Commonwealth of Puerto Rico
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 $862 million in Puerto Rico in 2006 to care for more than 125,000 veterans who live there.  That same year, 46,424 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in Puerto Rico.  VA provided 4,055 veterans, reservists or survivors education benefits through the GI Bill; 9,377 owned homes with active VA home loan guarantees originally valued at $267 million.  Puerto Rico veterans held more than 4,200 VA life insurance policies worth $40 million.  In 2006, 1,474 veterans were interred at the Puerto Rico National Cemetery.

• Health Care:  One of the most visible of all VA benefits is health care.  VA has 155 hospitals, 881 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 fiscal year 2006, VA facilities in Puerto Rico and the Virgin Islands treated 52,274 patients and had 509,705 outpatient visits.  VA operates a major medical center in San Juan, which had 10,815 inpatient admissions in 2006.  The medical center has 331 beds, a 149-bed nursing home care unit and a 12-bed blind rehabilitation center.  It also operates satellite clinics in Ponce (south Puerto Rico) and Mayagüez (west Puerto Rico) and community-based outpatient clinics in Arecibo (northwest Puerto Rico), Guayama (southeast Puerto Rico) plus St. Croix and St. Thomas in the Virgin Islands.

The San Juan VA Medical Center has various specialized services that are unique in Puerto Rico.  Programs include open heart surgery, rehabilitation, spinal cord injury, nursing home, hospital- based care, day treatment, alcohol and drug dependence treatment, a post traumatic stress disorder program, counseling, pulmonary function and an immunology evaluation clinic for HIV positive patients and a cancer center.  Compensation and pension examinations are performed at the San Juan Medical Center.

The San Juan facility is a primary receiving center for casualties in VA and Department of Defense contingency planning and has been selected as the primary medical facility for presidential and vice presidential visits to the Caribbean.

The San Juan Medical Center has affiliations with the University of Puerto Rico (UPR), Ponce School of Medicine, and Universidad Central del Caribe medical schools and the UPR Dental School.  The medical center is connected to the University of Puerto Rico Medical Sciences campus, which is its main affiliate.  More than 800 residents, interns and students are trained at the San Juan VA facility each year.

• 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 Puerto Rico, nearly 5,000 active duty service members and veterans of the Global War on Terror have sought VA health care.  Some veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Arecibo, Ponce, and San Juan; and on the islands of St. Thomas and St. Croix in the U.S. Virgin Islands.  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 Puerto Rico, 36,357 veterans over the age of 65 -- more than half of all veterans treated -- received medical care in 2006.  Through its VA-operated nursing home care unit, VA has made significant strides in addressing the needs of elderly Puerto Rico veterans.  In addition to the San Juan facility, VA provides home-care services to many veterans through its home-based primary care telemedicine and visiting nurse programs.  Throughout Puerto Rico, VA programs are directed at achieving the highest quality of life possible and maintaining veterans 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.

The San Juan VA Medical Center has an active research and development program.  This program includes studies in the fields of microbiology, hematology and oncology, infectious diseases, gastroenterology, social work, antihypertensive drugs, cardio-renal hemodynamics, nephrology, diabetes, schizophrenia, pulmonary diseases, health services, nursing, rheumatology, spinal cord injury, rehabilitation and primary care studies.  During fiscal year 2006, there were 60 research principal investigators working on 176 research projects at the San Juan medical center.  The total research funding last year -- from VA, National Institutes of Health and industry sources -- was more than $1.5 million.

• Disabilities and Pensions:  Not all military service related issues end when people are discharged from active duty.  About 2.6 million veterans receive monthly VA disability compensation for medical conditions related to their service in uniform.  VA pensions go to about 336,000 wartime veterans with limited means.  Family members of about 535,000 veterans qualify for monthly VA payments as the survivors of disabled veterans or pension recipients.

VA's San Juan Regional Office serves veterans and their survivors in Puerto Rico who are seeking VA financial benefits.  In fiscal year 2006, the San Juan Regional Office processed 5,175 disability compensation claims, including 1,088 veterans applying for the first time and 4,087 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than 750 Puerto Rico 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 homeless programs in Puerto Rico are primarily based in San Juan.  Services are provided to the city's homeless veterans in conjunction with local community organizations like Fondita de Jesus, which provides services such as counseling and coordination of services (housing, financial and medical).  Homeless veterans and their families are provided essential items such as clothes, sleeping bags and jackets, and are connected with local community support agencies.

• 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 one national cemetery in Puerto Rico.  In 2006, Puerto Rico National Cemetery in Bayamon had 1,474 burials.  Puerto Rico is seeking a VA grant to build a cemetery in Aguadilla.  VA provided 3,028 headstones and markers for the graves of veterans in Puerto Rico and 3,781 Presidential Memorial Certificates to survivors of Puerto Rico’s veterans.