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Submission For The Record of Ms. Kari Cowan, Surviving Spouse of CW3 Aaron William Cowan, United States Army

Chairman Runyan and Subcommittee Members, thank you for providing me this opportunity to offer testimony on the important issue of Sustaining the Sacred Trust as it pertains to our National Cemeteries.

Introduction
I am Kari Lin Cowan and I am the surviving spouse of CW3 Aaron William Cowan, United States Army.  CW3 Cowan, a 19 year member of the United States Army, suffered a line of duty death as a result of a combat aviation mishap in Paju, South Korea on February 26, 2005.

On May 7, 2005 my husband Aaron’s cremains were interred at sea pursuant to his wishes.  
I allowed our son Logan, who was 8 years old at that time, to choose the point of embarkation for the interment.  The interment ceremony was performed by honor guard and attendant crew of the USS Lake Erie during a mission off the coast of Oahu, Hawaii.  In keeping with the desire to memorialize Aaron near his burial site we subsequently chose to memorialize Aaron at the National Memorial Cemetery of the Pacific.  Logan and I traveled to Hawaii in June of 2005 at the invitation of the captain and chaplain of the USS Lake Erie to have lunch aboard ship and to receive Aaron’s burial flag and photographs of the interment ceremony.  

While in Hawaii we intended to visit the Punchbowl to visit the memorial marker.  Unfortunately we learned prior to the trip that the marker had been engraved incorrectly.  Cemetery staff informed me that the marker had been removed and a new one would made locally.  
We returned to Hawaii in February 2006 to mark the first anniversary of Aaron’s passing.  I contacted the cemetery staff ahead of my visit, had a vase installed and the cemetery staff marked the newly made memorial marker with a flag so we could locate it upon our arrival.

The trips I made with my son Logan to Hawaii were solely for the purpose of remembrance and healing.  Hawaii provided us with remarkable opportunities to spend extraordinary quality time bonding and growing together.  We did not simply fly to Hawaii, visit the cemetery and leave flowers.  Our trips were meaningful.  Every bouquet was hand-picked at the farmers market and hand-made and placed by us.  We learned the lay of the land at the Punchbowl and visited every single section and memorial site.  It was a rich history lesson in a beautiful, peaceful setting.
On each and every trip we honored Aaron’s love of aviation by doing memorial helicopter flights in his honor.  We visited a different island each trip and did the things that Aaron would have enjoyed.  We hiked the active lava fields of Kilauea, experienced volcanic earthquakes and visited the USGS seismographs to watch them in point of time. We made long and difficult journeys to places like a green sand olivine beach at the southernmost point of OCONUS.  We watched the sunset and star-gazed late into the night at the Mauna Kea observatories.  On Christmas morning we watched the sun rise at 14,000 feet on Mt. Haleakala and then rode bikes down the mountain, 30 miles to the sea.  During our visits we lived in his spirit and in his honor. Our last trip in December 2011 was no exception.  Then everything changed forever. Again.

The Missing Marker
We visited the National Memorial Cemetery on December 28th in part to pay our respects and to remember Aaron’s December birthday.  When Aaron was interred at sea by the Navy we were given a map with the burial coordinates.  I subsequently did research in 2008 on Google Earth and annotated the memorial marker coordinates.  During our visits to the cemetery we mapped out the location of the marker in a manner similar to orienteering.  This skill made it possible for us to navigate directly to the marker.  So when on December 28, 2011 we walked to where we knew the marker had been, and it was not there, confusion ensued.  I immediately felt a sense of panic and disorientation and I set my son on the task to find the marker by number.  He did eventually find the marker #366 which had previously occupied the next to last position in row 9, 35 yards away and in the 10th row in the first position.
I left my son in the section and went to the cemetery office for an explanation.  I carried with me photographs on my smart phone that did show the original location of the marker.  

The events that transpired when I made contact with the cemetery staff revealed a serious problem in how such issues are handled at that particular location.  I was ignored and summarily dismissed as someone who simply “was confused” or “did not remember” where the marker was.  I was asked which section was involved and when I said MB I was told “oh, it’s just a marker.”

I had no choice but to press the issue and refuse to leave the office.  I was told the Cemetery Director was on vacation and nothing could be done.  I refused to leave until the Director was called.  He was reached two hours later and advised of the situation but I did not speak to him. Not only was the marker in a different location, the urn I had purchased was not moved with it and that became a secondary issue.  I could not leave the flowers I brought because the urn was missing.  I was then told it had probably rotted or had been stolen.  Given the fact the marker had been relocated it seemed more logical and probable that the urn had been misplaced.  I returned to the MB section with the Public Affairs Specialist.  She had been recently employed and was not familiar with the section or its layout.  I took her to the marker section and walked her to where the marker had once been emplaced and then to the new location.  I showed her the photographs I had with me on my smart phone.  She gave them a cursory glance.

The Public Affairs Specialist and I were standing next to my husband’s marker in the new location when the head groundskeeper approached me and began to verbally assault me.  He was very aggressive and insistent that the markers had never been moved and that something like that never happens.  He stated that I just did not remember or know what I was talking about.  He got in my personal space and acted in a menacing and hostile manner.  I was so incensed that he would behave this way in front of my husband’s memorial, his son and his wife and that the Public Affairs Specialist just stood there silently.  I demanded he get out of my face and leave me alone.  I had to get very aggressive with him to make him understand that I was absolutely not going to condone such behavior.

I was hopeful when I left that day that although unresolved, there would be a resolution.  I was promised I would be contacted by the Director, but I never was, and to date I never have been.
The PAS made the effort to ensure another urn was placed at the marker and she personally placed the flowers and sent me photographs of them the next day, December 29, 2011.  She also included a statement in her e-mail that although not explicit, made reference to the missing urn and marker as: the “doubly unpleasant surprise you encountered” during the visit on December 28, 2011.  That would be the last time until April 27, 2012, when the cemetery officially acknowledged their error, that an admission as to what happened to the marker would be made by the cemetery staff or officials.

The Investigation
When I returned home on January 1, 2012 I began doing research, compiled my evidence and information for a complaint and enlisted the assistance of Congressman Gus Bilirakis’ office to resolve the issue.  At the same time I filed my complaint, the Honorable Jeff Miller ordered an investigation into all 131 national cemeteries including a national audit. I enlisted the help of investigative reporters at the Washington Post and the Honolulu Star.  I immediately learned of the national cemetery controversies occurring nationwide. The investigative reporters began making inquiries of National Memorial Cemetery of the Pacific’s Director Gene Castagnetti.  What ensued were serial denials made by Cemetery Director Gene Castagnetti through the Public Affairs Specialist to the press.  I was never contacted directly after I left Hawaii on January 1, 2012.  All statements made by Director Castagnetti were made indirectly to the press or to my congressional caseworkers in response to investigative inquiries on my behalf.

Resolution
Subsequent to filing the Congressional, the Regional Director for the National Cemetery Administration Bradley Phillips became involved in my case.  Director Phillips was deeply apologetic and by April 27, 2012 the NCA officially acknowledged that the marker had been moved. Ahead of official findings, on May 3, 2012 during a conference call with my congressional caseworkers, Director Phillips agreed to fulfill my request to have the marker in Hawaii destroyed and a new one made and emplaced at Fort Bayard National Cemetery.
Fort Bayard National Cemetery is in my husband’s home state of New Mexico.  Now emplaced in this location, the memorial marker is easily accessible to his immediately family.
Public Law 97-66
The decision my husband made to be interred at sea and be memorialized with a marker at a national cemetery was made possible under provision of Public Law 97-66 enacted on October 17, 1981.  In summary this Act expanded eligibility for memorial markers to include all veterans; whose remains have not been recovered or identified; whose remains were buried at sea, donated to science or cremated and required that suitable land was set aside at each cemetery for this purpose.  Public Law 97-66 effectively established a sacred place meant to memorialize the lives of all veterans and their distinguished lives of service regardless of the disposition of their remains.  

The Findings
In December of 2012, I was apprised by Director Phillips of the NCA’s final findings.  The findings were that in fact the marker was moved.  The findings also concluded that in fact no documentation other than what I furnished exists to explain how or when it happened.  
Therein lays the breach.  

I easily found past news articles in the Honolulu Star in which Director Castagnetti indicated the renovation began in 2009.  I found another article specifically addressing the fact that the first contractor hired for the Punchbowl Millennium Renovation project was fired for performance failures.  

The Director knew or should have known that there may have been past and potential ongoing contractor error.  No safeguards were put in place to prevent such errors and no oversight was provided.  I personally witnessed the haphazard manner in which urns were removed from the ground, displaced from their graves and left unmarked.  Newspaper articles frame other family members’ accounts of this and the reporter I sent to the Punchbowl witnessed this as well. The claim that the cemetery has no documentation or information to explain the movement of the markers in the MB section is refutable.  I personally saw a map in 2006 showing the original emplacement and on December 28, 2011 I was shown the new map with the marker in the new location.  Further, early in the investigation, Director Castagnetti stated that the marker “was where it belonged.”  Taken together these events indicate that the movement was planned.
Duty and Breach of Sacred Trust
It is my understanding that the National Cemetery audit is complete.  It is also my understanding that an insignificant percentage of errors regarding markers and burial issues are being reported by the national cemeteries. These reported errors may be few in number but are so egregious in nature that statistical minimization serves no satisfactory purpose.  One cannot simply say that a marker was erroneously moved, or that it was only a few, they are just markers, there were no remains involved and just dismiss the egregious nature of the causal action.  The breach of sacred trust is not limited to or dependent on whether remains are involved.  The sacred trust extends to the memorial.  Movement of a marker associated with remains may be more egregious by degree than one moved without associated remains, but the duty is the same.  Barring some unforeseen natural disaster or circumstance, I expected that a duty existed by which I would be properly noticed if there was such an occurrence that necessitated the removal or relocation of the memorial marker.  I did have the expectation that barring such extreme circumstances that my husband’s memorial would be in its original location of emplacement each time I returned and perpetually thereafter.  

It is my firm belief that there was a failure of due diligence and oversight.  The onus is on the director to ensure the integrity of the sacred trust. He should be held accountable for his failure to act in a manner consistent with the honor of accepting personal and professional responsibility for safeguarding the sacred trust.  The director was remiss and breached that duty. The result was negative oversight of a multi-million dollar invasive renovation project (Millennium Renovation Project).  This project caused the markers to be susceptible to relocation; the risk of which was foreseeable.  Further, the director was careless and remains ignorant of the cause and occurrence of the breach and failed to directly address my concerns.  The director owes a duty to the deceased and their families and he was negligent in his conduct as director.  To this day I have never had discourse with the director regarding this issue.  I credit the regional director and his commitment to finding the facts.  He conscientiously reviewed the substantial evidence I submitted in the form of satellite and personal photographs.  Otherwise, I would have no satisfaction and the outcome would be unresolved in favor of arrogant denial.  I was not allowed to be informed of any remedial measures at the Punchbowl other than re-training of staff had taken place.  Whether Director Castagnetti has been held accountable remains unknown to me.
The Burden
There is no question that in such a situation as mine the burden should have fallen on the cemetery director to compassionately address my concerns, make a proper procedural inquiry into the matter and acknowledge my evidence supporting the facts of the complaint.  Instead not only was the burden of proof shifted to me, I also faced a significant hurdle caused by a culture of disrespect and disregard toward the memorial markers in the section that lacked remains.  

Through my paralegal education I was uniquely qualified to undertake such an effort to prove my case.  I had the competent assistance of trained and experienced Congressional caseworkers to help me achieve the end result.  I was fortunate.  The average family member does not necessarily have the skills, knowledge or training or individuals at their immediate disposal to help them facilitate a resolution when the sacred trust is breached. There clearly exists a lack of compassionate outreach to the families and a culture exists that minimizes the severity of the impact of the breaches of sacred trust in question.  In all my research into VA policies and guidelines I found nothing that would give guidance on how to proceed under the circumstances at issue.

Future Remedies
I have been asked how I believe these incidents should be handled in the future.  There is no question that this issue speaks to an institutional lack of common sense and a comprehensive failure of respect for the living and the deceased.  Every complaint should be subject to the same principle.  Every complaint is valid until proven otherwise and the burden should be on the administration and not the complainant.  If common decency cannot dictate this process then some method of procedure must be implemented.  Protocols for re-training staff how to compassionately interact with family members of the deceased need to be developed.  Every individual should be treated with common courtesy, dignity and respect no matter what the concern.  Had I been treated with a modicum of respect and had my issue been properly investigated rather than minimized and denied, the outcome would have been significantly different.  I may have been willing to accept the mistake.  The intervention I sought from Congressman Bilirakis’s office was an effective form of mediation without which my complaint would have been summarily dismissed by Cemetery Officials.  I would have then been barred from receiving any resolution.  While necessary this simply is not an acceptable complaint resolution process. The VA has a long history of reliance on congressional offices to remediate veterans’ issues.  The VA should not rely on congressional offices to mediate their disputes simply because they have failed to implement appropriate procedures to address failures of service and breaches of trust. I would not discount the future viability of an alternate dispute resolution process conducted by a specially trained ombudsman or mediators within the VA/NCA.  It must be an effective process that is easily accessible to the complainant and one that does not unjustly burden the complainant.  This would shift the burden of responsibility back to the VA and help to eliminate or alleviate abuses of valuable congressional resources.

Conclusion
I am grateful I was granted the request to have my husband’s marker destroyed so that another could be emplaced in NM.  I have no confidence in Director Castagnetti and I could no longer go to a place where Aarons’ memory had been disrespected and my son and I had been mistreated.  Aaron’s family has benefitted greatly from the emplacement of the new marker and they too are grateful.  I have not yet had the opportunity to see it other than in photographs. I do not expect to see it in the foreseeable future.  While I appreciate this resolution it does not diminish the emotional impact of what occurred.  It also does not allay the concerns I have over stewardship.
I believe my complaint was met with vehement denials because the protection of the reputation of the director was paramount to exposing, admitting to and resolving a serious problem.  It was also clear to me that the prevailing attitude was that I would be geographically frustrated when I returned home and the matter would be forgotten. Logan was 15 on the day we discovered the marker was missing.  Logan is a Civil Air Patrol Cadet Officer and Air Force trained honor guardsman.  He has been instilled with deep respect for his sanctity of all veterans lost in the line of duty.  Something we found lacking at Punchbowl.  Logan was so distraught that day that I had to make emergency flight arrangements to remove him from Oahu.  There can be no real solace for me and my son.  Our loss has been compounded by these events.  For us there is no substitute for the special place we relied on and considered to be a permanent and safe haven in which to find peace, serenity, and healing from tragedy and where we could honor and remember Aaron.
It was my husband’s sincere desire in life to effect positive change.  Through my statement on his behalf I am confident his desire is posthumously fulfilled.  Thank you for this opportunity.