Tennessee
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.

VA spent more than $1.8 billion in Tennessee in 2006 to care for more than 532,000 veterans who live in the state.  That same year, 87,601 veterans and survivors received disability compensation, dependency and indemnity compensation, or pension payments in Tennessee.  VA provided 8,389 veterans, reservists or survivors education benefits through the GI Bill; 60,718 owned homes with active VA home loan guarantees originally valued at $1.9 billion.  Tennessee veterans held more than 23,000 VA life insurance policies worth $265 million.  In 2006, 1,730 were interred in Tennessee’s five 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 Tennessee, VA operates medical centers in Memphis, Mountain Home, Murfreesboro and Nashville.  Tennessee medical centers offer an array of services that include acute medical, surgical, psychiatric and nursing home care.  Ambulatory care clinics are located within driving distance of each medical center.

In fiscal year 2006, the Memphis medical center had 6,341 inpatient admissions and provided 469,065 outpatient visits; the VA Tennessee Valley Healthcare System (Nashville and Murfreesboro) had 9,710 inpatient admissions and provided 624,995 outpatient visits; and Mountain Home had 5,157 inpatient admissions and provided 352,679 outpatient visits.

Community-based outpatient clinics are operated at Chattanooga, Cookeville, Dover, Knoxville, Mountain City, Rogersville, Savannah, and Tullahoma.  Other clinics administered by Tennessee medical centers are in southwest Virginia; Ft.  Campbell and Bowling Green, Ky.; Jonesboro, Ark.; and Smithville and Byhalia, Miss.  Additional clinics are on the drawing board to open over the next few years.  A domiciliary located at the Mountain Home facility offers social and psychological rehabilitation and long-term health maintenance.

A 60-bed Spinal Cord Injury Center is located on the campus of the VA medical center in Memphis.  This center serves as a referral site for veterans being treated for quadriplegic and paraplegic conditions.  Nashville operates a transplant program, and a Geriatric Research, Education and Clinical Center (GRECC) is shared by Murfreesboro and Nashville.  Murfreesboro has one of VA's seven consolidated mail-out pharmacy programs on its campus.

All of the medical centers have affiliations with medical schools, including Eastern Tennessee State University’s James H. Quillen College of Medicine in Johnson City, Vanderbilt University School of Medicine in Nashville, Meharry Medical College in Nashville and the University of Tennessee at Memphis.  Each facility offers residency training in major medical and surgical specialties and subspecialties.  Associated health training is offered in nursing, psychology, audiology and speech pathology, social work, dietetics, pharmacy and other health care fields.

• 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 Tennessee, more than 8,500 active duty service members and veterans of the Global War on Terror have sought VA health care.  At the Memphis VA Medical Center, doctors have treated nearly 2,100 returning veterans; in Mountain Home, 1,376; at the Tennessee Valley Healthcare System (Murfreesboro and Nashville campuses), more than 5,000.  Many veterans from the conflict in Iraq and Afghanistan have visited VA counseling centers in Chattanooga, Johnson City, Knoxville, Memphis and Nashville.  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 Tennessee medical centers provide a wide range of services for geriatric and extended care patients.  The programs include in-house nursing home care (both short-term transitional care and longer-term supportive care), community-based nursing home care, adult day care, respite care, palliative care, home health care, geriatric outpatient care and rehabilitation services.  These extended care services are an essential component of the care required to meet the changing, complex and comprehensive needs of America’s older veterans.

The primary goal of geriatric and extended care services is to maximize the patient's independence, while maintaining autonomy, dignity and family involvement in care.  In 2006, more than 63,000 veterans age 65 and over were treated by VA facilities in Tennessee.   Additionally, Tennessee hosts one of only 20 VA Geriatric Research, Education and Clinical Centers (GRECCs), which focus on preventive health care and medication use for the elderly.

• 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.

In the VA Tennessee Valley Healthcare System last year, research principal investigators worked on more than 200 active research projects.  VA research funding for 2006 exceeded $4.6 million.  Current areas of research include pathogenesis of arthritis and other autoimmune disorders, diabetes, multiple sclerosis, gastroenterology, hypertension, schizophrenia, urinary incontinence, cardiology, nephrology, oncology, neurology, psychiatry, biochemistry, toxicology, pulmonology, hematology, endocrinology, wound healing, bipolar disorder, spinal cord injury, audiology, prostate cancer and  infectious diseases.  Many of the researchers work with their affiliated medical schools in joint projects.  VA Nashville is one of two VA pilot sites for a Clinical Research Center of Excellence to recruit junior clinical research faculty into academic medicine, retain the faculty in the VA system and produce research that has a direct impact on the health of veterans.

The Memphis VA medical center has investigators working on more than 200 active protocols, with a VA budget of nearly $7.3 million.  Mountain Home’s VA research budget for 2006 was $1.26 million.

• 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 Nashville Regional Office serves veterans and their survivors in Tennessee who are seeking VA financial benefits.  In fiscal year 2006, the Nashville Regional Office processed 17,877 disability compensation claims, including 5,851 veterans applying for the first time and 12,026 cases where veterans reopened a claim, usually to seek an increase in their disability rating level for higher payments.  More than two thousand Tennessee 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.

Tennessee homeless programs are located at all VA medical centers and provide varying degrees of service.  Each facility provides outreach that includes physical and psychiatric health exams, treatments, referrals and ongoing case management.  Each medical center has participated in the Homeless Providers Grant and Per Diem Program, which provides emergency and transitional beds for homeless veterans through community, state and local organizations.

The Memphis medical center has three community-based facilities under the Homeless Providers Grant and Per Diem Program, which offer 112 beds to homeless veterans.

The Mountain Home medical center has an inpatient homeless program providing evaluation and treatment while veterans are in a residential setting and also a homeless outreach program with offices in Johnson City and Knoxville.

The Nashville medical center developed a transitional living residence for women in conjunction with Operation Stand Down Nashville, Inc., to assist them in transitioning back into the community as productive citizens.  Facilities are also active with local homeless shelters and community action groups that work together to provide services for homeless clients.

• 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.

VA has five national cemeteries in Tennessee. Chattanooga National Cemetery had 999 burials in 2006 and Mountain Home National Cemetery had 361.  Three other national cemeteries bury eligible family members and cremation remains.  The Knoxville cemetery had 26 burials, the Memphis cemetery 158 and the Nashville cemetery 186.  In addition, three state veterans cemeteries have received VA grants.  The East Tennessee Veterans Cemetery in Knoxville had 321 burials; the West Tennessee Veterans Cemetery in Memphis had 907; and the Middle Tennessee Veterans Cemetery in Nashville had 485.  VA provided more than 10,000 headstones and markers for the graves of veterans in Tennessee and 4,629 Presidential Memorial Certificates for Tennessee survivors of veterans.