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    AUGUST 20, 2014

    Thank you for providing me this opportunity to share with you my experiences with VA Pacific Islands Health Care System (VAPIHCS) as the the spouse and full- time care-giver of my Vietnam combat-infantryman husband, Joseph Demoruelle, who has been rated as a 100% permanently service-connected disabled Veteran. It is exceptional to be invited to share openly with our Senator and the Congressional Committee how we have recently interacted with VAPIHCS and what needs to be done to improve care. I will share two of my most important findings.

    1. Lack of VAPIHCS administrative compliance with the VA Beneficiary Travel Program (BTP)

    Ever since my husband was awarded permanent 100% service- connected disability on November 17, 1989, I have argued with him about his entitlement to Beneficiary Travel (BT) payment – and my nagging has forced him to ask orally for BT at his Hilo CBOC visits. He was consistently told by those at the front desk that “there is no Beneficiary Travel payment for on-island travel.” The desk staff knew he drove 135 miles round-trip to Hilo from his on-going complaints, but they denied they were responsible for processing intra-island BT travel. To force an appealable written decision from Hilo CBOC or Pacific Islands Health Care System (VAPIHCS), at his last clinical visit on June 17th, I accompanied him and I personally submitted two VA Form 10- 3542 I found online when researching the BTP. To my surprise, a few days later, we were asked by Robynn Elliott (Hilo CBOC staff) to submit EFT information for BT payment, which I handed to her, and puzzlingly received two Treasury checks instead

  • Demoruelle Page 2 of 15 because the EFT deadline of December 31, 2013 promised in the GAO BT report wasn’t honored in our case. We do not understand why he had never received BT before because he had applied orally [per 38 CFR 70.20(a) and VHA Handbook 1601B.05 5.a]. This is not a minor issue since a review of our records shows at least 24 medical visits since 2012 amounting to denied mileage BT payments totaling $1,374.48. Now we find ourselves asking: how can this be rectified? As the VA policies state, BT is vital to allow distant veterans, like Joseph, to afford access to VA health care. But neither Hilo CBOC nor VAPIHCS has been responsive to my FOIA requests for how the BTP information is provided to veterans, who, like my husband, seem totally ignorant of this benefit? Burt Thornburg, Honolulu FOIA Officer, has even refused to provide me these administrative documents for free and has classified me as “commercial” because I am an individual (like Committee testifier Elisa Smithers), as opposed to an organization, even though I told him my purpose is educational, like informing this Committee or media for publicizing my findings to my fellow veterans and their families. I had requested a FOIA fee waiver as the information provided would likely “contribute significantly to public understanding of the operations and activities of VAPIHCS, a government agency, and is not in the commercial interests of the requestor,” which Mr. Thornburg has denied. According to the testimony from the organization, Concerned Veterans of Oahu, there are some within the DVA that “create confusion and block efforts of veterans seeking deserved financial and medical aid” (p.5).

  • Demoruelle Page 3 of 15

    So far, I have found this to be true. It has been impossible for me to find accurate information on local VAPIHCS BHP management processes. None of the policies and procedures VA has developed for BTP as listed in the July 2013 GAO Report shows any evidence of having been implemented by VAPIHCS:

     Veterans are not provided proper forms for filing for BT payments so there is no standardized method for applying in Hawaii that I can discern.

     While a threatening poster “Don’t Travel Down the Wrong Road”has been posted at Hilo CBOC with no apparent VAPIHCS directive, there is none of the positive posters, brochures, or written sheets like most other, such as San Deigo or Portland, VAMC systems provide to inform Veterans of these important benefits.

    Fred Ruge of the Maui Veterans Council spoke to the difficulty he faced as “setting up travel arrangements for our Maui Veterans via the VA Travel System is extremely difficult, and often turns out to be very problematic for all concerned.” Robert Strickland of the West Hawaii Veterans Council not coincidentally echoed these same BTP concerns: “Depending on the circumstances and whether care needed is service-connected or not, who pays for the travel can be a difficult process to work out.” Another important Veteran Representative from the State of Hawaii Office of Veterans Services, Ronald Han, Jr., gave even more testimony under his “Timeliness” concerns stating he worries about “the time it takes to get reimbursed for travel services from rural areas” (to Honolulu VAMC). Mr. Han further elaborated by stating: “Timely reimbursements for out of pocket transportation costs for those traveling to Tripler from the neighbor islands also have been addressed to our office for resolution. Some reimbursements have taken over 60 days or more for payment.”

  • Demoruelle Page 4 of 15

    It was extremely telling that the central VA demonstrated a total lack of awareness of this very real grassroots BTP problem that these wonderful Oahu, Maui and Kona people (who are constantly dealing with the ACTUAL needs of Hawaii’s Veterans) took their valuable time to bring to your attention. The only travel mention I could locate in the lengthy testimony of Dr. Tuchschmidt, VA Acting Principal Deputy Under Secretary for Health, was under the VA Office of Rural Health (ORH) which spoke of “Transportation Investments”. He goes on to say “since 2012 VA has ‘invested’ $15 million in air travel to VAMC Oahu” [emphasis mine]. There is an odd irony in the word “invest” for the utilization of $15 million in BTP benefits by buying tickets through the sole travel outlet for this TAMC/VAMC, Carlson Wagonlit Travel. It is chilling to think $15 million that could have allowed needy Veterans to drive to their VA appointments was given to a totally commercial global business whose Board of Directors includes titans of industry representing firms like JPMorgan Chase. Thus I challenge the GAO/OIG auditors to ask the question: Why can’t the BT Office negotiate tickets directly with the airlines, without “investing” $15 million in a giant for-profit corporation? Other than further identifying the “Geographic Challenges” in Hawaii of both distance and variability, Dr. Tuchschmidt did nothing to address the BTP issues previously mentioned by the Veteran Service Organizations. Based on my husband’s 25 year denial of any BT benefits, it seems apparent that the VAPIHCS local procedures are at variance with 38 CFR 70, so I am urging prompt Senate action to remedy this situation. Thus, we seek your assistance in ensuring VAPIHCS’ compliance with the existing VHA policies and sharing information on BTP with our Hawaii veterans.

  • Demoruelle Page 5 of 15

    Just last week I told Director Pfeffer directly in a letter to him:

    I hate to waste any more time on bringing to your attention the clear necessity to implement the BTP in Hawaii for the following reasons:

     38 CFR section 70 requires it

     VHA Handbook 1601B.05 requires you follow VA policies and rules developed through legal rulemaking processes and published in the Federal Register/Vol. 72, No. 140/Monday, July 23, 2007/Proposed Rules P. 40097

     OIG requires it to prevent fraud

     US Treasury required the EFT by March 2013

     GAO’s Report to Congressional Requesters, July 2013: VA HEALTH CARE: Additional Steps Needed to Strengthen Beneficiary Travel Program Management and Oversight promised system-wide EFT by December 2013, along with other improvements In light of this, it is apparent that that PIHCS and Hilo CBOC have unlawfully denied my husband BT benefits since 1989. From my experience on the initial OVS Advisory Board (for VAMROC “old-timers”, I was the one who always brought home-made cookies), BIVA and other veteran organizations, many more veterans are experiencing the same problem with Hawaii’s BTP. Therefore, I am asking you the straight-forward question: What are you (the medical center director or designee is the legally responsible VA official) going to do to implement VA BTP throughout the PIHCS facilities? Do I need to waste time seeking far more important people than me to bring this simple administrative problem with significant legal ramifications to your attention? I would rather assist in resolving the political heart of the BTP problem for medical centers; that is, that BTP requires a financial support that does not reduce funds available to provide actual medical care. My BTP energy could be more

  • Demoruelle Page 6 of 15

    productively put to use lobbying (directly and through local vet groups) the GAO Congressional Representatives listed in the report to address this “VA BTP vs health care” monetary concern. Per the GAO, the BTP implementation appears well organized at the central VA CBO level, providing software with helpful User and Tech manuals from OIT and simple three page guidance (BE