New Hampshire
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.  More than 100,000 veterans and family members were buried in VA’s national cemeteries and nearly 360,000 headstones and markers were provided for veterans’ graves worldwide.

In 2006, VA spent more than $283 million in New Hampshire to serve about 128,000 veterans who live in the state.  That same year, 17,669 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in New Hampshire.  VA provided 1,311 veterans, reservists or survivors education benefits through the GI Bill; 8,288 owned homes with active VA home loan guarantees originally valued at $287 million.  New Hampshire veterans held more than 8,500 VA life insurance policies worth $92 million.

• 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 fiscal year 2006, VA facilities in New Hampshire provided 181,223 outpatient visits.  The Manchester VA Medical Center (VAMC) operates a large primary care practice, two skilled care units, a same-day surgery program, specialty care services and an outpatient mental health program.  In addition, the emergency department provides for veterans requiring triage and various alternative levels of care such as observation status, primary care, skilled care and acute care.  Primary care services are also provided through four community-based outpatient clinics (CBOCs) in Portsmouth, Tilton, Conway and Wolfeboro.

Although acute inpatient medical and surgical care is not provided on-site, it is provided through partnerships with other VA New England Healthcare System medical centers and private health care facilities.  Medical services available through a blend of staff and contractual arrangements include general internal medicine, pulmonary medicine, cardiology, neurology, gastroenterology, rheumatology, endocrinology, dermatology, nephrology, pain management, infectious disease, oncology-hematology and women’s health.  Surgical services offered through staff and contractual arrangements include same-day surgery, urology, gynecology, optometry, orthopedics, vascular, ophthalmology, podiatry, anesthesiology, audiology, and ENT (ears, nose and throat).

Mental health services include outpatient mental health and substance abuse counseling, PTSD (post traumatic stress disorder) counseling, and consultation to skilled care units, primary care and the emergency department.  Ancillary services include social work, radiology, ultrasound, CT (computer tomography), rehabilitative medicine, visually impaired sight team, laboratory, respiratory therapy, pharmacy, nutrition, speech pathology and audiology.  Additional services including home-based primary care, contract community nursing home care, contract adult day care and specialized treatment services such as radiation therapy are provided to New Hampshire veterans through referral to VA medical centers in neighboring Massachusetts, Maine and Vermont.

The Manchester medical center supports major affiliations with many educational institutions in New England and offers student rotations in dental, optometry, pharmacy, nursing and social work services, and as physician assistants.

• 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 New Hampshire, more than 1,400 active duty service members and veterans of the Global War on Terror sought VA health care in 2006.  Many veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Auburn and Manchester.  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.

The Manchester VAMC cared for around 10,000 veterans aged 65 years and older in 2006.  Geriatric and extended care services include a 90-bed long-term care unit that provides skilled care and hospice and respite programs.  Services are provided through an interdisciplinary approach.  These services include social work, radiology, rehabilitative medicine, prosthetics, audiology, recreation therapy, dietary, pharmacy, advanced illness planning and spiritual care.  Other geriatric and extended care programs include a community nursing home program, community adult day care, home-based primary care, home hospice services and homemaker and home health aide.  A strong relationship exists between the VA medical center and the New Hampshire State Veterans Home to provide continuing care to eligible veterans.  The Manchester VAMC works closely with the State Veterans Council and other state veterans' organizations to locate homebound veterans so they can receive appropriate care in their homes and communities.

• 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.

For the past 20 years, the VA's research initiatives in New Hampshire have been funded through research grants from VA, the National Institute of Mental Health (NIMH), the U.S. Army and the American Society of Addiction Medicine.  Examination of the psychological and physiological consequences of exposure to severe stress have been, and remain, major focuses of our research.  The current research budget is approximately $572,000.

• 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 Manchester Regional Office serves veterans and their survivors in New Hampshire who are seeking VA financial benefits.  In fiscal year 2006, the Manchester Regional Office processed 1,882 disability compensation claims, including 588 veterans applying for the first time and 1,294 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than 400 New Hampshire veterans participated in VA’s Vocational Rehabilitation and Employment program in 2006.

• Homeless:  Less than 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.  Nearly 16,000 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.

The Manchester VAMC homeless coordinator does outreach to locate homeless veterans and help them receive VA and community-based services and care.  Placements for homeless veterans are made at the Helping Hands Outreach Center in Manchester.

The Manchester medical center participates in VA's Homeless Providers Grant and Per Diem Program.  The program promotes the development and provision of supportive housing (up to 24 months) and supportive services to help homeless veterans achieve residential stability, increase their skill levels and income and obtain greater independence.

• 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 2.9 million gravesites at 125 national cemeteries in 39 states and Puerto Rico, as well as in 33 soldier’s lots and monument sites.  In 2007, more than 100,000 veterans and dependents were buried in VA's national cemeteries.  Additionally, VA provided more than 359,000 headstones and markers and 423,000 Presidential Memorial Certificates to the loved ones of deceased veterans.  VA-assisted state veterans cemeteries provided more than 23,000 interments.

New Hampshire has no national cemeteries but the state veterans cemetery at Boscawen, which received a VA grant for major improvements, had 448 burials.  VA provided 1,821 headstones and markers for the graves of veterans in New Hampshire and sent 1,250 Presidential Memorial Certificates to New Hampshire survivors of veterans.