text:
Veterans Health Administration
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Not to be confused with Veterans Benefits Administration.
"VA Medical Center" redirects here. For transit stations of this name, see Medical Center Station.
This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (July 2017) (Learn how and when to remove this template message)
Agency overview
Formed
1865[1]
Jurisdiction
Federal government of the United States
Headquarters
810 Vermont Avenue NW., Washington, D.C., United States
38°54′03″N 77°02′05″W / 38.90083°N 77.03472°W / 38.90083; -77.03472
Employees
298,546 (2015)[2]
Annual budget
$65 billion USD (2015)[2]
Agency executives
David Shulkin,
Secretary
Vacant,
Under Secretary for Health
Parent agency
United States Department of Veterans Affairs
Website
www.va.gov/HEALTH/
The Veterans Health Administration (VHA) is the component of the United States Department of Veterans Affairs (VA) led by the Under Secretary of Veterans Affairs for Health[2] that implements the medical assistance program of the VA through the administration and operation of numerous VA Medical Centers (VAMC), Outpatient Clinics (OPC), Community Based Outpatient Clinics (CBOC), and VA Community Living Centers (VA Nursing Home) Programs.
Many evaluations have found that by most measures VHA care is equal to, and sometimes better than, care provided in the private sector, when judged by standard evidence-based guidelines.[3][4][5][6][7][8][9][10][11][12]
The VHA is distinct from the U.S. Department of Defense Military Health System of which it is not a part.
The VHA division has more employees than all other elements of the VA combined.
Contents
[hide]
1 History
1.1 Veterans Health Administration scandal of 2014
2 VA Health Reform
2.1 1993 Clinton Healthcare Reform
2.2 1994 VA Primary Care Directive
2.3 Dr. Kenneth W. Kizer and the VA Reform
3 Use of electronic records
4 Initiatives
5 Services
5.1 Mental health
5.2 PTSD
5.3 Women
5.4 Primary care
5.5 Specialty care
6 Evaluations
7 Physicians
8 Eligibility for VA health care benefits
8.1 Eligibility priority groups
9 Covered services/acute care benefits
9.1 Standard benefits
9.2 Limited benefits
10 Long term benefits
10.1 Standard benefits
10.2 Limited benefits
10.3 Financial Assessment for Long-Term Care Services
11 Home health care
11.1 Skilled Home Health Care Services (SHHC)
11.2 Homemakers/Home Health Aide Services (H/HHA)
11.3 Family Caregivers Program
12 Patient Aligned Care Team (PACT)
13 VA dental Care
14 Transplant service
15 Vet Centers
16 OEF/OIF/OND veterans
16.1 OEF/OIF/OND Care Management Team
17 Domiciliary Care Program
18 VA travel reimbursement
19 Federal benefits for veterans, dependents and survivors
19.1 Medical programs
20 See also
21 References
History[edit]
The first Federal agency to provide medical care to veterans was the Naval Home in Philadelphia, Pennsylvania. The home was created in 1812 and was followed by the creation of Soldiers Home in 1853 and St. Elizabeth's Hospital in 1855. Congress created the National Home for Disabled Volunteer Soldiers in 1865 in response to the high number of Civil War casualties. These homes were initially intended to be room and board for disabled veterans. However, by the late 1920s, the homes were providing a level of care comparable to hospital care.
President Hoover created the Veterans Administration (VA) in 1930 to consolidate all veteran services. General Omar N. Bradley was appointed to VA administrator and Bradley appointed Major General Paul Hawley as director of VA medicine, both in 1945. Hawley successfully established a policy that affiliated new VA hospitals with medical schools. Hawley also promoted resident and teaching fellowships at VA hospitals. Ultimately, Hawley was responsible for starting the hospital-based research program at the VA. Bradley resigned in 1947. However, upon resignation, 97 hospitals were in operation and 29 new hospitals had been built. As a result, the VA health system was able to serve a much larger population of veterans than it had served in previous years.
In 1988, President Reagan signed the Department of Veterans Affairs Act, which elevated the VA to Cabinet-level, then becoming known as the Department of Veterans Affairs. The Department of Veterans Affairs oversees the Veterans Health Administration.[13]
In the mid-1980s the VHA was criticized for their high operative mortality. To that end, Congress passed Public Law 99-166 in December 1985 which mandated the VHA to report their outcomes in comparison to national averages and the information must be risk-adjusted to account for the severity of illness of the VHA surgical patient population. In 1991 the National VA Surgical Risk Study (NVASRS) began in 44 Veterans Administration Medical Centers. By December 31, 1993 there was information for 500,000 non-cardiac surgical procedures. In 1994 NVASRS was expanded to all 128 VHA hospitals that performed surgery. The name was then changed to the National Surgical Quality Improvement Program.[14]
Beginning in the mid-1990s VHA underwent what the agency characterizes as a major transformation aimed at improving the quality and efficiency of care it provides to its patients. That transformation included eliminating underutilized inpatient beds and facilities, expanding outpatient clinics, and restructuring eligibility rules. A major focus of the transformation was the tracking of a number of performance indicators—including quality-of-care measures—and holding senior managers accountable for improvements in those measures.[15]
Veterans Health Administration scandal of 2014[edit]
Main article: Veterans Health Administration scandal of 2014
In May 2014, major problems with scheduling timely access to medical care became public. According to a retired doctor at the center interviewed by CNN, at least 40 veterans died waiting for care at the Phoenix, Arizona Veterans Health Administration facilities. An investigation of delays in treatment throughout the Veterans Health Administration system was conducted by the Veterans Affairs Inspector General, but it only found six deaths caused by the delay.[16][17] On May 30, 2014, Secretary of Veterans Affairs Eric Shinseki resigned from office due to the fallout from the scandal.[18] Despite the negative exposure and the subsequent vows by Washington lawmakers to take action, the major problems still exist.[19][20][when?]
On June 24, 2014, Senator Tom Coburn, Republican from Oklahoma, and a medical doctor, released a report called Friendly Fire: Death, Delay, and Dismay at the VA which detailed the actions and misconduct of employees of the Department of Veteran Affairs. The report is based on yearlong investigations conducted by Senator Coburn's office on Veterans Health Administration facilities across the nation. The report details the many veterans who have died waiting for health care as a result of the VA misconduct. Secret waiting lists, poor patient care, the millions of dollars that are intended for health care that has gone unspent every year and reports of bonuses paid out to employees who have lied and covered up statistics are also detailed in the report.[21]
However, a VA Inspector General's report issued on August 26, 2014, reported that six, not forty, veterans had died experiencing “clinically significant delays” while on waiting lists to see a VA doctor, and in each of these six cases, “we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.”[22][23]
VA Health Reform[edit]
1993 Clinton Healthcare Reform[edit]
The Clinton Healthcare Plan was a health care reform proposed by the Clinton Administration. Even though the reform was not successful, a task force was created in response to the Clinton Healthcare Reform proposal to determine if the VA was ready for managed care.[24] The negative results of market research forced the VA system to re-evaluate its current operations. Research revealed that three out of four veterans would leave the VA network if a national healthcare system were adopted. They also found that there was a high demand for primary care throughout the VA system. Research showed that many VA facilities believed that 55 percent of patients would choose to receive primary care at the VA facility if a primary care system was fully implemented in 1993. The study also showed that the VA facilities believed that 83 percent of veterans would choose to receive primary care at the VA if fully implemented by 1998. These results made it clear to the administration that it was time for a reform.[25]
1994 VA Primary Care Directive[edit]
This directive required all VA facilities to have primary care teams by year 1996.[26] As a result, percentage of patients receiving primary care at the VA increased from 38 percent to 45 percent to 95 percent, during 1993, 1996, and 1999.[25] This mandate served as the foundation for the VA reorganization under Dr. Kenneth W. Kizer.
Dr. Kenneth W. Kizer and the VA Reform[edit]
Dr. Kizer, a physician trained in emergency medicine and Public Health, was appointed by President Bill Clinton as Director of U.S. Veterans Health Administration in 1994. He was hired to update and modernize the VA health system in order to eliminate negative perception and to align the system with current market trends. Core issues included:
Advancements in technology and biomedical knowledge
Aging and socioeconomically disadvantaged Medicare patients
Coordinating care
Rising healthcare costs
There was much opposition to a major reform. Many legislators preferred an incremental change over a wide-scale reform. However, Kizer was known as being very innovative. To publicize his vision he expressed his mission and vision of the "new VHA" and outlined seven key principles to guide change. His ultimate goal was to provide coordinated, high quality care at a low cost.
He launched his reorganization plan in 1995 by decentralizing the VA system. He organized all VA operating units into 22 geographic based networks known as Veterans Integrated Service Networks (VISNs). This allowed networks to manage themselves and adapt to the demographics of their location. Patients were then assigned to a group of doctors who would provide coordinated care. One director was hired for each VISN network. Instead of hiring all directors internally, a third of the newly hired VISN directors were hired outside of the VA system. The directors were responsible for meeting performance goals and improving upon measurable key efficiency and quality indicators. Directors monitored performances and reports were generated to show each network's performance. Some of these indicators included:
chronic disease quality
prevention performance
patient satisfaction ratings
utilization management
The reform also changed the procedure for allocating funds to the various VISNs. Historically, funds were distributed between hospitals based on historical costs. However, it was found that this method affected efficiency and quality of services. Therefore, funding for each VISN was distributed based on the number of veterans seen in each network, rather than on historical values.[27]
The New England Journal of Medicine conducted a study from 1994–2000 to evaluate the efficacy of the healthcare reform. They gathered the results of the evaluated key indicators from each of the networks and interpreted the results. There were noticeable improvements, compared with the same key indicators used for the Medicare fee for service system, as soon as two years after the reorganization. These improvements continued through year 2000. These results indicate that the changes made throughout the VA healthcare system, under the leadership of Kizer, did improve the efficiency and quality of care in VA healthcare system.[28]
Use of electronic records[edit]
VHA is especially praised for its efforts in developing a low cost open source electronic medical records system VistA[29] which can be accessed remotely (with secure passwords) by health care providers. With this system, patients and nurses are given bar-coded wristbands, and all medications are bar-coded as well. Nurses are given wands, which they use to scan themselves, the patient, and the medication bottle before dispensing drugs. This helps prevent four of the most common dispensing errors: wrong med, wrong dose, wrong time, and wrong patient. The system, which has been adopted by all veterans hospitals and clinics and continuously improved by users, has cut the number of dispensing errors in half at some facilities and saved thousands of lives.[30]
At some VHA medical facilities, doctors use wireless laptops, putting in information and getting electronic signatures for procedures. Doctors can call up patient records, order prescriptions, view X-rays or graph a chart of risk factors and medications to decide treatments. Patients have a home page that have boxes for allergies and medications, records every visit, call and note, and issues prompts reminding doctors to make routine checks. This technology has helped the VHA achieve cost controls and care quality that the majority of private providers cannot achieve.[31] The Veterans Health Administration Office of Research and Development's research into developing better-functioning prosthetic limbs, and treatment of PTSD are also heralded. The VHA has devoted many years of research into the health effects of the herbicide Agent Orange used by military forces in Vietnam.
In October 2012, the VHA announced a new goal "to care for and heal our wounded Veterans. In addition to repairing their damaged bodies and minds, VA has embarked on a unique campaign to repair their crumbling intimate relationships."[32][33]
Initiatives[edit]
The VHA has expanded its outreach efforts to include men and women veterans and homeless veterans.
The VHA, through its academic affiliations, has helped train thousands of physicians, dentists, and other health professionals. Several newer VA medical centers have been purposely located adjacent to medical schools.
The VHA support for research and residency/fellowship training programs has made the VA system a leader in the fields of geriatrics,[34][35] spinal cord injuries,[36] Parkinson's disease [1], and palliative care.
The VHA has initiatives in place to provide a "seamless transition" to newly discharged veterans transitioning from Department of Defense health care to VA care for conditions incurred in the Iraq War or war in Afghanistan.
The Veterans Health Administration Office of Research and Development's research into developing better-functioning prosthetic limbs, and treatment of PTSD are also heralded. The VHA has devoted many years of research into the health effects of the herbicide Agent Orange used by military forces in the Vietnam War.
In October 2012, the VHA announced a new goal "to care for and heal our wounded Veterans. In addition to repairing their damaged bodies and minds, VA has embarked on a unique campaign to repair their crumbling intimate relationships."[32][33]
The VHA has also adopted Boston University's Project RED program,[37] designed to improve the discharge process for veterans in hopes that, by educating patients, the VHA will experience a reduced number of readmission among veterans and provide more information on telerehabilitation.[38]
Services[edit]
Mental health[edit]
The percentage of patients with a mental illness was 15 percent in 2007. The percentage of veterans with mental illnesses has trended up. The VHA allocated an extra 1.4 billion dollars per year to mental health program between 2005 and 2008. Mental health services in 2006 were evaluated as a part of the Mental Health Strategic Plan.[39][40] The report concluded:
"Quality of care at the VA was shown to be better than the private sector. The VA had a higher level of performance then the private sector for 7 out of 9 indicators. In fact, they "exceeded private plan performance by large margins....Patients did not indicate improvement in their conditions. However, they had a very favorable opinions of their care.[39]
In 2009, the VA implemented an initiative called Suicide Assessment and Follow-Up Engagement: Veteran Emergency Treatment (SAFE VET) to identify and treat veterans at risk of suicide by providing care coordination for outpatient mental health services and community-based support.[41]
PTSD[edit]
Veteran Affairs utilization rates among Iraqi and Afghanistan-war veterans in the mid-Atlantic region with PTSD diagnosis between 2002–2008 were tracked using ICD-9 codes of those newly diagnosed. When compared to veterans already being treated, veterans new to VA treatment program were less likely to complete follow up visits, and had fewer medication-possession days (74.9 days versus 34.9 days); also long wait times hindered VA medical utilization.[42] Limitations to this study included: type of treatment intervention was not delineated; only looked at PTSD treatment over a short period of time (180 days).
Another study found there was an increase in demand of the VA health system among veterans. Nearly 250,000 veterans were identified between 2001 and 2007; Iraq and Afghanistan war veterans had a 40 percent utilization rate, compared to only 10 percent of Vietnam veterans.[43] Veterans were categorized into three groups: non-mental health diagnosis, non-PTSD mental diagnosis, and PTSD mental diagnosis.[43] The most prevalent diagnosis was PTSD. The typical veteran affected by PTSD was male, from the Army or Marines, and a lower-ranked officer.[43] Veterans with PTSD had a high utilization of the VA system at over 91 percent.[43]
While this was a comprehensive study, there is more to be studied and understood about the effects of PTSD on returning veterans from active combat. A major limitation is that this study only captured the utilization of veterans within the VA health system. There was no data on veterans who sought medical services outside of the VA health system. We can have a better understanding of the mental health needs of veterans returning to civilian life. Moreover, it would be beneficial to explore and examine how utilization of mental health services is affected by the stigma that persists among veterans. Additional awareness of medical resources available to veterans can help to erase the stigma of seeking mental health treatment.
Women[edit]
With the population of women veterans projected to rise from 1.6 million in 2000 to 1.9 million in 2020, the VA has worked to integrate quality women's medical services into the VA system.[44] However, studies show that 66.9 percent of women who do not use the VA for women's services consider private practice physicians more convenient. Also, 48.5 percent of women do not use women's services at the VA due to a lack of knowledge of VA eligibility and services.[45]
Primary care[edit]
General care includes health evaluation and counseling, disease prevention, nutrition counseling, weight control, smoking cessation, and substance abuse counseling and treatment as well as gender-specific primary care, e.g., cervical cancer screens (Pap smears), breast cancer screens (mammograms), birth control, preconception counseling, Human Papillomavirus (HPV) vaccine and menopausal support (hormone replacement therapy).
Mental health includes evaluation and assistance for issues such as depression, mood, and anxiety disorders; intimate partner and domestic violence; elder abuse or neglect; parenting and anger management; marital, caregiver, or family-related stress; and post-deployment adjustment or post-traumatic stress disorder (PTSD).
Veterans may have experienced sexual harassment or sexual assault, known as military sexual trauma (MST) during their service. Health services are available to victims. VHA provides free, confidential counseling and treatment for MST-related mental and physical health conditions.
Specialty care[edit]
Management and screening of chronic conditions includes heart disease, diabetes, cancer, glandular disorders, osteoporosis and fibromyalgia as well as sexually transmitted diseases such as HIV/AIDS and hepatitis.
Reproductive health care includes maternity care, infertility evaluation and limited treatment; sexual problems, tubal ligation, urinary incontinence, and others. VHA is prohibited from providing either in-vitro fertilization or abortion services.
Rehabilitation, home care, and long-term care referrals are given to those in need of rehabilitation therapies such as physical therapy, occupational therapy, speech-language therapy, exercise therapy, recreational therapy, and vocational therapy.
Evaluations[edit]
"Patients routinely rank the veterans system above the alternatives", according to the American Customer Satisfaction Index. In 2008, the VHA got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. In the same report VHA outpatient care scored 3 points higher than for private hospitals.[31]
"As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators."[46]
A study that compared VHA with commercial managed care systems in their treatment of diabetes patients found that in all seven measures of quality, the VHA provided better care.[47]
A RAND Corporation study in 2004 concluded that the VHA outperforms all other sectors of American health care in 294 measures of quality. Patients from the VHA scored significantly higher for adjusted overall quality, chronic disease care, and preventive care, but not for acute care.[29]
A 2009 Congressional Budget Office report on the VHA found that "the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelines — particularly those that VHA has emphasized in its internal performance measurement system. Such research is complicated by the fact that most users of VHA's services receive at least part of their care from outside providers."[15]
A Harvard Medical School-led study shows that cancer care provided by the Veterans Health Administration for men 65 years and older is at least as good as, and by some measures better than, Medicare-funded fee-for-service care obtained through the private sector.[48]
Physicians[edit]
Doctors who work in the VHA system are typically paid less in core compensation than their counterparts in private practice. However, VHA compensation includes benefits not generally available to doctors in private practice, such as lesser threat of malpractice lawsuits, freedom from billing and insurance company payment administration, and the availability of the government's open source electronic records system VistA.[31]
Eligibility for VA health care benefits[edit]
A VA Veteran identification VIC card for Veterans eligible for VA health care benefits
To be eligible for VA health care benefit programs one must have served in the active military, naval or air service and separated under any condition other than dishonorable.
The minimum duty requirements are that veterans who enlisted after September 7, 1980, or who entered active duty after October 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. The minimum duty requirement may not apply to veterans who were discharged for a disability incurred in the line of duty, for a hardship or "early out". The VA determines the minimum requirements when the veteran enrolls for VA health care benefits.
To apply for entry into the VA health care system the veteran must complete VA Form 10-10EZ, Application for health care benefits.
Eligible veterans will receive a VA Veterans Health Identification Card (VHIC) formerly Veteran identification card (VIC) for use at all VA medical facilities.
By federal law, eligibility for benefits is determined by a system of eight priority groups. Retirees from military service, veterans with service-connected injuries or conditions rated by VA, and Purple Heart recipients are within the higher priority groups.
Current and former members of the Reserves and the National Guard who were called to active duty (other than for monthly drills and annual training) by a federal executive order may be eligible for VA health care benefits.[49]
Veterans without rated service-connected conditions may become eligible based on financial need, adjusted for local cost of living. Veterans who do not have service-connected disabilities totaling 50% or more may be subject to copayments for any care they received for nonservice-connected conditions.
Eligibility priority groups[edit]
Priority Groups
Group Description
Group 1
Veterans with service-connected disabilities rated 50 percent or more disabling.
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 who are former POWs.
Veterans awarded the Purple Heart Medal.
Veterans awarded the Medal of Honor.
Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
Veterans with VA service-connected disabilities rated 10 percent or 20 percent.
Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, "benefits for individuals disabled by treatment or vocational rehabilitation."
Group 4
Veterans receiving increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound.
Veterans determined by VA to be catastrophically disabled.
Group 5
Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0 percent, whose annual income and/ or net worth are not greater than the VA financial thresholds.
Veterans receiving VA Pension benefits.
Veterans eligible for Medicaid benefits.
Group 6
Compensable 0 percent Service-connected Veterans.
Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.
Project 112/SHAD participants.
Veterans who served in the Republic of Vietnam between January 9, 1962 and May 7, 1975.
Veterans who served in the Persian Gulf War in the Southwest Asia theater of operations from August 2, 1990, through November 11, 1998.
Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning January 1, 1957 and ending December 31, 1987.
Veterans who served in a theater of combat operations after Nov.11, 1998, as follows:
Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years post discharge.
Group 7
Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment.
Group 8
Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copayments. Veterans eligible for enrollment: Noncompensable 0-percent service-connected and:
Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.
Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less
Veterans eligible for enrollment: Nonservice-connected and Subpriority c: Enrolled as of January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status
Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less
Veterans NOT eligible for enrollment: Veterans not meeting the criteria above: Subpriority e: Noncompensable 0 percent service-connected Subpriority f: Nonservice-connected
Covered services/acute care benefits[edit]
Standard benefits[edit]
Preventive Care Services
Counseling on inheritance of genetically determined disease
Immunization
Nutrition Education
Physical Examinations (Including eye and hearing examinations)
Health Care Assessments
Screening Test
Health Education Programs
Ambulatory (Outpatient) and Hospital (Inpatient), Diagnostic and Treatment Services
Medical
Surgical (Including reconstructive/plastic surgery as a result of disease or trauma)
Mental Health
Dialysis
Substance Abuse
Prescription Drugs (when prescribed by a VA Physician)
Limited benefits[edit]
The following care services have limitations and may have special eligibility criteria:
Ambulance Services
Chiropractic Care[50] (at 47 VA hospitals[dead link])
Dental Care (see VA Dental Care)
Durable Medical Equipment (walkers, crutches, canes, bathtub seats)
Eyeglasses
Hearing Aids
Home Health Care
Maternity and Parturition (Childbirth) Services Usually provided in non-VA contracted hospitals at VA expense; care is usually limited to a mother. (VA may furnish health care services to a newborn child of a woman Veteran who is receiving maternity care furnished by VA for not more than seven days after the birth if the Veteran delivered the child in (1) a VA facility, or (2) another facility pursuant to a VA contract for services relating to such delivery)
Non-VA Health Care Services
Long term benefits[edit]
Standard benefits[edit]
Geriatric Evaluation. Geriatric evaluation is the comprehensive assessment of a Veteran's ability to care for him/herself physical health and social environment, which leads to a plan of care. The plan could include treatment, rehabilitation, health promotion and social services. These evaluations are performed by inpatient Geriatic Evaluation Management (GEM) Units, GEM clinics, geriatic primary care clinics and other outpatient settings.
Adult Day Health Care. The adult day health care (ADHC) program is a therapeutic day care program, providing medical and rehabilitation services to disabled Veterans in a combined setting.
Respite Care. Respite care provides supportive care to Veterans on a short-term basis to give the caregiver planned relief from the physical and emotional demands associated with providing care. Respite care can be provided in the home or other institutional settings.
Home Care. Skilled home care is provided by VA and contract agencies to Veterans that are home bound with chronic diseases and includes nursing, physical/occupational therapy and social services.
Hospice/Palliative Care. Hospice/Palliative care programs offers pain management, symptom control and other medical services to terminally ill Veterans or Veterans in the late stages of the choronic disease process. Services also include respite care as well as bereaverement counseling to family members.
Limited benefits[edit]
Nursing Home Care. VA provides nursing home services to Veterans through three national programs: VA owned and operated Community Living Centers (CLC), State Veterans' Homes owned and operated by the states, and the community nursing home program. Each program has admission and eligibility criteria specific to the program. Nursing home care is available for enrolled Veterans who need nursing home care for a service-connected disability, or Veterans or who have a 70 percent or greater service-connected disability and Veterans with a rating of total disability based on individual unemployability. VA provided nursing home care for all other Veterans is based on available resources.
Domiciliary Care. Domiciliary care provides rehabilitative and long-term, health maintenance care for Veterans who require some care, but who do not require all services provided in nursing homes. Domiciliary care emphasizes rehabilitation and return to the community. VA may provide domiciliary care to Veterans whose annual income does not exceed the maximum annual rate of VA pension or to Veterans who have no adequate means of support.
Financial Assessment for Long-Term Care Services[edit]
For Veterans who are not automatically exempt from making co-pays for long-term care services separates financial assessment (VA Form 10-10EC, APPLICATION FOR EXTENDED CARE SERVICES) must be completed to determine whether a Veteran qualifies for cost-free services or to what extent they are required to make long-care co-pays. Unlike co-pays for other VA health care services, which are based on fixed changes for all long-term care co-pay changes are individually adjusted based on each Veteran's financial status.
Home health care[edit]
Home health care includes VA's Skilled Home Health Care Services (SHHC) and Homemakers and Home Health Aide Services (H/HHA).
Skilled Home Health Care Services (SHHC)[edit]
SHHC services are in-home services provided by specially trained personnel, including nurses, physical therapists, occupational therapists and social workers. Care includes clinical assessment, treatment planning and treatment provision, health status monitoring, patient and family education, reassessment, referral and follow-up.
Homemakers/Home Health Aide Services (H/HHA)[edit]
H/HHA services are personal care and related support services that enable frail or disabled Veterans to live at home.
Family Caregivers Program[edit]
VA's Family Caregivers Program provides support and assistance to caregivers of post 9/11 Veterans and Servicemembers being medically discharged. Eligible primary Family Caregivers can receive a stipend, training, mental health services, travel and lodging reimbursement, and access to health insurance if they are not already under a health plan care.
Patient Aligned Care Team (PACT)[edit]
The Department of Veterans Affairs' Office of Patient Care Services has a Primary Care Program Office that has implemented a new patient-centered medical home (PCMH) model at VHA primary care sites. This PCMH model is referred to as Patient Aligned Care Teams (PACT). PAC Teams provide accessible, patient-centered care and are managed by primary care providers with the active involvement of other clinical and non-clinical staff. Veteran patients will be at the center of a "teamlet," which will include a primary care provider, RN care manager, LPN/health tech, and a medical support assistant (MSA). This teamlet is supported by a broader "team," which includes social workers, dieticians, pharmacists, and mental health specialists. Patient Aligned Care Teams (PACTs) are being implemented at all VA Primary Care Sites, including VA Community Based Outpatient Clinics (CBOC).
VA dental Care[edit]
For VA dental care a veteran must have a service-connected compensable dental disability or condition. Those who were prisoners of war (POWs) and those whose service-connected disabilities have been rated at 100 percent or who are receiving the 100 percent rate by reason of individual unemployability (IU) are eligible for any needed dental care, as are those veterans actively engaged in a 38 USC Chapter 31 vocational rehabilitation program and veterans enrolled who may be homeless and receiving care under VHA Directive 2007-039.
Transplant service[edit]
If the need arises, veterans are eligible for transplant service. The request will be coordinated by the Primary Care Team.
Vet Centers[edit]
The Vet Center Program was established by Congress in 1979 in response to the readjustment problems that a significant number of Vietnam-era veterans were continuing to experience after their return from combat. In subsequent years, Congress extended eligibility to all combat veterans who served on active duty from previous conflicts.
All community based Vet Centers provide readjustment counseling, outreach services and referral services to help veterans make a satisfying post-war readjustment to civilian life. Services are also available for their family members for military related issues. Vet Centers are staffed with small multidisciplinary teams some of whom are combat veterans themselves.
OEF/OIF/OND veterans[edit]
OEF/OIF/OND Care Management Team[edit]
The Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Care Management Team helps returning service members achieve a smooth transition of health care services. A specialized OEF/OIF/OND care management team provides case management and care coordination for all severely ill, injured and impaired combat veterans, including those suffering from:
Mental illness
Traumatic brain injury
Spinal cord injury
Blindness
Burns
Amputation
Terminal Illness/Injury
Polytrauma
Other conditions not mentioned above that cause significant impairment to daily living
Domiciliary Care Program[edit]
The Domiciliary Care Program of the Department of Veterans Affairs provides residential rehabilitative and clinical care to veterans who have a wide range of problems, illnesses, or rehabilitative care needs which can be medical, psychiatric, substance use, homelessness, vocational, educational, or social. The Domiciliary Care Program provides a 24-hour therapeutic setting utilizing a peer and professional support environment. The programs provide a strong emphasis on psychosocial rehabilitation and recovery services that instill personal responsibility to achieve optimal levels of independence upon discharge to independent or supportive community living. The VA Domiciliary Care Program also provides rehabilitative care for homeless veterans.
Eligibility: VA may provide domiciliary care to veterans whose annual gross household income does not exceed the maximum annual rate of VA pension or to veterans who the Secretary of Veterans Affairs determines have no adequate means of support. The copays for extended care services apply to domiciliary care.
VA travel reimbursement[edit]
Veterans may be eligible for mileage reimbursement or special mode transport in association with obtaining VA health care services if the veteran has a service-connected rating of 30 percent or more, or is traveling for treatment of a service-connected condition, receives a VA pension, the veteran's income does not exceed the maximum annual VA pension rate, the veteran is traveling for a scheduled compensation or pension examination, is in certain emergency situations. has a medical condition that requires a special mode of transportation and travel is pre-authorized, as are certain non-veterans when related to care of a veteran (caregivers, attendants and donors).
Federal benefits for veterans, dependents and survivors[edit]
Medical programs[edit]
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefit program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries. The program is available to spouses and children of veterans with permanent and total service-connected disability ineligible for the DoD TRICARE. The surviving spouse or child of a veteran who died from a VA service-connected disability, or who at the time of death was rated permanently and total disabled. Similarly to TRICARE, CHAMPVA beneficiaries are also accepted by TRICARE providers.
The Spina Bifida Program (SB). Is a comprehensive health care benefits program administered by the Department of Veterans Affairs for birth children of certain Vietnam and Korea War veterans who have been diagnosed with spina bifida (except spina bifida occulta). The SB program provides reimbursement for inpatient and outpatient medical services, pharmacy, durable medical equipment, and supplies.
The Children of Women Vietnam Veterans (CWVV) Health Care Program. Is a federal health benefits program administered by the Department of Veterans Affairs for children of women Vietnam War veterans born with certain birth defects. The CWVV Program provides reimbursement for medical care related to covered birth defects and conditions associated with the covered birth defect except for spina bifida.
See also[edit]
Veterans benefits for post-traumatic stress disorder in the United States
EBenefits
Gerontology
Rehabilitation Research and Development Service
References[edit]
Jump up ^ "VA History". VHA. Retrieved July 9, 2017.
^ Jump up to: a b c U.S. Department of Veterans Affairs (February 9, 2016). "Office of Budget". Va.gov. Retrieved September 20, 2016.
Jump up ^ Barry, Catherine N.; Bowe, Thomas R.; Suneja, Anecia (August 1, 2016). "An Update on the Quality of Medication Treatment for Mental Disorders in the VA". Psychiatric Services. 67 (8): 930. doi:10.1176/appi.ps.670804. ISSN 1075-2730.
Jump up ^ Watkins, Katherine E.; Smith, Brad; Akincigil, Ayse; Sorbero, Melony E.; Paddock, Susan; Woodroffe, Abigail; Huang, Cecilia; Crystal, Stephen; Pincus, Harold Alan (November 16, 2015). "The Quality of Medication Treatment for Mental Disorders in the Department of Veterans Affairs and in Private-Sector Plans". Psychiatric Services. 67 (4): 391–96. doi:10.1176/appi.ps.201400537. ISSN 1075-2730.
Jump up ^ Asch, Steven M.; McGlynn, Elizabeth A.; Hogan, Mary M.; Hayward, Rodney A.; Shekelle, Paul; Rubenstein, Lisa; Keesey, Joan; Adams, John; Kerr, Eve A. (December 21, 2004). "Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample". Annals of Internal Medicine. 141 (12): 938. doi:10.7326/0003-4819-141-12-200412210-00010. ISSN 0003-4819. PMID 15611491.
Jump up ^ Kerr, Eve A. (August 17, 2004). "Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study". Annals of Internal Medicine. 141 (4): 272–81. doi:10.7326/0003-4819-141-4-200408170-00007. ISSN 0003-4819. PMID 15313743.
Jump up ^ Trivedi, Amal N.; Matula, Sierra; Miake-Lye, Isomi; Glassman, Peter A.; Shekelle, Paul; Asch, Steven (2011). "Systematic Review: Comparison of the Quality of Medical Care in Veterans Affairs and Non-Veterans Affairs Settings". Medical Care. 49 (1): 76–88. doi:10.1097/mlr.0b013e3181f53575. JSTOR 25767038. PMID 20966778.
Jump up ^ Keating, Nancy L.; Landrum, Mary Beth; Lamont, Elizabeth B.; Bozeman, Samuel R.; Krasnow, Steven H.; Shulman, Lawrence N.; Brown, Jennifer R.; Earle, Craig C.; Oh, William K. (June 7, 2011). "Quality of Care for Older Patients With Cancer in the Veterans Health Administration Versus the Private Sector". Annals of Internal Medicine. 154 (11): 727. doi:10.7326/0003-4819-154-11-201106070-00004. ISSN 0003-4819. PMID 21646556.
Jump up ^ Shekelle, Paul G.; Asch, Steven; Glassman, Peter; Matula, Sierra; Trivedi, Amal; Miake-Lye, Isomi (2010). Comparison of Quality of Care in VA and Non-VA Settings: A Systematic Review. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US). PMID 21155199.
Jump up ^ Trivedi, Amal N; Grebla, Regina C (2011). "Quality and Equity of Care in the Veterans Affairs... : Medical Care". LWW. 49 (6): 560. doi:10.1097/MLR.0b013e31820fb0f6.
Jump up ^ Lancaster, Robert T.; Tanabe, Kenneth K.; Schifftner, Tracy L.; Warshaw, Andrew L.; Henderson, William G.; Khuri, Shukri F.; Hutter, Matthew M. (June 1, 2007). "Liver Resection in Veterans Affairs and Selected University Medical Centers: Results of the Patient Safety in Surgery Study". Journal of the American College of Surgeons. 204 (6): 1242–51. doi:10.1016/j.jamcollsurg.2007.02.069.
Jump up ^ Longman, Phillip. Best care anywhere. Berrett-Koehler Publishers, 2010.
Jump up ^ "VA History in Brief" (PDF). United States Department of Veterans Affairs. Retrieved May 30, 2014.
Jump up ^ Khuri, SF; Daley, J; Henderson, WG (2002). "The Comparative Assessment and Improvement of Quality Surgical Care in the Department of Veterans Affairs". Archives of Surgery. 137 (1): 20–27. doi:10.1001/archsurg.137.1.20. PMID 11772210.
^ Jump up to: a b Quality Initiatives Undertaken by the Veterans Health Administration Congressional Budget Office Report, August 2009
Jump up ^ Scott Bronstein; Drew Griffin. "A fatal wait: Veterans languish and die on a VA hospital's secret list". CNN. Retrieved May 31, 2014.
Jump up ^ "Obama vows action on any VA 'misconduct'". BBC News. Retrieved May 31, 2014.
Jump up ^ "Veterans Secretary Eric Shinseki resigns after report". BBC News. Retrieved May 31, 2014.
Jump up ^ VA crisis: solutions exist, but haven't happened, panel hears — CNNPolitics.com
Jump up ^ IG probes uncover more problems at VA hospitals | TheHill
Jump up ^ Friendly Fire: Death, Delay, and Dismay at the VA – Stripes.com
Jump up ^ The VA Isn’t Broken, Yet; Inside the Koch brothers’ campaign to invent a scandal and dismantle the country’s most successful health care system. by Alicia Mundy, Washington Monthly, March/April/May 2016.
Jump up ^ Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System VA Office of Inspector General, Veterans Health Administration. August 26, 2014. Pub. No. 14-02603-267
Jump up ^ Inglehart J. K. (1996). "Reform of the Veterans Affairs Health Care System". The New England Journal of Medicine. 335 (18): 18. doi:10.1056/nejm199610313351821.
^ Jump up to: a b Yano; et al. (2007). "The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration's Quality Transformation". American Journal of Public Health. 97 (12): 2151–59. doi:10.2105/ajph.2007.115709. PMC 2089092  . PMID 17971540. CS1 maint: Explicit use of et al. (link)
Jump up ^ Ashton, C., Headley, E., Parrino, T., Starfield, B. (September 1995). Primary Care in VA. Boston: Management decision and Research Center. Washington, DC: U.S. Department of Veterans Affairs. Office of Research and Development. Health Services Research and Development Service
Jump up ^ Kizer et al. (Jun 2000). Reinventing VA Healthcare: Systematizing Quality Improvement and Quality Innovation. Medical Care. 38(6 Suppl 1)
Jump up ^ Kizer, K.W et al. (May 2003). Effects of the Transformation of the Veterans Affairs Health Care System on the Quality of Care. New England Journal of Medicine. 348(22).
^ Jump up to: a b Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample Annals of Internal Medicine, December 21, 2004
Jump up ^ "Code Red" by Philip Longman, Washington Monthly, September 7, 2009
^ Jump up to: a b c Vets Loving Socialized Medicine Show Government Offers Savings Bloomberg, October 2, 2009
^ Jump up to: a b Relationship Retreats: Warriors to Soul Mates FatherhoodChannel.com, October 20, 2012
^ Jump up to: a b PAIRS Essentials VA Program Support Guide, January 2013
Jump up ^ "Geriatric Research Education and Clinical Center Home". Web.archive.org. Archived from the original on March 29, 2008. Retrieved April 10, 2017. CS1 maint: BOT: original-url status unknown (link)
Jump up ^ "VA Fellowship for Robert Wood Johnson Clinical Scholars – Office of Academic Affiliations". Va.gov. November 1, 2013. Retrieved May 16, 2014.
Jump up ^ Spinal Cord Injury & Disorders Services. "Spinal Cord Injury & Disorders Home". Web.archive.org. Archived from the original on April 27, 2008. Retrieved April 10, 2017. CS1 maint: BOT: original-url status unknown (link)
Jump up ^ "Project RED (Re-Engineered Discharge)". Boston University.
Jump up ^ "Transforming discharge processes for Veterans". U.S. Department of Veterans Affairs.
^ Jump up to: a b Watkins, K.E., Pincus, H.A. et al., (2011). Veterans Health Administration Mental Health Program Evaluation: Capstone Report, Santa Monica, Calif.: RAND Corporation, TR-956-VHA
Jump up ^ "Veterans Health Administration Mental Health Program Evaluation: Capstone Report". RAND. October 19, 2011. Retrieved May 16, 2014.
Jump up ^ "Emergency Departments Identify and Support Veterans at Risk of Suicide, Enhancing Their Access to Outpatient Mental Health Services". Agency for Healthcare Research and Quality. November 20, 2013. Retrieved November 25, 2013.
Jump up ^ Aakre, JM (2014). "Mental Health Service Utilization by Iraq and Afghanistan Veterans After Entry Into PTSD Specialty Treatment". Pschiatric Services.
^ Jump up to: a b c d Cohen, B; et al. (2009). "Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services Among Returning Iraq and Afghanistan Veterans". Journal of General Internal Medicine. doi:10.1007/s11606-009-1117-3.
Jump up ^ (2007). Women Veterans: Past, Present, and Future. Department of Veterans Affairs.
Jump up ^ Washington, D. L.; Yano, E. M.; Simon, B; Sun, S (2006). "To use or not to use. What influences why women veterans choose VA health care". Journal of General Internal Medicine. 21 Suppl 3: S11–18. doi:10.1111/j.1525-1497.2006.00369.x. PMC 1513176  . PMID 16637939.
Jump up ^ "Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care" New England Journal of Medicine, May 29, 2003
Jump up ^ Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study Annals of Internal Medicine, August 17, 2004
Jump up ^ VHA vs. Medicare: And the winner is … Harvard Gazette, June 6, 2011
Jump up ^ VA Health Care Eligibility & Enrollment
Jump up ^ Staff writer. "Veteran's affairs". ACAtoday. American Chiropractic Association. Archived from the original on August 16, 2006. Retrieved December 29, 2013.
[hide]
v
t
e
Agencies under the United States Department of Veterans Affairs
Headquarters: 810 Vermont Avenue NW
(Veterans Affairs Department Building)
David Shulkin, Secretary of Veterans Affairs
Thomas G. Bowman, Deputy Secretary of Veterans Affairs
Deputy Secretary of Veterans Affairs
Board of Veterans' Appeals
Center for Women Veterans
Office of Acquisition and Material Management
Office of Information and Technology
Office of Occupational Safety and Health
Office of Policy, Planning and Preparedness
Office of Regulation Policy and Management
Office of Small and Disadvantaged Business Utilization
VA Police
Under Secretary of Veterans Affairs for Health
Veterans Health Administration
Under Secretary of Veterans Affairs for Benefits
Veterans Benefits Administration
Under Secretary of Veterans Affairs for Memorial Affairs
National Cemetery Administration
Chairman of the Board of Veterans' Appeals
Board of Veterans' Appeals
Retrieved from "https://en.wikipedia.org/w/index.php?title=Veterans_Health_Administration&oldid=827535168"
Categories:
Healthcare in the United States
United States Department of Veterans Affairs
Hidden categories:
CS1 maint: Explicit use of et al.
CS1 maint: BOT: original-url status unknown
Use mdy dates from July 2017
Articles needing additional references from July 2017
All articles needing additional references
All articles with vague or ambiguous time
Vague or ambiguous time from May 2017
All articles with dead external links
Articles with dead external links from March 2016
Navigation menu
Personal tools
Not logged in
Talk
Contributions
Create account
Log in
Namespaces
Article
Talk
Variants
Views
Read
Edit
View history
More
Search
Navigation
Main page
Contents
Featured content
Current events
Random article
Donate to Wikipedia
Wikipedia store
Interaction
Help
About Wikipedia
Community portal
Recent changes
Contact page
Tools
What links here
Related changes
Upload file
Special pages
Permanent link
Page information
Wikidata item
Cite this page
Print/export
Create a book
Download as PDF
Printable version
Languages
فارسی
Edit links
This page was last edited on 25 February 2018, at 08:15.
Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. By using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.
Privacy policy
About Wikipedia
Disclaimers
Contact Wikipedia
Developers
Cookie statement
Mobile view
Enable previews

key: html

type: local

value: div

attrs: id class

values: mw-page-base noprint

values: mw-head-base noprint

value: a

attrs: id class lang

values: firstHeading firstHeading en

values: siteSub noprint

values: jump-to-nav mw-jump

attrs: href title

values:
note
hatnote navigation-not-searchable

value: img

attrs: alt src width height srcset data-file-width data-file-height

attrs: href class

value: td

value: b

values: Help:Introduction to referencing with Wiki Markup/1

value: span

value: i

value: small

values: plainlinks metadata ambox ambox-content ambox-Refimprove

values: US Department of Veterans Affairs vertical logo.svg

values: Maps, aerial photos, and other data for this location

values: United States Secretary of Veterans Affairs

values: United States Department of Veterans Affairs

values:
nofollow
https://www.va.gov/HEALTH/
external text

values: Under Secretary of Veterans Affairs for Health

values:
/wiki/St._Elizabeth%27s_Hospital
mw-redirect
St. Elizabeth's Hospital

values:
/wiki/Omar_N._Bradley
mw-redirect
Omar N. Bradley

values:
/wiki/United_States_Cabinet
mw-redirect
United States Cabinet

values: Edit section: Veterans Health Administration scandal of 2014

values: Veterans Health Administration scandal of 2014

values:
/wiki/Secretary_of_Veterans_Affairs
mw-redirect
Secretary of Veterans Affairs

values: The time period mentioned near this tag is ambiguous. (May 2017)

values: Wikipedia:Manual of Style/Dates and numbers

values: Edit section: 1993 Clinton Healthcare Reform

values: Edit section: 1994 VA Primary Care Directive

values: Edit section: Dr. Kenneth W. Kizer and the VA Reform

values:
/wiki/Open_source
mw-redirect
Open source

values:
nofollow
http://www.parkinsons.va.gov/
external autonumber

values:
/wiki/Mental_illness
mw-redirect
Mental illness

values:
/wiki/Sexually_transmitted_disease
mw-redirect
Sexually transmitted disease

values: Edit section: Eligibility for VA health care benefits

values: List of Veterans Affairs medical facilities by state

values: Reserve components of the United States Armed Forces

values: Edit section: Eligibility priority groups

values: Edit section: Covered services/acute care benefits

values:
/wiki/Nursing_home
mw-redirect
Nursing home

values: Edit section: Financial Assessment for Long-Term Care Services

values: Edit section: Skilled Home Health Care Services (SHHC)

values: Edit section: Homemakers/Home Health Aide Services (H/HHA)

values: Edit section: Patient Aligned Care Team (PACT)

values: Edit section: OEF/OIF/OND Care Management Team

values:
/wiki/Operation_Iraqi_Freedom
mw-redirect
Operation Iraqi Freedom

values:
/wiki/Operation_New_Dawn_(Afghanistan)
mw-redirect
Operation New Dawn (Afghanistan)

values: Edit section: Federal benefits for veterans, dependents and survivors

values: Rehabilitation Research and Development Service

values:
nofollow
external text
http://www.va.gov/budget/products.asp

values:
nofollow
external text
//doi.org/10.1176%2Fappi.ps.670804

values:
nofollow
external text
//www.worldcat.org/issn/1075-2730

values:
nofollow
external text
//doi.org/10.1176%2Fappi.ps.201400537

values:
nofollow
external text
//www.worldcat.org/issn/0003-4819

values:
/wiki/PubMed_Identifier
mw-redirect
PubMed Identifier

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/15611491

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/15313743

values:
nofollow
external text
//www.jstor.org/stable/25767038

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/20966778

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/21646556

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/21155199

values:
nofollow
external text
//doi.org/10.1001%2Farchsurg.137.1.20

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/11772210

values:
nofollow
external text
//doi.org/10.1056%2Fnejm199610313351821

values:
nofollow
external text
//doi.org/10.2105%2Fajph.2007.115709

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/17971540

values: Category:CS1 maint: Explicit use of et al.

values:
/wiki/Philip_Longman
mw-redirect
Philip Longman

values:
nofollow
external text
http://issuu.com/pairs/docs/va_support

values: Category:CS1 maint: BOT: original-url status unknown

values:
nofollow
https://www.bu.edu/fammed/projectred/
external text

values:
nofollow
external text
//www.ncbi.nlm.nih.gov/pubmed/16637939

values:
nofollow
external text
http://www.va.gov/healtheligibility

values: Template:United States Department of Veterans Affairs

values: Template talk:United States Department of Veterans Affairs

values: United States Deputy Secretary of Veterans Affairs

values: Center for Women Veterans (page does not exist)

values: Office of Acquisition and Material Management (page does not exist)

values: Office of Information and Technology (page does not exist)

values: Office of Occupational Safety and Health (page does not exist)

values: Office of Policy, Planning and Preparedness (page does not exist)

values: Office of Regulation Policy and Management (page does not exist)

values: Office of Small and Disadvantaged Business Utilization (page does not exist)

values: United States Department of Veterans Affairs Police

values:
navbox-image
5
width:1px;padding:0px 0px 0px 2px

values: Under Secretary of Veterans Affairs for Benefits

values:
/wiki/United_States_national_cemetery
mw-redirect
United States national cemetery

values: Chairman of the Board of Veterans' Appeals

values: nowraplinks hlist collapsible autocollapse navbox-inner

values: Category:Healthcare in the United States

values: Category:United States Department of Veterans Affairs

values: Category:Articles needing additional references from July 2017

values: Category:All articles needing additional references

values: Category:All articles with vague or ambiguous time

values: Category:Vague or ambiguous time from May 2017

values: Category:All articles with dead external links

values: Category:Articles with dead external links from March 2016

values: Discussion about edits from this IP address [ctrl-alt-n]

values: A list of edits made from this IP address [ctrl-alt-y]

values: You are encouraged to create an account and log in; however, it is not mandatory

values: You're encouraged to log in; however, it's not mandatory. [ctrl-alt-o]

values:
/wiki/Veterans_Health_Administration
View the content page [ctrl-alt-c]
c

values: Discussion about the content page [ctrl-alt-t]

values: p-namespaces navigation vectorTabs p-namespaces-label

values:
p-variants
navigation
vectorMenu emptyPortlet
p-variants-label

values: Past revisions of this page [ctrl-alt-h]

values: p-views navigation vectorTabs p-views-label

values:
p-cactions
navigation
vectorMenu emptyPortlet
p-cactions-label

values:
mw-wiki-logo
/wiki/Main_Page
Visit the main page

values:
/wiki/Main_Page
Visit the main page [ctrl-alt-z]
z

values: Featured content – the best of Wikipedia

values: Find background information on current events

values:
/wiki/Special:Random
Load a random article [ctrl-alt-x]
x

values: portal navigation p-navigation p-navigation-label

values: Guidance on how to use and edit Wikipedia

values: About the project, what you can do, where to find things

values: A list of recent changes in the wiki [ctrl-alt-r]

values: portal navigation p-interaction p-interaction-label

values: List of all English Wikipedia pages containing links to this page [ctrl-alt-j]

values: Recent changes in pages linked from this page [ctrl-alt-k]

values:
/wiki/Wikipedia:File_Upload_Wizard
Upload files [ctrl-alt-u]
u

values: A list of all special pages [ctrl-alt-q]

values: Permanent link to this revision of the page

values: Link to connected data repository item [ctrl-alt-g]

values: Printable version of this page [ctrl-alt-p]

values: اداره کل بهداشت سربازان بازنشسته – Persian

values: mediawiki ltr sitedir-ltr mw-hide-empty-elt ns-0 ns-subject page-Veterans_Health_Administration rootpage-Veterans_Health_Administration skin-vector action-view