City Council - Veterans, Military Families, and Military Affairs Committee Hearing on Dockets #0273 and #0274

Good morning. My name is Ed Flynn, Boston City Council. I am the Vice-Chair of the Boston City Committee on Veterans, Military Families and Military Affairs. Today is August 28th 2026. The exact time is 10 o'clock this hearing is being recorded it is also being live streamed at boston.gov city council 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.com that's at boston.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

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 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. 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 0 274 which is an order for a hearing to discuss services for women veterans. Docket 0273 was sponsored by myself, Councilor, Murphy, and Councilor Santana. And it was referred to the committee on February 4th, 2026. I am joined by my council colleagues in order of arrival, Councilor Murphy. I do want to acknowledge, well, I do wanna acknowledge as the vice-chair.

I will be chairing this hearing today and Councilor 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 and want to acknowledge his Chief of Staff, Ana Calderon who really helped set up this meeting as well. So I wanna say thank you to Ana for her support in commitment to veterans military families across the city of Boston as well. 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 Colley, Councilor Murphy to give an opening statement. And then 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 in what organization you are with. So let me start with Commissioner Santiago, please.

Good morning, Councilor Flynn and Councilor Murphy. Thank you very much for having me. I am Commissioner Robert Santiago of the City of Boston Veteran 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, Councilor Flynn and Councilor Murphy. My name is Mark Kennedy. I'm with the Boston Public Health Commission.

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

Good morning, Councillor Flynn and Councillor Murphy. My name is Renda Wiener. I am a pulmonary physician and researcher at the VA Boston Healthcare System and the Center for Health

Thank you to this distinguished panel for being here. Thank you for testifying. More importantly, thank and military families across the city, really across the country as well. I'm gonna read a letter into the record then I'm going to go straight to Councilor Murphy. Dear Chair Santana, this is from City Council President Breadon 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 plan to review the recording. You read this letter into the record. Thank you, Elizabeth Breadon, City Council President. We are also joined by city councilor at large, Lucey Louijeune.

Let me go to Council 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 the benefits that we know the veterans earned and 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 where 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 there are no groups around the city who are failing as though they're not getting what they need. 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 healthcare it's just wonderful to see full circle you know spending your life giving and then when you're near the end people showing up for you and it's great so thank you for all you do.

Thank you Councillor Murphy I do want to give Councilor Louijeune an opportunity for an opening statement, Councilor Louijeune.

Good morning everyone and thank you for being here. I want to thank you Councilor Flynn for your leadership and for your service to our country. I also want to think all of our panelists for your leadeship in your service too our country and I wanna 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, Councilor Louijeune. 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 healthcare, mental health services, childcare, 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 in 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 healthcare 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's 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 and thank you all for being here today in regards to this matter. Really here to learn more about and many more. We will continue to look at what sort of some of the deficiencies may be, where we can help strengthen those going further 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 okay 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'd 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 Write down the line and take the time you need to discuss whatever is important to you.

Thank you, Chair Flynn. Good morning, Chair Flint, Councilor Murphy, Councilors Louijeune and Fitzgerald. Thank you for having us here. I do just want to touch on something. 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 see on a daily basis and as a veteran and as the 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 is 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. We're going to hear a whole lot more about that a little bit later on from Dr. Wiener, who's here from the VA. It's an issue that as far as I'm concerned and many of us are concerned is 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. were 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 they were created to serve. There is also encouraging evidence.

Studies have 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 healthcare 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 healthcare 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 healthcare 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 programs help 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 Senate reflects an important promise that women veterans should never feel invisible or like and afterthought within the system 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 am to 6 30 pm Easter Standard Time. The phone number is 855-VAWOMEN or 825-829-6636 and I'll repeat it again, 855-829-6636. And if you wanted to contact the Boston office, you can 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 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, health care, 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 healthcare 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 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 H. 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 health care 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 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 weeks, the 25th anniversary 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 11th 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-911 veterans who answered that call, including those who never returned home and those who still carry the visible and invisible wounds of war. 25 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 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-911 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 Carter 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 member of the Cotopos 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 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 want to 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 patients. and our indigenous veterans here in the city of Boston. They have been doing screening, going to different locations, different posts over the past two years or more Thank you for joining us. No, they don't have. But the problem that I want to touch on this basis here is Even though they're visiting our communities and coming into our post, we are 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 How do we improve upon that? And I'm going to throw that on your desk, Commissioner Santiago. I want to throw it on the desk of our VA doctor because we need to be able Our system and how we are 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 was still missing a lot of our comrades that should be able to get screened, right? But I do applaud them for what they have been doing

Let's talk about service for 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 give birth, we carry children so we need that GYN, Thank you for watching. I applaud Carolyn for all of the hard work she does to make sure that we do have doctors within the women's clinic and the new clinic that they opened up focused on menopause. in the Bedford location. Men don't think about those things, women do. So we have perimenopause, we have menopause.

We have carrying children. We our fibroids. We 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 is the difference. We struggle with depression in a different way because not only depression about our service, especially women who have MST and our military sexual trauma, and those that have the post-trauma you know um and so on but at many times we are all focused on Thank you for watching. 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, 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 and many more. 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 talk, going this. And finally had to say to myself, go 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 get me through that. So, a lot of times we have 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 gonna 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 But those are things we work, we talk about within the female veterans community. Thank you for watching. But it's not done. We have more work to do, right? And a lot of times too now what I'm having a lot 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. It 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 want to put out there so we can figure out how are we going to work with our systems to help our sisters. I serve as a commander at a long-standing 107 year old

Post that it was strongly veterans of color, we are treated differently. And that's another thing. When you think about how different ways that veterans are treated, and then you have to think about when you're a veteran of color an indigenous veteran or so on, how people look at you if it's not your medical claim, if it is not your housing, if its not your mental health and so on people think that oh we are making this up but no we are treated differently. and all of these avenues because of the pigmentation of our skin, you know? And is that fear? No. Because we all served when we're on the field together, we don't see Thank you for watching.

and military attached of color. And so I want to 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 med, 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 street, we know he is checking into Pine Street but we haven't seen him in months and we're still trying to find him. So these are things that we need to do, maybe we need 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, Councilor. I wanna thank the committee for allowing me to join you today and speak. And also again, thank you everyone else who is gonna be speaking behind me on the panels and thank you Commissioner Santiago for the work that you do.

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 in for the panel but we have a tremendous amount respect for you, for the work that you do. So safe travel and enjoy the conference and we'll talk when you get back. Thank you Commander Tuitt. Let us continue, Commander?

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 Tewitt She's definitely one that I would yield ways for. Enjoy Louisville, Commander! My name is Craig Deold. I am a resident of the city of Boston, live in South Boston. I'm 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 neighborhoods every single day. So there is always a presence of our veterans and I'm not here only on behalf of the The State Organization of the VFW, but also again as a resident of the City of Boston and to speak 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 or whatever you want to call it where there was Significant segregation 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. Breathing in fumes from the engine rooms that are around hazardous materials is just, you know, the part and parcel of being on a Navy ship. The land forces, they're always going to be toxic exposures. Between the burn pits being in hazardous locations Even being in a tank, an armoured vehicle or infantry fighting vehicle you're around those You know, those fumes around the fluids and those environments are inherently hazardous. We all understand when we raised our right hand in joining this 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 this service broken. But a lot of times we'll come out of the service in that state. Again, it might not be due to 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 overall healthcare system that we're involved in. I've had the honor and pleasure of working at both Brigham & Women's and Dana-Farber for many years.

And I know firsthand, 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 Then within the city of Boston between the pre-hospital care that Boston EMS provides right through the VA hospitals and our great healthcare system here in the city. What we're looking at, though, is making sure that all veterans and especially our black veterans within this subset do have that access of care. We need to make sure

between our partnerships 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, 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 will help them through the appeals process even though 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, you 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 have received VA benefits since the start of the federal fiscal year this past October 1st, I've 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 Commonwealth.

The numbers are a little skewed because some of the South Coast does get pulled into the Providence numbers, but that's fine as long as those veterans are being taken care of. If we extrapolate the numbers, we're looking at $105 million directly into the pockets of veterans across the Commonwealth. I wish I was able to Thank you. The economic impact that we're making is huge, and that does go towards the access of care. If they're secure financially, they can be a little bit more secure In themselves, seeking the medical help. They feel like they're going to be able to go and seek that help to get better, to get that care from start to finish.

Transitioning to our women's veterans. I entered the service and got commissioned in 1991. Over the years, the nature of Military has changed quite drastically. We have women serving in the Air Force and combat equipped jets and strike fighters, we have women sailors serving on on armed combatant ships in the submarines. We have women in the Army and the Marine Corps serving as 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 and just the old boy network of, you know, the smoky 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 has come up to her and didn't recognize her as the veteran. I try to make it my own personal point. If I have a couple come in front of me, I'll start with the woman in front 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, do their jobs. So it's very important that again we're uplifting our women veterans making sure their voices are heard expanding the leadership of our service organizations to reflect the true nature and demographics At the police post, we currently have our first female or woman command post commander in Lisa Vienas. She's a retired or soon to be retired Boston Police Sergeant, Army veteran and she's our post 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. Last I'd like to mention, as again Commander Tuitt mentioned the our homeless veterans. They count they're out there it doesn't matter that They are part of any of our organizations. They served, they deserve our respect and support.

The VFW will do everything we can to make sure that across the board and through partnerships with with Commissioner Santiago and his department that we do look out and look after these veterans. And the Veterans of Foreign Wars has a national home out in Eaton Rapids, Michigan 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 Thank you for joining us. There's a lot of great organizations that are doing incredible things in their own lanes.

Again, you look across the table and across the room here. It does take a village 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, again, Councillor Flynn, Councillor Murphy, Councillor Fitzgerald. 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 fundraiser or anything like that, 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 gonna 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 veteran is going to be able to give you a true perspective on the ground what they're dealing with 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 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 I want to make sure you take the amount of time that you need to make 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 Councilor 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 at Mid-State for Gloria Fox, so it's just a real 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 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 you 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 a national average This could be due to increased screening, but new cases are not necessarily cases where the cancer was diagnosed early. will 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 lightly to survive five years when you compare it to white individuals. All that said, lung cancer is the leading cause of cancer-related death among U.S. veterans. Veterans have a higher rate of lung cancer and 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 25-76% higher risk of lung cancer and as best dose exposure remains a significant contributor to this elevated risk, which exacerbates risk for black men.

African-American veterans experienced disparities in diagnosis, treatment and survival rates compared to other groups. The U.S. 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 a second leading cause. I want you to note here, if you would that in addition to these risk factors that contribute to incidents not getting screened is also a significant risk factor and that contributes to mortality because for lung cancer and any other cancer Catching and treated 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 screening guidelines that would further expand access to screening. In 2021, the US Preventive Services Task Force expanded access to lung cancer screening to catch lung cancer earlier in high risk groups, particularly women as well as black adults who often develop lung cancer with lower smoking exposure. The task force, I'm sorry, 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 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, etc. 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 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.

Okay thank you, thank you Councilor Flynn, Murphy, 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 Councilor 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 then 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 when I started to study black women, so that made it kind of limited to black women veterans. One of the things I thought about I had trouble navigating the system. And so, 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. The Women Trauma Center, they said, how? How do I get there? How do I navigate? So with the programs and all of 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 need help with the claims and maybe they miss a part after 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, you know how do I complete a claim? If I'm able to walk into the municipal building in Hyde Park, how do i complete a 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 are we doing at 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, the Center for Health Optimization Implementation Research. Dr. Yorup?

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 you 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 Aphrodisiac 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, 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 Di 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? 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 life-saving 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 screamed 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 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 in 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 VF W Post 1018 and the Carter Post. So thank you again for your support and partnership. 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 Wellbeing 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 in the trust that we have built with veterans and community organizations. 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 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, thankyou 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. Want to give him the opportunity to speak and to testify. Usually, Donald you got two or three minutes but I don't cut off any veteran. A veteran can- A veteran can speak as long as they want. You've earned it. I also wanna acknowledge our friend that is not here, I know he's been mentioned, Heywood Fennell, a wonderful advocate in the city for veterans, military families, veterans of colour. 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 Resources that they need to get housing, for example rent a house and furniture. A key problem with veterans or 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 to find these resources to pay for some of the things that they need. Prince with my brother here, Robert here. We go back and forth here.

Councilman Flynn we just had a roundtable, a veterans' roundtable August 11th getting ready to prepare for stand down September 11th so we could do further more research on what the veterans needs are and what their complaints are and their concerns. We just sent, through the round table 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, he said probably so. Our goal is to help our veterans out. I've been a veteran of the Air Force here, also on

retired Local 4 operator, and also worked in the Air Force through civil engineering construction. The construction part of it is, the other part of my company is called Don Mitchell & Associates LLC which helps to find employment for those people who need 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 of the Year. Cosmo, Flynn and Sandy. I'm just going to get involved. I think I know Mr. Kennedy. We've met a couple of times. So I want 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 your testimony and thank you for your commitment to supporting veterans I'm going to go to my colleagues. I'm gonna start with Council Murphy, then go to Council Fitzgerald. I'll give each councillor maybe 10 minutes to ask questions. 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 that We're still seeing that more black women and men are just not getting the care they need. So how do we make sure, because without the screening, they're not going to get the health support they need? What should we do? What can we do, not just as a council but just as the city 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 while you were in the Navy we know you were on this ship. You were in military, you probably were exposed because many times people and many more. Thank you.

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 health care That said, especially primary care clinicians who are handling so many issues in a brief visit, sometimes they don't 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 qualify? Because when you say qualify, would the doctor have to kind of You smoke gore. 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 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 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 if do you Is there some sort of like ad or campaign or support? 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 a community and talk to not just our veterans but our veteran's families Our community members, our community leaders. The biggest thing that sometimes I see is that they see one of our events that it's just for veterans but it's open to everybody It's open to the whole community. It's opened 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 is available to the community as well and that's information they could pass on to someone who is a veteran or someone whom they may know as the son of a veteran, or daughter of a veterans.

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 A person in their family who was a veteran, they could pass that information on to. So what I implore people who may be listening or maybe 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 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 in all sorts 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 deal with 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, and make sure these individuals get the resources they need to do with the work that they need

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 healthcare support, so it is important. And if we see that we're losing federal state grants like how do we on the council shift? We work closely with your department to make sure we're not losing any money. And if anyway, we can add more to the department. Thank you just all for being here and advocating Thank you, Council Murphy.

At this time, I'm going to go to Councillor Fitzgerald. Councillor 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... The data is the data. Right? And so we know that what we're focusing on here today is an issue and that's not being told, that is being told to us by boots on the ground but also through the data that we're collecting. I was trying to think of what is the number one source of why this discrepancy exists. And I'll refer to lung cancer at the moment among black veterans. and, you know, I started writing down a list of what I think could happen. And I'm no doctor so this is why you guys are here, right? 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's the work lifestyle, such as where you might have served. And I added navigating the system in because from what I heard from this panel too was just navigating the systems.

Like of all the things, what do we think of that sort of list might be like 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. But what I'm asking is if we were to prioritize it, you can't do much about genetics, the work lifestyle that's already occurred and Black veterans. And so how do we know where we can place people in the future? Sure, it might help future generations but 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... You know, heavy paperwork type of setting.

I mean car insurance, health insurance, whatever it may be right? I think we all have trouble nabbing people walk into this building and the first thing they usually say is To help me navigate City Hall, where do I go? Who do I talk to for this issue? So I think that's an important one. Just trying to hone in, because I feel like if you extrapolate it outside of veterans too that the data probably correlates. 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 But at the same time, what can we learn from helping the veterans that can educate us so that we can bring it out to the larger continuum? A lot of you guys spoke on this, but I guess what I'm 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 it on every single one of these.

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 it. 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, the layman person, 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 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 personal point of view, there is no right answer.

I'll guess I'll start, Councilor. 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, 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 I could speak on my experiences as a Navy veteran where, you know, a lot of minority veterans and minority sailors like myself We were told to go sandblast a void on a ship.

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 in talking to other veterans as well, that could also be an underlying reason why those numbers may be high is because of of also the duties that we were given while we were in service. Now add that to the fact that when, you know, 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 They're doing a great job in trying to get the word out there, but one it's not enough. Two, there is always work to be done and so I guess the educational piece and again trying to let everybody know that these

that the lung cancer screenings are there for veterans, from pretty much anybody. The city of Boston also has a policy for lung cancer screening amongst municipal workers. 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 in her testimony when these service members become veterans what is the Department of Defense doing 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... that it's going to be I'm taking 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, among the VFWs, the DAVs, The American Legions. and his organization, Haywood and his Organization. And pretty much all the veteran organizations in the communities as well. It also takes the council as well that if and when you go out into the community Bring it up. Councilor Fitzgerald, if you're out in your community be like I was at a hearing about veterans and we talked about lung cancer here. Lung cancer amongst veterans. This is what's available. So just spreading the word out there whenever we go on to 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 make it part of the conversation. of the community conversation about veterans, you know, about lung cancer screening, about women veterans. You know 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 they need and many more. You know, there's been that stigma for many, many years that the VA is not there to help them. It could be the trusting 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, you know, 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 nonprofits like Home Base is located here through the MGH as well. So, you know 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, what a council can do, education awareness is where we should tackle. I just want to make sure. I don't know if anyone else would like to chime in. I have other questions as well.

Fitzgerald, thank you for the question. I'm going to say from my particular lane Is 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 ever 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, but I would say that family history or other genetics are issues of 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 it 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. Okay, 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 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 and 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 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 outcomes benefits, which is reduced mortality over a 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, 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 cancers and other areas in a way that informs the whole system.

I think we've got an unique opportunity here, and I think 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 now just quickly, is my mic on? Yes. One of the things about veterans that we look for community organizations because of brother and sisterhood. And then we also lean on our faith-based 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 At a point, we need to get our vets through the door into those screenings. And then how do we do that? Any time 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, a 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? And I keep, how do you get us through the doors because you couldn't get me through the Door 10 years ago. So 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, um, the VAM West-Westways having a screener. Why don't we hit the local coffeeshop down the street at the YMCA? Because I know if I can see it and I say hey this is a screenin', 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 those screenings. Got you.

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 like 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 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? Yeah. 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 do 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 I don't need to know the specific steps now, but are there steps being taken to say how will 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, Councilor. Across the military we did mention a lot of different environments where you are in hazardous conditions. Part of being 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 At the end of the day, you're employees in the most... Healthiest, Safest Environments. A lot of times it's not possible due to the conditions 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 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... 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 piece of equipment. So at the end of the day, your greatest asset is your individual service member. We want to make sure that whatever means are appropriate and 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.

As long as the military continues to constantly review where they're sending their most important assets and making sure that they're healthiest, I hope that would be more of the preventative work. is all I'm 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 Bosnians were burning their trash. Their trash would go into the rivers. It was 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. It was 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, yeah. A lot of times you're outside, you're doing things but again, it can be in confined spaces such as an armored vehicle or any types of vehicles

You can be on a ship, you could be on an aircraft that again, you're not always in the most healthiest environments. It comes down to the commanders to make sure they are taking care of their service members We're not ending up having to visit the VA after we're done.

Understood. Thank you. I know I'm well over time, but thank you very much for the added time, Chair. Thank You, Council 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. 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 Now the military, they do what they can to try and mitigate any dangers from their assets 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.

Could I make one other comment? Sure. I just want to make sure that people who have served veterans are aware 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 the result They don't need to approve. It's considered a presumptive condition that entitles them to benefits from the VA, healthcare and benefits.

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

Excellent. Thank you. Thank You, Council 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. In watching the recording please do not hesitate to contact my staff with any questions sincerely Henrique, Pepén, Councilor, Boston City Council District 5. I'm going to give myself five minutes also, I mean 10 minutes also. Okay.

So I want to say thank you to the panel for the important testimony you provided and in the exceptional answers and thoughts you responded to from my colleagues. I do want to ask maybe two specific questions, if I may. And I want to Both doctors a question, if that's okay. And I listened closely to your testimony. Maybe I'll start with Dr. Whitley, if it's okay? So, so Dr. Whitley as it relates to women veterans or black veterans or both and I listened about claims related issues in your Some of you points about that, which I certainly agree with.

So a woman veteran, for example, that has acclaimed Maybe it's for military sexual trauma. Maybe it is 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 healthcare provider, because I think having a woman health care provider or a woman at the VSO or at the VA can better understand and some of the issues a woman veteran is going through.

And that may, because of that you might see percentages lower than male veterans, which is totally unfair in terms of success of a claim. But just wanted to get your thoughts might be on that doctor.

So 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 VSO's work hard around the clock. So 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 their claim and they're sitting in front of a... 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 you know supposed to be a strong soldier so A lot of times when I talk to women, that's the first thing they say is that when I did my comp and pent a male showed up. And I wasn't given

You know, I wasn't given an opportunity to talk to a female. And a lot of times, you know, his face was looking at me like that I can't believe that happened to you or maybe it didn't happen to you. So it can be quite difficult to get a female VSO. It's not impossible, And maybe the wait might be a little longer, or maybe the weight might be longer for comp and pent with the male. So how do we reduce that? I think that female vets should have an opportunity and not a long wait to talk to a VSO who's a female. But again, 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 not a worker claim. But sometimes often when you call for VSO, you may have a male VSO. I had a male PSO when it was time to work my claim I didn't get a choice.

And for comp and pen, I had a female physician but that could be difficult and that's one of the reasons why someone may give up and they make it a denial because So, um, so,

Thank you again and thank you, Councilor, 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, it was at a private practice in his own home which is totally unacceptable. But to Malika's point while it may be difficult It's not impossible to get a woman VSO. In our office here in the city of Boston, we have a diverse group of veterans benefits specialists to include women veterans benefits specialists, to help out through these claims. But also we have a network of VSOs throughout the state through the Massachusetts Veterans Services Officers Association. There are a lot of ESOs out there in the Commonwealth that our 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 does want to file A claim, and I would hope they would go through a VSO because they do exceptional work. DAV, I went to 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, Renata Pinto, who is a Veteran's Benefit Specialist here. 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 it's through the Executive Office of Veteran 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 in that network as well. So there are many different avenues that a woman veteran could take to reach a BSO that they feel comfortable with. Okay, excellent.

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 So now they don't recognize the POA, which could be the DAV or BSO. So they're talking directly to an intake person and then they signed up for comp and pen 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 call Commissioner Santiago, call your local American Legion Call your VFW, call a BSO. 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.

Yeah, that's a very, very good point. Thank you, Malika, for saying that. That's a really good point because that's what we do run into. The people do go to the VA first instead of going to their local VSO and they should always contact their local 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, Councilor, I'm sorry to cut you off. We do have a female veteran of services Consultant that is based at the JFK Federal Building right here in Boston. That is a great resource and again, the VFW will walk the veteran through the entire process from intake through any of 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 our 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, Councilor, if I may, sir, is that 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. 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 You know, 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. Never mind. I know Rob, you and I worked on... I think they called them at one time claim shocks. Claim shocks, yeah. The other point of that Rob 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. Your perpetuity. 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 totally is outrageous. Rob, thank you for bringing that up. That a great point. Dr. Wiener, I was with you maybe a year ago 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 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 wanna 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 dot gov and I'm happy 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 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 Thank you. 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 through primary care or other appointments for military toxic exposures and whether the veteran has any concerns about that.

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 Bahrain, a small country called Bahrain and we went up to and many more. What am I calling it now? It used to be the, oh, the registry. 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 and what health related issues.

But I do want to recommend to veterans 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 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 in 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, Chair Flynn, thank you very much again for holding this. Thank you and also to Councilor Santana for setting up this conversation here today. Thank You Councilor Fitzgerald for also being here and for your thoughtful questions I'm sorry it took more most of your time or earlier today, but it really makes me optimistic on our next steps. We've 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 you know making Boston set the example locally for the rest of the country I think that's you know a great idea and i think it's something that we 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 both locally statewide federally And also with you with all the partner organizations is going to be key to ensuring Okay. Craig?

Thanks again, Councillor Flynn for convening us today. Councillor Fitzgerald your great questions and we appreciate the attention that these issues are being given Flynn, I'd like to offer up the Boston Police Post as someplace to host that off-site meeting, hearing, Veterans Town Hall, whatever you want to call it. We would be more than happy 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 and right up 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 What we will do is make sure that we do share that information with each other. The commissioner might have a question and he asks me, I might not know the answer but I can reach out to my network of 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 ideas that will make these issues attainable, where we'll be able to help solve some of these problems. Again, part of what we do with the VFW as well as the other service organizations like the Legion and the DAV. We're out in our communities all the time that we are community-based organizations 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, like the last time I was here and provided testimony, one word of caution that

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 if 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 What the City of Boston's veterans priorities are. And then we'll never see that $750,000 again into the budget. That $750 thousand dollars goes back into The Commissioner's ability to provide that outreach, to provide 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 demand that our council shows the leadership Across the Commonwealth that Boston is going to take the best care of veterans that it can, and we're gonna 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 part of that village that comes together to take care of veterans across the city and across the Commonwealth.

Thank you, Commander. Mr. Kennedy?

Let me just start by expressing my sincere and heartfelt thank you for the opportunity to be here. And let me rephrase, it's a privilege and honor to be 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, so 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 good navigation. 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 of 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 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 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 the system. How do 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 if there's 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 two? And do you understand what it means to do that from a cost perspective, because Massachusetts passed legislation, I think in 2024. We call it the Breast Cancer Diagnostic Bill. The official name of the bill is a little bit different but it took that diagnostic cost-sharing burden off women so that they could continue to adhere to what that screening member would have said. 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 you are introduced to and supported as they move through the clinical system in 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 systems 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. Fitzgerald. One of the things that I thought about is as veterans, we connect by storytelling Like we, that's our connection. We tell a story about how we served and what we did and that's how we connect but I think it's... 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, you know our black are black female soldiers. So why I said that is normally when we think about, when we're introduced to all these programs and we hearing these different things on TV or in the media

We don't actually see a person who, you know, actually worked 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 will bring more veterans. And if I'm looking right now at this, if I was home and I'm watching this and I say hey you know You know, I had trouble filing a claim. Right here we have someone from the VFW. We have someone for The Post. Now I know who Rob Santiago is. So I just feel the same as you. As long as we continue that navigating and making the 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 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 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're 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 Thank you. Thank you very much. I also just want to say because this is a stigmatized condition, sometimes doing the community events like we did or 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 health care 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 question Many veterans, and to Rob Santiago, both of you, many veterans don't even know the veterans. And they don't 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.

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 some questions, give the system a chance and let Let us help you navigate the system so that you could get the services and benefits that you have deserved, to earn.

So contact us, contact your local VSO, contact a 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 Veterans 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 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 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 Thank you for joining us. 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. Thank you, John. Thank There was an important discussion on support services for women veterans, for how we support veterans of colour on medical care including Lung Cancer Screening. And I think my colleague, Councilor 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 LGBTQ veterans. I don't have that experience But I want to and continue to be a strong supporter of all veterans, especially 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. programs that are in these programs. And as a nation, historically we haven't been welcoming too many women veterans or veterans of color. In fact I'm going to

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 returned 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

Get a little bit of services such as real estate, such as first-time home buyer 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 awhile and one who will 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 do 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 discharge should be upgraded and maybe Maybe that's an issue we're going to 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 veterans that historically have been denied access to the VA into 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.