ADRC-TAE Issue Brief June 2007 How ADRCs Can Effectively Assist Veterans Prepared by Amy Herr INTRODUCTION With the large number of veterans with disabilities returning from Iraq and Afghanistan, as well as many older veterans who served in prior conflicts, ADRCs should have in-depth knowledge and skill in linking individuals to Department of Veterans Affairs (VA) services. The VA provides a wide range of information and assistance services. ADRC staff should be prepared to collaborate with these efforts or provide additional assistance, when needed. Whether by establishing strong referral protocols with local or state veterans agencies or by serving veterans directly, ADRC staff should be trained to assist veterans who come to ADRCs for information, assistance, or referral. This issue brief includes an overview of veterans, the services and benefits offered by the VA, examples of productive collaborations between veterans agencies and ADRCs, and resources for ADRCs. TODAY’S VETERANS A veteran is defined as a “person who served in the active military, naval, or air service, and who is discharged or released therefrom under conditions other than dishonorable.”1 Active military service could have been with any of the following groups: Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service Commissioned Corps, Environmental Science Services Administration Commissioned Corps, or National Oceanic and Atmospheric Administration Commissioned Corps. (Persons with dishonorable discharges are generally ineligible for benefits.) According to the VA, the almost 24 million veterans in 2006, accounted for about one in five males over age 18. Female veterans account for about seven percent of all veterans. Almost 40 percent of living veterans are age 65 and older, and this group has been declining as World War II veterans age, but will rise again as Vietnam veterans reach age 65. With the current conflicts in Iraq and Afghanistan, the number of veterans with disabilities who are in younger age groups is increasing. Exhibit 1 displays data on the number of living veterans by age. 1 38 CFR § 3.1(d) 1 436079v1 ADRC-TAE Issue Brief June 2007 Exhibit 1: Living Veterans by Age, 2005 (in thousands) Total: 24,387 Under 35 years old 1,966, 8% 35-45 years old 2,996, 12% 65 years and older 9,348, 38% 45-55 years old 3,920, 16% 55-65 years old 6,157, 25% Source: U.S. Census Bureau When including veterans, family members, and survivors of veterans, about a quarter of the nation’s population – 63 million people – are potentially eligible for benefits and services from the VA. ADRC staff may encounter several potential populations. Older veterans, who may need supportive services, may seek guidance from the ADRC. Younger veterans who have returned recently from the Middle East may have acquired brain injuries or other disabilities. Third, family members and survivors may seek information from ADRCs, and may be unaware of their eligibility for benefits.2 Returning soldiers may face a variety of challenges as they “reintegrate” into civilian life, which can be complicated if the veteran has acquired a physical, psychiatric, or cognitive disability. ADRCs should be cognizant of the prevalence of post-traumatic stress disorder (PTSD) and traumatic brain injury among veterans. PTSD manifests itself in individuals after a stressful or traumatic event and one third of veterans report symptoms of PTSD. The psychological symptoms vary and may include nightmares, flashbacks, emotional detachment or numbing of feelings, insomnia, avoidance of reminders and extreme distress when exposed to the reminders ("triggers"), loss of appetite, irritability, hyper-vigilance, memory loss, excessive startle 2 Note that part-time soldiers, who have served as part of the National Guard or Reserves, may not qualify for benefits from the VA on an ongoing basis. 2 436079v1 ADRC-TAE Issue Brief June 2007 response, and anxiety. Persons with PTSD may exhibit a co-morbid psychiatric disorder, such as clinical depression, bipolar disorder, general anxiety disorder, and a variety of addictions.3 Traumatic brain injury is also very prevalent and has been called “the signature injury of Operation Iraqi Freedom.” The high use of improvised explosive devices combined with improved battlefield medical care have decreased combat deaths, but resulted in larger numbers of wounded. An additional complication is that traumatic brain injuries may manifest themselves immediately or an individual may experience limitations long after he or she has completed military service. DEPARTMENT OF VETERANS AFFAIRS BENEFITS The Department of Veterans Affairs provides both health care benefits and financial support to eligible veterans. The VA is composed of three key administrations, the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery Administration. More detail on the first two is included below. Veterans Health Administration The Veterans Health Administration (VHA) is the largest integrated health network in the United States and provides an array of services for enrolled veterans. Services include acute care services, such as hospital care and outpatient physician appointments, and institutional care, ranging from domiciliary care to nursing care (see Exhibit 1). Unlike Medicare and Medicaid and private health insurers, which pay for care, the VA is a provider of care. VHA operates over 1,400 facilities throughout the U.S. and its territories, including 155 hospitals, 881 outpatient clinics, 135 nursing homes, 46 residential rehabilitation treatment programs, and 207 readjustment counseling centers. 3 VA’s National Center for Post-Traumatic Stress Disorder, http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_lay_assess.html. 3 436079v1 ADRC-TAE Issue Brief June 2007 Exhibit 1: VHA Services Services Provided by the VHA Hospital services, outpatient medical, dental care, pharmacy, and prosthetic services Domiciliary, nursing home and communitybased services Sexual trauma counseling Specialized health care for women veterans Health and rehabilitation programs for homeless veterans Readjustment counseling Alcohol and drug dependency treatment Medical evaluation for disorders associated with military service in the Gulf War or exposure to Agent Orange, radiation, and other environmental hazards The VA provides nursing home and community based long-term cares services to eligible veterans. Nursing home care is provided in one of three settings: VA-operated nursing homes, non-VA (private) nursing homes under contract, and state-run veterans nursing homes. NonVA (private) nursing homes and state-run veterans nursing homes receive a portion of the daily cost of care from the VA. In 2006, the VA spent $3.2 billion on nursing home care, of which 74 percent was for VA-operated nursing homes, 12 percent was for community nursing homes under contract, and 14 percent was for state veterans nursing homes. Nursing home care represents about 9 percent of the VA’s total expenditures, but a large majority of long term care expenditures. In 2006, of VA’s long-term care expenditures, nursing home care accounted for 81 percent, other institutional care represented 12 percent and non-institutional care accounted for 7 percent of spending.4 The nursing home care provided by the VA is for a subset of veterans. Veterans eligible for nursing home care have a 70 percent or greater disability rating because of a condition related to their service. Some veterans with a 60 percent or greater disability rating who are classified as unemployable or permanently and totally disabled may also receive nursing home care from the VA. However, the majority of veterans who need nursing home care are served in other settings, which are not paid by VA. Many veterans are likely to need long-term care as they age, even if they did not have a service-related disability. Like non-veterans, these veterans finance their care through Medicaid, Medicare, private long term care insurance, and by the individuals themselves. 4 Department of Veterans Affairs, Fiscal Year 2008 Budget Estimate, available at: http://www.va.gov/budget/summary/VolumeIMedicalPrograms.pdf 4 436079v1 ADRC-TAE Issue Brief June 2007 VHA also provides an array of long-term care services in community-based settings, including the following: Home-Based Primary Care Contract Home Health Care Adult Day Health Care (ADHC) Community Residential Care Homemaker and Home Health Aide (H/HHA) Home Hospice Care Respite Care Telehealth Domiciliary Care Geriatric Evaluation and Management (GEM) Geriatric Research, Education and Clinical Centers (GRECC) The Department of Veterans Affairs has received accolades in recent years for the use of technology and electronic medical records in its medical system. In 1999, the VA linked its hospitals, clinics, nursing homes and rehabilitation centers by a universal medical records network. The use of this paperless system has allowed the VA health system to reduce medical errors and provide high quality care. In addition, the VHA has been a research leader in responding to combat-related issues. Specifically, VHA has a state of the art research program for improving the functionality of prosthetic limbs, a program to research post-traumatic stress disorder and other mental health challenges, and blindness rehabilitation services. Veterans Benefits Administration The Veterans Benefits Administration (VBA) is in charge of veteran registration and benefits eligibility and administers a number of non-medical benefits to veterans with service-connected disabilities. VBA provides pensions, disability compensation, and other financial benefits to eligible veterans (see Exhibit 2). Over half of VA’s budget is provided as cash benefits to veterans and their families. Certain benefits are only provided to veterans with wartime service. Appendix B displays estimated total expenditures for veterans by state in 2002. Exhibit 2: VBA Benefits Benefits Provided by the VBA Disability compensation Specially adapted homes and grants for home modifications Vehicle assistance Home loan assistance Education benefits and employment support VA group life insurance Spousal/ dependent benefits Other benefits (burial, special groups) 5 436079v1 ADRC-TAE Issue Brief June 2007 For more information on the services and benefits available from the VHA and VBA see Federal Benefits for Veterans and Dependants published by the VA each year, available on the VA website at http://www1.va.gov/opa/vadocs/fedben.pdf. ACCESSING BENEFITS In addition to national staff, VA has regional offices, state and county Veterans Affairs offices, and local “vet centers” to assist veterans in accessing benefits. These offices assist individuals in applying for benefits and also may provide services, such as counseling sessions related to stress disorders and bereavement counseling. Vet center locations are available on the VA website (see Resources section). Individuals enroll with the VA upon discharge from active military service and are assigned a priority group based on the level of their disability and service. The VA uses eight priority groups to balance demand for VA health care enrollment with resources (see Appendix A). Persons in priority group 1 have the highest level of service-connected disability and are entitled to the maximum benefits. Monetary benefits are available both to persons who have been disabled by active service and to veterans who qualify on a need-basis, because of lowincome. To apply, veterans complete the VA Form 10-10EZ, Application for Health Benefits, available at http://www.va.gov/1010ez.htm or at any VA facility or benefits office. Once enrolled, veterans can receive health care at VA health care facilities anywhere in the country. SUCCESSFUL COLLABORATIONS Because ADRCs assist persons with a range of physical, cognitive, and psychiatric disabilities, it is likely that veterans and their families will be among the individuals seeking assistance. A clear understanding of the services available to veterans will assist ADRC staff in developing appropriate options counseling for veterans. Several ADRC pilot sites have made efforts to specifically reach out to veterans. Idaho Idaho’s Coeur d'Alene pilot site has reached out to veteran groups in the ADRC service area. North Idaho is unique because no VA services or facilities exist in the area. For this reason, ADRC staff looked to other avenues to reach out to veterans and ultimately visited veterans at a local doughnut establishment and at Veterans of Foreign Wars (VFW) meetings. The ADRC staff have attended VFW meetings and made an effort to provide information about the ADRC and the services available to residents ages 60 and older with and without disabilities. The pilot site also invited a representative from the County Veterans Office to conduct training for ADRC staff. The ADRC and the Veterans Office have made several referrals back and forth. The ADRC also invited the Veterans Office as a featured presenter at one of their public educational events. 6 436079v1 ADRC-TAE Issue Brief June 2007 Minnesota Minnesota is launching a new “Veterans Linkage Line,” which will connect with other information services coordinated by the ADRC, including the Senior LinkAge Line and the Disability Linkage Line. Minnesota has seen an increase in calls from veterans returning from deployment in Iraq and Afghanistan, especially calls to the Disability Linkage Line from veterans with traumatic brain injury and other disabling conditions. One of the Minnesota ADRC Project Directors is part of the group charged with preparing the Veterans Linkage Line (VLL). The toll free line will be 1-888-Link-Vet. The ADRC Project Director has provided expertise to the planners in the following areas: development of a statement of work, work plan, job descriptions, referral protocols, establishment of standards, logo and sharing branding/marketing lessons learned so that VLL staff did not have to start from scratch. The development of these pieces was based on using lessons learned and products from the Senior LinkAge Line. South Carolina South Carolina’s Santee-Lynches ADRC has proactively served veterans in their four-county region, which includes Shaw Air Force Base. The ADRC staff recently prepared themselves to provide added help to veterans and their survivors living in the service area by training staff about available VA compensation and pension programs, and what is needed to fill out the numerous forms connected to VA programs. ADRC staff found that although many of their consumers have a VA connection, most were unaware of their entitlements. The ADRC and the County Veterans Services Office conduct referrals to each other and have a good working relationship. Two VA county officers travel with the ADRC’s mobile unit. These officers are Hispanic and can also assist with Spanish translation in rural areas. HOW ADRCS CAN EFFECTIVELY ASSIST VETERANS ADRC staff should take a proactive approach to providing services to veterans, survivors, and family members in their service areas. Successful models in the previous section, include relationship building, awareness of VA benefits, and a specific proactive approach to reaching veterans. These elements can be replicated in other ADRCs. Build relationships with local veterans offices It is essential that the ADRC build relationships with local representatives of the federal VA and state departments of veterans affairs, as well as local county veterans services offices. All of these officials are providing assistance similar to the ADRC and can find mutual benefit in coordination. At the same time, ADRC staff should make an effort to educate veterans staff about the services available through the ADRC, so that they can make appropriate referrals, when necessary. ADRC states that have developed these relationships report that the partnership is beneficial and that they have referred individuals in both directions. Once a relationship is developed, it may be helpful to invite veterans representatives to present jointly to public audiences. 7 436079v1 ADRC-TAE Issue Brief June 2007 Recognize people who may be eligible for VA services and benefits ADRC staff should consider incorporating screening questions for individuals who seek assistance that will identify people who are potentially eligible for VA services and benefits. As noted above, younger people, family members, and survivors may be eligible and may not appear to be likely candidates for VA services. Ensure ADRC staff are knowledgeable about benefits available to veterans ADRC staff should be knowledgeable about the services and benefits available to veterans, both from the federal government as well as services available in the ADRC service area. This knowledge will be important to provide effective, comprehensive options counseling. ADRCs should consider inviting veterans staff to provide training to ADRC staff (and should offer training about the ADRC in return). In addition to general information about VA services and benefits, staff should be trained on specific application forms and knowledgeable about specific places where veterans can be referred. Specifically identify veterans groups as part of your marketing plan ADRC staff should consider making veterans an explicit target group for marketing purposes. Veterans may receive information through different channels than the general public (e.g. advocacy organization newsletters, Veterans of Foreign Wars events, websites) and it may be beneficial to specifically target veterans in your efforts. MOVING AHEAD On May 23, 2007, the U.S. House of Representatives passed six pieces of legislation to assist veterans returning from Iraq and Afghanistan. The bills are as follows: H.R. 612 extends no-cost health care for returning troops from two to five years H.R. 2199 establishes traumatic brain injury research centers and mandates a comprehensive program for treating traumatic brain injuries H.R. 1863 authorizes mobile veterans’ centers to provide advice on the disability claims process H.R. 1470 expands the availability of chiropractic care H.R. 67 establishes a grant program for state veterans’ outreach programs H.R. 2239 expands eligibility for vocational rehabilitation to disabled troops not yet discharged from the military but who are likely to be discharged because of their condition Although these bills must also be approved by the U.S. Senate and President before coming law, their passage represents a renewed commitment at the federal level to provide care to returning veterans. ADRCs may have an opportunity to work with state veterans’ outreach programs, for example, if they are funded. 8 436079v1 ADRC-TAE Issue Brief June 2007 RESOURCES Below are resources that may be useful for ADRCs as they assist veterans and build relationships with veterans groups in their states. Department of Veterans Affairs website http://www.va.gov The Department of Veterans Affairs website includes information on veterans benefits and services. The site includes information on VA facilities, including health care facilities and Veterans Benefits Administration offices. Information is included for each of the 50 states, the District of Columbia, Guam, Puerto Rico, and the Philippines. The site includes a brief history of the VA at http://www.va.gov/facmgt/historic/Brief_VA_History.asp A state-by state listing of medical centers, clinics and vet centers is available at http://www1.va.gov/directory/guide/allstate_flsh.asp? The VA’s National Center for PTSD’s PTSD Information Center is available at http://www.ncptsd.va.gov/ncmain/information/ National Association of State Directors of Veterans Affairs website http://www.nasdva.com This website provides links to each state’s Department of Veterans Affairs website (from the homepage, click on “State VA Departments.”) U.S. Veterans Resource http://www.vetsresource.com/ The U.S Veterans Resource website provides many links of interest to veterans, including government links, legal services, veterans’ assistance, and advocacy organizations for veterans. Blinded Veterans Association http://www.bva.org/ The Blinded Veterans Association promotes the welfare of blinded veterans. The website includes information on BVA services, including peer-to-peer counseling for blinded veterans. Paralyzed Veterans of America http://www.pva.org/ Paralyzed Veterans of America (PVA) is an advocacy organization that supports veterans and all people with spinal cord injury or dysfunction. The website includes information about services for paralyzed veterans, downloadable publications and other resources. 9 436079v1 ADRC-TAE Issue Brief June 2007 NINDS Traumatic Brain Injury Information Page http://www.ninds.nih.gov/disorders/tbi/tbi.htm The National Institute of Neurological Disorders and Stroke (NINDS), of the National Institutes of Health, provides an information page on traumatic brain injury, which contains information on the condition as well as consumer resources. 10 436079v1 ADRC-TAE Issue Brief June 2007 APPENDIX A: VA PRIORITY GROUPS During VA enrollment, each veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. The table describes the priority groups. Priority Group Description Group 1 Veterans with service-connected disabilities rated 50 percent or more and/or veterans determined by VA to be unemployable due to service-connected conditions. Group 2 Veterans with service-connected disabilities rated 30 or 40 percent. Group 3 Veterans with service-connected disabilities rated 10 and 20 percent, veterans who are former Prisoners of War (POW) or were awarded a Purple Heart medal, veterans awarded special eligibility for disabilities incurred in treatment or participation in a VA Vocational Rehabilitation program, and veterans whose discharge was for a disability incurred or aggravated in the line of duty. Group 4 Veterans receiving aid and attendance or housebound benefits and/or veterans determined by VA to be catastrophically disabled. Some veterans in this group may be responsible for co-pays. Group 5 Veterans receiving VA pension benefits or eligible for Medicaid programs, and non service-connected veterans and non-compensable, zero percent service-connected veterans whose gross annual household income and net worth are below the established VA means test thresholds. Group 6 Veterans of the Mexican border period or World War I; veterans seeking care solely for certain conditions associated with exposure to radiation or exposure to herbicides while serving in Vietnam; for any illness associated with combat service in a war after the Gulf War or during a period of hostility after Nov. 11, 1998; for any illness associated with participation in tests conducted by the Department of Defense (DOD) as part of Project 112/Project SHAD; and veterans with zero percent service-connected disabilities who are receiving disability compensation benefits. Group 7 Non service-connected veterans and non-compensable, zero percent service-connected veterans with gross annual household income above VA’s national means test threshold and below VA’s geographic means test threshold, or with gross annual household income below both the VA national threshold and the VA geographically based threshold, but whose income plus net worth exceeds VA’s ceiling (currently $80,000) who agree to pay co-pays. Group 8 All other non service-connected veterans and zero percent, noncompensable service-connected veterans who agree to pay co-pays. (Note: Effective Jan. 17, 2003, VA no longer enrolls new veterans in priority group 8). Source: Federal Benefits for Veterans and Dependents, 2007 Edition, Department of Veterans Affairs 11 436079v1 ADRC-TAE Issue Brief June 2007 APPENDIX B: ESTIMATED VA EXPENDITURES BY STATE, FY 2002 Table B: Estimated Selected Expenditures by State, FY 2002 Readjustment Benefits Education Assistance Montgomery GI Bill Post-Vietnam State US--Total (1)................................... Alabama.............................................. Alaska................................................. Arizona................................................ Arkansas............................................. California............................................. Colorado.............................................. Connecticut......................................... Delaware............................................. District of Columbia............................. Florida................................................. Georgia............................................... Hawaii................................................. Idaho................................................... Illinois.................................................. Indiana................................................ Iowa..................................................... Kansas................................................ Kentucky............................................. Louisiana............................................. Maine.................................................. Maryland.............................................. Massachusetts.................................... Michigan.............................................. Minnesota............................................ Mississippi........................................... Missouri............................................... Montana.............................................. Nebraska............................................. Nevada................................................ New Hampshire.................................. New Jersey......................................... New Mexico......................................... New York............................................. North Carolina..................................... North Dakota....................................... Ohio..................................................... Oklahoma............................................ Oregon................................................ Pennsylvania....................................... Rhode Island....................................... South Carolina.................................... South Dakota...................................... Tennessee.......................................... Texas.................................................. Utah..................................................... Vermont.............................................. Virginia................................................ Washington......................................... West Virginia....................................... Wisconsin........................................... Wyoming............................................. Puerto Rico......................................... Total of Total Conflict Active Duty Selected Expenditures Readjustment (Chapter 32) Chapter 30 Benefits** Amount Trained During ($000) Fiscal Year $ 2,384 35 10 36 86 190 71 38 9 1 34 26 11 10 108 41 40 89 34 60 42 28 56 37 43 25 99 33 76 9 8 41 40 97 24 21 64 75 10 99 15 31 22 26 168 40 8 34 57 32 40 58 0 272,865 4,525 965 11,744 2,144 31,030 7,107 1,476 610 716 21,390 11,987 1,788 1,453 10,718 4,102 2,112 2,927 3,377 4,055 933 7,365 2,738 6,949 3,111 2,088 5,327 946 2,277 2,441 792 2,786 2,761 7,474 9,960 722 8,910 4,898 3,349 6,738 596 4,508 720 5,248 26,121 1,814 253 13,540 8,192 1,238 3,217 627 702 ($000) $ 53,968,143 1,074,596 195,617 1,131,266 885,230 4,592,251 1,003,183 484,720 150,434 1,649,461 3,760,630 1,555,178 245,457 239,858 1,629,287 754,746 514,896 538,360 785,381 936,692 393,419 836,268 1,192,367 1,214,244 855,187 740,991 1,391,725 215,816 424,436 453,532 227,424 862,486 544,845 2,826,236 1,623,061 152,110 2,011,723 1,010,877 846,187 2,161,190 225,683 907,827 282,937 1,361,323 4,102,078 323,666 166,269 1,414,897 1,339,283 713,487 874,533 144,797 694,725 ($000) $ 1,964,928 37,818 6,849 52,320 18,958 180,518 48,341 29,546 4,064 7,477 140,012 97,024 13,608 10,730 58,675 27,937 12,787 18,099 25,490 29,147 12,785 38,846 27,355 36,190 24,517 15,798 36,643 7,730 14,464 14,344 9,748 29,913 18,959 95,335 75,318 5,499 54,786 38,358 28,694 51,497 4,543 35,615 7,824 37,449 162,999 12,075 13,847 80,011 64,501 61,898 24,177 3,810 14,948 Selected Reserve Chapter 1606 Amount Amount Trained During ($000) Fiscal Year $ 1,045,175 18,112 3,832 32,105 8,576 120,978 26,807 5,641 2,226 1,362 75,657 48,514 7,552 6,554 40,298 15,794 8,007 11,749 13,666 16,998 3,774 19,580 11,160 23,901 12,641 8,943 21,226 4,344 8,256 9,100 3,025 11,005 10,869 30,408 42,512 3,152 33,701 18,856 16,127 29,279 2,169 17,691 3,259 21,002 100,674 6,789 1,033 47,441 37,117 5,281 13,990 2,442 3,223 80,152 2,004 161 1,260 1,446 4,652 720 1,026 321 115 3,358 1,996 869 618 3,944 1,959 1,682 1,075 1,391 3,043 329 1,279 1,550 1,631 2,321 1,864 2,030 418 985 314 219 1,342 518 3,385 1,807 915 3,787 2,153 964 3,652 319 1,530 882 1,363 4,133 1,411 156 2,096 1,393 1,067 2,456 243 1,608 ($000) $ 128,587 2,228 471 3,950 1,055 14,884 3,298 694 274 168 9,308 5,969 929 806 4,958 1,943 985 1,445 1,681 2,091 464 2,409 1,373 2,941 1,555 1,100 2,611 534 1,016 1,120 372 1,354 1,337 3,741 5,230 388 4,146 2,320 1,984 3,602 267 2,177 401 2,584 12,386 835 127 5,837 4,566 650 1,721 300 397 12 436079v1 State US--Total................. Alabama....................... Alaska.......................... Arizona......................... Arkansas...................... California...................... Colorado....................... Connecticut.................. Delaware...................... District of Columbia...... Florida.......................... Georgia......................... Hawaii........................... Idaho............................ Illinois........................... Indiana.......................... Iowa.............................. Kansas......................... Kentucky....................... Louisiana...................... Maine............................ Maryland....................... Massachusetts............. Michigan....................... Minnesota..................... Mississippi.................... Missouri........................ Montana....................... Nebraska...................... Nevada......................... New Hampshire............ New Jersey................... New Mexico.................. New York...................... North Carolina.............. North Dakota................ Ohio.............................. Oklahoma..................... Oregon......................... Pennsylvania................ Rhode Island................ South Carolina.............. South Dakota............... Tennessee.................... Texas............................ Utah.............................. Vermont........................ Virginia......................... Washington.................. West Virginia................ Wisconsin..................... Wyoming...................... Puerto Rico................... ADRC-TAE Issue Brief Table 22 (continued): June 2007 Estimated Selected Expenditures by State, FY 2002 Compensation and Pension Living and Deceased Veterans Total State US--Total...................... Alabama........................... Alaska............................... Arizona............................. Arkansas........................... California.......................... Colorado........................... Connecticut....................... Delaware.......................... District of Columbia.......... Florida............................... Georgia............................. Hawaii............................... Idaho................................. Illinois................................ Indiana.............................. Iowa.................................. Kansas.............................. Kentucky........................... Louisiana.......................... Maine................................ Maryland........................... Massachusetts.................. Michigan........................... Minnesota......................... Mississippi........................ Missouri............................ Montana............................ Nebraska.......................... Nevada............................. New Hampshire................ New Jersey....................... New Mexico...................... New York.......................... North Carolina.................. North Dakota.................... Ohio.................................. Oklahoma......................... Oregon.............................. Pennsylvania.................... Rhode Island.................... South Carolina.................. South Dakota.................... Tennessee........................ Texas................................ Utah.................................. Vermont............................ Virginia.............................. Washington...................... West Virginia.................... Wisconsin......................... Wyoming.......................... Puerto Rico....................... Number 3,201,892 79,272 11,383 66,878 46,654 269,584 55,320 25,784 9,055 6,987 254,468 114,026 15,025 17,010 79,487 52,661 26,325 29,902 54,337 59,621 24,031 56,838 71,314 80,707 49,333 42,586 63,009 14,726 23,414 28,318 16,956 61,791 30,332 144,810 117,985 8,186 112,666 64,800 44,815 126,092 12,819 63,024 12,459 78,551 264,280 16,534 6,716 110,268 91,566 30,531 52,000 6,656 45,990 Burial Service-Connected Amount Benefits ($000) ($000) Number $ 67,200 1,156 180 1,495 733 6,342 1,160 765 218 108 4,895 1,996 308 363 2,507 1,499 746 683 983 1,006 393 1,313 1,389 2,294 1,185 651 1,514 281 444 640 353 1,666 496 3,324 2,066 157 2,880 969 997 3,208 255 1,099 206 1,457 4,510 422 160 2,024 1,721 517 1,312 152 815 2,656,929 58,909 11,022 59,683 35,480 233,465 50,392 22,256 7,926 5,113 223,151 93,070 13,958 15,058 62,451 44,343 20,595 24,938 41,006 40,523 19,669 49,889 63,223 66,861 40,675 29,243 49,608 12,376 19,802 24,816 15,314 54,951 25,544 115,438 96,724 6,556 90,143 51,365 37,156 100,151 11,076 49,394 9,599 59,766 220,252 14,832 5,737 97,168 84,151 22,511 43,676 5,924 21,970 $ 24,906,560 597,520 94,783 571,338 435,453 2,041,707 426,399 179,318 65,051 89,029 1,901,396 843,033 124,133 139,733 540,172 377,879 198,361 226,374 436,632 465,057 241,548 420,651 556,783 543,882 377,175 345,818 494,092 123,221 197,851 216,227 137,834 448,331 291,518 1,050,404 933,050 60,752 792,249 634,295 400,480 948,493 107,169 493,927 99,217 611,309 2,146,882 129,146 58,912 791,389 770,113 278,881 400,147 51,447 406,226 Living Veterans Nonservice-Connected Amount ($000) $ 21,817,867 477,115 91,951 527,596 377,572 1,832,579 396,672 165,696 59,754 45,119 1,728,315 735,835 116,980 126,896 440,473 332,168 164,787 197,084 364,225 359,311 215,546 382,115 516,949 459,976 331,818 279,014 414,772 109,082 173,568 194,541 128,281 412,865 262,392 905,929 832,229 51,429 663,783 532,555 345,615 800,818 97,555 419,913 82,607 513,550 1,901,584 119,402 53,517 726,135 723,120 229,533 350,432 47,112 270,542 Total Amount Number 544,963 20,363 361 7,195 11,174 36,119 4,928 3,528 1,129 1,874 31,317 20,956 1,067 1,952 17,036 8,318 5,730 4,964 13,331 19,098 4,362 6,949 8,091 13,846 8,658 13,343 13,401 2,350 3,612 3,502 1,642 6,840 4,788 29,372 21,261 1,630 22,523 13,435 7,659 25,941 1,743 13,630 2,860 18,785 44,028 1,702 979 13,100 7,415 8,020 8,324 732 24,020 ($000) $ 2,988,768 119,250 2,652 42,247 57,147 202,786 28,567 12,857 5,079 11,077 168,185 105,203 6,845 12,475 97,192 44,211 32,828 28,607 71,424 104,741 25,610 37,223 38,444 81,612 44,172 66,153 77,805 13,858 23,838 21,046 9,200 33,800 28,630 141,151 98,754 9,167 125,585 100,772 53,868 144,467 9,358 72,915 16,405 96,301 240,787 9,322 5,235 63,230 45,272 48,831 48,403 4,183 134,869 Amount Number 2,689,784 61,621 10,806 57,976 36,920 229,229 48,595 22,317 7,717 5,674 218,050 92,317 13,292 15,143 67,780 45,175 22,103 25,447 43,607 45,862 20,875 48,346 61,615 69,309 42,239 31,952 52,287 13,148 20,349 25,271 15,047 53,035 26,001 120,927 95,904 7,068 95,273 53,656 39,149 104,585 10,946 50,571 10,564 62,469 219,194 14,669 5,721 92,429 81,079 24,871 45,623 5,981 33,612 ($000) $ 20,523,256 467,705 88,559 476,413 356,791 1,651,243 357,535 151,235 53,534 45,289 1,557,747 666,431 105,337 121,082 452,910 316,521 166,447 187,310 357,202 371,460 214,233 341,754 465,855 456,217 323,863 273,553 406,723 109,187 170,874 184,673 118,531 368,720 251,227 875,989 756,538 52,866 658,630 532,540 346,446 782,296 89,489 395,100 85,452 491,695 1,745,744 110,874 49,573 628,111 659,268 235,366 346,343 44,773 329,552 13 436079v1 ADRC-TAE Issue Brief Table 22 (continued): June 2007 Estimated Selected Expenditures by State, FY 2002 Compensation and Pension--Continued Living Veterans-Continued Service-Connected Amount State Number US--Total...................... Alabama........................... Alaska............................... Arizona............................. Arkansas........................... California.......................... Colorado........................... Connecticut....................... Delaware.......................... District of Columbia.......... Florida............................... Georgia............................. Hawaii............................... Idaho................................. Illinois................................ Indiana.............................. Iowa.................................. Kansas.............................. Kentucky........................... Louisiana.......................... Maine................................ Maryland........................... Massachusetts.................. Michigan........................... Minnesota......................... Mississippi........................ Missouri............................ Montana............................ Nebraska.......................... Nevada............................. New Hampshire................ New Jersey....................... New Mexico...................... New York.......................... North Carolina.................. North Dakota.................... Ohio.................................. Oklahoma......................... Oregon.............................. Pennsylvania.................... Rhode Island.................... South Carolina.................. South Dakota.................... Tennessee........................ Texas................................ Utah.................................. Vermont............................ Virginia.............................. Washington...................... West Virginia.................... Wisconsin......................... Wyoming.......................... Puerto Rico....................... 2,359,812 51,521 10,508 52,877 30,306 205,103 45,301 20,297 7,111 4,454 196,697 81,167 12,540 13,688 56,837 40,126 18,549 22,223 35,967 35,098 17,806 44,296 56,900 60,569 37,120 24,864 43,938 11,398 17,893 22,494 13,962 49,384 22,797 104,361 84,505 6,037 81,554 44,720 33,554 89,706 9,855 43,090 8,714 52,143 192,705 13,508 5,090 85,229 75,950 19,844 40,024 5,432 18,902 ($000) $ 18,183,032 387,247 86,157 441,014 313,042 1,485,432 333,591 141,114 49,731 36,245 1,421,017 591,063 99,706 110,122 373,988 281,544 139,356 163,566 303,178 294,096 192,351 312,925 435,004 388,656 288,118 225,610 345,605 97,041 150,341 165,965 110,719 342,885 227,979 766,289 686,444 45,407 557,955 449,383 301,214 670,275 81,682 343,014 72,015 422,535 1,557,667 102,988 45,242 582,082 621,409 196,767 305,027 41,230 232,426 Deceased Veterans Nonservice-Connected Total Amount Number 329,972 10,100 298 5,099 6,614 24,126 3,294 2,020 606 1,220 21,353 11,150 752 1,455 10,943 5,049 3,554 3,224 7,640 10,764 3,069 4,050 4,715 8,740 5,119 7,088 8,349 1,750 2,456 2,777 1,085 3,651 3,204 16,566 11,399 1,031 13,719 8,936 5,595 14,879 1,091 7,481 1,850 10,326 26,489 1,161 631 7,200 5,129 5,027 5,599 549 14,710 ($000) $ 2,340,224 80,458 2,402 35,399 43,749 165,811 23,944 10,120 3,804 9,044 136,730 75,368 5,631 10,960 78,921 34,977 27,091 23,744 54,024 77,364 21,882 28,829 30,851 67,561 35,745 47,943 61,118 12,146 20,533 18,708 7,811 25,835 23,248 109,700 70,094 7,459 100,674 83,158 45,232 112,021 7,808 52,086 13,437 69,160 188,077 7,887 4,332 46,029 37,859 38,599 41,316 3,543 97,126 Service-Connected Amount Number 512,108 17,651 577 8,902 9,734 40,355 6,725 3,467 1,338 1,313 36,418 21,709 1,733 1,867 11,707 7,486 4,222 4,455 10,730 13,759 3,156 8,492 9,699 11,398 7,094 10,634 10,722 1,578 3,065 3,047 1,909 8,756 4,331 23,883 22,081 1,118 17,393 11,144 5,666 21,507 1,873 12,453 1,895 16,082 45,086 1,865 995 17,839 10,487 5,660 6,377 675 12,378 ($000) $ 4,283,379 128,660 6,043 93,430 77,928 384,122 67,704 27,318 11,299 10,907 338,753 174,607 18,488 18,289 84,755 59,858 31,168 38,381 78,446 92,591 26,923 77,584 89,538 85,371 52,128 71,614 85,854 13,753 26,532 30,914 18,950 77,944 39,795 171,091 174,445 7,730 130,739 100,786 53,037 162,989 17,424 97,727 13,559 118,157 396,627 17,850 9,179 161,254 109,125 42,997 52,492 6,522 75,859 Nonservice-Connected Amount Number 297,117 7,388 514 6,806 5,174 28,362 5,091 1,959 815 659 26,454 11,903 1,418 1,370 5,614 4,217 2,046 2,715 5,039 5,425 1,863 5,593 6,323 6,292 3,555 4,379 5,670 978 1,909 2,322 1,352 5,567 2,747 11,077 12,219 519 8,589 6,645 3,602 10,445 1,221 6,304 885 7,623 27,547 1,324 647 11,939 8,201 2,667 3,652 492 3,068 ($000) $ 3,634,835 89,868 5,794 86,583 64,530 347,148 63,081 24,581 10,023 8,874 307,298 144,772 17,274 16,774 66,484 50,624 25,432 33,518 61,046 65,214 23,195 69,189 81,946 71,320 43,701 53,404 69,167 12,041 23,227 28,576 17,562 69,980 34,413 139,640 145,784 6,022 105,828 83,172 44,402 130,544 15,874 76,898 10,591 91,015 343,917 16,415 8,276 144,053 101,712 32,766 45,405 5,882 38,116 Amount Number 214,991 10,263 63 2,096 4,560 11,993 1,634 1,508 523 654 9,964 9,806 315 497 6,093 3,269 2,176 1,740 5,691 8,334 1,293 2,899 3,376 5,106 3,539 6,255 5,052 600 1,156 725 557 3,189 1,584 12,806 9,862 599 8,804 4,499 2,064 11,062 652 6,149 1,010 8,459 17,539 541 348 5,900 2,286 2,993 2,725 183 9,310 ($000) $ 648,544 38,792 249 6,848 13,398 36,975 4,623 2,736 1,276 2,033 31,455 29,835 1,214 1,516 18,271 9,234 5,737 4,863 17,400 27,377 3,728 8,394 7,593 14,051 8,427 18,211 16,687 1,712 3,305 2,338 1,389 7,964 5,382 31,451 28,661 1,708 24,911 17,614 8,636 32,446 1,550 20,829 2,968 27,142 52,710 1,435 903 17,201 7,413 10,231 7,087 640 37,742 Table B Notes: (1) "U.S. Total" does not include Puerto Rico. SOURCE: C&P expenditures for the 50 states, D.C. and Puerto Rico were derived from the Federal Assistance Awards Data System (FAADS). Education expenditures are also derived from FAADS. FAADS data differs from budgetary accounting data. FAADS shows payment amounts prior to adjustments. "Insurance and Indemnities Amount" data are provided by the VA Regional Office and Insurance Center, Philadelphia, Pa. Medical and Administrative and Construction estimates are derived from VA accounting reports. ** State totals include expenditures not shown in program categories. CONTACT: Henry Caplan at (202) 273-5124, Office of Planning and Analysis (008) 14 436079v1