Rep o r t: A d e q u a c y o f Se r vi c es f o r Ve t e r a ns

Transcription

1 January 09 Rep o r t: A d e q u a c y o f Se r vi c es f o r Ve t e r a ns R e p o r t t o t h e Le g is l a t u r e A c t 213, Se c t i o n 5 9 SL H J a n u a r y

2 Table of Content I. Introduction II. III. A. Summary of Act 213, Laws of Hawaii 2007, section 59 4 B. Discussion of interim Report submitted on April 15, 2008 Definition and Services provided by various agencies A. Background information 1. Definition of a Veteran Chapter War Timelines to define the specific report parameters! How the data is broken up between the wars and OEF \ OIF 3. Discussion of the Department of Veteran s Affairs (VA)! General discussion of the benefits provided by the VA! Discussion of the OEF\OIF initiatives Discussion on available data to meet report criteria A. Summary of the data available on Veterans (National Level and \ or Hawaii) 1. Discussion of the Department of Veterans Affairs initiatives and statistic data source 2. Using the VA website data, discussion on the overall services being provided to Veterans in Hawaii compared to the National Level Data Points to include:! Total Annual Expenditure for Veterans! Average Annual Expenditure for Veterans B. Data for OEF / OIF Veterans 14 IV. Discussion of items requested from Act 213, section 59 A. Mapping of data points on report Projections for the average cost per veteran served for each type of service Projections on the number of veterans that will require each type of service Total cost projection for each type of service Projected cost of failing to expand each type of service beyond the existing levels due to lost productivity 5. Total cost projection for each type of service Table of Contents 2

3 V. Discussion of services provided by Office of Veterans Services VI. A. Services provided today by the Office of Veterans Services 1. Charter for Office of Veterans Services 2. List of services and brief descriptions Discussion on issues which our Legislature could support to help our Veterans A. General support 24 B. Discussion of the number of Veterans could be serviced with the expanded support 28 C. Other services in need Appendix 30 Table of Contents 3

4 I. Introduction This report was prepared in response to in Act 213, SLH 2007, Section 59 that requested the Office of Veterans Services (OVS) to prepare a report detailing: The Office of Veterans Services (OVS), Department of Defense, conduct a comprehensive assessment of the adequacy of mental health services, medical and rehabilitative services, and job training and employment services for veterans of the conflicts in Iraq and Afghanistan who reside in Hawaii, and prepare a report on its findings; provided further that the report shall include statistics for the current and projected populations of these veterans in Hawaii, identification of gaps in services, and recommendations on how to fill the gaps in services; provided further that the report shall include: (1) Projections for the average cost per veteran serviced for each type of service (2) Projections on the number of veterans that will require each type of service (3) Total Cost projections for each type of service (4) Projected cost of failing to expand each type of service beyond existing levels due to lost productivity; and (5) A discussion of the level of federal funds available for each type of service and in aggregate, and the adequacy of federal funding dedicated to meet the needs of these veterans for service. Summary of Draft Report submitted on January 4, 2008 The Office of Veterans Services has been attempting to comply with Act 213, SLH 2007, section 59. The office has issued a draft report which is the framework for the final report. The report contained the following points: 1. The interim report served as the framework for the final report. 2. The OVS sought to contract with an appropriate consulting group for the research and preparation of the report -- various contractors included: University of Hawaii, private researchers, and others. An outline of the work and how the data were to be collected for the report was provided. Once reviewed, the researchers opinion was that it would require a team of researchers to acquire the data, assemble it and produce a Introduction 4

5 report addressing the points requested. One of the main concerns of the researchers is that the data itself might not exist in the form requested. 3. The clarification of a veteran and the scope of the report as it deal with a veteran. Introduction 5

6 II. Definition and services provided by various agencies This section of the report attempts to establish a baseline by defining the various data points that will be referenced. It is important to have a common point of reference to evaluate the benefits being provided to our Veterans. A. Background Information 1. Definition of a Veteran A. Chapter 363 Veterans Rights and Benefits Veteran means any person who has served in any of the armed services of the United States, or any person who is now a citizen of the United States who has served in any of the armed services of any country which was an ally of the United States in any war or campaign in which the United States was also engaged. B. The Federal Government By definition, veterans are individuals who have served on active military duty for at least two years and who have been discharged or released with an Honorable discharge. Individuals who are released prior to 24 months of service for medical reasons are also considered veterans. National Guard members and Reservists who are activated for Federal service must serve for a full period for which they are activated, unless discharged for medical reasons. Active duty military members are not considered veterans nor are they considered residents of the location which they are stationed, i.e. Hawaii, unless they are already residents of Hawaii. These individuals receive medical care from the Department of Defense (DOD) Medical System. Active duty military members receive mental health services, medical and rehabilitative services and job/employment services from the Department of Defense. Definition and Services provided by various agencies 6

7 2. War Timelines The following timeline outlines the Wars which the United States have been involved: United States War Timeline: Gulf War World War I World War II Korean War Vietnam War Operation Operation Desert Shield Enduring And Storm Freedom (Gulf) (Afghanistan) Operation Iraq Freedom (Iraq) * The end of the war is set by law or Presidential Proclamation Although the request is specific to the conflicts in Iraq and Afghanistan, some of the data will include the total veteran population in Hawaii. 3. Summary of the benefits provided by the Department of Veteran Affairs General discussion of the benefits provided by the VA The VA benefits and services fall into these major categories:! Disability Benefits There are two disability programs. Both pay monthly benefits to disabled veterans: 1. Disability Compensation VA can pay compensation if at least 10% of the disability is a result of military service. 2. Disability Pension VA will pay a pension to a wartime veteran with limited income who is either unable to work or age 65 years or older.! Education and Training Benefits Veterans benefits are available if enrolled in an approved training program: 1. Montgomery GI Bill Persons who first entered active duty after June 30, 1985, are generally eligible. The bill also includes a program for certain Reservists and National Guard members. Definition and Services provided by various agencies 7

8 2. Veterans Educational Assistance Program (VEAP) for veterans who entered active duty for the first time after December 31, 1976 and before July 1, 1985 and contributed funds to the program. 3. The Post-9/11 GI Bill is for individuals with at least 90 days of aggregate service on or after September 11, 2001, or individuals discharged with a serviceconnected disability after 30 days. The Post-9/11 GI Bill will become effective for training on or after August 1, This program will pay eligible individuals:! Tuiton & fees directly to the school not to exceed the maximum in-state tuition & fees at a public Institution of Higher Learning.! A monthly housing allowance based on the Basic Allowance for Housing for an E-5 with dependents at the location of the school. To determine the BAH for your school's ZIP code click here (link goes to a non-va website)! An annual books & supplies stipend of $1,000 paid proportionately based on enrollment! A one-time rural benefit payment for eligible individuals! This benefit is payable only for training at an Institution of Higher Learning (IHL)! If you are enrolled exclusively in online training, or still in the military, you will not receive the housing allowance or books & supplies stipend. This benefit provides up to 36 months of education benefits, generally benefits are payable for 15 years following your release from active duty Time limits: Generally, veterans have 10 years from the date they were last released from active duty to use the educational benefits. Reservists generally have 10 years from the date they became eligible for the program unless they leave the Selected Reserves before completing their obligations. Definition and Services provided by various agencies 8

9 ! Vocational Rehabilitation and Employment The VA helps veterans with service-connected disabilities prepare for, find, and keep suitable employment. For veterans with serious service-connected disabilities, the VA offers services to improve their ability to live independently. 1. Job Search Assistance in finding and maintaining suitable employment. 2. Vocational Evaluation An evaluation of abilities, skills, interests and needs. 3. Career Exploration Vocational counseling and planning 4. Vocational Training If needed, training such as onthe-job and non-paid work experience 5. Educational Training If needed, educational training to accomplish the rehabilitation goal 6. Rehabilitation Service Supportive rehabilitation and counseling services. Time limits: Generally, veterans have 12 years from the date they were notified (in writing) that they have at least a 10% rating for a service-connected disability to qualify for benefit.! Home Loans The VA offers a number of home loan services to eligible veterans including National Guard and Reservists: 1. Guaranteed Loans VA can guarantee part of a loan from a private lender to help a veteran manufacture a home, purchase a home, purchase a lot for a home, and purchase certain types of condominiums. The VA also guarantees loans for buildings, repairing and improving homes. 2. Refinancing Loans If a veteran has a VA mortgage or non-va loan, the VA can assist in refinancing loan to a lower rate. 3. Special Grants Certain disabled veterans and military personnel can receive grants to adapt or acquire housing suitable for their needs. Time limits: There are no time limits for a VA home loan. Definition and Services provided by various agencies 9

10 ! Loans for Native American Veterans Eligible Native American veterans can obtain a loan from the VA to purchase, construct or improve a home on Federal Trust land, or to reduce the interest rate on such a VA loan. The maximum loan amount is equal to the Freddie Mac conforming loan limit for a single-family home. Also, Veterans are entitled to the following benefits:! Burial Benefits! Dependent and Survivors Benefits! Life Insurance! Health Care Definition and Services provided by various agencies 10

11 Discussion of the OEF\OIF initiatives for the Department of Veteran Affairs The Department of Veteran Affairs has the following initiatives:! In 2007, prioritized claim processing for OEF/OIF veterans, finalizing claims received in an average of 110 days.! Hired 100 new outreach coordinators to provide services to returning OEF/OIF veterans.! Created an Advisory Committee on OEF/OIF Veterans and Families to advise the Secretary.! Coordinated 8,236 transfers of OEF/OIF service members and veterans from a military treatment facility to a VA medical facility.! Received 39,000 referrals from the Post Deployment Health Reassessment (PDHRA) initiatives.! Contacted 91% of severely-injured or ill OEF/OIF service members/veterans, through a VA case manager, within 7 days of notification of transfer to the VA health care system. Definition and Services provided by various agencies 11

12 III. Discussion on available data to meet report requirements The data to meet the requirements of the Act were not readily available for analysis. Also, the request was not clear in defining the Veteran universe all veterans or only those involved in OEF/OIF. As a result, the report will attempt to address all veterans and where the data are available, OEF/OIF veterans specifically. A. Summary of the data available on all Veterans (National Level and/or Hawaii) Total Veteran's Population: At a National level, the following table outlines the total expenditures by fiscal year: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ,701,354 $ 75,638, $ 34,724, $ 3,926, $ 1,730, $ 576, $ 31,364, $ 3,316, ,854,367 $ 72,801, $ 33,901, $ 3,276, $ 1,774, $ 548, $ 31,149, $ 2,149, ,256,800 $ 70,248, $ 32,068, $ 3,154, $ 1,809, $ 303, $ 32,913, N/A* ,654,778 $ 65,137, $ 29,797, $ 2,980, $ 1,864, $ 424, $ 28,133, $ 1,937, Year Average 24,116,825 $ 70,956, $ 32,622, $ 3,334, $ 1,794, $ 463, $ 30,890, $ 1,850, * Data was not broken down between Medical and General Operating Expenses for 2005 For Hawaii, the following table outlines the total expenditures by fiscal year: Hawaii's Veteran Population: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ,633 $ 338, $ 174, $ 25, $ 13, $ $ 115, $ 9, ,396 $ 339, $ 172, $ 20, $ 15, $ $ 121, $ 8, ,842 $ 324, $ 163, $ 19, $ 15, $ $ 124, N/A* ,310 $ 311, $ 150, $ 21, $ 15, $ 1, $ 112, $ 8, Year Average 108,295 $ 328, $ 165, $ 21, $ 15, $ $ 118, $ 6, * Data was not broken down between Medical and General Operating Expenses for 2005 Discussion of data to meet report requirements 12

13 2. Using the VA website data, discussion on the overall expenditures for Veterans in Hawaii compared to the National Level: At a high level, the data shows that the number of Veterans has increased and the total expenditures have remained constant over the years. Thus, less money were spent on Veterans in Hawaii. The data on the following charts show these key points: 1. The number of Veterans in Hawaii increased by 15.9% from Essentially, 9.5% higher than the 4 year national average. 2. The total expenditures for Hawaii:! 2006 = $339M! 2007 = $338M 3. The expenditures per Veteran for Hawaii decreased 13.7% for The figures are: = $3,311/veteran = $2,856/veteran The overall Veteran population for Hawaii trends as follows: 120,000 Veteran Population* (Hawaii) 4 Year Average 118, , , , % more Veterans than the 4 year National Average 15.9% Increase from , , , , ,000 95,000 90, Discussion of data to meet report requirements 13

14 The average expenditures per Veteran in Hawaii trend as follows: $3, $3, $3, Average Expenditures National 4 Year Average $3, $3, $3, Decrease of 13.7 % from 2006 $3, $ 2,940 $2, $2, $2, Decrease of 2.9% from the National Average $2, $2, $2, B. The data available for OEF/OIF Veterans for VISIN 21 (Source: Demographics Cube, v1.9 last update 1/10/2008) to the total Veteran population As stated in the data section, the scope of the report did not clearly define which Veterans should be included in the numbers. Should we include all Veterans or just the Veterans of the OEF/OIF conflicts? As stated in previous tables, the total Veteran population for Hawaii is estimated to be the following: Year Veteran Population* Total Expenditures ($000s) ,633 $ 338, ,396 $ 339, ,842 $ 324, ,310 $ 311, Year Average 108,295 $ 328, Discussion of data to meet report requirements 14

15 If the report was to focus only on the Veterans who were part of the OEF/OIF conflict, we would be looking at the following number of Veterans: 1. Veterans who used VA facilities prior to first deployment for OEF/OIF: User of VA Services # of Veterans Before First Deployment 230 After First Deployment 2,454 Not a user 6,210 Total 8,894 Note: The count does not include active military duty personnel. (Refer to definition of a veteran) 2. Breakdown of Veterans by branch of service for OEF/OIF Branch Classification # of Veterans Air Force Active Duty 574 National Guard 707 Reserve 249 Air Force Total 1,530 Army Active Duty 1,952 National Guard 1,084 Reserve 2,098 Army Total 5,134 Coast Guard Active Duty 11 Reserve 2 Coast Guard Total 13 Marine Corps Active Duty 701 Reserve 117 Marine Corps Total 818 Navy Active Duty 1,231 Reserve 168 Navy Total 1,399 Grand Total 8,894 Discussion of data to meet report requirements 15

16 3. Number of unique OEF/OIF Veterans using Veterans facilities: Station Number 459 Station (V21) (459) Honolulu, HI FY01 Uniques FY02 Uniques FY03 Uniques FY04 Uniques FY05 Uniques FY06 Uniques FY07 Uniques FY08 Uniques Increase Year over Year: 12.7% 20.0% 74.6% 87.1% 158.5% 52.3% 5.4% Note: Workload updated thru September 8, 4. Age breakdown for the Veterans involved with OEF/OIF: Age Veterans <25 1, , , , Unknown 6 Total 8,894 Approximately, 5,500 of the OEF/OIF veterans are under the age of 35 years. In the long run, these Veterans will require the services of the VA. Discussion of data to meet report requirements 16

17 VI. Discussion for the items requested from Act 213, section 59 Associating available data to respond to the items outlined in Act 213, the requested data categories need to be altered slightly to match the categories in the Veterans database. The modifications are necessary to ensure that the reported data are consistent with the numbers provided by the Veterans Administration. A. Mapping of the data points for the report As stated in our interim report, the data available from the VA does not map directly to the categories requested in Act 213, section 59. The data point mapping we will be using is: Categories Requested by Act 213, section 59 VA Data Categories Not requested Compensation & Pension Job Training and Employment Services Education & Vocational Rehabilitation Not requested Insurance & Indemnities Not requested Construction Mental Health Services Medical and Rehabilitative Services Medical Care Not requested General Operating Expenses The report will be using the VA data categories for the discussion of services provided to the Veterans. The following table summarizes the national average spent on Veterans for the last four fiscal years for all of the VA categories. Average $ Spent per Veteran (Overall): Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ,701,354 $ 3, $ 1, $ $ $ $ 1, $ ,854,367 $ 3, $ 1, $ $ $ $ 1, $ ,256,800 $ 2, $ 1, $ $ $ $ 1, N/A* ,654,778 $ 2, $ 1, $ $ $ $ 1, $ Average $ Spent per Veteran (Overall): $ 2, $ 1, $ $ $ $ 1, $ * Data was not broken down between Medical and General Operating Expenses for 2005 Discussion of Items requested in Act 213, section 59 17

18 B. Questions from Act 219, section Projections for the average cost per veteran served for each type of service: For all the veterans in Hawaii, the following table summarizes the average expenditure per veteran for the last four fiscal years: Average $ Spent per Veteran (Hawaii): Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ,633 $ 2, $ 1, $ $ $ 3.49 $ $ ,396 $ 3, $ 1, $ $ $ 3.98 $ 1, $ ,842 $ 3, $ 1, $ $ $ 6.38 $ 1, N/A* ,310 $ 2, $ 1, $ $ $ $ 1, $ Average $ Spent per Veteran (Hawaii): $ 3, $ 1, $ $ $ 7.58 $ 1, $ * Data was not broken down between Medical and General Operating Expenses for 2005 Looking specifically at OEF/OIF data for Hawaii, the VA was able to extract data for total medical care expenditures (medicine and mental health) provided in The data were based on unique encounters individual veteran data were not available to refine the results further. Clinic Name FP Fixed Direct Cost Variable Direct Cost Fixed Indirect Cost Total Clinic Stop Code Costs $Tot Total Medicine Services $ 100,009 $ 1,238,195 $ 1,165,658 2,503,862 Average Cost Per Visit (Medicine): $ 220 Average Cost per Unique Veteran visit (Medicine): $ 471 Encounters Unique Patients through Fiscal Period $ 11,389 5,314 Total Mental Health $ 53,250 $ 667,363 $ 721,542 $ 1,442,148 4,896 1,600 Average Cost Per Visit (Mental Health): $ 295 Average Cost per Unique Veteran visit (Mental Health): $ 901 Total Miscellaneous $ 2,607 $ 2,098 $ 3,311 $ 8, For FY 2008 in Hawaii: Average Cost Per Visit (Visit): $ 297 Average Cost per Unique Veteran visit (Visit): $ 348! Medicine = $475/unique veteran visit! Mental Health = $901/unique veteran visit Discussion of Items requested in Act 213, section 59 18

19 2. Projections on the number of veterans that will require each type of service At a National level, the data were not broken down to the number of Veterans serviced by the individual categories. The data reflected the expenditures for the entire Veteran population. Looking specifically at OEF/OIF data for Hawaii, the VA was able to extract data for medical services (medicine and mental health) provided for The data were based on unique encounters individual veteran data were not available in the dataset. Included in this dataset were the number of encounters and unique visits. Note: The unique number of veterans is high due to the double counting of veterans receiving multiple services at the clinics. Clinic Name FP Fixed Direct Cost Variable Direct Cost Fixed Indirect Cost Total Clinic Stop Code Costs $Tot Total Medicine Services $ 100,009 $ 1,238,195 $ 1,165,658 2,503,862 Average Cost Per Visit (Medicine): $ 220 Average Cost per Unique Veteran visit (Medicine): $ 471 Encounters Unique Patients through Fiscal Period $ 11,389 5,314 Total Mental Health $ 53,250 $ 667,363 $ 721,542 $ 1,442,148 4,896 1,600 Average Cost Per Visit (Mental Health): $ 295 Average Cost per Unique Veteran visit (Mental Health): $ 901 Total Miscellaneous $ 2,607 $ 2,098 $ 3,311 $ 8, Average Cost Per Visit (Visit): $ 297 Average Cost per Unique Veteran visit (Visit): $ 348 For FY 2008 in Hawaii:! Medicine = 11,389 visits (or 5,314 unique patient visits)! Mental Health = 4,896 (or 1,600 unique patient visits) If the data provided allowed for identification of the individual users, the report would be able to state the number of Veterans received services in the current FISCAL YEAR. Discussion of Items requested in Act 213, section 59 19

20 3. Total cost projection for each type of service: For the total Veteran population in Hawaii, the following table outlines the total expenditures for the various categories in the VA database. Hawaii's Veteran Population: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ($ 000s) ,633 $ 338, $ 174, $ 25, $ 13, $ $ 115, $ 9, ,396 $ 339, $ 172, $ 20, $ 15, $ $ 121, $ 8, ,842 $ 324, $ 163, $ 19, $ 15, $ $ 124, N/A* ,310 $ 311, $ 150, $ 21, $ 15, $ 1, $ 112, $ 8, Year Average 108,295 $ 328, $ 165, $ 21, $ 15, $ $ 118, $ 6, * Data was not broken down between Medical and General Operating Expenses for 2005 For FY 2008 in Hawaii:! Educational and Vocational Rehabilitation = $25M! Medical Care = $115M For the OEF/OIF veterans, the following costs were incurred for fiscal year Clinic Name FP Fixed Direct Cost Variable Direct Cost Fixed Indirect Cost Total Clinic Stop Code Costs $Tot Total Medicine Services $ 100,009 $ 1,238,195 $ 1,165,658 2,503,862 Average Cost Per Visit (Medicine): $ 220 Average Cost per Unique Veteran visit (Medicine): $ 471 Encounters Unique Patients through Fiscal Period $ 11,389 5,314 Total Mental Health $ 53,250 $ 667,363 $ 721,542 $ 1,442,148 4,896 1,600 Average Cost Per Visit (Mental Health): $ 295 Average Cost per Unique Veteran visit (Mental Health): $ 901 Total Miscellaneous $ 2,607 $ 2,098 $ 3,311 $ 8, Average Cost Per Visit (Visit): $ 297 Average Cost per Unique Veteran visit (Visit): $ 348 For OEF/OIF FY 2008 in Hawaii:! Medicine = $ 2.5M! Mental = $ 1.4M Discussion of Items requested in Act 213, section 59 20

21 4. Projected cost of failing to expand each type of service beyond the existing levels due to lost productivity: Based on the data available, there is insufficient information to make a determination of the impact if the programs are not expanded. 5. Discussion on the level of federal funding available for each type of services and in aggregate, and the adequacy of federal funding dedicated to meet the needs of veterans for services. The following tables outline the total expenditures for the Veteran population in Hawaii for the last four fiscal years: Hawaii's Veteran Population: Year Veteran Population* Total Expenditures ($000s) Compensation & Pension ($000s) Education & Vocational Rehabilitation ($000s) Insurance & Construction ($000s) Medical Care ($000s) Indemnities ($000s) General Operating Expenses ($000s) ,633 $ 338, $ 174, $ 25, $ 13, $ $ 115, $ 9, ,396 $ 339, $ 172, $ 20, $ 15, $ $ 121, $ 8, ,842 $ 324, $ 163, $ 19, $ 15, $ $ 124, N/A* ,310 $ 311, $ 150, $ 21, $ 15, $ 1, $ 112, $ 8, Total 433,181 $ 1,314, $ 661, $ 86, $ 60, $ 3, $ 474, $ 27, * Data was not broken down between Medical and General Operating Expenses for 2005 In order to discuss the adequacy of the funding, a comparison of the average monies spent per veteran in Hawaii compared to the national average will be used. Average $ Spent per Veteran (Overall): The average monies expended per veteran spent at a national average is summarized as follows: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ,701,354 $ 3, $ 1, $ $ $ $ 1, $ ,854,367 $ 3, $ 1, $ $ $ $ 1, $ ,256,800 $ 2, $ 1, $ $ $ $ 1, N/A* ,654,778 $ 2, $ 1, $ $ $ $ 1, $ Average $ Spent per Veteran (Overall): $ 2, $ 1, $ $ $ $ 1, $ * Data was not broken down between Medical and General Operating Expenses for 2005 Discussion of Items requested in Act 213, section 59 21

22 Average $ Spent per Veteran (Hawaii): The average monies expended per veteran in Hawaii is summarized as follows: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ,633 $ 2, $ 1, $ $ $ 3.49 $ $ ,396 $ 3, $ 1, $ $ $ 3.98 $ 1, $ ,842 $ 3, $ 1, $ $ $ 6.38 $ 1, N/A* ,310 $ 2, $ 1, $ $ $ $ 1, $ Average $ Spent per Veteran (Hawaii): $ 3, $ 1, $ $ $ 7.58 $ 1, $ * Data was not broken down between Medical and General Operating Expenses for 2005 Analyzing the average monies expended in Hawaii, the following table contains a year over year comparison of the monies expended on the Veterans. Average $ Spent per Veteran (Hawaii) Year over Year Comparision: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses , % -12.5% 5.1% -26.8% -12.3% -17.7% N/A* , % 7.8% 6.0% 1.5% -37.6% -0.5% N/A* , % 11.1% -4.1% 0.5% -61.8% 13.2% N/A* ,310 Baseline * Data was not broken down between Medical and General Operating Expenses for 2005 For FISCAL YEAR 2007, there is a consistent decrease in expenditures for all categories the only increase was for expenditures for Education and Vocational rehabilitation (5.1%). Discussion of Items requested in Act 213, section 59 22

23 The following table summarizes the expenditures for Hawaii as compared to the national average. Comparision of Hawaii to National Average: Year Veteran Population* Total Expenditures Compensation & Pension Education & Vocational Rehabilitation Insurance & Indemnities Construction Medical Care General Operating Expenses ,633 Below Above Above Above Below Below Above ,396 Above Above Above Above Below Below Above ,842 Above Above Above Above Below Below N/A* ,310 Below Above Above Above Below Below Above Average $ Spent per Veteran: Above Above Above Above Below Below Below * Data was not broken down between Medical and General Operating Expenses for 2005 Hawaii s average expenditures are above the national average for the last four fiscal years except in the area of construction and medical care. It could be assumed that expenditures below the national average may have a long term impact on the level of services provided to our veterans. Discussion of Items requested in Act 213, section 59 23

24 V. Discussion services available from the Office of Veteran Services A. Services provided today by the Office of Veterans Services 1. Charter for Office of Veteran s Services The Office of Veteran s Services (OVS) is the principle state office responsible for the development and management of policies and programs related to the veterans and their family members. The OVS acts as a liaison between the Governor and veterans organizations and the Department of Veteran Affairs. The objective of OVS is to assist veterans in obtaining State and Federal entitlement, supply the latest information on veteran s issues and to support veterans making the transition back into civilian life. 2. List of services and brief descriptions of OVS activities: Example of Services for Veterans, active military, spouses and dependents! Assist in preparation of VA claims! Assist with burials of indigent veterans! Employment and re-employment! Hawaii Veterans Newsletter, Roster, Website and Memorial Fund! Helping with the filing of individual VA appeals! Support various Grant-in-Aide requests for veteran related items Veterans cemeteries, Arizona Memorial, Aviation Museum, etc.! Obtain veteran birth, marriage, divorce and death certificates nationwide! Represent veterans at VA hearings Examples of Activities OVS Performs on behalf of Veterans:! Participate in Memorial and Veterans Day Ceremonies! Staff the Advisory Board on Veterans Services! Veterans cemeteries statewide oversight, grants and expansion! Testify at State and Federal legislature in support of Veterans issues Services available from Office of Veterans Services 24

25 VI. Discussion on issues which our Legislature could support to help our Veterans A. General Support The following is a list of issues/items in which the OVS could use support from our Legislature: 1. OVS produces a Newsletter (approximate annual budget $50K). General feedback from Veterans is very favorable good source of information and resource for Veterans. A large number of our elderly Veterans do not have internet access where possible, electronic versions are being sent out. 2. Continued and expanded outreach services to meet with 211 Veteran groups in State of Hawaii. Sessions are a good source of information for the Veterans to understand the issues facing the VA. 3. Support needed to work with the VA on establishing a format for medical records that are easily accessible -- electronically. The records are necessary to process VA application to obtain VA benefits 4. A computer resource center for Veterans to use within each of the OVS offices. Possible Federal mandate to process applications electronically hardware/software would be required. 5. Discharge and separation forms develop a system to scan hardcopy and file information electronically with the OVS office. How can services be expanded with support of the legislator 25

26 6. Continued support to fund the difference for the VA Plot allowances and actual burial costs: Internment Costs: FY 2007 FY 2008 # of Veterans # of Dependents Total Burials Average Burial Cost / Burial $ 814 $ 814 Total Estimated Burial Cost $ 424,094 $ 411,884 # of Plot Allowences received Total $s Received for Plot Allowances $ 102,300 $ 100,200 Difference: $ 321,794 $ 311,684 In order to close the funding gap, the OVS looks for the continued support of the Legislature to maintain support for funding the following contracts:! Burial Services Contract - $352K! Soil Contract - $65K! Vault Contract - $134K! Funding for maintenance personal to maintain cemeteries equipment, supplies, etc. So that the OVS will be able to properly service our deceased Veterans. How can services be expanded with support of the legislator 26

27 B. Assumptions of the number of Veterans that could be serviced with the expanded support As stated in OVS 2009 Legislative Budget testimonies, the OVS is looking for support to reach out to more of the Veteran population. The following table represents the number of office visit for FY 2007 and 2008: FY Type HOVS KOVS MOVS OOVS Grand Total 2007 New Contacts ,879 Office Visit 2,152 1,429 2,241 2,229 8,051 Outreach Activities Outreach Audience 2, ,650 7,146 Telephone Contacts 3,052 1,350 3,682 6,363 14, Total 8,466 3,400 7,063 13,035 31, New Contacts ,685 Office Visit 1,883 1,546 1,864 2,690 7,983 Outreach Activities Outreach Audience 3, ,966 8,725 Telephone Contacts 3,029 1,763 2,756 10,862 18, Total 8,254 4,328 5,388 19,476 37,446 Grand Total 16,720 7,728 12,451 32,511 69,410 Per Year Average visits: 8,360 3,864 6,226 16,256 34,705 Currently, the OVS does not track the number of unique Veterans visiting the office for assistance. Using the assumption that 75% of the office visits are related to a unique Veteran, we have the following estimate of the number of Veterans serviced in Hawaii by OVS: Assumption for unique Veterans (75% of total visits): HOVS KOVS MOVS OOVS Grand Total 6,270 2,898 4,669 12,192 26,029 Veteran Population (2007)*: 16,156 6,153 11,566 84, ,633 Notes: * Veteran population estimate as of September 30, 2007 by the VA Office of the Actuary (VetPop 2007). Estimated % of Veteran's Serviced **: 38.8% 47.1% 40.4% 14.4% 21.9% How can services be expanded with support of the legislator 27

28 With the support of the Legislature, the OVS could increase the counselor staff and thereby increase the number of Veterans service as follows: HOVS KOVS MOVS OOVS Grand Total Counselor Increase: Notes: **Target to increase number of visits by 30% Assumption for unique Veterans (75% of the visits): 8,151 2,898 6,070 19,507 33,837 Veteran Population (2007): 16,156 6,153 11,566 84, ,633 Projected % of Veteran's Serviced: 50.5% 47.1% 52.5% 23.0% 28.5% C. Other services that are in need The following items are a list of issues which are in need: 1. Supporting programs and providing necessary assets required to the Hawaii State Office of Veteran s Services to help Hawaii veterans obtain affordable and adequate health care and benefits they earned through their military service. 2. Supporting the Hawaii State Office of Veteran s Services effort to identify and propose additional legislative measures to improve the quality of life and recognize the service of our veterans and families. 3. Supporting initiatives to assist homeless veterans, those suffering from post-traumatic stress disorder, and those without service-connected illnesses. 4. Providing employers a tax credit for training and employing veterans. 5. Exempting a portion of military income from State income tax for Hawaii residents. 6. Ensuring adequate funding for the operations, maintenance, equipping and expansion of Veteran s Cemeteries, to include the procurement of burial vaults and monuments. 7. Providing the University of Hawaii with tuition waivers for State residents who are honorably discharged veterans. How can services be expanded with support of the legislator 28

29 8. Providing a proportional increase in specialized housing grants to totally disabled veterans who require modifications to their residence due to service connected disabilities. 9. Devising through private and government partnerships, a method to digitize and store veteran s records. How can services be expanded with support of the legislator 29

30 Appendix: Appendix 30

31 GEOGRAPHIC DISTRIBUTION OF VA EXPENDITURES FOR FY 2004 Expenditures in $000 VA MEDICAL CARE - FY 2004 Veteran Total Compensation Education & Insurance & Total Unique Medical STATE Population* Expenditures & Pension Voc Rehab Indemnities CNSTR GOE Patients ** Expenditures TOTALS 24,654,778 65,137,137 29,797,332 2,980,373 1,864, ,070 1,937,012 4,969,222 28,133,352 Alabama 426,322 1,306, ,463 58,934 25,308 4,768 15,114 91, ,130 Alaska 67, , ,270 10,950 2, ,104 12, ,574 Arizona 555,223 1,431, ,180 88,428 42,193 3,746 27, , ,920 Arkansas 268,353 1,054, ,199 29,366 15,925 6,678 11,128 82, ,939 California 2,310,968 5,620,993 2,446, , ,721 28,041 72, ,923 2,580,309 Colorado 427,956 1,000, ,415 78,140 29,866 5,073 23,345 62, ,563 Connecticut 268, , ,490 28,475 29,881 6,524 6,040 52, ,832 Delaware 80, ,105 79,527 6,278 5,822 2,509 1,655 13,190 71,314 District of Columbia 37,377 1,296,530 93,440 15,192 3, , ,235 11, ,601 Florida 1,788,496 4,647,883 2,186, , ,441 19,713 52, ,049 2,015,252 Georgia 760,323 1,909, , ,613 41,776 3,182 40, , ,984 Hawaii 107, , ,863 21,251 15,979 1,791 8,645 17, ,944 Idaho 133, , ,429 17,438 8,138 1,087 3,574 29, ,778 Illinois 896,640 1,963, ,899 94,855 77,571 27,972 51, ,541 1,078,510 Indiana 550,871 1,045, ,252 40,559 28,083 2,890 13, , ,643 Iowa 265, , ,321 19,274 22,923 4,990 5,581 64, ,184 Kansas 246, , ,517 30,064 18,523 3,887 6,953 59, ,226 Kentucky 359,845 1,058, ,304 41,739 18,352 4,069 12,432 88, ,597 Louisiana 366,957 1,112, ,310 45,957 22,126 4,614 12,864 87, ,195 Maine 143, , ,961 17,061 9, ,100 36, ,602 Maryland 486,298 1,122, ,742 54,619 39,706 7,672 13,037 73, ,682 Massachusetts 490,882 1,364, ,640 36,562 50,114 15,960 12,814 81, ,667 Michigan 836,950 1,440, ,436 58,857 50,882 8,391 17, , ,144 Minnesota 426,591 1,039, ,520 36,521 38,287 1,512 26,077 89, ,278 Mississippi 240, , ,421 24,459 13, ,381 71, ,264 Missouri 554,531 1,635, ,013 53,936 35,670 2,867 40, , ,616 Montana 102, , ,612 11,956 7, ,325 27, ,743 Nebraska 159, , ,376 21,703 13, ,954 40, ,161 Nevada 243, , ,977 24,127 12,997 3,330 5,917 49, ,544 New Hampshire 131, , ,250 12,369 9, ,820 25, ,667 New Jersey 582,917 1,098, ,197 39,236 64,600 2,312 9,834 81, ,052 New Mexico 180, , ,912 29,808 14,018 1,715 7,842 60, ,774 New York 1,171,900 3,196,934 1,176, , ,526 13,269 48, ,450 1,727,463 North Carolina 767,051 2,096,981 1,156, ,407 47,476 3,801 23, , ,572 North Dakota 55, ,925 74,926 8,653 4,765 2,348 3,182 16,728 63,051 Ohio 1,051,683 2,126, ,249 93,873 69,281 10,701 31, ,656 1,014,280 Oklahoma 355,312 1,280, ,596 56,876 20,843 1,826 34,203 78, ,974 Oregon 366,780 1,043, ,227 46,185 23,794 8,621 18,568 75, ,856 Pennsylvania 1,145,919 2,474,471 1,069,222 74,641 96,822 12,623 74, ,762 1,147,003 Rhode Island 91, , ,520 6,875 7, ,128 19, ,724 South Carolina 413,551 1,127, ,725 55,170 25,839 2,742 14,397 89, ,872 South Dakota 73, , ,721 11,282 5, ,484 28, ,590 Tennessee 540,778 1,464, ,075 59,940 27,895 13,309 20, , ,903 Texas 1,681,748 5,031,670 2,607, , ,955 14,519 88, ,693 1,923,666 Utah 151, , ,735 20,628 11, ,912 28, ,101 Vermont 57, ,073 67,772 11,034 4,362 1,571 1,475 14,138 72,859 Virginia 750,950 1,795, , ,118 54,650 7,851 35, , ,621 Washington 632,929 1,631, ,570 98,915 41,151 8,441 19,910 91, ,262 West Virginia 188, , ,488 48,598 10,265 2,669 9,636 59, ,028 Wisconsin 474,594 1,132, ,669 36,831 39,818 17,471 17, , ,109 Wyoming 54, ,887 60,956 6,015 3, ,236 97,959 Puerto Rico 131, , ,645 17,258 4,171 5,590 12,129 62, ,772 Notes: * Veteran population estimated as of September 30, Data from Office of the Actuary, Department of Veterans Affairs. Data is unrounded. ** The count of unique patients includes non-veterans who received medical care at the VA. Data is unrounded. Medical expenditures represent cost assigned to each patient based on services provided and overhead distribution. Congressional Districts are for the 108th Congress. CNSTR - Construction; GOE - General Operating Expenses Appendix 31

32 GEOGRAPHIC DISTRIBUTION OF VA EXPENDITURES FOR FY 2005 Expenditures in $000 Veteran Total Compensation Education & Insurance & Medical STATE Population* Expenditures & Pension Voc Rehab Indemnities Construction & GOE TOTALS 24,256,800 70,248,954 32,068,270 3,154,748 1,809, ,192 32,913,328 Alabama 421,992 1,374, ,564 57,566 24,672 2, ,023 Alaska 66, , ,403 10,577 2,481 1, ,831 Arizona 552,963 1,519, ,741 85,494 41,157 7, ,853 Arkansas 265,532 1,097, ,422 30,353 15,499 3, ,600 California 2,257,130 5,939,724 2,664, , ,061 28,303 2,756,990 Colorado 424,029 1,618, ,998 77,084 29,072 7, ,279 Connecticut 260, , ,599 42,702 28,786 2, ,042 Delaware 79, ,068 81,726 6,945 5,619 1,997 99,781 District of Columbia 36,056 1,765,921 93,351 15,330 3,302 4,626 1,649,312 Florida 1,768,359 5,156,967 2,547, , ,831 19,317 2,205,966 Georgia 758,963 2,049,475 1,080, ,708 40,966 14, ,034 Hawaii 104, , ,804 19,909 15, ,893 Idaho 132, , ,769 16,010 7,999 1, ,027 Illinois 874,387 1,892, ,043 92,901 74,774 28,889 1,021,236 Indiana 542, , ,767 37,635 27, ,809 Iowa 260, , ,947 19,847 22,241 2, ,738 Kansas 241, , ,066 28,242 17,898 1, ,348 Kentucky 355,576 1,008, ,571 40,220 17,876 4, ,437 Louisiana 361,757 1,258, ,578 48,870 23,480 2, ,887 Maine 141, , ,034 25,408 9,796 2, ,278 Maryland 478,543 1,006, ,180 60,010 38,276 3, ,902 Massachusetts 476,363 1,411, ,065 45,021 48,065 4, ,845 Michigan 820,485 1,568, ,938 60,713 49,199 8, ,111 Minnesota 418,386 1,142, ,299 38,041 37,363 5, ,630 Mississippi 238, , ,591 23,899 12,931 2, ,929 Missouri 546,416 1,684, ,033 55,633 34,509 3, ,364 Montana 101, , ,711 11,246 7, ,151 Nebraska 156, , ,924 20,985 13,454 2, ,998 Nevada 244, , ,197 24,943 12,587 7, ,050 New Hampshire 129, , ,451 15,714 9, ,399 New Jersey 563,953 1,027, ,614 59,300 62,025 2, ,834 New Mexico 178, , ,879 30,885 13,838 2, ,822 New York 1,132,703 3,365,992 1,211, , ,364 15,456 1,870,328 North Carolina 761,894 2,251,938 1,264, ,828 47,045 3, ,331 North Dakota 54, ,454 80,266 8,756 4,615 2,422 99,396 Ohio 1,032,095 2,795, ,206 86,172 66,439 10,075 1,689,005 Oklahoma 351,072 1,311, ,396 64,030 20,572 5, ,762 Oregon 362,104 1,143, ,793 47,154 23,303 10, ,627 Pennsylvania 1,117,004 2,640,348 1,099,113 73,050 93,452 9,491 1,365,242 Rhode Island 88, , ,063 6,551 7, ,737 South Carolina 411,987 1,167, ,454 59,358 25,423 3, ,228 South Dakota 72, , ,022 11,223 5, ,242 Tennessee 536,574 1,745, ,018 58,189 27,342 6, ,259 Texas 1,667,370 5,380,225 2,840, , ,797 15,795 2,123,974 Utah 148, , ,144 20,608 11, ,561 Vermont 56, ,704 69,051 18,430 4, ,905 Virginia 744,459 1,850,101 1,037, ,262 53,033 4, ,305 Washington 625,408 1,683, ,516 91,717 40,113 15, ,861 West Virginia 185, , ,552 62,266 10,088 1, ,936 Wisconsin 466,054 1,193, ,151 36,832 38,839 11, ,682 Wyoming 54, ,384 64,805 5,515 3,388 1, ,823 Puerto Rico 128, , ,352 18,689 4,148 2, ,727 Notes: * Veteran population estimated as of September 30, Data from Office of the Actuary, VA. Data is unrounded. GOE - General Operating Expenses Appendix 32

33 Appendix 33

34 State Veteran Population* Total Expenditures ($000s) Geographic Distribution of VA Expenditures for Fiscal Year 2007 Summary of Expenditures by State Education & Vocational Rehabilitation ($000s) Compensation & Pension ($000s) Insurance & Indemnities ($000s) Construction ($000s) Medical Care ($000s) General Operating Expenses ($000s) Totals 23,701,354 $ 75,638,660 $ 34,724,430 $ 3,926,253 $ 1,730,431 $ 576,941 $ 31,364,151 $ 3,316,454 Alabama 416,947 $ 1,540,871 $ 874,736 $ 71,448 $ 22,533 $ 10,522 $ 539,809 $ 21,823 Alaska 74,557 $ 246,243 $ 119,804 $ 13,361 $ 2,499 $ 4,240 $ 103,105 $ 3,233 Arizona 567,632 $ 1,692,200 $ 806,046 $ 102,484 $ 38,394 $ 11,937 $ 696,101 $ 37,237 Arkansas 262,374 $ 1,201,281 $ 573,577 $ 39,709 $ 15,531 $ 4,240 $ 541,312 $ 26,912 California 2,131,939 $ 6,542,229 $ 2,828,302 $ 374,780 $ 183,315 $ 95,490 $ 2,942,283 $ 118,058 Colorado 427,706 $ 1,193,479 $ 626,792 $ 92,639 $ 29,875 $ 13,891 $ 395,602 $ 34,679 Connecticut 253,800 $ 624,548 $ 213,377 $ 50,449 $ 28,844 $ 4,368 $ 318,170 $ 9,340 Delaware 80,592 $ 189,754 $ 89,792 $ 9,716 $ 5,265 $ - $ 82,182 $ 2,799 District of Columbia 39,243 $ 1,416,459 $ 53,458 $ 16,961 $ 3,241 $ 48,503 $ 114,824 $ 1,179,472 Florida 1,746,539 $ 5,716,609 $ 2,755,423 $ 268,488 $ 143,345 $ 75,288 $ 2,382,430 $ 91,635 Georgia 765,289 $ 2,347,397 $ 1,227,580 $ 191,617 $ 43,083 $ 6,460 $ 811,044 $ 67,613 Hawaii 118,633 $ 338,919 $ 174,876 $ 25,094 $ 13,193 $ 414 $ 115,721 $ 9,621 Idaho 137,152 $ 404,916 $ 201,042 $ 20,932 $ 7,430 $ 692 $ 170,089 $ 4,731 Illinois 841,679 $ 2,167,489 $ 736,604 $ 120,595 $ 70,662 $ 20,113 $ 1,146,837 $ 72,678 Indiana 517,764 $ 1,212,684 $ 518,568 $ 52,908 $ 26,736 $ 3,440 $ 591,716 $ 19,316 Iowa 251,420 $ 683,439 $ 273,938 $ 28,278 $ 20,135 $ 1,709 $ 351,945 $ 7,434 Kansas 236,596 $ 682,473 $ 292,485 $ 36,171 $ 16,866 $ 1,473 $ 325,040 $ 10,438 Kentucky 347,013 $ 1,248,171 $ 617,684 $ 52,060 $ 18,104 $ 2,665 $ 540,808 $ 16,850 Louisiana 325,992 $ 1,145,376 $ 571,055 $ 47,986 $ 20,450 $ 1,377 $ 485,958 $ 18,551 Maine 144,007 $ 568,686 $ 311,564 $ 29,701 $ 9,543 $ 378 $ 209,180 $ 8,320 Maryland 484,013 $ 1,237,489 $ 546,253 $ 74,648 $ 38,386 $ 8,747 $ 552,079 $ 17,376 Massachusetts 440,901 $ 1,404,320 $ 610,632 $ 55,361 $ 47,563 $ 4,333 $ 669,563 $ 16,868 Michigan 761,308 $ 1,679,789 $ 797,741 $ 81,466 $ 48,111 $ 13,206 $ 710,202 $ 29,063 Minnesota 408,468 $ 1,282,017 $ 570,073 $ 51,371 $ 33,455 $ 9,966 $ 566,035 $ 51,117 Mississippi 215,804 $ 888,653 $ 400,016 $ 27,321 $ 12,635 $ 13,327 $ 415,625 $ 19,729 Missouri 530,799 $ 1,565,700 $ 699,403 $ 68,914 $ 34,114 $ 10,004 $ 691,232 $ 62,033 Montana 104,391 $ 349,549 $ 180,667 $ 16,225 $ 7,192 $ 3,096 $ 137,257 $ 5,113 Nebraska 152,843 $ 493,340 $ 214,673 $ 27,415 $ 13,237 $ 5,308 $ 232,122 $ 584 Nevada 245,773 $ 757,492 $ 321,105 $ 33,400 $ 12,554 $ 26,687 $ 354,061 $ 9,685 New Hampshire 132,290 $ 359,934 $ 164,806 $ 21,352 $ 9,827 $ 293 $ 156,687 $ 6,969 New Jersey 506,752 $ 1,208,840 $ 549,563 $ 75,227 $ 57,651 $ 5,157 $ 508,939 $ 12,304 New Mexico 179,497 $ 768,725 $ 399,912 $ 37,352 $ 12,374 $ 14,843 $ 294,234 $ 10,010 New York 1,065,749 $ 3,564,054 $ 1,255,771 $ 185,733 $ 107,274 $ 6,415 $ 1,931,257 $ 77,605 North Carolina 773,630 $ 2,583,647 $ 1,425,344 $ 156,579 $ 43,312 $ 6,342 $ 909,189 $ 42,879 North Dakota 58,283 $ 183,381 $ 89,404 $ 11,944 $ 3,564 $ 690 $ 73,506 $ 4,272 Ohio 957,889 $ 2,877,619 $ 1,029,533 $ 102,429 $ 66,587 $ 17,649 $ 1,202,780 $ 458,641 Oklahoma 338,086 $ 1,427,916 $ 886,984 $ 67,945 $ 19,070 $ 598 $ 428,143 $ 25,175 Oregon 351,697 $ 1,229,527 $ 604,448 $ 59,917 $ 23,800 $ 15,258 $ 502,656 $ 23,449 Pennsylvania 1,057,073 $ 2,817,240 $ 1,166,975 $ 108,038 $ 89,988 $ 60,120 $ 1,289,640 $ 102,479 Rhode Island 79,616 $ 269,727 $ 125,657 $ 9,357 $ 8,027 $ 199 $ 121,278 $ 5,208 South Carolina 410,076 $ 1,387,469 $ 756,616 $ 75,114 $ 23,857 $ 8,074 $ 501,939 $ 21,868 South Dakota 74,273 $ 352,701 $ 136,258 $ 14,778 $ 4,950 $ - $ 191,098 $ 5,617 Tennessee 512,156 $ 1,682,881 $ 785,980 $ 74,988 $ 27,714 $ 8,719 $ 751,197 $ 34,282 Texas 1,707,365 $ 6,292,889 $ 3,215,501 $ 363,398 $ 105,171 $ 17,760 $ 2,243,419 $ 347,640 Utah 157,012 $ 445,928 $ 183,098 $ 25,834 $ 11,547 $ 309 $ 210,640 $ 14,499 Vermont 55,382 $ 175,100 $ 72,725 $ 20,939 $ 4,378 $ 12 $ 74,701 $ 2,345 Virginia 807,326 $ 2,138,049 $ 1,157,165 $ 170,635 $ 53,870 $ 3,272 $ 707,840 $ 45,267 Washington 643,302 $ 1,784,876 $ 1,025,951 $ 113,768 $ 40,858 $ 4,928 $ 573,036 $ 26,334 West Virginia 177,544 $ 888,944 $ 375,164 $ 66,437 $ 9,282 $ 3,313 $ 402,480 $ 32,267 Wisconsin 446,415 $ 1,285,488 $ 571,185 $ 53,327 $ 35,699 $ 562 $ 595,907 $ 28,808 Wyoming 56,125 $ 191,972 $ 73,166 $ 6,742 $ 2,872 $ 554 $ 107,877 $ 761 Puerto Rico 122,640 $ 900,183 $ 465,954 $ 22,923 $ 2,468 $ - $ 393,373 $ 15,465 Totals 23,701,354 $ 75,638,660 $ 34,724,430 $ 3,926,253 $ 1,730,431 $ 576,941 $ 31,364,151 $ 3,316,454 Notes: * Veteran population estimate as of September 30, 2007 by the VA Office of the Actuary (VetPop 2007). Expenditure data sources: Federal Assistance Awards Data System (FAADS) for Compensation & Pension (C&P) and Readjustment and Vocational Rehabilitation Benefits; Veterans Benefits Administration Insurance Center for the Insurance costs; the VA Financial Management System (FMS) for Construction, Medical, General Operating Expenses, and certain C&P and Readjustment data; and the Allocation Resource Center (ARC) for Medical Care costs. Appendix 34