The VA Pacific Islands Health Care System provides access to patient care to over 130,000 veterans across a 2.6M square mile area of the Pacific Ocean. Remote Island locations, separated by great distances of ocean, is the environment in which the VAPIHCS delivers a full range of comprehensive health care services. The VAPIHCS operates seven community-based outpatient clinics (CBOCs) covering seven county areas. These outpatient clinics are in America Samoa, Guam, Hilo, Kauai, Kona, Leeward, and Maui. VAPIHCS is a Level 3 facility within the VA Sierra Pacific Network (VISN 21). The Dermatology Physician (MD/DO) is administratively and clinically responsible to the Specialty Care Physician Supervisor. The physician, as a member of the specialty care department within the Akaka VA