For U.S. veterans from the FSM living in the islands, the battle for health care is far from over.

More than 40 years of military service and sacrifice, yet access to care at home remains uncertain.

For some United States veterans, the battle does not end when they leave the military. It follows them home, into their families, their communities and, sometimes, into old age.

For veterans of the Federated States of Micronesia (FSM) who served in the U.S. Armed Forces, that battle can take another form: trying to obtain medical care in the very islands they call home.

“Personally, I don’t believe for a moment that the Veterans Affairs considers our individual sacrifices and collective struggles 

important,” said Filemino Killicho, a U.S. veteran living in Chuuk. “Or we’d have seen the result already.”

The issue is no longer simply whether America recognizes these men and women as veterans. It is whether the benefits they earned through military service can actually be accessed when they need medical attention.

That question has become increasingly urgent following a 2026 report by the U.S. Government Accountability Office, which found that the VA was pursuing a limited expansion of health services for veterans in the Freely Associated States but had not established an implementation timeline.

Domingko Saladier, another Chuukese U.S. veteran living in Guam, understands what that uncertainty means for veterans back home.

“For FSM U.S. veterans (living in FSM), it’s got to be frustrating,” he said.

The FSM citizens started flocking to enlistment in the Armed Forces in 1986, when they first became independent. But there were other citizens who were part of the earlier Vietnam conflict. 

“Over forty years is a long time,” Killicho added, “to implement programs and make corrections, if needed. But aren’t we just a bunch of disregarded veterans?”

A promise caught between policy and reality

FSM citizens have served in the American military for decades under the relationship established by the Compact of Free Association. They have worn American uniforms, accepted military responsibilities and, in some cases, made extraordinary sacrifices.

But returning home to the FSM can mean confronting a health care system with limited facilities, medical personnel and specialist services.

Unlike veterans living near VA hospitals and clinics in the continental United States, those in the FSM are scattered across geographically isolated islands. There is no VA hospital or clinic in the country. Accessing specialized treatment may require travel outside the FSM, often at considerable expense.

Killicho described the health care situation in Chuuk as extremely poor.

He also raised difficult questions about whether veterans receive adequate consideration when seeking treatment.

Could veterans receive priority when they need medical attention, particularly when their conditions are urgent? And could they also receive VA assistance when medical errors cause harm?

These questions reflect more than frustration. They expose the practical difficulties veterans face when trying to obtain reliable care in communities where medical resources are already stretched.

Distance is not merely an inconvenience. It can mean airfare, accommodation, transportation, time away from family and the difficult decision of whether a medical need justifies the expense.

For an older veteran living on limited income, an earned benefit that cannot be accessed affordably may offer little immediate relief.

The Foreign Medical Program has limitations

The VA’s Foreign Medical Program provides coverage for eligible veterans receiving medically necessary treatment for qualifying service-connected disabilities in foreign countries.

However, it is not comprehensive health insurance covering every medical condition a veteran may develop.

Generally, treatment must be connected to a VA-recognized service-connected disability or certain conditions associated with and aggravating that disability. Depending on the circumstances, veterans may also have to pay providers first and seek reimbursement afterward.

For veterans living in remote Pacific communities, these requirements can create additional obstacles.

A veteran may need treatment but lack the money to pay upfront. A local provider may not offer the required service, while a specialist may be available only outside the FSM.

This is the difference between having a benefit on paper and having meaningful access to care.

The question, therefore, is not whether the Foreign Medical Program has value. It does. The question is whether it can meet the broader health care needs of FSM veterans on its own.

The available circumstances suggest it cannot.

“Most of us know nothing. We’re aware of nothing,” Killicho said. “We also need a central information clearinghouse.”

That lack of information is another barrier. Veterans need to understand what benefits are available, who qualifies and where to turn when they need assistance.

Congress opened a door. Why is it taking so long?

A significant legislative step came with the Compact of Free Association Amendments Act of 2024, which gave the VA new discretionary authority to provide hospital care and medical services to eligible veterans living in the Freely Associated States. It also authorized certain beneficiary travel payments.

The change offered hope that veterans could receive more care closer to home, including through arrangements with local health care providers.

But congressional authorization is not the same as implementation.

According to the GAO’s 2026 report, the VA had previously decided not to exercise its new authorities. In August 2026, agency officials told the GAO that the department was pursuing partial implementation.

The proposed services included telehealth, delivery of pharmaceutical and medical supplies, reimbursement for care received in the Freely Associated States, and beneficiary travel benefits for eligible veterans with service-connected conditions.

Yet the VA provided no implementation timeline.

“People are even dying because of medication errors (issuing wrong meds.),” he said.

That is the central accountability question: When will the services authorized by Congress become services veterans can actually use?

Veterans need clear answers about what treatment will be covered, which providers can participate, how prescriptions will be delivered and who will pay for travel when appropriate treatment is unavailable locally.

“The veterans should have the freedom to just go and do their check-ups, get specialty services, etc.,” Killicho said. “They should not depend on announcements, because for many there might be no way of getting those announcements.”

Veterans also need help navigating the system

The need for better information and advocacy brings another important example into the discussion.

In Guam, HMI, a not for profit veteran-support organization whose name incorporates the CHamoru phrase, “I Hinanao I Magahet Yan I Ininna,” (By veterans For veterans), describes its mission as assistance by veterans and for veterans only.

According to its organizational materials, HMI offers individual assistance throughout the VA benefits claims process, community support and educational workshops known as “Benefits Boot Camps.”

Its approach is important because receiving benefits is not always as simple as knowing they exist. Veterans may need help understanding eligibility, preparing claims, gathering documentation and navigating the VA system.

For FSM veterans, similar educational and outreach efforts could help close an information gap that Killicho identified.

However, claims assistance and health care delivery are two different responsibilities. Organizations such as HMI can help veterans understand and pursue benefits, but they cannot replace the VA’s obligation to implement the health care authorities Congress has approved.

Veterans should not have to become experts in complicated government procedures just to access the support they earned.

This is also a test of the U.S.-FSM partnership

The Compact of Free Association is more than an agreement governing financial assistance and strategic access. It represents a longstanding relationship between the United States and Pacific nations whose geography is important to American interests in the Indo-Pacific.

Within that relationship, the military service of FSM citizens carries particular significance.

These veterans are not simply asking for special treatment. They are asking for a workable way to access health care support associated with their service to the United States.

Delivering that support would demonstrate that the partnership recognizes individual sacrifice, not just national interests.

“I’d like to know if I, as a veteran, and my sacrifice 

matter to the VA,” Killicho said. “Because, I suspect, that if any of us matter, the results would’ve shown. Heck, it’s been more than 40 years!”

The way forward requires a public implementation plan from the VA, developed in cooperation with the FSM government.

That plan should establish clear deadlines, identify available services and explain eligibility and application procedures. It should also provide workable arrangements with qualified local health care providers, expand telehealth where practical, clarify prescription delivery and reimbursement procedures, and address transportation assistance for treatment unavailable at home.

The FSM government must also press for measurable commitments, communicate regularly with veterans and ensure their experiences inform negotiations.

Congress, meanwhile, should exercise oversight to determine whether the authority it approved is translating into meaningful services.

Progress should be measured by results: How many eligible veterans are receiving treatment? Are prescribed medicines reaching them reliably? How long does reimbursement take? Can veterans obtain specialist care without facing unmanageable travel costs?

Those are the questions that matter.

Service deserves more than recognition

For FSM veterans, the years of service have already been given. Their sacrifices cannot be undone, and their time in uniform cannot be returned.

“It’s long overdue,” Killicho said.

What remains within the power of governments is the decision to make the benefits earned through that service meaningful.

America does not need another ceremony, another speech or another expression of gratitude to prove its appreciation. Those gestures have their place, but they cannot replace medical treatment.

A veteran who needs care needs an accessible doctor, necessary medicine, a workable referral system and the financial means to reach appropriate treatment.

More than four decades of military service and sacrifice should not lead to an indefinite wait for a system that works.

The United States has taken a legislative step, and the VA has signaled movement toward implementing some services. But without a clear timeline and tangible results, the distance between authorization and access remains uncertain.

For the veterans who served America and returned to their Pacific island homes, the question is simple:

If their service was valuable enough to America, why should access to the health care they earned remain so difficult?

They did their part.

Now America must deliver.