Military veterans seeking medical treatment at the Spark M. Matsunaga VA Medical Center are sometimes still waiting to see a doctor years after asking for help, or have simply given up.
Like retired Army Spc. Randall Tsuneyoshi of Mililani.
Tsuneyoshi ended up buying his own Kaiser medical insurance last year after he could not get an appointment at the Matsunaga VA for a painful right knee that he attributes to his days running in combat boots.
Tsuneyoshi instead hobbled into Pali Momi Medical Center where he was diagnosed with avascular necrosis, sometimes referred to as "bone death."
"The blood didn't get to the bone, the bone started dying and it was basically fractured," Tsuneyoshi said.
Asked why he paid out of his own pocket to get his knee diagnosed and then surgically replaced through Kaiser, the 67-year-old Vietnam War veteran said, "If I had to rely on the VA, I would probably be dead."
Hawaii's congressional delegation has grown increasingly exasperated with the leadership of the VA Pacific Islands Health Care System, which runs the VA in Hawaii. U.S. Rep. Tulsi Gabbard this month even called for the firing of Wayne Pfeffer, director of the VA Pacific Islands Health Care System, who refuses to resign.
But in their pleas for truthfulness from Pfeffer and an accurate accounting of the problems plaguing the VA here and across the country, Hawaii's congressional representatives have insisted that their frustrations pale in importance to the frustrations of military veterans seeking the medical care they were promised.
"Whatever I may feel, it's got to be in the perspective of what's best for the veterans," said U.S. Rep. Colleen Hanabusa. "The primary goal is getting the veterans the services they are entitled to."
VA officials in Hawaii said they are barred by federal medical privacy laws from commenting on veterans' cases without the vets' written permission.
But Pfeffer on Monday set a three-month timetable for himself and his staff to reduce the longest wait in the VA system for new patients to see a primary care physician from 145 days to just 30 days.
Pfeffer acknowledged the long wait times while trying to reassure veterans that he's working on solutions.
"I want to reach out especially to our veterans because I want them to have confidence in the care we provide and I want them to know that we're really working diligently to get down patient wait times to make sure every veteran is seen," Pfeffer said, before adding, "The new-patient waitlist is problematic."
In the meantime, in many cases, veterans continue to wait.
"We have been forgotten," said Vic Craft, 65, of Kapolei, who served in both the Air Force and Marine Corps and retired as an Air Force staff sergeant.
In 2012, Craft waited six months for his first appointment with a VA primary care physician. He still has not obtained an appointment with a dermatologist.
Like many older veterans, Craft said years of delays and long waits to get medical help at the Matsunaga VA are overshadowed by their concerns for the newest generation of combat veterans waiting to be treated for post-traumatic stress disorder and a long list of other conditions.
"The military does two things," Craft said, "break things and hurt people. They're not necessarily good at dealing with your concerns when you come home. That scares me for these younger guys. These kids are coming back after three, five, seven tours in Iraq and Afghanistan, and they're getting screwed up."
Asked about his own post-traumatic stress disorder from the Vietnam War, Craft said, "Till this day, loud noises still scare the hell out of me. Forty-something years out I'm still dealing with this."
Craft attended an emotional veterans talk-story session with Gabbard three weeks ago that was sometimes painful to watch.
"One very irate Navy veteran, a female, set the tone," Craft said. "She had all of her documentation, everything squared away, and she still could not get seen (at the VA). She just unloaded and it got a little loud. I really felt for Tulsi, who had to stand there and just take it. She was clearly upset that the whole system is just so broken."
Retired Army Spc. Manny Dias, 65, of Kapolei attended the same talk-story session and apologized to Gabbard's staff when he walked in the door and was asked to sign in.
"I had to tell them that I can't sign my name because my tremors are so bad from PTSD that it wouldn't be legible," Dias said.
In an interview with the Honolulu Star-Advertiser, Dias also apologized for not being able to remember all of the times he failed to get medical care for his PTSD at the Matsunaga VA, which continues to deny his claim and will not treat him.
"I have memory problems, and a stroke affected parts of my brain," he said. "Today I'm pretty good, but when you jump me back in time, sometimes I stumble."
Dias does remember spending months waiting to see a VA doctor -- or never even getting an appointment -- for a variety of ailments, some of which he links to his military service: tremors, PTSD, heart attack, stroke, hearing loss and severe pain in his left foot.
In civilian life Dias retired as a state aircraft rescue firefighter at Honolulu Airport. So he used his state health benefits to get treatment at Kaiser earlier this year for his foot. That's when Kaiser doctors informed Dias that he had a much more serious condition: non-Hodgkin's lymphoma.
Asked how it felt that no VA doctor even saw him while he suffered from an undiagnosed, life-threatening cancer, Dias said, "What upsets me is that we did our thing as young guys and girls. So it really frustrates me now that we can't get seen by the VA."
Tsuneyoshi, after his successful knee replacement, is now scheduled for the same surgery on his left knee.
Instead of spending money on his Kaiser copayments, fellow veterans tell Tsuneyoshi he should take advantage of his military benefits and have the surgery done through the VA instead.
"They want me to go to Tripler (where the Matsunaga VA is located)," Tsuneyoshi said, "but I've had too many bad experiences there. I'll just pay for it myself."