Missouri
and the
U.S. Department of Veterans Affairs

• General:  The Department of Veterans Affairs (VA) offers a wide variety of programs and services for the nation’s 24.3 million veterans.  In 2006, about 5.3 million people were treated in VA health care facilities, 3.6 million veterans and survivors received VA disability compensation or pensions, nearly 600,000 used GI Bill education benefits and more than 2.4 million owned homes purchased with GI Bill home loan benefits originally valued at $236 billion.  About 97,000 veterans and family members were buried in VA’s national cemeteries and 335,000 headstones and markers were provided for veterans’ graves worldwide.

VA spent nearly $1.8 billion in Missouri in 2006 to serve more than 538,000 veterans who live in the state.  That same year, 72,737 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in Missouri.  VA provided 9,959 veterans, reservists or survivors education benefits through the GI Bill; 35,988 owned homes with active VA home loan guarantees originally valued at $1.1 billion.  Missouri veterans held nearly 30,000 VA life insurance policies worth $329 million.  In 2006, 4,597 interments were conducted in Missouri's three national cemeteries.

• Health Care:  One of the most visible of all VA benefits is health care.  VA has 153 hospitals, 895 ambulatory care and community-based outpatient clinics, 209 Vet Centers, 135 nursing homes, 47 residential rehabilitation treatment programs and 92 comprehensive home care programs.  To improve patients’ ability to access care, VA has changed from a hospital-based system to a primarily outpatient-focused system over the past decade.  Veterans will make 55 million outpatient visits to VA health care facilities this year.

In Missouri, VA operates major medical centers in Columbia, Kansas City, Poplar Bluff and St. Louis.  In 2006, VA facilities in Missouri had 18,440 inpatient admissions and provided nearly 2.4 million outpatient visits.  To provide better access to care for veterans, especially those living in rural areas, Missouri operates 17 community-based outpatient clinics (CBOCs).  Six CBOCs, in St. James, Mexico, Warrensburg, Cameron, St. Louis and Cape Girardeau, are collocated with Missouri state veterans homes.  There are 152 nursing home beds at Missouri VA facilities.  All of the medical centers are affiliated with universities or allied health care providers to provide training and education in all areas of health services.  The Kansas City medical center, for example, is affiliated with the University of Kansas, University of Missouri–Kansas City and 42 additional educational institutions.  The St. Louis VA Medical Center (VAMC) also maintains dual affiliations with Washington University and Saint Louis University Medical Schools.  The St. Louis VA operates a 32-bed Spinal Cord Injury Center, which provides rehabilitation and sustaining care services to veterans in Nebraska, Kansas, Missouri, southern Illinois and Kentucky.

• Post-Conflict Care:  VA has launched special efforts to provide a "seamless transition" for those returning from service in Operations Iraqi Freedom and Enduring Freedom (OIF/OEF).  Each VA medical facility and benefits regional office has a point of contact to coordinate activities locally to help meet the needs of these returning combat service members and veterans.  In addition, VA increased the staffing of benefits counselors at key military hospitals where severely wounded service members from Iraq and Afghanistan are frequently sent.  Once home, recent Iraq and Afghan veterans have ready access to VA health care, which is free of charge for two years following separation for any health problem possibly related to wartime service.  Some 205,000 veterans from the Global War on Terror have sought VA health care since returning stateside, about one-third of the total number of men and women leaving military service.

In Missouri, nearly 7,800 active duty service members and veterans of the Global War on Terror have sought VA health care.  In Columbia and Kansas City, VA provided care to 4,337; in Poplar Bluff and St. Louis, 3,447.  Some veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Kansas City and St. Louis.  These community-based Vet Centers serve as an important resource for veterans who, once home, often seek out fellow veterans for advice or help transitioning back to civilian life.

• Geriatric Care:  Long-term care is a critical issue for America’s veterans.  Approximately 39 percent of living veterans are at least 65 years, compared with 12 percent of the general population.  The challenge to care for these 9.5 million men and women is met through a spectrum of home and community-based programs such as home-based primary care, homemaker and home health aide services, home respite and hospice and adult day care health.  VA also provides home and domiciliary care for veterans who can no longer be safely maintained in non-institutional settings.  Additionally, VA conducts nationwide research on the causes and treatment of Alzheimer’s disease and other dementias and funds 21 geriatric research, education and clinical centers, each focusing on a major geriatric problem.

In Missouri, 112,850 veterans aged 65 or older received medical care from VA in 2006.  A wide range of geriatric, rehabilitation and extended care services are available, and programs continue to expand to meet the growing needs of this elderly population.  For example, Missouri medical centers offer elderly veterans physical rehabilitation, interim care, psychogeriatric care, hospice services, respite, nursing home care, dementia treatment, home care, geriatric evaluation and management, adult day health care, residential services and blind rehabilitation.

Missouri operates seven state veterans homes supported by VA funds.  Cape Girardeau, Mexico and St. James each have 150-bed nursing care; Cameron, Mt. Vernon and Warrensburg are 200-bed facilities.  The Missouri veterans home in St. Louis, with its 100-bed specialized dementia unit, has 300 beds.  Pharmaceuticals are provided to all seven homes from the pharmacy distribution center at the Columbia VAMC.  Pharmacists from VA medical centers in Columbia, Kansas City, Poplar Bluff and St. Louis provide consultant services.  The Missouri Veterans Commission estimates that this arrangement saves Missouri taxpayers more than a million dollars each year.

• Research:  To provide the highest quality of health care to the nation’s veterans, VA sponsors a world-renowned research and development program that addresses some of the most difficult challenges facing medical science today, such as aging, vision loss, women’s health, Gulf War illnesses, diabetes, bioterrorism and hepatitis. VA researchers led the way in developing the cardiac pacemaker, the CT scan, magnetic source imaging and improving artificial limbs.  More recently, injuries sustained by armed forces engaged in current deployments have further increased the long-standing emphasis on VA research on limb loss; prosthetics and tissue replacement; traumatic brain injury; spinal cord injury; and mental health issues including post-traumatic stress disorder.  The quality of the research and relevance to the veteran population remain the determining factors in deciding what studies to fund.

VA’s research program in Missouri includes studies in organ and tissue repair, cancer research, neuroscience, infectious diseases and environmental toxins, cooperative studies and drug development, rehabilitation, and health services and outcomes.  Combined VA research funding for Missouri facilities was nearly $5.2 million in 2006.

• Disabilities and Pensions:  Not all military service related issues end when people are discharged from active duty.  About 2.7 million veterans receive monthly VA disability compensation for medical conditions related to their service in uniform.  VA pensions go to about 330,000 wartime veterans with limited means.  Family members of about 527,000 veterans qualify for monthly VA payments as the survivors of disabled veterans or pension recipients.

VA's St. Louis Regional Office serves veterans and their survivors in Missouri who are seeking VA financial benefits.  In fiscal year 2006, the St. Louis Regional Office processed 13,016 disability compensation claims, including 4,257 veterans applying for the first time and 8,759 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than 1,300 Missouri veterans participated in VA’s Vocational Rehabilitation and Employment program in 2006.

• Homeless:  Nearly one-quarter of all homeless adults are veterans, and many more veterans who live in poverty are at risk of becoming homeless.  VA is the only federal agency that provides substantial hands-on assistance directly to the homeless.  It has the largest network of homeless assistance programs in the country.  More than 15,000 residential rehabilitative, transitional and permanent beds are available for homeless veterans throughout the country.  VA aggressively reaches out to veterans on the street, conducts clinical assessments, offers needed medical treatment, and provides long-term shelters and job training.  More than $265 million is dedicated to specialized homeless programs to assist homeless veterans, including grants and per diem payments to more than 400 public and non-profit groups.

VA’s major homeless programs in Missouri are based in St. Louis and Kansas City.  In 1987, the St. Louis homeless program became the first in VA to offer services for homeless who are mentally ill.  Through outreach to various shelters, soup kitchens and the streets, thousands of homeless veterans have been clinically assessed with mental health and substance abuse problems.  An estimated additional 2,000 veterans have been screened as homeless.  There are approximately 9,000 homeless adults on the streets in St. Louis on any given night, one-third are veterans.  It is also estimated that two percent of homeless veterans are females.

The St. Louis homeless program is a per diem program, which authorizes VA to assist public or non-profit private groups in establishing new programs to furnish services and housing for homeless veterans.  St. Louis has two operational programs that are approved for 45 beds and two non-operational programs that are being renovated and scheduled for operation in 2006.  This would allow 72 beds for homeless veterans to be maintained annually in four community-based houses under the per diem program.  The St. Louis medical center at Jefferson Barracks has a 60-bed capacity directed toward homeless veterans who are employable.

The Kansas City area is estimated to have approximately 1,600 homeless veterans.  The VA medical center also has a per diem program for veterans, operating two homes in the metropolitan area.  Many veterans have been helped with placements into a contract community residential home.  The majority of these veterans have been homeless from six months to over two years.

• Memorial Affairs:  Most men and women who have been in the military are eligible for burial in a national cemetery, as are their dependent children and usually their spouses.  VA manages the country’s network of national cemeteries with more than 2.7 million gravesites at 125 national cemeteries in 39 states and Puerto Rico, as well as in 33 soldier’s lots and monument sites.  In 2006, nearly 97,000 veterans were buried in VA's national cemeteries.  Additionally, VA provided more than 335,000 headstones and markers and 405,000 Presidential Memorial Certificates to the loved ones of deceased veterans.  VA-assisted state veterans cemeteries provided more than 22,000 interments.

VA has three national cemeteries in Missouri.  In St. Louis, the Jefferson Barracks National Cemetery had 4,478 burials in 2006.  In Springfield, where the national cemetery buries eligible family members and cremation remains, there were 116 burials.  The cemetery in Jefferson City buries only family members and had three burials.  The state has four veterans cemeteries built with VA grants.  The Missouri Veterans Cemetery in Bloomfield had 141 burials in 2006; the Higginsville cemetery had 159; the Jacksonville cemetery performed 83 interments; and the Springfield facility had 487 burials.  VA provided more than 10,000 headstones and markers for the graves of veterans in Missouri and sent 5,210 Presidential Memorial Certificates to Missouri survivors of veterans.