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The Department of Veterans Affairs (VA) offers substantial support to veterans needing assistance in accessing medical care, primarily through its Veterans Health Administration (VHA).1 Community transportation providers need to have a clear understanding of the kinds of support provided by VA in order to tailor their own programs to best serve the mobility needs of veterans. This report provides the information needed by community transportation providers to develop that greater level of understanding. This report provides (a) an overview of veterans and the transportation issues that they face, (b) the transportation services now offered by VA, (c) transportation options currently available for veterans, (d) programs now in place in various communities that offer transportation services to veterans, (e) strategies that could be adopted by community transportation providers who wish to enhance their services for veterans, and (f) suggestions for additional areas of research into the transportation needs of veterans. In coming years, veterans should be able to look forward to improved mobility if the issues and options identified in this report are addressed in a meaningful way. KEY FACTS CONCERNING VETERANS Overall Statistics There are about 23.1 million veterans of military service in the United States today.2 About 40 percent of them are 65 years of age and older. Health care services are provided to veterans by the Veterans Health Administration (VHA), an office within the U.S. Department of Veterans Affairs (VA). In FY 09, there were 8.1 million veterans enrolled in the VA Health Care System and 5.7 million unique patients were treated that year. More than 3.1 million veterans were receiving VA Disability Compensation as of December 31, 2009. The number of veterans rated as 100 percent disabled as of that date was 280,830; the number of veterans receiving a VA pension was 312,206. FY 2010 appropriations for VHA were $45.1 billion. 1 VHA is authorized to make payments for travel expenses incurred to help veterans and other persons obtain care or services from VHA. Payment procedures are specified in United States Code (USC), Payments or Allowances for Beneficiary Travel 38 U.S.C. 111. See Appendix A for VHA's Frequently Asked Questions concerning its Beneficiary Travel Program and Appendix B for a list of acronyms. 2 VA Benefits & Health Care Utilization, Department of Veterans Affairs, Office of Policy and Planning, National Center for Veterans Analysis and Statistics, February 1, 2010, http://www1.va.gov/vetdata/docs/4X6_winter10_sharepoint.pdf, accessed March 2, 2010. 10

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Important Considerations Concerning Transportation Services for Veterans Veterans Are Now More Highly Concentrate in Rural Communities In 2004, the National Rural Health Association (NHRA) reported3 that many rural and non- metropolitan counties had the highest concentration of veterans in the civilian population aged 18 and over from 1990 to 2000 according to the 2000 US Census.4 NRHA quoted figures showing that "Roughly 14.4 percent of the residents of West Virginia, the second most rural state in the country as indicated by percentage of the state population living in rural areas, are veterans and for Vermont, the most rural state, this figure is 13.6 percent. Among the veteran populations in these rural states, 35.9 percent are Vietnam veterans in West Virginia, and 34.6 percent in Vermont."5 For the United States. as a whole, the national average of veterans living in rural areas was 12.7 percent.6 NHRA concluded that "The disproportionate representation among rural Americans serving in the military has created disproportionate ' care 7 8 for our nation's veterans. The dispersed nature of the populations in rural and frontier areas should be a significant concern for rural health advocates. . ." 9 The 2000 Census showed the proportion of veterans living in rural areas is highest in Montana (16.2 percent), Nevada (16.1 percent), Wyoming (16 percent), and Maine (15.9 percent). The Census Bureau has updated its definitions of urban and rural populations, but the figures are still based on 2000 data. The 2006 2008 American Community Surveys (ACS) collect information on the percent of "civilian veterans" in each state. Nonetheless, of the 10 states in which ACS reports a higher-than-average proportion of the population is comprised of veterans--Alaska, Montana, Maine, Wyoming, Virginia, Washington, Nevada, South Dakota, Idaho, and New Hampshire--8 of these states have a significantly higher-than-average proportion of their 3 Rural Veterans: A Special Concern for Rural Health Advocates, National Rural Health Association, Kansas City, Missouri, July 2004. 4 Richardson, C. and Waldrop, J. (2003) Veterans 2000, Census 2000 Brief http://www.census.gov/prod/2003pubs/c2kbr-22.pdf accessed on May 21, 2010. 5 "Veterans: 2000 Census Brief." US Census Bureau, US Department of Commerce, Economics and Statistics Adm., May 2003: 5. 6 Ibid. 7 Veterans Health Administration, April 2000, A Report by The Planning Systems Support Group, A Field Unit of the Veterans Health Administration Office of Policy and Planning-Geographic Access to Veterans Health Administration (VHA) Services in Fiscal Year 2000: A National and Network Perspective. 8 Miller, L. J., June 2001, "Improving Access to Care in the VA Health System: A Progress Report," Forum, A publication of the Veterans Administration Office of Research & Development. 9 NHRA, op cit. 11