VA’s ‘no choice’ health care in Puerto Rico

Vietnam War veteran Julio Martinez says he has never used the Department of Veterans Affairs Choice Card program. He never received his card and doesn’t know a single veteran in Puerto Rico who has been able to use the Choice Card, which is supposed to expand access to private healthcare for veterans who qualify for the program.

Any veteran who waits more than 30 days for VA health care, or lives more than 40 driving miles from a VA facility, can use the Choice Card to receive medical care from VA-approved facilities in the private sector.

Martinez, commander of American Legion Post 46 in Gurabo, talks with many veterans enrolled in VA. “Everybody says the same thing: ‘I called and they told me I don’t qualify.’ They get their Choice Card in the mail, but when they call the 800 number, (VA) says that Puerto Rico doesn’t qualify because, first of all, we’re a 100 (miles) by 35, so that limits the 40-mile range. And if you don’t have a hospital (within 40 miles), you have a clinic.”

But those clinics close at 4 or 5 p.m., Martinez says, and many veterans who can’t get there in time have to wait until the next day. VA’s community-based outpatient center in Mayaguez “is horrible. They try to paint it as good but the phone system doesn’t work, they don’t have a psychiatrist there all the time, and they send you – if they can – to the main hospital (in San Juan).”

Martinez was one of the veterans who attended The American Legion’s town hall meeting April 6 in San Juan. Other veterans complained about the apparent exclusion of Puerto Rico from VA’s Choice Card program. “Just recently I received this card, and it has no value for us right now,” said Jose Valenzuela, a Vietnam War veteran from the town of Ponce.

Verna Jones, executive director of The American Legion in Washington, facilitated the meeting along with Louis Celli, director of the Legion’s Veterans Affairs & Rehabilitation Division. Jones told attendees that the Choice Card does apply to veterans on the island. “There is no provision in the law that says Puerto Rico is exempt – that’s absolutely not true.”

Ramon Dinerez, a veterans advocate, said he has heard from many veterans in the last three weeks who were told by VA that the Choice Card doesn’t apply to them. “In fact, I called one day and what they told me was there is no place in Puerto Rico that is more than 40 miles (from a VA facility).”

“There is the perception that we all live within 40 miles of San Juan,” another veteran commented. “I tell you that is entirely not true.”

Duane Hamlin, director of the VA medical center in San Juan, said that confusion about the Choice Card program existed nationally and that Puerto Rico “is no different than anywhere else in the nation. The Choice program applies similarly here as anywhere else."

The suggestion was made by one attendee that, because Puerto Rico is a Spanish-speaking island, VA should have issued bilingual versions of the Choice Card and instructions related to its use.

Jones said that she and Celli will be speaking with officials at VA's Central Office in Washington about problems with the Choice Card “and get that squared away, because the program is a law and veterans are entitled to that. Veterans shouldn’t be confused about a program that is designed to be advantageous.”

Celli reminded the veterans that “VA has the authority to get you the care you need with or without the Choice Card – they have contracting authority.” Then he noted that Congress is working to fine-tune the program “to try to make sure that access needed by the veteran is within 40 miles.” Some veterans do not qualify for Choice Cards because they live less than 40 miles from a VA facility; yet that facility cannot provide the required medical services.

Celli asked the VA attendees if the Choice Card has yet been used by one single veteran in Puerto Rico. One of Hamlin’s staff said no, “but the program still is alive and well.”

Jones retorted that the program “is alive, but it’s not well,” if, to date, “not one person has used it. And unless VA realizes that it’s not alive and well, we’re going to have this same group of people (thinking that) the program does not exist in Puerto Rico. Until you recognize that, you’re going to have veterans who are not getting the benefits of this Choice program.”

Jones said The American Legion would do “whatever we can to help” the Choice Card program work in Puerto Rico. Then she asked all the Legionnaires in the room to raise their hands. “Look at all these people who can help you. But your program’s not well and we have to do something to fix that.”