VA Advisory Committee on Tribal and Indian Affairs Meet for the First Time

Urban Indian Organization Representative Sonya Tetnowski named co-chair of the Veterans Health Administration Subcommittee

On January 25, 2022, the U.S. Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs (Committee) met for the first time and held a three-day long session to advise the VA on matters relating to Native American veterans.  The Committee is made up of 15 veterans, representing the 12 Indian Health Service (IHS) service areas, the Native Hawaiian veteran community, and Urban Indian Organizations (UIOs).  From January 25 – 27, the Committee provided advice and guidance to VA Secretary Dennis McDonough on matters related to Native Veteran healthcare services, COVID-19 efforts, homelessness and affordable housing initiatives, Indian Health Service (IHS) and urban Indian health, benefit access including memorial services, and the Vet Center program, among other items.  The National Council of Urban Indian Health (NCUIH) played a key role in the creation of the Committee and Sonya Tetnowski (Makah), NCUIH’s President-Elect and CEO of the Indian Health Center for Santa Clara Valley, currently serves as one of its members.

UIO Representation and Meeting Highlights

During the first meeting of the Committee, Ms. Tetnowski quickly established herself as a strong advocate for Native Veterans from all areas, including those living in urban areas. As an Army veteran, member of a rural tribe, and current executive of a UIO, Ms.Tetnowski highlighted many of the barriers AI/AN Veterans face in accessing health care and other benefits they earned from the United States.  She elevated urban Indian health priorities and issues throughout the conversations with the VA.  She reminded the VA that they have yet to fully implement the VA-IHS Memorandum of Understanding (MOU) for UIO reimbursements and that a VA Urban Confer Policy has yet to be executed.  Additionally, Ms. Tetnowski inquired about the rollout of the reimbursement agreement program (RAP) template for UIOs and how communications for that were to proceed.

Ms. Tetnowski also highlighted the importance of looking at the whole person and making sure that their needs are being met. She also brought forth potential subcommittees, including unhoused urban Veterans, Native Healer utilization and Behavioral Health and Substance Use.  At the end of the three-day meeting, Sonya volunteered to be, and was selected to be, Chair of the Veterans Health Administration (VHA) subcommittee within the TAC.

NCUIH is incredibly proud of Ms. Tetnowski and her extraordinary advocacy throughout this initial meeting of the Committee.  NCUIH will continue to support Ms. Tetnowski in her work on the Committee in addition to its ongoing advocacy work for UIOs before the VA.

Background

The advisory committee was created by Congress in 2020 and members were officially appointed to their roles in October 2021.  NCUIH played a critical role in getting this legislation passed in 2020 and in nominating an urban Indian Organization (UIO) representative to the Committee.  The purpose of the Committee is to advise the Secretary on all matters relating to Indian Tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. This includes advising the Secretary on the administration of healthcare services and benefits to American Indians and Alaska Native Veterans; thereby assessing those needs and whether VA is meeting them.

On October 30, 2019, the House Committee on Veterans’ Affairs, Subcommittee on Health conducted an oversight hearing in which NCUIH’s then Board Vice President, Sonya Tetnowski, testified.  In her testimony, Ms. Tetnowski highlighted that “most AI/AN veterans live in urban areas and would benefit from the culturally competent care provided at UIOs.”

Additionally, NCUIH signed onto a December 4, 2020 letter with other National Native organizations regarding the VA Technical Advisory Committee bill.  In the letter, NCUIH emphasized the importance of UIOs in the healthcare delivery system, especially when addressing Native Veteran access to culturally competent care. Thanks to NCUIH’s advocacy, the legislation creating the Committee requires it to have a sitting member represent UIOs and be nominated by a national UIO.

NCUIH also provided testimony on Native Veterans Suicide Prevention to the House Committee on Veterans Affairs on September 21, 2022.  Again, Ms. Tetnowski testified on behalf of NCUIH and reiterated the importance of culturally competent health care provided to Native veterans.  She highlighted how UIOs offer several culturally centered mental health care services to Native Veterans, including operating residential substance use disorder (SUD) programs with inpatient treatment.

NCUIH nominated its President-Elect and CEO of Indian Health Center of Santa Clara Valley, Sonya Tetnowski to the Committee and she was selected as a member.   Ms. Tetnowski is a Makah Tribal Member and a Veteran of the U.S. military, having served in the Army as a Paratrooper.  She was deployed multiple times during her service in the Army and has tirelessly advocated on behalf of health equity for American Indians, including Native Veterans, through Congressional testimony and leadership at NCUIH.

About Native Veterans

According to a VA report, 140,507 Veterans identify themselves as American Indian or Alaska Native (AI/AN), and a higher percentage of AI/AN Veterans served in the Pre-9/11 period (17.7%) compared to Veterans of all other races (14.0%).  The report also showed that significant disparities between AI/AN veterans and other veterans including that:

• AI/AN Veterans had lower personal incomes than Veterans of other races, ($29,847 v $38,792).
• AI/AN Veterans were more likely to have some college compared to Veterans of other races (44.3% vs. 37.4%, respectively) but less likely to hold a bachelor’s degree (13.7% and 16.9%, respectively).
• The percentage of AI/AN Veterans who were unemployed was higher than the percentage of Veterans of other races who were unemployed (5.5% vs. 3.4%, respectively).
• AI/AN Veterans were more likely to lack health insurance than Veterans of other races (7.4% vs. 2.9%).
• AI/AN Veterans were more likely to have a service-connected disability than Veterans of other races (30.0% vs. 23.0%, respectively).

AI/AN Veterans used Veterans Benefits Administration (VBA) benefits or services at a lower percentage than Veterans of other races (41.6% vs. 52.7%) in FY 2017.