Ovenny Jermeto was on a combat tour 7,000 miles away from his island home in the Pacific when a bomb blew up his vehicle in the Hindu Kush mountains of Afghanistan. He survived and completed his deployment, but later lost feeling in his right foot and struggled with anxiety and depression.
He returned to the United States to finish his enlistment, eventually getting discharged on medical grounds. Then, he had to make a difficult decision: remain in the United States for free health care or return home to the Marshall Islands, in the middle of the Pacific Ocean, and spend thousands of dollars a year traveling to military hospitals in America for treatment.
This is a predicament for hundreds of people from the Marshall Islands, Palau and the Federated States of Micronesia — all former American colonies in Pacific Micronesia — who served in the U.S. military as foreign citizens. Thousands of foreign citizens enlist in the U.S. military every year; hundreds of them are from Micronesia, a result of the country’s close ties to the United States. According to the State Department, the regional rate of enlistment is double the rate in the United States, with almost 1 percent of Micronesians serving.
The Veterans Affairs Department, which oversees veterans’ benefits, is largely hamstrung. Federal law prohibits it from directly providing medical services to veterans in foreign countries other than the Philippines, a department spokesman said. Most veterans are not entitled to use the Military Health System, which is overseen by the Defense Department and is responsible for active-duty soldiers, retirees and their families.
Mr. Jermeto, 44, chose to move back to Majuro, the capital of the Marshall Islands, in 2019, almost a decade after the episode in Afghanistan. Since then, he has scrounged for three trips to the closest U.S. military hospital, a five-hour flight away in Hawaii, and spent years without medication. To cope, he said, he drinks regularly with other veterans. He tries to limit himself to 12 beers a session. The alcohol emboldens him to share memories of Afghanistan, which in turn allows him to cry.
“The only option is drinking,” he said. “Drinks are my meds.”
Hospitals in the Marshall Islands should, theoretically, be an option. A V.A. spokesman, John Santos, said that although the department could not directly provide care outside America, it reimburses veterans if they get it. All veterans are eligible for subsidized care, and those with conditions related to their service get it for free. But health systems in Micronesia are so short of resources that getting care locally is practically impossible.
Traveling to V.A. hospitals is also not easy. Federal law permits the V.A. to compensate veterans for health-related travel, but regulations restrict that to movement within the United States and its territories. Micronesian officials estimate that hundreds of veterans live there, but they do not have a precise number.
The United States has expanded its support for Micronesia in recent years, largely driven by concern over China’s efforts to win influence in the region. The Marshall Islands, Palau and the Federated States of Micronesia are independent, but remain closely affiliated with the United States, which controls their defense policy and funds much of their government spending under agreements known as compacts of free association.
Another Marshallese veteran, Misao Masao, 40, served two tours in Iraq. On the second, a friend took his spot on a patrol that was hit by two suicide bombers. Mr. Masao’s friend was killed.
“It could have been me,” said Mr. Masao, who has struggled with anxiety and depression ever since. He was prescribed a cocktail of six medications, but the difficulty of traveling to the V.A. hospital in Honolulu means that “I run out of medication all the time.”
The United States, Mr. Masao said, “forgot” him. “If you treat my fellow soldier in California good, then treat your fellow soldier in the Marshall Islands the same,” he added. The V.A. declined to comment.
There has been a bipartisan push in Congress to address the issue.
“This is a question of basic fairness,” Senator Brian Schatz, Democrat of Hawaii, said in an interview. “If someone puts on the uniform to serve our nation, they should be given the same benefits that our service members receive, no matter where they live.”
In 2019, Mr. Schatz proposed legislation that would require the V.A. to experiment with providing services to veterans in Micronesia through telehealth and by opening small clinics there. The bill remains stalled.
Mr. Jermeto enlisted in 2006. He was fresh out of college with a young son to provide for and few job prospects. Soon he wrapped up a tour of Iraq. In 2011, he was sent to the Pech River Valley in Afghanistan, where he patrolled narrow mountain roads.
One day his vehicle struck an explosive device. When he regained consciousness, he said, he saw that shrapnel had gouged his right leg, shredded his gunner’s belly, and sliced into his commander’s left arm.
Treatment helped him complete the tour. But he eventually lost feeling in the leg and was incapacitated by anxiety and depression.
By the time he was discharged in 2018, he could not tolerate crowded areas, so he sought refuge in the Marshall Islands. But even there, his condition, he said, forces him to isolate from family.
Traveling to “the mainland,” as many Marshallese refer to the United States, to refill his prescriptions can be prohibitively expensive. Mr. Jermeto, whose main source of income is a disability benefit, can catch a free military flight from a nearby American base to Honolulu, but a round-trip flight from his home to the base costs about $500. The military flight is also often full, and. Hotels and food in Hawaii can cost hundreds more.
In April, Mr. Jermeto traveled to Honolulu for his third V.A. appointment since his discharge. But a scheduling error forced him to wait three more weeks to consult a doctor in person and refill his prescriptions.
Kalani Kaneko, a Marshallese senator and former health minister, has repeatedly appealed to V.A. officials to treat people like Mr. Jermeto like other hard-to-reach veterans.
“We’re not trying to invent new ways of operating in the V.A. because they’re the same things they’re doing now for those isolated places in the United States,” Mr. Kaneko said.
Mr. Kaneko, 47, is a two-decade veteran of the U.S. Army. He suffered traumatic brain injuries while training as a tank driver in Fort Irwin, Calif., for which he takes several medications and travels frequently to V.A. hospital in Portland, Ore., for care.
But his main motivation to push for change is a sense of guilt. Toward the end of Mr. Kaneko’s military career, he worked as an Army recruiter. He persuaded Mr. Jermeto and many other Marshallese men to enlist.
“I lose sleep over that,” Mr. Kaneko said. “They could have been better off doing something else, but I pursued them.”