North Carolina
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, 3.7 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 more than $2.3 billion in North Carolina in 2006 to care for more than 756,000 veterans who live in the state.  That same year, 138,379 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in North Carolina.  VA provided 15,699 veterans, reservists or survivors education benefits through the GI Bill; 108,072 owned homes with active VA home loan guarantees originally valued at $3.6 billion.  North Carolina veterans held more than 39,000 VA life insurance policies worth nearly $458 million.  In 2006, 578 were interred in the state’s national cemeteries.

• Health Care:  One of the most visible of all VA benefits is health care.  VA has 153 hospitals, 882 ambulatory care and community-based outpatient clinics, 207 Vet Centers, 136 nursing homes, 45 residential rehabilitation treatment programs and 92 comprehensive home care programs.  Due to technology and national and VA health care trends, 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 North Carolina, VA operates major medical centers in Asheville, Durham, Fayetteville and Salisbury.  The four North Carolina medical centers, like the nation's health care industry, have transitioned to outpatient care from an inpatient setting.  Combined, the medical centers provided more than 1,331,000 outpatient visits and had 15,193 inpatient admissions in 2006.  A full range of medical services is provided, including acute medical, surgical, psychiatric and nursing home care.  Ambulatory care clinics are located in each of the medical centers and community-based outpatient clinics are in Charlotte, Durham, Greenville, Raleigh, Morehead City, Wilmington and Jacksonville, with a satellite outpatient clinic in Winston-Salem.

Additionally, VA medical centers support five Vet Centers -- in Charlotte, Greenville, Fayetteville, Greensboro and Raleigh.  The Charlotte Vet Center, supported by the Salisbury VA Medical Center, provides readjustment counseling services weekly at remote locations in Shelby, Morganton and Rock Hill, S.C.  The Greenville Vet Center, supported by the Durham VA Medical Center, provides weekly readjustment counseling services in Beaufort, Jacksonville, Wilson, Goldsboro, Morehead City and Elizabeth City.

North Carolina VA facilities have affiliations with Duke University, Wake Forest University and the University of North Carolina, as well as with numerous dental, nursing and allied health schools.

• 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 North Carolina, nearly 12,000 active duty service members and veterans of the Global War on Terror have sought VA health care.  Many veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Charlotte, Fayetteville, Greensboro, Greenville, and Raleigh.  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.

North Carolina VA medical centers cared for 67,947 veterans age 65 and older in 2006.  A wide range of geriatric, extended care and rehabilitation services are available throughout the state, to include home-based primary care, hospice and respite care.  Programs continue to expand to meet this growing population.  Each geriatric program is geared towards assisting veterans in reaching their optimum level of functioning.  The Durham medical center is one of 16 VA medical centers that has a national Geriatric Research, Education and Clinical Center (GRECC).  GRECCs work in collaboration with federal, state, county and city programs to share best practices in the treatment of conditions related to aging.  Additionally, the Durham center has a community partnership with the Department of Social Services for a case worker, who assists with placement of patients in community nursing homes and in applying for other needed community social services.

Asheville also has a community partnership with the Buncombe County Department of Social Services for a case worker.  Asheville’s Home-Based Primary Care program participates in the AHEA, a program to improve end of life care for demented patients who prefer to stay home.  Fayetteville hosts a state veterans home for North Carolina.  Salisbury operates a first-class geropsychiatric unit and hosts a state veterans home with 99 beds that opened in 2005.

• 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.

With more than $26.5 million in VA and non-VA funding, VA's research initiatives in North Carolina supported more than 456 research projects.  Durham is where most of the state’s VA research projects are conducted.  The Durham VA Medical Center has a large funded research and development program, including a Geriatrics Research, Education, and Clinical Center as well as the Center for Health Services Research in Primary Care (one of 11 national centers in health services research) and the Epidemiology Research and Information Center (one of three national centers in epidemiology).  Topics of research include heart disease, cancer, leukemia, stroke, lupus, arthritis, rehabilitation medicine, clinical cooperative studies, infectious diseases, telemedicine projects, shingles vaccination, screening for diabetes and colorectal cancer, patient-physician communication, potential role of neuron hyperexcitability in neurotoxicity, alcoholism, PTSD, motor neuron regeneration, improving blood pressure control in hypertensive patients and end-of-life issues.  Research activities in Salisbury include post-deployment mental health, rehabilitation of functional impairment associated with low vision and blindness, and smoking cessation.  More than 160 principal investigators are committed to North Carolina’s research projects, which support the advancement of the health and care of veterans and the community at large by gaining new knowledge of techniques and products that lead to improved prevention, diagnosis, treatment and disease management.

• 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 Winston-Salem Regional Office serves veterans and their survivors in North Carolina who are seeking VA financial benefits.  In fiscal year 2006, the Winston-Salem Regional Office processed 37,499 disability compensation claims, including 18,117 veterans applying for the first time and 19,382 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  Nearly two thousand North Carolina 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.

Programs to help the homeless are a primary concern for North Carolina's VA medical centers.  Homeless veterans throughout the state are assisted through a range of services, primarily based upon community outreach, transitional housing, and compensated work therapy programs.  Each medical center and the Winston-Salem Regional Office has a homeless coordinator to work with veterans and develop programs to meet their needs.  Stand downs are also hosted throughout the state on a regular basis.  North Carolina VA medical centers coordinate with three Oxford Houses located in Charlotte, Durham and Fayetteville that help substance abusers.

• 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 four national cemeteries in North Carolina.  In 2006, Salisbury National Cemetery had 501 burials.  The other three North Carolina national cemeteries bury only eligible family members.  The cemetery in New Bern had 34 burials, the one in Raleigh had 28 and the cemetery in Wilmington had 15.  Three state veterans cemeteries have received VA grants.  The Western Carolina cemetery in Black Mountain had 261 burials, the Coastal Carolina cemetery in Jacksonville had 226, and the Sandhills State Veterans Cemetery in Spring Lake had 285.  The state plans to expand the cemetery in Jacksonville with a VA grant.  VA provided 9,402 headstones and markers for the graves of veterans in North Carolina and sent more than 8,700 Presidential Memorial Certificates to North Carolina survivors of veterans.