VETERANS CARE

Since the 1970s, the U. S. Department of Veterans Affairs (VA) has responded to a vital demographic trend: Although the total number of veterans is declining, the proportion of older veterans is increasing dramatically. In addition, the proportion of older persons in the veteran population far exceeds the proportion of older persons in the U.S. population in general. Anticipating the needs of a rapidly aging veteran population, VA initiated a comprehensive, three-pronged plan encompassing clinical services, research, and education and training. In meeting the challenge of this aging imperative, VA has become recognized as a national leader in the development and implementation of innovative health care services for older persons (Cooley, Goodwin-Beck, and Salerno). This entry summarizes VA’s mission and health care service delivery structure; demographic trends in the veteran population; VA’s aging-related clinical programs, research, and health care provider education and training; and examples of emerging VA initiatives in aging.

Mission and service delivery structure

VA’s mission is to serve America’s veterans (individuals who have been honorably discharged from U. S. military service) in three major areas: health care, which is coordinated by the Veterans Health Administration (VHA); socioeconomic support and assistance, coordinated by the Veterans Benefits Administration; and burial services, coordinated by the National Cemetery Administration.

VHA operates the largest health care system in the nation, encompassing 172 hospitals, 132 nursing home care units, 40 domiciliaries, and over 600 outpatient clinics. VHA also contracts for care in non-VA hospitals and in community nursing homes, provides fee-for-service visits by non-VA physicians and dentists for outpatient treatment, and supports care in one hundred state veterans homes in forty-seven states.

Since 1995, VHA has undergone a major reorganization. There are twenty-two regional Veterans Integrated Service Networks (VISNs), each comprised of from five to eleven facilities. The VISN, rather than the individual medical center, is the basic planning and budgetary unit of health care delivery in the new VHA structure. VISNs are responsible for providing a coordinated continuum of care for veterans treated in each network of facilities and for supporting research and health profession education activities. Key domains of health care value in which VISN performance is measured include access to care, quality of care, patient satisfaction, patient functional status, and cost-effectiveness.

In addition, VHA has shifted from an inpatient, hospital bed-based system to outpatient, primary, and ambulatory care. There is increased emphasis on noninstitutional settings such as outpatient clinics, home-based services, and other ambulatory and community-based venues.

Demographic trends

In 2000, the median age of veterans was fifty-seven years (U. S. Department of Veterans Affairs), compared to only thirty-six years for the general U. S. population (Administration on Aging). Over 37 percent of the veteran population (9.5 million of the total 25.5 million veterans) was age sixty-five or older, compared to 13 percent of the general population. By 2020, nearly half of the entire veteran population (7.6 million, or 45 percent, of the total 16.9 million veterans) will be age sixty-five or older. Although most veterans are male, the number of female veterans is growing. In 2000, over 5 percent (1.4 million) of all veterans and 3 percent (325,000) of veterans age sixty-five or older were female. By 2020, over 9 percent (1.6 million) of all veterans and 4 percent (316,000) of veterans age sixty-five or older will be female. Among female veterans, the proportion age sixty-five or older was 23 percent in 2000 and is projected to be 20 percent in 2020. As in the general U.S. population, the ‘‘old-old’’ are the fastest-growing segment of the veteran population. By 2020, 6 percent of all veterans and 13 percent of veterans age sixty-five or older will be age eighty-five or older (1.1 million). Thus, VA will continue to encounter a very large group of potentially frail, older veterans in the next twenty years.

Clinical programs in aging

Typically, older persons have higher use of health care services, including increased number of physician visits, short-term hospital stays, number of days in the hospital, and greater need for long-term care services. Anticipating these needs, VA has developed a broad continuum of geriatrics and extended care services that are provided in a wide variety of settings, including home and the community, outpatient clinics, hospitals, and nursing homes. Together these programs provide preventive, acute, rehabilitative, and extended care on an outpatient and inpatient basis. Home- and community-based programs are emphasized, with coordinated use of hospital and nursing home programs. The shared purpose of these programs is to prevent or lessen the burden of disability on older, frail, chronically ill patients and their families, and to maximize each veteran’s functional independence.

Several innovative home- and communitybased services are offered. These include Home-Based Primary Care (HBPC), which provides in-home primary medical care to veterans with chronic illnesses. A home-based, interdisciplinary treatment team prescribes medical, nursing, social, rehabilitation, and dietetic regimens and provides training in supportive care to the patient and family caregivers. In addition, VA’s homemaker/home health aide program enables selected patients who meet criteria for nursing home placement to remain at home through the provision of personal care services purchased by VA from public and private agencies in the community, with case management provided directly by VA staff. VA also offers Adult Day Health Care, which provides health maintenance and rehabilitation services to veterans in a congregate, outpatient setting during daytime hours. This program uses a medical model of services, which in some circumstances may be a substitute for nursing home care. Another communitybased program is Community Residential Care/ Assisted Living, in which private homes provide room, board, personal care, and general healthcare supervision, at the veteran’s expense. Veterans in this program do not require hospital or nursing home care, but because of health conditions, they are not able to live independently and have no suitable support system to provide needed care. All residential care homes are regularly inspected by a multidisciplinary team of VA staff, and veterans in this program receive monthly visits from VA health care professionals who monitor the care provided in the home.

VA Domiciliaries are residential rehabilitation and health maintenance centers for veterans who do not require hospital or nursing home care but are unable to live independently because of medical or psychiatric disabilities. Veterans receive medical and psychiatric care, rehabilitative assistance, and other therapeutic interventions on an outpatient basis from the host hospital, while residing in the structured, therapeutic, homelike environment of the domiciliary. There are specialized, interdisciplinary treatment programs for rehabilitation of head trauma, stroke, mental illness, chronic alcoholism,heart disease, and a wide range of other disabling conditions. For some veterans, domiciliary care can help prepare for return to independent or semi-independent community living.

In the area of geriatric assessment, VA pioneered the concept of the Geriatric Evaluation and Management (GEM) program, which includes inpatient units, outpatient clinics, and consultation services. An interdisciplinary health care team provides comprehensive, multidimensional evaluations for a targeted group of older patients with multiple acute and chronic diseases, functional impairments, and psychosocial problems.

For veterans in need of skilled nursing care and related medical services, there are VA hospital–based nursing home care units. These units employ an interdisciplinary care approach to meet the multiple physical, social, psychological, and spiritual needs of patients. Many also provide sub-acute and post-acute care.

All VA facilities have a hospice consultation team, which coordinates a hospice and palliative care program of pain management, symptom control, and other medical services to terminally ill veterans, as well as bereavement counseling to their families. In addition, VA provides respite care to relieve spouses or other caregivers from the burden of caring for a chronically disabled veteran at home. Respite is provided for planned, brief periods of care in a variety of settings, including the veteran’s home, community nursing home, or VA hospital or nursing home.

Veterans with Alzheimer’s disease or other dementias participate in the full range of VA services, including in-home, community-based, and institutional-based acute and extended care services. In addition, some VA facilities have developed specialized inpatient or outpatient dementia services for diagnosis; management of comorbid medical, emotional, and behavioral problems; or palliative care. Programs for family caregivers of persons with dementia include support groups and caregiver education.

Research in aging

VHA is one of the nation’s largest research organizations, with a research appropriation from Congress of $316 million in 1999.

A cornerstone of VA’s response to its ‘‘aging imperative’’ is the Geriatric Research, Education and Clinical Center (GRECC) program, which began in 1975. As centers of excellence in geriatrics, GRECCs’ mission is to improve the health and care of older veterans through research, training and education, and the development and evaluation of innovative models of care. GRECCs are widely recognized as having provided leadership in geriatrics and gerontology, both within VA and throughout the nation (Goodwin and Morley). In 2000, there were twenty GRECCs across the VA system, each with a specific programmatic focus (e.g., osteoarthritis and osteoporosis; stroke rehabilitation, neurobiology and management of dementia; prostate disease; falls and instability; exercise in frail elderly; end of life care).

VA also funds a wide range of aging-related research, including basic biomedical, applied clinical, rehabilitation, and health services topics, as well as cooperative studies involving multiple VA sites. Aging is one of nine designated research areas used to prioritize VA research funding. In addition to individual investigator awards, VA supports aging research at Health Services Research and Development Centers of Excellence and at Rehabilitation Research and Development Centers. In 1999, VA provided $19.9 million for 150 aging-related research projects. VA investigators received another $33.8 million from non-VA sources to support another 339 aging-related research projects.

Education and training in aging

VA conducts the nation’s largest coordinated education and training effort for health care professionals, with over 100,000 health profession students receiving clinical training in VA facilities annually, including the GRECCs and other geriatrics and extended care settings described above. VA’s creation of a physician fellowship program in geriatric medicine in the 1970s played a significant role in the later recognition of geriatric medicine as a specialty in the United States (Goodwin and Morley). In addition, VA has developed a wide range of other fellowships and specialty training in geriatrics for psychiatrists, dentists, nurses, psychologists, and other associated health professions. VA also pioneered the concept and practice of interdisciplinary team training in geriatrics. In addition to student training, VA also provides aging-related continuing education for professional staff from VA and the community on a regular basis.

New initiatives in aging

In 2000, an area of intense focus within VA was the integration of primary care, geriatrics, and mental health. One initiative is the Unified Psychogeriatric Biopsychosocial Evaluation and Treatment (UPBEAT) project, in which elderly patients with symptoms of depression, anxiety, and substance abuse in VA medical and surgical hospital settings are evaluated by an interdisciplinary psychogeriatric team and followed by care coordinators on an outpatient basis. Preliminary results indicate cost savings from fewer hospital days for patients managed in this way. A second initiative is the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) project, a four year controlled study cosponsored by VA and the U. S. Department of Health and Human Services. Eleven sites, including five VA-funded sites, will compare two models for delivering mental health and substance abuse services to older adults in primary care settings: One model uses an integrated team of primary care and mental health/ substance abuse professionals, and the other uses referrals to specialty mental health/substance abuse care. A key question to be examined is under what conditions are integrated or referral models most effective in terms of access, treatment adherence, patient outcomes, and cost. A third initiative in this area is the VA’s Primary Care Multidisciplinary Education Committee (PCMEC). In 2000, PCMEC identified over twenty-five innovative and promising models of integrated primary care, mental health, and geriatrics at VA facilities. A variety of educational activities will be developed to evaluate and disseminate best practices from these model programs.

Other innovative projects are underway in the area of dementia care. One is the Chronic Care Networks for Alzheimer’s Disease (CCN/ AD) project, co-sponsored by the National Chronic Care Consortium and the Alzheimer’s Association. VA’s Upstate New York Healthcare Network (VISN 2) is among seven partnerships of health care organizations and Alzheimer’s Association chapters that are testing new, integrated approaches to serving persons with dementia and their families through networks of primary, acute, and long-term care. A set of clinical tools has been developed to facilitate dementia diagnosis and care management in the CCN/AD study sites. A second dementia project is Advances in Home-Based Primary Care for End of Life in Advancing Dementia (AHEAD). Begun in 2000, this project will involve approximately fifteen VA HBPC teams using a rapid cycle change process to improve end of life care at home for individuals with dementia.

In 2000, other significant initiatives were underway as part of the implementation of Public Law 106–117, the Veterans Millennium Healthcare and Benefits Act, which was passed by Congress in November 1999. This major legislation includes numerous provisions related to VA long-term care services, such as inclusion of certain noninstitutional extended care services in the medical benefits package and specification of priority groups for nursing home care.

Conclusion

As VA enters the new millennium, health care needs of older veterans remain a high priority. Through its early and continued response to a demographic aging imperative, VA has demonstrated leadership in geriatric research, clinical program development, and professional education. VA’s health care network structure presents great opportunities for comprehensive, coordinated care and evaluation of innovative service delivery models. Lessons learned from VA’s past and future aging initiatives will benefit veterans and their families as well as all older Americans.

Susan G. Cooley Judith A. Salerno

See also Geriatric Medicine; Long-term Care.

BIBLIOGRAPHY

Administration on Aging. ‘‘Resident Population of the United States: Estimates by Age.’’ 2000. Based on 1990 U. S. Census. Available on the World Wide Web at www.aoa.gov

Cooley, S. G.; Goodwin-Beck, M. E.; and Salerno, J. A. ‘‘United States Department of Veterans Affairs Health Care for Aging Veterans.’’ In Geriatric Programs and Departments Around the World. Edited by B. Vellas, J. P. Michel, and L. Z. Rubenstein. New York: Springer Publishing Co., 1998. Pages 183–198.

Goodwin, M., and Morley, J. E. ‘‘Geriatric Research, Education and Clinical Centers: Their Impact in the Development of American Geriatrics.’’ Journal of the American Geriatrics Society 42 (1994): 1012–1019.

Kizer, K. W. ‘‘Geriatrics in the VA: Providing Experience for the Nation.’’ Journal of AmericanMedical Association 275, no. 17 (1996): 1303.

U.S. Department of Veterans Affairs. Vet Pop 2000. (version 2.07, 30 September 2000) [Data file]. Available on the World Wide Web at www.va.gov

Veterans OverviewRevolutionary WarCivil WarWorld War IWorld War IIKorean WarVietnam War
Veterans: Overview Two major changes have taken place in the relation of the American veteran to civilian society, especially since 1865: the growth of veterans' groups as nationalist lobbies, and the rapid expansion of a military pension system that some scholars see as the template for the twentieth‐ century American welfare state. Even before the Revolutionary War ended, however, questions of veteran/civilian relations had arisen. In 1776, the Continental Congress pensioned veterans disabled in war, but beyond this step (which had long colonial and English precedents) there was sharp disagreement. Some representatives embraced the ideal of the civilian volunteer, and argued that the service pensions Congress had promised in 1778 represented an entering wedge for standing armies. Such worries were heightened when officers of Washington's army encamped at Newburgh, New York, demanded pensions or a cash equivalent as the price of their disbandment in 1783, and formed a hereditary order, the Society of the Cincinnati. Among enlisted personnel, indigent veterans would finally be pensioned in 1818, but full service pensions did not arrive until 1832. Thus, from its inception, the U.S. military pension system drew distinctions between three classes of the deserving: war invalids; indigent “dependents”; and soldiers whose only claim to benefits was their service.

As a result of the Newburgh remonstrances, Congress, in the Commutation Act of 1783, provided officers with five years' full pay in lieu of half‐pay pensions for life. Because the federal government continued in default until 1791, however, many officers sold their commutation certificates for as little as 12 1/2 cents on the dollar, a fate that also befell many enlisted veteran holders of Continental land warrants. Under acts of 1776 and 1780, Congress had promised the veterans large tracts of the public domain, mostly in the Northwest and Southwest territories; land‐rich states such as Virginia and New York made additional grants. But conflicting state land claims, wars with Indian nations, and land sales restrictions made land warrants of small value to most veterans until the late 1790s, by which time most had sold their warrants to speculators. Eventually, title to 2,666,080 acres of public lands was issued on the basis of Revolutionary claims.

Revolutionary War veterans never organized for mass politics and had little public visibility in the early republic. Many of the estimated 232,000 men who served had been militiamen, whose irregular, seasonal war service produced scant national consciousness (it also excluded them from pension benefits, much to the disgust of those who saw volunteer militias as bulwarks of liberty). Even Continental regulars often had little contact with soldiers from states other than their own, and consequently Revolutionary veterans' organizations were limited in scope. The Society of the Cincinnati declined to only six state chapters, all in the Northeast, by 1832; the Society of St. Tammany, founded by New York City veterans in 1789, quickly evolved into a Democratic political club.

The wars of the early nineteenth century likewise produced few veterans' groups, in part because they produced few veterans: 28,186 were demobilized from the War of 1812, 139,036 from the Mexican War. A tiny Society of the War of 1812 led a fitful existence from 1853 into the 1890s, when it became a hereditary order; the National Association of Mexican War Veterans was not formed until 1874, and lasted barely into the twentieth century. Veterans of both wars benefited immediately from federal land grants and invalid pensions, but dependent and service pensions came only as part of the tremendous pension rush following the Civil War—to War of 1812 veterans in 1871 and to Mexican War veterans in 1887 (dependent) and 1907 (service). Because most Mexican War volunteers had been southerners, there was great resistance to pensioning them in the post–Civil War era, and the law of 1887 excluded those whose wounds had been sustained in Confederate service or who were politically disbarred by the Fourteenth Amendment.

The Civil War revolutionized the relationship of veteran to society. The number of troops involved was unprecedented: at least 2 million men fought for the Union, some 750,000 for the Confederacy. More important, veterans of the Union army in 1866 created a powerful mass organization, the Grand Army of the Republic (GAR), to lobby for their interests and promote loyalty to the nation‐state. Nearly every Northern town had a GAR post, and with more than 400,000 members by 1890, the GAR was a voting machine for the Republican Party. Politicians of both parties vied for the veterans' favor with generous pension legislation, especially the Arrears Act (1879) and Dependent Pension Act (1890), the latter granting a virtual service pension to Union veterans at a time when many were still in their fifties. By 1891, military pensions accounted for one dollar of every three spent by the federal government, and at the peak in 1902, 999,446 persons (including widows and dependents) were on the pension rolls. By 1917, the nation had spent approximately $5 billion on Civil War pensions. Reformers attacked the frauds that riddled this system.

Beyond pensions, Civil War veterans occupied the center of a postwar culture that in each region venerated its ex‐soldiers. In the North, cities erected expensive monuments; Gettysburg was preserved as a historical park; and Grand Army men lectured schoolchildren on patriotic holidays, including Memorial Day, first proclaimed by GAR commander in chief John Logan in 1868 to honor the Union dead. By 1888, twelve northern states and the federal government had erected soldiers' homes. Union veterans won land grants, special treatment under the Homestead Act, and preference in hiring—by law in some states, de facto in federal agencies such as the Pension Bureau. The most important aspect of Union veteran culture, however, was its intensely conservative nationalism, visible in the GAR's crusades against anarchy, flag desecration, and “impure” school textbooks in the 1890s. Veterans of the Union army were the first to assert a privileged relation to the national state.

In the South, Confederate veterans organized late, at least partly in reaction to the GAR. Barred from federal entitlements, they obtained pensions and soldiers' homes from most southern states, though such benefits usually were quite modest. (Georgia's Confederate disability pensions, for example, averaged 14% of the federal rate.) The United Confederate Veterans (1889) presided over a veteran culture that shifted ground from intransigence in the 1870s to a romantic “Lost Cause” sensibility in the 1890s that even Union veterans could accept with some reservations.

The legacy of Civil War veterans was immense. First, the Civil War pension system provided the United States's first significant encounter with entitlement spending. When other groups—mothers, workers, the unemployed—sought state aid after 1900, their claims were evaluated in light of the partisanship, nationalistic rhetoric, and fraud that had characterized the Civil War system. Second, the GAR provided an organizational model and political agenda that twentieth‐century veterans' groups copied. Founded after World War I, the American Legion adopted the GAR's internal structure and consulted with aging GAR members on political strategy. All veterans' organizations until the Vietnam War continued the GAR program of flag ritualism, “patriotic instruction,” and unqualified nationalism.

The Spanish‐American War produced only two significant organizations: the United Spanish War Veterans (1904), which soon faded, and the Veterans of Foreign Wars (VFW), founded in 1913. Unlike the GAR and United Confederate Veterans, the VFW admitted all overseas veterans, not just those from one war, a policy that has allowed it to persevere to the present. On the other hand, the VFW policy of limiting membership to overseas veterans initially hampered the organization in competition with the more inclusive American Legion.

The approximately 4 million veterans of World War I returned to a situation markedly different from that following the Civil War. High unemployment marked both periods, but the soldiers of 1865 came back mostly to farms, while those of 1919 returned primarily to cities, where joblessness was acute and vocational training scarce. Rural land grants proposed by Interior Secretary Franklin Lane in 1919 proved impracticable in any case, since most arable public land had already been given away. Meanwhile, labor and political strife were rampant—revolution in Russia, chaos in Germany, a general strike in Seattle, a race riot in Chicago, and indices of class and racial turmoil elsewhere in the United States.

Under such circumstances, the American Legion (founded at Paris in 1919) came out immediately against “Bolshevism” and other radicalism, which it defined broadly to include everyone from the Communist Party to the League of Women Voters. Legion members helped break strikes of Kansas coal miners and Boston police in the summer of 1919, and from the 1920s through the 1950s made a war on “reds” one of their main activities. Legionnaires helped bring a House Un‐American Activities Committee into existence in 1938 and aided FBI probes of subversion thereafter. The interwar Legion was strongest in smaller cities and among prosperous members of the middle class. Like the GAR, it left racial matters largely to localities, which in practice usually meant segregated posts.

The War Risk Act of 1917 was intended to avoid the expense and abuses of the Civil War pension system by allowing World War I soldiers to pay small premiums in return for life insurance and future medical care. Ad ‐min istration of the act was inefficient, however, and veterans' hospitals proved too few in number and unable to cope with late‐developing disabilities and shell shock. The first vocational training and rehabilitation programs for veterans, established in 1917, similarly suffered from underfunding, poor teaching, and the tendency of veterans to treat “training” grants as pensions. Veteran protests brought about the consolidation of medical and educational programs in the Veterans Bureau (1921), which in 1930 became the Veterans Administration (VA). It was not until Frank Hines replaced the corrupt Charles Forbes in 1923, however, that the bureau began to function effectively.

World War I veterans never received service pensions and were eligible for nonservice‐related disability pensions only briefly, from 1930 to 1933. Instead, attention focused on “adjusted compensation,” a bonus approved by Congress in 1924 and payable in 1945, designed to make up for wartime inflation and lost earnings. Veterans were seriously divided on the propriety of the bonus, even after depression hardships drove 20,000 of them to march on Washington in 1932 as a “Bonus Army” demanding its immediate payment. Although troops led by Gen. Douglas MacArthur violently expelled the veterans from the city, the bonus was finally paid in 1936.

The rise of a general social welfare system under the New Deal decreased the need for military pensions and made aid to ex‐soldiers seem less like “special benefits.” Thus, when the 12 million veterans of World War II returned home, debate was minimal over the largest package of veterans' benefits in American history. The G.I. Bill (1944), drafted by former Legion commander Harry Colmery, provided World War II veterans with free college education and medical care, unemployment insurance for one year, and guaranteed loans up to $4,000 to buy homes or businesses. Other legislation guaranteed farmers loans on crops, reinstituted vocational training, and tried to safeguard the jobs of returning employees. By the 1970s, VA spending was greater than all but three cabinet departments (it achieved cabinet status in 1989). By 1980, benefits distributed under the G.I. Bill totaled $120 billion, an enormous investment in “social capital” and social mobility.

Unlike previous wars, World War II was fought mostly by conscripts, which may have made taxpayers more willing to compensate them for “forced labor.” These veterans were slightly younger and better educated than World War I veterans; they were mustered out into considerably less class and racial strife than the veterans of 1919. Still, they joined older veterans' groups rather than forming significant new ones: American Legion membership, which had fluctuated between 600,000 and 1 million before 1941, reached a record 3.5 million in 1946, while VFW membership rose from 300,000 to 2 million. Among liberal alternative groups founded in 1945, only AMVETS reached 250,000 members.

The Korean and Vietnam conflicts produced none of the triumphalism that followed World War II. Although the VA continued to grow—its 1995 budget was $37.4 billion, more than half of it earmarked for benefits—the Legion and VFW struggled throughout the 1960s and 1970s to attract new veterans. After the Vietnam War, which the older organizations supported fiercely, young veterans felt alienated from a society that often ignored or pitied them. In 1967, they formed the first significant antiwar veterans' group, the Vietnam Veterans Against the War (VVAW; after 1983, the Vietnam Veterans of America, VVOA). With less than 20,000 members, the VVAW publicized war atrocities and lobbied for American withdrawal. In the 1980s, more Vietnam veterans began to join the Legion and VFW, bringing those groups up to their 1995 memberships of approximately 3 million and 2 million, respectively. Yet the Vietnam Veterans War Memorial, dedicated at Washington in 1982, remains starkly noncelebratory: a sunken black granite wall listing names of the dead.

More recent health problems of Persian Gulf War veterans have highlighted the special needs of servicemen and women.
[See also Battlefields, Encampments, and Forts as Public Sites; Memorials, War; Newburgh “Conspiracy.”]

Bibliography

William Glasson , Federal Military Pensions in the United States, 1918.
Dixon Wecter , When Johnny Comes Marching Home, 1944.
Mary R. Dearing , Veterans in Politics: The Story of the G.A.R., 1952.
Wallace Davies , Patriotism on Parade: The Story of Veterans' and Hereditary Organizations in America, 1783–1900, 1955.
Paul Starr , The Discarded Army: Soldiers After Vietnam, 1973.
Peter Karsten , Soldiers and Society: The Effects of Military Service and War on American Life, 1978.
William Pencak , For God and Country: The American Legion, 1919–1941, 1989.
Stuart McConnell , Glorious Contentment: The Grand Army of the Republic, 1866–1900, 1992.
Theda Skocpol , Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States, 1992.
R. B. Rosenberg , Living Monuments: Confederate Soldiers' Homes in the New South, 1993.
Laura S. Jensen , The Early American Origins of Entitlements, Studies in American Political Development, 10 (1996).
Eric T. Dean, Jr. , Shook Over Hell: Post‐traumatic Stress, Vietnam and the Civil War, 1997.

Stuart McConnell

Bibliography

John C. Dann, ed., The Revolution Remembered: Eyewitness Accounts of the War for Independence, 1980.
John P. Resch, Politics and Public Culture: The Revolutionary War Pension Act of 1818, Journal of the Early Republic, 8 (Summer 1988), pp. 139–58.

G. Kurt Piehler

Bibliography

Gaines M. Foster , Ghosts of the Confederacy: Defeat, the Lost Cause, and the Emergence of the New South, 1987.
Stuart McConnell , Glorious Contentment: The Grand Army of the Republic, 1866–1900, 1992.

Stuart McConnell

Bibliography

William P. Dillingham , Federal Aid to Veterans, 1917–1941, 1952.
William Pencak , For God and Country: The American Legion, 1919–1941, 1989.

William Pencak

Bibliography

Davis R. B. Ross , Preparing for Ulysses: Politics and Veterans During World War II, 1969.
Richard Severo and and Lewis Milford , The Wages of War: When America's Soldiers Came Home—From Valley Forge to Vietnam, 1989.

G. Kurt Piehler

Bibliography

Richard Severo and and Lewis Milford , The Wages of War: When America's Soldiers Came Home—From Valley Forge to Vietnam, 1989.
Charles S. Young , Missing Action: POW Films, Brainwashing and the Korean War, 1954–1968, Historical Journal of Film, Radio, and Television, 18 (1998), pp. 49–74.

G. Kurt Piehler

Bibliography

David E. Bonier,, Steven M. Champlin,, and and Timothy S. Kolly , The Vietnam Veteran: A History of Neglect, 1984.
Joel Osler Brende and and Erwin Randolph Person , Vietnam Veterans: The Road to Recovery, 1985.
Ghislaine Boulanger and and Charles Kadushin , The Vietnam Veteran Redefined, 1986.

Faris R. Kirkland

Veterans

Fighting in the U.S. Civil War drew to a close during the spring and early summer months of 1865. By June 1865 all Confederate armies had surrendered. General Ulysses S. Grant wrote, "The surrender of the rebel armies and the collapse of the rebellion rendered a large part of our military force unnecessary" (Simon 1967, vol. 15, p. 357). Hundreds of thousands of Union soldiers and their Confederate counterparts were demobilized and disbanded in a matter of months. Never before in U.S. history had an army been comprised of so many volunteers; at the end of hostilities, troops needed immediate, efficient release and safe transport home. As one Union soldier wrote in a May 1865 diary entry, "the dismantling of this mighty engine of war; of returning this 'citizen army' to its legitimate and proper field of action … is an Herculean task" (Lane 1905, p. 264).

Establishment of Veterans' Organizations

Ulysses S. Grant, general-in-chief of all U.S. armies, reported to Secretary of War Edwin Stanton in October 1865 that an impressive 800,000 Union troops transitioned "from the army to civil life so quietly that it was scarcely known, save by the welcomes to their homes, received by them" (Simon 1967, vol. 15, pp. 357–358). One officer's wife observed that "in a few brief weeks the thousands who had followed the life of soldiers laid aside their accoutrements of war and took up the implements of peace, dissolving into citizens as rapidly as they had become soldiers" (Logan 1913, p. 200). "It became necessary to dissolve all organization in a few days," a Confederate surrendering at Appomattox remarked, and although his brigade "kept somewhat together, for a day or two, we soon broke apart, each brigade taking the nearest route towards home" (Caldwell 1866, p. 244).

As former soldiers transitioned into civilian life, many encountered financial hardships. The average Union soldier returned from the war was in his mid-twenties, and most likely had lacked a steady occupation before the war. Many Confederate veterans returned to their farms only to find them ruined by warfare. One Southerner wrote that her "part of the country has suffered more heavily than any other from the war," and veterans went to great lengths "in order to keep themselves and their families from starvation" (Leigh 1883, p. 119).

Confederate and Union veterans alike sought to recapture that sense of military camaraderie in the postwar years. Early Confederate groups were organized primarily on the local or county-wide level; the Confederate veterans' movement proved "sketchy and poorly coordinated," but "its course of organization was logically adapted to the environment and the troubled times" (White 1962, p. 25). Still, these organizations laid the groundwork for the rejuvenation that forged the largest Confederate veterans' group, the United Confederate Veterans (UCV).

The UCV, formed in Louisiana in 1889, was "designed as an association of all bodies of ex-Confederate soldiers and sailors throughout the Union" (News and Observer, September 6, 1889). It was organized in the military tradition. The UCV elected Confederate general John B. Gordon as its first leader. In an address to the veterans, Gordon addressed its purposes, to "succor the disabled, help the needy, strengthen the weak and cheer the discontent" (Milwaukee Sentinel, September 8, 1889). At its height, the UCV boasted over 150,000 members.

The UCV's federal counterpart was the Grand Army of the Republic (GAR). Dr. Benjamin Stephenson, veteran surgeon of the Fourteenth Illinois Infantry, saw the daily "neglect of the solider and the soldier's widow and orphans" at his medical practice, and quickly became "convinced that something must be done" (Stephenson 1894, p. 41). After various discussions with Union generals John A. Logan and Richard Oglesby, Stephenson devised the outline and regulations for the GAR; the organization extended membership to "all those who served under the federal flag and who received an honorable discharge," and held as its main objectives to "perpetuate those ties of friendship which had been formed in the smoke of battle and to secure the interests of those who had suffered for the Union" (Macmillan's Magazine, November 1891). April 6, 1866, saw the establishment of "the first encampment of the Grand Army of the Republic, Post No. 1, of Decatur, District of Macon, Department of Illinois" (Stephenson 1894, p. 43).

The Indianapolis Journal deemed the new organization "full of spirit" and "destined to become immensely popular" (Harpers Weekly, December 29, 1866). The GAR called upon "every honorably discharged soldier and seaman of the Union army and navy, whose heart yet stirs with the fraternal feeling which scenes of death and danger inspired" to "rally once again… for peaceful communion and pleasant intercourses " (Chicago Tribune, September 3, 1871). Upon the conclusion of wartime activities, "it was natural that while such citizens ceased to be soldiers they should still seek to cherish the feeling of old comradeship and the memories of a common cause and a common peril" (Harper's Weekly, August 10, 1889).

The GAR adopted, appropriately, an organizational system in the military tradition. Local units were divided into various "posts," the state levels into "departments," and a "commander-in-chief" was in charge of the entire operation. Its primary objectives involved promoting camaraderie, providing for disabled veterans and their dependants, and fighting the pension battle. "If the majority is ready to make the Grand Army a pension-reform organization, well and good; it can be a very powerful one, and can do much to purify the pension list" (Harper's Weekly, June 10, 1893).

The GAR spanned the entire breadth of the United States. On a trip to the George H. Thomas Post in San Francisco, California, GAR commander-in-chief John Kountz called it "the grandest army of the grandest Republic the world has ever seen" (Los Angeles Times, April 24, 1885). Harper's Weekly acknowledged that "the Grand Army of the Republic stands practically without parallel in this country" (August 31, 1889). Determining the actual membership numbers proved almost impossible, yet most estimates placed membership around 500,000 Union veterans by 1891 (Blight 2001, p. 171). "The idea of the G.A.R. seemed to take right hold of the hearts of the soldiers," and as an immediate consequence, "posts sprang up rapidly" (Stephenson 1894, p. 45).

The GAR officially endorsed egalitarianism, unlike many other nineteenth-century fraternal organizations. Some 178,000 African American troops had served during the Civil War (Schaffer 2003, p. 11). Although the national level of the GAR boasted a color-blind membership, individual posts had notorious reputations of discrimination. GAR members accepted new members to a post based on a vote. In 1870, a Worcester, Massachusetts GAR post rejected the membership of an African American veteran on three consecutive ballots, even after the post leaders reemphasized the GAR's nondiscriminatory policies (Shaffer 2004, p. 144). In the lower South, GAR posts were often segregated. As a result of such prejudice, many African Americans opted to create their own veterans' organizations, such as the Colored Soldiers' and Sailors' League and the Colored Veterans Association, to celebrate the contributions of African American soldiers.

Wielding Political Power

As the GAR reached its pinnacle in the late 1880s and early 1890s, no one could deny the veteran organization's sheer force in the world of politics. Members firmly believed the GAR could "create a public sentiment in this country…The Grand Army can force Congress to pass such laws" (Los Angeles Times, April 14, 1885). The staunchly Republican organization played a pivotal role in presidential elections for more than thirty years, until the turn of the twentieth century. No president could secure an election without first receiving GAR support. Union veterans wielded political power unmatched by any other veterans' organization.

Some viewed the GAR's vast political influence as a severe abuse of power and misappropriation of trust. One writer to Harper's Weekly raved that "nothing could be more unworthy and illegitimate than to convert such an association into a political society," and that the Grand Army of the Republic had transformed into "a machine to extort advantages of every kind for themselves and their kind by promising their continued political support." Rather than the fraternal organization in its original form, the GAR had taken "a course which necessarily covers the association with discredit, and alienates the sympathy of patriotic and intelligent citizens everywhere…. It disgraces the name of Union soldier" (August 10, 1889).

President Grover Cleveland, the first Democrat elected since the Civil War, personally witnessed the GAR's partisan potential. Cleveland was scheduled to attend the annual GAR encampment in St. Louis, Missouri, in 1887. Upset by his consistent vetoes of pension legislation, and further angered by his suggestion to return captured Confederate flags, livid members of the GAR sent hostile mail and "threats of personal violence and harm" to Cleveland. The attitude of many GAR members, according to Cleveland, indicated "such prevalence of unfriendly feeling and such menace… that they cannot be ignored" (News and Observer [Raleigh, NC], July 8, 1887). Cleveland cancelled his planned visit to the GAR National Encampment for fear of personal harm.

Veterans Pensions

Such incidents underscored the highly charged issue of veteran pension legislation. Veterans of the Civil War witnessed, and in most cases caused, massive changes in the federal pension system. In 1862, President Abraham Lincoln had signed into law a pension act that provided payment to all disabled veterans of the war. After the war, the definition of pension eligibility grew even broader. The Dependent Pension Act of 1890, which extracted the wartime service disability qualification, allowed eligibility for any disabled veteran who served at least ninety days in uniform; nevertheless, the burden of demonstrating pension eligibility rested with the veteran. As a result, many veterans enlisted the aid of newspaper editorials, veterans' organizations, and lobbyists. Cognizant of the challenges of establishing entitlement, the clerk Thomas J. Brown made repeated pleas to the pensions' bureau to tabulate veterans' vital statistics. Frustrated by the government's lack of fervor for veterans but its pronounced intervention on behalf of mortgage debtors, Brown noted that "it is supremely sad to reflect that the worthy desire to know the average life of a mortgage… is tenfold more potent to put the wheels of government into rapid and beneficial revolution than the equally worthy, if not worthier, desire to know the number and age-expectations of veterans of the Civil War" (p. 8).

Pension laws did not overtly discriminate. Many African American veterans applied for and received benefits from the U.S. government. Still, former slaves had a particularly difficult time providing proof of service, often were illiterate, and sometimes did not know their birthplaces and birthdates. Difficult as it was for white soldiers to prove eligibility, African Americans faced even tougher circumstances.

Confederate veterans, in contrast, had no such pension system. Due largely to the distressed conditions and "wide-spread ruin" of the individual Southern states at the war's end, and the political turbulence and military occupation of Reconstruction (1865-1877), Confederate veterans would not see a pension system in effect until the late 1880s. They relied on a less satisfactory system of pensions managed by the state. Southern pension eligibility was limited solely to disabled veterans and widows.

Pension legislation did have its share of opponents. Criticism of the pension system often emanated from the higher economic strata of society. The veteran Benjamin F. Scribner wrote that "the laws granting pensions to soldiers have undergone much hostile criticism from those whose lines were cast in pleasant places during the war" (Scribner 1887, p. 307). When both armies instituted drafts, wealthy citizens were able to pay for men to replace them on the battlefield. As a result, many members of the more affluent classes never saw a day in uniform, and therefore were ineligible for pensions. Some were unwilling to spend tax dollars on benefits for others. Scribner continued, "if these objectors would reflect a moment and try to estimate the sum of money that would induce them to stand up within a range of a line of muskets and take the chances of one volley there-from, I do not think they would consider the pittance so enormous which has been granted" to veterans (Scribner 1887, p. 307). In addition to such complaints, the pension system was steeped in fraud. News pieces such as the Cleveland Herald's "Audacious Forgeries," which claimed fraud in the pension claims offices, appeared frequently (November 29, 1882).

Disabled Veterans

Not only did veterans face pecuniary, political, and pension battles, but thousands suffered permanent battle scars and disabilities. Ever-present reminders of the carnage of war caused them daily pain and difficulty. As the war came to a close, local populations began "turning their attention to the question of how best to provide permanently for those soldiers who have been disabled in the service" (New York Times, May 9, 1865). Concern for disabled veterans frequently made its way into national discussion. In his second inaugural address, President Lincoln made clear his desire "to care for him who has borne the battle." On March 21, 1866, Congress passed legislation chartering the National Asylum for Disabled Volunteers, later renamed the National Home for Disabled Volunteers. These "Soldiers' Homes," as they were commonly known, provided "the care and protection of the… maimed veterans of the late bloody strife" (Milwaukee Daily Sentinel, June 8, 1874).

General Benjamin F. Butler filled the role of president of the organization, and immediately began scouting cities and towns across the country for potential Soldiers' Home branch locations. Butler and various board members did "invite proposals for sites by donation or sale," the stipulations being that sites "must be situated in loyal States; they must contain not less than two hundred acres, must be in healthy locations and easily accessible by railroad or otherwise" (Lowell Daily Citizen and News, May 19,1866). Over the next forty years, Soldiers' Home branches appeared all across the country, from Maine to California. As with pension laws, the Soldiers' Homes had no explicit racial restrictions, yet, African American veterans comprised only an average of 1 percent of the Soldiers' Home population (Shaffer 2003, p. 137). These institutions received funding via military fines and forfeitures, rather than by direct taxation. As one resident of the National Military Asylum in Dayton, Ohio, explained, "it is not a 'charity,' but a contribution of soldiers to soldiers; nor is it an almshouse, but a home in every sense of the word" (Vermont Watchman and State Journal, July 20, 1870). The Daily Arkansas Gazette reported that in 1875 alone, "reports from the several homes showed 6,651 disabled soldiers were cared for" (December 18, 1875).

The National Home for Disabled Soldiers provided care solely for Union army veterans. The postwar devastatation of the Southern states and tumultuous years of Reconstruction prevented any such organization from developing in the former Confederate states. Upon a visit to a hospital in 1874, ex-Confederate president Jefferson Davis wrote to his wife, Varina, "the veterans in many stages of decay and disability came in, each bearing a smart tricolor and many with military orders on their breasts…. It was a spectacle which could but painfully remind me of our neglected braves and their unprovided orphans. It is well that virtue is its own reward, for sometimes it would otherwise be without compensation" (Hudson 1966, p. 393). Institutions similar to Soldiers' Homes for Confederate veterans finally came to fruition in the 1880s and 1890s, but remained the responsibility of organizations such as the United Daughters of the Confederacy and United Confederate Veterans.

Veterans' Publications

Contending with these problems and maintaining contact with comrades became easier with the publication of veterans' newspapers. William O. Bourne's The Soldier's Friend and the GAR-endorsed The Great Republic hit the presses in 1864 and 1866, respectively. Confederate Veteran magazine became the official organ of the United Confederate Veterans, and remained in publication until 1932. Sometimes, publications were intended to settle old scores from the battlefield. The Southern Historical Society Papers aimed to promote a strictly Confederate version of the history of the war; under the tutelage of Jubal Early, president of the Southern Historical Society, many of the papers contributed to the canonization of Robert E. Lee (1807-1870) at the expense of Richard S. Ewell (1817-1872), James Long-street (1821-1904), and other subordinates. Other publications simply strove to help their readers, promoting events and holding contests: Left-handed penmanship contests for veterans who had lost a right arm proved particularly popular. The wounded veteran Seth Sutherland, a yearly contestant, wrote to the Soldier's Friend editor that the contest "will infuse new life and vigor into the heart of many a wounded soldier, and be another evidence to him that his services… are not forgotten" (Sutherland to Bourne, July 22, 1865). The Soldier's Friend attracted loyal readers such as veteran George N. Dale: "I think every true American ought to patronize the Soldier's Friend" (Dale to Bourne, March 18, 1868).

The most influential and lasting newspaper, however, was the National Tribune. Founded by George B. Lemon, a Washington, DC, pension claims agent and veteran of the One Hundred Twenty-fifth New York Volunteer Infantry, the National Tribune featured articles written by veterans describing their wartime experiences. The paper provided veterans an ideal forum for debate, and an opportunity to reminisce. In 1884, Lemon hired veteran John McElroy as another editor for the Tribune. Until the turn of the twentieth century, articles written by veterans describing their wartime experiences appeared regularly; Lemon and McElroy devoted large amounts of space in the paper to various news pieces from veterans' organizations (e.g., the GAR, the Women's Relief Corps, etc.). The paper provided veterans an ideal forum for debate and opportunity to reminisce. As time progressed, the Tribune attempted to appeal to a wider audience, and it grew popular with veterans of the Spanish-American War. The GAR stopped publication around the outbreak of World War I, but a private corporation continued the paper, changing its title to Stars and Stripes.

Veterans Reunions

These papers also announced hundreds of reunions beginning in the 1880s and continuing until the final meeting of the Blue and Gray at Gettysburg in 1938. Large organizations such as the GAR and the UCV held yearly national encampments, drawing thousands of veterans from across the country. Reunions involving both Union and Confederate veterans gained popularity, becoming "not only a pleasant custom, but a gratifying indication of the gradual passing away of the passions and prejudices of the war" (Harper's Weekly, July 19, 1884). A culture of romantic reunion had emerged. Chicago Daily Tribune coverage of one early Union Army of the Potomac banquet indicated "the greetings were hearty and affectionate, for there were vacant chairs, and the members… knew not if they would meet again," a sentiment commonly shared in veterans' reunions (January 7, 1891). These reunions were often accompanied by the erection of monuments on the battlefields. One of the most famous of these episodes occurred on July 2, 1887, when members of the Philadelphia Brigade invited former Confederates of General George Pickett's division to attend a monument dedication at Gettysburg. What once had been the site of fierce combat, death, and destruction became a place of reunion where former enemies shook hands and celebrated a common, united future.

For the rest of their lives, veterans "continued to set themselves above 'civilians' as a class by virtue of their military service" (McConnell 1992, p. 34). These battle-hardened veterans, by recalling and celebrating the conflict, encouraged the late-nineteenth-century emergence of the vigorous manhood and athleticism movements. At the outbreak of the Spanish-American War, these concepts were coupled with a new, virile patriotism. Often, these sensibilities encouraged the idea that veterans were of a higher caliber. According to one colonel, although most assumed that a veteran's lifespan would be less than those "who have not been exposed to the shock of battle and the hardship and privation of field, camp, and prison…by the operation of the law of the survival of the fittest…the survivors have become a selected class, where average duration of life is likely to be greater than that of an equal number of nonveterans" (memorandum quoted in Brown Papers). The New York Times wrote that veterans, "the defenders of their country in time of war, are its best citizens in every walk of life now that the war is over" (August 12, 1872). Veterans placed themselves on a different, and higher, level of society due to their wartime experiences. As Oliver Wendell Holmes orated in a speech delivered before a New Hampshire GAR post in May 1884, "the generation that carried on the war has been set apart by its experience. Through our great good fortune, in our youth our hearts were touched with fire" (Holmes 1884).

BIBLIOGRAPHY

Blight, David. Race and Reunion: The Civil War in American Memory. Cambridge: Belknap Press of Harvard University Press, 2001.

Brown, Thomas J. "The Census and the Soldier and the Census and the Mortgage: A Parallel." Papers of Thomas J. Brown. Library of Congress,Washington, DC.

Caldwell, J. F. J. The History of the Brigade of South Carolinians. Philadelphia: King and Baird, 1866.

Chicago Daily Tribune, September 3, 1871; January 7, 1891; December 7, 1892.

Cleveland Herald, Cleveland, OH, November 29, 1882. Daily Arkansas Gazette, Little Rock, AR, December 18, 1875.

Dale, George N. Letter to William O. Bourne, March 18, 1868. Papers of William O. Bourne. Library of Congress, Washington, DC.

Davies, Wallace Evan. Patriotism on Parade: The Story of Veterans and Hereditary Organizations in America, 1793-1900. Cambridge, MA: Harvard University Press, 1955.

Dearing, Mary R. Veterans in Politics: The Story of the G.A.R. Baton Rouge: Louisiana State University Press, 1952.

Harper's Weekly, December 29, 1866; August 10, 1889; August 31, 1889; June 10, 1893; July 19, 1884.

Holmes, Oliver Wendell. "Dead Yet Living," address delivered May 30, 1884. Boston: Ginn, Heath, & Company, 1884.

Hudson, Strode, ed. Jefferson Davis: Private Letters,1823-1889. New York: Harcourt Brace Jovanovich, 1966.

Lane, David. A Soldier's Diary: The Story of a Volunteer, 1862-1865. Jackson, MI: 1905.

Leigh, Frances Ann Butler. Ten Years on a Georgia Plantation since the War. London: Bentley and Son, 1883.

Logan, Mary Simmerson. Reminiscences of a Soldier's Wife: An Autobiography. New York: Charles Scribner's Sons, 1913.

Logue, Larry M., and Michael Barton, eds. The Civil War Veteran: A Historical Reader. New York: New York University Press, 2007.

Los Angeles Times, April 14, 1885; April 24, 1885.

Lowell Daily Citizen and News, Lowell, MA, May 19, 1866.

Macmillan's Magazine 65 (November 1891–April 1892).

Marten, James. Civil War America: Voices from the Home Front. Santa Barbara, CA: ABC-CLIO, 2003.

McConnell, Stuart. Glorious Contentment: The Grand Army of the Republic, 1865-1900. Chapel Hill: University of North Carolina Press, 1992.

Milwaukee Sentinel, June 8, 1874; September 8, 1889.

New York Times, May 9, 1865; August 12, 1872.

News and Observer, Raleigh, NC, July 8, 1887; September 6, 1889.

Rosenburg, R. B. Living Monuments: Confederate Soldiers' Homes in the New South. Chapel Hill: University of North Carolina Press, 1993.

Scribner, Benjamin F. How Soldiers Were Made; Or, The War as I Saw it Under Buell, Rosecrans, Thomas, Grant, and Sherman. New Albany, IN: George S. MacManus, 1887.

Shaffer, Donald R. After the Glory: The Struggles of Black Civil War Veterans. Lawrence: University Press of Kansas, 2004.

Simon, John. Papers of Ulysses S. Grant. Carbondale: Southern Illinois University Press, 1967.

Stephenson, Mary Harriet. Dr. B. F. Stephenson. Springfield, IL: H.W. Rokker Printing House, 1894.

Sutherland, Seth. Letter to William O. Bourne, July 22, 1865. Papers of William O. Bourne, Library of Congress, Washington, DC.

Vermont Watchman and State Journal, Montpelier, VT, July 20, 1870.

Wagner, Margaret E., Gary W. Gallagher, and Paul Finkelman, eds. Civil War Desk Reference. New York: Simon and Schuster, 2002.

White, William W. The Confederate Veteran. Tuscaloosa, AL: Confederate Publishing Company, 1962.

Allison E. Herrmann

VETERANS AFFAIRS DEPARTMENT

The Department of Veterans Affairs (VA) operates programs to benefit veterans and members of their families. Benefits include compensation payments for disabilities or death related to military service, pensions, education, and rehabilitation. The VA also guarantees home loans, provides burial services for veterans, and operates a medical care program that includes nursing homes, clinics, and medical centers. Located in Washington, D.C., the VA in 2003 had 224,724 employees, a workforce second in size only to the defense department. The department's projected budget for FY 2003 was 459.6 billion.

The Department of Veterans Affairs was established in 1989 as an executive department by the Department of Veterans Affairs Act (38 U.S.C.A. § 201 note). Its establishment came after more than 24 years of effort by members of Congress to elevate the department's predecessor, the Veterans Administration, to cabinet status. Proponents argued that promotion to cabinet level would increase the political accountability of the VA and improve the quality of its services. The Veterans Administration was established as an independent agency by

presidential executive order No. 5398 of July 21, 1930, in accordance with the act of July 3, 1930 (46 Stat. 1016). This act authorized the president to consolidate and coordinate the U.S. Veterans Bureau, the Bureau of Pensions, and the National Home for Volunteer Soldiers.

The Department of Veterans Affairs consists of three organizations that administer veterans' programs: the Veterans Health Administration, the Veterans Benefits Administration, and the National Cemetery System. Each organization has field facilities and a central office. Each central office also includes separate offices that provide support to the organization's operations as well as to VA executives. Central office managers, including the inspector general and general counsel, report to the highest level of department management, which consists of the secretary of veterans affairs and the deputy secretary.

Board of Veterans' Appeals

The Board of Veterans' Appeals (BVA) is responsible, on behalf of the secretary of veterans affairs, for entering the final appellate decisions in claims of entitlement to veterans' benefits. The board is also responsible for deciding matters concerning fees charged by attorneys and agents for representation of veterans before the VA. The mission of the board (contained in 38 U.S.C.A. §§ 7101–7109) is to conduct hearings, consider and dispose of appeals properly before the board in a timely manner, and issue quality decisions in compliance with the law. The board is headed by a chairperson who is appointed by the president and confirmed by the Senate. The chairperson is directly responsible to the secretary of veterans affairs. Members of the board are appointed by the secretary with the approval of the president and are under the administrative control and supervision of the chairperson. Each BVA decision is signed by a board member acting as an agent of the secretary. Final BVA decisions can be appealed to the u.s. court of appeals for veterans claims.

Board of Contract Appeals

The Board of Contract Appeals was established on March 1, 1979, pursuant to the Contract Disputes Act of 1978 (41 U.S.C.A. §§ 601–613). The board is a statutory, quasi-judicial tribunal that hears and decides appeals from decisions of contracting officers on claims relating to contracts awarded by the VA or by any other agency when such agency or the administrator for federal procurement policy has designated the board to decide the appeal.

In August 1985 the board's jurisdiction was expanded to include applications for attorneys' fees and expenses under the Equal Access to Justice Act, as amended (5 U.S.C.A. § 504 note). Board decisions are final within the VA but may be appealed, either by the government or by the contractor, to the U.S. Court of Appeals for the Federal Circuit.

Additionally, the chairperson of the board, who is the senior official within the department, is responsible for promoting alternative dispute resolution pursuant to the Administrative Dispute Resolution Act (5 U.S.C.A. § 581 note). Finally, the board is charged with resolving disputes between drug manufacturers and the secretary with regard to provisions of the Veterans Health Care Act of 1992 (38 U.S.C.A. § 101 note) dealing with pharmaceutical pricing agreements.

Health Services

The Veterans Health Administration (formerly the Veterans Health Services and Research Administration) provides hospital, nursing home, and domiciliary care and outpatient medical and dental care to eligible veterans of military service in the armed forces. In 2002 the VA operated 163 hospitals (at least one in each of the 48 contiguous states, Puerto Rico, and the District of Columbia), more than 850 ambulatory care and community-based outpatient clinics, 137 nursing homes, and 73 comprehensive home-care programs, and provided health care to more than 4.5 million people. The administration also provides for similar care under VA auspices in non-VA hospitals and community nursing homes and for visits by veterans to non-VA physicians and dentists for outpatient treatment. Under the Civilian Health and Medical Program, dependents of certain veterans are provided with medical care supplied by non-VA institutions and physicians. The VA medical system serves as a backup to the Defense Department during national emergencies and as a federal support organization in times of major disaster.

The administration conducts both individual medical and healthcare delivery research projects and multi-hospital research programs. It assists in the education of physicians and dentists and in the training of many other health-care professionals through affiliations with educational institutions and organizations. These programs are all conducted as prescribed by the secretary of veterans affairs pursuant to 38 U.S.C.A. §§ 4101–4115 and other statutory authority and regulations.

Veterans Benefits

The Veterans Benefits Administration (VBA), formerly the Department of Veterans Benefits, conducts an integrated program of veterans' benefits. It provides information, advice, and assistance to veterans, their dependents, beneficiaries, and representatives, and others applying for VA benefits. It also cooperates with the labor department and other federal, state, and local agencies in developing employment opportunities for veterans and referrals for assistance in resolving socioeconomic, housing, and other related problems. In addition, the VBA provides information regarding veterans' benefits to various branches of the armed forces.

Programs are provided through VA regional offices, medical centers, visits to communities, and a special toll-free telephone service. The programs are available in all 50 states, the District of Columbia, and Puerto Rico.

Compensation and Pension

The Compensation and Pension Service has responsibility for claims for disability compensation and pensions, automobile allowances and special adaptive equipment, claims for specially adapted housing, special clothing allowances, emergency officers' retirement pay, and eligibility determinations based on military service for other VA benefits and services or those of other government agencies. The service also processes survivors' claims for death compensation, dependency, and indemnity compensation, death pensions, burial and plot allowance claims, claims for accrued benefits, claims for adjusted compensation in death cases, and claims for reimbursement for headstones or markers.

Education

The Education Service has responsibility for the Montgomery GI Bill—Active Duty and Selected Reserve, the Post Vietnam Era Veterans' Educational Assistance Program, the Survivors' and Dependents' Educational Assistance Program, and school approvals, compliance surveys, and work study.

Vocational Rehabilitation

The Vocational Rehabilitation Service has responsibility for providing outreach, motivation, evaluation, counseling, training, employment, and other rehabilitation services to disabled veterans. The service also provides evaluation, counseling, and miscellaneous services to veterans and service persons and other VA education programs, as well as to sons, daughters, and spouses of totally and permanently disabled veterans and to surviving orphans, widows, or widowers of certain deceased veterans. Rehabilitation services are provided to certain disabled dependents.

Loan Guaranty

The department has played a major part in the financing of homes since the end of world war ii. Loan guaranty operations include appraising properties to establish their value, supervising the construction of new residential properties, establishing the eligibility of veterans for the program, assessing the ability of a veteran to repay a loan and the associated credit risk, servicing and liquidating defaulted loans, and disposing of real estate acquired as the consequence of defaulted loans.

Insurance

Life insurance operations are conducted for the benefit of service members and veterans and their beneficiaries. The day-to-day processing of all matters related to individual insurance accounts is handled by a regional office and insurance centers in Philadelphia, Pennsylvania, and St. Paul, Minnesota. These two centers provide the full range of functional activities necessary for a national life insurance program. Activities include the complete maintenance of individual accounts, underwriting functions, and life and death insurance claims awards, as well as other insurance-related transactions.

The agency is also responsible for the administration of the Veterans Mortgage Life Insurance Program for those disabled veterans who receive a VA grant for specially adapted housing. In addition, the agency is responsible for supervising the Servicemen's Group Life Insurance (SGLI) and Veterans Group Life Insurance (VGLI) Programs.

Veterans Assistance

The Veterans Assistance Service provides information, advice, and assistance to veterans, their dependents, beneficiaries, representatives, and others applying for benefits administered by the Department of Veterans Affairs. In addition, the Veterans Assistance Service cooperates with the Department of Labor and other federal, state, and local agencies in developing employment opportunities for veterans and referrals for assistance in resolving socioeconomic, housing, and other related problems. The service is responsible for maintaining a benefits protection program (fiduciary activities) for minors and incompetent adult beneficiaries. It also provides field investigative services for other VA components.

The service ensures that schools and training institutions comply with VA directives. It also ensures compliance with Title VI of the civil rights act of 1964 (42 U.S.C.A. § 2000d), Title IX of the Education Amendments of 1972 (20 U.S.C.A. § 1681), section 504 of the Rehabilitation Act of 1973 (29 U.S.C.A. § 794), and the age discrimination Act of 1975, as amended (42 U.S.C.A. § 6101).

The service's programs are provided through VA regional offices, VA medical centers, itinerant visits to communities, and a special toll-free telephone service available in all 50 states, the District of Columbia, and Puerto Rico.

The Veterans Assistance Service also provides information on veterans' benefits to the various branches of the armed forces in the United States and abroad and to veterans residing in foreign countries through U.S. embassies and consular offices. The service also coordinates veterans' activities with foreign governments.

National Cemetery System

The National Cemetery System (NCS) provides services to veterans, active duty personnel, reservists, and national guard members with 20 years' qualifying service and their families by operating national cemeteries and furnishing headstones and markers for graves. The NCS provides presidential memorial certificates to the loved ones of honorably discharged, deceased service members, and veterans. The NCS also awards grants to aid states in developing, improving, and expanding veterans' cemeteries.

The National Cemetery area offices (located in Atlanta, Georgia; Philadelphia, Pennsylvania; and Denver, Colorado) provide direct support to the 114 national cemeteries located throughout the United States and Puerto Rico.

further readings

U.S. Department of Veterans Affairs. Available online at <www.va.gov> (accessed August 16, 2003).

——. 2003. Federal Benefits for Veterans and Dependents. 2d ed. Indianapolis: JIST.

U.S. Government Manual Website. Available online at <www.gpoaccess.gov/gmanual> (accessed November 10, 2003).

cross-references

GI Bill; U.S. Court of Appeals for Veterans Claims; Veterans' Rights.

VETERANS AFFAIRS, DEPARTMENT OF

VETERANS AFFAIRS, DEPARTMENT OF. On 3 July 1930, Congress established the Veterans Administration and charged it with handling all matters of disability compensation, pensions, home and educational loan benefits, medical care, and housing for American war veterans. Offices for veterans' affairs prior to 1930 originated in the common colonial practice of supporting those disabled in the defense of the colony. A federal veterans' pension provision was administered by the secretary of war under the supervision of Congress from 1776 to 1819, when the program passed entirely to the War Department. In 1849 it moved to the Interior Department, where it remained until 1930 as the Bureau of Pensions.

In 1866 the National Home for Disabled Volunteer Soldiers was founded, with branches around the country for invalid servicemen. After World War I other offices for veterans' compensation, vocational reeducation, and insurance were brought into existence, and were consolidated as the Veterans Bureau in 1921.

After its establishment in 1930, the Veterans Administration expanded rapidly in scope and complexity. It originally served 4.6 million veterans, 3.7 percent of the U.S. population. By 1971 veterans numbered 28.3 million, a sizable 13.7 percent of the citizenry. It was estimated that they had approximately 97.6 million relatives, making 47 percent of the U.S. population actual or potential beneficiaries of the VA.

In 1987 President Ronald Reagan threw his support behind a movement to raise the Veterans Administration, an independent government agency since its creation in 1930, to a cabinet-level department, and in 1988 he signed a bill creating the Department of Veterans Affairs (VA).In 1989 the secretary of veterans affairs became the fourteenth member of the president's cabinet. The VA is the second-largest cabinet-level department of the government; only the Department of Defense is larger.

The VA is responsible for administering a wide variety of benefits for military veterans and their dependents, including medical care, insurance, education and training, loans, and guardianship of minors and incompetents. Some 60 percent of the budget goes to compensation and pensions, the former to recompense veterans for the loss of earning power because of injury or disease arising from military service. Pensions recognize an obligation to give aid when necessary for non-service connected disease or death. Some 20 percent of the VA budget goes for medical programs. In 1972 the VA maintained 166 hospitals and 298 other facilities, such as nursing homes and clinics, serving 912,342 inpatients. Health benefits administered by the VA include hospitals, nursing homes, and outpatient medical and dental care. More than half the practicing physicians in the United States received part of their training within the health care system administered by the VA. There is a Prosthetics Assessment and Information Center, and programs include vocational as well as physical rehabilitation.

Within the VA are the Veterans Health Services and Research Administration, the Veterans Benefits Administration, and the National Cemetery System. Their heads and the general counsel for the VA are appointed by the president and confirmed by the Senate. The VA oversees military pensions, compensation for disabilities and death, and insurance and loans for veterans. The GI Bill of 1944 provided housing and educational benefits for World War II veterans, and benefits have been continued for veterans of the Korean, Vietnam, and Persian Gulf Wars, all administered by the VA. More than 20 million veterans have received GI Bill benefits for education and job training since the program's inception. Cumulative GI Bill outlays surpass $73 billion.

The Department of Veterans Affairs currently represents the interests of more than 25 million veterans and their dependents in the United States. The VA managed a budget of $49 billion in fiscal year 2001, with $21 billion for health care and $28 billion for benefits.

BIBLIOGRAPHY

Daniels, Roger. The Bonus March: An Episode of the Great Depression. Westport, Conn.: Greenwood Pub. Co., 1971.

Greenberg, Milton. The GI Bill: The Law that Changed America. New York: Lickle Publishing, 1997.

Whitnah, Donald R., ed. Government Agencies: The Greenwood Encyclopedia of American Institutions.Westport, Conn.: Greenwood Press, 1983.

Richard W.Moodey/a. g.

See alsoArmy, United States ; Bonus Army ; Bonuses, Military ; Defense, Department of ; Demobilization ; Pensions, Military and Naval ; Pension Plans ; Soldiers' Home .