court ‘‘How To’’ guide to help identify and link Native American Veterans involved 

with the criminal justice system with VA resources and other providers as an alternative to incarceration. The anticipated release of this guide is scheduled for September 2012. Our goal is to provide Tribal governments the resources they need to 

incorporate, at their discretion, elements of the Veterans Treatment Court model 

that may promote healing in their communities. This model may not work for every 

Tribal justice system, but these practices generally are consistent with the holistic 

approach to criminal justice practiced by many tribal justice systems and may be 

a valuable tool at their disposal. Local circumstances will help define our ability to 

implement many of these best practices, but we must learn from our experiences 

and leverage our successes. 

Conclusion 

Secretary Shinseki’s leadership has enabled VA to move forward with developing 

partnerships with Tribal Governments to enhance access to services and benefits for 

American Indian and Alaska Natives. VA provides high quality care and services 

to Native American Veterans and our partnerships with both IHS and Tribes will 

enhance our ability to provide care closer to home. We can and will do more to increase access to and utilization of benefits such as compensation and pension, vocational rehabilitation and employment services, and Post-9/11 GI Bill and other education benefits that they have earned. Additionally, we are pleased to have been 

able to move forward with the first grants for tribal cemeteries in 2011 and look 

forward to increase outreach for this program. 

We see a future where American Indian and Alaska Native Tribal governments 

view VA as an organization of integrity that advocates on behalf of Native American 

Veterans for their needs. We see a future where VA demonstrates its commitment 

9

to Native American Veterans by being culturally competent, respecting the unique 

sovereign status of Tribes, and reaching out to Veterans in their communities. We 

are committed to building relationships with Tribal leaders built on a culture of 

trust and respect. We see a bright future, but there is still much to be done. 

Thank you again for the opportunity to discuss VA’s programs and services for 

American Indians and Alaska Natives. I look forward to answering any questions 

you may have.

The CHAIRMAN. Mr. Grinnell, please proceed with your testimony. 

STATEMENT OF RANDY GRINNELL, DEPUTY DIRECTOR,

INDIAN HEALTH SERVICE, U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES; ACCOMPANIED BY DR. SUSAN 

KAROL, CHIEF MEDICAL OFFICER 

Mr. GRINNELL. Thank you, Mr. Chairman and members of the 

Committee. 

Good afternoon, I am Randy Grinnell, Deputy Director, Indian 

Health Service. I am accompanied by Dr. Susan Karol our Chief 

Medical Officer. 

Dr. Roubideaux has laryngitis today and she is very sorry that 

she is unable to attend. I am here to testify on behalf of IHS and 

programs and services for Native American veterans. 

American Indian and Alaska Native veterans may be eligible for 

health care services from both the IHS and the Department of Veterans Affairs. The IHS patient registration system documents approximately 45,000 veterans have received care in our system of 

IHS, Tribal and urban Indian health programs. 

American Indian and Alaska Native veterans have told us they 

want better coordination of services between VA and IHS. IHS is 

primarily a rural health system. Therefore, in some locations our 

facilities may be some distance from VA facilities. In addition, the 

eligibility rules for IHS and VA health care services differ which 

may cause confusion about coverage for services. 

For some American Indian and Alaska Native veterans navigating the two health care systems may prevent optimal use of 

health services for which they are eligible. VA and IHS will continue to work together to address the input we receive from Tribes 

and to improve services. We are making progress. 

The Department of Health & Human Services, IHS and VA have 

made progress in developing a draft agreement to facilitate VA reimbursement for direct care services for eligible American Indian 

and Alaska Native veterans by IHS and participating Tribal programs. 

IHS and VA initiated consultation on March 5 of this year to request input from Tribes on the main points of this agreement. IHS 

and VA also held a consultation session at the IHS Tribal Consultation Summit on March 13 here in Washington, D.C. On April 

5, IHS and VA sent a letter to Tribes with the draft reimbursement 

agreement and requested input. 

The draft agreement focused on reimbursement for direct care 

services provided to veterans at IHS and participating Tribal facilities. IHS and VA proposed that implementation of these agreements begin with a demonstration project to be followed by national implementation. Tribes were asked to provide written comments on the draft agreement and recommendations for the demVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00013 Fmt 6633 Sfmt 6601 S:\DOCS\76708.TXT JACK
10

onstration project. The deadline has been extended to May 25 of 

this week. 

The national draft agreement also informed the recently signed 

agreements between VA and the Alaska Tribal Health Programs. 

IHS has a unique government-to-government relationship with 

Tribal governments and is committed to regular and meaningful 

consultation and collaboration. Comments from Tribes include requests to include specific types of services in the agreement, questions about timelines and process, and comments about reimbursements and copays. 

IHS and VA are reviewing Tribal input and plan to proceed soon 

on the demonstration and national implementation of the reimbursement agreement. 

In 2010, MOU between IHS and VA was renewed and signed to 

establish coordination, collaboration and resource-sharing between 

the two departments. It builds upon decades of successful collaboration. The MOU provides a framework for a broad range of IHS 

and VA collaboration at the local level by IHS area offices and 

Tribal health programs with the Veterans Health Administration. 

The MOU recognizes the importance of a coordinated and cohesive effort of national scope while acknowledging local adaptation 

to meet the needs of individual Tribes and communities. IHS and 

VA have consulted with Tribes on priorities for implementation of 

this MOU. 

The MOU sets five mutual goals for serving veterans: increasing 

access to and improving the quality of care; promoting patient-centered collaboration and facilitating communication; establishing 

consultation with Tribes, effective partnerships and sharing agreements; and ensuring appropriate resources are identified and improving health promotion and disease prevention services. 

To further these goals, IHS and VA actively collaborate and coordinate activities across several broad areas. Our written testimony cites several of these examples. 

In addition to our collaboration work with VA at the national 

level, the Director has instructed all of our area directors to meet 

with the VA’s Veterans Integrated Services Networks in their areas 

and to consult with Tribes. We have included this work in partnership with the VISNs and Tribes at the local levels to improve the 

coordinated provision of health services to the veterans. It is also 

part of their performance contracts. Several new collaborative efforts have emerged from these partnerships and are detailed in our 

written testimony. 

In summary, the MOU has facilitated collaboration at the national, regional and local levels with the goal of providing quality 

access to care for veterans. The reimbursement agreement will help 

increase access for all of our veterans. IHS and VA are committed 

to working in partnership to improve the provision and coordination of services in consultation with Tribes. 

I want to recognize the strong support and commitment of Secretary Shinseki and his staff as we work together to more effectively serve our common missions. Our American Indian and Alaska Native veterans deserve our best efforts to honor their service. 

While we have made progress, we understand there is much more 

to do and both agencies are committed to this work. 

11

Mr. Chairman, that concludes my testimony and I will be happy 

to answer any questions. 

[The prepared statement of Ms. Roubideaux follows:]

PREPARED STATEMENT OF YVETTE ROUBIDEAUX, M.D., M.P.H., DIRECTOR, INDIAN

HEALTH SERVICE

Mr. Chairman and Members of the Committee: 

Good afternoon. I am Dr. Yvette Roubideaux, the Director of the Indian Health 

Service (IHS). I am pleased to have the opportunity to testify on Programs and 

Services for Native American Veterans. 

As you know, the Indian Health Service (IHS) plays a unique role in the Department of Health and Human Services because it is a health care system that was 

established to meet the federal trust responsibility to provide health care to American Indians and Alaska Natives (AI/AN). The mission of the Indian Health Service 

is to raise the physical, mental, social, and spiritual health of AI/AN to the highest 

level. The IHS provides high-quality, comprehensive primary care and public health 

services through a system of IHS, Tribal, and Urban operated facilities and programs based on treaties, judicial determinations, and acts of Congress. The Indian 

health system provides services to nearly 1.9 million American Indians and Alaska 

Natives through hospitals, health centers, and clinics located in 35 States, often representing the only source of health care for many AI/AN individuals, especially for 

those who live in the most remote and poverty-stricken areas of the United States. 

The purchase of health care from private providers through the Contract Health 

Services program is also an integral component of the health system for services unavailable in IHS and Tribal facilities or, in some cases, in lieu of IHS or Tribal 

health care programs. IHS accomplishes a wide array of clinical, preventive, and 

public health activities, operations, and program elements within a single system 

for AI/ANs. 

American Indians and Alaska Natives have a long and proud record of service to 

this Nation. No other population group has a higher level of participation in military service. American Indian and Alaska Native Veterans may be eligible for 

healthcare services from both the Indian Health Service and the Department of Veterans Affairs (VA). IHS’ patient registration system documents approximately 

45,000 veterans have received care in our system of IHS, Tribal and Urban Indian 

health programs. American Indian and Alaska Native veterans have told us they 

want better coordination of services between VA and the IHS. IHS is primarily a 

rural health system; therefore, in some locations, our facilities may be a significant 

distance from VA facilities. In addition, the eligibility rules for IHS and VA health 

care services differ, which may cause confusion about coverage for services. For 

some AI/ANs Veterans the complexity of navigating two health care systems may 

prevent optimal use of federally funded health services for which they are eligible 

through IHS and VA. VA and IHS will continue to work together to address the 

input we receive from Tribes and to improve services for American Indians and 

Alaska Natives and we are making progress. 

Indian Health Service—Department of Veterans Affairs Collaborations 

VA Reimbursement for Services Provided by IHS to Eligible American Indian and 

Alaska Native Veterans 

IHS and VA are committed to improving access to services and benefits for AI/

AN Veterans. The Department of Health and Human Services/Indian Health Service 

and VA have made significant progress in developing a draft agreement to facilitate 

VA reimbursement for direct care services provided to eligible AI/AN Veterans by 

IHS and participating Tribal health programs. IHS and VA initiated a consultation 

on March 5, 2012 to request input from Tribes on the main points of the draft agreement between VA and IHS. IHS and VA also held a consultation session at the IHS 

Tribal Consultation Summit on March 13–14, 2012 in Washington, D.C. On April 

5, 2012, IHS and VA sent a letter to Tribes with the draft reimbursement agreement and requested input. The draft agreement focuses on reimbursement for direct 

care services provided to AI/ANs at IHS facilities and participating Tribal facilities. 

IHS and VA propose that implementation of these agreements begin with a demonstration project to be followed by national implementation. Tribes were asked to 

provide written comments on the draft agreement and recommendations for the 

demonstration project; the deadline for input has been extended to May 25, 2012. 

The draft national agreement also informed the recently signed agreements between 

VA and Alaska Tribal Health Programs. 

12

The IHS has a unique government-to-government relationship with AI/AN Native 

Tribal governments and is committed to regular and meaningful consultation and 

collaboration with Tribes. The IHS considers consultation an essential element for 

a sound and productive relationship with Tribes. The initial analysis of comments 

from Tribes include requests to include specific types of services in the agreement, 

questions about timelines and process, and comments about reimbursements and 

copays. IHS and VA are reviewing Tribal input and plan to proceed soon with the 

demonstration and national implementation of the reimbursement agreement. 

IHS and VA staff have been working together to prepare for billing and collection 

under the agreement. To date, six webinar training sessions on VA eligibility and 

enrollment process have been held and more training on eligibility, enrollment, 

claims filing, and reimbursement processing are planned. These collaborative efforts 

support outreach of IHS, Tribal, and Urban health programs to assess, assist and 

inform AI/AN veterans about potential health benefits. 

Indian Health Service—Veterans Health Administration Memorandum of 

Understanding 

A Memorandum of Understanding (MOU) between the IHS and the Department 

of Veterans Affairs (VA) was renewed and signed in 2010 to establish coordination, 

collaboration, and resource-sharing between the two Departments; and it builds 

upon decades of successful collaboration. It outlines joint goals and objectives for ongoing collaboration between IHS and VA to further their respective missions, in particular, to serve AI/AN veterans who comprise a segment of the larger beneficiary 

population for which they are individually responsible. The purpose of the MOU is 

to foster an environment that brings together the strengths and expertise of each 

organization to actively improve the care and services provided by both agencies. It 

provides a framework for a broad range of IHS–VA collaborations at the local level 

by IHS Area Offices and Tribal Health Programs with the Veterans Health Administration (VHA). The MOU recognizes the importance of a coordinated and cohesive 

effort of national scope, while also acknowledging that implementation of such efforts requires local adaptation to meet the needs of individual Tribes and communities; and, VA and IHS have consulted with Tribes on priorities for implementation 

of the MOU. 

The MOU sets forth 5 mutual goals for serving Native American Veterans. These 

goals include (1) increasing access to and improving the quality of health care and 

services offered to Native Veterans by both agencies; (2) promoting patient-centered 

collaboration and facilitating communication among VA, IHS, AI/AN Veterans, Tribal and Urban Indian Health Programs; (3) establishing in consultation with Tribes, 

effective partnerships and sharing agreements in support of AI/AN Veterans; (4) ensuring appropriate resources are identified and available to support programs for 

AI/AN Veterans; and (5) improving health promotion and disease prevention services to AI/AN veterans to address community-based wellness. 

To further these goals, the IHS and VA actively collaborate and coordinate activities across several broad areas. I will describe our activities in these areas along 

with the most recent accomplishments in each one. 

Improve Coordination of Care 

IHS and VA staff have been working to improve coordination of care for AI/AN 

Veterans served by IHS, Tribal, or Urban Indian health programs and VA. Six 

training sessions on VA eligibility requirements for the IHS, Tribal and Urban Indian health programs have been held to improve the ability of frontline patient registration, business office, and Contract Health Service personnel to assist AI/AN 

Veterans access VA services. This training focused on how to assist an AI/AN Veteran seen in an IHS facility with completing the VA eligibility paperwork and how 

to assist with accessing VA services. 

Development of Health Information Technology 

Improving care through the development of health information technology, including the sharing of technology and the inter-operability of systems continues as a 

part of a long history of active collaboration between the IHS and VA around information technology. Both agencies continue to actively consult on electronic health 

record (EHR) certification and Meaningful Use requirements. IHS staff is meeting 

regularly with VA and Department of Defense (DOD) representatives in planning 

for the Integrated Electronic Health Record (iEHR) and designing the EHR interface 

and care management functions, with an anticipated implementation plan starting 

in FY 2014. These activities will result in the ability of IHS and VA to share medical records and better coordinate care for AI/AN Veterans that receive care in both 

health care systems. 

13

Development and Implementation of New Models of Care Using New Technologies 

Enhancing access through the development and implementation of new models of 

care using new technologies is another focus area for IHS and VA staff. For example, activities include completion of a summary document on the best practices for 

providing tele-psychiatry services to AI/AN veterans, completion of implementation 

of telemedicine services to provide connectivity between the Prescott VHA facility 

in Prescott, AZ and the IHS in Chinle, AZ on the Navajo Reservation, and evaluation of an outreach project for homeless veterans. 

Improve Efficiency and Effectiveness at the System Level 

IHS and VA are focusing on improving efficiency and effectiveness at a system 

level through sharing of contracts and purchasing agreements. Staff is developing 

pre-approved templates for agreements, and the standard policies and common 

agreement procedures to support local collaboration. The MOU also provides opportunities to strengthen existing sharing agreements with VA. To illustrate how this 

supports local collaboration, the IHS Tucson Area Leadership staff met with the 

Southern Arizona VA and a local agreement is being developed as a result of the 

national MOU. 

Improve the Delivery of Care through Active Sharing of Programs 

This focus area aims to improve the delivery of care through active sharing of care 

process, programs, and services with benefit to those served by both IHS and VA. 

These activities include a focus on Post-Traumatic Stress Disorder (PTSD) and 

staffs are currently working on a satellite broadcast designed to engage and educate 

VA providers on cultural considerations that may need to be taken into account 

when providing mental health services to AI/AN veterans living in rural environments. While each Tribe has its own unique culture, there are similarities across 

Tribes that providers should be aware of when providing care to this population. 

Staff is also focusing on suicide prevention and working to develop an AI/AN-sensitive Operation SAVE version, a VA gatekeeper training program, for use in Indian 

country this year; staff report 157 Tribal outreach activities provided to date. 

IHS and VA staffs have also undertaken Pharmacy collaborations and have successfully completed a pilot program between the VA Consolidated Mail Outpatient 

Pharmacy (CMOP) and IHS, with expansion to the following sites: Phoenix, AZ; 

Claremore, OK; and Yakama, WA, and Rapid City, SD. In fiscal year 2011, over 

19,000 medications were dispensed through the CMOP program, and, to date, over 

50,000 prescriptions have been dispensed within the IHS, through the CMOP program. The IHS, VA, and DOD have also partnered to train pharmacy technicians. 

Staffs focusing on Long-Term Care services have increased the number of American Indian and Alaska Native Veterans served through the VA Home Based Primary Care (HBPC) program with IHS and Tribal Nations from 55 in December, 

2010 to 234 by September, 2011. There are currently 160 AI/AN veterans actively 

enrolled in this program. 

VA has an ongoing collaboration with Alaska that continues to enhance our collaborative activities. The Tribal Veteran Representative (TVR) program has trained 

47 people on VA eligibility and benefits, and to improve coordination of care, support outreach, and co-management of patients. 

Increase Cultural Awareness and Competent Care 

Attention to cultural awareness and increasing culturally competent care for VA 

and IHS beneficiaries is the focus of IHS and VA staff who are developing a three 

tiered cultural awareness training program, with each tier having a different level 

of intensity and immersion into cultural issues. 

Training and Workforce Development/Sharing of Staff and Enhanced Recruitment 

and Retention of Professional Staff 

Increasing capability and improving quality through training and workforce development, and increasing access to care through sharing of staff along with enhanced 

recruitment and retention of professional staff are also an important focus of collaborations between IHS and VA staff. Activities include sharing of educational and 

training opportunities and resources, and specialty services. VA has made 239 webbased courses and 7 video courses available to IHS. Of these, 124 have been made 

available through the Department of Health and Human Services’ (HHS) Learning 

Management System. An additional 215 courses are currently under review by IHS. 

In 2012 training programs will reside outside of firewalls and therefore be more easily accessible to staff from both agencies. 

14

Address Emergency, Disaster, and Pandemic Preparedness and Response 

IHS and VA staff are working together on emergency, disaster, and pandemic preparedness and response by sharing contingency planning and preparedness efforts, 

joint development of materials targeting AI/AN veterans, and joint exercises and coordination of emergency response. Current activities include working with the Federal Emergency Management Agency to supply materials for training of Tribal 

emergency response teams. 

Development of Joint Implementation Task Force to Identify Strategies and Plans for 

Accomplishing the Tasks and Aims of the MOU 

The development of a joint implementation task force to identify strategies and 

plans to accomplish the tasks and aims of the agreement continues. IHS and VA 

leadership meet regularly to address the draft reimbursement agreement, consultation comments and issues, and regular meetings of IHS and VA staff on focus areas 

previously mentioned. 

Collaboration with VA at the IHS Area and Local Levels 

In addition to our collaborative work with VA at the national level, I have instructed all of my IHS Area Directors to meet with the VA Veterans Integrated 

Services Networks (VISNs) in their Areas and to consult with Tribes on how to better coordinate services at the Area and the local levels. We have included this work 

in partnership with the VISNs and Tribes at the Area and local levels to improve 

the coordinated provision of health services to AI/AN Veterans as an element in performance contracts. 

Several new collaborative efforts have emerged from these partnerships. In Alaska, 47 people in Alaska are trained as Tribal Veterans’ Representatives to help 

Alaska Native veterans gain access VA health and other benefits. The Area’s goal 

is to train 100 by the end of the fiscal year. 

The IHS Areas in the northern plains—the Billings and Aberdeen Areas—are also 

working collaboratively with VA. The Billings Area meets regularly with VA to discuss issues related to telemedicine, VA eligibility rules and regulations, and Tribal 

Veteran Representative trainings. The Area also coordinates discussions between 

the Billings Area Urban Indian programs and VA because of the large population 

of Native American veterans living in the urban towns of Montana and Wyoming 

that may be eligible for services at the urban clinics. The Aberdeen Area continues 

collaborative efforts to foster strong and productive working relationships with VA, 

such as use of the VA mobile MRI. Agreements are currently in place with the VA 

for Consolidated Mail Outpatient Pharmacy Service and Compensated Work Therapy Programs. The Area and VA are working on a post-traumatic stress disorder 

DVD and continue to participate in suicide prevention workgroup conference calls. 

The Bemidji Area works closely with VISN 11 and 12 outreach workers to provide 

an information session on VA programs to Tribes in Michigan and Wisconsin. As 

a result, Tribal Programs began working with VA facilities to coordinate care. The 

acting Area Director and the Behavioral Health Consultant attended the VA Office 

of Tribal Government Relations, Central Region Meeting held in April. Ongoing 

meetings with the three VISN’s are planned. A meeting with VISN 23 Directors is 

planned for May and there is a pending meeting with the Fargo VA to work on coordination of care for beneficiaries of the three federal sites. The Cass Lake Pharmacy was invited to present on their Medication Reconciliation process as part of 

the IHS–VA CMOP webinar entitled ‘‘Medication Use Crisis’’, a joint presentation 

to VHA and DOD personnel on May 18. Cass Lake Pharmacy is also seeking to 

work with the Fargo VA on medication reconciliation for joint beneficiaries. This effort is expected to also include the Bemidji Community Based Outpatient Clinic 

(CBOC) and the St. Cloud Veterans Administration Medical Center (VAMC). Area 

Patient Benefits Coordinators were informed about the upcoming VA–IHS webinar 

training on VA Enrollment and Eligibility. 

The IHS Areas in the Southwest—the Navajo and the Phoenix Areas, are also collaborating with VA on serving American Indian veterans. In the Navajo Area, the 

VA VISN 18 (Southwest) developed video connectivity for direct patient care between the Chinle, AZ IHS facility and the VA facility in Prescott, Arizona. In the 

Phoenix Area, VA has newly established a Native American Coordinator Position. 

This Coordinator has met with Phoenix IHS Area leadership and has also established meetings between one of the VISNs and IHS Service Units regarding the VA 

scope of services. 

Summary 

The MOU has facilitated collaboration between IHS, Tribal and Urban programs 

and VA at the national, regional, and local level, with the common goal of providing 

15

quality access to health care services to our AI/AN Veterans. The reimbursement 

agreement will help increase access for AI/AN Veterans. The activities that I have 

described illustrate a range of active and effective areas of collaboration. IHS and 

VA are committed to working in partnership to improve the provision and coordination of services for AI/AN Veterans in consultation with Tribes. I want to recognize 

the strong support and commitment of Secretary Shinseki as we have worked together to more effectively serve our common missions. Our American Indian and 

Alaska Native Veterans deserve our best efforts to honor their service through our 

collaborative activities to improve access to quality health services. While we have 

made significant progress, we understand we have much more to do, and both agencies are committed to this important work. 

Mr. Chairman, this concludes my testimony. I will be happy to answer any questions that you may have. Thank you.

The CHAIRMAN. Thank you very much, Mr. Grinnell. 

Mr. Gover, please proceed with your statement. 

STATEMENT OF KEVIN GOVER, DIRECTOR, NATIONAL 

MUSEUM OF THE AMERICAN INDIAN 

Mr. GOVER. Good afternoon, Mr. Chairman. 

We welcome the opportunity to come and discuss the work of the 

National Museum of the American Indian with regard to Native 

veterans. 

As you know, our responsibility at the NMAI is the presentation 

of the history, art and culture of the Native peoples of the Americas and Hawaii. It stands to reason that because service in the 

Armed Forces of the United States is so deeply embedded in the 

traditions and history of many of the Native American nations that 

we would spend a considerable amount of our time treating the 

subject. 

A couple of things come to mind about this work. First, you 

should know that one of the most popular exhibitions we have created and sent out into the world to go to various venues was an 

exhibition about the Code Talkers of Word Wars I and II. That exhibition is still traveling throughout the United States. It has been 

to many reservations but also many non-Indian communities. It always comes as a surprise to many people to see the depth of commitment to service of the Native Americana community. 

Second, having grown up in Oklahoma where the 45th Infantry 

was legendary for their service during World War II and many of 

the men who served in that division were American Indians, including my grandfather, we got to see firsthand how deeply embedded this reverence for service and for our veterans is in Native culture in Oklahoma. As I grew older and traveled to other parts of 

the country, I could see that was practically a universal thing. 

Much in the way Senator Franken was describing this reverence 

for veterans and the honoring of veterans, it is embedded in many 

elements of contemporary Tribal culture and ritual and so, again, 

it will always be a major part of our work at the National Museum 

of the American Indian. 

I do want to mention a specific statutory authorization that the 

Museum has which is to construct and maintain a National Veterans Memorial at the NMAI. It is an usual statute in a number 

of respects in that it specifies a location within the structure that 

was authorized by Congress when it established the National Museum of the American Indian, but then it goes on to say that fundraising and the conduct of a competition for the design of such a 

16

memorial would be carried out by the National Congress of American Indians. 

NCAI does a great deal of fine work and they have any number 

of other things they need to do. It strikes me as somewhat unlikely 

to make it to the top of NCAI’s priority list and given that we are 

literally prohibited from using our own resources or from raising 

funds ourselves for such a memorial, it seems unlikely that we are 

going to be able to construct such a memorial within the foreseeable future. 

We invite Congress’ attention to that issue and your guidance on 

how we might proceed going forward. 

With that, Mr. Chairman, I thank you again for the opportunity 

to testify today. Thank you for your attention to issues affecting 

Native veterans. I would be happy to answer any questions you 

may have. 

[The prepared statement of Mr. Gover follows:]

PREPARED STATEMENT OF KEVIN GOVER, DIRECTOR, NATIONAL MUSEUM OF THE

AMERICAN INDIAN

Good morning, Mr. Chairman and members of the Committee. I am honored to 

be here today to discuss the work of the Smithsonian Institution’s National Museum 

of the American Indian concerning Native American veterans. As you might expect, 

programming, research, and exhibitions concerning the contributions of Native 

American veterans is a large part of our work at the NMAI. Service in the Armed 

Forces of the United States is a strong tradition among many Native nations, and 

the acknowledgement of Native veterans has therefore become embedded in the cultures, traditions, and histories of many Native communities. 

Our programming at the NMAI has included many events relating to Native veterans. Just in the few years since I arrived at the NMAI, we have had Veterans’ 

Day and Memorial Day programming relating to Native service in the Armed 

Forces. Our film and video program occasionally presents films relating to Native 

veterans, and we have had several authors of books about Native veterans present 

their work at the museum. 

Perhaps our most significant treatment of the subject is the traveling exhibition 

that the NMAI created. It is titled Native Words, Native Warriors. The exhibition 

explores the service of Native American communication specialists who used their 

Native languages to develop codes that could not be broken by the enemies of the 

United States in World War I and World War II. Native Words, Native Warriors

tells the remarkable story of Indian soldiers from more than a dozen tribes who 

used their Native languages in the service of the U.S. military. The exhibition was 

designed to travel to other museums, cultural centers, and libraries, and through 

the Smithsonian Institution’s Traveling Exhibition Service, it has found many 

homes and received enthusiastic responses from a broad range of audiences. 

As you know, the NMAI has also been authorized by Congress to ‘‘construct and 

maintain a National Native American Veterans’ Memorial.’’ Several limitations on 

that authority make it unlikely that we will be able to build such a Memorial. First, 

the statute requires that the Memorial be located ‘‘within the interior structure’’ of 

the NMAI’s museum on the National Mall. This limits our options in locating a permanent Memorial, given the limited space available within the Mall museum. 

Second, the statute places a great deal of responsibility on the National Congress 

of American Indians, rather than the NMAI, to develop the Memorial. NCAI is authorized by the law ‘‘to hold a competition to select the design of the Memorial.’’ 

Further, the statute provides that the National Congress of American Indians ‘‘shall 

be solely responsible for acceptance of contributions for, and payment of expenses 

of, the establishment of the Memorial.’’ Finally, the statute prohibits any use of federal funds to pay for any expense related to the establishment of the Memorial. 

Mr. Chairman, the powerful tradition of Native American patriotism finds its 

clearest expression in the service of young Native men and women. It is a key component of modern tribal life, and we could not present the histories and cultures of 

Native America without delving deeply into this subject. We will continue to do so 

as opportunities arise. 

I would be pleased to answer any questions the Committee might have.

17

The CHAIRMAN. Thank you very much, Mr. Gover. 

Ms. Birdwell, since established last year, the Office of Tribal 

Government Relations has been very active in conducting outreach 

and seeking to best serve Native veterans. Please discuss the important role your office would continue to play moving forward. 

Ms. BIRDWELL. Yes, sir, I am happy to. 

Our team at the Office of Tribal Government Relations always 

acknowledge that prior to establishment of the office, there were 

many people within VA who worked hard over the years to establish at the local level positive working relationships with Tribal 

governments to reach our veterans in Indian country. 

The establishment of the office in many ways strengthens and 

enhances the agency’s ability to reach veterans in Indian country, 

to build a relationship with Tribal leaders and really ensure that 

voice is heard in programs and policies implemented by the Department. 

We like to say our office does not do per se health care benefits 

or the work of the National Cemetery Administration but we work 

very closely with our colleagues nationwide in each one of those organizations to ensure that if there is a particular issue, if there is 

an issue related to training, information, technical assistance, that 

we ensure those subject matter experts and leaders are made available to meet with Tribal leaders and to meet with those who serve 

veterans in Indian country. 

We also like to say we want to ensure that VA is part of the 

landscape of Indian country, that Tribes know who we are, what 

we offer and how to get to us. That, I think, sort of defines the 

level of our work within VA. 

The CHAIRMAN. Thank you very much. 

Mr. Grinnell, your testimony mentions that IHS has estimated 

45,000 Indian beneficiaries registered as veterans in the agency’s 

patient registration system. Is there specific outreach to these 

45,000 veterans to ensure that they are aware of all the services 

they have earned at both HS and the VA? 

Mr. GRINNELL. Yes, Mr. Chairman, there is. One of the things we 

are doing in collaboration with the VA is actually training our business office staff. The VA also has a program, the Tribal veteran 

representatives, which helps to further provide outreach and education. Recently we have had a number of trainings with them, web 

sessions and so forth, that are not only training our staff but also 

the Tribal Health Program staff so that more importantly, first and 

foremost, they are trying to get veterans enrolled in the VA system 

and identified as to what benefits they are eligible for. That close 

coordination allows us to try to maximize the benefits veterans can 

access. 

The CHAIRMAN. Thank you very much. 

Mr. Gover, you discussed some of the obstacles in constructing 

the National Native American Veterans Memorial authorized by 

Congress. Is there any way Congress can alleviate these obstacles 

without burdening the taxpayers? 

Mr. GOVER. Mr. Chairman, I believe so. Obviously Congress and 

the Administration should review the statute together. If the question is sufficient Tribal support for such a memorial, I absolutely 

believe there will be. If, for example, the NMAI was authorized to 

18

receive contributions for that purpose, just from the general level 

of interest that has been expressed to me from a variety of Tribal 

representatives, I don’t have any doubt that we would be able to 

generate private resources to construct such a memorial. I think it 

would be relatively expensive but I believe that level of support exists for the memorial. 

The CHAIRMAN. Thank you. 

Senator Franken, any questions you may have? 

Senator FRANKEN. Yes. Thank you, Mr. Chairman. 

Director Birdwell, you spoke at the top about the issue of trust 

between the VA and the Native community. Mr. Grinnell, you 

talked about the years and decades of work that has been done between the Health Service and VA. What is the source of this distrust, in your opinion? 

I understand we have this new Memorandum of Understanding 

and we are working on reimbursement to the IHS from the VA. 

Where does the distrust come from and to what extent are this 

Memorandum of Understanding and these kinds of actions mitigating that distrust? 

Ms. BIRDWELL. That is an excellent question. I think that some 

of the areas of mistrust from the VA perspective, maybe historically one of the analogies sometimes that I make is that when it 

comes to the VA, over the last five years, VA has really ramped up 

an aggressive effort to really focus on the needs of veterans in rural 

areas. 

A large number of Tribal communities are in very rural areas 

and historically, with VA being more concentrated in urban locations, I think that it would be fairly accurate to say that maybe VA 

did not historically reach out to rural locations because they were 

hard to get to, specifically with Tribal communities because they 

were hard to get to, the agency didn’t speak the language in terms 

of understanding some of the unique cultural issues and it was 

complicated. Maybe the agency wasn’t aware of the importance of 

engaging the voice of Tribal leaders to understand what some of 

the challenges were in Tribal communities. 

I think the converse was true that the VA was hard to get to, 

didn’t speak the language, understanding the bureaucracy and it 

was complicated. I think in some respects maybe veterans had a 

bad experience with the VA because of lack of understanding, lack 

of engagement and also maybe not consistently showing up. Maybe 

there was mistrust built up over time that was also synonymous 

with mistrust of the Federal Government in general. 

That would be what I would say was the basis of some of the 

mistrust. I think also the importance of really understanding the 

VA and the Indian Health Service have a common consumer, the 

Native veteran and to really press through this MOU, which is 

much more specific, the one in 2010 than the one in 2003, to really 

understand how we can join forces and work together to build upon 

each other’s expertise where one of us may be stronger than the 

other with respect to understanding the unique cultural needs, the 

importance of engaging the voice of Tribal leaders, looking at the 

infrastructure that may exist through the IHS health care system 

that maybe VA has not gone into that market. 

That would be my response to that question. 

19

Senator FRANKEN. Mr. Grinnell? 

Mr. GRINNELL. In terms of the mistrust, some of the comments 

we have received from Tribes and individual patients a lot of times 

has been about the challenges they experience in trying to access 

the system. In some cases, that is both systems. A lot of times it 

is because the location of the VA facility may be further away. The 

IHS facility may be closer because many of our facilities are located 

on the reservation. 

The other challenge is the eligibility requirements which I mentioned in my testimony. There is different criteria that comes into 

play both in the VA and the IHS system for certain types of service, for example contract health service. You have to be a resident, 

a member of that Tribe, and so forth. 

A lot of times, the feedback we receive from veterans has been 

they feel they are shuffled back and forth between the two systems. 

We feel the MOU will help us to move closer toward our mutual 

goal of trying to address the true needs of our veterans. 

Senator FRANKEN. Thank you. 

Mr. Chairman, I know I have gone through my time but unfortunately, I am going to have to leave after this panel. I was wondering if I could ask one more question of the panel? Would that 

be all right? 

The CHAIRMAN. Yes. 

Senator FRANKEN. Thank you, Mr. Chairman. 

Director Birdwell, you did mention one of the barriers was that 

so many Native veterans are in rural areas. As I mentioned in my 

opening statement, I have a piece of legislation I introduced with 

Senator Boozman of Arkansas that addresses rural veterans’ 

health care including Native veterans in rural areas. 

We are hoping to get action on that bill this year. The bill is 

meant to get VA’s Office of Rural Health to plan more strategically 

and therefore use its resources more prudently to improve access 

to health care for rural veterans. My bill specifically calls on the 

Office of Rural Health to include in its strategic plan, plans to coordinate care and share resources with IHS. 

Ms. Birdwell, can you tell me how your Office of Tribal Government Relations works with the Office of Rural Health within the 

VA and the same question for you, Mr. Grinnell. Does IHS work 

the VA’s Office of Rural Health? 

Ms. BIRDWELL. Yes, sir, the Office of Tribal Government Relations works very closely with VA’s Office of Rural Health. The Office of Rural Health is the entity within VA that is tasked to work 

directly with the Indian Health Service related to implementation 

of all of the activities related to the MOU. 

Our Tribal government relations specialists are actively engaged 

in some of the work group activities related to the MOU. We meet 

on a regular weekly, sometimes multiple times in one week, basis 

with the Office of Rural Health. We have four Tribal government 

relations specialists located in various places around the country 

and they are tasked with managing a portfolio of relationships with 

Tribes in their regions. 

They are really our eyes and ears in many ways on the ground 

working directly with Tribes to really assist with informing the OfVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00023 Fmt 6633 Sfmt 6601 S:\DOCS\76708.TXT JACK
20

fice of Rural Health what the unique needs are with respect to veterans in Tribal communities. 

ORH, as it is called, in the meantime is doing a fine job of 

launching a number of special projects that affect the American 

and Alaska Natives. For the last two years, ORH has expended I 

think $35 million worth of projects in Tribal communities nationwide. We have seen quite an expansion in home-based primary 

care programs, telehelp and telemedicine supporting of Tribal veterans, representative training and all those efforts are achieved 

through grants through the Office of Rural Health. 

Since our office is tasked with implementing the Tribal consultation policies, one of the VA-specific consultation topics is how to engage Tribes in activities related to the VA/IHS MOU, meaning at 

the national and local levels. Sometimes we will meet with Tribal 

leaders and say we don’t hear the good news stories, we don’t hear 

the outcomes of the work of some of the ORH grants. Our role is 

serve as that kind of conduit between the agency and the Tribes 

and in this particular instance with ORH to build awareness of 

those activities and how to engage Tribes more effectively. 

Senator FRANKEN. Thank you. 

Mr. Grinnell? 

Mr. GRINNELL. The Office of Rural Health is the primary office 

within the VA that our area and our clinical staff at the service 

unit community level has been working with the VA and the respective hospitals. 

As I mentioned, there have been years of collaboration with the 

VA on various things. Some of the more notable items are telemedicine where you are beginning to see greater expansion. Our electronic health record and patent management system is actually a 

VA product we have utilized and implemented throughout our entire system. 

There are many projects going on locally with lots of collaboration and it is going towards trying to bring more services from the 

VA to the local communities to utilize our facilities and our staff 

as well as theirs to try and improve access to care. 

Senator FRANKEN. Thank you all. 

Thank you, Mr. Chairman, for your indulgence. 

My apologies to the second panel, I do have to leave now. Thank 

you. 

The CHAIRMAN. Thank you very much, Senator Franken. 

I want to thank the first panel very much. I have further questions for you that I will put in the record and have you respond 

to them. 

Our schedule has just changed. They have moved up the votes, 

we need to move on. I want to thank you so much for being here 

and helping us with this hearing. 

Thank you. 

Will the second panel please come forward? The second panel 

consists of: Mr. Wayne Burke, Chairman, Pyramid Lake Paiute 

Tribe located in Nixon, Nevada; Lt. Col. Kelly McKaughan, Director, Veterans Advocacy, Choctaw Nation in Durant, Oklahoma, accompanied by Maj. Nathaniel Cox, Director, Choctaw, Global Staffing, Choctaw Nation, in Durant, Oklahoma; Ms. Cheryl Causley, 

Chairperson, National American Indian Housing Council located in 

21

Washington, D.C.; and Ms. Noelani Kalipi, President of the TiLeaf 

Group in Hilo, HI. 

I want to welcome you all here today. Chairman Burke, will you 

please proceed with your statement? 

STATEMENT OF HON. WAYNE BURKE, CHAIRMAN, PYRAMID 

LAKE PAIUTE TRIBE 

Mr. BURKE. Good afternoon, Mr. Chairman. I appreciate the opportunity and the honor to come before this Committee to give testimony this afternoon. 

My name is Wayne Burke, Chairman of the Pyramid Lake Paiute Tribe located in the Great Basin area in northern Nevada. 

Our Native people have lived and sustained the life of a warrior. 

Our ancestors and relatives fought and defended our Tribal nations 

to secure food, our homelands and to protect the young, the old and 

our families. That warrior spirit is passed on in our songs, our stories, our dances and our traditions. 

Many of our battles against the United States Government, along 

with the massacres perpetrated against the Native Nations, are not 

found in history books or taught in schools, but they are passed on 

through our oral teachings. From the young to the old, some stories 

are never to be told again. As with the old people, the younger generations continue to answer the call to arms and serve our Tribal 

and Federal nations taking that warrior spirit with them. 

We serve in the Army, the Air Force, the Navy, the Marines and 

the Coast Guard and National Guard. As with all veterans, representing all the nations under the United States flag, we serve 

with honor, dignity and the desire to protect, fight and to win battles. 

With conflicts and the continued threat of terrorism on those who 

live in all regions and lands of the globe, the United States military 

continues to provide that protection and service through our men 

and women who enlist in the Armed Services. 

As our warriors return home, I see the demand and need for advocacy and support for our veterans. Cultural traditions and beliefs 

are significant in the manner in which Tribes and Native people 

prepare, sustain, heal and survive war. These cultural beliefs and 

ways of life need to be recognized and used to offer and provide 

more services and resources to Native veterans. 

It is estimated that more than 12,000 American Indians served 

in the United States military during World War I. More than 

44,000 American Indians out of a total Native American population 

of less than 350,000 served with distinction between 1941 and 1945 

in both European and Pacific theaters of war. 

More than 42,000 Native Americans, more than 90 percent of 

them volunteers, fought in Vietnam. Native American contributions 

to the United States military combat continued in the 1980s and 

1990s as they saw duty in Grenada, Panama, Somalia and the Persian Gulf. 

Per population, more Native veterans serve in the United States 

military than any other ethnic group. The Vietnam War Memorial 

has a statute of three soldiers representing the white, black and 

Hispanic. Our Native warriors should stand alongside those three 

22

statutes as a testimony to our contributions and brotherhood with 

all American soldiers we fought alongside. 

The VA must understand and know the population they serve. 

Tribes from the north, the south, the east and the west all have 

distinct traditions and beliefs. The VA is a complex system which 

is intimidating and frustrating for veterans to navigate. As a young 

Marine returning from Africa and being discharged shortly after, I 

was told I could get my teeth cleaned 90 days after I discharged 

and I had some money somewhere in the GI bill. Services through 

the Veterans Administration should be transparent and more accessible. Veterans need to know what services and resources are 

available to them. 

Educational benefits and college enrollment has become more 

cumbersome, expensive and intimidating. I have spoken to veteran 

representatives from colleges in northern Nevada and they have reported the GI bill and accessing those funds has become very complex and requires extensive reporting and knowledge in obtaining 

and ensuring college courses meet GI bill regulations. Transfer 

credits and criteria for higher education credits is becoming increasing more complicated. 

With the growing number of veterans who have served on foreign 

shores and been exposed to the harmful effects of chemical and biological weapons, stress and combat action, we are not prepared or 

have limited resources to provide services from documented cases 

of Post Traumatic Stress Disorder, depression, suicide and other 

emotional mental health issues. Many of our reservations are found 

in extreme rural areas of the country where ambulatory and mental health services are only available on a very limited basis. 

How does a veteran receive a business or home loan? I have gone 

to the local Small Business Administration and advised banks are 

not approving business loans because of the economic development. 

Natives who reside on trust land or reservations such as Pyramid 

Lake and other reservations across the country cannot access loans 

because banks will not authorize loans to Indians who live on Tribal lands. Tribes, in many instances, must waive their sovereign immunity rights to receive traditional loans from banks. 

Next are the advantages and disadvantages of Indian health 

services. Big Brother is always watching and regulating. As Tribal 

nations we must adhere and conform to the operational standards 

of the Federal agencies which regulate health care which includes 

appropriations, services, resources and most importantly, contract 

health services and paying medical bills. When bills and contracted 

health services are not paid in a timely manner, Tribal members 

are taken to creditors, are refused services and wait for authorization from Indian Health Services. 

I have had the opportunity to meet with Dr. Roubideaux, Director of the Indian Health Service. She so eloquently put it ‘‘We must 

hold our veterans harmless from the system.’’ The Memorandum of 

Understanding between the Veterans Administration and the Indian Health Service was signed in 2010 under the authority of the 

Indian Health Care Improvement Act, 25 U.S.C. § 1645, 1647 and 

38 U.S.C. § 523. 

Under the current MOU, what is the charge, what is the authority and who is responsible for ensuring that IHS and the VA are 

23

working in collaboration with Tribal nations and the governmentto-government trust obligations are being met? The first time I saw 

this MOU was in 2011. Who or what agency is ensuring regulation 

and compliance with the Memorandum of Understanding? 

The CHAIRMAN. Mr. Burke, will you please summarize your 

statement? You have gone over your time. 

Mr. BURKE. Excuse me. 

One last thing, Mr. Chairman. I come from a reservation on a 

street that has broken down fences, rusty cars, rez dogs and more 

importantly, family and children who depend on our programs to 

protect, serve and provide for sustainable Tribal nations. My home 

and my street is the greatest place to live in this great land. 

To those who serve and answer the call to arms, I say, thank 

you, God speed and God bless all of us. Dance, pray and fight with 

honor. 

Thank you. 

[The prepared statement of Mr. Burke follows:]

PREPARED STATEMENT OF HON. WAYNE BURKE, CHAIRMAN, PYRAMID LAKE PAIUTE

TRIBE

Our Native people have lived and sustained the life of a warrior; our ancestors 

and relatives fought and defended our tribal nations to secure food, homelands, and 

to protect the young, the old... the family. 

That warrior spirit is passed on in our songs, our stories, our dances, and our traditions. Many of our battles against the United States, along with massacres perpetrated against the Native Nations are not found in history books or taught in 

schools, but they are passed on through oral teachings. From young to 

old . . . some stories are to never to be told again. As with the old people, the 

younger generations continue to answer the call to arms and serve our tribal and 

federal nations... taking that warrior spirit with them. We serve in the Army, 

Air Force, Navy, Marines, Cost Guard, and National Guard. As with all veterans, 

representing all the nations under the United States Flag, we serve with honor, dignity and the desire to protect, fight, and win battles. 

With conflicts and the continued threat of terrorism on those who live in all regions and lands of the globe, the United States military will continue to provide that 

protection and service through our men and woman who enlist in the armed forces. 

As our warriors return home, I see the demand and need for advocacy and support for our veterans. Cultural traditions and beliefs are a significant part in the 

manner in which tribes and Native people prepare, sustain, heal, and survive war. 

These cultural beliefs and ways of life need to be recognized and used to offer and 

provide more services and resources to Native Veterans. 

Per population, more Native Veterans serve in the United States Government 

than any other ethnic group. 

Veterans Administration 

The VA must understand and know the population they serve. Tribes from the 

North, South, East, and West all have distinct traditions and beliefs. The VA is a 

complex system which is intimidating and frustrating for veterans to navigate. As 

a young Marine returning from Africa, and being discharged shortly after, I was told 

I could get my teeth cleaned 90 days after my discharge, and I had a GI Bill somewhere. Services through the VA should be transparent and more accessible. Veterans need to know what services and resources are available. 

Education 

Educational benefits and enrolling into college has become very cumbersome, expensive and intimidating. I have spoken to Veterans’ representatives from colleges 

in Northern Nevada, and they have reported the GI Bill and accessing those funds 

has become very complex, and require extensive reporting and knowledge in obtaining and ensuring college courses meet the GI Bill regulations. Transfer credits, and 

criteria for higher education credits is becoming increasingly more complicated. 

24

* The information referred to can be found at http://www.ihs.gov/announcements/documents/3-OD-11-0006.pdf 

Mental Health Services 

With the growing number of Veterans who have served on foreign shores, and 

have been exposed to the harmful effects of chemical/biological weapons, stress, and 

combat action; we are not prepared or have limited resources to provide services 

from documented cases of PTSD,depression, suicide, and other emotional/mental 

health issues. Many of our reservations are found in extreme rural areas of the 

country where ambulatory and mental health services are only available on a limited schedule. 

Business and Mortgage Loans 

How does a Veteran receive a business or home loan? I have gone to the local 

Small Business Administration and I was advised banks are not approving business 

loans because of the economic environment. Natives who reside on trust land (Reservations) such as Pyramid Lake and other reservations, cannot access loans because banks will not authorize loans to Indians who live on tribal lands. Tribes in 

many instances must waive sovereign immunity to receive traditional loans from 

banks. 

Indian Health Services 

The advantage and disadvantage . . .. Big Brother is always watching and regulating. As Tribal Nations, we must adhere and conform to the operational standards 

of federal agencies which regulate health care, which includes appropriations, services, resources, and most importantly contract health services and paying the medical bills. When bills and contracted health services are not paid in a timely manner, 

Tribal members are taken to creditors, are refused services, and wait for authorization from Indian Health Services. I have had the opportunity to meet with Dr. 

Roubideaux—Director IHS, she so eloquently put it: ‘‘We must hold our Veterans 

harmless from the system.’’

The Memorandum of Understanding between the VA and IHS was signed in 2010, 

under the authority: The Indian Health Care Improvement Act, 25 U.S.C. Section 

1645, 1647; 38 U.S.C. Sections 523(a}, 6301–6307, 8153. * 

Under the current MOU, what is the charge, the authority, and who is responsible 

for ensuring the IHS and VA are working in collaboration with Tribal Nations, and 

the government-to- government/trust obligations are being met. The first time I had 

ever heard or seen of this MOU was in 2011. Who or what agency is ensuring regulation and compliance with the MOU? 

Our Elected Tribal Leaders and Government 

The Tribes continue to manage and support their communities through existing 

638 contracts, Federal grants, and revenue generated programming, and economic 

development. Under continued resolutions, regulations, and federal statutes, Tribal 

governments continue to meet the demands of those we serve, or to the best of our 

abilities. 

I have no doubt in my mind that our Tribal Nations have the ability and resources to collaborate and assist the Federal Government and Federal agencies in 

effecting and supporting policies and regulations that can support our Veterans. 

My Request of This Committee 

Appropriate funding and authorize Veteran liaisons/caseworkers to represent and 

work with Tribal Nations in establishing and providing transportation, services/resources, and secure education and training for Native Veterans and programs such 

as the VA, Disabled American Veterans, and all regional Veteran Service Offices. 

These liaisons/caseworkers would assist all Native Veterans in obtaining, securing, 

and accessing benefits and services. Educating agency staff and establishing a network of services and funding for continued services and resources. 

I am very grateful for the support of Nevada Senators Harry Reid, Dean Heller, 

and Governor Brian Sandoval in their support and acknowledgement of our veteran’s issues in Indian Country. I would also like to thank Lt. John Hansen (retired) 

Disabled American Veterans Service Officer for the collaboration and services he 

provides to several of the 27 Northern Nevada Tribes, and the work he has done 

in advocating for our Veterans. 

In Closing 

I come from a reservation, on a street that has broken down fences, rusty cars, 

rez dogs, and more importantly, families and children who depend on our programs 

25

to protect, serve, and provide for sustainable tribal nations. My home and my street 

is the greatest place to live in this great land. 

To those who serve and answer to the call to arms I say thank you, god speed, 

and god bless all of us. Dance, pray, and fight with honor. 

Attachment


524a1.eps
26

The CHAIRMAN. Thank you so much, Mr. Burke. 

Mr. MCKAUGHAN. will you please proceed? 

STATEMENT OF LT. COL. KELLY MCKAUGHAN, DIRECTOR,

VETERANS ADVOCACY, CHOCTAW NATION; ACCOMPANIED 

BY MAJ. NATHANIEL COX, DIRECTOR, CHOCTAW GLOBAL 

STAFFING, CHOCTAW NATION 

Mr. MCKAUGHAN. Good afternoon, Mr. Chairman. 

My name is Kelly McKaughan, Director of the Choctaw Nation 

Veterans Advocacy Program. I have Major Nathaniel Cox with me. 

Chief Pyle and Assistant Chief Batton both send their regrets that 

they were otherwise detained and weren’t able to come and speak 

themselves. 

To begin, I want to talk about the Choctaw Nation. We talked 

a while ago about rural areas. The Choctaw Nation covers the 

southeastern most counties of Oklahoma. It is very rural, a large 

area, we have large counties covering over 11,000 square miles. 

The Choctaw Nation has over 250,000 members currently. 

The reason I am here and the reason our program was started 

was Chief Pyle came to me one day and said our veterans aren’t 

getting services. They don’t know what they are eligible for, they 

don’t have people coming to them and they don’t like to go to outVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00030 Fmt 6633 Sfmt 6601 S:\DOCS\76708.TXT JACK

524a2.eps
27

side services such as the VA. Maybe they will come to the Choctaw 

Nation and use their own people. 

Therefore, in 2005, Chief Pyle, along with our Tribal council, established our program, the Veterans Advocacy Program, to try to 

assist those people who are being missed. Chief Pyle has said many 

times, we want to get those people who are being missed right now. 

That is why we were established. 

We noticed there was a need for an actual application process. 

If you don’t apply to the VA, you don’t get disability. We try to provide that service to them if they don’t want to go to the VA. Since 

our Tribal members have to travel so far, sometimes up to four 

hours, to a VA facility in Muskogee, Oklahoma, they are not going 

to do it. We have advocates who go out, meet them at their homes 

or our senior citizen centers. We do disability and compensation 

claims for them, help them get grave markers. Some World War I 

or II veterans never had a grave headstone at all. Those are some 

of the services we provide that were somehow missed. 

Health care is a big deal. The problem is they have to go to the 

health care facility. Again, in rural Oklahoma, it is difficult for 

them to get that far. We can’t really assist with that. We also provide special events. We have an annual Veterans Day celebration 

where we honor our veterans every year which they are very appreciative. We give them a gift, a jacket of some kind. 

We have that at our council grounds and have a veterans memorial that was old and worn out. We are in the process right now 

of upgrading that memorial, making it more proper for our veterans. 

We also have annual events at each center to honor the Native 

veterans. A lot of the old Vietnam veterans didn’t get recognition 

they needed, so we try to recognize them and show how important 

they are to us still. 

Our Veterans Advocacy Program is not a recognized service organization so a lot of our work is referrals, simply getting the veteran 

to the right person, the VA, the veteran service officer. Oklahoma 

doesn’t have counties but has regions. We get them there and that 

way they get the proper help they need. 

Another thing we do for our veterans—it is actually serving 

members now, which I am still a member of the National Guard 

and I just come back from overseas—we actually give care packages. We send it out to all Native Americans and any 

servicemember’s family which asks, we send it. We have had requests to send specific items like handheld radios, some specialty 

knives they have asked for. One big thing was a sonogram machine 

that the military would not provide to this unit and we did. 

That is what we are doing to try to help. Pending your questions, 

that is all I have. 

[The prepared statement of Mr. McKaughnan follows:]

28

PREPARED STATEMENT OF LT. COL. KELLY MCKAUGHAN, DIRECTOR, VETERANS

ADVOCACY, CHOCTAW NATION


524a3.eps
29

The CHAIRMAN. Thank you so much, Col. McKaughnan. 

Ms. Causley, please proceed with your statement. 

STATEMENT OF CHERYL A. CAUSLEY, CHAIRWOMAN, 

NATIONAL AMERICAN INDIAN HOUSING COUNCIL 

Ms. CAUSLEY. Good afternoon, Chairman Akaka, Vice Chairman 

Barrasso and distinguished members of the Senate Committee on 

Indian Affairs. 

I would like to thank you for conducting this oversight hearing. 

My name is Cheryl Causley. I am an enrolled member and Director of Housing for the Bay Mills Tribe of Chippewa Indians. I appear before you today in my capacity as Chairwoman of the National American Indian Housing Council. 

NAIHC’s primary goal is to support Native housing entities in 

their efforts to provide safe, decent, affordable, culturally appropriate housing for Native people, including our distinguished Native veterans. 

As the members of this Committee know, Native Americans represent a small percentage of the U.S. population. Throughout hisVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00033 Fmt 6633 Sfmt 6601 S:\DOCS\76708.TXT JACK

524a4.eps
30

tory, however, a high percentage of Tribal members have volunteered to serve in all branches of the United States military. In 

fact, some Native Americans were serving in the American Armed 

Forces before they were even granted citizenship. In times of national need, Native Americans have been the first to answer the 

call and step forward to protect this great country that we all call 

home. 

Our Native American people will never forget PFC Lori Ann 

Piestewa. Lori was a member of the Hopi Tribe who served in Iraq 

and was the first American female soldier to die in combat. Her 

spirit, her memory will always live in the minds and hearts of all 

of our people. 

While our communities show deep respect for our Native veterans in combat, it is a sad reality that often when they return to 

our homelands, they face another extraordinary challenge in fulfilling one of the most basic needs—they come home to find a place 

to live. 

In 2005, we actually held a news conference in this building, in 

this room and brought two Native veterans who recently had returned from tours of duty in Iraq. They provided a deeply emotional statement that they returned home to their reservations to 

living conditions in Indian country that were worse than those they 

faced in Iraq. 

As noted in a 2005 Washington Post article, Staff Sergeant Julius Tulley from the Navajo Nation shared this statement: ‘‘I am 

not here to bash my Commander in Chief, nor am I here to speak 

out against the military. I am here to say that I have gone to war, 

I have put my life on the line, my brothers put their lives on the 

line. I want to say, look, I have done my part, my family has done 

their part. Now, I want something in return.’’ His want should 

have been simple. He wanted a house to live in. 

Yesterday, Mr. Tulley shared with us that after seven years, his 

conditions in his home in his community of Blue Gap, Arizona have 

not changed. According to Tulley, at every Native veterans’ meeting, the issue of housing is still a major concern. 

He also shared that he is diagnosed with Post Traumatic Stress 

Disorder and has yet to receive any treatment, even though he has 

made consistent requests over the last seven years. He shared, ‘‘I’d 

like to go. I would still like to go, but I think they forgot about me.’’

Tulley’s story is common throughout Indian country. Unfortunately, with the lack of resources and data, it is very difficult for 

us to measure the true, unmet needs of our Native heroes. NIHC 

strives to work with the leadership of this important Committee 

and Congress to recognize the acute housing needs that continue 

to exist in our Tribal communities and how this impacts Native 

veterans. Let me give you three examples. 

A survey conducted in 11,500 households in the Navajo Nation 

revealed that 2,726 were households that included at least one Native American veteran. Severe overcrowding coupled with wounded 

veterans returning home to caretakers has added tremendous 

stress on a community that has continued to experience a serious 

housing shortage. 

American Indians are significantly over-represented among the 

homeless populations in Minnesota. According to two separate MinVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 S:\DOCS\76708.TXT JACK
31

nesota studies, American Indians make up one percent of the population but are 11 percent of the off-reservation homeless adult population. Furthermore, American Indians make up 20 percent of the 

homeless veterans throughout Minnesota. 

In Montana, Native Americans make up 6.3 percent of the population, but according to the Montana Veterans Foundation data, in 

2009 Montana had 475 homeless vets, 54 of which were Native 

American. Also in 2009, they had 43 homeless females, 25 who 

were veterans, 9 were Native American women. 

Consider these needs against a backdrop that includes the following observation from the GAO in a February 2010 report. 

NAHASDA’s first appropriation in fiscal year 1998 was $592 million; the average funding was $633 million between 1998 and 2009. 

However, the GAO report underscored that when accounting for inflation and constant dollars, the allocation for Indian housing has 

generally decreased since the enactment of NAHASDA. 

The needs in Indian country have not lessened since this report. 

In fact, the Census actually shows that we have an increased need 

with growth in every younger population. The Census reported that 

the American Indian and Alaskan Native population increased by 

26.7 percent. Our median income was roughly $15,000 lower than 

the rest of the Nation and furthermore, 28.4 percent of Natives 

were in poverty. 

Bottom line, funding for Indian housing has not increased while 

the need in our population and Tribal communities is on the rise. 

The funding trend is stifling not only in housing development but 

economic development, job creation and an opportunity to build 

sustainable communities. 

Our veterans have courageously served our country and should 

not be left behind in their communities, their homelands because 

we lack safe and decent housing. 

Thank you. 

[The prepared statement of Ms. Causley follows:]

PREPARED STATEMENT OF CHERYL A. CAUSLEY, CHAIRWOMAN, NATIONAL AMERICAN

INDIAN HOUSING COUNCIL

Good afternoon Chairman Akaka, Vice Chairman Barrasso, and distinguished 

members of the United States Senate Committee on Indian Affairs. Thank you for 

inviting me to attend today’s oversight hearing on Programs and Services for Native 

Veterans. My name is Cheryl Causley and I am the Executive Director of the Bay 

Mills Indian Housing Authority. I am an enrolled member of the Bay Mills Indian 

Community in Brimley, Michigan. Today, I appear before you in my capacity as 

Chairwoman of the National American Indian Housing Council (NAIHC). I wish to 

thank the Committee for this opportunity to appear before you today to discuss programs for Native Veterans. 

Before I speak directly about the housing programs that affect our Native veterans, permit me to remind the Committee about the NAIHC. NAIHC is the only 

national, tribal non-profit organization dedicated solely to advancing housing, physical infrastructure, and economic and community development in Native American 

communities throughout the United States. 

The NAIHC was foundeded 1974 and has, for 38 years, served its members by 

providing invaluable training and technical assistance (T/TA); sharing information 

with Congress about the issues and challenges that tribes face in terms of housing, 

infrastructure, community and economic development; and working with key Federal agencies to help meet the challenges of improving the housing conditions in 

tribal communities. 

The membership of NAIHC is comprised of 271 Indian Housing Block Grant 

(IHBG) recipients, representing 463 tribes and tribal housing organizations. The priVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00035 Fmt 6633 Sfmt 6621 S:\DOCS\76708.TXT JACK
32

mary goal of NAIHC is to support Native housing entities in their efforts to provide 

safe, decent, affordable, culturally appropriate housing for Native people, including 

our distinguished Native Veterans. 

As the members of the Committee know, Native Americans represent a small percentage of the United States population. Throughout history, however, a high percentage of tribal members have volunteered to serve in all branches of the United 

States military. Many tribal nations are traditional, warrior societies, and this tradition has translated into an extraordinarily high level of patriotism in Native 

America—of dedication and commitment to service in the United States armed 

forces. 

In fact, some Native Americans were serving in the American armed forces before 

they were even granted citizenship. In times of national need, Native Americans 

have been the first to answer the call and step forward to protect this great country 

that we all call home. Yet, sadly, Native Veterans often return to their homelands 

to face extraordinary challenges in finding a place to live. 

Our first Americans face some of the worst housing and living conditions in the 

country, and the availability of affordable, adequate, and safe housing in Indian 

Country falls far below that of the general U.S. population. Veterans return home 

to find too few housing opportunities and are put on a wait list for tribal housing—

a list that includes many families who have been waiting many, many years to access affordable housing. 

There is an agreement among most members of Congress, HUD, tribal leaders, 

and tribal organizations that there is a severe housing shortage in tribal communities; that many homes are, as a result, overcrowded; that many of the existing 

homes are in need of repairs—some of them substantial; that many homes lack 

basic amenities that many of us take for granted, such as full kitchens and plumbing; and that at least 250,000 new housing units are needed in Indian Country. 

These issues are further complicated by the status of Indian lands, which are held 

in trust or restricted-fee status. As a result, private financial institutions will generally not recognize tribal homes as collateral to make improvements or for individuals to finance new homes. Private investment in the real estate market in Indian 

Country is virtually non-existent, with tribes almost entirely dependent on the Federal government for financial assistance to meet their growing housing needs. The 

provision of such assistance is consistent with the Federal Government’s well-established trust responsibility to American Indian tribes and Alaska Native villages. 

The Native American Housing Assistance and Self-Determination Act 

(NAHASDA) was enacted to provide tribes with new and creative tools necessary 

to develop culturally appropriate, safe, decent, affordable housing. NAIHC and its 

membership appreciate the investment and continuing efforts that this Administration and the Congress have made since NAHASDA became law in 1996. However, 

despite the increase in overall spending within the Department of Housing and 

Urban Development, the Administration has proposed level funding for the Indian 

Housing Block Grant (IHBG) at $650 million for FY 2013. 

Were the President’s budget proposal to be accepted, it would mark the third consecutive year that the funding for Indian housing would be flat-lined. We will work 

with the Congress, including the leadership of this important Committee, to recognize the acute housing needs that continue to exist in tribal communities and how 

this impacts Native Veterans. Let me give just three examples. 

A recent survey conducted of 11,500 households on the Navajo Nation Reservation 

revealed that 2,726 were households that included at least one veteran. Severe overcrowding, coupled with wounded veterans returning home to family caretakers, has 

resulted in a tremendous stress on housing needs. We also know that Native veterans have a great need for housing assistance in off-reservation and urban areas 

throughout the country. 

American Indians are significantly overrepresented among the homeless population in Minnesota, according to studies conducted by the Amherst H. Wilder Foundation and the Corporation for Supportive Housing’s American Indian Supportive 

Housing Initiative. American Indians make up 1 percent of the Minnesota population, but 11 percent of the off-reservation homeless adult population. Furthermore, 

American Indians make up 20 percent of the homeless Veterans throughout Minnesota according to another Wilder Foundation study. 

In Montana, Native Americans make up 6.3 percent of the population. According 

to the Montana Veterans’ Foundation data, in 2009, Montana had 475 homeless veterans, 54 of whom were Native American. Also in 2009, Montana was home to 43 

homeless females, 25 of whom were veterans. Nine of the 25 were Native American 

women. 

Consider these needs against a backdrop that includes the following observation 

from the Government Accountability Office (GAO) in their Report 10–326, Native 

33

American Housing, issued in February 2010 to the Senate Banking Committee and 

the House Committee on Financial Services:

NAHASDA’s first appropriation in fiscal year 1998 was $592 million, and average funding was approximately $633 million between 1998 and 2009. The highest level of funding was $691 million in 2002, and the lowest was $577 million 

in 1999. For fiscal year 2009, the program’s appropriation was $621 million. 

However, when accounting for inflation, constant dollars have generally decreased since the enactment of NAHASDA. The highest level of funding in constant dollars was $779 million in 1998, and the lowest was $621 million in 

2009.

The needs in Indian Country have not lessened since this report was issued just 

over two years ago. In fact, the Department of Commerce’s Bureau of the Census 

clearly shows that the needs continue to increase along with a growing and everyounger population. In a report prepared in November 2011, the Census reported 

that:

• The nation’s American Indian and Alaska Native population increased by 1.1 

million between the 2000 Census and 2010 Census, or 26.7 percent, while the 

overall population growth was 9.7 percent;

• The median income of American Indian and Alaska Native households was 

$35,062 compared with $50,046 for the nation as a whole.

• The percentage of American Indians and Alaska Natives that were in poverty 

in 2010 was 28.4 percent compared to the 15.3 percent for the nation as a 

whole.

• The percentage of American Indian and Alaska Native householders who owned 

their own home in 2010 was 54 percent compared with 65 percent of the overall 

population.

I wish to conclude this testimony by thanking Chairman Akaka, Vice Chairman 

Barrasso, and all of the members of the Senate Committee on Indian Affairs. 

NAHASDA is not just about constructing houses, it is about building tribal communities—communities where health and safety are a top priority and where education 

can thrive. However, the path to a self-sustaining economy is not achievable without 

a robust housing sector, and tribal housing conditions cannot be improved without 

adequate funding. Veterans who have so courageously served should not be left behind because their communities—there homelands—lack safe and decent housing. 

We often here people say, ‘‘thank you for your service.’’ Let’s make sure these 

words are not hallow. We can best say thank you to our veterans by making sure 

they have a home to return to after serving our Nation. I know we can count on 

you to support our efforts. Together, we can continue the important work of building 

vibrant communities in Indian Country.

The CHAIRMAN. Thank you very much. 

Ms. Kalipi, will you please proceed with your statement? 

STATEMENT OF D. NOELANI KALIPI, PRESIDENT, TILEAF 

GROUP 

Ms. KALIPI. Aloha, Chairman Akaka, Vice Chairman Barrasso 

and distinguished members of the Senate Committee on Indian Affairs. 

My name is Noelani Kalipi and I am a Native Hawaiian veteran 

having served on active duty in the United States Army. 

Of the approximately 117,000 veterans living in Hawaii, a significant number are Native veterans who were born and raised in 

Hawaii. Like our Native brethren in Indian country and Alaska, 

Native Hawaiians have a cultural and spiritual tie to our lands. 

We seek to live on our land and will find a way to survive in our 

homeland because no matter how challenging the economic conditions, no matter how bad or scarce the jobs are, our family ties and 

our relationship to our lands are intricately tied to the essence of 

our being. 

34

The State of Hawaii depends on imported fossil fuels for more 

than 75 percent of its electricity generation and imports 85 percent 

of its food. This means the State of Hawaii currently imports 2 million meals per day. We have a serious food security and energy security issue in Hawaii and we have a wonderful opportunity for 

Native Hawaiian veterans to lead the way in addressing this. 

The Hawaii Veteran to Farmer Pilot Program begins in a week 

and the first 12 participants are Native Hawaiian veterans with 

agricultural leases within the Hawaiian Homelands Trust. Participants will receive hands-on training on all aspects of farming and 

participate in an educational curriculum that focuses on the business aspects of successful farming operations including marketing, 

accounting and best practices. 

This is a win-win situation where Native Hawaiian veterans can 

lead the way in addressing critical needs in Hawaii while incorporating cultural and traditional practices, creating jobs, generating revenue and creating additional opportunities for economic 

development and empowerment. 

Mr. Chairman, as a Native Hawaiian and as a veteran, I thank 

you for all you have done over your career to assist and empower 

all veterans but in particular, Native veterans. Your insight as a 

Native veteran has been invaluable in facilitating programs in recognition of the Federal trust relationship between the United 

States and its Native peoples. 

Establishment of the VA Native American Direct Home Loan 

Program, for example, serves as an important precedent in demonstrating how Federal programs can be modified to provide the 

delivery of benefits and services to Native veterans living on trust 

lands. 

We thank you for all that you have done. 

Mahalo. 

[The prepared statement of Ms. Kalipi follows:]

PREPARED STATEMENT OF D. NOELANI KALIPI, PRESIDENT, TILEAF GROUP

Aloha Chairman Akaka, Vice-Chairman Barasso and Distinguished Members of 

the Senate Committee on Indian Affairs. Thank you for providing me with the opportunity to share information with you about the Veteran to Farmer initiative we 

are implementing on the island of Hawaii. 

Background 

My name is D. Noelani Kalipi and I am a Native Hawaiian Veteran. I work with 

TiLeaf Group, a native social enterprise. We work with native and non-native companies and organizations focused on projects, services and programs that contribute 

to the well-being of native communities. A substantial portion of our activity is focused on economic development and empowerment in native communities involving 

energy, agricultural and data security initiatives. 

I served on active duty in the United States Army Judge Advocate General’s 

Corps (JAGC) where I was stationed at Fort Stewart, Georgia, home to the 3d Infantry Division (Mechanized). As a young JAGC attorney, I served in a number of 

positions. I found my experience with the Trial Defense Service (TDS) to be the 

most insightful. As a TDS attorney, I represented soldiers facing non-judicial punishment, administrative separation, or courts-martial. I learned very quickly about 

the trials and tribulations faced by soldiers and their families as they struggled to 

balance rigorous training and deployment schedules with demands and challenges 

of everyday life. While many military members thrive in these conditions, I worked 

primarily with those who encountered difficulties. These experiences served me well 

in my professional career which has led me to work with military members and Veterans in various capacities. 

35

1 Renewable Energy in Hawaii June 2011, Hawaii Economic Issues, Economic Report 2011, 

Department of Business, Economic Development & Tourism, June 2011. 2Food Self-Sufficiency in Hawaii, A Hawaii Department of Agriculture White Paper, Hawaii 

Department of Agriculture, December 2008. 

Native Veterans 

Native Veterans have a strong tradition of military service despite the often tragic 

circumstances underlying the history between the federal government and their native governments. Native Veterans have served at the highest rate per capita of any 

population in the United States. According to the Department of Veterans Affairs 

(VA), studies have also shown that Native Veterans suffer disproportionally from 

the consequences of service, including higher rates of disorders related to combat 

exposure. 

According to the U.S. Census Bureau’s American Community Survey, 27, 800 Veterans identified themselves as single-race Native Hawaiian and Other Pacific Islanders. Four out of five of these Veterans are 65 years old or younger. This means 

we have a relatively young population of Native Hawaiian and Pacific Islander Veterans. Additionally, given the multicultural population in Hawaii, a large number 

of Native Hawaiians identify themselves in the multi-race category. We therefore 

know that we have a significantly larger population of Native Hawaiian Veterans 

in the United States. 

Of the 117,000 Veterans living in Hawaii, a significant number are native Veterans who have been born and raised in Hawaii. Like our native brethren in Indian 

Country and Alaska, Native Hawaiians have a cultural and spiritual tie to our 

lands—we seek to live on our lands and will find a way to survive in our homeland 

because no matter how challenging the economic conditions or how scarce the jobs 

are, our family ties and our relationship to the ‘aina or land, is intricately tied to 

the essence of our being. 

Hawaii Island 21st Century Roadmap 

The State of Hawaii is composed of islands in the Pacific Ocean. The nearest metropolitan population is located more than 2500 miles away. Hawaii depends on imported fossil fuels for more than 75 percent of its electricity generation 1 and imports 

85–90 percent 2 of its food. This means that the State of Hawaii currently imports 

more than two million meals per day. If the barges were to be stopped, Hawaii has 

approximately 2–3 weeks of fuel for electricity and 7 days of locally grown food. 

Energy and food security, therefore, are key priorities for the people of Hawaii. 

The volatility in oil prices impact all aspects of commerce in Hawaii as the cost of 

importing items and the cost of electricity are factored into all products and services. These additional costs make it very difficult for any Hawaii-based business to 

be competitive with its counterparts on the continent and greatly impact the standard of living for individuals living in rural communities. 

Given our geographic isolation coupled with our dependence on imports for vital 

needs such as electricity and food, Hawaii is on the precipice of a future that can 

be either very good or very bad. It can be very bad if we retain the status quo and 

fail to proactively address our energy and food security challenges. 

On the other hand, Hawaii is blessed to have robust, renewable resources that 

can be utilized for electricity generation. On my island of Hawaii, we have geothermal, solar, wind, and hydropower resources that can be utilized to generate 

enough electricity to make our island completely energy self-sufficient. We also have 

abundant water resources and fertile soil that can revitalize a once vibrant agricultural industry. Whether we change our behavior and utilize these natural resources 

in a manner that meets our needs while preserving them for use by future generations is the key to whether we contribute to a vibrant, thriving or depressed economic future on our island. Native Hawaiians play a vital role in shaping this future. 

Many of us look back to our native kupuna, or elders, for guidance on how to 

move forward. The ancient Native Hawaiians were incredibly scientific people. They 

had identified the stars and constellations and used them for navigation across the 

Pacific Ocean. They had developed a calendar that dictated when to fish, when to 

plant and what to plant, so that their subsistence needs were met in abundance 

while still preserving Hawaii’s precious natural resources. They had identified hundreds of thousands of species of plants and animals and had named, categorized and 

learned how to use them. Native Hawaiians worked comprehensively and collaboratively, using complex engineering methods to maximize the use of resources such 

as water for everything from agriculture to advanced forms of aquaculture. 

As we look back to move forward, our native communities can see the vast opportunities available for the perpetuation of our native culture, language, practices, and 

36

3 ‘‘April Electric Rates Up on All Islands Except One,’’ Star-Advertiser, April 12, 2012. 

traditions. We know that our elders were not so mired in tradition that they refused 

innovation. Our ancestors were incredibly intelligent and if they were here today, 

they would not hesitate to couple their incredible wisdom with today’s technology 

to figure out how to sustain our population and be responsible stewards of the environment. As Hawaii is increasingly viewed as the ‘‘test bed’’ or ‘‘pilot’’ for energy 

and agricultural security, our native communities have become much more active 

and are certainly willing to be the ‘‘tip of the spear’’ that leads this fight for survival. 

TiLeaf Group is just one of many partners involved in developing and implementing the Hawai’i Island 21st Century Economy Roadmap, a comprehensive plan 

that seeks to develop a viable, robust, and self-sufficient economy for Hawaii Island. 

The Roadmap has been developed by Rivertop Solutions, LLC over the past two 

years with the participation of key stakeholders on the island. It includes 29 

projects, each with a viable business model and plan which allows the project to succeed on its own, and more importantly, to support the rest of the projects in the 

roadmap, thereby building a comprehensive, self-sufficient infrastructure on the island that yields economic success and community empowerment. 

Addressing Agricultural Capacity on Hawaii Island 

Many Hawaii farmers are struggling to compete with imported foods because of 

the high price of electricity. On my island of Hawaii, for example, we paid an electric rate of 40 cents per kilowatt hour in the month of April 2012 in comparison 

to the national average of 11 cents per kilowatt hour. 3 If we want to increase our 

agricultural capacity, we need to find a way for farmers to be competitive with their 

counterparts on the continent. 

A critically important facet of the Hawaii Island 21st Century Economy Roadmap

is revitalizing Hawaii’s agricultural capacity by (1) developing processes that lower 

input and processing costs, (2) increasing educational and apprenticeship programs 

that help transition individuals into farming, and (3) generating market demand 

through the commitment of large businesses, organizations, government agencies. It 

is essential that we are able to match market demand with increased agricultural 

capacity to ensure economic growth and to sustain progress. 

Richard Ha, a Native Hawaiian Vietnam Veteran who owns and operates 

Hamakua Springs Farm, one of the more successful farming operations on Hawaii 

Island, summarizes the situation succinctly: ‘‘The farmer will farm if the farmer can 

make money. If the farmer cannot make money, the farmer cannot farm.’’ Given the 

volatility of oil prices and its devastating impact on Hawaii’s economy, Mr. Ha has 

focused on helping Hawaii to stabilize its electric generation prices by utilizing Hawaii’s robust renewable resources. He was motivated to actively help his community 

to address energy and food security following the spike in oil prices in 2008 which 

radically increased the cost of fuel, electricity, and fertilizer and caused his farm 

workers to ask him for loans to pay for gas to get to work. 

The first pilot project from the Hawaii Island 21st Century Economy Roadmap is 

the Pu’ukapu Agricultural Community Facility which includes an anaerobic digester, post-harvest facility, and certified kitchen. The anaerobic digester will process organic waste to produce methane which will be utilized to generate electricity 

and soil amendments which will serve as low cost fertilizer. The electricity will 

power a Post-Harvest facility, complete with processing equipment and refrigeration. A certified kitchen will also be included in the facility to provide for the manufacture of value-added products such as sweet potato chips and tomato paste. The 

facility improves agricultural capacity by providing low-cost fertilizer and low-cost 

electricity which enables post-harvest processing by local farmers, which has traditionally been cost-prohibitive. Such post-harvest processing enables farmers to sell 

produce to larger markets, including the Department of Defense, University of Hawaii at Hilo, grocery stores and resorts. 

This facility will be located on the Hawaiian Home Lands trust in Waimea, Hawaii. Congress created the Hawaiian Home Lands trust in 1921 via the Hawaiian 

Homes Commission Act which set aside approximately 200,000 acres for residential, 

agricultural, and pastoral homesteading by qualified Native Hawaiians. The trust 

lands are noncontiguous and are located on each of the islands. Each homestead 

community has a homestead community association, composed of lessees and family 

members, with democratically elected leadership. 

The Pu’ukapu Community Agricultural Facility will be owned and operated by the 

Homestead Community Development Corporation (HCDC), a statewide nonprofit 

owned and operated by several homestead community associations on Kauai, Oahu, 

and Hawaii Island. The Waimea Hawaiian Homestead Association, which repVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00040 Fmt 6633 Sfmt 6621 S:\DOCS\76708.TXT JACK
37

resents the homestead community in which this facility is located, will be the lead 

on managing this project for HCDC. Native Hawaiians, therefore, are not only participating, but managing and leading the way towards increased agricultural capacity and creating economic development and empowerment opportunities that simultaneously address food and energy security. 

Veteran to Farmer Initiative 

The Hawaii Veteran to Farmer Initiative can address not only Hawaii’s food security challenges but also the growing food security challenges across the nation. The 

average age of a farmer in Hawaii is 60 years old and the U.S. average is similar. 

The United States Department of Agriculture has loan programs in place to aid the 

addition of 100,000 new farmers every year because in the next decade, half of the 

current farmers are expected to retire. Rebuilding the nation’s ability to feed itself 

is a critical component of the strength of our country. 

Young Veterans consistently have higher than average unemployment rates. Not 

only are their unemployment rates higher than average, but there are numerous 

other social and personal welfare indicators where Veterans and families of returning Veterans also rank higher than average such as substance abuse, homelessness, 

and domestic violence. These figures all show there is a need to better support the 

transition of Veterans from the areas of conflict where they served, back into civilian life. 

There is a definite need to introduce a younger generation into agriculture careers 

with most of the U.S. farmers approaching retirement. Though only one sixth of the 

U.S. population is in rural communities, nearly 45 percent of the military comes 

from rural communities; so many Veterans have strong background knowledge of 

agriculture. Native Veterans represent the highest proportion of rural Veterans. Additionally, in Hawaii, four out of five of the individuals who identified themselves 

as Native Hawaiian or Other Pacific Islander Veterans, were under the age of sixtyfive, indicating a younger population of Veterans. 

Horticulture has been used as a therapy tool for decades. Horticulture therapy is 

a proven method of reducing stress and anxiety, improving coping skills and motivation. It also promotes confidence and hopefulness among other qualities important 

for Veterans suffering from post-traumatic stress disorder and traumatic brain injuries. In addition to providing a path to a career well-suited to re-integrating the Veterans, the Hawaii Veteran to Farmer initiative can provide a structure that includes 

routine monitoring by VA certified healthcare providers who will have routine contact with program participants, as needed, to ensure that treatment for physical and 

mental health of the Veterans and their families is on track. 

The Hawaii Veteran to Farmer initiative provides: (1) a certificate level handson farming skills training curriculum, (2) classroom-based business training, (3) 

business start-up support, and (4) as-needed health monitoring and assessments for 

Veterans. A key goal of the program is to enable Veterans to develop the necessary 

skills and provide opportunities that utilize these skills in farming while acknowledging the difficulties many face in transitioning back to civilian life after military 

service. Completion can enable Veterans to both create new farm businesses, and 

to meet the requirements to acquire the leases and loans needed to start a farm. 

The Hawaii Veteran to Farmer pilot program supports the Pu’ukapu Agricultural 

Community Facility because it increases the agricultural capacity that will be serviced by the facility. The program pilot begins in June 2012 and the first 12 participants include homesteaders who are Native Hawaiian Veterans and who have been 

granted agricultural leases within the Hawaiian Home Lands trust. The pilot will 

be completed in December 2012. 

Each program participant will be provided the supplies necessary to build at least 

one greenhouse on their property. Participants will receive hands-on training on all 

aspects of farming from building the greenhouse to germination, drip-irrigation 

methods, and harvesting. They will also participate in an educational curriculum 

that focuses on the business aspects of successful farming including marketing, accounting, and business relations. 

The hands-on training has been developed and will be taught by Mike Hodson, 

a Native Hawaiian homesteader who owns and operates a successful organic vegetable farm, WoW Farms, on his agricultural homestead. The educational curriculum 

is being developed in collaboration with the University of Hawaii system and agricultural industry. Classes for this pilot program will be held at a Native Hawaiian 

educational facility located in the homesteader community, thereby making access 

easy for program participants. 

Each participant in the pilot program has committed to, upon completion, ‘‘paying 

it forward’’ by continuing to participate as instructors so that the model can grow 

exponentially. At the end of the pilot we will have 12 working farms. If each particiVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00041 Fmt 6633 Sfmt 6621 S:\DOCS\76708.TXT JACK
38

pant helps even just two additional Native Hawaiian Veteran homesteaders with 

the practical hands-on training, there could be 24 additional working farms within 

the next two years in this rural homestead community. 

The pilot program will be used to refine and finalize the curriculum and to develop the required documentation to certify the program with various federal agencies. At least eight additional homestead communities have been identified by the 

State of Hawaii for participation in the program. While the pilot and its initial rollout focuses on participation by Native Hawaiian Veterans, non-native Veterans who 

have access to lands for farming or who seek to work on farms are eligible to participate. This is truly a community empowerment and community economic development model that can grow exponentially in a relatively short period to address our 

food security and economic development challenges in our rural communities. 

This program involves many, many stakeholders throughout Hawaii. The Roadmap and the Pu’ukapu Agricultural Community Facility involve participation by 

Native Hawaiian leaders, Native Hawaiian organizations, State agencies and officials, Federal agencies and officials, County agencies and officials, and communitybased organizations involved in food security, agricultural industry, energy security, 

economic development and workforce training. As we continue to progress, more interest is generated and we continue to expand the number of partners and collaborators in this project. 

The fact that the tip of this spear to address food and energy security is being 

led by Native Hawaiian Veterans is not only symbolic, it just and it is right. This 

is a win-win situation where Native Hawaiian Veterans can lead the way in addressing critical needs in Hawaii while incorporating cultural and traditional practices, creating jobs, generating revenue, and creating additional opportunities for 

economic development and empowerment. 

Conclusion 

Mr. Chairman, as a Native Hawaiian Veteran, I thank you for all that you have 

done over your career to assist and empower Veterans, but in particular Native Veterans. 

Your insight as a native Veteran has been invaluable in facilitating programs in 

recognition of the federal trust relationship between the United States and its native peoples. The establishment of the VA Native American Direct Loan program, 

for example, helped Native American Veterans to utilize the VA loans for homeownership on native lands. While there are additional barriers to increased participation in the program, the establishment of the VA Native American Direct Loan 

program serves as important precedent in demonstrating how federal programs can 

be modified to support the delivery of benefits and services to native Veterans living 

on native lands. 

The definition of trust lands utilized since 1992 as part of the VA Native American Direct Loan program has continued to help native communities. The 2008 

Farm bill codified this definition of trust lands as ‘‘Substantially Underserved Trust 

Areas’’ and authorized certain programs within the USDA’s Rural Development program to issue low-interest loans and grants on these lands. This is a vitally important tool to economic development and empowerment on native lands. If this definition can be expanded to apply to other USDA and federal programs, it could greatly 

incentive private capital to invest in native communities and on projects on native 

lands. 

Your unwavering support for the recognition of the accomplishments of native 

Veterans from the Navajo Code Talkers to the young Hawaiian men sent to colonize 

Baker, Jarvis, and Howland Islands to Medal of Honor recipients have served to memorialize the important contributions of native Veterans in defending and honoring 

our nation. We also greatly appreciate your efforts as a longstanding member, and 

as the Chairman of, the Senate Committee on Veterans’ Affairs, in striving to maintain the commitment of the United States to its military members and Veterans, 

but especially the native Veterans. 

As a beneficiary of the Montgomery GI Bill, you truly understand its value to Veterans and we applaud your accomplishments in strengthening the program to meet 

the needs of today’s Veterans. Innovative programs like the Veteran to Farmer initiative can be successful because your insight, thereby resulting in economic development, community empowerment, jobs and food security in native and rural communities.

The CHAIRMAN. Thank you very much. 

I am going to have to wrap up right now, ten minutes ago the 

vote was called but we finished you because we have a series of 

39

votes that we will be taking. I want to thank you again. You are 

doing community work that is incredible and I encourage you, in 

Hawaiian, [phrase in Hawaiian], that you strive for the highest as 

you continue to work with our Native veterans. 

I am looking forward to the next update from the Veterans Administration, the Indian Health Service and others about how you 

are working in the spirit of [phrase in Hawaiian], collaboration and 

cooperation as you are doing with health services and veterans affairs to maximize the reach of resources available to our Native 

veterans. 

Please remember, the hearing record is open for written testimony for two weeks. Your full statements will be placed in the 

record. I have questions that I wanted to ask you that I am going 

to put in the record for you to respond to. 

I want to thank you so much. We tried to move this up so we 

could take more time but they have moved the votes up also. I 

thank you so much for being so patient and for your responses 

today. You have been helpful and we will continue to work together 

to try to bring some things about that can help our Native veterans 

and of course our indigenous peoples. 

Mahalo nui. Thank you very much. Aloha and safe trip home. 

This hearing is adjourned. 

[Whereupon, at 2:07 p.m., the Committee was adjourned.] 

(41)

APPENDIX

PREPARED STATEMENT OF HON. LISA MURKOWSKI, U.S. SENATOR FROM ALASKA

Thank you Chairman Akaka and Vice Chair Barrasso, I would like to thank you 

for holding this important and timely hearing on programs and services for Native 

veterans. Last year in June I requested the Committee hold a hearing to examine 

the VA’s record of service to Native veterans and its progress toward implementing 

the several tools provided by Congress to improve access and quality to VA programs in Indian Country, and at last year’s Alaska Federation of Natives Convention I stayed at the Veteran’s listening session until the last Alaskan had shared 

their story. 

This hearing is timely because it comes just before Memorial Day and on the 

heels of the historic signing of a Memorandum of Understanding between 14 Alaska 

Native tribal Healthcare providers and the VA. The MOU seeks for the first time 

to allow rural Alaska veterans to receive healthcare benefits at Native health clinics 

instead of hundreds of miles from home. Alaska Native health providers have long 

been concerned that they must subsidize care to rural veterans from limited federal 

Indian Health funds. The agreement was crafted in consultation with and facilitated 

by the Alaska Native Health Board, it’s something I’ve been pushing through my 

Care Closer to Home initiative through MILCON appropriations, and I hope that 

the MOU helps the VA reassume its responsibility to veterans. 

Under the agreement, the VA will reimburse the participating Native health care 

entities for the services they provide, and it will also allow non-Native veterans to 

get care at the participating tribal health facilities. As our military heroes start to 

come home, it is increasingly important that we renew our commitment to ensure 

that the promises made to our Veterans, particularly our Native Veterans, are 

promises that we honor. 

In November of 2007, during my tenure as Vice-Chair, I presided over a field 

hearing before the Senate Committee on Indian Affairs in Anchorage, Alaska. That 

hearing, about ‘‘Health Care for Alaska Native Veterans .’’ offered important insights into the concerns voiced by Alaska Native and non-Native veterans from 

across the state. I am proud of provisions in the GI bill that authorizes a year of 

advance appropriations for VA healthcare so the VA is able to start the federal fiscal 

year with enough funding. And I am proud of our success in getting TRICARE to 

delay the implementation of their policy requiring ‘‘drive time waiver’’ for retirees 

living more than 30 minutes or 100 miles from a base hospital. I will continue to 

advocate for the needs of military children and for mental health services for our 

veterans, to support families because empowering veterans is a key part of America’s future success. 

Nearly 24,000 American Indians and Alaska Natives are now serving as active 

duty personnel across the Armed Forces, and I’m glad we are holding this hearing 

to discuss issues they will face. Alaska is home to over 77,000 veterans. We proudly 

claim that Alaska is home to more veterans as a percentage of our total population 

than any other State in the Nation. We know that over the next five years more 

than a million military service members will return home. As we welcome them 

home as heroes, I encourage employers to recognize them when hiring—recognize 

their skills, experience, leadership, and values that will help reinvigorate our communities and economy. I am proud to say that my personal office employs five current and former military veterans from branches of the Army, Navy, Coast Guard, 

and Marines. I would like to take a moment to thank those who have served and 

who currently serve, and their families, as well as pay my respects to the courageous men and women who have given the ultimate sacrifice, their lives, defending 

our safety and our liberties. 

42

PREPARED STATEMENT OF JEFFERSON KEEL, PRESIDENT, NATIONAL CONGRESS OF

AMERICAN INDIANS


524b1.eps
43


524b2.eps

Veterans Health lmpl'OvcmentAct of2009 is somewflat am~lklt'llting but critical gaps 

""main. 

W.: commend the VA lIlId lHS in make progress to better ccllabarau: lIlId provIde veteran 

r.ealth CJI~ under the VA"IHS Memomnd-~m <lfUrnk.rst:mding. The NCAI sllbmlt:tW 

comrmmts on behalf cf !noes. which l\lC all atI.iIchm~nt to this stuWmenL, ooout tll~ Dtdt 

AgreelnN'J: between the VA and [HS fur re[mbu1"wment thl" Direct Health Care Service~. 

The NCAT expre~~ed concern about !hI) dcla:Jild time and ~QSt in tm: decision \0 c.cale a 

demonstration projeot that tile Indian Health Care Improvement Act did not authorIze:. We 

also expressed the n=~d to ensure that all scrvice$ fm which native \·cteraRS arc eligible 

under VA belll'lfi~ should 00 reimbursable mcludlnghome one, residential treatment fur 

menta! health or substance abU5\!, diagnoses or tre.lltmcnt, nursing home care, and 

l.n!ditiWlul he~ling. Othel' areas we addresSlld wereoopayment waivers and retroactive 

billing. 

HO!I'l'ing 

It Is common. knov.1edge and dlmesslng~hJt tr.erePl;rn!ins a revere llQl.!l;illg shortage 

throughout fndhm COUIlt!)', Native veteran sre less ikelyto own their own home then 

otl-Jer veteranS. 63%oompared to 74%. Some effurt:l; toilddress this problem have bi:en 

made but the result.<; IU·C notyctdramatic, M~ny native veterans are likely to bellelit 

greatly rrom the re~el1t pass~ge of the Indian Veteran~Housing Opportunity Act thai 

cxdudes income received by ~ veteran Or hislherfamily for n service-related disability, 

under the definition in In~ome in the Native Am~rk..an HoU\<ing Assislan~~ and Self 

Determination Act, 

The VA Hoosing Loan p!"Ogmm is specifie~ly fOl· ~w. NeAl undorstands thn I.llIly 28 

hollsins: ~ >ll?pl!~!<timl!< weru pnl~<:'~$!...,j in FY 2011. Tn;" P"'1l""1l n:<jwru;:; 'I."ib~s ro- hll.w Ii 

signed agreemem with the VA before a tribal member Veteran 1s e:Jglb!e to submit a I-.orm: loan 

application. Severn.l trfoos do have not sign~d agt"ecmerJls with the VA, and nol.alt tribal offICials 

wtd veterans unde:stand how tIle progrem wotks. The NeAl recommenos tllMthe VA Implement 

I\ll acti~ outre~ch ~nd ~dUClltion effolt1otrtblll governments regardingt!;." loan program. 

The Housing ~nd Urban Development Native Americm 184 Programs is a nationwide loan 

program for tribal nlember$to buy, build, or refinan:>e housing, HUn ONAP has tl<:me a 

gooojob ofSfeking out mortgage capillli. The processing fonn for 184 housing does 1I0t 

contain infommtion on whether Iheappllcam 1$ a voleran. This information miGht be 

helpful in lhe future to US\:e!1ain whelh~rVl:tIlrans housing needs UN bclr.ghelpe<l through 

either one 01" ttle other progrom~< Tne NC.-'lJ tl!l}"$li1t~ t1om:nnme to WOl"k with HUD and 

0,\18 to modify the funn wlllt 11 si>nple que.o>uon 00 ~mn status of the appllCSIl'"_ 

Hom,,]eOj;nesl!. 

There is not an abundance of datil on IIlltive vei.e!:ilIIl\omeiessnoos. "''hat is known I; that 

nearly halfofh[\Jlll'l.\ess veterans served during tho Viclnl:lITl War but they include vetefllflS 

going back to World War II up through AighanistulllUld IllIq deployment, and tile 

military's lInti-drug CUltivation in Souti"t Amerie:J. The hOlJleless veteran population is 

predominantly mule Witll ebout 5% being femlLle. tI..ceordmg to the VA nnd HUD. an 

estimated 67,000 v~ro.""ns are homeless on any ~i"en night, 
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524b3.eps

Natil'e veterans, both malo Rnd female, generally do notconsiderth<:msclves II.!l hrnnd~s8 

sinee they may thinkofarolative's home II.!l their own home a~ well eVen though they may 

be only sleeping there (lI:(:a"iOllally. This aspect of thinking ~DIl!ributes 10 a low count of 

homeless Native ve(erans who I\ro less likely to utili?.., homeless facilities. In tufal areas 

homelcsmess is even harder to discern sinee the population is dispersed and again the 

homeless Velcro" maybe living in tents or,'ncnnt building$ as homes fGrthem 50 they do 

not self_identiryas homeless. 

A National Coalition for Homeless Veteraas report slated the reasons behind homeless 

include extreme shortage of affordable housing, income IUld aCCC:SS to health care, PTSD. 

and subsb!nee abuse that is compounded by a Jackoffnmily £ll1.d SCOw.! networks. TIle VA 

does have a homeless program ItIld is serving many, but like other worthwhile fedeml 

programs, the services are limitcd due to budget shortfalls. We ask the Committee to 

continue its vjgilantrole to find ways III incr~e support far homeless V~lcran programs 

that will helpvetemns reestablish their slllIlding in theircommunitie5 as proud and 

productive citizens to whom we owe deep gratitude for h~ving have served our clIunlry 

well. 

Veteran Service Officers 

The is.-ne of Veteran Service Officer (VSO) involvement, or more properly the IRck of, has becn 

one ofthuse anecdotal thiugs- no one ever writ~. about it, buteverycneknows about it. It is our 

understanding thulsome state and looal veteran service offices arcdthe mind that it is not COSIeffective forthem to go to thn rnscfVHtiOlls and outlying tribal communities. Organizations like the 

DAV now require membership (orally delivered condition) for servIce, nnd the others are seeking 

memben;hip dues, preferably life memberships. Two exceptions to this seem to be Purple Heart 

andthe Vietnam Velerans of Americ:a.. M1!I1ynative veteransm..ve express in NCAI VetereJ1s 

Committee meetings that it is nO Ee<:rl:L that thoy have experienced raoism from state 'l'eteran 

represenlllti\'CS. 

When nsti'l'e veterans' claims are denied they dll hsve not resources Dr representation to pursue 

appeals either 10Clllly Dr regionally. Thcre is a greatl1~ed for Tribal Veterans RepresentatIve (lVR) 

prognuns \0 bcoome certified nod serve ru; advocates. The barrier to a TVR program is the need to 

wnend the regulnticm, for tribal community eligibility us 11 state. The regulation as wrifum is 

inherelllIydiscriminatoJ)' •. and the NCAI urges action to chan~e this unfair regulation. The NCAI 

passed H resl)lution in support ofmodif}ring the Cod_", ofFcdcral Regulations fortribnl govermnents 

to bererognized by the VA for purposes ofadministeringvctcmn prob'T1lms and establishingTrlbaJ 

VSOs throughout IndilUl Country (38 C.F.R. Chapler 14). rt is ourunderstandingthrtt legIslation 

rna}' 00 forthcoming in this congrcilS to change tile regulations and we look to this Committee to 

champion this effort. 

Tribal Veterans Centers 

One ofthc more challenging issues is access to effective processing lind prosecution of claims for 

pension and compensation. While the Tribal Vetuans Representatives (TVR) program has b~cn II 

resouree in this respect, the I~ck ofdirect rcprcsenllltion lind prosecution ofcluims before the VA 

has- greatly inhibited the SUCCC3SrU\ prosecution of VA claims to ful! benefits. The progrnm 

op<:[Il;tes asllliaison progrrun with infomlation flowing through the IVRsto VSOs outside orand 

trnfamiliar with either the 'l'eteran orthe Commtlrnty, Consequentlytbere are fewer appeals of 

adverse deci5ions to either the Board ofVere1'1ll1' Appeals Dr t/u: U.S. Court of Appeals for Veterons 
45


524b4.eps

Claims (CAVC). II should be: noled thai ful! compensation for a vctcrun and a famil), cffour brings 

well over $3000 tax free per month into the community, along with heDlth care and educational 

benefits. 

Tribal Veterans Ccnters on reservalions and in tribal communities for would provide a ~ite for 

benefits counseling for veterans and their families, as well as a resource center for oo_li= ~ccc.s LO 

various economic rutd eduoatiOlial benefits. Those cenlers should be cooperative efforts between 

Department of Veterans Affairs, BlA, IHS (under the MOU between VA and lHS) and the tribal 

govemmenw. Theywould provide employment for communit), residents trained to staffth~m. 

Telemedioine, which is II significant partofthe proposed increase in provision of health care to 

vctmlns and th~irfamilie5 would b~ available,!IS well 3S substance abuse treatment and connseling. 

The Centernwould provide training and support services for family care-gi'vers ofooverely Injured 

vcterans, kccpingthcm at home ratherthan in state and federal nursing homes. Thc ooaring 

incidenccofTBI. PTSD, the need for suicide prevention on a Iocallcvc1 and the advent of disorders 

resUlting from exposure to depleled uranium that has yet to be ick:ntified as well as other 

catastrophic mjurics from m:pll)Eive devices lie within the expertise ofVHA, not IHS. Tradition2l 

healing, including sweat lodges and traditional healers, which arc essential to pmvldinll cuhumlly 

compliant services should also be available. TIle Centers .... ,ould provide theS(: resources for women 

veterallS and flunUy counsellng. 

As II resource for beuefits counseling, the Centers would be connected across Indian country 

through broadband to provide support services fur TVRs with enhanced training (and certification 

on the same footing as :dBtc and county veterans' S<lTVic~ llfficc!»). This would also provi<:k: access 

on line to the coming V~!emns Benefilll Administration dectronio claims ~ystern, obviating the 

necessity fcruse cfVSOs outside oflhe community. The Genters-would also provlde the 

opportunity forenhancing1he position of Indian veterans within their communi lies byproviding a 

iocation for community activities. honor ceremonies, para-gllmcs and "stand downs." 

Tribal Ve1crnns Treatment Coll11:5 

The incidence ofcriminal invo!vementofvelerans who are afflicted with posttrammrtio slro~s 

disordcr{PTSD), often exacerbated bytrau!T1>rtic brain injuries(TBls) ia increa.iog ala rapid rate in 

indian communiti~s. It isestimttted thcItthe inoidence ofPTSD in theveteron population as a whole 

after Vietnam was 30%" 35%. lbls estimate Increases to 50% and higher among the Southwest 

Asill veLermls. The types of criminal behavior attributable III this population indude petty crimes. 

assault, domestic violence, substance abuse (from self-medication) and suicidal risk-taking 

behavior. Within the family structure these behaviors are extremely destructive, re!illiting in broken 

homes and all too frequently, suicide. 

Veteran Treatment COUrI.'l integmted into the Trihal Justice System under the Tribal Law Bnd Ord~r 

Act would provIde ll. further resource furJustice involved veterans. 111e benefits ofthis innovation 

und~r the TI.OA am sllb:rtnntial. The Genrts -would be, as they an') elsewhere, cooperative elforts 

between tribal C()urts. prosecution (induding DOJ and Federal Defenders whel'll appropriate), 

defense bar Bud community soc:ial services. 

The enhanced sentencing authority of tribal eourtjudges under the TLOA provides a palm i)fo:ntry 

forthe Veterans Courts. Th. identifi~ation of a def~nd.ant as a veteran and an ensuing assessment 

(by VA) af eligibi!ityll~d ne~s lcads 10 a contract with tile Court. PrcS!:culion is deferred pending 
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524b5.eps

successful completion of a personalized program which includes treatment ofphysicll.1 disorders 

and psychic iTauma, counseling, and family involvement as wel! as mentoring by peers ar elders. 

The application for compensation Rnd educational benefIts is also essentilll to the Court progrnm. 

Tribal ccurts w(luld m(lnitor progre!15 in each case through periodic appearnnccs bylhe veteran and 

the mentor with progress reparts from VA and other involved parti,,~ 1(1 the MOU. 

M[Jst tribal couttjudgcs would much prefer that they have the flexibility to avoid confinement lind 

10 keep the family iniaC! wherever possible. Wh~n "Ppropriat~, fcd<:l'lIl pro.ecution may be d~reITed 

in order 1(1 utilize tile Veteran Treatment Court option, The Traditional Trib!\l Veterans Centers 

would be II focal point of the services provided for CElSe& in the Courl~ and for continuing support 

Ilfiersu~essful completion of the individual contrllcL 

Legislative support through enabling legislation to permit inter-agency funding and estahlishment 

of the Centers and the Courts is essentia1. We beHc:ve that judicious usc of ex is ling funding and 

resources (such as physical structures currently unus~d and re-allocation offunds currently used for 

similar activities) pooled by participating 3gencic~ would prov{l in the long run to be highly cost 

effective. 

In Clo!ling 

There ore two mar" disturbing fneLS thnt w~ caH npon the committee to find a WI!.'1 t.o address. 

AllAN veterans lIIe more likely tq have on average a household Income of less than 10,000 dollars 

compared to twice the amount for veterans in ~eral. Nearly 60% of A1fA~ veterans are 

uncmployoo compared to 55 parcen! of the genernl veteran papulation. These arc shameful 

stntistlcs and we call upon thIs CommIttee, tills Congress and thisAdminls1rnlion to find a way to 

ameliorate these statistic!! in this downturn economic andjobh:,ssclimalc. We believe thai 

continuing to caUat!enlion to these facts, as unseemly as they may be, will at some point grab the 

attention of enough people to bring aooutchang<l for the better for our respected 'WIUriOrs who stood 

guatrllitall coots for our freedom. 

Mr. Chairman, Ranking Member, and Members ofthis Committee, the NeAl is grateful tltat you 

have conducted lhis hc::arillg and te\:ognizcd the needless difficulties native vetel'lUls ful:e 10 obtain 

fair and just aeus. to benefits and programs, They served their obligations willingly and are 

reluctant to speak ootto seek the promises and bencfrtsfmm theirs~rviec to this clJUntry to which 

they we eotitled. They deserve no le~~ Ihen Ihcseentitlements and the NCAljoins this Committee 

in v.orklng to find asolution to improve ~ervices delivery and other ex.isting problems. 

Furtltcmore, the NCAI is appreciative of the agencies and tribal entities that have provided 

comments on these critical matters. Thank you fOfllllowing this statement and we-join you in 

honoring our commitment to our YCtcJilru<. 
47

PREPARED STATEMENT OF PAPA OLA LOKAHI NATIVE HAWAIIAN HEALTH BOARD


524c1.eps

Welina. Chsirmen Akaks, Vice Chairman John Barrasso, and Members 

of the Senate Committee on Indian Affairs. thank you for this opportunity 

to submit testimony on this critical issue. 

Papa Ola Lekahi is the Native Hawaiian Health Board that was 

established by the Native Hawaiian community in 1987 10 plan and 

Implement programs, coordinate projects and programs, define po6cy, 

and educate about and advocate for the improved health and wellbeing 

of Native Hawaiians, an Indigenous Peoples of the United Stales. 

These tasks were incorporated within US policy when the United States 

Congress established its policy in 1988 ~to raise the health status of 

Native Hawaiians to the highest possible level and to provide e>:isting 

Native Hawaiian health care programs with all the resources necessary 

to effectuate this policy (42 USC 122fSection 11702). 

Native Hawaiians and Hawai'j nationals have selVed in Ihe mililary 

services of the Uniled Stales and partiCipated in combat for thIs nation 

rrom its very beginning. I've altached for your review and the record a 

brief article from the Hawaiian Historical Society's Hawaiian Journal of 

Historr which provides a historical review of the distinguished record of 

HawalTs cltlzens In the Armed Forces of the United States. As a side 

note, a number of Native Hawaiians also have served in the armed 

forces of other countrles including England and Canada during times of 

worldwide conflict. 

~The article has been retained in Committee files~ 
48


524c2.eps

Four years ago, POL Initiated Its Native Hawaiian Veterans Project uncler tile direction of 

William Ctayton Sam Park. He is a retired Command Masler Sergeant with 3 years 

aClive duly In Vietnam and 21 years of service wilh the Hawaii Army National Guard. He 

Is also ratired from the DVA with 28 years or $<.;lrvico and a disabled veteran. 

POL's program fac!l!tat-es ihe aMIty -of HaW1.IiT3 Native vetefans (Native Hawaiians, 

American lndkms, and Alaska Natwes) to access programs Ihr0U9h the local Veterens 

Affairs office. Hawati's involveme:ll in both Iraq conflicts and the contfnufng effort in 

Afghanistan has greati\, taxed not only regUlar Armed Forces units but also lhasa of our 

National Guard. The health and wellness needs of these returning men snd women BS 

thc\, leave the !lervice conlinue to stress the VA system. To assls! in addressing this 

need, POL undel· Mr, Park's direction, has ast9bllshed a naUonal and Hawa!,i statewide 

network of "Auntioils" and "Uncles" who pr.:Jvide v<l!uable inforrnaliOil and "parental 

advice" 10 those veterans seeking help. "Hands on" assistance in completing all the 

necessBry forms required for enlry Into the VA system is provided. And, through the 

statewtde net .... ork of Native Hawaiian Health Care Systems (on all the major Hawaiian 

Islands), working wilh community hoilaJIh centers, the health :::are needs of Na!:f\.fe 

veterans, IncludIng American Indians and Alaska Natives resident in Hawafj, are being 

sewed elth<!t through needed primary care and/or feferro! :>ervk:es; but the need far 

eXc8eds the existing resources. 

POL continues to look forward to developing a formal MOU with the VA; ene similar to 

that currently In place between the VA and !be Indian Health Service. AI th1s point In time 

pal serves as the only federally-identified mechanism 10 specifically address the health 

of Native HaWBiil'lTls and, so, In that oapaclly, it Sl!rvBS a role simililf to Ihilt of the Indian 

Health Service. POL, WOiking with Ke 0101 Mama, the Natlva Hawaiian Health Care 

System serving Ihe i;;;land of O·ahu, has fooifilated a contract for primary care fer 

American lttdians and Alaska Nalives residen! in Hawai'i. An expanded MOU with IheIndian Health SeNk:e forvemrans Is something POL would Hke to explore. 

Over the pest years, POL has made a number of recommendations addres3ill£l 

Improved Native veterans' care in testimony before the SellBte Committee on Veterans 

Affairs. We would like 10 bring forth these recommendations for joint considO'l<llion by the 

Senate Committee on Indian Affairs: 

1. Continue to enh"lnce VA capacity to address health and wellnesSi issue!> not 

only of the Native VA beneficiary but also tho$e aftlle benefICiary'S family; 

White addressing Ihe Nalive VA beneficiary's health needs which is cnlical to lila VA 

m~ssjon, biara needs to be the ablJUy within the VA also to ad'.lfe,,~ the l'elSC!!ant heallh 

iGsues and needs of the Nafiwl VA beneficiary's family. This ls partk:ularly true with 

those Native beneficiaries with TSI and/or PTSO. Wilhoul!hls abiiit,r, lhF,m~ is often a 

family breakdown and a less than satisfactory outcome for Ihe Nalive VA boneficiary, the 

family, Bnd tile community. 

2. Oevelop VA capacity to contract with Native groups and organizat1ons to 

provide outreach service:> to VA benefic:iarles and thllir families; 

In Hawai'l, the VA has begun to reach oul 10 rurel oommuililies, parlicularl\' on the 

neighbor islands, and provide needed services to VA beneficiaries living in these areas. 
49


524c3.eps

POL asks that the VA contract with Native Hawaijan and ather appropriate groups and 

arganlzatlons to provico Qulrcach service>:; \(J N,.~ve VA beneflciaries and th ... ir families 

in these remote areas. 

3. Deve!op VA capacity tQ contn:lct with Nativ" Hawaiian Health care Systems to 

provide Native VA benefICiaries and thefr fan"JlIas \\ito primary care services in 

IUra! areas; 

For the same masons noled previously, the VA sinply does not have the capacity at this 

time to reach out into communilias in Ihese rural island areas wIlere there are currently 

primary care sep,oi~e providers. It would mallo sense for the VA to aontract ror primary 

care services with these exisling entities in thMe rural communities. !n Hawai'i, there 

are 5 Native Hawaiian Health Care Systems which qulaMy link with 14 OXlmm(lnity health 

centers la provide primary care. 

4. Train VA service providers workIng with Native popuraUOl1~ In nlstQt)', cultural 

sensitivity, and cultural competency; 

Mo~t VA $sl'v10:" providers are not from lhe l\iat/Vl:! wltum. POL has demonstmted from 

past efforts Just how effective \raining VA SGlviCf.) personnel in historiM! contaxt and 

cultural sensitivity and competency can improve VA service provider and Native VA 

benefic:lalY understanding and compliance with good outcomes. 

5. Expand VA capacity to provide traditional Nallve heating practk:es and 

alternative and complementary heating practices to Native VA benenci<uies and 

their families; 

Nalive cultures have traditional hea~n9 practices such asJomlloml (Hawaiian massage), 

ho'oponop<:mo (oounSllEng), and la'all !apa'w (hero • .! me'dicinejln our Natlve Hawaiian 

culture. This lncll:TIC$ trndltlona! pracl!css and pm~CIJ!s tJarniitioning the 'warrior' back 

into civilian socialy. Ameliean Indian and Alaska NativEl VElte.rans havs simiiar 

ceremanies, All of Ihese have demonstrated effecliveness for the Notive VA beneficiary. 

The VA needs to suppart these traditioool methods <lnd praclices. In addition, there are 

numerous alternative and complemental)' health care practices such as I!!C1JplJIlcture, 

chirapractic, Chinese medicine, and naturopathy which may be of perliculll.r interest and 

therapeutic ta Nallve VA beneficiaries. These, too, should be allowable and available. 

6. Support and dwclop specific work plans fnr each oftha racommendations of 

the Advisory CommIttee on Minority Vetenms' July 1. 2008 and July 1, 2009 

reports; 

In 1994, iegisJaliDfl was passed which esrobRsheci Ihe Advisory Committee on Minority 

Veterans. The work and recommendations of this cDmmitlee MOld to be actlveiy 

supported <:Inc! implemented respectively. It is strongly recommended Ihal a Native 

Hawanan representfltive be added to the committee as soon as appropriatE!. In addltron, 

Native HOIwaiians laok forward to particip.atrng with the federally,chartered National 

American Indian Veterans group and applaud the recently produced DVD enlltled 

"Nawe American Veterans: Storytelling for Healhg," whiah includes American Indian, 

Alaska Native, ant.! Native Hawaiian veterans' stores produced by the Mminlstration for 

Native Americans, US Department of Heal!h .md Human Services. 
50


524c4.eps

7, Collect, an.-Iyze, and report data on Nativ(l! VA beneficiaries and their families in 

accordance with 1997 OMB 15 revised standards, including dis3ggrcgating Native 

Hawaiian from Othel' Pacific Is1,mderdata; 

in 1997, OMS diS:~9gregaled the Nilan Pacific Islander (API) identifler and established 

two dis!lnct eategaries; Ji.sian (A) and Native Hcr.vairan a~ ather Paciflo Islander 

(NHOFr,t, 1'llo VA neeels to Incorporate this disaggregation wllhln its reporting syslems, 

Addmonaily, "Nalhre Hawallans~ neec: to be distinctively ldenllfled apart from "Other 

Pacific 15Iandar$~ as Nat1v9 Hawana"s have a unique relationship with the federal 

government similar 10 Ihat of Amelioan indians/Alaska Natives. 

a, Enhance the VA and HHS agencies' capae!ty to undertake research ~m ways to 

improve health and wallness outcomes for Native VA beneficiarie$ and thair 

famllfes, 

The VA's msearel1 Ilungal: has teen llmiled alier the past decade. The US Departmei"\t 

of Heafih and Human Sevices has the ma.lor hea~lh research budget (NIH). Adtiitkmal 

furnls need to be ",lto~ted 10 rel;'.;arciJ how lietter health outcomes !;8n be acoompr!Shed 

for Native veterans and thei- famifies. This Is particularly eriUca[ for li'Jose wilh TBI and 

PTSD. One ama of ctitic;aj importance is to Investigate what the health and wallness 

IS6U96 are for relurning Nalivft mom and women lielerans from today's war zones, Many 

of Ihese potential studies could and should be undertaken by Native health researchers 

them~elves, 

Thank you again Chalnnan Akaka, Vice choinnan Barrasso, and Members of the Senate 

Committee on tndlan Affairs for this opportunity to ~hare with YOll POL's 

rec:omrnendatlons.. POL especially .... Ishes In ttXpmss lis gralUude and Ioloha to the 

Chairman. Senatol' iJan;el K. Akaka, who has so welt seNed Hav/ai'i, this nalkm, and aU 

Native Peoples.. /Jlahalo Nul loa. 

Ourieslimony concludes willi an ·o!elo, a Vllr$e, in 1.'1e Hawaiian la1l9u:oge: 

KE KAULANA PA'A "A1NA ON NA AU-I 

Which is simply translated as "The famed landholders of the chiefs· .• , The meaning hare 

is that the besl warriors were awarded the be;st lands by Ollr chiefs beoa~J$e of their 

bravery and servl('.a, That Is why POL provIdes this teslimony, POL \limply W'dnis the 

best healih care pos~ib!e ror our warriors who have given so much and cfter\ saerifleed 

Ireirown heallh for this nalion's benefrl. 
51

PREPARED STATEMENT OF RICHARD ALLEN ADAME, SERGEANT FIRST CLASS, RETIRED

U.S. ARMY, PRAIRIE BAND POTAWATOMI NATION VETERAN


524d1.eps
52


524d2.eps

slopped this improper pratticu in 2Oll1 in [espouse to the Depal'tmcnt of Justicc's isslll.\ll~<:: ora 

memomndtlm opillion for the General Counsel ofilie Department oiDefense. 

In the WOO .mmorandum op!nion. the Departmwt of Justi~ roncilliled m~t :he $SeRA, 

l':sp.eciMly when rea<l1l'C light of ~1 prim:iploo.,> of fede..-ai Indian law, pr!lempiS ~y r"u!!1()r1ty II. 

Stare =<aliling a Native Am!:rlc::m's. ttiirnJ rcsidefl\:t'. nmy {)t1)t;!WI3C have 10 tlUl: that NatiV!l 

AmeneaR's miEtllry m(;o''lle, The Dcpartm.cm QfDef'r:r4e agreed willi Justice's COOCllci(.'l)l, and 

hnHcd the improper wUblm1dlng of state income tID!: frOl":'l Native service member.:; domiciled 

within Iheir trihaL reservations. 

In July 2Qll2, th~ Departnlent ofDefMse imple!l1en~d l). Mw form - Form DO 2OSll-2 Native 

Amtlril'an State lncome T~.:ot WlthholdingExempti(m CertiIkale. This is. the first eCfortlQ my 

lcllowledge thaI the Dr-pM-\Juen! made 10 altcmpllo enSltre thaI eligibl~ Nal1;'e setvice members 

did not :m\'C state income Illx '\\llbhe.!d from !l:eir p~y. DtrrillgmY Mellty ~e<lrs cfwrvlce. ill tbe 

United &at&!> A=..y.!. w(\s never lflmie /tffll.(<:<It any p;tpe'IIOIkm: otherwa}' to pr<W{;l1\ slllteo 

kCOmC!lU f."'!lID lleingwlthheld from my !!illi!uy F~Y. The purpc:ie ofF<mn DD205S-21sl1J 

enable a Na!i',~ service member If.l SlOP 8ml" income- 1m!: withholding from his mIlitary 

rompc:nsa\ioo. Thi!: im®l1;>lior; submitted by theNativ(: service membe-.- Qll the Ferm bcrJ;lrrn:st! 

permanent part oftlle active duly pay system of the sc;vice concerned. This js a tn:.mtmdt)us step 

in the right llirecLiOll for ensuring that eligible Nati"~ ~et'lice members do not have state Inoome 

tnx withheld from thelrmm\ary pay. 

However, even though the D~p!lrtment of Defense reco.goize9 thol its former staw. il)come tal' 

witl!boldingpracliCl:s. WIllrtl improper, il:i new ami P\'operpiacti= do not apply !~troactively. 

Tbfs meani tb.at Ni1li.vtIsery!w members rmd veleruns from the World ,Varl! era It) the early 

twmlty·firl:;t ~tury wIlt} were i!'Xempt from state inoollle Imi: but from whew military pay state 

lm':Cme la),'!:S .mWltf.elez were impwp;:rly withheld hove 'lim."1lliy lID way 10 rCCO\.\j) the ronne},>, 

(bey are owW.l1le statute ofIbrilatioos tor refunds of Stilw inmma tlI/f is very li-~l: 111 most 

Slllles. These statutes of Iimltati(lTls typIcally nrn for only two years from !he tax year f\'lr wbicha 

refund is due. Betamlli Ih" $!iltute ofllmilations for stall!. ill~ome tax refunds for roOMY:; 

improperly withheld 'from the military pay of statt,-tnx·e)(()Il1pl Native service members Rnd 

veterans prior 10 2001 bas already fUn, these ;n!I.hidl1al~ ;11'" unnble to seek recoupmllllt of the 

improperly withheld monies dlrecUyfrom the states. FurthelIJlorc:, because th~ ~1~le ln~ome lou:. 

wlthholdlngs wereimpropcr in the fiTst place, requirlnz Natjve ~ervice membeIS and veterans to 

sell}:: remulleration :o«)llgh t~e slate refund process dues not seem app'Opm\B. 

In ZCiJ4, Rep. Tom Udall :>OUgl\l !Xl restore We nnp!'l>{lCtlJ' wllhheM flmcis to ell$l'We Nau;lc 

-veter~n<; Jl.t the feder~ level. He mtm!t,l;:ed H.R. 5275, wh~ Ouhlne<.l a p~ "'Ameriean 

Inman Vete=>.sPay ResWatkm Act of2(jQ4". The BIl! $Ought \o:l p~de for the- restitution In 

eligible Nalivt: vet.;:m.l~~ oJ: amounts of stale income tal; improp!Mly widlhcld from rni!ilmy ba~ic 

pay during the pE:rlods tbo~e Native veterans w~re In act[ve service and were domictled in Indian 

country. Rep. UdElll's BiU .!I':tfortb '!he definition of''qurliifying llldian veterans", allowoo 

widows and snrvil'cl'S of~u.;;h veterans to seek recoupment of (he irnproperlywilhh~,ld fund~, 

along with interest,;md crealed aD application proce:l8 bywlltcb qualifying lndi~n veterans or 

their survivor~ could sea!;: rep~llleTIt. The Bill alSO nuthoriZt){lan oppraprtaticn ill' $S,Q(lll,OOO 

from whicb stich paytn()l'1S were IQ be made. Wh.m !\)payrnents of wrcmgfully wi!hheld stat!:-
53


524d3.eps

income taxes were mad!: to the qualifying 1n~ian v~teta\1 or survivor, the Bill uuthori?ed tile 

United States. to seek recovery from the state thaI received th~ improperly wiUlheld talle&. Much 

to the disappointment of tile Native veteram! to whQm tlw. Bill aoughllo restore juslke, Rep_ 

Udall abandoned the Bin fur lack ill stl;lporL 

Withcutfederal action, affecled Native servicernembiUS alld vetemns must deal rllrecUywiih the 

stales thut received the improper\ywithheld slute inCOme IllXfrom their military pay. This is a 

monumental task, esp~chilly in light of the strict st~lute of limitations on stale inooliia tax refunds 

and the lack of a more appropriate remuneration plocedure. WJthout federal direl;tion, it is 

unlikely that the several slates will hearken to the leqllesls [0, repaymc.nl of the improperly 

withheld Slate income tax !ill\[)unlli. 

Theone excoption. however, is the State of New Me:>:iro. New Mexico stands as an exempl~r of 

how justiceCll.1l be restored to Native service mem)(.J"!i and vtltcBns who wenl. irnpro~e:ly taxed 

by theStatc.ln 2010, the New MCl'i<:o Dl!pllrtmeui: ofVelet<ms' Sel"'liees (N1.illVS), 1m: New 

Mc:'Iico D::partIDCIlt of Taxation and ReY1:nue cleplll:tment ami lIre N~w Mexico Depurtment of 

Indian Affairs tean::ed up to launch the "Native Ameri("$I\ Vele:=~' lncDme Tax Settlement 

FUnd". This fund was cre~tecl by tlie State of New Me:>:loo 10 addrC/;s the issue thai state income 

lax may have been withheld from the paycher$s of Native American soldie~ whil~ th~y were 011 

active dUly and Jeg..Jly dl)midled on tribnlland. Uoder New :Mexico's Tax Settlement Fund 

proglllm, Native American Veterall5 can ~ubmit an application and supporting dOCllmentation to 

rocoup New Mexico SI:ltc t~xes wfDngfully withheld from their military pay. 

Ttw Native service members amI ve,efllllS offectcc bYlhe Department ofDcfcnse'5 improper 

wilhholdmg ofslr.tc Income tax from wi, military pay "ted the help of I.lu: &nrue Committee 

on !milan Affair.;, Possible soluuoM inclOCc S'JFPr-ting;md soreiug the enactme::lt cffcdend 

lr:<>Jslatio... similar to that introduced by Rep. UdaR in 2004 ill HR. 5I15. FWen\llcgi.~!atlon 

requiring and Dfieriog int;entives 10 lh<:: sel'llrnl st~!es 10 develop" 5~u!ement fund simil3r 10 lhat 

implemented by thllo Stale QfNew Me:>:ioo is anotr.er possible option. 

I am aware thai the Unitt:d Statf!S Olllgmss Itas a recent history of intervening on behalfof 

Sfln'ire rnclllbcr$ whos~ d!;":h!:l hElve beeu wrong$tl, III '2Q{lf}, nfter a battle of Mllfly 03 ye:rrs, 

Congress eompensated Filipino Worl~ War n vottrnns and their survivors for money promised 

to those vetemllS in 1942 but that was never paid 10 thE~ll. This oompensatron, in the words of 

Sell.lnouye,. wasn=.>uY becausc « ••• the. OOllor(lfthe United Stales is what is involved." 1 am 

also aware lim! 118 retentiy <IS 2011, the United StlitlS hE.'[ stcpp..'"ll in to step IhewlmJg<""ul 

fGreclc~ures on the htllllllS of nctive duty servlce members. lam lrusting the Senate Commil{f:e 

Oil IliGian Affairs to inkrvelle on behalf ofNatl"BwlVice memoon; and wlenms and 10 

spearhe2d rederal efforts to restore the hODorof the Unit~d Stal!!S witll regard to tim WIle income 

taxes improperly withheld by the D~pmtmj'J]1 of ~ren'ie flOm the pay of sl~te-t:.1x.exempt 

Native slm'ice member.;. and veterans 

On behnlf of the courageous and dedicated Native se>vlce members and velernns WllO were 

impropcIly subjectcd to state income Ia.'!: withholding.~ and who have no wily to seet.: restoration 

oflhcse funds, I bearti!y and rcspcctfuUy ask the SeIlllte Committee on Indian Afiails to work I!I 

;us!ore Ihis pay \() eligible Native service members and veterans.. n.e tru~t reh.lionsbip cbligales 
54

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

STEPHANIE BIRDWELL

Question 1. The 2010 MOU built upon and seeks to improve the 2003 MOU. Will 

the VA/IHS MOU need to be updated every few years to best serve Native veterans? 

Answer. The VA/IHS MOU will need to be updated every two to three years. The 

Joint Implementation Task Force is charged with this duty and ensures the update 

will take place. The MOU provides the foundation of understanding between IHS 

and VA which defines purpose, priorities and specific areas of focus for working together to improve, access, quality of care, collaborations, sharing of resources and 

programs to serve American Indian/Alaska Native (AI/AN) Veterans. As accomplishments are documented and progress improves, changes and adjustments will be 

made to keep up with the needs of the population served.

Question 2. Can you please discuss the importance of having accurate data to 

properly serve Native veterans? Are there areas where you can improve data collection and analysis to better serve Native veterans? 

Answer. It is important to maintain up-to-date and accurate data to properly 

serve Native Veterans and meet their needs. The Office of Rural Health (ORH) collects data from all Veterans Integrated Service Networks twice a year and maintains an inventory of programs, activities, and projects. ORH coordinates MOU 

workgroup activities, attends their meetings, and obtains quarterly status updates 

and reports of accomplishments from the workgroup leaders. Also, ORH tracks the 

numbers and types of sharing agreements that advance the goals ofand objectives 

of the MOU between VA and IHS and between VA and Tribes. Sharing agreements 

are developed at local health care facilities continuously through the year. A list of 

the agreements is reported to ORH twice a year to track and trend progress in 

meeting MOU goals and objectives. Information communicated to VA leadership is 

utilized to support activities and improve Native Veteran care and services.

Question 3. In your testimony, you discussed the updated VA/IHS MOU. Are there 

mechanisms in place to measure the effectiveness the MOU has had and will have 

in the future? 


524d4.eps
55

Answer. The MOU Metrics Report is used to measure the effectiveness of the 

MOU. At the present time, three metrics have been defined to monitor performance 

progress and success across all MOU workgroups. The three distinct metrics are: (1) 

The number and types of programs developed between VA and IHS and between 

VA and Tribes, (2) The number and types of outreach activities provided to help and 

impact AI/AN Veterans, their families, caregivers and communities, and (3) the 

number and types of sharing agreements developed between VA and IHS and between VA and tribes. This data will be reported annually. The first report will be 

completed by August 31, 2012 and will be reported to the Senate Appropriations 

Committee, target date September 30, 2012.

Question 4. In March 2012, Secretary Shinseki assured me that he would look into 

ways to work with Native Hawaiian health care systems and Native American Veterans systems to provide services to Native Hawaiian Veterans who live in rural 

parts of Hawaii. To your knowledge, has any progress been made on this effort? 

Answer. The VA Pacific Islands Health Care System (VAPIHCS) has approximately 45,000 Veterans enrolled throughout our 4.5 million square mile Pacific 

Ocean area of responsibility, including Hawaii (Oahu, Maui, Kauai, Big Island, 

Molokai and Lanai), American Samoa, Guam and the Commonwealth of the Northern Mariana Islands (CNMI—Saipan, Tinian and Rota). These 45,000 enrollees are 

made up of people from many cultures, including Native Hawaiian, other Polynesian, Asian and European based cultures. 

In addressing the health care needs of all Veterans in the Pacific, VAPIHCS has 

put forth an effort to establish new and close working relationships with the Federally Qualified Health Centers (FQHCs) on Maui, Kauai, Big Island, Molokai and 

Lanai. These FQHCs, while close in proximity to our existing Community Based 

Outpatient Clinics, offer a variety of health care services to native Hawaiians including native Hawaiian Veterans. 

We have a well established relationship, over many years, with the leadership of 

Papa Ola Lokahi, a consortium of providers that make up the Native Hawaiian 

Health Care (NHHC) Clinic System, throughout Hawaii. 

We have an initiative in place with the NHHC System for VA to actively enroll 

Native Hawaii Veterans into VAPIHCS. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN BARRASSO TO

STEPHANIE BIRDWELL

Question 1. In 2010, the Indian Health Service and the Department of Veterans 

Affairs established a Memorandum of Understanding outlining a plan for coordination, collaboration, and resource sharing. However a prior interagency agreement for 

the same purposes has been in existence since 2003. Tribes have contended that no 

action has been taken by the Indian Health Service and the Department of Veteran 

Affairs to improve services, despite the existence of these two agreements. How will 

the 2010 Memorandum of Understanding be implemented more effectively than the 

prior agreement? 

Answer. VA/IHS workgroups have been established to accomplish the work of the 

MOU. These workgroups include: Services and Benefits, Coordination of Care, 

Health Information Technology, New Technologies, System Level Agreements, Payment and Reimbursement, Sharing of Care Processes and Services, Cultural Competency Awareness, Training and Recruitment, Emergency and Disaster, and Oversight. Each of these workgroups has a defined purpose, goals, objectives and action 

plans. These workgroups are proactively meeting to discuss their purpose, goals, objectives and action plans and ways to enhance them. Each workgroup has defined 

membership and leaders. They meet regularly and their accomplishments are 

tracked and reported quarterly to the MOU Oversight Workgroup. This information 

is used to improve care and services for Native Veterans.

Question 2. The 2010 Caregiver and Veterans Omnibus Health Services Act allows, in certain circumstances, electronic transfers of health records of Indian Veterans between Indian Health Services and VA. This Act was intended, in part, to 

provide seamless health care services to these Veterans. What is the status on the 

implementation of this Act? 

Answer. Section 303 of Public Law (P.L.) 111–163 (Caregivers and Veterans Omnibus Health Services Act of 2010) permits VA to carry out demonstration projects 

to examine the feasibility and advisability of alternatives to expand care for Veterans in rural areas. The demonstration projects could include (1) a partnership between VA and the Centers for Medicare and Medicaid Services of the Department 

of Health and Human Services (HHS) at critical access hospitals to coordinate care 

for rural Veterans, (2) a partnership between VA and HHS at community health 

56

centers to coordinate care for rural Veterans, or (3) expanding coordination with 

IHS to expand care for American Indian and Alaska Native (AI/AN) Veterans. VA 

would be required to ensure that the demonstration projects are carried out at facilities that are geographically distributed throughout the United States. VA is required to submit a report to Congress, no later than 2 years after enactment, on 

the results of the implemented demonstration projects. 

VA has not implemented any new demonstration projects under this discretionary 

authority. However, there are considerable efforts underway to improve rural health 

care under other authority that builds on existing agreements with HHS and IHS. 

For example, VA and IHS have established a task force to explore using existing 

authorities to expand coordination between the two agencies. In addition, VA’s Office of Rural Health (ORH) currently supports a number of projects already that involve expanded access and collaborations with other parties, including HHS and 

IHS. ORH activities include funding for Community Based Outpatient Clinics; enhancing primary care for women Veterans in rural areas; expansion of tele-health 

services including tele-renal, tele-psychiatry, tele-dermatology, tele-mental health, 

tele-rehabilitation, tele-amputee, tele-pharmacy, tele-PolyGram and tele-radiology; 

expansion of Home-Based Primary Care (HBPC); expansion of Outreach Clinics; 

services to homeless Veterans and expansion of mental health services. ORH also 

funds the pilot program required by section 403 of P.L. 110–387, the Veterans’ Mental Health and Other Care Improvements Act of 2008, Project ARCH, or Access Received Closer to Home, under which covered health services are provided to covered 

Veterans through qualifying non-VA health care providers. Additionally, the Veterans Rural Health Resource Centers (VRHRC) are developing local partnerships 

and innovative programs to address the needs of Veterans in rural and highly rural 

areas. Veterans Integrated Service Networks are also sponsoring a number of efforts 

to increase access for Veterans in these areas. VA advised the House and Senate 

Veterans’ Affairs Committees of the decision not to develop any new demonstration 

projects under section 303 on May 17, 2012.

Question 3. A 2010 Department of Labor report, mandated by the Veterans Benefits Improvement Act of 2008, found that Native American Veterans living on tribal 

lands were often unaware of employment programs available to them. In addition 

to finding that increased awareness of these programs is needed within Native 

American communities, the report also found that increased collaboration is needed 

between the several Federal agencies (Department of the Interior, Department of 

Labor, and Department of Veterans Affairs) that maintain employment services programs serving Native American Veterans. Among other things, the report recommends consolidating these programs, at least to some extent, by creating ‘‘onestop Veterans helps shops’’ on Indian reservations. What is your agency doing to address the issues highlighted in this report? 

Answer. In an effort to ensure that Native American Indians, particularly those 

living on Indian reservations and in rural areas, are aware of services provided by 

VA’s Vocational Rehabilitation and Employment (VR&E) benefits, VR&E Service 

has taken the following steps:

• Collaborate with other offices within VA, such as the Center for Minority Veterans, Benefits Assistance Service, the Office of Tribal Governmental Relations 

(OTGR), and ORH to promote outreach efforts specifically targeted to Native 

Americans;

• Attended the first Eastern Region Summit sponsored by OTGR to provide information on VR&E services and build stronger relationships with stakeholders to 

better serve Veterans and their families;

• Presented information on VR&E benefits and services during the 2012 Consortia of Administrators for Native American Rehabilitation (CANAR) Mid-Year 

Conference, which was held June 17–20, 2012;

• Presented at the following Native American events:

—VA Alaska Tribal Consultation, May 25, 2012

—Lincoln Consultation, June 17, 2012; and

• Developed a Memorandum of Understanding between VR&E and the Alaska 

Consortium of Tribal Vocational Rehabilitation.

Question 4. What is the status on implementing the recommendations in this report, including collaborating with the other Federal agencies to create ‘‘one-stop Veterans help shops’’ on Indian reservations? If these recommendations are not currently being implemented, please explain why. 

Answer. The Department of Labor (DOL) is responsible for establishing ‘‘One-Stop 

Career Centers,’’ including new locations on Indian reservations. VA collaborates 

57

with DOL to ensure the ‘‘One-Stop Career Centers’’ are publicized on VR&E’s 

VetSuccess.gov transition and employment Web site as well as VA’s eBenefits Web 

site. VR&E Service will also ensure that information regarding ‘‘One-Stop Career 

Centers’’ is provided during outreach events with Native American Veterans. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO

CHERYL A. CAUSLEY

Question 1. Last Congress, we enacted the Indian Veterans Housing Opportunity 

Act to ensure that amounts received by Indian veterans for disabilities resulting 

from military service would not be included in calculating family income for housing 

purposes. Are there other barriers Congress can remove to allow greater housing opportunities for Native veterans? 

Answer. Indian Country is enormously grateful to this Committee for showing 

your full support and championing the passage of the Indian Veterans Housing Opportunity Act of 2010. This law ensures that Indian veterans who receive federal 

disability and survivor benefits are not denied support under NAHASDA. The passage of this legislation demonstrates that when Congress and Tribes work together 

we can find tangible solutions that will help our Native Veterans. 

As you may recall, this law ensures that Indian veterans who receive federal disability and survivor benefits are not denied support under NAHASDA. This is good, 

but it only applies to NAHASDA. We understand that similar legislation needs to 

be passed so that Native veterans and their families are eligible to receive housing 

services from the BIA’s Housing Improvement Program (HIP). NAIHC is researching the issue, but we believe that neither Indian veterans nor their families should 

be denied services through the BIA–HIP because the veteran or family is receiving 

federal disability or survivor benefits.

Question 2. In your testimony, you cited housing data related to Native Veterans 

only in certain states. Is there a need for more comprehensive data related to the 

housing needs of Native veterans? 

Answer. There is little to no housing information or housing data available on Native veterans and there is no funding available to collect that housing information 

or data. Indian Country is in dire need of accurate and reflective data to help us 

build a solid case for support, but to also help tribal communities in prioritizing and 

planning housing projects for Native veterans. 

However, there are solutions to this problem. First, provide funding to tribes and 

tribal housing programs to collect information on Native veterans. Second, build 

training and technical assistance programs so tribes have the tools necessary to 

build an appropriate database on the scope and needs of Native veterans. Third, develop partnerships and collaborations among various agencies at the local, regional 

and national level to share information and data. For example: at the local level, 

the tribal veterans affairs office, local veterans organizations and tribal housing authorities can come together to share information and data on Veterans in their community—often these offices and programs are separate; and at the national level, 

the federal agencies need to build interagency working groups to collaborate services 

for Native veterans. The Department of Veterans Affairs and HUD should have 

joint agreements to share information and data, and create initiatives to fund and 

support tribes in this effort.

Question 3. Ten years ago, the GAO released a report identifying barriers for Native American veterans seeking to use the Native American Veterans Direct Home 

Loan Program. To your knowledge, have those barriers been removed and are Native American veterans utilizing the program at a greater rate? 

Answer. The VA Direct Home Loan Program has the potential to be an important 

tool for housing development in Indian Country. The program has, however, been 

underutilized as noted in the August 2002 GAO report on Native American Housing. 

Barriers that remain are as follows:

• Insufficient income or credit history to qualify Native Veterans for the direct 

loan.

• Lack of infrastructure on tribal land, especially in more remote reservation locations, and land availability for those tribes that have insufficient ‘‘buildable’’ 

land.

• Difficulty in securing a clear title for home site leasing purposes on tribal land.

There have been notable improvements. The loan limits have increased to 

$417,000—when the 2002 GAO report was issued, the maximum loan was $80,000. 

Also, the Department of Veterans Affairs is making a concerted effort to get inforVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00061 Fmt 6601 Sfmt 6621 S:\DOCS\76708.TXT JACK
58

mation about the Direct Loan Program to tribes, tribal housing entities, and tribal 

members. I was pleased to see that Ms. Stephanie Birdwell, the VA’s Director of 

Tribal Government Relations, appeared before the Committee to testify on behalf of 

the VA. Stephanie has worked with NAIHC and the National Congress for Americans Indians to make sure that VA Direct Loan Program training sessions take 

place during our annual meetings. She has also worked diligently with other national Indian organizations to ensure that the VA’s tribal programs are available 

and that needed technical assistance is conducted to ensure access to the VA programs. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN BARRASSO TO CHERYL

A. CAUSLEY

Question 1. In 2002, the Government Accountability Office released a report identifying several issues affecting the use of the Native American Veterans Direct 

Home Loan Program. These issues included, among others, land fractionation-where 

multiple interests in a tract of land make mortgaging difficult, if not impossible. In 

addition, a 2006 report by the Department of Veterans Affairs found that Native 

American veterans are less likely to own their own homes than veterans in general. 

Do you think there has been improvement in addressing any of these problems identified in either report? 

Answer. As has been stated in our response to Chairman Akaka’s questions, there 

has been an improvement in the way the Department of Veterans Affairs administers the Native American Direct Loan program, especially the increase in the loan 

limits, and in VA’s notable outreach to tribes and tribal organizations. However, 

Federal agencies could greatly improve access to housing programs with better coordination and communication among themselves. There are multiple Federal programs for housing assistance. A February 2012 General Accountability Office (GAO) 

report identified 51 areas where programs could be more effective in providing housing services , including the areas of affordable housing (low income), green building, 

and housing counseling programs. Tribes and their housing departments are keenly 

aware that some programs within HUD, USDA, and the Veterans Administration 

often serve the same purposes yet rarely coordinate their programs or administrative requirements.

Question 1a. How should the issues identified in these reports be addressed? 

Answer. There are two primary areas that need to be considered when addressing 

the issues identified in these reports. The first is the need for data and the second 

is the need for infrastructure development in tribal areas. 

Tribes need guidance on the nature of the data required by Congress and the Administration. Tribes consistently hear the refrain, ‘‘you need to give us more data!’’ 

However, tribes rarely receive guidance on what kinds of data are actually useful 

to policy makers and Administration officials. In the absence of such guidance, there 

is no consistency to the data that is collected and reported across the country. Meaningful data must be focused and consistent across the board, and data should center 

on building a robust, reliable, and representative quantification of the tribal housing 

conditions and needs. It is noteworthy that twenty years ago the final report of the 

National Commission on American Indian, Alaska Native and Native Hawaiian 

Housing, the Commission explained that, ‘‘Various agencies have presented testimony establishing the current housing needs for Native Americans at somewhere 

near 100,000 units of new housing. Almost no specific information exists that would 

profile, tribe by tribe, the typical family waiting for assistance.’’ We now estimate 

that there are 250,000 units needed in Indian Country, and still, the Federal government has not found nor identified a means by which to provide this information. 

Sound physical infrastructure is vital for housing to be an engine of economic development. Challenges to physical infrastructure development include access to capital and financing, conflicting statutory and regulatory provisions, and a need for 

comprehensive planning. HUD does not collect grantees’ infrastructure plans nor 

does it measure their investments in infrastructure for affordable homes funded by 

the Indian Housing Block Grant program (See GAO Report February 2010). There 

is an acute need for sanitation-related infrastructure for Indian housing in general, 

and the GAO survey indicated a significant need for sanitation infrastructure for 

HUD assisted housing. Nothing in Indian County compares to the tax base available 

to municipal, county, and State governments. There are limited examples of tribes 

and tribal communities developing a revenue stream through taxation and providing 

basic community development and infrastructure. Bonding and other methods to 

raise capital are desperately needed for infrastructure development. 

59

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. DANIEL K. AKAKA TO RANDY

GRINNELL

Question 1. Your testimony covers many areas in which the IHS and VA collaborate and coordinate services. For a Native veteran seeking healthcare services, is 

there a one-stop shop available at IHS? 

Answer. If an American Indian or Alaska Native (AI/AN) Veteran is eligible for 

IHS, they can go to the nearest IHS facility for healthcare services. If their need 

for services exceeds local capacity, referral to the VA or private sector may be required.

Question 2. Will the VA/IHS MOU need to be updated every few years to best 

serve Native veterans? 

Answer. The 2010 MOU provides a framework for a broad range of IHS–VA collaborations which is national in scope, with implementation requiring local adaptation. As new opportunities present themselves, updates to the existing MOU may 

be appropriate. The VA/IHS MOU will also be reviewed on an annual basis by both 

agencies.

Question 3. Can you please discuss the importance of having accurate data to 

properly serve Native veterans? Are there areas where you can improve data collection and analysis to better serve Native veterans? 

Answer. Accurate data is important to properly serve Native Veterans. Many AI/

AN Veterans are eligible for health care services from both the Veterans Health Administration (VHA) and the Indian Health Service (IHS). Having accurate data 

helps IHS and VHA provide quality healthcare services that are comprehensive, coordinated and continuous. Exchanging data with the VA will improve data accuracy 

and therefore services to AI/AN Veterans. For example, IHS meets regularly with 

VA and DOD in planning for the Integrated Electronic Health Record (iEHR); VA, 

DOD, and IHS staffs are designing the EHR interface and care management functions. These activities will result in the ability of IHS and VA to share medical 

records with appropriate privacy protections and better coordinate care for American Indians and Alaska Native Veterans that receive care in both health care systems.

Question 4. Are there mechanisms in place to measure the effectiveness the MOU 

has had and will have in the future? 

Answer. The IHS/VA MOU sets forth five mutual goals for serving AI/AN Veterans. These goals include: (1) increasing access to and improving the quality of 

health care and services offered to Native Veterans by both agencies; (2) promoting 

patient-centered collaboration and facilitating communication among VA, IHS, AI/

AN Veterans, Tribal and Urban Indian Health Programs; (3) establishing, in consultation with Tribes, effective partnerships and sharing agreements in support of 

AI/AN Veterans; (4) ensuring appropriate resources are identified and available to 

support programs for AI/AN Veterans; and (5) improving health promotion and disease prevention services to AI/AN Veterans to address community-based wellness. 

VA and IHS staff are working together to support these goals and have established 

action items and target dates for deliverables. Where appropriate, VA and IHS staff 

also document outreach activities resulting from the MOU partnerships and the 

number of AI/AN Veterans impacted by such activities. IHS Senior leaders are required in their performance evaluations to describe measurable activities and accomplishments that promote implementation of the VA–IHS MOU each year. 

RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JOHN BARRASSO TO RANDY

GRINNELL

Question 1. In 2010, the Indian Health Service and the Department of Veterans 

Affairs established a Memorandum of Understanding outlining a plan for coordination, collaboration, and resource sharing. However, a prior interagency agreement 

for the same purposes has been in existence since 2003. Tribes have contended that 

no action has been taken by your agency to improve services despite the existence 

of these two agreements. How will the 2010 Memorandum of Understanding be implemented more effectively that the prior agreement? 

Answer. The IHS/VA MOU sets forth five mutual goals for serving AI/AN Veterans, as outlined above. To further these goals, IHS and VA staff actively collaborate and coordinate activities targeted at the twelve strategic objectives. These strategic objectives include: (1) to increase access to services and benefits of IHS and 

VA; (2) to improve coordination of care, including co-management, for AI/AN Veterans served by both IHS, Tribal, or Urban Indian health programs and VA; (3) to 

improve care through the development of health information technology; (4) to enVerDate 0ct 09 2002 12:37 Dec 13, 2012 Jkt 076708 PO 00000 Frm 00063 Fmt 6601 Sfmt 6621 S:\DOCS\76708.TXT JACK
60

hance access through the development and implementation of new modules of care 

using new technologies; (5) to improve efficiency and effectiveness of both VA and 

IHS at a system level; (6) to increase availability of services, in accordance with law, 

by the development of payment and reimbursement policies and mechanisms; (7) to 

improve the delivery of care through active sharing of care process, programs, and 

services; (8) to increase cultural awareness and culturally competent care for VA 

and IHS beneficiaries; (9) to increase capability and improve quality through training and workforce development; (10) to increase access to care through sharing of 

staff and enhanced recruitment and retention of professional staff; (11) to address 

emergency, disaster, and pandemic preparedness and response; and (12) to accomplish the broad and ambitious goals of this agreement through the development of 

a joint implementation taskforce. Following the release of the MOU in November, 

2010, the IHS Director instructed each of the IHS Area Directors to meet with their 

regional VA counterparts on how to better coordinate services between IHS and the 

VA under the MOU in their respective regions and their progress is measured in 

their annual performance evaluations.

Question 2. The 2010 Caregiver and Veterans Omnibus Health Services Act allows, 

in certain circumstances, electronic transfers of health records of Indian Veterans 

between Indian Health Service and the Department of Veterans Affairs with appropriate privacy protections. This Act was intended, in part, to provide seamless 

health care services to these Veterans. What is the status on the implementation 

of this Act? 

Answer. Since the VA–IHS 2010 MOU, VA and IHS staff have been working on 

twelve strategic objectives to improve AI/AN Veteran’s health services and care. 

Strategic objectives 3 and 4 highlight efforts to improve health care services:

Strategic Objective 3: Health Information Technology 

Purpose: Development of Health Information Technology 

Major Tasks: Share technology; interoperability of systems; develop processes to 

share information on development of applications and technologies; and develop 

standard language for inclusion in sharing agreements to support this collaboration.

Accomplishments:

• Consultation on EHR Certification and Meaningful Use: the agencies continue 

to actively consult on EHR Certification and Meaningful Use requirements.

• ICD–10 Development and Implementation: staff have met to design system 

changes to VistA and Resource & Patient Management System (RPMS) in preparation for transition to ICD–10.

• Bar Code Medication Administration: staff have met to define scope, support 

agreement, and needs to leverage VA experience with Bar Code Medication Administration in support of potential use in IHS and Tribal hospitals.

• VA–DOD EHR: IHS meets regularly with VA and DOD in planning for the Integrated Electronic Health Record (iEHR); VA, DOD, and IHS staffs are designing 

the EHR interface and care management functions. These activities will result 

in the ability of IHS and VA to share medical records with appropriate privacy 

protections and better coordinate care for American Indians and Alaska Native 

Veterans that receive care in both health care systems.

• Both agencies will be participating in health information exchange through the 

Nationwide Health Information Network (NwHIN). NwHIN is a group of federal 

agencies and private organizations that have come together to securely exchange electronic health information. NwHIN ‘‘onboarding’’ (process to join the 

Exchange) is underway in IHS and should be complete for all federal facilities 

by the summer of 2013. Through NwHIN Connect, IHS and Tribal providers 

will be able to download (‘‘pull’’) summary of care documents for any VA patient 

(or, for that matter, any patient whose private sector provider participates in 

Health Information Exchange (HIE)), and vice versa. Also, as part of Meaningful Use, IHS will be adopting the Direct Exchange protocols, which will allow 

IHS providers to deliver patient records to any trusted entity such as a VA hospital or provider. This solution is scheduled for implementation in 2014.

Strategic Area 4: Implementation of New Technologies 

Purpose: Development and implementation of new models of care using new 

technologies. 

Major Tasks: Tele-health services; mobile communication technologies; enhanced telecommunications infrastructure; share training programs to support 

these models of care; and share knowledge gained from testing new models.

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Accomplishments: 

• Completed best practices for providing telepsychiatry services to AI/AN Veterans.

• Established videoconferencing connectivity between Prescott VA and the IHS 

Chinle facility to implement telemedicine services, connection made Aug. 2011.

• Coordination of network-to-network connectivity for videoconferencing with 

Work Group 3—Health Information Technology.

• Explored mVET program (a VA program that targets prevention of acute crises 

which lead to death among homeless Veterans) within the context of the MOU 

collaborative (Work Group 4—to enhance access through the development and 

implementation of new models of care using new technologies), to provide homeless vets with a smart phone with ‘‘life-line’’ apps.

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