For military veterans in need of medical care or grappling with homelessness in Hawaii, progress is in the works, albeit slow-moving.

Four years after a health care scandal swept through the U.S. Department of Veterans Affairs — intolerably long wait times, botched record-keeping and inadequate treatment of “invisible” wounds like PTSD — reforms are still taking hold. The Hawaii VA is among those rocked by the upheaval in 2014.

At one point it had the longest wait times in the entire VA system for an incoming patient to get an initial appointment with a primary care physician — 145 days. The current average wait time at Honolulu’s Spark M. Matsunaga VA medical center is 40 days, according to the VA. While vastly improved, that’s still a long wait for that first doctor’s appointment.

In the latest round of VA hospital performance ratings, Honolulu maintained its middling 2-star rating. Eighteen of 146 hospitals managed to secure the top 5-star rating. Nine got the worst rating, with five as repeat 1-star hospitals.

Hawaii’s Matsunaga center was among 68 facilities that earned the same rating as last year. Thirty- eight improved, and 40 dropped at least one star. There’s no doubt that in the interest of veterans and taxpayers, much more must be done to make good on called-for reforms.

What’s more, it’s worrisome that overall progress appears to be slowing. In 2016, more than 80 percent of VA facilities showed improvement. This time around, just 66 percent met that mark.

Although Honolulu remains in the bottom third, the new rating, released last month, did note strides in access to primary care and specialty-care services as well as mental health care for matters such as post-traumatic stress disorder. Military veterans are particularly hard hit by PTSD, which has previously been tagged as “shell shock” or “combat fatigue.”

About 11 to 20 out of every 100 veterans who served in Operations Iraqi Freedom or Enduring Freedom, in Afghanistan, have PTSD in a given year. There’s speculation that the suspect in last week’s nightclub mass shooting in California — a Marine veteran, last stationed at Kaneohe Bay — may have had PTSD. He had reportedly not pursued treatment.

According to a National Academies of Sciences, Engineering, and Medicine study released this year, nearly half of American vets who need mental health care don’t get it. Also, more than half of those who would benefit from care don’t know they need it, the research found. All that is truly alarming.

More needs to be done to assess vets and persuade the PTSD- afflicted to undergo therapy. Among those with promising ideas on how to make progress is B. Christopher Frueh, a psychology professor at the University of Hawaii at Hilo.

In a recent UH-Hilo publication, Frueh suggests that a short-term outpatient PTSD program, through which a set of nearly 30 therapy sessions is packed into three weeks, can be more successful than the current standard, which spreads sessions over three months. The intensive tactic is yielding positive clinical outcomes and fewer dropouts.

Also, rather than addressing a single factor of physical or emotional health, Frueh advocates for a more holistic approach that folds in social skills training, such as anger management, and exposure therapy, which exposes a patient to virtual reality programs that mimic Iraq and Afghanistan combat situations.

In the absence of effective treatment, the disorder’s symptoms, which can range from re-experiencing the trauma through flashbacks to reckless and self-destructive behavior, can derail ability to manage normal daily routines. So, it’s not surprising that PTSD is pegged as a big contributing factor to homelessness in the vet population.

Eight years ago, the tally of homeless veterans nationwide topped 74,000. Since then, according to federal figures, an annual point-in-time count has marked a largely steady decline — thanks, in part, to stepped-up efforts of the VA and communities committed to reducing homelessness.

The latest census, conducted in January, counted 37,878 veterans living on the streets or in transitional housing and shelters — a decrease of 5 percent from January 2017. In Hawaii, the count fell by 13 percent to 532. Honolulu, which has the majority of the state’s homeless population, saw a 9 percent reduction.

The progress follows a pledge by Mayor Kirk Caldwell — and hundreds of other mayors — made four years ago to then-first lady Michelle Obama to end vet homelessness. Sixty-five communities spanning 33 states have already finished the job.

The qualifications to “end veteran homelessness” require placement of vets in permanent housing within 90 days after they’re identified as homeless. That’s a tall order for Honolulu, the urban center of the state with the nation’s highest overall homeless population per capita. Still, the city is making progress.

As we observe Veterans Day, a fitting tribute to all veterans — past, present and future — would be to redouble efforts that respect their service. That includes providing the effective medical care and related assistance needed to heal the wounds of war.