Congress authorized care but Micronesian veterans are still waiting.

By Alex J. Rhowuniong

For veterans in the Federated States of Micronesia, obtaining health care is about more than distance. It is about whether the United States will turn its promises to those who served in its military into meaningful medical services in their island homes.

In 2024, Congress authorized the U.S. Department of Veterans Affairs to expand health care services for eligible veterans in the freely associated states, which include FSM, the Marshall Islands and Palau.

Yet more than two years later, many veterans remain uncertain when, or if, those benefits will reach them. A Sept. 25 report by the U.S. Government Accountability Office found the VA is pursuing only partial implementation of the new authority and has not established a timeline for delivering the planned services.

“For FSM U.S. veterans (living in FSM), it's got to be frustrating,” said Domingko Saladier, a Chuukese U.S. veteran living in Guam.

Based on GAO reports he had reviewed, Saladier said there was no timeline for implementation.

For these veterans, uncertainty has real consequences.

The Compact of Free Association Amendments Act of 2024 gave the VA discretionary authority to provide hospital care and medical services to eligible veterans in the FAS. It also authorized travel payments associated with qualifying care.

But exercising that authority requires agreements with the three FAS governments, including arrangements addressing medical licensing and which services can legally be provided.

While Congress created the legal pathway, implementation has proven far more complicated.

According to the GAO, the VA decided in April 2025 not to exercise its new authority, citing its desire to ensure equity with all U.S. veterans.

The agency later resumed engagement with the FAS governments. By August 2026, it was pursuing partial implementation that could include telehealth, delivery of pharmaceutical and medical supplies, reimbursement for eligible care provided locally, and travel benefits for eligible veterans with service-connected disabilities.

However, officials had not provided a timeline.

“I think Veterans Affairs should, at the very least, publish a timeline and cost estimate so that the freely associated states veterans have something to look forward to,” Saladier said.

He believes giving veterans hope without a clear path forward is unfair.

After all, these are U.S. veterans. As Saladier put it, what is done for one should also be done for another.

For FSM U.S. veterans, geography can turn routine medical care into an expensive undertaking.

Specialized treatment may require travel to Guam, Hawaii or elsewhere. Airfare, accommodation, meals and transportation can add substantial costs, while time away from family creates additional burdens.

Some veterans who could have sought care in Guam or Hawaii instead counted on the promise of receiving greater assistance at home. As implementation remains uncertain, they continue to face difficult decisions about how and where to seek treatment.

The GAO has documented difficulties accessing VA care in the FAS, including limited availability of specialty services such as mental health care and cardiology. It also found that veterans must travel to the U.S. mainland or territories to use VA health facilities and do not receive beneficiary travel reimbursement for those trips.

Expanded services could help change this reality.

Telehealth could make some consultations possible without overseas travel. Access to authorized medications through delivery services could improve continuity of treatment. Local care arrangements could provide additional options for veterans who otherwise face long journeys.

These measures would not eliminate every barrier. Some conditions require specialized examinations, equipment or hospital services unavailable in FSM. Nevertheless, bringing appropriate care closer to veterans could reduce unnecessary travel and improve access.

The responsibility for moving forward cannot rest solely on veterans.

“Ultimately, in my book, the VA should make sure everyone is educated on what's owed them, and then make sure that they're well taken care of,” said Aggie Umwech, the wife of a veteran from Chuuk. “The veterans have laid down their lives … so we civilians could pick up ours.”

The VA should explain what remains unresolved, which agreements are outstanding, what resources are needed and when eligible veterans can reasonably expect services to begin.

The FSM national government and state governments also play important roles in negotiations and in determining how services could be delivered locally.

The VA's concerns about equitable treatment deserve consideration. But fairness must also account for geography. Veterans living on remote Pacific islands face different obstacles from those living near major VA medical facilities.

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Treating veterans fairly does not always mean providing identical arrangements. It means addressing legitimate barriers so eligible veterans have a realistic opportunity to obtain the care they have earned.

The United States and FSM share a longstanding relationship under the Compact of Free Association. Military service by FSM citizens is one part of that relationship, and their sacrifices deserve recognition through meaningful support after service.

Those sacrifices are no less significant because veterans live in Micronesia rather than in the continental United States.

Congress has opened the door to expanded care. The VA has begun pursuing some of the authorized options. But until those efforts result in accessible treatment, medication and practical assistance, the promise remains a promise.

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