City Council - Regular Meeting

Good morning. My name is Ed Flynn, Boston City Council. I am the Vice Chair of the Boston City Council Committee of Veterans, Military Families, Military Affairs. Today is August 28th, 2026. The exact time is 10 o'clock. This hearing is being recorded. It is also being livestreamed at boston.gov slash citycouncil dash tv. and broadcast on Xfinity, Channel 8, RCN, Channel 82, Fios, Channel 964. Written comments may be sent to the committee email at ccc.vetsatboston.gov and will be made part of the record and available to all city councilors. Public testimony will be taken at the end of this hearing or if anyone would like to testify virtually, we'll try to get you in during the hearing. If you have any scheduling related issues and you need to testify immediately, please let me know and I'll try to get you in to testify as we speak. Individuals will be called on in the order in which they sign up and they'll have two minutes to testify, I will not cut anyone off. If you need to speak for more than two minutes, please take the time that you need. If you are interested in testifying in person, please add your name to the sign-up sheet near the entrance of the City Council Chamber. If you are looking to testify virtually, please email our City Council Central Staff Liaison, Shane Pack, at shane.pack at boston.gov for the link, and your name will be added to the list. Today's hearing is on actually two dockets, docket 0273, it's an order for a hearing to discuss lung cancer rates among black veterans, and the second docket is docket 0274, which is an order for a hearing to discuss services for women veterans. Docket 0273 was sponsored by myself, Councillor Murphy, and Councillor Santana, and it was referred to the committee on February 4th, 2026. I am joined by my council colleagues in order of arrival, Councillor Murphy. I do want to acknowledge Well, I do want to acknowledge, as the vice chair, I will be chairing this hearing today, and Councillor Henry Santana does express his respect for the veterans that are here and the veterans throughout the city of Boston. He's just unable to be here, but he wanted me to know that he is paying close attention to this and want to acknowledge his chief of staff, Ana Calderon, who really helped set up this meeting as well. So I want to say thank you to honor for her support and commitment to veterans, military families across the city of Boston as well. Um, I do have a letter of absence that I do want to read into the record and then I'm going to give an opportunity for my council colleague, councilor Murphy to give an opening statement and then I, and then, um, I want to ask each panelist to give an opening statement as well. But before we do that, could I just ask the panel maybe to go, starting from Commissioner Santiago, could you just state your name for the record and what organization you are with? So let me start with Commissioner Santiago, please.

Good morning, Councillor Flynn, Councillor Murphy. Thank you very much for having me. I am Commissioner Robert Santiago, City of Boston Veterans Services. Thank you, Commissioner.

Good morning, Councillor Flynn, Councillor Murphy. My name is Craig Diehl, a resident of the City of Boston, and I am the State Commander of the Veterans of Foreign Wars.

Good morning, Councillor Flynn, Councillor Murphy. My name is Mark Kennedy. I'm with the Boston Public Health Commission.

Good morning, my name is Malika Whitley. I'm with the American Legion, post-78, and I also work with VA benefits.

And good, is this on?

Yes, it is.

Okay. Good morning, Councilor Flynn and Councilor Murphy. My name is Renda Wiener. I am a pulmonary physician and researcher at the VA Boston Healthcare System and the Center for Health Optimization and Implementation Research there.

Thank you to this distinguished panel for being here. Thank you for testifying. More importantly, thank you for your commitment to veterans and military families across the city, really across the country as well. I'm going to read a letter into the record, then I'm going to go straight to Council Murphy. Dear Chair Santana, this is from City Council President Braden. I regret that I am unable to attend tomorrow's hearing on docket 0273-0274. hearing to discuss lung cancer rates among black veterans, services for women veterans. While I am unable to attend the hearing, members of my team will be listening in to this critically important discussion, and I plan to review the recording. I kindly ask that you read this letter into the record. Thank you, Elizabeth Braden, City Council President. We are also joined by City Councilor at Large, Luzzi Louis-Jean. Let me go to Councilor Murphy for an opening statement.

Thank you, Council Flynn. And thank you to the panelists. Thank you, Commissioner Santiago for all you do here at the city and obviously across the state and country always showing up for veterans as a veteran yourself. And I mean, I don't want to take all my time just thanking people for being here. But Craig also in coming from like the VA and the different posts across the city, we know that many veterans When they come to those places, it's not just for socialization, even though that's a wonderful thing. It's also to connect and help connect to the benefits that we know the veterans earned. and in many times aren't always aware of what's out there for them. And when we have subgroups like this, I think it's very important that we're talking about, and thank you for uplifting these concerns about the lung cancer rates among our black veterans and making sure our women veterans are getting everything they need while they're enlisted, but also when they come home, making sure that they're supported. So as a veteran mom, I know it's important that we always support our veterans, but As a counselor, I think it's also important that we're making sure there's no groups around the city who are feeling as though they're not getting what they need. So just happy to be here, and also Public Health Commission in the VA. My papa, Papa Jack, my stepdad, 92 now, and he's getting a lot of support from the VA and the senior home health care. And it's just wonderful to see full circle, spending your life giving. And then when you're near the end, people showing up for you. And it's just great. So thank you for all you do.

Thank you, Councillor Murphy. I do want to give Councillor Louis-Jean an opportunity for an opening statement. Councillor Louis-Jean.

Good morning, everyone, and thank you for being here. I want to thank you, Councillor Flynn, for your leadership and for your service to our country. I also want to thank all of our panelists for your leadership and your service to our country. And I want to thank you, starting with the commissioner, for all the incredible work that you do in the Office of Veterans Services to make sure that our veterans in the city have the resources that they need once they come home. to thrive and to really be thanked for the work that you've done. I know, Malika, you're celebrating a lifetime of service this year, and it is a well-deserved one. And to everyone who is here, Dr. Wiener and all of the panelists, I'm really appreciative of the work that you do at The Post. George, is that? I'm sorry. Craig and Mark, thank you for being with us today. There are a lot of race-based health gaps in this country, and that is also true for our veterans when it comes to lung cancer and other types of cancer. So just know that in me and in the City Council, you have allies and people who are committed to making sure that we're doing everything we can to close those gaps. So thank you, and we look forward to continuing working with you and partnering with you. Thank you.

Thank you, Counselor Louis-Jean. I'll give an opening statement, then I'll go right to our panel. Hopefully I only take two minutes. Women veterans are one of the fastest growing populations within the United States military in the Department of Veterans Affairs. Yet many continue to face barriers after leaving the service. Women veterans make up nearly 20% of those serving military personnel and about 10% of the veteran population, But many struggle to access gender-specific health care, mental health services, child care, housing, employment. Approximately 25% of women experience military sexual trauma, which can increase the risk of PTSD, depression, substance use, suicide. Some women also avoid VA services because returning to a military environment can cause anxiety. The VA has taken steps to improve care through efforts such as the Deborah Sampson Act, which expands primary care and counseling services for women veterans. Other legislation, including the BRAVE Act and other pieces of legislation, focus on maternity and mental health needs. Massachusetts also supports women veterans through the Women Veterans Network which provide information, resources, support. However, more gender-specific healthcare, counseling, childcare, career transition programs are needed. The VA should also work to fill counseling positions and increase the number of women providing care. Veterans also face serious health risk, including lung cancer. Military exposure, such as asbestos, can increase veterans' risk of developing the disease. African-American veterans face additional disparities in lung cancer diagnosis, treatment, and survival. Improving access to early screening and quality treatment is especially important for those communities. In Boston, organizations such as the VA Health Care System and the Veterans Outreach Center at Harvard Street Neighborhood Health Center provide veterans with health care and other resources. Expanding these services can help address the racial gap, gender disparities, ensure veterans receive the support they need after their military service. We must continue to work together to provide all veterans with access to the critical care and services they earned. Before I go to Council Fitzgerald for an opening statement, I do want to acknowledge the incredible work Commissioner Santiago of your team, of you, of your dedication and support of women veterans, of support of veterans of color, and also working closely to ensure LGBTQ plus veterans are treated with the dignity and respect that they have earned. So having said that, I wanted to give Council Fitzgerald an opportunity for an opening statement.

Thank you, Chair. I appreciate it. Thank you all for being here today in regards to this matter. Really here to learn more about what some of the deficiencies may be, where we can be better, how we can help strengthen those going further. You guys have the answers, so I'm just here for you to educate us on how we can be more supportive of you all. As always, thank you for everything that you guys do, not just for our city, but for our country as well. Thank you, Council Flynn. I appreciate it.

Thank you, Council Fitzgerald. At this time, I do want to ask the panel if they would like to provide an opening statement on women veterans, on how we're able to support veterans of color. I know there's two specific dockets, but we can combine them into one if that's OK with everybody. And I don't necessarily have any time that I'm putting the panelists on. So take the time that you need to make sure your message gets out to the public. I like to do these hearings because the public does watch these. And I like to educate the public about what we're doing here in City Hall and to ensure that if veterans are watching, they know who to contact if they are in need of services. So let me start with Commissioner Santiago, and we'll go right down the line. And take the time you need to. discuss whatever is important to you.

Thank you, Chair Flynn. Good morning, Chair Flynn, Councillor Murphy, Councillor Lujan, Councillor Fitzgerald. Thank you for having us here. I do just want to touch on something. I wanted to thank the City Council. I know it says a lot about your actions and your passion for our veterans here in the City of Boston by always showing up, not just on Memorial Day or Veterans Day, but also year-round for our veterans. And that is definitely something that I that I see on a daily basis and as a veteran and as a commissioner, I do thank you. I also just want to thank my fellow panelists who are here today, my fellow veterans who are watching, advocates, and neighbors. This is an important hearing. And one thing that I love about having this hearing is that it's more of just a hearing. It's also a conversation about what we could do best for our veterans when it comes to the topics that we are talking about either today, and sometimes it rears into other topics as well, which is also welcomed. But today, we're talking about lung cancer rates amongst African-American veterans. and our support of our women veterans. Lung cancer is not simply a medical issue, and we're going to hear a whole lot more about that a little bit later on from Dr. Weiner, who's here from the VA. It's an issue that, as far as I'm concerned and many of us are concerned, is of racial equity, an issue of access, trust, early detection, and whether veterans receive the care that they earned through their service. Many veterans face elevated risks because of smoking, secondhand smoking, asbestos, especially those like myself who have served on older Navy ships, those who served in burn pits, around burn pits, airborne hazards, chemicals, and other toxic exposures that are encountered through military service. Yet, exposure alone does not determine an outcome. Timely screening, early diagnosis, access to specialists, reliable transportation, And trust in the healthcare system can determine whether cancer is found when it is treatable or after it has also progressed. VA research indicates that fewer than 10% of the approximately 1 million eligible veterans studied have received lung cancer screening, with screening rates even lower amongst black veterans. The research also indicates and identifies barriers, including limited awareness, mistrust, stigma, unequal relationships with their providers, and adverse social detriments of health. These are not failures of our veterans. These are warnings that our systems must do a better job of reaching the people that they were created to serve. There is also encouraging evidence, studies that found that when black veterans receive care within an integrated VA system, their lung cancer treatment and outcomes can be comparable and sometimes better than those of their white veteran counterparts. That tells us something that's very important. Disparities are not inevitable. When care is accessible and it's coordinated, culturally responsive, and equitable, we can save lives. And our women veterans, as the counselor has mentioned, are our fastest growing segment of the veterans population, with more than 2.1 million women veterans in the United States today. Approximately 20% of women veterans are black, and 43% of women using VA health care system belong to a racial or ethnic minority group, yet women veterans are still too often overlooked, mistaken for military spouses, or made to feel that veteran programs and facilities were designed primarily for their male veteran counterparts. Women veterans need comprehensive and respectful care that includes primary care, cancer screening, reproductive and maternal health care, mental health treatment, support following military sexual trauma, menopause care, toxic exposure evaluations as well, homelessness prevention and assistance navigating disability claims and benefits. They also need providers who understand how systems, risk factors, and treatment experiences are different for them as women. I want to recognize the outstanding work of the Women Veterans Care Center within the VA Boston Health Care System and its program manager, Carolyn Mason-Holey, whom I spoke with yesterday. This program here in Boston provides women veterans with comprehensive, coordinated care in an environment where their service, their experiences, and individual health care needs are understood and also respected. Its specially trained providers offer primary care, gynecology, maternal and post-mortem support, mammograms and other preventive screenings, menopause care, mental health counseling, support for survivors of military sexual trauma, and also family planning services. Just as importantly, the program helps women veterans navigate the VA healthcare system, and it connects them with the specialists and resources that they have earned because of their service. The center reflects an important promise that women veterans should never feel invisible or like an afterthought within the system that they serve to defend. They deserve timely, compassionate, gender-specific care in a place where they are recognized first and foremost as veterans. Also available to our women veterans is the Veterans Call Center, which provides women veterans with information about VA services and resources, benefits, and eligibility. It's a toll-free hotline, which is available Monday through Friday from 8 a.m. to 10 p.m. Eastern Standard Time, and on Saturdays from 8 a.m. to 6.30 p.m. Eastern Standard Time. The phone number is 855-VA-WOMEN or 855-829-6636. And I'll repeat it again, 855-829-6636. And if you wanted to contact the Boston office, you could call 617-981-9277. Also here in the Commonwealth of Massachusetts, the primary program for women veterans, as was mentioned by Councilor Flynn, within the Massachusetts Executive Office of Veterans Services, or EOVS, is the Massachusetts Women's Veterans Network, which acts as a central resource, peer group, and advocacy body dedicated to empowering women who have served in the military. Since 2019, the Mayor's Office of Veterans Services here in the City of Boston has hosted an annual Women Veterans Roundtable, which has provided women veterans with a welcoming and trusted space to share their experiences, learn about available benefits and healthcare resources, and speak directly with the leaders and organizations that serve them. Most importantly, the Roundtable ensures that women veterans help shape the programs and policies intended to meet their needs. It reinforces a simple but essential message that women veterans are not invisible. They serve, they sacrifice, and their voices must be heard. Also here in the city of Boston, we host an annual Black Veterans Appreciation Brunch recognizing the extraordinary service, sacrifice, and continuing contributions of our black veterans throughout Boston's history. It is also an opportunity to connect veterans and their families with benefits healthcare, and community resources while creating honest conversations about the disparities that they have and may encounter. By celebrating their achievements and listening to their experiences, we affirm that honoring black veterans requires more than recognition. It requires sustained advocacy, equitable access, and meaningful action. Here in Boston, we are fortunate to have the VA health care system, which is one of the best in the country and the world, which includes campuses in West Roxbury and in Jamaica Plain. We also have world class hospitals and cancer centers. We have the Boston Public Health Commission, which we're going to hear from here very shortly. We have community health centers, the Massachusetts Executive Office of Veterans Services with Secretary Eric Granolik and Deputy Secretary Andrea Gail Bennett at the helm. We also have the Massachusetts Women's Veterans Network led by Director Jessica Frost, veterans organizations like the VFW, like the American Legion and the DAV, and trusted neighborhood leaders. And of course, our partnerships with our fellow city departments like the Boston Public Health Commission, Age Strong, the Office of Food Justice, the Mayor's Office of Housing and Neighborhood Services, just to name a few. We all work together to help connect veterans and their families with healthcare and wellness resources, nutritious food, food access programs, housing assistance, transportation, benefits advocacy, mental health support, and services for our older veterans. By working across agencies, we can and continue to address the social and practical barriers that too often prevent veterans, especially women veterans, black veterans, and older veterans and those facing financial hardships from receiving the care and support that they have earned. My hope is that this hearing here today will lead to greater awareness and measurable action where more veterans are screened, more cancers are detected early, more women veterans receiving the care designed around their needs, and lives saved. Lastly, as part of our continuing commitment to honor, service, and sacrifice, and as our nation not only marks the 250th anniversary of our country, but also, here in a couple of weeks, the 25th anniversary of September 11, 2001 terrorist attacks. We must never forget the nearly 3,000 innocent lives taken that day, the first responders who ran toward danger, and all those who continue to live with its lasting effects. September 11 forever changed our country and redefined service for an entire generation. And in the days and years that followed, Americans stepped forward to serve in our armed forces, in our fire and police departments, in our emergency service, and in our communities, united by a shared commitment to defend our nation, but more importantly, to care for one another. We especially honor the post-9-11 veterans who answered that call, including those who never returned home and those who still carry the visible and invisible wounds of war. Twenty-five years later, our responsibility remains clear. Remember every life lost, honor every person who served our country, and ensure that their sacrifices are never forgotten. The City of Boston will never forget. This year, we're also going to host our annual POW MIA recognition ceremony on September 18th in City Hall Plaza. We will gather with veterans' families, community members, and the state leaderships of the VFW, DAV, and the American Legion to reaffirm that our prisoners of war and our missing personnel will never be forgotten. We also invite everyone to join us for Boston's Veterans Day Parade on November 9th, where we will recognize veterans of every generation, including the post-9-11 veterans who answered our nation's call during these past 25 years. Together, these observances remind our veterans that Boston remembers their service, Boston honors their sacrifices, and Boston remains committed to supporting them and their families. Thank you to the Council for bringing attention to these critical issues. and for your continued commitment to our Boston veterans and their families. And I'm looking forward to the conversation here today.

Commissioner Santiago, thank you very much for your testimony, for your leadership. I do want to make one change to what I mentioned earlier. I know we were going to go straight down the line. Commander Meredith Tewitt is a member of the American Legion in the CATA post. And I know she's going to the American Legion post convention now. I do want to take her out of order, give her the opportunity to speak, provide an opening statement, because I have great respect for her as a veteran, as a woman veteran, a veteran of color, but also I'm a member of the Cotopost, so I have to take care of my commander as well, all right? So could we ask Commander Tewitt to... if we could bring her forward. Good morning, Commander. It's good to be with you.

Good morning, Chairman, and morning, everyone. I do appreciate you, Chair, and the committee pulling me out of turn. As you know, I am out running errands, getting ready to head to Louisville, Kentucky for National American Legion Convention. So I appreciate You're pulling me out of turn. Also, I want to thank Commissioner Santiago for all the work that he does for the veterans here in the city of Boston and all the other panelists that are going to be speaking. Thank you. We all have to continue our service for veterans, veterans of color. and also for female veterans. I am District 7 Suffolk County Council Commander for the American Legion, so I have about 20 posts under me, and then also Commander of the Carter Post in Mattapan. So I'm always speaking with my veterans, veterans of color, female veterans. I'm part of the WVN and many other organizations. First, I wanna say I applaud, And I appreciate the doctors and the advocates from the VA who have been working around the screening of lung cancer, especially for African-American veterans and our indigenous veterans here in the city of Boston. They have been doing screening and going to different locations, different posts over the past, say, two years or more to see be able to screen as many of our comrades as they possibly can to get them assistance and get them help for those that are detected and also to make sure that those that don't have know they don't have. But the problem that I want to touch on this basis here is that Even though they're visiting our communities and coming into our post, we're still losing, we're still missing some of our comrades who might have lung cancer. Our older generation who sometimes can't get out to be screened or at these locations. So how do we improve upon that? And I'm gonna throw that on your desk, Commissioner Santiago, I'm gonna throw it on the desk of our VA doctor, because we need to be able to work with our, our system and how we're doing the screenings to be able to accommodate our elders who don't come out when there's a screening because one, they don't follow social media, two, they might not see a flyer. And we've done barbershops, we've done all sorts of different locations when we were doing it at the Carter Post, but we're still missing. So I just wanted to put that out there. We're still missing a lot of our comrades that should be able to get screened right but i i do applaud them for what they have been doing um let's talk about service for um female veterans a lot of times i have veterans that say we shouldn't say female veterans a veteran is a veteran yes but female veterans health care is different we we um you know, we give birth, we carry children, so we need that GYN, we need that OB doctor to deal with, and it took a while for when the OB doctor left Jamaica Plain, it took them almost two years before they found another one, and I applaud Carolyn for all of the hard work she does to make sure that we do have doctors within the the women's clinic and the new clinic that they opened up focused on menopause. I think it's in the Bedford location, but men don't think about those things, women do. So we have perimenopause, we have menopause, we have carrying children, we have our fibroids, we have all these things that men don't have that are crucial to our livelihood and our health. And our mental health is also something else that is different. We struggle with depression in a different way because not only depression about our service, especially women who have MST and military sexual trauma and those that have the post trauma, you know, and so on. But at many times we are all focused on our children and taking care of our household and keeping our jobs and, you know, and being looked as if we, you know, as we are being too aggressive and to this and to that. So the mental health, for female veterans is different. So that's something that we could do better. I have a lot of my sister veterans who say to me sometimes when they go to a therapist that they don't think the therapist is really listening to them because some therapists say, oh, you know, You can handle it. You're strong. No, sometimes we don't want to hear that. And those are things that we need to be able to have that cultural competency, that mental competency, that environment that we're in. So those are things that we need to focus in. I don't know if it's more training or how do we do it, but those are things that I hear a lot about from my sister comrades. And I want to say... For myself, I went through a traumatic loss of like my second mother about a year and a half ago. And I want to tell people I went to therapy because that loss put me in a depression that I didn't even realize I could experience it. And I'm always out here telling my sisters, go and get help, go and talk, go and this. And I finally had to say to myself, go and get help, go and talk to someone because it was very hard. And when I walked out my door, I still had to put on that face, that strong face, because I was working with veterans, working with women and trying to get things done. But internally, I was screaming. But I was able to talk to a therapist that was able to get me through that. So a lot of times we have to think about women's depression, women's mental health is impacted in different ways. Also, again, I want to thank Commissioner Santiago for bringing it up. A lot of times female veterans are looked at as just the spouse of a veteran. And I've been talking about ways that we can acknowledge that Women served. You know, if it's a license plate or whatever, I'm going to have to go back and rally this year to see if we can get some legislation around that because my veteran's plate on my car, people think it's my husband's plate. I don't have a husband yet. You know, but those are things we we we work. We talk about it within the female veterans community being acknowledged. Not we used to be invisible. We are now we're still in a little bit in the shadow, but we're coming coming out, you know, and But it's not it's not done. We have more work to do. Right. And a lot of times to now what I'm having a lot of my sister veterans talk about is how they get looked at. Say they go through a divorce and there's child custody issues and so on. A lot of times because they're female veterans. they're being treated a certain way in the court system because of their female veteran, or they might have MST, they might have PTS, they might have this, and the judges are using that because the spouse that they're battling with is using that against them. So those are things that I wanna put out there so we can figure out how are we gonna work with our systems to help our sisters. to help my sisters help my sister comrades and and i'll never you know i'm not going to leave out my my veterans of color i serve as a commander at a long-standing 107 year old um post that it was strongly um veterans of color um we we are treated differently And that's another thing. When you think about how different ways that veterans are treated, you know, and then you have to think about when you're a veteran of color and an indigenous veteran or so on, how people look at you. If it's not your medical claim, if it's not your housing, if it's not your mental health and so on, people think that, oh, we are making this up. But no, we are treated differently. in all of these avenues because of the pigmentation of our skin. And is that fear? No, because we all served. When we're on the field together, we don't see skin color anymore like they used to do back in the days. Because when I went in, they still saw it. But here we are now, we're still going through things because we are veterans. and military attached of color. And so I wanna say that Commissioner Santiago's office does as much as they can. Comrade Flynn as a fellow sailor, we know that there are still struggles out there. And that's why I appreciate when you have these hearings so we can talk about what has been done good and what still needs to be worked on. And I know I'll get beaten up by Haywood Fenella and some of my other comrades if I don't talk about the veterans that are still on the streets, still homeless, still looking for a single room somewhere. Or our veterans that are on the street because they don't take their meds and they're off their meds. I have one of my comrades right now who we haven't found him on the streets. He stopped his meds. He lost his apartment. We know he's on the streets. We know he's checking into Pine Street, but we haven't seen him in months and we're still trying to find him. So these are things we need to do. Maybe we need to put together a group where we can go out and look for those that we know are on the streets and their families are worried about them and so on. So those are things that I'd like to get onto the table, onto a piece of paper somewhere so we can do more work and maybe pull some types of meetings together to talk about how do we do this? How do we walk the corridor and find our missing homeless veterans that are out there? And I want to thank you for the time that you gave me, Councillor. I want to thank the committee for allowing me to join you today and speak. And also, again, thank you to everyone else who is going to be speaking behind me on the panels. And thank you, Commissioner Santiago, for the work that you do. And I'm going to enjoy Louisville, Kentucky for you guys. Thank you so much.

Well, thank you. Thank you, Commander Tewitt. And I know I speak on behalf of my council colleagues and for the panel but we have a tremendous amount of respect for you for the work you do so safe travel and enjoy the conference and we'll talk when you get back thank you committed to it um let us let us continue uh commando good morning councillor flynn councillor murphy councillor fitzgerald

There's not many people that I would let hop the line in front of myself, but my comrade commander and good friend, Commander Tuitt, she's definitely one that I would yield way for. Enjoy Louisville, Commander. My name is Craig Deold. I am a resident of the city of Boston, live in South Boston. I am a member of the Boston Police Post VFW 1018, and I currently serve the VFW as the state commander. In that role, I'm overall responsible for 146 posts across the Commonwealth between our combat veterans and our auxiliary members, brothers and sisters. there's over 20,000 of us across the Commonwealth. And just here within the city of Boston, we have four vibrant posts that are out advocating for our veterans, advocating for our neighborhoods every single day. So there is always a presence of our veterans. And I'm not here only on behalf of the state organization of the vfw but also again as a resident of the city of boston and to speak on on behalf of our four vibrant posts here in the city overall the lung cancer rates with our black veterans is alarming and a lot of it goes back to a darker time within the defense department department of war whatever you want to call it where there was significant segregation of different types of people in different types of units and doing different work. As Commissioner Santiago mentioned before, there's folks that would be serving in the Navy that would always be below decks. They'd never see the light of day. And they're in environments where there's going to be asbestos in that environment. They're breathing in fumes from the engine rooms. They're around hazardous materials. You know, the part and parcel of being on a Navy ship. The land forces, they're always going to be, again, toxic exposures. Between the burn pits, again, being in hazardous locations of even being in a tank, in an armored vehicle, an infantry fighting vehicle, you're around those things. Those fumes, you're around the fluids, and those environments are inherently hazardous. We all understand when we raised our right hand and joined the service as a volunteer that we're going to be putting ourselves into these situations for the benefit of our communities, of our country, and for the world in general overall. We don't go into the service broken. But a lot of times we'll come out of the service in that state. Again, it might not be due to a combat injury. It could be just regular occupational hazards within our nature of our service. But the cancer rates within our African American and black comrades is something that needs to be continued to look at, looked at by not only the VA, but as part of the overall health care system that we're involved with. I've had the honor and pleasure of working at both Brigham and Women's and Dana-Farber for many years, and I know firsthand and used to see the outstanding effects that our health care system has for not only our black veterans, but anybody within the city of Boston and the world at large. Boston is a medical mecca of the world. There's no better place to get sick or be hurt than within the city of Boston, between the pre-hospital care that Boston EMS provides right through the VA hospitals and our our great healthcare system here in the city. What we're looking at, though, is making sure that all veterans, especially our black veterans within this subset, do have that access of care. We need to make sure that we, between our partnerships with, through the VFW, the commissioner's office, and through the VA, that we need to make sure that when I have a veteran come to me saying, hey, I've got this stuff going on, where can I go? The VFW is there to be able to help steer the veterans in the right direction to get that care, be it city service, going back through the VA. We have an incredible network of veteran service officers who assist any veteran, not just VFW members. any veteran with filing their VA disability claims. And we'll take them right through the initial intake. And if they need, if they get denied initially, we'll help them through the appeals process, even going as far as to a hearing in front of an administrative judge. And we'll take them through that whole process free of charge to that veteran. We don't look for anything in return. We don't put any membership requirements on anything. We will help any veteran. So that's an important distinction that we need to make sure. Through that process, the VFW and their power of attorneys through the veterans that receive VA benefits since the start of the federal fiscal year this past October 1st have brought $87 million directly back into the economy of the Commonwealth of Massachusetts. that doesn't get filtered to any other attorneys that goes directly into the pockets of our veterans that are within our our commonwealth the numbers are a little skewed because some of the south coast does get pulled into the providence numbers uh that but that's you know that's fine as long as we're those veterans are being taken care of uh if we extrapolate the numbers we're looking at 105 million dollars directly into the pockets of veterans across the Commonwealth. I wish I was able to break out what comes back directly into the city of Boston. I'm sure it's a very impressive number. But again, through the VFW and our service officers, that economic impact that we're making is huge. And that does go towards the access of care. If they're secure financially, they're going to be a little bit more secure. in themselves seeking the medical help. They feel like they're gonna be able to go and seek that help to get better, to get that care through from start to finish. Transitioning to our women's veterans. I entered the service and I got commissioned in 1991. Over the years, the nature of our military has changed quite drastically. We have women serving in the Air Force in combat equipped jets and strike fighters. We have women sailors serving on armed combatant ships in the submarines. We have women in the Army and the Marine Corps serving in infantry billets. They're doing the same thing that men are doing. We need to look at, again, embracing overall our women veterans. And we try to do that through the VFW. We're encouraging our women veterans, our members, to take on leadership positions within our post so we can uplift their voices to get another different point of view than just the old boy network of the smoky, a cave of a VFW or American Legion post of the days of yore. Those thankfully don't exist anymore. As Commander Tuitt had mentioned, she's had experiences where somebody's come up to her and didn't recognize her as the veteran. I try to make my own personal point. If I have a couple come in front of me, I'll start with the woman in front of me and ask her, where did you serve? And, oh, great, I served here, I served there. Or, oh, I'm not the veteran. My husband is. Well, still, she's part of the veteran family. And that's important as well, that we embrace not just the veteran, the service member, but the entire veteran and service members' family, because they're serving as well. They're going through hardships just as much as the service member does when they go up and deploy and do their jobs. So it's very important that, again, we're uplifting our women veterans, making sure their voices are heard. We're expanding the leadership of our service organizations to reflect the true nature and the demographics of our military service. Finally, at the police post, we currently have our first female or woman post commander, Lisa Venus. She's a retired or soon to be retired Boston police sergeant, Army veteran, and she's our post's first female commander. And we're excited. She's been a hard charger coming up through the ranks, and we're looking forward to some great opportunities with her through this year and going forward. So there is a changing of the scenery throughout the veteran service organizations. I applaud our commander Tuitt and our commanders here that, again, they're taking that leadership role, and their voices matter. Without their voices, nothing will change across our service organizations to reflect the true nature of our environment right now. Lastly, I'd like to mention, Again, Commander Tuitt mentioned our homeless veterans. They count. They're out there. It doesn't matter that they're a part of any of our organizations. They served. They deserve our respect. They deserve our support. The VFW will do everything that we can to make sure that across the board and through our partnerships with Commissioner Santiago, and his department that we do look out and look after these veterans. The Veterans of Foreign Wars has a national home out in Eaton Rapids, Michigan that has been around for over 100 years and they help support service members, their families that are Looking for a little, not a handout, but a hand up. They can go, they move their family there, they stay rent free, utilities free for a number of years to get back on their feet. So they're able to move on back to their communities that they're looking to join or rejoin. And that might be something that we can look at too within the city. There's a lot of opportunities out there. There's a lot of great organizations that are doing incredible things in their own little Their own lanes, but again you look across these the table and across the room here It does take a village to to support the veterans community and all of our communities This is not an individual sport We can't do it by ourselves. It does take a team and we've got a great team here and I do applaud the city councilor and Again, Councillor Flynn, Councillor Murphy, Councillor Fitzgerald, I do appreciate you taking the time on a Friday morning at the end of August as the waning days of summer are closing in on us. I do appreciate that you guys, you're all taking the time to listen to us. I would implore that you take the time in your busy days to go visit our posts. Not just when they're having a chicken bake or any type of know a fundraiser or anything like that you know reach out to the post go to one of their meetings that's when you're going to have the one-on-one conversations with our veterans and you're going to find out really what's on their mind so you got to take that with a grain of salt you might not want to hear everything that's on their mind but the the veteran is going to be able to give you a true perspective on the ground, what they're dealing with. And it's going to be that one-on-one interaction that is going to really bring it home to you when you're making your deliberations, you're having your discussions. And it matters not only dealing with veterans, but across the city. Veterans are a small subset of our society, but it's a very diverse and distinctive group that has already dedicated their lives to public service. They've raised their right hand. They've served. They've given their blood, sweat, tears, body parts, and some of them part of their minds to the defense of our country and the betterment of our society. So again, thank you for your support, and I look forward to any questions that you might have. Thank you.

Thank you, Commander. We have Mr. Kennedy from the Boston Public Health Commission. Sir, thank you for being with us and want to give you an opportunity to give an opening statement. Again, want to make sure you take the amount of time that you need to make sure that your message gets out because I do know a lot of veterans watch this program on television and want to give you an opportunity for your opening statement. Mr. Kennedy, thank you for being here.

Excuse me. Thank you, Councillor Flynn, and of course, Councillor Murphy and Fitzgerald as well. If I may, for just one second. It was a real pleasure to hear from Meredith Tewitt. I worked with her quite a bit in the past while she was working at State Rep Gloria Fox. Okay, yeah. It was just a real pleasure to hear from her. Again, my name is Mark Kennedy. Thank you so much for having me. It's my pleasure and honor to be here. I'm a Senior Program Manager in the Chronic Disease Prevention and Control Division at the Boston Public Health Commission, and I'm leading the creation and implementation of the Commission's first chronic disease and cancer early detection initiative. The mission of the Boston Public Health Commission is to work in partnership with communities to protect and promote the health and well-being of all Boston residents, especially those that have been impacted by racism or systemic inequities. To put my comments about lung cancer among African-American veterans in that context, let me start by highlighting the City of Boston and the Boston Public Health Commission's first population health equity agenda, which we refer to as Live Long and Well. The Live Long and Well agenda is about convening partners across sectors to address the three leading causes of premature mortality in Boston, unintended drug overdoses, cardiometabolic disease, and yes, preventable cancers. Major cancers, including lung cancer, are referred to as preventable because there's a screening guideline associated with them that can help to detect these cancers early when they can be treated with the best chance of survival. Nationally, Statewide and in Boston, lung cancer is the top cause of cancer-related mortality. In Boston, lung cancer is the deadliest and most frequently diagnosed fatal cancer for both men and women. For black men, lung cancer causes more death than breast, colorectal, and prostate cancers combined. Overall, when we look at trend data, mortality from lung cancer has trended downwards. but of course not for everyone. Massachusetts is near the top nationally for early diagnosis, surgical treatment, and overall survivorship, but total incidence, which includes new cases, is higher than the national average. This could be due to increased screening, but new cases are not necessarily cases where the cancer was diagnosed early. We'll continue to track local data on age and stage of diagnosis to quantify that finding more new cases early leads to less mortality. Meanwhile, Boston's black population has a lower incidence of lung cancer than the national average. Nationally, black individuals with lung cancer were 13% less likely to be diagnosed early. They were 19% less likely to receive surgical treatment. 11% more likely to not receive any treatment, and 13% less likely to survive five years when you compare to white individuals. All that said, lung cancer is the leading cause of cancer-related death among US veterans. Veterans have a higher rate of lung cancer and a lower rate of survival than the general population. African-American veterans face higher risk due to military-related exposure, like asbestos. According to the US Department of Veterans Affairs, veterans have a 25% to 76% higher risk of lung cancer, and asbestos exposure remains a significant contributor to this elevated risk, which exacerbates risk for black men. African-American veterans experience disparities in diagnosis, treatment, and survival rates compared to other groups. The US Department of Veterans Affairs diagnoses and treats approximately 8,000 veterans for lung cancer each year. Veterans have a higher risk for lung cancer due to older age, smoking, and environmental exposures during and after military service. Smoking is the primary cause of lung cancer, with many veterans reporting that they started using tobacco after entering military service. Exposure to radon gas is the second leading cause. I want you to note here, if you would, that in addition to these risk factors that contribute to incidence, not getting screened is also a significant risk factor, and that contributes to mortality. Because for lung cancer and any other cancer, catching and treating it early exponentially increases survivorship. Systemically, black veterans have lower odds of completing lung cancer screening than white veterans, particularly due to loss between referral and the connection with screening programs. Let me conclude by saying this. For lung cancer, veterans and the general population would benefit tremendously from changes to the screening guidelines that would further expand access to screening. In 2021, the U.S. Preventive Services Task Force expanded access to lung cancer screening to catch lung cancer earlier in higher risk groups, particularly women as well as black adults who often develop lung cancer with lower smoking exposure. The task force expanded access by lowering the starting age from 55 to 50 and from reducing the pack year history requirement from 30 pack years a year to 20 pack years a year. You do still have to be a current smoker or have quit within the past 15 years to be eligible. In 2023, the American Cancer Society went further and eliminated 15 years since quit criteria. But lung cancer screening is still tied strictly to tobacco use. For veterans who are exposed to radon and or asbestos, for individuals who work in occupations such as firefighter, construction, hair salons, et cetera. For general public city dwellers that are exposed to elevated levels of automobile exhaust and other environmental carcinogens on a daily basis, lung cancer screening eligibility needs to be expanded beyond just tobacco use. Also, systemic changes need to be made so the veterans who are referred to or referred to screening don't fall through the cracks. I'll conclude there. And again, thank you for allowing me an opportunity to speak. And I look forward to any questions that you might have.

Thank you, Mr. Kennedy. We have with us now Dr. Whitley, who's also a veteran and a member of the American Legion Post.

Thank you. Thank you, Councilor Flynn, Murphy, and Fitzgerald. I didn't write anything because one of the things that happened to me yesterday was I attended a debate, and my question was, What laws or what funding would you implement for high denial cases denied amongst black women? And that question wasn't quite answered. So then I thought about when Counselor Murphy was campaigning for her. to become a city councilor at large. And I stopped her, and she was in Hyde Park, and I was having this trouble with my claims. And I said to her, well, what do I do? I need a 526-0995. And she was like, give me your number. And then I had someone call me a VSO to walk me through those claims. But I started to think about when I wrote my dissertation. and why I became a doctor of education. So one of the things that I noticed, and I started to study black women, so that made it kind of limited to black women veterans. One of the things I thought about years ago, because I just retired June 1. I spent many years in the military. I had trouble navigating the system. And so I am happy with the statistics, the lung cancer, the MST. But when I requested participants for my study, I had over 70 black women vets. And at 10 participants, the data was saturated. And one of the things they said to me, and we talked about the VA and how great the health care was and the Women Trauma Center. They said, how? How do I get there? How do I navigate? So with the programs and all the great things that we have, how do we get our women, black women vets to go for screening if It's a high number of denial for claims. Maybe not the fault of themselves. Maybe they just don't know how to write the claims, or maybe they need help with the claims, or maybe they miss a part after a year the claim closes. So I think about, in the community, we need to implement of, if we're at the post, that someone can walk in and say, how do I complete a claim? If I'm able to walk into the municipal building in Hyde Park, how do I complete a claim as a vet? So one of the things that I want to say is that if I was watching this and I was just out of the military, or MST or trauma happened to me because I served 30 years ago, how would I do it? How would I navigate through this? So I oftentimes just think about that word, to navigate through the system. And that was my dissertation. Black women veteran navigating the mental health system after trauma. So I thank you guys all for the statistics. But I think that we need to focus on how do we get them into the VA? What do we do on a city level? What do we do on a community level to bring them in? What if we want to say, hey, I want to do a claim? Where do they go if they've never been to the VA or maybe denied for the VA?

Thank you, doctor. Important recommendations. I know we'll be discussing them in a couple of minutes. So thank you for bringing that information forward. Thank you for your service. Dr. Wiener from the VA Center for Health Optimization Implementation Research. Dr. you're up.

Thank you so much. Good morning, everyone, and thank you to the Council for the opportunity to participate today in such an important hearing. And I want to also thank the veterans who are present for your service to the country. My name is Renda Wiener, and as I've already mentioned, I'm a pulmonary physician and a researcher at the VA Boston Health Care System. And it's been my great honor and privilege to take care of veterans with lung conditions for more than 20 years, including lung cancer, and to engage in research to try to address some of the issues that we're talking about today. How do we improve veteran health? How do we improve access to care and improve equity? In addition to my roles as a physician and researcher, I also am the deputy chief consultant for the National Center for Lung Cancer Screening for the Veterans Health Administration, and I'm a professor of medicine at the Boston University Chobanian and Avedisian School of Medicine. I have also been a physician at Boston Medical Center. So I'm speaking from those various perspectives, but I do need to also disclose that The perspectives I'll share in this hearing are my own views and don't necessarily represent the positions or policy of the Department of Veterans Affairs or US government. So I'm here today because veterans in our city, especially black veterans, are dying from lung cancer. And many of these are needless deaths. We are so fortunate that the greater Boston area is home to some of the most active lung cancer screening programs in the country, including at the Boston VA. And if we were reaching more veterans for screening, we could be saving more lives. You've heard that lung cancer is a critical issue facing veterans and that 8,000 veterans are diagnosed with lung cancer every year. Just take a moment to think about that and how many families are affected by this disease. You've also heard that veterans have higher rates of lung cancer than others in the US population due to military exposures, among other issues. But perhaps more dire still is this. So I testified before this council about a year and a half ago. And during that time, approximately 7,500 veterans in this country have died from lung cancer. It's an average of 15 veterans every single day. In fact, lung cancer is far and away the leading cause of cancer death among veterans. But again, many of those deaths could have been prevented. Catching cancer early when it's still treatable is critical to improving lung cancer outcomes. Early detection through lung cancer screening followed by timely treatment represents our best hope to improve outcomes for veterans and others at risk of lung cancer. Lung cancer screening means getting a simple CAT scan of the chest. It takes just a few minutes. It's painless. And having a screening CAT scan every year can reduce lung cancer deaths by 20%. One of the hard truths we've already begun to hear about is that black veterans and black men nationwide die of lung cancer more often than any other group in the US population. Many develop lung cancer at a younger age and with a lower smoking history than white Americans. And why is that? It's because they don't often know that screening is an option or how to access it, as you alluded to. And then they experience delays and gaps in every step of the pathway from diagnosis through treatment and are less likely to get the best, most effective treatments for lung cancer. The good news is that the VA system breaks this pattern. When black veterans get care through the VA, their lung cancer survival is the same as white veterans. VA lung cancer screening rates, early cancer detection rates, and survival rates are equal or better across the board than those outside of the VA system. And the difference here isn't biology. It's access to timely, equitable health care. And we're fortunate that within the VA system, VA Boston's lung cancer screening program is one of the leaders in the nation. But many people who are eligible for lung cancer screening, veterans and other Bostonians, have never heard of screening, and they don't realize that they qualify for this lifesaving test. In fact, fewer than 25% of eligible Americans have been screened for lung cancer, and black people are even less likely to have been screened than others in the population. So let me just take a minute to raise awareness on some key facts. Guidelines recommend lung cancer screening for people ages 50 to 80 years old with a significant smoking history. And regardless of whether you get it through the VA or outside of the VA, screening is covered by insurance and completely free with no co-pays for people who qualify. But sharing information at meetings like this isn't enough. Our teams at VA Boston and at our research center choir are actively working to improve lung cancer screening awareness, and expand access to screening. And we're doing this work right now here in Boston. So first, the Vet Peer Connects study. Last year, we partnered with black veterans and community groups like NABVETS, the National Association for Black Veterans, and the Triad Veterans League, led by Boston's own Heywood Fennell, to co-design a community outreach program by black veterans for black veterans. We partnered actually with many people here today We partnered with the Office of Veterans Services from the city and the Commonwealth and veteran organizations, including the VFW and American Legion, including specifically VFW Post 1018 and the Carter Post. So thank you again for your support and partnership. So we partnered with those groups to hold community events around Greater Boston, trying to reach veterans where they are and help get them connected to lung cancer screening. So we're now building on what we learned in VetPeer Connects to create a sustainable program with greater reach. We launched a new website and social media campaign developed together with veterans to share their stories about screening. And we're creating a toolkit for veteran organizations to use with their own members. We're also leading a precision screening trial across 28 VA medical centers, including VA Boston, that's designed to engage veterans who have the highest benefit from screening but haven't yet been reached. And many of these are black veterans. And finally, we're kicking off a project to connect veterans who have a history of toxic military exposures to the whole health well-being services at the VA, and also connecting them to clinical trials that will help better understand the relationship between military exposures and lung cancer and what the role of screening might be for those veterans. And these things are working. One veteran at a time, people are talking to their doctors, getting screened, regaining trust in the VA, and accessing the health care that they earned and deserve. I want to acknowledge and thank the many veterans, community partners, and VA staff who've helped make this series of studies a success, as well as the support of the city and the Commonwealth. Most importantly, I want to thank the men and women veterans who inspire our team every day. But there is still more work to do, and we need the council and all of your help in these efforts. We hope you'll help us to continue to build on this momentum. The approaches that we've developed are resonating with Boston veterans. And let's continue to sustain these partnerships and the trust that we've built with veterans and community organizations. Second, please help us to continue to get the word out. Partner with us to amplify screening awareness through the city's many channels and resources. And then also, as individuals, tell other veterans about lung cancer screening. These one-on-one interactions are incredibly powerful and could help save a veteran's life. I can't think of a more important goal than getting veterans the screening and the health care that they earned and deserve, especially black veterans and women veterans who have been left behind. That's not just my mission as a doctor. I really believe that for all of us, improving equity is a value we all share. And I'm honored to fight for that and hope you'll continue to work with us to achieve that goal.

Thank you, doctor. Thank you for being here. Thank you for the important work you were doing. Before I go to my colleagues to ask questions, I do want to go to public testimony. And if there is anyone here, I know my friend Donald Mitchell is here. I believe he's an Air Force veteran. I want to give him the opportunity to to speak and to testify. Usually, Donald, you get two or three minutes, but I don't cut off any veteran. I'm sorry. A veteran can speak as long as they want. You've earned it. I also want to acknowledge our friend that is not here. I know he's been mentioned, Hayward Fennell, a wonderful advocate in the city for veterans, military families, veterans of color. But Donald, we'd love to hear your testimony.

My name is Don Mitchell. I'm the president and CEO of Don Foundation, which is a non-profit organization that helps veterans with the resources that they need to get housing, rent housing, furniture, certifications, and help them get jobs in the industry. A key problem with veterans and people who are homeless is the fact that they when they come out of incarceration or they're out there in the field, they don't have the housing and employment which is key for their salvation. We help them out, our organization will help them out to find these resources to pay for some of these things that they need. Friends with my brother here, Robert here. We go back and forth here. Custom friend, we just had a roundtable, a veterans roundtable August 11th. Getting ready to prepare for a stand down September 11th so we could do furthermore resource and research on what the veterans needs are and what their complaints are and their concerns. We just sent, through this, Roundtable, we just sent a gentleman named Brian Mullen to one of the partners that we met at the Roundtable, and he's being assisted because he's had multiple situations and he's had problems. So our goal is to help our veterans out. I've been a veteran of the Air Force there. Also, I'm a... retired Local 4 operator and also worked in the Air Force through civil engineering and construction. So the construction part of it is the other part of my company is called Don Mitchell & Soldiers LLC, which helps to find employment for those people who work and who needs employment. So we'll be working diligently trying to find resources and things for our veterans who are in the area. I'm aware of Because my friend and Sandy, I'm just going to get involved. I think I know Mr. Kennedy. We've met a couple times. So I'm going to be contacting you in the future to try to figure out how we can further help our veterans on out.

Thank you, Donald. Thank you for being here. Thank you for your testimony. And thank you for your commitment to supporting veterans Across our Commonwealth. I'm going to go to my colleagues. I'm going to start with Council Murphy, then go to Council Fitzgerald. I'm going to give each councillor maybe 10 minutes to ask questions. I know there's a lot of people on the panel that might want to weigh in, too. So if a councillor goes over 10 minutes, that's fine. We'll just continue the conversation. Council Murphy, you're up.

Thank you. Thank you for your testimony, everyone. One of the things I kept hearing from all of you is the screening. And the statistics are trending in a good way. We are fortunate to live here where we have such great health care, but at the same time, even though nationally our numbers may look good when we zone in on Boston, the state specifically, we're still seeing that more black women and men are just not getting the care they need so how do we make sure that you know because without the screening they're not going to get the support the health support they need so what what should we do what can we do not just as a council just as a city like to make sure and as a medical doctor like do you Do enough, do you think, to make sure that you don't have to ask for it, right? That if a doctor knows, well, you were in the Navy, we know you were on this ship. You were in the military. You probably were exposed. Because many times people aren't aware to even ask for the help. And obviously, you've said it yourself and others saying that too. So what can we do from the medical side, but also all of you who are advocating and working alongside our veterans every day?

I'll say from the medical standpoint, at the VA we have implemented systems to help doctors on the front line identify when the veterans that they're seeing are eligible for a lung cancer screening and flag them to remind them to make sure that they offer it. And I know that's the case in many healthcare settings outside of the VA as well. That said, especially primary care clinicians who are handling so many issues in a brief visit, sometimes they don't get to it. So I think it is also important to raise awareness among the public about lung cancer screening and empower folks to ask their doctors about it.

Do most insurance not cover it if you don't Because when you say qualify, would the doctor have to kind of say, you smoke, or there's reasons to believe it? It wouldn't automatically be covered if a doctor referred it?

So insurance companies do cover for people who meet USPSTF eligibility criteria, and there's no charge for that, and that's inside, outside the VA system. But as Mr. Kennedy alluded to, those criteria don't catch everybody who could benefit from screening. That's one of the things that we are studying in that trial that I mentioned. We are doing precision approaches to predict who would benefit from screening, including people who fall outside of the US preventive services task force criteria and offering screening to those veterans. That's a clinical trial, so it's not you know, for everybody, but hopefully we will be able to reach veterans in VA Boston as well as the 27 other VA sites that are participating in that trial.

Thank you. I don't have any other really specific questions other than, you know, it was said people just don't always know that there are services out there and how do we connect them. And it's never at a loss of hard work. and advocacy from your commission it happens i think for every department across the city we often hear like well how do i get that fixed who should i have called or so do you um is there some sort of like ad or campaign or support you know thinking of the city level how to support our veterans and advocate that way

I think one of the greatest way that we could collectively as a city do it is through continued partnership with the Boston Health Commission, with H-Strong, with the Office of Neighborhood Services. So basically pretty much the village here in the city of Boston municipality to get together when we do go out into the community and talk to not just our veterans but our veterans' families. our community members, our community leaders. The biggest thing that sometimes I see is that they see one of our events that is just for veterans, but it's open to everybody. It's open to the whole community. It's open even to somebody who may not even live in Boston, who could just be in the area to come by, and go to the fair and expo that we had at Gordine Park this past weekend and see what's available to our veterans, see what's available to the community as well. And that's information that they could pass on to someone who they may know who's a veteran or someone who they may know is a son of a veteran or a daughter of a veteran. So all these events, all these communications that we may have or leaflets, While from my office they may be geared to veterans, but actually they're for everybody because everyone should know a veteran or knows somebody who knows a veteran or has a person in their family who is a veteran that they could pass that information on to. So, you know, what I implore people who may be listening, who may be watching, to understand is that read these informations, come to our events, be a part of our event because It is for the benefit of the whole community. And part of that community is our veterans, because veterans do cover all demographics here in the city of Boston. And we're all in all communities. So I think that communicating this to everyone in the city and beyond is very important.

I think one of the things that we must do is safeguard the resources that comes into the veterans' budget. We're being cut all sorts of ways and raided all sorts of ways. VA needs funding to do their research. The post needs funding to do what they have to do. Boston's health situation needs some funding to do with the situation. But if we have different agencies, including our federal government, doing all these cuts and everything out there, we need to safeguard the funding that goes into our veterans pool to make sure these individuals get the resources they need to do the work that they need to do.

Thank you. I was going to mention that, too. When we were going through the budget cycle, the fire department, who many of the members are veterans, did not receive that $1.2 million grant. And much of that grant was directly related to screening and health care support. So it is important. And if we see that we're losing federal state grants, how do we on the council shift? I know that we work closely with your department to make sure we're not losing any money. and if any way we can add more to your department. Thank you just all for being here and advocating and just know I'm a support and resource anyway. I can help more than I am. I'd love to, thank you.

Thank you, Council Murphy. At this time, I'm gonna go to Council of Fitzgerald. Council of Fitzgerald, you have 10 minutes. Thank you, Chair.

I appreciate it. So thank you all for the testimony. As I was sort of listening to everybody, I was writing down, you know, the data is the data, right? And so we know that what we're focusing on here today is an issue, and that is being told to us by boots on the ground, but also through the data that we're collecting. And so I was trying to think of, you know, what is the number one source of why this discrepancy exists? I'll refer to lung cancer at the moment among black veterans. And I started writing down a list of what I think could, and I'm no doctor, so this is why you guys are here. But I was like, there's either genetics, there's education and awareness about it, there is the insurance, There is your personal lifestyle that can affect it. There is the work lifestyle such as where you might be, where you might have served. And I added navigating the system in because from what I heard from this panel too is that just navigating the system. Of all the things, what do we think of that sort of list might be? If we were to hone in on what would have the biggest impact, and there may be others that I could add to this list, but what would be the area that we would say, hey, if we corrected insurance, a lot more people would be covered and we could identify more early? Or is it, hey, is it the education awareness and getting, and I know it's a mixture of all, right? But what I'm asking is if we were to prioritize it, right? You can't do much about genetics. The work lifestyle, that's already occurred. right, in black veterans. And so how do we know where we can place people in the future? Sure, it might help future generations, but that just knowing where they are and making sure certain benefits are available to them. And then helping navigate the system, I think that's in any sort of large, heavy paperwork type of setting. I mean, car insurance, health insurance, whatever it may be, right? I think we all have trouble navigating people walk into this building and the first thing they usually say is i'm you know to help me navigate city hall where do i go right who do i talk to for this issue so um i think that's important one but Just trying to hone in, because I feel like if you extrapolate it outside of veterans too, that the data probably correlates, right? That lung cancer among black individuals is also probably higher than white counterparts. And so that's what got me thinking to the other things of like, well, if we help one, we can help the veterans. If we help the larger continuum, then we can help the veterans. But at the same time, what can we learn from helping the veterans that can educate us that we can bring it out to the larger continuum, right? A lot of you guys spoke on this, but I guess what I sort of is wondering is if we were to hone in, right, because government gets pulled in a lot of different ways, and we'd love to hone in on every single one of these, but that would be all day every day, and there's a lot of other people asking for our help. if we could hone in, what would you think would be the best parameter to sort of say, let's solve this one. Let's solve education awareness and put the money towards that and put our effort towards that. Let's tackle insurance and make sure, I think insurance is a sham anyway. I don't know how you guys, you guys are the doctors, but just from a guy on the outside, a layman's person, I think that's the biggest thing we got to tackle next. But, you know, is it making sure the system is more streamlined or at least more You know, that you can work with it easier to understand. I don't know. So I put that all to you guys and say if you had to prioritize, what would you think would be the most impactful one to attack? And we could all have different answers. I'm sort of just wondering from a personal point of view. There is no right answer.

I'll guess I'll start, counselor. Thank you for the question and bringing that up. And it's everything you mentioned. Right. It's a little bit of everything. But I think part of it has to do also, which we alluded to, and incidentally myself and Craig here, before we even came to the council hearing, we actually were having a cup of coffee and talked about it. Talked about what is the underlying reason why the cancer rates are so much higher in the black veterans community. and also in the minority community as a whole. And we could speak on that from our experience as veterans. A lot of it has to do with whatever their job duties or collateral duties were given to the black veterans in service. I could speak on my experiences as a Navy veteran where a lot of minority veterans and minority sailors like myself, we were told to go sandblast a void on a ship. you know, or we were working in an engine room, pretty much what Craig had mentioned earlier in his testimony. So a lot of the And I'm not saying that that's the reason why the rates are so high. I'm just speaking again on my experiences and from what I have seen and talking to other veterans as well, that that could also be an underlying reason why those numbers may be high is because of also the duties that we were given while we were in service. Now, add that to the fact that when we're no longer in service and now we're veterans, navigating the system, knowing the system, knowing what is out there for us, and like Dr. Weiner had mentioned in her testimony, the VA, they're doing a great job in trying to get the word out there, but one, it's not enough. Two, there's always work to be done. And so I guess the educational piece, and again, trying to let everybody know that the lung cancer screenings are there for veterans, for pretty much anybody. The city of Boston also has a policy for lung cancer screening amongst municipal workers. Go to contact your CBA and see what those may be. But I think as far as veterans are concerned, the education piece is huge. Getting to those veterans, and Malika had mentioned it, Dr. Wheatley had mentioned it in her testimony, when these service members become veterans, what is the Department of Defense doing when service members are transitioning into becoming veterans and coming back into our communities, are we reaching them in a timely fashion once they come out? I know that the state does what they can to notify us municipalities, us veteran services offices throughout the state to let us know who in our community is returning from service and reaching them and letting them know and also being able to be an asset to them when they transition and integrate back into the system. back into their communities as well. So it's really not something that it's going to be taken care of immediately, but it's something that we're going to be able, that we have to continue the conversation on amongst our groups, amongst advocacy groups, amongst the VFWs, the DAVs, the American Legions, you know, Don and his organization, Haywood and his organization, and pretty much all the veteran organizations in the communities as well. And it also takes the council as well that, you know, if and when you also go out into the community Bring it up, you know, Councilor Fitzgerald, you know, if you're out in your community, be like, you know, I was at a hearing about veterans, and we talked about lung cancer here, you know, lung cancer amongst veterans. This is what's available. So, you know, just spreading the word out there. Whenever we go out into the community, just bring it up. Even if the subject matter may not be about veterans, I always bring up veterans. Why? Because I am a veteran. You know, why not? But, you know, make it part of the conversation. Make it part. of the community conversation about veterans, about lung cancer screening, about women veterans. Right now, there's close to, I believe it's 940,000 women that are enrolled in the VA. But there's 2.1 million women veterans that we know, so those numbers need to go up as well. So women veterans could also get the care that they need in the VA system because it's there for them. How many of them actually went to the VA to get that care, or is it the trust thing as well? Are we talking about trust? They just don't trust the system to help them out. Just the same thing with black veterans, just the same thing with minority veterans. There's been that stigma for many, many years that the VA is not there to help them. It could be the trust thing that we need a breakthrough as well. So there's a lot of... It's a big web that we're weaving here that we need to go through and break through. But I think what it all comes down to is the word communication, talking to the veterans, getting them out there, letting them know that the VA has come a long way. And I'm proud to say that the Boston VA is definitely the best damn VA we have in this country. And it's because of the partnerships that we have with the state, the partnerships that we have with all these medical facilities. We have one of the best nonprofits like Home Base is located here through the MGH as well. So all those partnerships, getting together and communicating that, hey, we're here for you, and we're going to make sure that you get what you deserve. That's excellent.

Thank you very much. I appreciate it. From our point of view of what a council can do, education awareness is where we should tackle. I just want to make sure you're there. I don't know if anyone else would like to chime in. I have other questions as well.

I get it. First of all, Councillor Fitzgerald, thank you for the question. I'm going to say from my particular lane, Because everybody here is bringing, whether it's an experiential or a professional perspective into this. Again, as I said in my introduction, my focus is on early detection of, in this particular case, of course, lung cancer. I've never had lung cancer. I'm not a veteran. I've never smoked. I listened to your list of the things that could be causing this. Genetics was the first thing you said. I don't know if it was any particular order. No particular order. But I would say that family history or other genetics are issues in a lot of cancers. I think the biggest issue for lung cancer is exposure, particularly with veterans, because we all have said in various ways and shapes and forms, people didn't start smoking until they entered military service or some other type of position that put them in an exposure situation to something other than tobacco. A lot of that is what's driving lung cancer rates up, in particular for black veterans. To answer your question, my single word again from my lane basically goes right back to the guidelines. And let me just put some context around that. What we do at the Boston Public Health Commission, at least in terms of my job, because I don't provide any direct service, so I don't actually do the screening. What I basically do in my role is to communicate about screening, okay? But I always tell myself, I am doing a disservice to the public if I don't go into that job acknowledging that there is a balance, there's two dimensional chess being played here. Because I have to communicate something that provides a call to action to the public. But when they get into the medical system, the doctor has to do what I want them to do when the patient shows up. If the doctor's not going to do that, why should I tell people to go have it done if they can't actually get it done? The guideline piece I'm trying to talk about here goes to the fact that lung cancer screening is basically tied to tobacco use. And a lot of the lung cancer that veterans suffer are from things other than tobacco.

Gotcha.

You also talk about veterans that weren't smoking before they came into military service, and they began to smoke as a result. So if you think about this particular group, and again, the other context I'll add is I'm with the Boston Public Health Commission, but what we're talking about here is population health. It's a segment of our population, i.e. veterans, that are experiencing lung cancer differently than the general public. What can we hone in on and focus on with that? You talk about we've heard the tremendous work that the VA hospital is doing here, which is different, unique, and better than what's happening across the country. My hope is that there's an opportunity with local legislation engaging local payers and a strong medical and clinical institution like the VA hospital to say let's set the tone for the rest of the country for how to get this right. Because we now can basically create a local closed loop that says what we do is we screen people not just for tobacco use, but for exposure to the things that we ask them to do in the context of the military service. Get pairs on board, open up lung cancer screening to people that actually need it, not just smokers. Look at the financial benefits of that over a period of time. Look at the outcomes benefits, which is reduced mortality over a period of time. Present this to the country and say, look, we are getting it right in Massachusetts. You could be doing more in wherever you are that's not Massachusetts because we've got, as you said, we've got a community of local resources clinically that are probably the best in the country, if not the world. And if we get it right here for veterans, not only will it inform the way we treat veterans across the country, but that navigation system and everything else that's involved literally opens up cancer, early detection for other characters in other areas in a way that informs the whole system. I think we've got a unique opportunity here and I think the city council, local clinicians, advocates like myself, communicators like myself, can really get on board and put a plan together.

Well, that's what Boston does, lead the way. So I hope we can do that on that. I know some other folks wanted to potentially chime in.

So, no, just quickly. Is my mic on?

Yes.

One of the things about veterans is we look for community organizations because of brother and sisterhood. And then we also lean on our faith-based organizations. churches. So if we're talking about education and you know, how would we employ that education? How will we get veterans in the door? And you know, the VA is a great system and we have great screening, but at a point we need to get our vets through the door into those screenings. And then how do we do that? Anytime that we are opening up something in Boston, I think that Any community organization that vets are attached to, whether it's the YMCA or whether they go to their local community system, local community like Hall or The Post, all of that needs to be filtered down. So if I'm walking into any community, place that I'd love to visit, I should be able to know that this is free screening. Because we can offer it, but the education part of it, how do we get them through the door? How do you get us through the door? Because you couldn't get me through the door 10 years ago. So how do we do that? So we really need to start thinking about where is our underserved communities for vets? Where do they often visit? Maybe the local coffee shop. Maybe the VA in West Rosway is having a screener. Why don't we hit the local coffee shop down the street at the YMCA? Because I know if I can see it and I say, hey, this is a screener, you know, I may go and say, or maybe call this number for some information. So I really think about the educational piece and how we're going to bring them into the door to get the screeners. Gotcha.

John?

And I completely agree with everything people have said so far. I'll add one other thing. I do think that it's access to health care and then the costs as well. I mentioned that the initial screening, if you meet the criteria, is free of cost no matter where you get it. But what is often a barrier is if you need something more than just that screening test, if there's a screening detected finding that needs further workup, there is cost associated with getting the subsequent tests. And that's a real barrier for a lot of people. So that's something within the VA, those costs are often lower outside the VA. That can add up. So I think that's something that could be addressed.

I imagine that goes to the insurance, right? That's right. I know I'm well over my time, but just two more quick questions if you don't mind, Chair. Thank you. One, I thought about is the military doing anything now when we talk about the workplace that has caused it? Is the military doing anything now to identify those positions that say, okay, what are we doing to prevent? If I'm working below deck in the engine room, You know, 24-7. Are there steps being taken? I don't need to know the specific steps now, but are there steps being taken to say, how are we making that area a healthier workplace for our military so that when they come out, they do not have these issues post-service?

Thanks for that question, counselor. Across the military, we did mention a lot of different environments where you are in hazardous conditions. Part of being a commander is looking after your troops. So it behooves every commander, no matter what level, from your lowest level up through the president or any of your service secretaries, that you want to have your, I guess it's end of the day you're your employees you know in the the most uh healthiest safest environments a lot of times it's not possible due to the conditions where where they send us to do our work we're not always sent to the most lush garden spots across the world but a lot of times you you want to take those necessary steps to make sure that your soldiers, your sailors, your marines, your airmen are in the safest environments. If that includes additional personal protective equipment. A lot of times the guidelines within the military don't always follow OSHA, but they're very similar and sometimes they're even more stringent to make sure that, again, If your service member is getting sick and unable to perform their duties, then you're no longer going to be mission capable as a unit, as a vessel, as a piece of equipment. So at the end of the day, your greatest asset is your individual service member. So we want to make sure that whatever means are appropriate and appropriate, for every situation, you are going to take care of that service member. So that is top of mind for a commander at any level is to make sure your service members are getting taken care of as best as they can.

Great. Well, as long as we, I hope the military continues to constantly review where they're sending their most important assets and making sure that they're the healthiest, I hope that that would, more of the preventative work, right, is all in making sure.

Absolutely. And coming home back in 1998-99, I served a tour over in Bosnia. At that point in time, the air quality was not the greatest. A lot of The local the Bosnians were Burning their trash their trash would go into the rivers. It was a an environmental nightmare One of the things that as we were redeploying back home after our tour was over was we had chest x-rays To get a baseline of where our respiratory system was at Just a few years ago, but then redeploying to places like the Middle East, again, you're not in the most healthiest environments. Again, as a soldier, a lot of times you're outside, you're doing things, but again, you can be in confined spaces such as an armored vehicle or any types of vehicles, or you can be on a ship, you can be on an aircraft that, again, you're not always in that most healthiest environments. And again, it comes down to the commanders to make sure that they're taking care of their service members. So we're not ending up having to visit the VA after we're done.

Understood. Thank you. Thank you. I know I'm well over time, but thank you very much for the added time, Jim. Thank you. Thank you, Counsel Fitzgerald.

Just one quick thing that I wanted to add also, and I know Mark has mentioned a lot about tobacco use being prevalent in the military. And part of the main reasons why that is is because of the stressors that military folks go through in the job. And to piggyback off what the commander here said is, The military, they do what they can to try to mitigate any dangers from their assets, which is the main asset, which is a service member. And I know that they do have one of the highest funded cancer researches in the world. But they do what they can, but of course there's always more that could be done. Understood.

Could I make one other comment? Sure. I just want to make sure that people who have served veterans are aware that if they have had military toxic exposures, that's something the VA is now routinely screening everyone enrolled for and adding them to registries to understand what the health effects are, and that veterans who develop lung cancer, a number of other cancers, other respiratory conditions as a result of, well, They don't need to approve. It's considered a presumptive condition that entitles them to benefits from the VA, health care and benefits.

Yeah, that's all part of the PACT Act that was signed by President Biden.

Excellent. Thank you. Thank you, Counsel Fitzgerald. I'll also give myself 10 minutes, but before I do that, I have another absence letter. I just want to read it into the record. Dear Chair Santana, I regret to inform you that I'm unable to attend today's meeting, Committee on Veterans and Military Families, to discuss lung cancer rates among Black veterans, services for women veterans. I will follow up with additional questions upon reviewing my staff's notes and watching the recording. Please do not hesitate to contact my staff with any questions sincerely. Enrique Pepin, Boston City Council District 5. I'm going to give myself five minutes, I mean 10 minutes also. Okay. So I want to say thank you to the panel for the important testimony you provided and the exceptional answers and thoughts you responded to from my colleagues. I do want to ask maybe two specific questions, if I may, and want to ask both doctors a question, if that's okay. So, and I listen closely to your testimony. Maybe I'll start with Dr. Whitley, if that's okay. So, Dr. Whitley, as it relates to women veterans or black veterans or both. And I listened about claims related issues, and some of you points about that, which I certainly agree with. So a woman veteran, for example, that has a claim, maybe it's for military sexual trauma, maybe it's for other women related health issues, How challenging is it to speak to someone at a VSO or the VA that when they're submitting their claim that they can talk to a woman that can understand some of the challenges that they are going to, but also when they go to the C&P exam before the VA, that they're able to speak to a woman health care provider. Because I think having a woman health care provider or a woman at the VSO or at the VA can better understand some of the issues a woman veteran is going through. And that may, because of that, you might see the percentages lower than male veterans, which is totally, totally unfair. in terms of success of a claim, but just wanted to get your thoughts might be on that, Doctor.

Thank you for that question because actually that question came up. One of the things with the VSO, we don't have as many VSOs as one may think, and our VSOs work hard around the clock. If a woman walks in, and a lot of times MST is an old claim that they never got any counseling, maybe they're ready to file that claim, and they're sitting in front of a male VSO. Sometimes it's hard to get out exactly what happened, and it goes back to shame. Like, I'm ashamed this happened to me. I was supposed to be a strong soldier. A lot of times when I talk to women, that's the first thing that they say is that when I did my comp and pent, a male showed up. I wasn't given an opportunity to talk to a female. A lot of times, I felt that his face was looking at me like, I can't believe that that happened to you or maybe it didn't happen to you. It can be quite difficult to get a female via, so it's not impossible. And maybe the weight might be a little longer, or maybe the weight might be longer for, you know, competent. You know, with the mail, so how do we reduce that? I think that. Females that should have an opportunity and not a long way to talk to a who's a female. But again, I go, I go back to commissioner Santiago if you call his office. He could put you in touch with someone who know how to work a claim and a female that know how to work a claim. But sometimes often when you call for a VSO, you may have a male VSO. I had a male VSO when it was time to work my claim. I didn't get a choice. If a competent, I had a female physician. But that could be difficult. And that's one of the reasons why someone may give up and they may get a denial because they may not give enough information on, you know, the claim or exactly what happened. So I think that sometimes that's a 50-50. What do you think? So...

thank you again and thank you council for bringing up that question which does come up quite a bit and i have known some cases where a woman veteran when she was going through her cmp did end up with a male physician and she felt uncomfortable and in some cases um it was at a private practice in his own home uh which is totally unacceptable um but to malika's point um while it it it may be difficult it's it's not impossible to get a a woman vso In our office here in the city of Boston, we have a diverse group of veterans benefit specialists to include women veterans benefit specialists to help out through these claims. But also, we also have a network of VSOs throughout the state through the Massachusetts Veterans Services Officers Association. There are a lot of VSOs out there in the Commonwealth that are women. and that do specialize in women veteran claims as well. We also have organizations like the American Legion, the DAV, the VFW, who also has VSOs within their organizations that are both women and men as well to help out in those claims. So if there is a woman veteran who feels uncomfortable working their claim with a male VSO, we could definitely ensure that we get her to that comfort level that she needs to get her claim through with a woman VSO.

So Rob, just as a follow-up, if a woman veteran is watching this now and a woman veteran does want to file a claim and I would hope they would go through a VSO because they do exceptional work, DAV. I went through the DAV. I know the VFW. There's other ways to do it, other VSOs, American Legion. But how would you help that woman veteran get in touch with someone that could help her with her claim that's a woman?

I would recommend first going through your local veteran services office. So if you're in Boston, obviously, that's through the mayor's office of veteran services, which is my office. And then talk to Matt Cudahy, who's the senior veterans benefits specialist there, myself, Renato Pinto, who's a veterans benefits specialist there, and get their comfort level to see. Another way is, like I mentioned, was through the MBSOA, the Massachusetts Veterans Services Officers Association. Another way is through the Executive Office of Veterans Services for the state. Contact them, and they will connect you to the Women's Veterans Network, who also has women VSOs that are part of that organization and that network as well. So there are many different avenues that a woman veteran could take. to reach a VSO that they feel comfortable with. Okay, excellent.

Maybe, oh yes, doctor. So it's two different things that I just noticed. If a woman veteran is watching right now, some people start at the VA. They pick up the phone and there's an intake person that calls, the intake person. So now they don't recognize the POA, which could be the DAV, a BSO. So they're talking directly to an intake person. And then they're signed up for competent. And then they may not have a choice whether it's male or female. So if a woman veteran is watching right now, I would say, You know, call Commissioner Santiago, call your local American Legion, call your VFW, call a VSO. Then once you get in touch with one of these organizations, we will help you navigate the system of putting your claim through. So I think that's the best. If I was a woman vet watching right now, that's what I want to know. Because the first thing I would say is claims. Let me dial the VA and get it started, you know.

Yeah, that's a very, very good point. Thank you, Malika, for saying that. That's a very good point because that's what we do run into, that people do go to the VA first instead of going to the local VSO. And they should always contact their local VSO first and then eventually get that POA done and then help that veteran navigate the system through that way as opposed to going directly to the VA because that's exactly what happens.

Thank you. Let me go.

With the VFW, counselor, I'm sorry to cut you off. Okay. We do have a female veteran services consultant that is based at the JFK Federal Building right here in Boston. Okay. That is a great resource. And again, the VFW will walk the veteran through the entire process from intake through any potential appeals. So we don't just take your POA and send you off to the VA and good luck to you. We'll be able to walk you through the process to make sure that you are taken care of, you're looked after, and you get your appointments scheduled in a timely manner. So again, for the city of Boston per se, the VFW at the Iowa state level We do have a benefits consultant that's based right at the JFK building, and we're happy to be able to assist any veteran, especially women veterans that need any help.

Another thing I would like to add, Counselor, if I may, sir, is that no veteran, no veteran, and I repeat, no veteran should have to pay to get their claims processed. So if you have a lawyer out there or someone who thinks they know and say, well, if you give me 10%, 20% of whatever you get from the VA, I'll make sure you get your claim processed. That's a red flag. Do not go to that person. There are many, many qualified VSOs out there. You've heard of up here, through all these organizations, through your local municipal offices as well, here in Boston it's through my office, to get those claims done and processed accurately and for free. No veteran, and I repeat again, no veteran should have to pay or should pay to get their claims processed.

And one more thing that I know if someone's watching who has denials of service connections, we still take care of you through the denial. Yes. All POAs, we go back in and see why the denial happens. Because I know people are saying, well, I got denied, so I'm not going back in for anything. All denials will look at that why the service connection was denied. And it may be something just easy enough for you to correct. So I want to put that out.

Yeah, that's a good point. Now you got us going now. I know, Rob, you and I worked on, I think they called them at one time claim shocks. The other point of that, Rob, right, is not only do they get 10% of what you earn, they get 10% of what you receive for the rest of your life, basically. So as long as you get VA disability, they'll continue to get 10%, 15% of what you get every month. That's outrageous. That's outrageous. It totally is outrageous. Well, let me go, and Rob, thank you for bringing that up. That's a great point. Let me go to Dr. Wiener. I was with you. I don't know, maybe a year ago, I think we were at the Kroc Center with a group of people, and you were talking to black veterans and talking to them about lung cancer-related issues. And, you know, there was a steady group of veterans that did come in that did engage you. So my question is, what steps should a black veteran take if they want to talk to you, they want to talk to someone from your team to learn more about your services. Just give us an idea what the steps would be.

Well, anybody is welcome to reach out to me directly. My email address I can provide. It's renda.wiener at va.gov, R-E-N-D-A dot W-I-E-N-E-R at va.gov. And I'm happy to help direct anybody who has questions or needs help about lung cancer screening or any other issues. I can try to direct them to what they need.

When a black veteran is at the VA, are they screened? Are they screened for any type of respiratory issues or lung related issues automatically or do they have to request that?

Well, so the process for lung cancer screening specifically is when somebody goes to their primary care clinician at the VA. There's a process where there is an automatic recording of their smoking history for people who fall in the age range for screening. And if they meet criteria for lung cancer screening, again, this is using the USPSTF criteria, which doesn't capture everyone, but that will flag their primary care provider to discuss screening. So hopefully the veteran doesn't have to bring it up themselves. But And then, as I mentioned, the VA also routinely screens it through primary care or other appointments for military toxic exposures and whether the veteran has any concerns about that. And oftentimes, those are respiratory concerns that people have related to exposure to burn pits or other toxic exposures. And so that also puts a flag in the record to discuss those concerns and address them with the veteran.

Yeah, thank you, doctor. Just as an FYI for the public, I was in the military 24 years, mostly reserves, but some active. When I was stationed overseas, I was in Bahrain, a small country called Bahrain, and we went up to the Iraqi oil platforms all the time. And then when I came back, I also noticed respiratory-related issues, and I was recommended to join or to enter into the, what am I calling it now? It's the, it used to be the, oh, the registry. Yes. The Gulf Registry that is still open in accepting. You don't necessarily make a claim there, but you document that you were in a particular area of the country in what health-related issues. But I do want to... recommend to veterans that if you're in a particular area and you do have some health-related issues, that you should enter into this registry. So my final point before we kind of conclude, I gave all my colleagues well over 10 minutes. And well, let me ask, is there any public testimony from anyone else that's here? Okay, so there's no more public testimony here. If any person at the panel would like to give a closing statement, that would be helpful. And maybe as part of the closing statement, if you can highlight what our next steps could be as a committee on where we go from here, because I would like to do a hearing maybe outside of City Hall, but maybe in Roxbury, maybe in Dorchester, and listen to veterans, all veterans, but specifically listen to veterans of color, listen to women veterans, listen to them and their challenges, their concerns. But I do want to ask and give everyone the opportunity, if you would like to have a closing statement for two or three minutes, To take the opportunity then then I'll give my colleagues an opportunity for a closing statement for two or three minutes as well So let me start with Commissioner Santiago first and foremost a Cheerful and thank you very much again for for holding this Thank you and also to concert Santana for setting up this this conversation here today.

Thank you concert Fitzgerald for also Being here and for your thoughtful questions. I'm sorry. I took more most of your time and or earlier today, but it really makes me optimistic on our next steps. We talked a lot about navigating the system here, and how do we get vets into the system, and I think Mark some of his comments when he was talking earlier about making Boston set the example locally for the rest of the country. I think that's a great idea and I think it's something that is worth looking forward to going into what Constable Flynn said about going into the community, talking to the veterans. and seeing where the need is and how we could get these veterans into the system you know like i mentioned earlier there's less than a million women veterans that are in the system but yet we have 2.1 million women veterans in the country you know and this is also a way that we could also work on getting them into the system and having these conversation now the continued partnerships uh both locally statewide federally and also with the with with with all the partner organizations is going to be key to ensuring The success of what we do to ensure that our veterans have access You know for all the benefits and services that they have earned. So I'm looking forward to the future steps.

Okay Hey, Craig Thanks again councillor Flynn for Convening us today Chancellor Fitzgerald your great questions and we appreciate your the attention that these issues are being given First off, Councillor Flynn, I'd like to offer up the Boston Police Post as some place to host that off-site meeting, hearing, Veterans Town Hall, whatever you want to call it. We would be more than happy to host that and work with you on that. The overarching question is how do we take care of this problem? I'll ask the question of how do you eat an elephant? one bite at a time. And that's the way that we're going to be able to make the conditions for not just the black veterans that are dealing with lung cancer, the women veterans and their particular health issues as women, but all veterans across the board, no matter what their other demographics are. It does take a village to solve this problem. at this table right here, we're a bunch of folks that, we got a guy. We might not have the answer to the question, but I know somebody else that does. And what we will do is make sure that we do share that information with each other that, okay, The commissioner might have a question. He asks me. I might not know the answer, but I can reach out to my network of my fellow state commanders across the country and say, hey, guys, how are you handling this issue? And I'll have somebody from Idaho or from Arizona or from Texas say, hey, this is what we're doing here. Like, wow, that sounds like a great idea. Maybe we can replicate that in Boston. It's those types of networks and those types of ideas that will make this issue, these issues, Attainable that we'll be able to help solve some of these problems. Again, part of what we want, what we do with the, as well as the other service organizations, like the Legion and the. We're out in our communities all the time that we are community based organizations that. We will be able to get our folks together. We come together monthly or on a daily basis, depending on the types of posts that we have. Come out and visit. We want to be able to be productive members in the process here. Again, the last time I was here and provided testimony, one word of caution that the The rest of the Commonwealth pays attention to what goes on in the City of Boston as far as veterans are concerned. They see that, oh, we just cut $750,000 from the veterans budget. Thank goodness we had a group like Brighton One step up to help fill that gap. But that doesn't mean that next year or even tomorrow, their priorities change from what the City of Boston's veterans priorities are. We'll never see that $750,000 again into the budget. That $750,000 goes back into the commissioner's ability to provide that outreach, to provide that education to the veterans community of the city. So I just want to be able to implore upon you. What happens here in Boston just doesn't necessarily happen here in Boston. The rest of the Commonwealth pays attention. And I really, yeah, yes, I do demand that, you know, our council shows the leadership across the council, across the Commonwealth, that, you know, Boston is going to take the best care of veterans that it can. And we are going to stand up. and provide that leadership to make that happen. So again, thank you for all your efforts. Thank you for your attention. And we look forward to being, again, part of that village that comes together to take care of veterans, again, across the city and across the Commonwealth.

Thank you, Commander. Mr. Kennedy.

Again, let me just start by expressing my sincere and heartfelt thank you for the opportunity to be here. And let me rephrase the privilege and honor to be here amongst city council and the esteemed members of this panel. I really am thrilled to have been able to participate in this discussion. I made a lot of comments about the guidelines piece. And again, I stand by that. what you said and what you said also. So my comment here is basically a build, and it's this. I think everybody on this panel at some point mentioned the word navigation. We know the word navigation is critical. I have a very high level of resonance to that because I started my career in public health. as a patient navigator at the Dana Farber Cancer Institute. I believe in navigation. I believe in the power of navigation to support patients and get them to the best outcomes that they can have. The point I want to make is we talk about patient navigation and the implication is that there's a patient with a diagnosis that is going now through the system to make sure that they get the treatment that they need. And our cancer plan for the city I'm looking to move navigation a bit further upstream. I talk about the concept of a screening navigator. So pre-patient, how do you take that mentality, that focus on supporting a patient while they're going through treatment? and move it up so that before a person becomes a patient, they get help with navigating administratively and otherwise how you move through a system, how you get screened for a particular location, what are the follow-up procedures that allow you to adhere to make sure that if, as you mentioned earlier, you might get a screening mammogram, But it is something that's wrong with that, which causes you to then have to come back and get a diagnostic mammogram. Do you show up? Do you understand the difference between the 2 and do you understand what it means to. To do that from a cost perspective, because Massachusetts. Past legislation, I think in 2024, we call it the, um. The breast cancer diagnostic bill, the official name of the bill is a little bit different, but it took that diagnostic member, but I'm cost sharing burden off of women. So that they could continue to adhere to what that's going to have said.

Right?

My point is this. Navigation sounds like all of us agree is a critical part of this. We know that CMS put in physician billing codes in 2024 that allow clinical practice to reimburse for navigation. Let's take advantage of that and make sure that navigation is a standard part, a standard sustainable part of the way people that want to file claims or whatever have years. are introduced to and supported as they move through the clinical system in the VA. And again, let the Massachusetts VA be the model for the rest of the country. Not only when we're talking about access to screening for lung cancer beyond just tobacco use, but navigation for veterans through the system so that nobody falls through the cracks, everybody has answers to questions that they want, and they get through the system with the best outcomes. Navigation and guidelines, I think, are two main points of this. I think the VA and veterans have an opportunity to set the tone for the rest of the country. I hope you do.

Thank you, Mr. Kennedy. Doctor?

Thank you, Counsel Kern. Thank you, Counsel Fitzgerald. One of the things that I thought about is, as veterans, we connect by storytelling. That's our connection. We tell a story about how we served and what we did, and that's how we connect. I think if we continue to advocate for equitable access to resources and raising awareness about trauma, mental health needs, and health needs, I think we can create a program that culturally identifies our black of black female soldiers. So why I said that is normally when we think about when we're introduced to all these programs and we're hearing these different things on TV or in the media, we don't actually see a person who actually work in that department or like the Boston Public Health Scheme and the VA. So as long as we continue these town halls and continue to have this discussion, we'll bring more veterans. And if I'm looking right now at this, if I was, I was, if I was home and I'm watching this and I say, Hey, you know, you know, I had trouble filing the claim right here. We have someone from the VFW, we have someone from the polls. Now I know who Ross Santiago is. So I just feel the same as you, as long as we continue that navigating and making a system as easy as possible, for someone to navigate through the system for health care needs, for mental health needs, and for education. That's our golden ticket to get to, you know, our vets in the City of Boston, Massachusetts, wherever they're at.

Excellent. Thank you, Doctor. And Dr. Huena?

Thank you so much for the opportunity to be here today for this important hearing, for the thoughtful questions, for all of the wisdom that's been shared by the other members of the panel and also from the public. I want to touch on one other point that we haven't talked about so much today, and that's that lung cancer is a highly stigmatized condition. because of the strong link with smoking, even though we know that there are other factors that contribute to lung cancer risk. But I want to say that nobody, no veteran, no person deserves lung cancer, and we are here to help. We are here to, the VA and other healthcare systems in this amazing city are here with screening to try to identify cancers early and get people into treatment. I love the ideas about navigation, including veteran peer-to-peer navigation, which we have in the VA, and using the power of the community-based organizations that veterans have access to to spread the word about screening and help people get connected to I also just want to say because this is a stigmatized condition, sometimes doing the community events like we did or like you're talking about doing, sometimes it doesn't reach the people who most need to be reached because they may be reluctant to go to something that's about lung cancer or whatever because of the stigma and the shame and blame that people feel. So one thing we learned from our work and Vet Peer Connects was that one of the most powerful things was actually reaching people who maybe weren't eligible for lung cancer screening, but then they went and talked to other members of their community who didn't come to the events, but like spreading the word that way and helping convince people to come in and get the healthcare that they need and deserve.

Thank you, Doctor. Before I go to Councilor Fitzgerald for a closing statement, Doctor, I just want to make one quick point or ask a brief quick question. Many veterans in Orchard, Rob, Santiago, both of you, many veterans don't even know the veterans and they don't even realize that they can participate in services for veterans They might be older at this time, but they're still eligible for services and programs at the VA, and it's not too late to sign up. Is that correct?

That's correct, absolutely.

Rob, what should someone do if they're an older person, for years they weren't treated well, coming back from service? They are veterans. They haven't engaged in the system yet. What's their first step?

Contact us. Okay. Contact us. Get a hold of us. We could navigate and communicate with you what's available to you. Give the system a second chance. It's not... Now, I know that... Speaking of stigma, there's been a lot of veterans that have been stigmatized because of the services they got in the VA back in the 70s and 80s where they didn't have the kind of services that are being provided today. And the PACT Act covers a lot of that. especially when it comes to the presumptive conditions that we're talking about here today that include many different cancers. So contact us, ask us questions, give the system a chance, and let us help you navigate the system so that you can get the services and benefits that you have deserved and continue to earn, so contact us, contact your local VSO, contact your local veteran organization, and let us do our job for you.

Rob, give us your contract information once again. I know you provided it already, but give it to us one more time, please.

So for the Boston Office of Veteran Services, you could contact us, boston.gov slash veterans, or you could give us a call at 617-635-3030. Thank you, Rob. Council Fitzgerald.

Thank you, Chair. I just want to say thank you all for the important work that you do, because not only do we have the subset of veterans that we can help, but it will have an impact on everybody, veterans and not veterans, when we talk about health. we're all the same human individuals. And so if we can figure out what's wrong with one subset, hopefully we can apply it to another and so on and so on. And so just thank you all for your leadership and the important work that you do. And please always feel free to reach out to Ed, to myself, when you have to teach us what we need to do for you, right? You guys are the ones going through it and experiencing it. And that goes, I know we touched on it a lot, but even for the Women Veteran Services, not a veteran and not a woman, and so I do tread lightly and say I take my cues from you all. And so please educate me and tell us what we need to do. But thank you again.

Well, thank you, John. Thank you for being here. There was an important discussion on support services for women veterans, for how we support veterans of color, on medical care, including lung cancer screening. And I think my colleague, Counsel Fitzgerald, highlighted an important point that I kind of wanted to close with, is the importance of listening. you know, listening to women veterans, listening to veterans of color, listening to LGBTQ veterans. I don't have that experience, but I want to and continue to be a strong supporter of all veterans, especially and including women veterans, veterans of color, LGBTQ veterans. But it is about listening. It's about learning. And that's why I called this hearing today so we can give an opportunity for you to speak about your experiences. But more importantly, there might be someone sitting home that this information might connect with them, and maybe they'll pick up the phone or send an email next week to Rob Santiago or to the other veteran leaders here as well. But we have to acknowledge the incredible Service sacrifice of women veterans of veterans and veterans of color We're not giving them any services. We're not giving them any programs liver in these programs and as a nation Historically, we haven't been welcomed welcoming too many women veterans or veterans of color. In fact, I'm going to Provost I'm going to send a to the city council a resolution to support a piece of federal legislation to support it. And it's basically to ensure that when black veterans return from World War II, they really didn't participate or receive the services that they earned, specifically on housing, VA housing programs. Because of that, they didn't generate generational wealth, like other veterans have. But this piece of federal legislation would provide grandchildren, or children maybe, I have to do a little bit more research, giving them an opportunity to get a little bit of services, such as real estate, such as first-time homebuyer programs through the VA because they were denied that benefit due to racism. They were denied that specific program due to the color of their skin, due to discrimination. But that's a piece of legislation I'm going to look at. I know you and I talked about that, Rob, for a while. And I want to also acknowledge Commissioner Santiago, we worked on especially under President Biden, when gay and lesbians were discharged from the service, they were discharged with a discharge that wasn't honorable. So when you have that discharge that is not honorable, it limits what benefits and services you can get as a veteran. But through the work of Commissioner Santiago, we did a lot of work at the federal level. And I say gay and lesbians. Now it's LGBTQ+. But we have to ensure that they are also treated with respect and dignity that they've earned. and if they were discharged for reasons due to their sexual orientation, I believe that that discharge should be upgraded, and maybe that's an issue we're gonna have to continue to work on as we go forward, because I know I'm committed to it, and Rob, you are committed to that as well. But having said that, this is about justice, this is about respect for all veterans, especially historically, especially veterans that historically have been denied access to the VA and to services and programs that they've earned. This hearing on docket number 0273-0274, a hearing to discuss lung cancer rates among black veterans and services for women veterans is adjourned.