Hawaii
and the
U.S. Department of Veterans Affairs

• General:  The Department of Veterans Affairs (VA) offers a wide variety of programs and services for the nation’s 24.3 million veterans.  In 2006, about 5.3 million people were treated in VA health care facilities, 3.6 million veterans and survivors received VA disability compensation or pensions, nearly 600,000 used GI Bill education benefits and more than 2.4 million owned homes purchased with GI Bill home loan benefits originally valued at $236 billion.  More than 100,000 veterans and family members were buried in VA’s national cemeteries and nearly 360,000 headstones and markers were provided for veterans’ graves worldwide.

VA spent more than $337 million in Hawaii in 2006 to serve more than 102,000 veterans who live in the state.  That same year, 17,527 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in Hawaii.  VA provided 3,192 veterans, reservists or survivors education benefits through the GI Bill; 5,482 owned homes with active VA home loan guarantees originally valued at $260 million.  Hawaii veterans held more than 11,000 VA life insurance policies valued at almost $151 million.  In 2006, 966 were interred at the National Memorial Cemetery of the Pacific.

• Health Care:  One of the most visible of all VA benefits is health care.  VA has 153 hospitals, 895 ambulatory care and community-based outpatient clinics, 209 Vet Centers, 135 nursing homes, 47 residential rehabilitation treatment programs and 92 comprehensive home care programs.  To improve patients’ ability to access care, VA has changed from a hospital-based system to a primarily outpatient-focused system over the past decade.  Veterans will make 55 million outpatient visits to VA health care facilities this year.

The Spark M. Matsunaga VA Medical and Regional Office Center in Honolulu, part of the VA Pacific Islands Health Care System, provides outpatient primary medical care, mental health and dental care, and specialized outpatient care.  Nearly 22,000 veterans were treated in 2006.  That same year, VA facilities in Hawaii had 348 inpatient admissions and provided 162,519 outpatient visits.

Treatment programs include substance abuse, day care, geriatric evaluation and management, as well as several medical specialty clinics staffed by VA and University of Hawaii physicians.  These services are located at Tripler Army Medical Center, adjacent to the VA Ambulatory Care Clinic, as part of a VA-Department of Defense (DoD) joint venture.  Additionally, VA provides 20 inpatient psychiatric care beds at Tripler medical center.

A 16-bed VA post-traumatic stress disorder residential rehabilitation program is operated in Hilo on the island of Hawaii.  Medical and surgical inpatient care for veterans is provided by a VA-DoD sharing agreement with Tripler Army Medical Center and by non-VA facilities in the community under VA contract.

The medical center offers telehealth services in spinal cord injury evaluation, cardiology, dermatology, pre-operative surgical consultations, and home-based primary care.  Telepharmacy uses automatic drug dispensing systems on the neighbor islands.  Community-based outpatient clinics have telehealth coordinators whose primary responsibility is to ensure seamless telehealth visits.

• Post-Conflict Care:  VA has launched special efforts to provide a "seamless transition" for those returning from service in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF).  Each VA medical facility and benefits regional office has a point of contact to coordinate activities locally to help meet the needs of these returning combat service members and veterans.  In addition, VA increased the staffing of benefits counselors at key military hospitals where severely wounded service members from Iraq and Afghanistan are frequently sent.  Once home, recent Iraq and Afghan veterans have ready access to VA health care, which is free of charge for two years following separation for any health problem possibly related to wartime service.  Some 205,000 veterans from the Global War on Terror have sought VA health care since returning stateside, about one-third of the total number of men and women leaving military service.

In Hawaii, more than 1,600 active duty service members and veterans of the Global War on Terror sought VA health care in 2006.  Many veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Hilo, Honolulu, Kailua-Kona, and Lihue.  These community-based Vet Centers serve as an important resource for veterans who, once home, often seek out fellow veterans for advice or help transitioning back to civilian life.

• Geriatric Care:  Long-term care is a critical issue for America’s veterans.  Approximately 39 percent of living veterans are at least 65 years, compared with 12 percent of the general population.  The challenge to care for these 9.5 million men and women is met through a spectrum of home and community-based programs such as home-based primary care, homemaker and home health aide services, home respite and hospice and adult day care health.  VA also provides home and domiciliary care for veterans who can no longer be safely maintained in non-institutional settings.  Additionally, VA conducts nationwide research on the causes and treatment of Alzheimer’s disease and other dementias and funds 21 geriatric research, education and clinical centers, each focusing on a major geriatric problem.

In Hawaii, nearly 8,000 veterans aged 65 and older received medical care from VA in 2006.  Long term care and transitional rehabilitative care are provided by a VA-operated, 60-bed Center for Aging on the Tripler Medical Center grounds.  However, the VA emphasizes non-institutional long-term care when possible, because veterans normally prefer to remain in their homes as long as they can.  Consequently, VA provides extensive geriatric care through outpatient programs, including contract adult day care, homemaker health aide, home-based primary care, and community nursing home placement.  A home-based primary care program also is located on Oahu.

• Research:  To provide the highest quality of health care to the nation’s veterans, VA sponsors a world-renowned research and development program that addresses some of the most difficult challenges facing medical science today, such as aging, vision loss, women’s health, Gulf War illnesses, diabetes, bioterrorism and hepatitis. VA researchers led the way in developing the cardiac pacemaker, the CT scan, magnetic source imaging and improving artificial limbs.  More recently, injuries sustained by armed forces engaged in current deployments have further increased the long-standing emphasis on VA research on limb loss; prosthetics and tissue replacement; traumatic brain injury; spinal cord injury; and mental health issues including post-traumatic stress disorder.  The quality of the research and relevance to the veteran population remain the determining factors in deciding what studies to fund.

The VA Pacific Islands Health Care System (VAPIHCS) supports an active research and development program.  Studies are being conducted on stress and trauma, aging and dementia, feasibility and efficacy of biofeedback, risk factors of Parkinson's disease, and the efficacy of telemedicine.  Other research includes the assessment and treatment of post-traumatic stress disorder, hepatitis, diabetes, lipid/cholesterol management, nurse staffing and patient outcomes, and medication administration system. In fiscal year 2006, VAPIHCS received more than $438,000 in VA research funding.   In addition, the system has received support from other sources such as the National Institutes of Health, Department of Defense, National Alliance for Research on Schizophrenia and Depression, and various pharmaceutical sponsors.

• Disabilities and Pensions:  Not all military service related issues end when people are discharged from active duty.  About 2.7 million veterans receive monthly VA disability compensation for medical conditions related to their service in uniform.  VA pensions go to about 330,000 wartime veterans with limited means.  Family members of about 527,000 veterans qualify for monthly VA payments as the survivors of disabled veterans or pension recipients.

VA's Honolulu VA Medical and Regional Office Center serves veterans and their survivors in Hawaii who are seeking VA financial benefits.  In fiscal year 2006, the Honolulu VAMROC processed 4,344 disability compensation claims, including 1,396 veterans applying for the first time and 2,948 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than 1,100 Hawaii veterans participated in VA’s Vocational Rehabilitation and Employment program in 2006.

• Homeless:  Less than one-quarter of all homeless adults are veterans, and many more veterans who live in poverty are at risk of becoming homeless.  VA is the only federal agency that provides substantial hands-on assistance directly to the homeless.  It has the largest network of homeless assistance programs in the country.  Nearly 16,000 residential rehabilitative, transitional and permanent beds are available for homeless veterans throughout the country.  VA aggressively reaches out to veterans on the street, conducts clinical assessments, offers needed medical treatment, and provides long-term shelters and job training.  More than $265 million is dedicated to specialized homeless programs to assist homeless veterans, including grants and per diem payments to more than 400 public and non-profit groups.

The VA Pacific Islands Health Care System, in partnership with U.S. Veterans Initiative Inc. (US Vets), a private nonprofit group, has converted three former barracks and property from the base closure of the Barbers Point Naval Air Station on the island of Oahu into a facility to care for homeless veterans.  This program includes a substance abuse treatment program, a back-to-work program, supported housing, and an independent living program.

• Memorial Affairs:  Most men and women who have been in the military are eligible for burial in a national cemetery, as are their dependent children and usually their spouses.  VA manages the country’s network of national cemeteries with more than 2.9 million gravesites at 125 national cemeteries in 39 states and Puerto Rico, as well as in 33 soldier’s lots and monument sites.  In 2007, more than 100,000 veterans and dependents were buried in VA's national cemeteries.  Additionally, VA provided more than 359,000 headstones and markers and 423,000 Presidential Memorial Certificates to the loved ones of deceased veterans.  VA-assisted state veterans cemeteries provided more than 23,000 interments.

VA has one national cemetery in Hawaii.  The National Memorial Cemetery of the Pacific in Honolulu, which buries eligible family members and cremation remains, had 966 burials in 2006.  Hawaii has eight state veterans cemeteries, which received VA grants, and collectively had 832 burials in 2006.  VA provided 1,784 headstones and markers for the graves of veterans in Hawaii and sent 485 Presidential Memorial Certificates to Hawaii survivors of veterans.