While serving in the Army, I learned an old saying of “somebody always has it better” and “somebody always has it worse.” This saying is never more evident than the Department of Veterans Affairs (VA) medical services provided for veterans residing outside of the Continental United States (OCONUS).
All service-connected veterans deserve access to high-quality medical care and should not have to travel great distances to receive medical care and their medications. This statement is an excellent goal for all veterans.
However, the veterans residing outside of CONUS have significantly more challenges in obtaining their earned VA services. Specifically, the veterans residing in American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands.
These commonwealths and territories are all part of the United States. They all have Congressional Representation and more importantly they have veterans who served valiantly in the military.
Veterans residing in these areas often have to fly commercial aircraft to get to medical appointments or to fill their prescriptions. These areas often experience severe weather conditions, such as monsoons and typhoons, which negatively impact flying conditions.
Not one of these commonwealths/territories have a VA Specialty Substance Use Disorder (SUD) Program. However, a Mental Health Residential Rehabilitation Treatment Program (RRTP) is scheduled to open in Puerto Rico in 2024 to treat veterans who are in dire need of these services.
Hopefully, there will be a focused effort to treat veterans with SUD and particularly gender-specific programming, to include a separate section for Puerto Rican women veterans. Statistics indicate that Puerto Ricans serve in the military at higher numbers per capita, than many states within the United States.
Veterans residing overseas face two (2) significant barriers that veterans in CONUS often do not experience. They are: travel distance and monetary reimbursement for their transportation.
For the travel distance example, if a veteran residing in Saipan, the Northern Marianas Islands, requires a leg prosthesis, the veteran must fly to Hawaii for a measurement. The distance for this all-day flight is 3,825 miles. The next day in Hawaii, the veteran is measured for the prosthesis.
The following day, the veteran flies back to Saipan.
This same schedule is then followed when the veteran returns for the first fitting of the prosthesis in Hawaii and a possible return for any adjustments/ modifications of the leg prosthesis. The veteran would travel three (3) times (round-trip) for the prosthesis, covering nearly 24,000 miles.
For the monetary reimbursement, the VA has set-up the Beneficiary Travel Self-Service System (BTSSS), which was designed to automate the travel reimbursement claims process.
In a recent May 2023 Report, the VA’s Office of Inspector General (OIG) found significant problems regarding the slow processing of BTSSS payments and improper payments made to beneficiaries.
In this example, a veteran resides in Guam and the veteran experiences severe back pains that requires surgery. There is no specialty care on Guam for this procedure and the veteran is forced to travel to Hawaii, over 3,000 miles away.
There are no available military aircraft based at Anderson Air Base on Guam for the flight, so the veteran must pay 1,200 up-front for the roundtrip ticket to Hawaii.
The veteran then needs to pay for transportation to the military hospital and lodging at a hotel, also up-front financial obligations incurred by the veteran. Once the veteran returns home to Guam after flying 6,000 miles away to receive medical care, the veteran must file a claim using the BTSSS for travel reimbursement.
After filing the BTSSS claim, the veteran may now have to wait weeks and often (according to the May 2023 OIG Report) even months to receive their reimbursement for the expenses the veteran paid. Unfortunately, waiting for the travel reimbursement not only occurs overseas, but in many rural areas of the United States.
My Opinion: The simplistic argument could be made that the VA cannot construct infrastructure, such as hospitals and clinics, just to serve a small number of veterans residing over 3,000 miles away from the State of Hawaii.
The rebuttal of that argument is something told to me by Congressman Gregorio Salban, who represents the Northern Mariana Islands in Congress. In summary, “Uncle Sam didn’t care where the veterans came from when they were needed for serving in Vietnam. Now Uncle Sam says these veterans live too far away to receive quality medical care from the VA for their service-connected injuries.”
Now when I think of the saying, “somebody always has it worse”, I think of the veteran in American Samoa waiting for a BTSSS payment or the veteran flying from Guam to Hawaii for a medical appointment or the veteran in the Northern Mariana Islands flying several times to Hawaii for a proper fitting prosthesis.
These OCONUS veterans deserve better from the VA and the Disabled American Veterans (DAV) and other veteran service organizations.
We must work with Representatives Gregorio Salban (Northern Mariana Islands); Stacy Plaskett (U.S. Virgin Islands); James Moylan (Guam); Aumua Radewagen (American Samoa); and Jenniffer Gonzalez-Colon (Puerto Rico) to ensure our veterans received the benefits they earned.
BioSketch: John Plahovinsak is a 32-year Army veteran who served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio Hospital Chairman and the Adjutant of the DAV Chapter #63 (Clermont County). He can be contacted at: plahovinsak@msn.com.