[Administrator of Veterans Affairs, Annual Report, 1981]
[From the U.S. Government Publishing Office, www.gpo.gov]
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Veterans Administration
annual report 1981
Administrator of Veterans Affairs
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Veterans Administration
annual
report
1981 SAN DIEGO PUBUC LIBRARY
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3 1336 08668 0684
Letter of Transmittal
To the President of the Senate and the Speaker of the House of Representatives of the 97th Congress:
In accordance with the provisions of 38 U.S.C. 214, I have the honor of submitting a report on the activities of the Veterans Administration for the fiscal year ending September 30, 1981.
ROBERT P. NIMMO
Administrator of Veterans Affairs
iii
Contents
Letter of Transmittal iii
The Veteran Comparative Highlights...................................................... 1
Summary................................................................... 1
Number of Veterans and Period of Service...................................2
Age of Veterans............................................................2
Female Veterans............................................................3
Veterans and Their Families................................................4
Characteristics of Veterans................................................4
Educational Attainment and Income........................................5
Work Experience......................................................... 6
Employment Status........................................................6
Family Income............................................................6
New Legislation............................................................6
Health Care Comparative Highlights...................................................... 9
Summary................................................................... 9
Types of Care............................................................ 10
Hospital Care.......................................................... 10
Ambulatory Care........................................................ 11
Geriatrics and Extended Care........................................... 11
Medical Care for Dependents............................................ 15
Services................................................................. 15
Medicine............................................................... 15
Surgery................................................................ 16
Mental Health and Behavioral Sciences.................................. 17
Rehabilitation Services................................................ 19
Audiology and Speech Pathology..........................................20
Blind Rehabilitation................................................... 20
Prosthetic and Sensory Aids.............................................20
Spinal Cord Injury......................................................21
Environmental Medicine....................................................21
Neurology ............................................................... 22
Radiology.................................................................22
Nuclear Medicine..........................................................23
Dentistry.................................................................24
Optometry ............................................................... 24
Podiatry..................................................................24
Pathology.................................................................25
Nursing...................................................................26
Recreation................................................................28
Pharmacy..................................................................28
Dietetics ............................................................... 29
Social Work...............................................................29
Chaplain Service..........................................................30
Canteens ................................................................ 30
Monitored Professional Services Programs..................................31
Academic Affairs..........................................................31
VA Facilities - School Affiliations.....................................32
VA Staff as Academic Faculty............................................33
Graduate and Undergraduate Medical and Dental Education.........................................................33
v
CONTENTS — Continued
Fellowship Programs.....................................................34
Health Professional Scholarship Program.................................34
Graduate and Undergraduate Education in Nursing and Associated Health Professions and Occupations.......................34
Continuing Education and Staff Development..............................35
Library.................................................................36
Medical Media...........................................................37
Educational Space.......................................................37
Exchange of Medical Information.........................................37
Assistance for Health Manpower Training Institutions....................38
VA Administrative Scholars Program......................................38
Research and Development..................................................39
Medical Research........................................................40
Health Services Research and Development................................40
Rehabilitative Engineering..............................................41
Resources.................................................................42
Costs ................................................................. 42
Employment..............................................................44
Quality of Care......................................................... 45
Quality Assurance Review................................................45
Patient Satisfaction Survey.............................................46
Planning and Sharing......................................................47
Medical District Initiated Program Planning Process.....................47
Coordination of VA and Community Health Planning........................48
Emergency Preparedness and Contingency Planning.........................48
Sharing of Specialized Medical Resources................................49
Facilities and Equipment..................................................49
Engineering ........................................................... 49
Biomedical Equipment................................................... 50
Building Management.....................................................50
Physical Security and Law Enforcement...................................50
Characteristics of VA Patients............................................51
Age.....................................................................51
Service Connected and VA Pensioners.....................................52
Diagnoses.............................................................. 53
Duration of Stay........................................................53
Disposition Status..................................................... 54
Compensation and Pension Comparative Highlights................................................... 57
Summary.................................................................. 57
Compensation ............................................................ 58
Pension...................................................................59
Period of Service.........................................................50
Vietnam Era.............................................................50
Korean Conflict.........................................................61
World War II............................................................51
World War I.............................................................61
Other Periods...........................................................61
Burial Allowance ........................................................ 62
Education Benefits Comparative Highlights................................................... 63
Summary .................................-................................63
Education and Training....................................................63
Veterans' Educational Assistance (Gl Bill)..............................63
Post-Vietnam Era Veterans' Educational Assistance.......................64
Dependents' Educational Assistance......................................64
State Approving Agencies..................................................65
School Liability..........................................................65
vi
CONTENTS - Continued
Housing Assistance Comparative Highlights................................................. 67
Summary................................................................67
Mobile Home Loans......................................................69
Plant Inspections....................................................69
Onsite Inspections...................................................69
Compliance with Warranty.............................................70
Profile of Mobile Home vs. Gl Home Market............................70
Defaults.............................................................71
Direct Loans.......................................................... 71
Gl Home Loans..........................................................71
Credit Market Conditions...............................................72
Funding Operations.....................................................72
Specially Adapted Housing Assistance...................................72
Fair Housing Program.................................................. 73
Life Insurance Comparative Highlights................................................. 75
Summary............................................................... 76
Government Administered Programs.......................................76
U.S. Government Life Insurance (USGLI)...............................76
National Service Life Insurance (NSLI)...............................76
Veterans Special Life Insurance (VSLI)...............................77
Service Disabled Veterans Insurance (SDVI)...........................77
Veterans Reopened Insurance (VRI)....................................78
Total Disability Income Provision (TDIP).............................78
Death Claim Settlement Under Option 2................................78
Government Supervised Programs.........................................79
Servicemen's Group Life Insurance (SGLI).............................79
Veterans Group Life Insurance (VGLI).................................79
Veterans Mortgage Life Insurance (VMLI)..............................79
Veterans Assistance Comparative Highlights................................................. 81
Summary................................................................81
Outreach...............................................................81
POW Outreach.........................................................82
Elderly Beneficiaries..................................................82
incarcerated Veterans..................................................82
U. S. Veterans Assistance Centers......................................83
Employment Assistance..................................................83
Fiduciary and Field Examination Activity...............................83
Equal Opportunity Compliance...........................................83
Vocational Rehabilitation and Counseling Comparative Highlights............................................... 85
Summary............................................................... 85
Vocational Rehabilitation..............................................85
Independent Living Program...........................................86
Work Measurement.................................................... 86
Veterans Advisory Committee on Rehabilitation........................87
Coordination with other Federal Programs.............................87
Counseling............................................................ 87
Cemeteries and Memorials Comparative Highlights............................................................... 89
Summary................................................................89
Construction Projects..................................................90
Headstones and Markers.................................................90
State Cemetery Grants Program..........................................92
Administration and Comparative Highlights................................................. 95
Management Agency Funding..........................................................95
vii
CONTENTS — Continued
Personnel Management....................................................96
Staffing ............................................................ 97
Employment of Veterans................................................98
Executive Development and Training....................................98
Labor Management Relations............................................99
Employee Recognition..................................................99
Equal Employment Opportunity.......................................... 100
Minority Employment................................................. 100
Employment of Women................................................. 101
Employment of Disabled Veterans and Handicapped Individuals......... 101
Automatic Data Processing............................................. 102
Computer System Improvements........................................ 102
Medical Applications................................................ 103
Veterans Benefits Applications...................................... 103
Other Applications.................................................. 104
Telecommunications.................................................... 105
Telephone Service................................................... 105
Broadband Integrated Telecommunications System (BITS)................105
Closed Circuit Television........................................... 105
Radio................................................................105
Nurse Call Communications............................................105
Data Transmission - Pharmacy........................................ 106
Supplies and Equipment.................................................106
Construction...........................................................108
Contracts........................................................... 108
Energy Engineering.................................................. 109
Construction Research............................................... 109
Barrier-Free Design................................................. 109
State Veterans' Home................................................ 110
Real Estate and Space Management.....................................110
Management Improvement.................................................111
Records and Information Management.................................. 111
Reports Management.................................................. 112
Financial Management.................................................113
Audits and Investigations........................................... 114
Audiovisuals........................................................ 114
Presidential Memorial Certificate Program........................... 115
Legal Matters........................................................115
Appellate Review.....................................................118
Statistical Tables 123
Index 235
viii
The Veteran
Comparative Highlights Period of Service Veteran Population Sept. 30, 1980 Net Separations from Armed Forces Deaths in Civil Life Veteran Population Sept. 30, 1981 Percent Change
Total veterans1 30,118,000 346,000 381,000 30,083,000 - 0.1
War veterans1 26,065,000 93,000 369,000 25,789,000 - 1.1
Vietnam era-Total 9,015,000 93,000 21,000 9,087,000 + 0.8
With no Korean conflict service With Korean 8,463,000 89,000 15,000 8,537,000 + 0.9
conflict service 552,000 4,000 6,000 550,000 - 0.4
Korean conflict-Total 5,826,000 4,000 49,000 5,781,000 - 0.8
With no World War II service With World War II 4,659,000 4,000 30,000 4,633,000 - 0.6
service 1,167,000 - 19,000 1,148,000 - 1.6
World War Il-Total 12,422,000 - 252,000 12,170,000 - 2.0
With no Korean conflict service With Korean 11,255,000 - 233,000 11,022,000 - 2.1
conflict service 1,167,000 - 19,000 1,148,000 - 1.6
World War I 521,000 - 72,000 449,000 -13.8
Service between Korean conflict and Vietnam era only 3,050,000 - 10,000 3,040,000 - 0.3
Post-Vietnam era 1,003,000 253,000 2,000 1,254,000 + 25.0
'Not included are Spanish-American War veterans who numbered 147 on September 30, 1980 and 86 on September 30, 1981; 61 died during FY 1981.
Summary
During the more than two centuries of United States history, this country has been involved in 10 major armed conflicts, some fought on American soil and others carried out in foreign countries. Nearly 39 million Americans have participated in these wars, and over 90 percent of them have served during the 20th century. The death toll has been high; more than a million people have sacrificed their lives in defense of this nation during periods of war. The living veteran population stood at just over 30 million at the end of FY 1981. Eighty-five percent of these were veterans of America's wars; the remaining 4.3 million ex-service personnel served during peacetime periods only.
1
Number of Veterans and Period of Service
Age of Veterans
For the first time in 16 years, the estimated number of veterans in civil life has begun to fall. The veteran population peaked in November 1980 at an estimated total of 30,143,000, but by the end of fiscal year 1981 this count had declined to 30,083,000. The reversal of the trend can be traced to Public Law 96-342. This legislation, approved by the President on September 8, 1980, stipulates that any individual who enlists in a regular component of the armed forces on or after the date this law was enacted, and who fails to complete at least two years of military service, will not be afforded veteran status or the rights and benefits attached to such status.1 Approximately 42,000 separatees from the armed forces were denied veteran status as a result of these restrictions. The marginal decrease in the size of the veteran population during FY 1981 was the net result of the addition of 366,000 service personnel discharged from the armed forces, the return from civilian life of 20,000 who reenlisted, plus the loss of 381,000 veterans who died during the year. Further reductions in the estimated number of living veterans are expected, although the decreases will be of a low magnitude.
For only two periods of military service—the Vietnam era only and the post-Vietnam era —were increases posted in the number of living veterans during FY 1981. The number of ex-service personnel from the Vietnam era grew to a total of 8,537,000 on September 30, 1981, a rise of 74,000 over a year earlier. The group of post-Vietnam era veterans continued to rise markedly, increasing 25 percent during the 12-month period to 1,254,000. World War II veterans accounted for two of every five members of the living population on September 30, 1981, in spite of the death of over a quarter of a million persons. Veterans whose only service occurred during the Vietnam era accounted for 28 percent of all living veterans, and Korean conflict veterans with no World War II service (4,633,000) constituted 15 percent. Veteran survivors of World War I fell below the half million mark; they numbered 449,000 at the end of FY 1981. Peacetime veterans who served only in the peacetime period between the Korean conflict and the Vietnam era dropped slightly to an estimated total of 3,040,000.
The average age of veterans in civil life on September 30, 1981 was 48.0 years, a figure which will gradually rise over the next two decades. Now that the number of living veterans has started to decline, the average age of the population will increase
ESTIMATED VETERAN POPULATION BY AGE
'Exceptions to this law are persons who sustain service-incurred disabilities as well as those who are classified as hardship cases.
2
Female Veterans
by about six years in the next two decades, provided no large build-up of the Armed Forces is required. This aging process will be the net result of the movement of the large cohort of World War II veterans into the older age groups combined with comparatively smaller numbers of younger veterans entering the population as they leave military service. This phenomenon may be illustrated by examining the proportion of the population 65 years of age and older. The share of living veterans on September 30, 1981, who fell into this age group was 11 percent, or an estimated 3.3 million persons. By the turn of the century, ex-service personnel 65 years old and over will number about 9.0 million and will comprise about one-third of the entire veteran population. This transformation of the veteran age structure is of major importance to VA planners who recognize the strains this will place on the veteran health care system over the next 20 years.
Since age is highly correlated with period of military service, the average ages of different groups of veterans fall into order according to the chronological sequence in which the periods of service occurred. Spanish-American War veterans, who numbered 86 at the close of FY 1981, had an average age of 101.0 years.
Chronologically, they were followed by veteran survivors of World War I (85.3 years), World War II (60.5 years), and the Korean conflict (51.1 years). Veterans whose only service was between the Korean conflict and the Vietnam era averaged 42.2 years, while Vietnam era veterans had a mean age of 34.3 years. The youngest living ex-service personnel were those who served only after May 7, 1975 (i.e., post-Vietnam era veterans); their ages average 23.4 years.
The estimated number of female veterans on September 30, 1981 was 742,000, an increase of 4.1 percent over the total a year earlier. The net addition of 29,000 women to the veteran population during FY 1981 was, in part, a reflection of the impact of Public Law 96-342. A greater share of women than men in the armed forces failed to complete at least two years of military service, and thus proportionately more women than men were denied eligibility for veteran benefits during the 12-month period as a result of this legislation. Despite this, however, the female veteran population, unlike that for males, continued to grow and accounted for 2.5 percent of all living ex-service personnel at the close of FY 1981.
Female veterans of World War II numbered 283,000 on September 30, 1981, or 38 percent of all female veterans. Those whose only service was during the Vietnam era comprised the second largest group (197,000), followed by female veterans of the
ESTIMATED FEMALE VETERAN POPULATION BY AGE: SEPTEMBER 30, 1981
3
Veterans and Their Families
post-Vietnam era only (125,000). The number of women veterans of the Korean conflict was estimated to be 74,000 and there were 56,000 women veterans whose service occurred between the Korean conflict and Vietnam era only. Less than one percent (7,000) of all female veterans were survivors of World War I. The distribution of women veterans by period of military service in large part explains why the average age of female veterans (46.2 years) at the end of September 1981 was somewhat below that of all veterans in general (48.0 years). Whereas the post-Vietnam era group accounted for only 4 percent of all living ex-service personnel, this sector comprised 17 percent of all female veterans. The age of post-Vietnam era veterans is much younger than for any other period of service, and this group's comparative overrepresentation among female veterans served to hold down slightly the average age of all female veterans.
Current projections of the living veteran population indicate declining numbers in the years ahead. Such is not the case for the female veteran population, however.
Despite the restriction imposed by P.L. 96-342, the female veteran population is expected to increase in size as women take on a bigger role in the armed forces of the nation.
Living veterans are only a part of the total number of potential recipients of VA benefits. As of September 30, 1981, there were an estimated 24.1 million spouses of veterans, 21.9 million dependent children, and 10.2 million other family members. Although only a small proportion of these dependents are likely to seek benefits directly from the VA at any time in the future, benefits paid to veterans will indirectly affect the socioeconomic well-being of a great number of their dependents. Deceased veterans' dependents numbered about 3.2 million at the end of FY 1981. The 2.7 million widows and widowers, 432,000 dependent children, and 113,000 dependent parents of deceased veterans brought the total population of potential beneficiaries to some 89.5 million, or approximately 39 percent of the resident population of the United States.
VETERANS AND THEIR FAMILIES SEPTEMBER 30, 1981
499,000 married female veterans are counted as veterans, but not as spouses.
2 Number of own children under age 18.
Characteristics of Veterans
The VA obtains data on various socioeconomic characteristics of male1 veterans and nonveterans from the Current Population Survey (CPS) through a contract agreement
Vn conducting the Current Population Survey, only males are asked if they have ever served in the armed forces. If data on female veterans were collected in that survey, the sample would be so small that any data on characteristics of female veterans would be considered unreliable or unrepresentative of the population. Data on female veterans were collected on the long form of the 1980 Decennial Census, but the data are not yet available.
4
Educational Attainment and Income
All Veterans
with the Bureau of the Census and approval of the Department of Labor, the survey's sponsor. Data from the CPS includes educational attainment, income, work experience, school enrollment, and employment status.
Differences between veterans and nonveterans in median income may be largely explained by variances in their age distributions. If the nonveterans' age distribution is made to conform to that of veterans, differences in income are reduced considerably.
There were 70.5 million male veterans and nonveterans in the civilian noninstitutional population of the United States in March 1981. Of this number, 28.8 million were veterans and their median education level was 12.7 years; for the 41.7 million nonveterans, the comparable figure is 12.6 years.
Population Group Noninstitutional Male Population (in thousands) Percent of Total
War veterans 24,876 35.3
Peacetime veterans
(Post-Vietnam era and service between Korean conflict and Vietnam era only) 3,907 5.5
Nonveterans 41,746 59.2
Total 70,529 100.0
Seventy-five percent of the war veterans, all of whom were 23 or more years old, had completed the requirements for a high school diploma or its equivalent. Eighty-six percent of the peacetime veterans and 68 percent of the nonveteran males also had high school diplomas or the equivalent. Both of these latter groups include substantial numbers of 17 to 25 year olds. Twenty percent of the war veterans, 18 percent of the peacetime veterans, and 19 percent of all nonveteran males had college degrees.
Higher education correlates with increased earnings and this can be seen in the median incomes of both veterans and nonveterans in calendar year 1980. Differences in median incomes at progressively higher education levels are substantial as demonstrated in the table.
Attained Level of Education Median Income in 1980
Veterans Nonveterans
No high school $ 8,770 $ 6,670
Some high school 12,310 9,620
High school graduate 16,980 12,890
Some college 19,520 11,630
College graduate 26,550 20,050
The median income of veterans was higher than that of nonveterans at every educational level.
The median income for veterans ranged from $8,770 for those with no high school to $26,550 for those who were college graduates. Median incomes for nonveteran males
5
with no high school education was $6,670 while for those who completed college it was $20,050.
Vietnam Era Veterans Vietnam era veterans under age 40 had a median educational level of 12.9 years and a median income of $17,660 in 1980. Nonveteran males of similar age also had a median educational level of 12.9 years but a median personal income of only $12,290. Comparison of the distribution of educational attainment for Vietnam era veterans and nonveterans shows that 9 of 10 Vietnam era veterans had completed high school only while 8 of 10 nonveterans under 40 years old had done so. Despite the greater proportion of high school graduates among veterans, the percentage who had completed college was about the same for nonveterans (20.3 percent for Vietnam era veterans, 22.1 percent for nonveterans under 40 years old).
Work Experience All Veterans A larger percentage of veterans than nonveterans in the civilian male noninstitutional population worked at some time during calendar year 1980— 83.5 perent of the veterans, 80.3 percent of the nonveterans. Seventy-nine percent of the 24.0 million working veterans and 70 percent of the 33.5 million working nonveterans worked throughout the year, either full-time or part-time. Ninety-seven percent of the veteran year-round workers and 94 percent of the nonveteran year-round workers held full time jobs for all or part of the year.
Vietnam Era Veterans Ninety-six percent of all noninstitutional male Vietnam era veterans under 40 years of age worked during calendar year 1980. Seventy-seven percent of the 7.2 million Vietnam era veterans who worked had year-round employment. Ninety-three percent of the nonveteran males under 40 years old worked during the year and about 68 percent of these nonveterans worked year round.
Employment Status War Veterans Male war veterans experienced a 0.4 percentage point increase in their unemployment rate in FY 1981 over FY 1980, averaging 4.4 percent for the year. Male non-veterans also experienced an increase, but it was of greater magnitude, 0.7 percentage points. During FY 1981 their average unemployment rate was 8.5 percent.
Vietnam Era Veterans The civilian labor force included an average of 8.2 million Vietnam era veterans during FY 1981. Of this number an average of 480,000 were unemployed. Their unemployment rate for FY 1981 was 5.8 percent.
Family Income War Veterans The number of families headed by male war veterans was estimated to be 19.6 million in 1980 and their median family income for the year was $25,640. Families headed by nonveterans had a median family income of $20,030. In 54 of 100 families headed by war veterans, wives worked; in 53 of 100 families headed by nonveterans, wives worked. Among families headed by veterans, the wife's earnings increased the median family income to $29,990, compared with $21,680 when the wife did not work. Median family incomes ranged from a high of more than $30,000 for families headed by veterans 45-49 years old, to a low of $12,430 for families whose veteran head was 70 or more years old. Family income declines rapidly for families whose veteran head reaches retirement age, from a median of $29,110 if the family head is 55-59 years old, to $23,180 when the family head is 60-64 years old, to $17,590 when he is 65-69 years old. Taking the entire 19.6 million veteran families into consideration, one of 19 had a family income below $7,500, the approximate poverty level for a nonfarm family of four in 1980.
Vietnam Era Veterans There were 5.4 million families in the United States headed by male Vietnam era veterans under 40 years of age in March 1980. Seven percent had incomes below $10,000, but the median family income in 1980 was $24,170 compared with $22,190 for families headed by similar-aged male nonveterans. In 66 of 100 families headed by Vietnam era veterans the wife worked, thereby raising the median family income to $25,800 compared with $21,510 for those young veterans' families in which the wife did not work.
New Legislation The following laws of particular interest to the VA, veterans, and their families and survivors were enacted in FY 1981. Public Law 96-385— Veterans' Disability Compensation and Survivors' Amendments of 1980
6
Compensation rates were increased 14.3 percent for veterans disabled 50 percent or more, and 13 percent for those disabled less than 50 percent. Additional compensation for dependents was increased by 14.3 percent, as was the annual clothing allowance. Dependency and Indemnity Compensation (D.I.C.) rates for widows and children and non-service connected benefits paid at the D.I.C. rates were increased by 14.3 percent. Special home adaptation grants were provided for veterans with service connected blindness or loss of use of both hands. Veterans who had used their VA loan guaranty will be allowed to refinance their loans at lower interest rates with continued VA loan guaranty. Title V of this law continues through FY 1985 the authority to maintain a regional office in the Philippines, authorizes furnishing of VA headstones for use in state veterans' cemeteries, rescinds the prohibition against concurrent payment of military retired pay with VA non-service connected pension, modifies criteria for reduction of VA pension due to hospital admission, and limits compensation or D.I.C. payments for persons incarcerated for more than 60 days as a result of a felony conviction.
Public Law 96-466— Veterans' Rehabilitation and Education Amendments of 1980
This law increases the vocational rehabilitation subsistence allowance by 17 percent, extends vocational rehabilitation eligibility and provides a new range of rehabilitation services designed to enable service connected veterans with employment handicaps to secure and maintain suitable employment, or if that is not feasible, to maximize their independence in performing daily living tasks. Chapter 34 and 35 assistance was increased by 10 percent adjustments made to the standards for Chapter 34, 35, and 36 benefits. This law also extends Chapter 32 eligibility, provides for distribution of unused Chapter 32 contributions on the death of the participant, and increases the flexibility of payment of the monthly contribution. Title V directs the Administrator, in consultation with the Secretary of Labor, to promote employment opportunities for service connected disabled veterans utilizing on-the-job training and outreach program specialists. Provisions for hiring of Vietnam era veterans by government contractors are liberalized and preference in VA hiring of qualified "special disabled veterans" and Vietnam era veterans is mandated. Title VI repeals PREP training under Chapter 32 and restricts educational assistance for persons incarcerated for conviction of felonies. Flight instruction reimbursement is reduced from 90 to 60 percent. The remainder of the title provides for offset against future benefits of indebtedness to the VA, addition of interest and administrative costs to such debts, collection action by VA attorneys, and disclosure of information regarding the debt to credit bureaus.
Public Law 96-497—Gold Star Wives of America
This act grants a Federal Charter to the Gold Star Wives of America as a service organization.
Public Law 96-499—Omnibus Reconciliation Act of 1980
This law excludes persons receiving VA compensation or pension by waiver of retired pay from the minimum disability annuity provisions allowing Federal employees disabled after five years of civilian service to retire with 40 percent of their average salary, or the earned annuity after projecting service to age 60, whichever is less.
Public Law 96-511 — Paperwork Reduction Act of 1980
This law created a new office in 0MB with broad authority over collection, maintenance, use, and dissemination of information in the Federal government, and mandated a goal of a 15 percent reduction in information collection by the end of FY 1981. The head of each agency must designate a senior official to review its information systems to see that they do not overlap those of other agencies. New agency regulations requiring collection of information must be submitted to 0MB for review.
Public Law 96-526—HUD-lndependent Agencies Appropriations, FY 1981
This spending act substantially approved the Administration's budget requests for the various VA accounts. Construction rescissions at Camden and Baltimore were approved, as were deferrals at Chillicothe, Denver, East Orange, Long Beach, Palo Alto,
7
and Washington, D.C. Proposed deferrals at Gainesville, New Orleans, and St. Albans were disapproved.
Public Law 97-13—National POW-MIA Recognition Day
July 17, 1981, was designated as "National POW-MIA Recognition Day" to honor those who have been prisoners of war and those missing in action.
Public Law 97-15—Extension of Funds for VA in Support of State Medical Schools
This law extends by one year the period during which funds already appropriated for grants by the VA for the establishment and support of new state medical schools may be spent. The original seven-year period was extended because unforeseen staffing difficulties prevented expenditure of the grant monies when the act originally went into effect.
Public Law 97-32—National Blinded Veterans Recognition Day
August 13, 1981, was designated as "National Blinded Veterans Recognition Day" for Americans to honor the sacrifices and service of blinded veterans.
Public Law 97-35— Omnibus Budget Reconciliation Act of 1981
Among other things, this law, effective October 1, 1981, limited the payment of burial and funeral expenses for deceased veterans to those who had received VA compensation or pension, curtailed'outpatient dental treatment for veterans having noncompensable dental conditions, prohibited the pursuit of flight training, reduced the reimbursement rate for correspondence training, and terminated VA's education loan program for most veterans.
Additionally, the law disqualified certain ex-service members discharged after July 1, 1981, from receiving unemployment compensation.
Public Law 97-37—Former Prisoners of War Benefits Act of 1981
This law shortened from 6 months to 30 days a POW's internment period to establish a presumption for certain diseases. The act also provided outpatient medical treatment and priority outpatient care for POWs regardless of their internment period and outpatient dental services for internment of 6 months or more.
To continue improvement in services for POWs, the law established an Advisory Committee on Former Prisoners of War to advise the Administrator on the needs of POWs regarding compensation, health care, rehabilitation, and administration of benefits.
8
Health Care
Comparative Highlights
Percent
Item FY 1981 FY 1980 Change
Facilities operating at end of year
Medical centers 172 172
Hospital care (172) (172)
Outpatient care (172) (172)
Nursing home care 95 92
Domiciliary care 15 15
Independent or satellite clinics 50 50
Independent domiciliaries 1 1
Employment (net full-time equivalent) 193,578 194,331 -0.4
Operating costs (in millions) $6,642.2 $6,157.8 + 7.9
Medical care 6,447.0 5,971.8 + 8.0
Research in health care 144.7 137.7 + 5.1
Other 50.5 48.3 + 4.6
Inpatients treated 1,360,256 1,359,271 + 0.1
VA facilities 1,276,933 1,275,446 + 0.1
Other facilities 83,323 83,825 -0.6
Average daily inpatient census 102,751 105,085 -2.2
VA facilities 81,874 83,936 -2.5
Other facilities 20,878 21,149 -1.3
Outpatient medical visits 17,929,550 17,971,407 -0.2
VA staff 15,825,064 15,751,690 + 0.5
Fee-basis 2,104,486 2,219,717 -5.2
Outpatient dental care
VA staff
Examinations 155,493 157,601 -1.3
Treatment cases completed 155,151 149,594 + 3.7
Cases completed on fee-basis 74,528 71,550 + 4.2
Prescriptions dispensed 39,265,391 36,687,165 + 7.0
Lab procedures (unit count) 215,990,010 214,818,805 + 0.5
Radiology examinations 5,553,131 5,707,389 -2.7
Summary
At the end of FY 1981, the VA health care system was providing care in 172 medical centers, 226 outpatient clinics, 95 nursing home care units, and 16 domiciliaries. These facilities included a new 720-bed replacement medical center at Bronx, New York; three new nursing home care units at Martinsburg, West Virginia; Memphis, Tennessee; and Temple, Texas; and three new replacement domiciliary facilities at
9
Types of Care
Hospital Care
Bay Pines, Florida; Martinsburg, West Virginia; and Dayton, Ohio. In addition, three new Vet Centers under the Readjustment Counseling Program for Vietnam era veterans were opened at Tucson, Arizona; Reno, Nevada; and Evansville, Indiana.
During the year, the VA cared for approximately 1.36 million hospital inpatients in VA and non-VA facilities, 41,800 nursing home inpatients in VA and community facilities, and 14,900 patients in VA domiciliaries. Outpatient visits for medical care totaled 17.9 million, of which 15.8 million were to VA staff and 2.1 million to private physicians on a fee-for-service basis. Dental care also continued to play a major role in the delivery of health care to veterans.
The VA continued to help support veterans receiving hospital, nursing home or domiciliary care in 44 state homes. The VA also continued its agreement with the Department of Defense under which the DOD contracts for care for individuals who had established entitlement under the Civilian Health and Medical Program of the VA authorized by Public Law 93-82.
VA clinician-investigators and research scientists throughout the country continued the search for knowledge to improve health care in support of the Agency's mission to provide veterans with quality medical care. The VA also provided education and training in the health care field to about 100,000, including physician residents and interns.
A major initiative was undertaken with the implementation of the Medical District Initiated Program Planning whose major objective is to create a dynamic, strategic operational planning activity to support the Department's national goals. Major planning efforts focused on how best to meet the needs of the aging veteran population. To assist in this, a Geriatrics and Gerontology Advisory Committee was established in accordance with Title III of Public Law 96-330. The Committee's membership includes the country's outstanding authorities in this area.
To accomplish its mission, VA's Department of Medicine and Surgery operated with a budget of $6.7 billion and employed 193,578 (full-time equivalent) persons.
During the fiscal year, VA medical centers operated an average of 82,079 hospital beds—40,501 in medical bed sections (including extended hospital care beds), 17,533 in surgical bed sections, and 24,045 in psychiatric bed sections. During the year, the average bed occupancy rate was 80.9 percent.
HOSPITAL PATIENTS TREATED IN VA MEDICAL CENTERS
Thousands
1,400 —
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Ambulatory Care
The number of hospital patients treated in VA medical centers and in non-VA hospitals during FY 1981 (i.e., the number of discharges and deaths during the year plus the number on the hospital rolls at the end of the year) totaled 1,284,196. Of this number, 1,248,502 were treated in VA medical centers. The increase in the number of hospital patients treated was accomplished largely by reducing the length of time patients spent in the hospital during an episode of care.
Ambulatory care activities in FY 1981 played a central role in the delivery of health care to VA patients. There were 15.8 million outpatient medical visits made to VA staff and 2.1 million visits made to private physicians authorized on a fee-for-service basis. Improvement of the physical facilities of VA outpatient clinics continued with the completion of construction, renovation, and improvement projects. These involved expansion of available outpatient space and improvement of the flow of patient care services.
In FY 1981, VA staff dentists provided care for a greater proportion of Class l-VI service connected outpatient dental cases, continuing a trend developed over the last several years. The steady increase in staff cases is especially significant since it continued through a major rise in the number of dental care applications brought about by Public Law 96-22, which was effective October 1, 1979. During FY 1981 alone, over 56,000 additional veterans turned to the VA for treatment under this eligibility. VA staff completed approximately 60 percent of these cases as additional workloads over and above normal levels, with virtually no increase in staffing. As the table shows, despite a major increase in total cases and steady inflationary pressures, funds obligated for fee-basis dental care were 7 percent lower in FY 1981 than in the previous year.
1981 1980
Total Class l-VI cases completed 160,564 145,881
Cases completed by VA staff 86,036 74,331
Staff cases as percent of total 53.6% 50.9%
Cases completed on a fee basis 74,528 71,550
Funds obligated for fee cases (000) $50,305 $54,195
Geriatrics and Extended Care
The name of the Office of Extended Care was changed this year to the Office of Geriatrics and Extended Care, signifying an increasing emphasis on all phases of care for aging veterans, whether it be in the acute, long-term, or ambulatory and community sector. The tables show the estimated aging trend of veterans.
1971 1981 1990 2000
Total number of veterans (000) Number of veterans 65 years and older (000) Percent of total 28,288 1,993 7.0 30,083 3,320 11.0 28,497 7,327 25.7 25,317 7,988 31.6
The VA now has developed a comprehensive, integrated, high quality program for long-term care for aging veterans, complemented by ambulatory and acute care. Nowhere else are all of these elements present for the appropriate care of aging patients. The 65 years and older group has increased 66.6 percent during the past ten years and by 1990 the number of veterans in this group is expected to increase 120.7 percent over the 1981 number. During this same period, the number of veterans 75 and over is expected to increase 75.9 percent. Even more significantly, this group is projected to grow by 158.3 percent during the period 1990-2000.
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1971 1981 1990 2000
Total number of veterans (000) Number of veterans 74 years and older (000) Percent of total 28,288 1,085 3.8 30,083 767 2.5 28,497 1,349 4.7 25,317 3,484 13.8
The Office of Geriatrics and Extended Care oversees a variety of programs, including VA nursing home care, community nursing home care, domiciliary care, state home care (nursing home, domiciliary and hospital), hospital-based home care, adult day care, residential care, and the geriatric research, education and clinical centers (GRECC) program. In addition, a pilot hospice program at the VA medical center in Wadsworth, Los Angeles, California, is under examination.
The office works closely with other Federal offices concerned with aging, including the National Institute on Aging, the Administration on Aging, and the Health Care Financing Administration, among others. In addition, the office works with various voluntary groups, including the Gerontological Society of America, the National Council on Aging, the Western Gerontological Society, the American Geriatrics Society, the American Health Care Association, and the American Association of Homes for the Aged.
The VA also participates actively with Federal agencies in efforts on behalf of elderly veterans to provide information and referral services (Interdepartmental Task Force on Information and Referral), to minimize duplication of effort, and to promote efficient use of resources.
The geriatric and extended care programs administered by the VA are described below.
VA Nursing Home Care
The nursing home care units located in VA medical centers provided skilled nursing care and related medical services, as well as opportunities for social, diversional, recreational, and spiritual activities. Nursing home patients typically require a pro-
NURSING HOME CARE Average Daily Census (Thousands)
0 J________I______I______1______I______1______I______I I I
72 73 74 75 76 77 78 79 80 81
Fiscal Year
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longed period of nursing supervision and rehabilitation to attain and maintain optimal function. In FY 1981, 13,554 veterans were treated in VA nursing homes which had an average daily census of 8,145. The average age of the veterans treated was 69.7 years, 61.3 percent were 65 or over, and their average attained length of stay was 3.11 years. Approximately 25.9 percent were receiving compensation for service connected conditions and 39.8 percent were receiving VA pensions. The trend toward increased provision of nursing home care by the VA is shown in the chart. Three new 120-bed nursing home care units were activated at the VA medical centers in Martinsburg, West Virginia; Memphis, Tennessee; and Temple, Texas. These and other changes resulted in a net increase of 477 operating beds for a total of 8,973 nursing home beds at 95 VA medical centers by the end of FY 1981.
Community Nursing Home Care This is a contract program for veterans who require skilled or intermediate nursing care in making the transition from a hospital to the community. Veterans who have been hospitalized in a VA facility for treatment primarily of a service connected condition may be placed at VA expense for as long as they need nursing care. Other veterans may be eligible for placement in community facilities at VA expense for a period not to exceed six months. The program requires assessment of participating facilities and follow-up visits to veterans by teams from the VA medical centers. In an effort to reduce unnecessary duplication and the expense of multi-member team visits in the assessment of nursing homes, the VA has arranged to make use of inspections conducted for Medicare or Medicaid certification. Copies of the Medicare/ Medicaid inspection documents are reviewed to confirm that the home complies with standards. A social worker and a nurse then make an on-site visit to evaluate the quality of care, the quality of life, and to describe the general characteristics of the facility. In FY 1981, 28,242 veterans were treated in approximately 2,900 community nursing homes in the 50 states and Puerto Rico. These facilities had an average daily census of 8,348. The average age of these veterans was 67.8 years; 56.5 percent were 65 or over, and their average attained length of stay was 1.03 years. Approximately 46.8 percent were receiving compensation for service connected conditions and 28.0 percent were receiving VA pension. As with VA nursing home care, there has been an upward trend in the provision of community nursing home care.
VA Domiciliary Care Domiciliary care in VA facilities provides necessary medical and other professional care for eligible ambulatory veterans who are disabled by age, disease, or injury and are in need of care but do not require hospitalization or the skilled services of a nursing home. New program directions have created a better quality of life for veterans requiring prolonged domiciliary care and have prepared veterans returning to community living for active participation. Special attention is being given to older veterans in domiciliaries with a focus on keeping them active and productive, as well as encouraging their integration into existing senior centers and other resources in the community. In FY 1981, 14,877 veterans were treated in VA domiciliaries which had an average daily census of 7,353. The average age of the veterans treated during the year was 59.8 years, 29.9 percent were 65 or over, and their average attained length of stay was 3.98 years. Approximately 27.5 percent were receiving compensation for service connected conditions and 44.3 percent were receiving VA pension. Replacement domiciliary facilities were activated at the VA medical centers in Bay Pines, Florida; Martinsburg, West Virginia; and Dayton, Ohio. Built on the same plan as the facility at Wood, Wisconsin, their programs emphasize an active rehabilitative approach.
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DOMICILIARY CARE Average Daily Census (Thousands)
14 ----------------------
0 |------1------1------1------1------1------1------1------1------1
72 73 74 75 76 77 78 79 80 81
Fiscal Year
State Veterans' Homes
Hospital-Based Home Care
The VA's relationship to state veterans' homes is based on two grant programs. One is a per diem program which enables the VA to assist the state in providing care to veterans eligible for VA care and who are furnished domiciliary, nursing home, or hospital care in state home facilities. The other grant program provides VA assistance with up to 65 percent Federal funding in the construction of new domiciliary and nursing home care facilities, and the expansion, remodeling, or alteration of existing facilities. During FY 1981 the state homes maintained an average daily census of 5,855 nursing home, 4,572 domiciliary, and 881 hospital patients. Veterans treated during the year in state veterans' nursing homes and domiciliaries were, on average, four years older than those in VA facilities. A greater proportion was 65 years of age or over than in VA facilities.
In FY 1981, a second state home for Michigan was established at Marquette, and Nebraska opened a third annex at Omaha. New construction resulted in the addition of a 180-bed nursing home facility at Marshalltown, Iowa, and a 250-bed nursing home facility at Minneapolis, Minnesota. The VA also obligated funds in FY 1981 totaling $13 million for construction and renovation projects including a new state home for West Virginia consisting of 200 domiciliary beds.
The trends in state nursing home and domiciliary care follow those of the VA programs. The states differ greatly in the availability of facilities they operate for veterans, and therefore can supplement, but not substitute for, other VA extended care programs.
This program allows for early discharge of veterans with chronic illness to their own homes and reduces readmissions to the hospital. The family provides the necessary personal care under coordinated supervision of a hospital-based multidisciplinary treatment team. The team provides medical, nursing, social, rehabilitation, and dietetic regimens as well as the training of family members and the patient. Thirty VA medical centers are providing hospital-based home care services. More acute care beds in hospitals are made available by providing increased days of care in the home.
In FY 1981, 145,000 home visits were made by health professionals. Over 5,600 patients were treated, of whom about 20 percent were terminal cancer patients. Eleven percent of these patients died in their own homes with the support of the hospitalbased home care team.
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Adult Day Care Staff in numerous VA medical centers have expressed strong interest in the value of adult day care programs in facilitating the return of older veterans to their own homes, to shorten the length of stay in acute beds, and to provide an environment in which these veterans can continue rehabilitation programs among their peers in the community. Several program models are in operation. The VA medical center in North Chicago, Illinois, has a comprehensive program located on the medical center grounds. A program of the VA medical center at Loma Linda, California, functions in a nearby community in conjunction with the local American Legion post. The program is licensed as an adult day health program in the State of California. Other program models are in operation at the VA medical centers in American Lake, Washington, and Palo Alto (Menlo Park Division), California, and at the VA outpatient clinic in Boston, Massachusetts.
Residential Care (formerly Personal Care Home Program) This program provides residential care, including room, board, personal care, and general health care supervision to veterans who do not require hospital or nursing home care but who, because of health conditions, are not able to resume independent living and have no suitable family resources to provide the needed care. All homes are inspected by a VA multidisciplinary team prior to incorporation into the program and annually thereafter. Care is provided in private homes selected by the VA, at the veteran's own expense. Veterans receive monthly follow-up visits from VA social workers and other health care professionals, and are outpatients of the local VA facilities. An approximate average daily census of 12,500 was maintained in this program throughout FY 1981.
Geriatric Research, Education and Clinical Centers (GRECCs) The GRECC program consists of eight centers and represents an important response to the health care needs of aging veterans. It serves to attract and develop superior staff in the field of gerontology and geriatrics, to utilize and redirect resources for geriatric care, and to advance and integrate research and educational achievement in geriatrics and gerontology into the VA clinical system. Geriatric evaluation units (GEL)) and geriatric rehabilitation units consisting of from 10 to 30 beds have been activated at most of the GRECCs for intensive diagnosis, research, and therapy. These GEUs are currently under study, as are other models of geriatric and extended care service delivery. The clinical foci include team care, medical evaluation and rehabilitation, cardiopulmonary rehabilitation, endocrinology, and various dementias. The research and educational efforts of the GRECCs concentrate in related areas such as neurobiology, connective tissue and metabolism, the aging nervous system, immunology, and neuroendocrinology. Congress has recognized the need to strengthen existing GRECCs, and stipulated in Title III of Public Law 96-330 that, prior to funding new centers, the existing centers should receive adequate funding to enable them to function more effectively. During FY 1981, a Title III Implementation Committee was established. Title III authorizes the designation of up to 15 VA medical centers as locations for GRECCs, including the eight existing ones. It also includes the criteria for selection of existing and new GRECC sites and establishes a new Geriatrics and Gerontology Advisory Committee (GGAC). The GGAC began site visits to evaluate the existing GRECCs during the year.
Medical Care for Dependents By the end of FY 1981, there were approximately 221,000 individuals (128,000 adults and 93,000 children) in 137,000 family groups who had established entitlement for medical care under CHAMPVA (Civilian Health and Medical Program of the VA) authorized by Public Law 93-82. The law authorizes VA to furnish medical care to the spouse or child of a veteran who has a total disability, permanent in nature, resulting from a service connected disability, and to the surviving spouse or child of a veteran who died as a result of a service connected disability, or who at the time of death had a total disability, permanent in nature, resulting from a service connected disability. Effective January 1, 1980, eligibility was extended to the surviving spouse or child of a person who died while on active duty. CHAMPVA care may be furnished to these eligible dependents provided they are not eligible for CHAMPUS or Medicare. Since the program began in September 1973, $217,085,000 has been expended for hospital care, physician visits, and prescriptions.
Services Medicine VA medical services continued to emphasize the areas of hypertension, sickle cell disorders, dialysis, rheumatology-immunology, cardiology, pulmonary disease, inten-
15
Gas laser is used to destroy abnormal tissue during surgery.
Surgery
sive care, and pace-makers. In addition, activities specifically related to geriatric patients were conducted during 1981.
Thirty-two VA medical centers participating in the special hypertension screening and treatment program treated approximately 37,000 veterans. Another 25,000 veterans considered at risk were followed at intervals of three months to one year. Eighty-five percent of these veterans receive their primary care from allied health professionals (registered nurses or physician assistants) under the supervision of a physician coordinator. The continued decrease in strokes, heart disease, and renal disease is attributed in great part to the control of this health problem.
Forty VA medical centers were participating in a sickle cell screening and education program. During the year, 40,910 patients were identified and screened, 67,435 persons attended education sessions, and 2,976 people were counseled. Professional staff at each of these 40 VA medical centers consists of a physician, a counselor, and a technician. The VA film, "A Matter of Chance,” was shown in various community sickle cell programs as well as in VA medical centers.
The number of patients in the VA dialysis program, including patients dialyzed in non-VA units at VA expense, was about 4,000 during FY 1981. Development continued of the large scale Rheumatology-Immunology Center at the VA medical center in Philadelphia, Pennsylvania. Along with a smaller program previously begun at the VA medical center in Wood, Wisconsin, these centers provide comprehensive care to patients suffering from arthritis, rheumatism, connective tissue diseases, and related disorders.
Cardiac catheterizations were performed on approximately 21,000 patients. Utilization standards recommended by the Federal Health Resources Sharing Committee were adopted. Worn or antiquated equipment was replaced in cardiac catheterization laboratories (CCLs) at four VA medical centers. Diagnostic services, echocardiography, nuclear cardiology, stress testing, and arrhythmia monitoring were expanded. New construction criteria for CCLs were approved.
A national program of networks of automated electrocardiographic interpretive services continued to be developed with an estimated completion date of FY 1986.
A formal schedule for purchasing pacemakers and pulse generators, assuring greater uniformity and lower cost, was developed during the year. Plans were also developed to establish a clinical phase pacemaker registry and to increase direct patient surveillance capability.
More than 68,000 patients were treated in VA coronary care and medical intensive care units. New construction criteria were in the process of development to modernize the intensive care units and to make provision for step-down units. Many older intensive care units have recently been renovated.
During FY 1981, there were 372,502 surgical procedures performed in 139 VA medical centers.
Continuing education of professional personnel continued to be encouraged. Comprehensive care of amputees was the subject of a program to teach new techniques to orthopedic and peripheral vascular surgeons in order to reduce morbidity and mortality as well as length of hospitalization of amputees. Another program for anesthesia personnel addressed early identification and appropriate treatment of the syndrome of malignant hyperthermia.
The cardiac surgery volume continued to increase, with the mortality rate holding at approximately the national level of 5 percent. Renal transplant statistics reflected a downward trend in the number of procedures performed. A heart transplant program was approved at the VA medical center in Richmond, Virginia. Close monitoring of these special programs by consulting committees continued in Central Office.
VA surgeons continued to participate in all forms of surgical research and coorperative studies. Numerous surgeons participated with distinction in various na-
16
Mental Health and Behavioral Sciences
Mental Hygiene Clinics, Day Hospitals, and Day Treatment Centers
tional and professional programs, and contributed to the surgical literature in journals and textbooks. Many hold office in national organizations, an indication of the high caliber of VA surgeons.
During FY 1981, 936,337 patients were provided psychiatric and other mental health services in the VA through the utilization of professionally trained personnel in a multidisciplinary approach to treatment.
There are now 128 VA medical centers with psychiatric bed services. Outpatient services include 102 alcohol dependence treatment programs, 52 drug dependence treatment programs, 40 day hospital programs, 57 day treatment centers, and 143 mental hygiene clinics. In addition, the VA operates 94 readjustment counseling centers for Vietnam era veterans. Psychology Services in 154 VA medical centers and outpatient clinics provided clinical and psychological readjustment counseling. Many centers also provide services through biofeedback and relaxation methods for long-term pain problems.
On any given day in FY 1981, 20,487 inpatients were receiving psychiatric care. Services included chemotherapy and psychotherapies; group, individual, and family therapy; treatments such as behavior modification; incentive work programs; and programs for vocational appraisal for training and education.
The table reflects the effort to maintain the number of patients treated while concurrently reducing the number of psychiatric beds.
VA Psychiatric Bed Sections FY 1981 FY 1976
Operating beds at end of fiscal year 23,793 38,762
Average daily census 20,487 24,839
Admissions 157,874 161,969
Average monthly turnover rate 66.7 56.6
Patients treated 184,811 193,735
As the figures show, the reduction in operating psychiatric beds since 1976 (17.3 percent) has been significantly greater than the decline in the number of patients treated (4.6 percent). Outpatient mental health program visits numbered 3,333,643 in FY 1981.
Continued emphasis on outpatient care and rapid intensive treatment, with shorter periods of hospital stay, has resulted in an increase in the number of veterans treated by the VA's 143 mental hygiene clinics, 57 day treatment centers and 40 day hospitals.
Mental hygiene clinics serve as the basic units in the delivery of ambulatory psychiatric care. During FY 1981, 1,247,389 visits were made to mental hygiene clinics.
Day treatment centers provide supportive, maintenance and learning environments for chronic psychiatric patients experiencing long-term difficulties with community adjustment, interpersonal relations, vocational, educational, emotional, or behavioral problems. These centers received 537,343 visits from long-term psychiatric patients in FY 1981.
Day hospital programs are ambulatory care programs for patients able and willing to come on a daily basis to a VA medical center to receive intensive individual and group therapy. These veterans' problems are of an acute, intensive or situational nature and can be resolved within a short period of time. During FY 1981, 156,335 visits were made to day hospital programs.
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Vocational Evaluation and Counseling Assisting veterans in adjusting to the psychological impact and disabling consequences of injury or illness is an integral part of comprehensive care. Responsibility for this complex psychological process belongs to Psychology Service. VA medical centers employ counseling psychologists and clinical psychologists to assist veterans to reestablish their ability to function independently. Specific targets in treatment and rehabilitation involve productive work. During FY 1981, VA provided psychological evaluation and assessment as a part of treatment and medical rehabilitation to 116,640 patients.
Alcohol and Drug Dependence Treatment Two new specialized programs for alcoholism treatment, at Anchorage, Alaska, and at the VA medical center in Providence, Rhode Island, were activated in FY 1981, bringing the total of such programs to 102. These programs emphasize short hospitalizations during which comprehensive biomedical and vocational assessments are accomplished. Individualized treatment plans for the alcoholism and alcohol-related disorders are developed jointly between patient and hospital staff. When the veteran is discharged from bed level care, the outpatient clinic continues the rehabilitation activities, providing such treatment as group therapy, family therapy, and vocational services. Many veterans are admitted directly to ambulatory treatment, when it obviates the need for hospital treatment. A close collaboration with Alcoholics Anonymous is central to all programs. Section 104 of Public Law 96-22 continued to be implemented. This legislation provided the VA with authority to contract with non-VA community programs for treatment and rehabilitation services for veterans with alcohol or drug dependence and abuse. One hundred eighteen contracts sponsored by 63 VA medical centers were approved and became operational during FY 1981. Other planning initiatives included the development of on-campus, VA-operated halfway house programs for treatment of alcohol and drug dependent veterans. The second of these, a 20-bed halfway house program, was activated in October 1980 at the VA medical center in West Haven, Connecticut. During FY 1981 inpatients treated for alcoholism numbered 100,757, 51,474 of whom were in Alcohol Dependence Treatment Program (ADTP) beds. The average monthly turnover rate in ADTP beds increased from 131.7 percent in FY 1980 to 137.9 percent in FY 1981. The number of outpatient visits for alcohol dependence treatment was 425,295 in FY 1981. Follow-up contacts of former patients for therapeutic/counseling purposes or for assistance with social/economic problems increased by 18.7 percent. In drug dependence treatment programs, the total number of inpatients treated amounted to about 19,610, 5,559 of whom were in Drug Dependence Treatment Program (DDTP) beds. This was about six percent less than in FY 1980. The average monthly turnover rate in DDTP beds decreased from 110.4 percent in FY 1980 to 109.4 percent in FY 1981. The number of outpatient visits to DDTP, as well as the total number of outpatient visits for drug dependence treatment, was 967,282.
Readjustment Counseling The Operation Outreach program for Vietnam era veterans was established by Public Law 96-22, signed June 13, 1979. Public Law 97-72, extended for three years, until September 30, 1984, the period within which eligible veterans may apply for readjustment counseling services under this special program. During FY 1981, the Veterans Administration was authorized to expand Operation Outreach. When this expansion is completed, there will be 135 Operation Outreach facilities (Vet Centers) employing some 567 persons. During FY 1981, the Operation Outreach program provided readjustment counseling services to 60,319 veterans, for a total of 171,904 visits. In addition, there were 34,510 visits by family members and "significant others."
Study of Vietnam Era Veterans A major study to determine the number of Vietnam era veterans with unresolved personal, social and psychological readjustment problems, including those in which excessive use of alcohol or inappropriate use of prescribed drugs and other substances are presenting symptoms requiring medical intervention, was completed. The study
18
Prisoners of War
Rehabilitation Services
Rehabilitation Medicine
Inhalation therapist and patient at VAMC Boston.
identified the nature of these problems and the comparative frequency of their occurrence among the Vietnam era veterans and a matched sample of non-veterans.
The need for the study was based on limited research findings, general consensus of experts, professional staff of VA medical centers and considerable direct feedback from Vietnam era veterans, their families, and from other concerned groups of citizens that approximately 20 percent of Vietnam era veterans are continuing to have readjustment problems.
The survey of Vietnam era veterans was completed by the Center for Policy Research, Inc., in March 1981. The study is entitled, "Legacies of Vietnam; Comparative Adjustment of Veterans and Their Peers." It has been published and placed in all VA libraries.
A review and assessment of current physical and psychological health and adjustment problems of former POWs was completed in coordination with the Agency study of POWs mandated by Public Law 95-479. All available research reports were reviewed and evaluated, and a systematic analysis of the adequacy of medical records of 300 randomly selected POWs from WWII-Europe, WWII-Japan, and the Korean conflict was conducted.
Another significant event during FY 1981 was the passage of Public Law 97-37, August 17, 1981, which established eligibility on a presumptive basis for former POWs for certain health services and benefits. It also called for the establishment of an Advisory Committee on Former Prisoners of War.
Other VA initiatives during the year for POWs were: The VA application form was revised to identify specific POW status; the patient treatment file was reprogrammed to permit detailed data on POW health problems; a symbol was added to the medical charts of former POWs for easy identification; and an autopsy register, in conjunction with the Armed Forces Institute of Pathology, was established.
The advancing age of the veteran population has prompted nearly all programs in VA's Rehabilitation Medicine Service to focus on the demands this will create.
Early efforts to identify innovative geriatric rehabilitation programs resulted in sensory integration and reality orientation programs that require aging patients to maintain their physical and mental status at as high a level as possible. Bringing together local elementary and high school students with residents of VA nursing home care units has fostered relationships between young and old which have helped improve the social awareness levels of both. Some VA medical centers have instituted "sports days" where wheelchair bound and physically deteriorated individuals have been given the opportunity to compete in modified game activities.
During the year, six independent living centers were established at selected sites in the VA health care system. In addition to some elderly patients who need these centers as part of their transition to community living, the independent living centers provide service to all types of physically and emotionally disabled veterans. A multidisciplinary venture, these centers utilize the services of social workers, psychologists, physicians, and certain rehabilitation medicine therapists.
The case management program, which was developed jointly between the VA's Department of Veterans Benefits and Department of Medicine and Surgery in 1980, was reinforced with additional positions for distribution to 50 of the more active VA medical centers. Case managers help guarantee that all potentially eligible veterans are identified for vocational services, and that these services are provided.
During the period March 1978 through October 1981, over 315 new cardiopulmonary rehabilitation patients were referred for over 12,000 patient contact hours of full multidisciplinary treatment. Specialized driver training for handicapped veterans continued to be provided in 40 designated centers. Over 13,250 severely handicapped veterans have been referred for this sophisticated training since it was initiated over six years ago; more than 40 percent successfully completed the program. Nearly 141,000 driver training hours have been recorded.
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Certain administrative functions which ultimately affect the quantity and quality of patient care are now being addressed. A one-year study and field testing program was initiated to determine future staffing and productivity standards for all rehabilitation medicine therapists. In another project, a task force of VA, university, and professional organization representatives of four therapy disciplines was established to review and update the existing standards of clinical training offered by the VA. Improvement of these standards should help in providing a higher quality of therapist for employment in VA and non-VA rehabilitation settings.
Prosthetic and Sensory Aids During FY 1981, the VA provided prosthetic services at a cost of $84 million. Each year, the VA provides appliances and services to about 1 million veterans. Direct purchase of new commercially available prosthetic/orthotic appliances costing $300 or less and repairs to existing prosthetic appliances costing up to $300 is now allowed. This has resulted in quicker delivery, improved efficiency, and less processing time. An analysis of the national contract for artificial limbs resulted in an improved cost analysis methodology. The contract was simplified and changed to provide prices more comparable with the private sector. Implementation of these changes should take place when the contract is renegotiated and should result in improved prosthetic services to veterans.
Blind Rehabilitation During FY 1981, the three VA Blind Rehabilitation Centers and three Blind Rehabilitation Clinics offered training to over 650 blinded veterans. This training included adjustment to blindness or low vision, electronic reading aids, and electronic travel aids. Visual Impairment Service Teams (VIST) offered outpatient services to over 7,000 blinded veterans, consisting of annual physical examinations, benefits counseling, family counseling, and various other medical and social services. Twelve full-time VIST coordinator positions were established at selected VA medical centers throughout the country, bringing the total of full-time centralized VIST positions to 18. Approximately 60 VIST positions remain as part-time coordinators. Blind Rehabilitation Service continued to monitor a field service contract between VA and the Blinded Veterans Association. Under this contract, blinded veterans are employed as field representatives to seek out other blinded veterans to motivate them or assist in various ways to get services for them from the VA, other Federal agencies, and state or local agencies. Construction was nearly completed on the new Blind Rehabilitation Center in Birmingham, Alabama, which is due to accept its first patients in FY 1982.
Audiology and Speech Pathology During the FY 1981, there were more than 544,500 patient visits reported by the 94 VA audiology and speech pathology programs throughout the nation. This represents more than a 3 percent increase over the previous year. The prevalence of speech communication disorders in VA health care facilities was one of the major findings in VA's annual patient census. The census results indicated that 23.4 percent (18,965) of 80,921 veterans surveyed possessed a speech disorder. Of the group exhibiting speech disorders, approximately 9 percent (1,688) were being seen by a speech pathologist, with another 4.5 percent (862) having been referred and waiting to be seen. It was also reported that 25 percent (4,741) of these veterans should be seen by a speech pathologist but referrals either had not been or could not be made. The types and severities of the speech disorders were also reported. A program offering increased audiology and speech pathology services to veterans living in remote areas is being developed at the VA medical center in Birmingham, Alabama. The REMATE (Remote Machine-Assisted Treatment and Evaluation) program has proven to be both effective and cost-saving. Veterans who normally would have to travel to a VA medical center to receive face-to-face individual audiology and speech pathology services can now receive most of these services by telephone. In-
20
Spinal Cord Injury
Environmental Medicine (Agent Orange)
dividualized therapy programs placed in a computer are capable of evaluating the responses to the therapy material that are received from the veteran and programmed therapy is available on a 24-hour basis, allowing the veteran to control the amount of therapy that can be comfortably accommodated. Using REMATE, the veteran can be scheduled for therapy at a VA medical center approximately once a month instead of the normal twice per week regimen. A considerable savings in beneficiary travel can be realized from this program along with time savings for both the veteran and the speech pathologist.
The VA pioneered the field of spinal cord injury (SCI) medicine in the U.S. beginning at the end of World War II. It developed and effectively practices the multidisciplinary mode in the management of these patients. Originally based at five large centers, VA's SCI Service currently operates 19 units, the latest addition being a 60-bed service at the VA medical center in Augusta, Georgia.
The increasing success in managing these patients has improved their life expectancy as well as the rehabilitation rate of quadriplegics who are respiratory dependent. The incidence of spinal cord injury in the U.S. is 30 per million per year. This places an ongoing demand on the VA SCI system which treats approximately 85 percent of all SCI veterans. There are estimated to be 20,000 spinal cord injured veterans, or 10 percent of the estimated total SCI population in this country.
The VA SCI system treated 6,890 inpatients during FY 1981 and delivered care to outpatients with a total of 30,358 visits. The average daily census was 1,050 and the total number of admissions was 5,768. The hospital-based home care program recorded 5,941 visits to SCI patients.
Early admission following trauma is essential, and an agreement with the Armed Services Medical Regulating Office for early transfer of active duty military personnel to VA SCI centers was actively observed. Other sources of admission shortly after onset of disability are civilian hospitals and non-SCI VA hospitals. Patients with spinal cord injuries require lifelong follow-up with multiple hospitalizations for the management of life-threatening complications.
During the past two years the VA has developed a classification of levels of care: acute, intensive rehabilitation, sustaining care, and long-term care. Each unit has been assigned one or more of these missions according to its capabilities.
For the past year and a half, DM&S has structured and funded a two-year physician fellowship program at five SCI units, designed to create a reservoir of skills in the multidisciplinary management of SCI patients. There are 17 physicians in this program and the first five available for employment will graduate in July 1982. A very effective 4-month practitioner program is being conducted at the Long Beach, California, unit, which has been supplying registered nurses with special skills in SCI for the past two years.
A major demographic survey of the SCI veteran population is presently being conducted to identify their geographic and other characteristics. This will permit a more accurate data base on which to plan the allocation of services.
The yearly meeting on spinal cord injury sponsored jointly by VA Central Office, the American Paraplegia Society, and the Paralyzed Veterans of America (PVA) was held in St. Louis, Missouri, in September 1981. It had the best attendance to date and it also included a special meeting between all SCI service chiefs and the leadership of the national PVA.
The VA continued efforts to resolve the complex medical and scientific issues surrounding the defoliant Agent Orange.
By the end of FY 1981, over 67,000 Vietnam era veterans had received Agent Orange-related examinations at VA health care facilities. The results of these examinations are entered into the VA's Agent Orange Registry. The Registry assists in serving Vietnam era veterans by providing a mechanism for identifying concerned veterans, allowing follow-up activities, documenting the health status of participants, detecting health
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trends, and suggesting areas for further research. As of the end of FY 1981, medical information from the examinations of more than 50,000 veterans had been entered into the Registry.
Neurology
Radiology
The VA contracted on May 1, 1981, for the design of an epidemiological study of possible adverse health effects of Agent Orange. The initial proposal prepared by research scientists at the University of California, Los Angeles, was submitted for comment to the VA's Advisory Committee on Health-Related Effects of Herbicides and to external peer review groups, including the White House-established Agent Orange Working Group and the Office of Technology Assessment.
The VA contracted with J.R.B. Associates, Inc., of McLean, Virginia in December 1980, for the preparation of a review and analysis of the world literature on Agent Orange and other phenoxy herbicides. On October 1, 1981, the completed literature review was submitted to the VA. Copies have been widely disseminated within the agency, and to individuals, agencies, or countries concerned with the possible adverse health effects of these substances.
During the year, VA cooperated with other government agencies and public institutions in related research. It jointly funded with the Departments of Defense, and Health and Human Services, a birth defects study being conducted by the Center for Disease Control in Atlanta, Georgia. Progress on the "Operation Ranch Hand" study of Air Force personnel involved in spraying Agent Orange in Vietnam was closely monitored by the VA.
The VA also continued to participate in the White House's Interagency Work Group to Study the Possible Long-Term Health Effects of Phenoxy Herbicides and Contaminants, a committee redesignated in August 1981 as the Agent Orange Working Group. Quarterly "open" meetings of its own VA Advisory Committee on Health-Related Effects of Herbicides provided the VA with the assistance and guidance of experts from outside the agency, and provided an effective mechanism for consumer input. The VA afforded close cooperation to state Agent Orange commissions and other concerned staff groups in their own Agent Orange-related efforts.
Education of staff and the public continued to be emphasized during FY 1981, including nationwide use of the award-winning film, "Agent Orange: A Search for Answers," and publication of the Agent Orange Bulletin, a newsletter designed to educate and inform VA environmental physicians and other staff. Special nationwide conference calls between the DM&S Office of Environmental Medicine and key field health care staff at all major VA health care facilities enhanced the education of staff on VA policy and significant Agent Orange issues.
Although the number of Neurology Services remained the same, several changes were made to resolve problems with distribution of resources. One service was closed and its workload directed to another VA medical center within the same urban center. One new service was established in a rural area not previously served well. Four services were combined into two, such that each new service supports the neurologic mission at one acute and one chronic care VA medical center. This should facilitate interchange between the two levels of care, enhancing both.
A large number of VA neurologists contributed to an educational bulletin, "Epilepsy: Practical Guidelines for Diagnosis and Treatment," which should be available for distribution early in fiscal year 1982.
FY 1981 was another progressive and professionally stimulating year in the field of radiology, which encompasses the specialties of diagnostic radiology, ultrasound, radiation therapy, and computerized tomographic (CAT) scanners. Extensive planning went into the development of modern and technologically advanced X-ray departments for planned VA medical centers, and also into the updating of X-ray departments at VA medical centers in New Orleans, Louisiana; Oklahoma City, Oklahoma; Denver, Colorado; Providence, Rhode Island; Kansas City, Missouri; and several others. Improvement of space and equipment in other X-ray departments is planned.
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Radiology continued to be a major supportive and consultative service to other specialties, performing 5,553,131 examinations of inpatients and outpatients, and processing 17,063,285 X-ray films.
Nuclear Medicine
In the field of radiation therapy, 24 VA medical centers offered Cobalt 60, linear accelerator, and betatron supervoltage radiotherapy to patients with deep-seated malignancies. A total of 40,861 patients received 381,187 treatments at these centers. At other VA medical centers, patients were treated by transfer to the nearest VA radiotherapy center or, through contractual sharing agreements, to a community or university radiotherapy center. Plans were developed for adding a supervoltage radiotherapy center at the VA medical center in Albany, New York.
Radiology Service maintained an active quality assurance program, and received support in this endeavor from the Bureau of Radiological Health. Through joint efforts, advances have been made in radiation control and safety, and VA medical centers were kept operating according to the latest concepts in the practice of radiology.
The use of radioindicators to identify the presence of disease in the body's organ systems has continued to expand throughout the VA system. Nuclear medicine units in VA medical centers now number 130. Nuclear diagnostic procedures increased by more than 10 percent in FY 1981, yet the unit cost of such work dropped over 10 percent. The VA has enhanced patient care among veterans and fulfilled a national leadership role in this medical discipline. VA physicians presented more scientific papers and exhibits at the annual meeting of the Society of Nuclear Medicine than any group in the country.
VA Nuclear Medicine achieved newer, more specific knowledge of such diseases and states of the body as: atherosclerosis, thrombosis, thyroid function, body composition, lipoproteins, liver metabolism and cirrhosis, gall bladder function, gastrointestinal physiology, endocrine function, peptide analysis, hematology, and cerebral, thyroid, pulmonary, cardiac, kidney, adrenal, and testicular function.
The development of monoclonal antibody techniques and the use of chelates for the diagnosis and treatment of cancer have been pioneered by VA physicians.
VA Nuclear Medicine, which inaugurated the computerization of scintillation imaging techniques, has seen it adapted to such new techniques as computed tomography. The seminal work on positron-electron emission (commonly called PET) scanning, is being done at the VA medical center in Madison, Wisconsin.
Advances in administrative medicine were made by the development of Patient Service Units as a means for assessing productivity in the nuclear medicine unit. This is the first attempt anywhere to make amorphous evaluation techniques orderly and comprehensive. The public sector has expressed great interest in this work and its outcome. Additional effort also went into the development of criteria and standards for the unit.
Close attention was paid to all aspects of radiation exposure during the fiscal year. The VA is represented on the Federal Radiation Policy Council and at meetings of the Interagency Radiation Research Committee and similar groups. Work continued with the Nuclear Regulatory Commission on radiation protection, and much literature was distributed to VA medical centers on this subject. Production of a VA nuclear disaster manual was also underway during the year. The feasibility of applying the principles of Nuclear Magnetic Resonance (NUMAR) to patient care in the diagnosis of disease states, both in delineation of organ abnormalities and disturbances in blood chemistry, was under investigation. Studies are already being done at VA medical centers, and imaging devices are expected to be available shortly. The promising field of microwave imaging is being explored jointly with the staff at Walter Reed Army Hospital.
New techniques in ultrasound, such as laser-ultrasound and microwave-ultrasound methods, were also examined.
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Dentistry
Optometry
Podiatry
Training on the new VA Dental Data System was completed and field implementation was begun in four of the six VA medical regions. The remaining regions will receive training, and the new manual system will be functional in all Dental Services during the following fiscal year. When incorporated nationwide, the system will provide management at all levels with data necessary to assess the performance of the dental services in relation to the overall goals and objectives of the Department of Medicine and Surgery. Two VA medical centers are field testing an automated system that will provide more rapid and complete analysis of patient care information.
Significant progress in updating dental equipment and construction materials has been achieved during the past few years. Modern equipment and clinic design facilitate the delivery of quality care. Space criteria for dental clinics have been updated for modern dental operating techniques and the current philosophy of dental/ oral health care delivery systems. Extensive analyses of functional area size and configuration were conducted to determine how professional capability could be enhanced in the practice of team dentistry.
In response to the Radiation Guidance to Federal Agencies for Diagnostic X-Rays promulgated by the President, the Office of Dentistry has completed a program guide, entitled “Dental Radiation Safety and Protection." This publication will give VA dental personnel more detailed procedural guidance, and will provide for implementation of the latest radiation safeguards.
The Office of Dentistry has been actively involved as a part of the multidisciplinary planning process to assure VA's readiness to provide appropriate health services for the anticipated increase in geriatric patients. As in other types of medical and surgical care, the geriatric patient often requires modifications in type and extent of dental treatment. To prepare VA dentists and auxiliaries to meet the "geriatric challenge," several approaches are being taken. As the result of a workshop on geriatric dentistry involving consultants from within and outside the VA, a needs assessment survey is being readied to ascertain the character and extent of continuing education in gerontology required by VA dental personnel. Dental Education Centers are preparing faculty and course materials to fulfill the indicated requirements.
The Optometry Service continued to make progress in optometric patient care. Staffing levels were increased by the addition of 25 staff optometrists, many of whom are recent graduates of VA optometric residencies, and have brought insight, specific knowledge, and veteran compassion to the staffs of VA medical centers across the nation.
In recognition of the accomplishments of VA's Optometry Service since it was authorized by Congress in 1976, a special issue of the Journal of the American Optometric Association was devoted to clinical papers written by VA optometrists at the VA medical center in Northport, New York. The center was featured on the cover of that issue. Also this year, the Journal of the American Academy of Optometry devoted one of its issues solely to clinical and research papers authored by VA optometrists. In December 1980, the Academy, at its annual meeting, awarded its Carol C. Koch award for interprofessional relations to Mrs. Martha L. Phillips, Deputy Director of the Department's Office of Program Analysis and Development.
The pilot VICTORS (Vision Improvement Center to Optimize Remaining Sight) clinic at the VA medical center in Kansas City, Missouri, increased greatly the number of visually impaired veterans treated in its four-state region. It is now serving as an example to other districts of how better care can be rendered veterans with permanent visual losses from 20/40 to 20/100.
In addition, a pilot eyeglass procurement program from the Army Optical Laboratory was initiated, as approved by the Federal Health Resources Sharing Committee. It is hoped that this pilot program will lead to decreased costs and enable the VA to provide improved optical services at lower unit costs.
During FY 1981, new full-time podiatric programs were added at 15 VA medical centers, bringing the total to 45. By the end of the year, podiatric medical care pro
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grams were available in 138 VA health care facilities, primarily staffed by part-time podiatric personnel, and consultants and attendings.
The most significant area of growth in podiatric activities for FY 1981 was the development and expansion of post-doctoral residency training programs. The number of podiatric residency positions was expanded from 36 to 52 positions. VA-sponsored podiatric medical residencies are one-year postdoctoral training programs, and are now located in 22 VA medical centers. It is expected that these programs will continue to develop as the requirements and staffing qualifications for VA podiatric medical care programs expand.
Podiatric Service was actively involved in the establishment of standards and criteria for foot care to be used in VA's Systematic External Review Program. These represent a significant advancement in the maintenance of foot care standards for VA patients.
Podiatric medicine's involvement in the clinical care and rehabilitation of aging and disabled patients received emphasis through a system-wide continuing education program. In June 1981, a major VA-sponsored seminar on podiatric care of the aging and disabled drew hundreds of podiatrists to San Francisco, California.
The chart reflects the age distribution of patients seen by VA podiatric services.
AGE OF PATIENTS SEEN IN VA
Pathology
The use of automation in VA Laboratory Services is leveling off, and future expansion of automation will be slower as instrumentation in the more difficult areas (microbiology, hematology, immunology) is refined. Improvement now is needed in the speed and dependability of data handling systems. Increased awareness of the costs of medical care has focused attention on the review of laboratory utilization and the need for discrimination in test selection. Selected laboratory data are shown in the table.
As of the end of FY 1981, all but one of 177 VA Laboratory Services enrolled in the College of American Pathologists laboratory inspection and accreditation programs were accredited.
All VA laboratories participate in survey programs provided by the College of American Pathologists. Those performing tests for syphilis participate in the special
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FY 1981 FY 1980 FY 1979
Procedures (unit count) 215,990,010 214,818,805 203,242,806
Workload (unit values) 674,694,593 685,205,320 670,053,272
Deaths 46,467 46,413 46,048
Autopsies 15,716 16,732 15,975
Surgical accessions 385,737 381,883 376,899
Cytological accessions 198,236 197,024 206,449
Nursing
comprehensive syphilis serology survey, those performing tests for therapeutic drugs in the therapeutic drug monitoring survey, and those performing blood gas analyses in the blood gas survey. Selected VA laboratories also participate in the Center for Disease Control's proficiency survey for drugs of abuse.
The program of systematic external review of VA autopsies and surgical tissues was in its fourth year in FY 1981, providing additional continuing education for VA pathologists.
The special registry for former prisoners of war established at the Armed Forces Institute of Pathology in January 1980, remained active. The chief purposes of this registry are to study pathological specimens from former prisoners of war and to insure this material remains available for investigation of the long-term consequences of the war experience.
During FY 1981, a total of 621,324 units of whole blood and blood components were transfused, representing a 24 percent increase over FY 1980. Voluntary donors provided 97 percent of that blood. The percentage of packed red cells transfused in FY 1981 was 53 percent. Total blood donations increased 9 percent over FY 1980, and outdated blood decreased from 3 to 2 percent.
On April 9, 1981, the Pathology Service sponsored a one-day meeting in Central Office to present results of a survey of the current status of therapeutic hemaphoresis in the VA medical centers. The meeting yielded much valuable information, defining the clinical possibilities and limitations of this form of therapy.
The VA Pathology Service is collaborating with the National Cancer Institute (NCI) in a study of mesothelioma, as a part of a larger effort to determine the public health and etiologic significance of occupational exposure to asbestos. Initially, the VA will compile an inventory of cases of mesothelioma at selected VA medical centers.
The foremost concern of the VA Nursing Service continues to be the increased difficulty in the recruitment and retention of nurses. The shortage has intensified at a time of increasing complexity in patient care, a heightened professional awareness of working conditions, and the need for support services to facilitate clinical nursing practice. The highly competitive market for qualified nurses throughout the nation makes it difficult to recruit and retain them. High vacancy rates create inadequate staff coverage, heavy workloads, high turnover rates, increased dissatisfaction, and fatigue. Problems related to nurse recruitment and retention require collective effort and coordination within and outside the agency.
Intensive efforts were directed toward the provisions of Public Law 96-330 intended to improve the recruitment and retention of VA nurses. A task force chaired by the Deputy Assistant Chief Medical Director for Nursing Programs made recommendations to alleviate these problems. Eighty-three VA medical centers have implemented registered nurse pay adjustments which permit the VA to be more competitive with other hospitals in their geographic areas. Twenty of these have implemented expanded salary rate ranges.
A recruitment and retention study mandated by Public Law 96-330 was underway during the year. The study deals with four major issues: working conditions, control over
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nursing practice, dignity and self-respect, and relationships. Flexible work scheduling, day care centers, and other programs designed to promote staff retention also are being studied.
Criteria for VA Professional Nurses Scholarship Program, also designated by Public Law 96-330, were completed.
The VA is working with the Office of Personnel Management to determine procedures for implementing special pay rates for licensed vocational nurses and licensed practical nurses. Nursing Service also participated in the separation of the Nursing Assistant classification series GS-621 into the Practical Nurse series GS-620 and the Nursing Assistant series GS-621. Twenty-five percent of participants in the VA upward mobility program were LPNs and Nursing Assistants obtaining academic preparation to become registered nurses.
Other efforts to enhance the recruitment and retention of nursing personnel include the following:
• Development of a better method for allocation of resources throughout VA Nursing Service.
• Refinement and development of computerized information capabilities critical to the effective management of nursing care.
• Emphasis on executive development and the authority of nursing for administrative and clinical decision making.
• Strengthening the relationship between the VA Nursing Service and academia, including the establishment of a liaison with the American Association of Colleges of Nursing.
• Support for clinical nurse specialists in traineeships. Grants will enable 21 VA nurses to study nursing administration at the graduate level at three universities.
• The Nursing Career Development Program to provide career opportunities for more registered nurses.
• Publication of "Nursing Service Preceptorship Training Programs," to provide guidance in the development of nursing leaders.
• Publication of "History and Heritage of the VA Nursing Service, 1930-1980," to enhance the public awareness and image of Nursing Service.
Data obtained from a survey of 94 VA nursing home care units have led to proposals for a centralized training program to prepare newly appointed supervisors of nursing home care units for a Gerontological Nurse Fellowship program. A special recruitment effort has been directed toward obtaining clinical nurse specialists in gerontology.
Efforts to enhance clinical practice through education and research included the following:
• Cooperative efforts between the VA and the Eastern Paralyzed Veterans of America enabled ten more nurses to complete the spinal cord injury nurse practitioner program.
• Concepts in rehabilitation nursing were presented to 80 VA nurses in Regional Medical Education Center teaching programs.
• Several new subjects, including suicide prevention, patient abuse, bioethics, and radiation safety were designated as mandatory continuing education topics for nursing personnel.
• Nursing Research representatives identified strategies to improve patient care through research in nursing practice.
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Recreation The VA continues to be the model provider of therapeutic recreation services, and during FY 1981 provided over 900,000 programming hours to VA patients. A one-year study at 32 VA medical centers was instituted to determine the extent of past, current, and anticipated future involvement of hospitalized veterans in recreational activities. The study will also ascertain the attitudes of the hospitalized toward recreation, and develop a recreation profile of hospitalized veterans. This information will help improve the recreation delivery system and the allocation of resources. Program guides were developed for therapeutic recreation programs in spinal cord injury units, nursing home care units, contract nursing homes, and domiciliaries. An instructional module was designed to provide continuing education and training for recreation therapists in applying systems management techniques to patient therapy planning. The learning elements allow the therapists to assimilate the techniques into their normal clinical environment and to transfer abstractions into clinical experiences. The Recreation Service Field Advisory Committee (FAC) provided Central Office with consultative services relating to regional and departmental issues, and strengthened working relationships between the medical centers and Central Office. The FAC served as the DM&S regional coordinating body for International Year of Disabled Persons (IYDP) activities to promote a better understanding of the needs and concerns of disabled persons. Over 6,000 activities were arranged at VA medical centers during the fiscal year. Two of the most important national events directed by Recreation Service were the all-veteran wheelchair games with participation from veterans representing 14 states, and the VA IYDP National Music Contest in which over 650 hospitalized veterans participated.
Pharmacy Pharmacy Service continued to provide safe and effective drugs to veteran patients and to assure appropriate drug utilization in the VA health care system. Recognizing the complexities and sophistication of drugs and drug technologies, and the narrowing of the benefit-risk ratio, more patient-care-oriented pharmacy services are being implemented. During FY 1981, approximately 36 million prescriptions for ambulatory patients were dispensed from 220 pharmacies. In addition, over 250 million inpatient medication doses plus five million intravenous and total parenteral nutrition solutions were prepared and distributed. High priority was placed on the development of the automated outpatient pharmacy system to include inpatient and inventory control modules. When completed, the system will process the flow of medications more efficiently and provide for effective clinical and administrative decision making. The VA supported the combined Federal procurement directives to standardize drug procurement, nomenclature, product description, and drug selection, and to eliminate duplicate stocked drug items. These procedures are expected to be cost-effective and to reduce the total cost of medications to the VA and other Federal agencies. The Pharmacy and Therapeutic Agents Committees and the Infectious Disease Committees at VA medical centers implemented criteria to monitor the rational use of anti-infective agents. While improving patient care, these efforts have been cost-effective as well. Special packaged drugs are purchased to provide the patient with a ready-to-use prescription container, assuring quality and saving labor. Pharmacy training activities were directed toward improving the clinical skills of VA pharmacists to provide more patient-oriented and veteran-centered pharmacy services. Pharmacists from over 100 medical centers have participated in clinical functions skills seminars. Programs to give pharmacists training skills to upgrade technician capabilities were also conducted several times during FY 1981. By the end of the year, completed conversions to the medication management dispensing system (unit dose) totaled 48. This represents over 23,000 beds on the unit
28 dose system with anticipation of more facilities and additional operating beds being
converted in the next fiscal year. The program has brought about a reduction in medication losses, less probability of medication errors, less diversion of drugs to street traffic, savings in nursing time devoted to medication activities, and a total medication profile on patients. Pharmacy Service was also in the process of developing an evaluation system to measure the quality of care provided by pharmacy program activities.
Dietetics During FY 1981, nearly 89 million meals were served in VA health care facilities at a raw food cost of $90 million or $1.01 per meal (an increase of six cents from FY 1980). Dietitians are active participants in nutritional support teams whose primary responsibility is to respond promptly to the treatment needs of patients at nutritional risk. In coordination with other professional disciplines, guidelines for nutritional screening and for total parenteral and enteral feedings were developed and disseminated to assure that dietitians and other health care providers would be more responsive to veterans' nutritional care needs. Dietitians at selected medical centers studied the problems in nutritional care of geriatric patients. As a result, guidelines to assist dietitians in improving the quality of care were developed and specific problem areas, such as appropriate anthropometric standards for geriatric patients, will be addressed. Initial efforts were made to identify professional staffing requirements for qualified dietitians in direct patient care. As the role of the clinical dietitian expands, more qualified dietetic technicians must be available to assure appropriate utilization of professional staff time, knowledge, and skills. Selected Central Office and VA medical center dietitians assisted the Office of Personnel Management in the development of criteria to rate applicants for the position of dietitian. The criteria identify the knowledges, skills, and abilities needed to perform specific entry level dietitian's responsibilities.
Social Work Patient care services provided by social workers affect veterans and their families throughout the VA health care system—in inpatient programs, in admissions and ambulatory care, and in community outreach in support of VA benefits and health care. During FY 1981, 1,465,000 cases were treated by VA social workers, using the standardized problem categories reported by social workers, the percent distribution of psychosocial problems treated for these cases is shown below: Need for health care planning 23% Need for discharge planning 17% Coping with illness 15% Emotional/behavioral 14% Financial 9% Adjustment to community living 9% Family related 8% Other 5% Social workers perform a variety of functions in VA health care, and have established clinical privileges. Basic patient care services provided by social workers include patient screening, social assessments, and treatment of psychosocial problems. Services are particularly directed to persons confronted with crisis, life-threatening illness, traumatic loss, and chronic or disabling illness. Criteria are being developed to assist in identifying those patients whose physical, behavioral, or social conditions make them likely to lose health care gains or to develop significant new problems. Other functions include discharge and aftercare planning, education, research, and community resource development and coordination. The percent distribution of VA social work service staff, by type of care, was as follows in FY 1981:
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Inpatient Care
54%
General medicine, surgery, and special medical services 26% Mental health programs 24% Outpatient Care 46% Ambulatory care 17% Mental health programs 16% Community care 13% Under Social Work leadership, innovative community support programs responsive to the needs of the elderly and disabled are being developed to enhance quality of life, prevent unnecessary hospital care, and provide coordinated services more efficiently. The Day Ambulatory Services for Health (DASH) programs, initiated at the VA medical center in Loma Linda, California, is meeting the needs of the frail elderly who otherwise might have to face institutional care. VA and community health, social, education, and recreational services have become an integral component of an adult day health center licensed by the state. A number of medical centers have developed shared apartment living models for the disabled through which veterans are encouraged to assume major responsibility for management of their own affairs. In addition, pilot centers for independent living have been established at six VA medical centers to meet the special needs of veterans with severe medical or psychiatric disabilities who require an extensive community support system. Social workers are a key resource in developing non-institutional models to integrate VA medical center and community resources. The development and expansion of cost-effective alternatives to institutional care is a prime concern. In addition to patient care activities, social workers provided professional counseling, consultation, and referral services during the year to over 6,600 VA employees to promote employee work effectiveness and enhance morale. Social workers continue to provide leadership roles in VA health care programs. At least 131 social workers administer or coordinate multidisciplinary and service programs of patient care.
Chaplain Service The mission of the Chaplain Service is to provide spiritual and religious ministry for patients in all VA medical centers as an integral part of the medical team. The Chaplain Service represents all major denominations, and conducts a program of educational workshops for chaplains to enhance their capabilities. Workshops conducted during FY 1981 included how to deal with the orthopedic patient, the patient who suffers from substance abuse, the aging patient, and the terminally ill patient and his family. Through study in these areas, VA chaplains keep abreast of the needs of patients and staff so the services they offer are meaningful and useful. The Chaplain Service continued its work with the Church Ecclesiastical Endorsing Agencies of all faith groups to establish guidelines for bringing into the service and nurturing new VA chaplains.
Canteens Thirty-five years ago, Congress passed a law creating the Veterans Canteen Service, a self-sustaining, independent organization within the VA. The primary mission of the VCS is to provide America's hospitalized veterans with essential merchandise and services at reasonable prices. With the opening of one more cafeteria in FY 1981, all 172 VA medical centers have a canteen-operated retail store, cafeteria, and vending machine area.
In recognition of the vital role it plays in the VA, the Veterans Canteen Service (VCS) received an Administrator's Commendation in FY 1981. It reads in part: "This cer-
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Monitored Professional
Services Programs
Academic Affairs
tificate is awarded ... in recognition of (VCS's) exceptional performance and outstanding service to veteran patients, members and their families, VA medical center employees, volunteers and visitors. Through their combined efforts and dedication, VCS employees have increased productivity, controlled inventories, improved customer service and generated sufficient operating income to assure mission accomplishment and quality service.”
Innovations occurred in the food service area during 1981. VCS shifted emphasis from prepared convenience foods to made-to-order items. This achieved two purposes — more palatable food for the customer and better control of fat, salt, sugar and other ingredients which may be harmful to certain patients. In some canteens, customers prepare their own salads from a variety of selections. This encourages healthful eating while cutting down on waste. To assist management with these changes and to provide a more professional food service, five highly acclaimed regional food workshops were held. These were VCS's first attempt at large-scale, centrally directed food workshops.
Forty-nine canteen areas (13 food service, 13 dining, 13 kitchens, and 10 retail stores) were remodeled in FY 1981. VCS occupied its third pre-constructed building this year. These edifices prove less costly than remodeling of old space. Furthermore, they provide an area free of support columns which allows for total use of space. An entire canteen may be laid out in one building —barber shop, offices, retail store, and cafeteria.
The assignment merchandise program, which uses volume purchases, has turned 1981 inflation to VCS's advantage. More and more manufacturers are reducing inventories because of high interest rates. VCS buyers, who are in constant contact with national manufacturers, react quickly to new introductory merchandise programs, manufacturers' overruns, or item phase-outs. This makes it possible to offer exceptional values to VCS customers. The program has grown to the point that 7 to 8 percent of total sales are made from assigned merchandise.
Even so, only through strict controls, strong management, and firm fiscal responsibility has sufficient operating income been provided. Net income for FY 1981 was $1,578,302. This money will be used in FY 1982 to pay for increased salary costs, planned canteen improvements, and to offset the impact of inflation.
Systemwide incorporation and expansion of new medical technologies is accomplished through precise monitoring and control of selected programs. These programs have identified priorities and emphasize the medical needs of service connected veterans in such areas as rehabilitation, alcohol and drug dependency treatment, spinal cord injury, aging and readjustment programs for younger veterans. They offer the greatest impact on overall quality of care and represent viable alternatives to costly inpatient care. Individual unit efficiency and effectiveness assessment is routinely performed. The table shows the number of units in each monitored program at the end of FY 1981.
Alcohol dependency treatment units 102
Blind rehabilitation centers 3
Blind clinics 3
Cardiac catheterization laboratories 67
Cardiopulmonary by-pass surgery 42
Computed tomography 17
Drug dependency treatment units 52
Hemodialysis centers and home dialysis 55
Hypertension screening and treatment program 32
Renal transplant centers 15
Satellite (self)dialysis 23
Sickle cell program 40
Spinal cord injury centers 18
The VA conducts the largest coordinated health professions education and training effort of its kind in the country. Its purpose is twofold:
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VA Facilities — School Affiliations
• Assuring the highest quality of veteran's health care by educating and training health professionals within the VA system, and providing continuing education and career development for health care facility personnel.
• Developing sufficient numbers of all categories of professional and other health personnel to meet the needs of the VA system and contribute to the health manpower of the nation.
In all, the VA is affiliated with over 1,000 educational institutions, and nearly 100,000 students each year receive some of all of their clinical training in VA facilities. Continuing education for employees involved with health care delivery is provided through a network of VA-directed Regional Medical Education Centers and other educational field units.
VA health care facilities have training relationships with schools of medicine, dentistry, nursing, pharmacy, social work, and other associated health professions and occupations at the graduate and undergraduate levels. More than 100 physicians and other senior health professionals work at the hospital, local community, and regional levels as associate chiefs of staff for education, directors of regional medical education centers, directors of dental education centers, directors of cooperative health manpower education programs and patient health education coordinators. These centrally approved representatives are responsible for monitoring existing education and training programs, developing new activities consistent with the needs of their institutions and those in their region, and coordinating these programs with the affiliated schools and colleges and the communities they jointly serve.
Since 1946, the affiliation of VA health care facilities with educational institutions has been a partnership of shared responsibility for insuring the maintenance of high quality health care to veterans. At the local level, each VA facility brings its own substantial resources as well as its expert and extensive staff to this endeavor. At the national level, the Office of Academic Affairs coordinates local and regional affiliation activities with the accrediting agencies and the national organizations that represent the affiliated institutions and professions.
During the year, 132 VA health care facilities and 40 outpatient clinics were affiliated with 100 medical schools; 92 of these same facilities and three outpatient clinics were affiliated with 59 schools of dental medicine. All VA health care facilities were engaged in education and training of students in health care professions and occupations through affiliation with at least one university, school, or college.
The table reflects the status of VA's health care training efforts by discipline.
Discipline FY 1981 FY 1980 FY 1979
Total 96,858 96,670 96,583
Medical house staff 25,036 24,286 23,393
Medical students 20,106 20,427 19,392
Dental house staff 748 706 609
Dental students 1,439 1,216 1,085
Nursing 26,853 27,699 29,968
Other associated health
professions & occupations 21,828 21,548 22,300
Administrative 848 788 836
Affiliation agreements between VA medical centers and medical schools are implemented through deans' committees which advise medical center directors and the Chief Medical Director on the education and research programs of VA facilities. Membership consists primarily of physicians who are deans and senior faculty in medical schools. However, 74 committees have deans of dental schools, 32 have deans of nursing schools, and 23 have deans of schools of allied health among the membership. Public Law 96-330, enacted in 1980, required the appointment of one or
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more members of the full-time clinical staff of the VA medical center as voting members of deans' committees. During 1981, 123 such VA staff members were appointed to membership on deans' committees at 73 facilities.
VA Professional Staff as Academic Faculty
Graduate and Undergraduate Medical and Dental Education
A policy to include veterans' service organizations as ex-officio members of deans' committees was established in 1977, and later included in the DM&S Consumer Program. By 1981, a total of 114 VA facilities (86 medical centers and 28 outpatient clinics) had appointed 122 veterans' service organization representatives to deans' committees.
As affiliation with health sciences schools and colleges developed and expanded, recognition of the academic stature of VA staff has been demonstrated in the increased number of faculty appointments. As shown in the table, the number was 9,259 at mid-FY 1981; a decade earlier the figure was 2,686.
VA Physicians, Dentists, and Other Staff (Full-time and Part-time) With Faculty Appointments
April 15, 1981
Academic Title Total Physicians Dentists Other Staff
Total 9,259 7,232 407 1,620
Professors 1,216 1,129 12 75
Clinical professors 193 155 15 23
Associate professors 1,323 1,172 34 117
Associate clinical professors 559 415 46 98
Assistant professors 2,750 2,414 66 270
Assistant clinical professors 1,154 874 100 180
Instructors 730 464 26 240
Clinical instructors 767 374 77 316
Lecturers 86 48 3 35
Other titles 481 187 28 266
During 1981, a total of 122 VA health care facilities participated in 1,604 specialty and subspecialty programs for physicians. Of these, 1,551 were cooperative arrangements between VA facilities and their affiliated medical schools. The other 53 residency programs were conducted in VA health care facilities and 18 community teaching hospitals with which they are associated. The majority of these latter programs are sponsored in relatively remote VA facilities.
The VA supported approximately 7,500 full-time medical residency positions, representing about a sixth of the nation's total number of residents in training. By cooperative affiliation arrangements, about three resident physicians are rotated through each supported position in the course of the academic year. VA medical centers are involved in the education and training of about 40 percent of the trainees in all medical specialties except preventive medicine, obstetrics/gynecology, and pediatrics. Special emphasis is given to supporting programs in psychiatry, anesthesiology, radiology, and physical medicine and rehabilitation. Through affiliations with medical schools, VA facilities provide clinical education experiences for undergraduate medical students in increasing numbers.
The VA also contributes significantly to dental education with 98 VA health care facilities involved in either undergraduate dental clerk programs or graduate dental residency positions. Although 312 dental positions were allocated for all dental residency training, the largest portion of the advanced program is in dental general practice residency training with 69 facilities supporting such programs. This represents 27 percent of all fully approved general practice programs in this country.
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Fellowship Programs The geriatric fellowship program for physicians completed its second two-year cycle in June 1981 and certificates of training were awarded to thirteen Fellows. Of these, eight accepted positions in the VA system and two received awards of a third year in research at a VA medical center. Sixteen physicians advanced to the second year, and 19 became first-year participants in this clinical/educational program in geriatric medicine and gerontology at 12 VA training sites.
Increasing interest in the spinal cord injury fellowship program resulted in a total of 17 participants; 11 first-year and six second-year Fellows.
Participation in the substance abuse fellowship program increased from four to ten, when six physicians entered this two-year program on July 1, 1981.
Health Professional Scholarship Program The VA health professional scholarship program was authorized by Title II, Public Law 96-330, to assist in providing an adequate supply of physicians and nurses for the VA and for the nation. The anticipated surplus in the supply of physicians and the critical shortage of professional nurses in the VA led to a policy decision to make scholarship awards to nursing students if appropriations become available. Baccalaureate nursing students and students in master's programs emphasizing clinical specialties needed by the VA would be eligible to apply, as would VA-employed nurses who meet the eligibility criteria.
Students who receive scholarships would incur an obligatory period of VA service equal to the period of support or two years, whichever is greater. The program should permit increased recruitment of professional nurses and better retention of nursing personnel. Regulations, forms, and other program materials are being developed.
Graduate and Undergraduate Education in Nursing and Other Associated Health Professions and Occupations During 1981, the VA health care system contributed significantly to the education and training of personnel in nearly 50 recognized associated health professions and occupations. The term "associated health" includes all personnel other than physicians, dentists, and medical or dental students, engaged in providing direct services to patients. The table shows the extent of supervised clinical instruction provided in VA facilities to nursing and selected other health professions students.
Participating VA Health Care Facilities Students Receiving Training
Nursing Social Work Psychology Rehabilitation medicine Audiology and speech pathology Dietetics Optometry Podiatry Pharmacy 158 142 125 110 96 74 24 28 82 26,853 896 1,173 1,878 654 1,098 282 574 1,934
Interdisciplinary Team Training in Geriatrics (ITTG) is continuing at five model sites: Sepulveda, California; Portland, Oregon; Salt Lake City, Utah; Little Rock, Arkansas; and Palo Alto, California. ITTG sites are selected in conjunction with the ongoing geriatric programs located at the medical centers. This educational effort is based on the concept that health care delivery by a team of professionals holds promise of more efficient utilization of personnel and better management of elderly patients in need of continuing care.
A total of 70 master's level clinical nurse specialist student positions were supported in 1981 at 28 VA medical centers through 27 affiliations with accredited schools of nursing. The students receive their clinical training at VA facilities in the priority areas of geriatrics, rehabilitation, or mental health. Summer traineeships were awarded to
Continuing Education and Staff Development
321 trainees to assist VA medical centers which have difficulty recruiting students during the academic year. This was the second year for this project.
The VA operates a systemwide continuing education and staff development program for DM&S employees to help insure quality care through education and training. Continuing education deals with both maintaining and enhancing skills to keep abreast of advances in health care and administration. Activities include workshops, seminars, and individual training, and a variety of audiovisual, print, and electronic media.
This year major emphasis was placed on developing quality standards for continuing education operations and administration. An assessment of the feasibility of an interactive audio telelecture education system solely to meet DM&S needs was initiated during the year. An improved system for reporting and recording educational activities is also under development.
In 1981, over 2,900 DM&S entry and mid-level managerial staff attended programs designed to increase management competency, knowledge of broad health care issues, and skills needed to deal with local management issues, and to assist them in performance of ther current and future responsibilities. This included administrative leadership training for social work trainees, university health care training specifically developed for 180 VA employees, and 83 local seminars for 2,500 medical center staff. Skills training in accounting, building management, engineering, fiscal, management analysis, medical administration, personnel, and supply were also provided for 230 administrative career entry-level trainees. In addition, an experimental program in organizational development was evaluated at two VA medical centers and found effective. Another organizational development initiative called Quality Circles, featuring staff participation in problem solving, was begun in three VA medical centers.
VA medical centers and outpatient clinics were allocated Postgraduate and Inservice Training (PIT) program funds to provide continuing education and staff development for employees. Activities included workshops, seminars, grand rounds, independent study, and work details both within and outside the agency.
Continuing education field education units provided programs to assist facilities in meeting demonstrated needs. Each of the field units has particular strengths and expertise which complement and supplement a field facility's continuing education program, as described in the following paragraphs.
Regional Medical Education Centers (RMECs) are central to the DM&S continuing education program. In 1981, a seventh RMEC was activated at Cleveland, Ohio. The other RMECs are located at Northport, New York; Birmingham, Alabama; Minneapolis, Minnesota; St. Louis, Missouri; Salt Lake City, Utah; and Long Beach, California. At each RMEC, educational expertise is available to the facilities in the region. RMECs provide general educational planning and consulting services as well as sponsoring specifically planned activities. These activities are at three levels:
• local, in collaboration with individual facilities;
• regional, to address identified regional needs; and
• national, to address systemwide needs identified by Central Office or other RMECs.
During 1981, a total of 524 training activities were offered by the RMECs involving over 1,700 employees. The topics covered included general medicine and surgery issues, management and administration, geriatrics, rehabilitation, pharmacy, patient education, psychiatry, and Health Systems Review Organization. RMECs also devoted considerable efforts to training on the Department's new planning process (Medical District Initiated Planning Process), health care quality assurance, and cost control techniques. A Continuing Education Center at the VA medical center in Washington, D.C., began operating in 1981 and serves as an instructional design and development center for high priority systemwide education programs.
Dental Education Centers (DECs) at the VA medical centers in Washington, D.C., and Wadsworth, Los Angeles, California, provide specialized continuing education activities for dental employees. The DECs offer traditional short courses and wet labs, and produce single-concept films in such areas as geriatric dentistry, hospital
35
periodontics, and dental assistant utilization. During 1981, DECs conducted 16 activities involving VA employees.
The Engineering Training Center (ETC) at the VA medical center in Little Rock, Arkansas, offers educational activities for DM&S engineering personnel with emphasis on biomedical engineering, including operating room equipment, physiological monitoring, clinical lab equipment, and hemodialysis. In 1981, the ETC offered 25 activities involving 249 VA employees. In addition, the ETC has developed and administers correspondence courses, which involve over 180 VA medical center employees.
The Rehabilitation Engineering Education Program (REEP) provides continuing education opportunities for prosthetics and orthotics personnel and staff in related disciplines. In 1981, REEP staff developed and conducted short courses, coordinated apprentice and driver training programs, evaluated prosthetic devices, and worked with several universities to provide additional continuing education opportunities for the staff of VA medical centers. REEP offered 17 activities for 275 VA employees. In addition, 95 employees attended the university short course and 13 participated in the driver training program.
Cooperative Health Manpower Education Programs (CHEPs) provide educational programs in remote areas served by VA medical centers. The VA supports programs at Togus, Maine; Saginaw, Michigan; Erie, Pennsylvania; Tuskegee, Alabama; Lincoln, Nebraska; Boise, Idaho; and Dublin, Georgia. The Dublin CHEP was established late in 1981 and was not yet operational by the end of the year. Working through consortia with education and health care institutions in their geographical areas, CHEPs trained about 6,000 health professionals in 1981. Topics included intensive care, coronary care, gerontology, dental care and education, alcoholism, and leadership development. This program in continuing education represents another DM&S community sharing initiative, which also reinforces sharing activities in the patient care sphere.
The Patient Health Education Program includes a coordinator at each RMEC, and Patient Health Education Coordinators at 15 VA medical centers. Coordinators assist VA medical centers in identifying patient health education needs, planning and evaluating patient education programs, and coordinating the efforts of health care providers.
The scope of collections held by the VA Library Network (VALNET) covers the totality of the medical center world with its many disciplines, professions, and health care services.
The 176 VALNET libraries are encouraged to establish themselves as the major component of a Learning Resources Center, serving as the information and distribution resource for continuing education, and patient education and training activities. Computerized bibliographic data bases provide the foundation for significant advances in the network's ability to provide agency health care professionals with the most current information for use in caring for the veteran patient. In 1981, 105 VA hospital libraries had direct access to on-line bibliographic data bases—15 more than in 1980. Continuing access to the DIALOG system, which provides over 100 separate data bases covering the physical, life, and behavioral sciences, was furnished to the network through the libraries at facilities hosting Regional Medical Education Centers. During 1981, access to a new computerized data base, NEXIS, was obtained for use in VA's Central Office. Through this data base, library staff has access to full-text, current affairs information from the Washington Post, Congressional Quarterly, wire services, and other sources.
Increased efficiency and cost effectiveness in document delivery are being provided through continuing development of union catalogs listing the holdings and locations of print and nonprint materials held by the network libraries. During 1981, a prototype VA Union List of Monographs, containing 9,000 book titles held by VA libraries, was published and distributed on microfiche. In addition, progress to update the 1978 VA Union List of Audiovisuals continued. The materials listed in these microfiche catalogs are available for sharing throughout the VA and to outside organizations. In related efforts to contain costs and prevent duplication, the Central Office Library provides
Library
36
4
centralized purchase and network distribution of audiovisuals, and coordinates a pre-and post-production review of all audiovisual programs intended for use throughout the agency.
Medical Media At the close of 1981, there were Medical Media Production Services at 104 VA medical centers helping meet an increasing demand for audiovisual aids from medical center staff and for specialized programs at Regional Medical Education Centers. A new uniform system of data collection now permits monitoring of media production workload and costs in order to estimate average costs of a variety of products. During 1981, a program was initiated to consolidate major production resources into the smallest number necessary to adequately meet verified DM&S needs for audiovisual educational support materials. Four major teleproduction sites were established and existing resources were reallocated to fortify the capabilities at those sites. Studies continue on the role and effectiveness of closed circuit television networks as interactive links with schools of health professions. Nearly 40 scientific exhibits were displayed at major conferences and 45 audiovisual programs were approved for VA distribution. The Learning Resources Service at the VA medical center in St. Louis, Missouri, continued to be a yearly Emmy award recipient, this time for the film, "Agent Orange: A Search for Answers."
Educational Space and Facilities During the year, 23 projects to provide new educational facilities or renovate and equip existing facilities were approved and funded. These projects included space for conference/classrooms, libraries, medical media production areas, and related space. The facilities provided through these projects will serve the many programs for patient education, continuing education for medical center staff, and the training of students and house staff from affiliated academic institutions. Projects under construction in 1981 included the renovation of a building at the VA medical center in Cleveland, Ohio, (Brecksville Division) for the Mid-Atlantic Regional Medical Education Center. Renovation will provide classrooms, administrative space, and facilities for medical media support. Projects to provide education space for academic institutions receive support under Public Law 92-541, the VA Medical School Assistance and Health Manpower Training Act. One of these is a project to renovate three existing buildings at the VA medical center in Columbia, South Carolina, for use by the University of South Carolina School of Medicine. Initial work has begun on the development of a systemwide education space inventory. This will provide up-to-date information on the kind and amount of education space in individual medical centers and in DM&S as a whole.
Exchange of Medical Information Public Law 89-785 charges the VA with the responsibility to strengthen VA medical facilities located remote from medical teaching centers, and to promote consultation and cooperation among clinicians and other members of the medical and health professions either within or outside of the VA. Pursuit of these goals obliges the VA to seek out and adapt the latest advances in biomedical communications and educational modalities which will help maintain the highest standards of patient care. The Exchange of Medical Information (EMI) program is one vehicle through which this is accomplished. EMI activities enhance educational, diagnostic, therapeutic, and administrative activities at medical centers and help reduce professional isolation at relatively remote VA facilities. The pilot activities conducted under the EMI program are supported by providing grants to medical schools, hospitals, and research centers, and through direct funding to VA medical centers. As projects become fully developed and operational, continuing support is provided from other funding, freeing EMI funds for support of new projects. Hence, the most effective utilization of limited funds is achieved. During 1981, 13 EMI projects were supported, covering a wide range of activities and regions. Examples include development of a 34-station audio-teleconferencing network (a major university, three VA medical centers, the Indian Health Service
37
Assistance for Health Manpower Training Institutions
VA Administrative Scholars Program
facilities, the National Health Service Corps Clinic, and Ellsworth Air Force Base Hospital) in South Dakota. The network was used for medical education, diagnostic, and administrative purposes; application of adult learning principles to continuing education of health professionals; and clinical application of chromosome analysis to the diagnosis, prognosis, and treatment of leukemia and cancer.
Public Law 92-541 authorizes a program of grants to academic institutions which, in affiliation with VA facilities, conduct programs of education and training in the health professions and occupations. Funds may also be allocated for modifying and equipping VA-owned facilities which are shared for educational purposes by the VA and the affiliated institutions to help accommodate the educational programs in which they are participating.
Since 1974, when the program was implemented, the VA has provided essential resources for the creation of five new state medical schools to be operated in affiliation with VA facilities and community hospitals, and for major expansion of 18 medical schools with established VA affiliations. These grants involved 32 VA facilities, 19 of which are actively participating in teaching programs for the first time. The 32 VA health care facilities are also principally responsible for the appointment of as many as 550 highly qualified full- or part-time physicians, and many other health professionals who can combine the challenge and stimulation of teaching with their service to veteran patients. In addition to 34 grants (including suppiementals) to support new state medical schools and previously affiliated medical schools, the VA has made 138 grants (including suppiementals) to other health manpower training institutions. These grants provide for expanding and strengthening education and training for other professional and technical personnel in academic programs affiliated with VA facilities.
Funds were provided to a number of VA health care facilities for projects associated with approved and funded grants. Projects include major building additions, and alteration of existing space to provide classrooms, teaching laboratories, clinical training facilities, and offices.
All five of the new state medical schools are now accredited and have initiated educational programs with classes of from 24 to 100 students. The 18 other medical schools with established VA affiliations have been assisted in increasing undergraduate enrollments through the grant-supported projects designed to strengthen faculty and curriculum, develop new areas of emphasis such as primary care outreach, establish new clinical campuses, or convert from 2- to 4-year degree-granting programs. Five of these grants concluded during 1981, leaving 14 grants (including two suppiementals) still active.
The 138 grants that have been made to other health manpower institutions are for one to seven years, and have initiated or enhanced clinical affiliations with 97 VA facilities. Programs in nursing, pharmacy, optometry, social services, and many associated health professions have been funded. Grantee institutions build programs on resources unique to VA health care facilities, to produce manpower especially prepared to meet needs common to the VA and the community. Since the program for grants was implemented in 1974, the number of students enrolled in programs receiving grant assistance has increased greatly, and VA health care facilities and other institutions have been able to hire graduates of these training programs. Of the 138 grants initiated, 95 have come to completion, leaving 43 active grants.
The authority for these programs is provided in Title 38, U.S.C., Chapter 82. In recognition of its significant contribution toward maintaining an adequate supply of health manpower for the VA and the nation, Congress extended the appropriation authority through 1982, omitting the provision of assistance in the establishment of new medical schools and eliminating institutional enrollment increases as a basic requirement for eligibility.
The VA Administrative Scholars Program was established in 1976 to respond to the increasing size, cost, and complexity of the U.S. health system by developing leaders who could help to shape the system's future. Those selected for the 2-year period of
38
Research and Development
executive development are mid-career health professionals whose past achievements and apparent potential suggest they will have major leadership positions. The program is sponsored by the VA with contractual assistance from the George Washington University.
A Board of Governance, composed of nationally known experts in the U.S. health system, worked with the program and the individual Scholars to provide policy direction advice and expertise.
Five Scholars were selected initially and began in September 1977, followed in the next two years by two more groups of five. Scholars devote one-third of their time to issues related to the VA that could result in meaningful contributions to the agency. Individual Scholar interests have ranged widely on issues varying from technology assessment to critical manpower considerations. Two graduates have accepted positions in the VA.
The program will end in September 1982.
Clinician-investigators and research scientists in VA medical centers and clinics throughout the country continued the search for knowledge in support of the agency mission to provide veterans with quality medical care.
Research and development programs in biomedical research, health care services delivery, and rehabilitation of the physically handicapped veteran have significantly contributed to the advancement of medical care by providing new and improved therapies, techniques, prostheses, and diagnostic procedures. Information developed by VA researchers through scientific inquiry into disease process, incidence, and treatment is shared with the medical and scientific community by publication of research findings, and by presentations at professional and scientific meetings. In this way, research into the problems of veterans contributes to the nation's health.
During the fiscal year, achievements of VA investigators were recognized through a number of important scientific awards, which included the following:
• The Silver Helmet, representing the AMVETS Civil Servant of the Year Award, was given to Dr. Andrew V. Schally, Senior Medical Investigator at the VA medical center in New Orleans, Louisiana. This was in recognition of his outstanding research on hypothalamic hormones.
• The President's Award for Distinguished Federal Civilian Service was presented to Dr. William H. Oldendorf, a Senior Medical Investigator at the Brentwood VA medical center in Los Angeles, California. This award recognized his research contributions to brain imaging and his studies on the blood brain-barrier.
• The Henry Baldwin Ward Medal was given to Dr. David G. Colley of the VA medical center in Nashville, Tennessee by the American Society of Parasitologists. This represents the Society's highest honor for leadership in parasitological research.
• The Lilly Award was given to Dr. Jerold Olefsky, Chief of Endocrinology and Metabolism at the VA medical center in Denver, Colorado, by the American Diabetes Association for his research on the metabolism of insulin.
• The William S. Middleton Award, VA's highest honor for medical research, was given to Dr. Norman Talal of the VA medical center in San Francisco, California. Dr. Talal is best known for elucidating the mechanisms of autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematous.
• The Nellie Westerman Prize of the American Federation for Clinical Research was awarded to the interdisciplinary research team of William B. Carter, Ph.D., Associate Director of Health Services Research and Development at the VA medical center in Seattle, Washington, and Richard Deyo, M.D., M.P.H., VA fellow in the University of Washington Robert Wood Johnson Clinical Scholars Program. The award was based on a national competition for original research describing creative solutions to ethical problems of research involving human subjects.
39
• Dr. Margaret J. Giannini, Director of Rehabilitative Engineering Research and Development Service in VA's Central Office, was elected to the Institute of Medicine of the National Academy of Sciences. She was recognized for her personal achievements and demonstrated interest, concern, and involvement with problems and critical issues affecting the health of the public. • Dr. Eric Blom, a speech pathologist, and Dr. Mark Singer, an otologist, both from the VA medical center in Indianapolis, Indiana, were the recipients of the Olin E. Teague award. Drs. Blom and Singer were recognized for the development of a tracheoesophageal puncture technique with an accompanying inexpensive, replaceable prosthesis which allows the majority of laryngectomized patients immediate and effective speech. The relatively simple surgical technique and the prosthesis are being used internationally and are heralded as a highly significant contribution to solving the speech communication problems of laryngectomized patients.
Medical Research The Medical Research Service provides opportunities for clinician and non-clinician scientists to study health problems in the veteran population. During FY 1981, approximately 4,100 investigators participated in 5,440 medical research projects conducted at 129 VA health care facilities, including medical centers and independent outpatient clinics. Important areas under investigation include schizophrenia, alcoholism, aging, delayed stress disorders of Vietnam era veterans, spinal cord injury/regeneration, possible adverse effects of exposure to herbicides, injuries related to wartime experience, and other prevalent health problems of veterans, such as cancer, diabetes, chronic heart disease, and chronic pulmonary disease. As many VA investigators are predominantly health care providers in VA medical centers, many VA medical research studies emphasize practical applications to the care of veterans and the general population. Many VA medical research studies are conducted cooperatively. Cooperative studies are clinical studies in which important health problems are uniformly studied at two or more VA medical centers. During the year, four new studies were initiated and three were completed. The number of investigations in progress at the end of the year was 22. An additional 21 studies were in the planning phase and 10 cooperative studies were in the final phase of analysis. The following examples illustrate the value of the cooperative study approach: • A study involving five VA medical centers to evaluate the efficacy of pneumococcal vaccine in patients at high risk to develop pneumococcal disease. These patients include the elderly, patients with diabetes mellitus, chronic alcoholics, and patients with chronic renal, hepatic, cardiac, or pulmonary diseases. The study will also monitor the frequency of adverse reactions to the vaccine in these high risk patients. • A study involving seven VA medical centers to assess different antihypertensive drug regimens, including how they influence daily living, as well as emotional and cognitive functions in elderly veteran patients. • A study involving five VA medical centers to evaluate conventional removable partial dentures as compared to fixed dental implants. It is anticipated that this investigation will make a substantial contribution in the field of prosthodontics.
Health Services Research and Development The Health Services Research and Development Service (HSR&D) emphasizes generation and dissemination of information that is relevant to decision making by VA health care system managers, providers, and consumers. In FY 1981, explicit priorities were: • Research to improve VA health care operations. • Care of the aging veteran. • Improvement of rehabilitation services. • Assessment of the cost effectiveness of patient care technologies.
40
Preventive health care services.
Rehabilitative Engineering
Research and Development
The HSR&D Service supports projects to evaluate alternative policies and interventions to improve the effectiveness, efficiency, accessibility, and quality of the VA health care services delivery system, and of VA initiatives to promote, maintain, and improve the health of veterans.
The HSR&D Service funded 42 investigator-initiated research studies at 28 VA medical centers during FY 1981. Projects completed contributed information about:
• Valid and cost effective diagnostic indices for coronary artery disease.
• An ambulatory care information system that provided the basis for a similar system for the VA's hospital-based home care program.
• Alternative methods of providing medical care in domiciliary facilities.
• The influence on laboratory costs of showing physicians the ''bill'' for their requests.
• The impact of ophthalmic technicians on outpatient eye care.
• Factors that may improve communication between patients and health care providers.
The VA's pilot program in preventive health care, established in response to Public Law 96-22, included six projects in the areas of schizophrenia, hypertension (cardiovascular risk and compliance monitoring), psychiatric screening, dentistry, and an evaluation of a selected set of preventive health care services. A second solicitation for preventive health research proposals was issued in July 1981.1
Plans were developed during the year to establish six to eight regional HSR&D field programs to integrate research with management and health practice information requirements.
A program of collaborative and service-initiated research was established in FY 1981. Included in this program were projects to:
• Refine VA's bed-sizing methodology.
• Analyze VA prosthetics services.
• Analyze prescribing practices in nursing homes.
The mission of the Rehabilitative Engineering Research and Development (RER&D) program is to improve the quality of life and allow more functionally independent daily living by physically disabled or infirm veterans. This is accomplished through research, development, and evaluation of new and unique prostheses, orthotics, mobility aids, and techniques and concepts in rehabilitation. In addition, the program encourages the transfer of knowledge and techniques from the research laboratory to use by clinicians in patient care.
Studies dealing with war-related injuries are given high priority with the goal of improving the quality of life of the disabled veteran. Examples of these are ''smart” wheelchairs (avoids obstacles by ultra-sonic radar), anti-rollback wheelchairs, computer terminals, for low-vision blind (identifies letters and words by tone), and spoken-word attachments for the Opticon reading machine for the blind. In FY 1981, the RER&D program supported 80 investigator-initiated projects at 36 VA medical centers as well as research activities at two RER&D centers.
Recent technological achievements have been incorporated in automatic controls, manipulative devices and sensory aids for the severely disabled veterans. Significant progress was made during the year in the following areas:
'This information is included in compliance with Section 105, Public Law 96-22.
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Automatic speech-cuing devices for deaf adults.
Resources
Costs
• Computer-assisted manipulative devices for quadriplegics or other severely disabled persons.
• Improved techniques in amputee management.
The degree of independence afforded severely disabled veterans involves activities of daily living such as employment, manipulative environmental controls, and socio-recreational activities. RER&D has promoted activities of daily living by developing aids for the severely disabled that allow self-feeding, improved mobility, computer or typewriter interface, telephone answering and dialing, book selecting and page turning, and participating in selected recreational activities.
Included in rehabilitative engineering research and development activities supported during the year were projects to improve the function of artificial limbs, and the design and function of wheelchairs and mobility devices.
The costs of VA's Department of Medicine and Surgery during FY 1981 were $6,699,064,000 an increase of 7.8 percent over FY 1980. The table summarizes the distribution of these costs by major program.
Activity Costs (In Thousands)
FY 1981 FY 1980
Total DM&S $6,699,064 $6,214,741
Medical care 6,446,985 5,971,778
Miscellaneous operating expenses 50,453 48,320
Medical and prosthetic research 144,725 137,665
Other medical programs* 56,901 56,978
*Does not include Revolving or Trust Funds
WORKLOAD
Inpatient Program Outpatient Program
Fiscal Year Average Daily Patient Census Patients T reated Staff Visits
Number Index (1972=100) Number Index (1972=100) Number (In Thous.) (1S Index 172=100)
1972 80,971 100 846,298 100 7,930 100
1973 82,479 102 985,862 116 9,165 116
1974 81,453 101 1,043,293 123 10,458 132
1975 79,973 99 1,113,873 132 12,596 159
1976 78,264 97 1,178,894 139 14,223 179
1977 75,285 93 1,209,763 143 14,675 185
1978 73,008 90 1,228,755 145 15,070 190
1979 69,821 86 1,230,252 145 15,053 190
1980 68,109 84 1,247,516 147 15,752 199
1981 66,376 82 1,248,502 148 15,828 200
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COST EFFECTIVENESS OF INCREASED TURNOVER
Fiscal Per Diem Cost Cost Per Inpatient Treated
Year Amount Index (1972=100) Amount Index (1972=100)
1972 $ 52.61 100 $1,851 100
1973 57.92 110 1,769 96
1974 65.08 124 1,855 100
1975 75.71 144 1,984 107
1976 87.86 167 2,135 115
1977 103.27 196 2,346 127
1978 119.10 226 2,583 140
1979 133.82 254 2,772 150
1980 154.00 293 3,077 166
1981 168.35 320 3,267 176
Inflation and increased usage are the major factors in the growth of operating costs. Other contributing factors are the higher costs associated with efforts to improve the quality of care. The latter can be demonstrated by the technological cost of procuring and maintaining innovative medical equipment and systems, and of providing the trained work force to utilize these innovations effectively.
VA strives to deliver the highest quality of care and at the same time contain costs by assuring the most appropriate type of care and the most cost efficient mode of delivery. The success of these efforts is evident in the increased number of inpatients treated with fewer days of care per patient (with a resultant decrease in the patient census), and in the growth of the ambulatory mode of treatment. The tables on pages 42 and 43 demonstrate these points.
The impacts of inflation and technological innovation are difficult to assess precisely, but their overall impact on per diem costs for major medical care activities are shown in the table.
Type of Care Unit Costs Percent Change FY 81 v. FY 80
FY 1981 FY 1980 Change
Medical Care in VA
medical centers
Cost per pat. per day $ 168.36 $ 154.00 $ + 14.36 + 9.3
Total costs (000) 4,078,563 3,838,951 + 239,612 + 6.2
Personal services 3,016,151 2,755,769 + 260,382 + 9.4
Other 1,062,412 1,083,182 - 20,770 - 1.9
Visits to VA staff
Cost per visit $ 64.09 $ 61.60 $+ 2.49 + 4.0
Total costs (000) 1,064,006 970,331 + 93,675 + 9.7
Personal services 689,648 599,725 + 89,923 + 15.0
Other 374,358 370,606 + 3,752 + 1.0
Domiciliary care in
VA facilities
Cost per pat. per day $ 32.04 $ 29.39 $ + 2.65 + 9.0
Total costs (000) 86,000 84,923 + 1,077 + 1.3
Personal services 56,693 53,697 + 2,996 + 5.6
Other 29,307 31,226 - 1,919 - 6.1
Nursing home care in
VA facilities
Cost per pat. per day $ 81.72 $ 75.40 $+ 6.32 + 8.4
Total costs (000) 242,955 218,906 + 24,049 + 11.0
Personal services 185,350 161,794 + 23,556 + 14.6
Other 57,605 57,112 + 493 + 0.9
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Employment
The net full-time equivalent employment (FTEE) in DM&S decreased from 194,331 in FY 1980 to 193,578 in FY 1981. The largest decrease occurred in VA hospital activities, where FTEE decreased from FY 1980 by 2,079.
Total Health Care: Net Full-Time Equivalent Employment Fiscal Years 1980-1981
Appropriation/ Fund FY 1981 FY 1980
Total 193,578 194,331
Medical Care 184,865 185,698
Inpatient Care 153,322 155,131
Hospitals 141,572 143,651
Nursing Homes 9,052 8,666
Domiciliaries 2,698 2,814
Outpatient Care 29,267 29,026
AllOther 2,276 1,541
Medical Administration and
Miscellaneous Operating
Expenses 866 831
Research 4,295 4,360
Medical Research 4,079 4,164
Rehabilitative Research 112 91
Health Services Research 104 105
Canteen Service 3,552 3,442
The trend in staffing ratios for major health care activities in VA facilities is shown in the table.
Fiscal Year Hospital Care (FTEE/Census) Outpatient Care (FTEE/1000 Visits) Nursing Home Care (FTEE/Census) Domiciliary Care (FTEE/Census)
1972 1.46 1.92 0.89 0.28
1973 1.51 1.83 0.90 0.30
1974 1.57 1.73 0.92 0.30
1975 1.65 1.61 0.97 0.30
1976 1.75 1.56 1.00 0.32
1977 1.85 1.63 1.02 0.33
1978 1.99 1.75 1.08 0.35
1979 2.04 1.79 1.05 0.35
1980 2.11 1.84 1.09 0.36
1981 2.13 1.85 1.11 0.37
A significant increase in retirements from the executive workforce was offset through the implementation of improved recruitment, promotion, and development programs for upper level managers. An individualized development system now provides executives with the knowledge and management skills associated with health care administration and with Federal leadership during the current period of economic constraints. The passage of public Law 96-330, "The VA Health Care Amendments of 1980," provided substantial support to these initiatives by authorizing the employment of medical center directors under Title 38 U.S.C. In addition, using the authority of
44
that law, the VA is paying increased amounts of special pay to physicians, and higher salary rates, in certain geographic areas, for nurses. This has helped to ease the recruitment and retention difficulties in these critical fields.
Voluntary Service Community involvement in the care of sick and disabled veterans has been an aim of the 35-year-old Voluntary Service program from its inception. Increasingly, as the veteran population ages, this involvement has included programs for the aged, the long-term patient, and the terminally ill. In FY 1981, there were 10.3 million hours of service provided by more than 75,000 community volunteers. Services encompassed not only the wide variety of traditional activities but innovative approaches as well. Volunteers came from the customary sources, and from some new sources, too. For example: • In a program at the VA medical center in Biloxi, Mississippi, members of training detachments from Keesler Air Force Base each adopted a domiciliary resident. Residents were invited to cookouts, home visits, and tours of local places of interest. In turn, residents invited their Keesler representatives to special events at the medical center. • In a year-long "Toys for Tots" program at the VA medical center in Topeka, Kansas, volunteers helped severely disabled patients build toys and distribute them to disadvantaged children at Christmas. Local groups donated the materials. In a similar program, volunteers provided necessary help with a handyman program at the VA medical center in Leavenworth, Kansas, in which domiciliary residents assisted senior citizens with minor repairs or replacements in their homes. • In a Telecare program at the VA medical center in Omaha, Nebraska, 400 telephone contacts a month were made by the Telephone Pioneers of America to visually impaired and bedridden veterans throughout the state. At the same facility, the local agricultural industry recruited teen-age girls with clerical skills to visit patients, record dictation of letters, and type and mail them at company expense. Group participation by children in programs for the older patient was encouraged in situations where adequate adult supervision could be provided. For example, at the VA medical center in Augusta, Georgia, a nursery school class visited and entertained intermediate care patients in the neuropsychiatric division weekly. At the VA medical center in Wood, Wisconsin, sixth-graders from a nearby elementary school and their parents visited nursing home patients, arranged outings, and even invited patients into their homes. The services of volunteers were invaluable in Vietnam Veterans Outreach Centers and in care of the terminally ill. In both of these areas, as in many other aspects of VA assistance,veterans benefited from personal attention from concerned individuals.
Quality of Care Quality Assurance Review During FY 1981, the Medical Inspector Office, the Investigations Staff, and the Evaluation and Analysis Office were combined into the Medical Inspector and Evaluation Office. This organizational change resulted in more effective quality assurance and improved objectivity. It has also enhanced DM&S responsiveness to the 44 external evaluation agencies which regularly assess the VA health care system. These evaluation agencies include the Joint Commission on Accreditation of Hospitals, the VA Inspector General, the General Accounting Office, and the veterans' service organizations. Significant developments took place in the DM&S Health Services Review Organization (HSRO) in FY 1981. The Systematic External Review Program (SERP), which was involved in surveys of 47 VA medical centers, continued to draw increased numbers of experienced, highly skilled physicians and administrative participants. Also, several survey approaches to optimize resource utilization were studied during the year. Field and Central Office VA officials cooperated in the continued development of peer-based Standards, Criteria, Evaluative Algorithms and Measuring Instruments (SCEM) for use by SERP, and served as reference sources for the medical centers' Systematic Internal Review (SIR) component of HSRO. The SCEMs
45
support HSRO by providing uniform, valid, objective criteria for measuring and judging the quality of health care (direct or indirect) in various services. In addition to 11 SCEMS in use, an additional eight SCEMs were developed for various ancillary services.
There were also 10 SCEMs in various stages of development. These are building management, engineering, extended care, fiscal, library, medical administration, personnel, supply, hospital-based home care, and medical center top management. Others were in various stages of formulation, including academic affiliation and ambulatory care. It is estimated that SCEMs for 37 services and programs will have been completed by FY 1982.
Another significant step during the year was the development of regulations to implement Public Law 96-382, signed on October 7, 1980, which provides for confidentiality of VA medical quality assurance records and documents. Protecting against inappropriate disclosure of information generated through the peer review process will encourage providers to conduct candid, reliable, valid, and objective reviews to improve care both by deterring poor performance and by assisting others to aspire to higher performance standards.
Developmental work in other areas included a quality assurance-based risk management model system, termed Patient Injury Control (PIC). PIC tests are planned for a sample of VA medical centers in 1982, before broad implementation as part of HSRO.
SERP data from all health care facilities provide system-wide insights in many areas, demonstrating significant potential for program planning and activity monitoring by the offices of medical district and regional directors. To develop and utilize the information as a component in the departmental health care management information system, an ongoing project titled Quality Assurance Information System (QAIS) is receiving ADP support. Development of data management systems is underway, and preliminary forms of information output have been used to show trends in quality of health care. The system will improve the timeliness and usefulness of existing quality assurance information as the project evolves.
Patient Satisfaction Survey The annual patient satisfaction survey provided individual facilities with extensive feedback about their performance, including comparisons with similar patients in similar facilities. The survey provided systemwide information as well. Participating in the latest survey were more than 20,000 hospitalized patients and 54,000 clinic patients selected to be a valid representation of the veteran population for whom the VA provides health care. These consumer surveys serve as a management tool useful for local allocation of resources and for taking corrective actions where reasonable consumer expectations are not being met.
For the VA system as a whole, satisfaction with services is very high. For most aspects of satisfaction, the percentage of positive or favorable responses is in the 80s, —for some in the 90s. Satisfaction with waiting for care and with the amount of time physicians and nurses spend listening to and talking with patients were at lower levels, and these problems are shared in common with other health care providers. Hospitalized patients' satisfaction with care was essentially unchanged from the prior survey. In contrast, clinic patients showed a small but consistent increase in satisfaction, a noteworthy occurrence considering the high level of satisfaction that existed previously.
When compared with surveys of satisfaction with health care in the general population, it is found that VA patients are generally more satisfied with their nursing care and food. As a group, VA patients are also somewhat more satisfied with physicians' care, and with the time physicians and nurses devote to them, than are non-VA patients. VA outpatients are somewhat more satisfied with the time they have to spend waiting for treatment and with the courtesy of employees, than are those in the non-VA sector. VA has not found any area where VA patients are less satisfied than those who receive their care from other-than-VA sources.
46
Planning and Sharing
Medical District Initiated
Program Planning Process
A major initiative was undertaken by the VA in FY 1981 with the implementation of the Medical District Initiated Program Planning (MEDIPP) process, which is designed to involve administrative and clinical personnel at all levels of DM&S. The district plans resulting from this process will describe changes necessary to meet future health care delivery needs in all elements of VA's health care system.
The purpose of the MEDIPP process is to create district plans which are:
• Responsive to the health care needs of veterans.
• Reflective of resource needs, as determined at the medical district level.
• Based on local and national demographic analyses.
• Supportive of the approved mission of each VA health care facility in a district.
• Built upon specific professional and supportive programs and activities.
• Reflective of current directives and policies, as set forth in the Chief Medical Director's guidance.
From the beginning, development of the planning process, emphasized field involvement through a month-long series of task force meetings attended by all levels of field personnel. The 60 participants included regional directors, medical district directors, facility directors, chiefs of staff, chiefs of service, district planners, district coordinators and various Central Office representatives. A review of the task force products was conducted by the Planning Subcommittee of the Chief Medical Director's Field Advisory Committee. Comments were also solicited from the Administrator's Special Medical Advisory Group and additional reviews were completed through other meetings held in July and August 1981.
Creation of district plans requires constant coordination between personnel in VA health care facilities, medical districts, regions, and in Central Office, and specific assignments for each of these entities assure completion.
An integral part of this coordination is the responsibility of all concerned to maintain free-flowing communications with everyone involved in planning. The foundation of the planning effort is exchange of information and problem resolution through group interaction. The process demands coordination, collaboration, and cooperation at all levels of the Department. In addition, each entity has specific functions.
The functions of the VA health care facility are demographic analysis, workload forecasting, review of local resources in and outside the facility, and subsequent implementation of the approved District Plan.
The Medical District initiates and directs the planning process, develops the District Plan, responds to comments from the Region and Central Office, and reviews and assesses documentation following approval of the plan.
The Region reviews and comments on the District plans, coordinates and monitors the resolution of problems relating to regional issues, and implements and monitors the approved plans.
Central Office reviews and comments on the plans and coordinates the resolution of problems relating to the Chief Medical Director's guidance, prior to final approval of the plans.
The MEDIPP Cycle is a series of events, beginning each year on November 1 and ending on October 30, which provides for the annual documentation of changes in the medical district strategic plans, and for the recording of the effects of the implemented plans. The first such cycle will result in the approval and implementation of the medical district strategic plans for fiscal years 1985-1990. These plans are expected to balance programs and initiatives, while fostering complementary rather than competitive relationships among facilities, medical districts, and regions.
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Coordination of VA Planning and Community Health Planning
Emergency Preparedness and Contingency Planning
VA Support to DOD
The district plans will include information on clinical programs and services, veteran patient utilization, initiatives for change, and information on the impact of the identified changes. They are not intended to replace any existing budgeting, planning, operation, or managerial activities. Rather, they are intended to complement other cyclical planning processes.
VA planning and development of health resources for the care of eligible veterans is coordinated with community planning efforts. This effort is in accordance with all major health planning legislation enacted into law by Congress. In the past this was Public Law 89-239, which established the Regional Medical Program, and Public Law 89-749, which established Comprehensive Health Planning. With the expiration of these authorities and that of the Hill-Burton Program in 1974, the Congress enacted Public Law 93-641 to replace and expand these prior programs. In recognition of VA's national role in the delivery of health services, provision was made in Public Law 93-641, the National Health Planning and Resource Development Act, for involving the VA in community and national health planning efforts.
The Federal administrative review process prescribed by OMB Circular A-95 requires that the VA notify appropriate state and local agencies about plans for construction and major investment in equipment. These agencies then review and comment upon the appropriateness of these plans in their communities. The mechanism enables the VA to account for the interests of the non-Federal community in its planning process.
The role of DM&S in emergency preparedness is to serve as a contingency health care system for the Department of Defense (DOD), and to serve the needs of the community in preparing for natural and technological disasters.
In support of the VA's role as a contingency health care system to DOD, there is an existing liaison between VA Central Office and the Armed Services Medical Regulating Office. This liaison is used to control transfer of service members from military hospitals to VA medical centers. In recognition of the need for a contingency back-up to military hospitals, the DM&S Emergency Planning Office was established to help develop a closer working relationship with military medicine. A recent General Accounting Office report recommended that Congress enhance the VA mission by establishing a higher priority for the treatment of battlefield casualties in support of DOD.
There are statutory constraints, however, that proscribe establishing such a priority in the absence of Congressional action.
Legislation which would recognize the VA as the primary medical care back-up to DOD during periods of conflict was proposed but had not been enacted at the end of FY 1981. In considering legislation, several issues and problems were addressed:
• In the absence of authorizing legislation, the VA can neither ensure the availability of health care services for battlefield casualties nor commit resources to provide contingency support to DOD.
• In furnishing a significant level of support to DOD, some veterans might be displaced from the VA health care system in a period of military conflict.
To ensure the availability of VA health care personnel, they should be relieved of reserve duty commitments during any period when contingency services are needed. Legislative authority could provide for this exemption and a VA/DOD agreement could establish administrative procedures for its exercise.
The VA is committed to an integrated approach to emergency planning in the Federal government. Planning efforts, will involve the Federal Emergency Management Agency (FEMA) in the development of the contemplated VA/DOD agreement. Meetings have been held between the VA and other Federal agencies separately and jointly for improving interagency coordination and planning. A joint task force of representatives from VA, FEMA, and DOD was established in August 1980, and will meet monthly until Federal emergency plans are in place.
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VA Support to the Community
Sharing Specialized
Medical Resources
Facilities and Equipment
Engineering
Over the years, many VA medical centers have provided community assistance in natural disasters, such as hurricanes, snow storms, and highway accidents. Each VA medical center has disaster plans to meet its own contingencies, including fire, flood, earthquake, limited war, and nuclear exchange. The VA medical centers test semiannually their readiness for different disaster situations and update their planning every two years. They also participate in community-wide drills, thereby relating VA planning to local emergency preparedness authorities, Department of Defense medical centers, medical schools, and other appropriate institutions.
The basic authority for the VA to share specialized medical resources was granted in 1966, in Public law 89-785. The rationale was to permit VA medical centers with underutilized, specialized, scarce, and costly resources to share these with medical centers, community hospitals, Federal and state hospitals, clinics and blood and organ banks, eliminating the need for these institutions to develop duplicate resources. Conversely, the law permitted the VA to utilize similar community resources for the care of veterans. It is a basic requirement that the sharing of these resources cause no reduction in service to the veteran and that provision be made for reciprocal reimbursement.
Since the beginning of the program, the VA and the health care community have reaped substantial benefit from sharing agreements, most of which have been renewed annually with new items and services added each year. By the end of FY 1981, 109 VA medical centers had entered into 368 sharing agreements with community health care facilities with the annual cost of services amounting to $30,257,000.
Some typical examples of shared resources are CAT scans, electron microscopy studies, specialized laboratory procedures, nuclear medicine services, radiation therapy, cardiac catheterization, open heart surgery, dialysis, ultrasound, and mammography.
VA's 172 medical centers comprise over 5,000 buildings totaling more than 110 million square feet valued at $13 billion. Necessary minor construction, maintenance, repair, and plant operations during FY 1981 cost $723 million, or over 11 percent of the year's health care expenditures. Over $248 million was expended on recurring maintenance and repair, $67 million on nonrecurring maintenance and repair, $328 million on plant operations, and $80 million on capital improvements. In addition, Chiefs of Engineering Service served as resident engineers for design and construction of 260 construction projects totaling some $113 million.
The table provides a breakdown of the nonrecurring maintenance and repair, and capital improvement projects by primary category. Top priority for funding was, once again, given to projects for correction of deficiencies identified by the Joint Commission on Accreditation of Hospitals (JCAH) and by fire and safety surveys.
Category Number of Projects Cost of Projects (Million $)
Electrical 71 $ 16.5
Fire and safety 156 18.2
JCAH deficiencies 122 14.6
Heating, ventilation, and air
conditioning 72 9.6
Boiler plants 39 27.4
Elevators 22 4.6
Exterior maintenance 94 10.4
Exterior utilities 24 6.5
Interior building maintenance 34 2.5
Interior utilities 56 5.0
Quarters 6 0.3
Architectural barriers 42 3.5
Energy conservation 106 15.6
Renovations 122 10.3
Education 10 1.2
Research 13 0.8
TOTAL 989 $147.0
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Biomedical Equipment
Building Management
Fully automated washers and oil-heated ironers enable the laundry at Battle Creek VAMC to process over 3,000 pounds of textiles per hour.
Physical Security and Law Enforcement
The medical equipment inventory of VA medical centers continues to increase in quantity and technical sophistication. Comprehensive support of this instrumentation includes emergency repair, electrical safety and preventive maintenance inspections, equipment planning and selection consultation, and user education. VA biomedical engineers and technicians provide this support at costs substantially lower than if it were provided by non-VA sources. Approximately 85 percent of all medical equipment is supported in-house with assistance provided by manufacturers as necessary. The remainder is under service contracts. The use of in-house biomedical engineering personnel resulted in an estimated cost avoidance of $24.7 million while providing the additional benefits of immediacy.
An Engineering Service Center (ESC) located in St. Louis, Missouri, provides all VA medical centers a variety of potentially costly services, such as difficult-to-obtain equipment service documentation and technical consultation. Additionally, the ESC often serves as a liaison with manufacturers in the resolution of equipment field service and hazard problems.
Building Management Service provided support to VA medical centers in three major program areas during the year: environmental care, textile care, and interior design. Care of textiles was given special emphasis during FY 1981.
In coordination with GSA, new flame resistant blankets and bedspreads were developed as a part of continuing research in patient safety. The blankets and bedspreads are available to VA medical centers in ten colors and are manufactured by the National Institute for the Blind. An automated laundry system was installed at the VA medical center in Battle Creek, Michigan. This laundry is the most advanced and automated in the world. Visitors from some 14 foreign countries including China, France, Israel, Japan, and Saudi Arabia have toured this facility. The laundry requires fewer employees than traditional laundries to produce the same amount of linens.
Consolidating the workload of the VA medical centers at Ann Arbor, Allen Park, and Saginaw, Michigan, the Battle Creek laundry produces more pounds per employee than any other laundry known. Thirty-eight employees produce approximately 40,000 pounds of textiles per eight-hour day.
By avoiding the cost of buying replacement laundry equipment for these VA medical centers, a saving of $4.2 million was achieved. In addition, a hard cash recurring savings of $1.5 million was achieved in employee salaries, laundry supplies, and utilities. The Battle Creek laundry serves as an excellent example of how to maximize production without sacrificing quality.
Another important endeavor was the development of a color-coordinated uniform program so that VA employees can be readily identified by patients and their families. Constructed of modern wrinkle-free fabrics, this wearing apparel will provide a cheerful, professional look in VA medical centers.
In most cases, women's uniforms can be worn with slacks or skirts. Accessories include wraparound aprons for dietetic workers. Nursing assistants are the only employees issued uniforms who will wear all white. In all other instances, various colors will identify services. These uniforms have been designed to accomplish their purpose at no additional cost while fostering a more positive image of the VA employee.
Security in health care facilities was realigned in FY 1981 as a separate service in Central Office under the Assistant Chief Medical Director for Administration and at medical centers as an element under the Office of the Director.
The objectives of this realignment are to achieve direct management control over both security and law enforcement activities and to maximize medical center police effectiveness in patient, personnel, and property protection.
Highest priority in medical center police officer operations and training was the protection of patients and employees. Property loss prevention was also emphasized through increased police authority in the techniques of stop and search.
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Standards for the selection of candidates for the specialized medical center police occupation were strengthened, and requirements for the pre-employment screening of candidates' suitability were implemented. Centralized training of all medical center police unit chiefs was accomplished to raise their managerial skills and to uniformly emphasize an orientation toward obtaining highest individual police officer performance.
Characteristics of VA Patients
Age
The demographic and medical characteristics of VA patients are derived from the Patient Treatment File (discharges occurring during FY 1981) and the Annual Patient Census (taken on June 24, 1981). The data on discharges during FY 1981 excludes 232,644 one-day hemodialysis discharges. Census figures for hospital and domiciliary patients in VA facilities are based on a 20 percent sample; figures for nursing home patients in VA and community facilities are based on a 100 percent survey.
As the veteran's age increases so does the utilization of VA medical centers. This phenomenon is demonstrated in the table which shows the number of hospital, domiciliary, and nursing home patients discharged during FY 1981 from VA facilities and from community nursing homes.
Age Veteran Population on 3/31/81 (Thousands) Hospital Patients Discharged From VA Facilities Domiciliary Patients Discharged From VA Facilities Nursing Home Patients Discharged From VA and Community Facilities
Number Rate Per 1,000 Veterans Number Rate Per 1,000 Veterans VA Nursing Home Care Units Community Nursing Homes Total Rate Per 1,000 Veterans
Total 30,129 945,245 31.4 6,612 0.2 4,555 15,780 20,335 0.7
Under 25 1,198 20,814 17.4 56 1 13 28 41 1
25-44 11,117 188,775 17.0 884 0.1 164 393 557 0.1
45-54 6,965 165,554 23.8 1,495 0.2 378 1,114 1,492 0.2
55-64 7,928 332,828 42.0 2,662 0.3 1,240 4,268 5,508 0.7
65-74 2,204 156,884 71.2 1,107 0.5 1,141 4,320 5,461 2.5
75-84 475 43,838 92.3 285 0.6 718 2,624 3,342 7.0
85 and over 242 36,074 149.1 123 0.5 901 3,033 3,934 16.3
Unavailable2 478 — - -
Under 65 27,208 707,971 26.0 5,097 0.2 1,795 5,803 7,598 0.3
65 and over 2,921 236,796 81.1 1,515 0.5 2,760 9,977 12,737 4.4
'Less than 0.1
2Records for which data are not available
A 10-year trend in the age distribution of hospital patients remaining in VA medical centers near the end of the fiscal year is shown in the table below.
Census Date Age Distribution of Hospital Patients Remaining in VA Medical Centers
Total1 Under 35 34-44 45-54 55-64 65 a Over
June 24, 1981 65,450 8,432 5,570 11,731 22,122 17,595
September 24, 1980 69,290 8,841 5,339 13,611 23,319 18,183
September 26, 1979 69,995 8,871 5,465 14,438 22,754 18,466
October 4, 1978 72,037 8,680 5,887 16,404 22,352 18,714
September 28, 1977 75,057 8,813 6,542 17,970 22,766 18,966
September 29, 1976 76,890 9,421 7,274 19,413 21,804 18,986
October 1, 1975 78,830 9,053 8,446 21,576 20,444 19,311
October 2, 1974 80,715 9,435 8,992 23,689 19,383 19,216
Octbbfcr 3, 1973 82,485 9,679 9,978 24,738 18,377 19,710
October 18, 1972 83,425 9,618 11,006 25,954 17,500 19,345
October 20, 1971 81,150 8,813 10,502 24,802 16,834 20,196
1 Totals may not equal sum of parts due to rounding
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Service Connected and VA Pensioners
Of the hospital discharges from VA medical centers 48.9 percent were veterans who had a service connected disability or were in receipt of a VA pension. In FY 1981, the VA health care system continued a leveling off in the proportion of hospital discharges involving veterans who have a service connected condition or who receive a VA pension. The trend for the last 10 years is shown in the chart.
HOSPITAL PATIENTS WITH A SERVICE CONNECTED CONDITION OR RECEIVING VA PENSION DISCHARGED FROM VA MEDICAL CENTERS
Percent
30 ---------------------------------------------------------
20 ---------------------------------------------------------
10 ----------------------------------------------------------------
0 I_______1______i______I______I______I______I______I------1--------1
72 73 74 75 76 77 78 79 80 81
Fiscal Year
Of the 65,450 hospital patients in VA medical centers on June 24, 1981, 55.4 percent had a service connected disability or were receiving a VA pension. The fact that this is 7 percent higher than their proportion among discharges illustrates the longer term nature of the service connected patient. The table indicates the percentage distributions of hospital patients in VA medical centers on the census days of 1977 through 1981, according to their compensation and pension status.
Percent Distribution of Hospital Patients in VA Medical Centers on Census Day
Compensation and Pension Status 1981 1980 1979 1978 1977
Receiving care for a service connected disability 15.9 16.2 17.5 17.0 16.9
Receiving care for a non-service connected disability and has a service connected disability which does not require medical care 13.5 13.2 12.1 11.6 12.4
Total service connected 29.4 29.4 29.6 28.6 29.3
Receiving care for a non-service connected disability and on VA pension rolls 25.9 24.6 26.6 26.5 26.5
Receiving care for a non-service connected disability and not on VA compensation or pension rolls 44.2 45.5 43.4 44.4 43.8
Non-veterans 0.4 0.4 0.4 0.5 0.4
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Diagnoses
Diagnoses are classified by the VA as either principal or associated. The principal diagnosis is the one that the discharging physician considers to be responsible for the major part of the patient's length of stay. Associated diagnoses are all others for which the patient has been treated up to the time of discharge. The VA statistical system permits the reporting of a maximum of eight diagnoses per patient discharge. Thus, a count of total diagnoses includes the principal diagnosis and up to seven associated diagnoses. As shown on the table, five major categories accounted for the majority of principal diagnoses among hospital patients discharged from VA medical centers during the past five years. When both principal and associated diagnoses are considered, and attention is focused on more specific diagnostic categories, the two most common are heart disease and alcoholism, accounting for 28 and 18 percent of the total diagnoses, respectively.
Major categories of principal diagnosis ICDA1 Percent by Diagnosis of Hospital Patients Discharged from VA Medical Centers
FY 1981 FY 1980 FY 1979 FY 1978 FY 1977
Mental disorder 22.0 22.7 22.9 22.7 22.8
Circulatory 15.7 15.5 15.3 15.3 15.2
Neoplasms 10.3 10.3 10.1 10.0 9.7
Digestive 9.3 9.1 9.2 9.3 9.4
Respiratory 6.6 6.4 6.3 6.5 6.2
'International Classification of Diseases, Adapted.
The number of hospital patients in VA medical centers on the June 24, 1981 census day, by age and major diagnostic category, are shown in the following table. As in previous years, general medical and surgical patients tend to be older (32.7 percent over 65 years of age), than patients with psychoses (20.0 percent over 65).
June 24, 1981
Type of Patient Total Under 45 45-54 55-65 65 and over
All patients1 65,450 14,002 11,731 22,122 17,595
General, medical & surgical 36,972 4,246 5,983 14,634 12,108
Psychoses 17,508 5,395 3,638 4,981 3,494
Psychiatric 10,970 4,361 2,110 2,507 1,992
'Figures may not equal the sum of the component parts due machine rounding. Note: Changes in this table reflect new ICD-9-CM codes.
Duration of Stay
There has been a steady decline in the average length of stay of patients discharged from VA hospitals over the past several years; FY 1981 continued that trend with an average length of stay of 27.3 days, down from 28.0 days in FY 1980. Similarly, the median length of stay has decreased from 10.7 days in FY 1980 to 10.4 days in FY 1981. The most notable change was among psychotic patients, where the average length of stay dropped from 92.2 days to 88.4 days in the same time period. Among general medical and surgical patients, who accounted for 76.9 percent of all the FY 1981 discharges, the average length of stay of 20.2 days was somewhat greater than the FY 1980 average of 18.7 days. This difference may be the result of new codes used in FY 1981. The table shows the median length of stay of patients discharged, by type of patient, during FYs 1979, 1980, and 1981.
53
Type of Patient Median Length of Stay of Hospital Patients Discharged From VA Medical Centers (In Days)
FY 1981 FY 1980 FY 1979
All patients 10.4 10.7 10.9
General medical & surgical 9.3 9.3 9.6
Psychoses 21.7 21.9 22.0
Other psychiatric 14.1 13.5 13.5
Neurological * 13.3 13.7
Tuberculosis * 18.8 20.1
*New ICD-9-CM codes include tuberculosis and neurological patients under GM&S.
The complex combination of long- and short-term, and acute and chronically ill patients who received VA hospital care means that a single measure of duration of stay, such as average or median, may obscure as well as explain the process. The following observations about length of stay in VA hospital beds illustrate the point.
During FY 1981, 83.5 percent of the 945,245 hospital patients discharged from VA medical centers spent 30 days or less in a hospitalized status. Though this group comprised the majority of the discharges, they accounted for only 2.9 percent of the 25.8 million days of care received since admission by all the discharges. These short-term patients had an average length of hospital stay of 9.4 days. At the other extreme, 0.6 percent of discharges had stays of more than one year and had received 30.3 percent of all the days of care. Their average length of stay was 1,328 days.
As the table indicates, among hospital patients remaining in VA medical centers on the census days for the past five years, there was a gradual increase in the proportion with stays of less than 90 days, until FY 1981. The change may be due to new codes which count tuberculosis and neurological patients as general medical and surgical.
Type of Patient Percent of Hospital Patients in VA Medical Centers With Less Than 90 Days of Attained Stay on Census Day
1981 1980 1979 1978 1977
All patients 69.4 70.2 70.1 69.3 66.9
Psychotic 40.2 39.4 40.2 39.4 36.4
General medical & surgical 82.2 90.4 90.0 89.5 87.5
Disposition Status
Of the FY 1981 hospital discharges from VA medical centers for whom disposition data are available, 89 percent returned to the community. Although this overall percentage has changed little over the past five fiscal years, two of its components have changed considerably. The percentage of patients discharged for further care as VA outpatients has increased progressively from 64 percent in FY 1977 to 69 percent in FY 1981. Correspondingly, the percent discharged to no further care has decreased from 18.6 to 15.0 in the same period.
As shown in the table, 7 percent of hospital patients were discharged from VA medical centers for further inpatient care (hospital, domiciliary, or nursing home care) in another VA facility or a community nursing home. Deaths accounted for 5 percent of discharges.
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Manner of Disposition Hospital Discharges from VA Medical Center During FY 1981
Number Percent of Total
Total 934,636 100.0
To community 830,807 88.8
Further care as VA outpatients 641,931 68.6
No further care 140,722 15.0
Irregular, refuse care, neglect or obstruct
treatment, AWOL, regulatory offense, etc. 48,154 5.1
To further VA inpatient care 61,042 6.5
Another VA medical center for hospital care
Another VA medical center or community 30,318 3.2
nursing home for nursing home care 23,761 2.5
VA facility for domiciliary care 6,963 0.7
Deaths 42,787 4.5
'The total number of discharges excludes 10,609 cases with missing data on manner of disposition. Data vary slightly from reports based on all discharges.
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Compensation and Pension
Comparative Highlights
Fiscal Year Percent Change
1981 1980
Cost (billions) $12.5 $11.3 + 11.0
Disability cases on rolls 3,154,029 3,195,395 - 1.3
Service connected 2,279,070 2,273,589 + 0.2
Non-service connected 874,783 921,602 - 5.1
Special acts and retired
officers 176 204 -13.7
Death cases on rolls 1,381,256 1,450,785 - 4.8
Service connected 355,011 357,971 - 0.8
Non-service connected 1,026,228 1,092,797 - 6.1
Special acts 17 17 —
Summary
Compensation and pension programs administered by the VA fall into five broad categories:
1. Disability Compensation—A veteran is entitled to compensation for disability incurred or aggravated while on active duty. The amount of compensation is based on the degree of disability.
2. DIC and Death Compensation—Dependents of a veteran who died of service connected causes on or after January 1, 1957, are entitled to dependency and indemnity compensation (DIC). Dependents of veterans who died before that date are entitled to death compensation, or may elect to receive DIC.
3. Disability Pension —Veterans who served in time of war are eligible for pension benefits for non-service connected disabilities. The veteran must either be permanently and totally disabled or age 65 or older, and meet specific income limitations. Spanish-American War veterans are entitled to a pension on the basis of their service.
4. Death Pension —The surviving spouse and children of a war veteran who died of non-service connected causes are eligible for death pension benefits, subject to specific income limitations.
5. Burial Allowances—These benefits include a burial allowance, a burial plot allowance, and a flag to drape the casket of a deceased veteran. All benefits require separation from the armed services under other than dishonorable conditions. A plot allowance is available in the case of veterans who die of non-service connected disabilities and are not buried in a national cemetery. An award of $1,100 in lieu of basic burial and plot allowances is payable for veterans who die of service connected disabilities.
During FY 1981 the cost of compensation and pension benefits continued to rise, reaching $125 billion in FY 1981, an increase of $1.2 billion from last fiscal year. This
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increased cost is primarily attributable to new legislation which granted cost of living increases.
Compensation
Public Law 96-385 (October 7, 1980) increased the rates of disability and dependency and indemnity compensation for disabled veterans and their survivors by 14.3 percent.
As shown in the chart, the number of veterans receiving compensation for service connected disabilities increased slightly during FY 1981, despite declines among World War I, World War II, and Korean conflict cases. The overall increase recorded in FY 1981 was 1,865 below the increase in FY 1980.
Disability Compensation Cases
Period of Service FY 1981 FY 1980 Change
Cases Percent of Total Cases Percent of Total Number Percent
World War 1 25,417 1.1 29,720 1.3 - 4,303 -14.5
World War II 1,167,481 51.2 1,193,196 52.5 -25,715 - 2.2
Korean conflict 233,820 10.3 235,654 10.4 - 1,834 - 0.8
Vietnam era 568,234 24.9 553,326 24.3 +14,908 + 2.7
Peacetime 284,112 12.5 261,685 11.5 + 22,427 + 8.6
Spanish-American 1 * 3 * 2 -66.7
Mexican Border 5 * 5 * 0 0
Total 2,279,070 100.0 2,273,589 100.0 + 5,481 + 0.2
*Less than 0.1 percent
COMPENSATION AND PENSION CASES AS OF SEPTEMBER 1981
Service Connected
Non-Service Connected
Peacetime
(service ■ ] connected)
only
I___I____I___I____I___I___l__l I I I I I I I I
700 600 500 400 300 200 100 0 0 100 200 300 400 500 600 700
THOUSANDS
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For the fifth straight year there has been a decline in the number of service connected death cases for which payments are made to dependents of deceased veterans. Like the previous year, the overall decline was less than 1 percent. Only Vietnam era, Korean conflict, and peacetime cases showed an increase from FY 1980.
Service Connected Death Cases
Period of Service FY 1981 FY 1980 Change
Cases Percent of Total Cases Percent of Total Number Percent
World War I 28,731 8.1 30,128 8.4 -1,397 - 4.6
World War II 169,791 47.8 173,286 48.4 -3,495 - 2.0
Korean conflict 39,192 11.0 39,186 11.0 + 6 *
Vietnam era 66,815 18.8 65,284 18.2 + 1,531 + 2.4
Peacetime 50,357 14.2 49,943 14.0 + 414 + 0.8
Spanish-American 120 * 137 * - 17 -12.4
Mexican Border 1 * 2 * 1 -50.0
Indian War 0 * 0 * — —
Civil War 4 * 5 * 1 -20.0
Total 355,011 100.0 357,971 100.0 -2,960 - 0.8
*Less than 0.1 percent
Pension
Effective June 1, 1981, improved pension rates were increased by 11.2 percent simultaneously with Social Security rates. The maximum annual rates of pension payable are shown in the accompanying table.
Effective Date
June 1981 June 1980
Veteran
Alone $4,960 $4,460
One dependent 6,499 5,844
Alone, A&A allowance 7,936 7,136
One dependent, A&A allowance 9,474 8,519
Alone, housebound 6,064 5,453
One dependent, housebound 7,602 6,836
Surviving Spouse
Alone $3,324 $2,989
One child 4,353 3,915
Alone, A&A allowance 5,318 4,782
One child, A&A allowance 6,347 5,707
Alone, housebound 4,064 3,654
One child, housebound 5,092 4,579
The decrease of about 5 percent in the disability pension rolls during FY 1981 is similar to that experienced during the previous two years. Awards based upon two periods of service—the Korean conflict and the Vietnam era —showed increases during the year.
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Disability Pension Cases
Period of Service FY 1981 FY 1980 Change
Cases Percent of Total Cases Percent of Total Number Percent
World War I 140,919 16.1 167,808 18.2 -26,889 -16.0
World War II 633,279 72.4 656,401 71.2 -23,122 - 3.5
Korean conflict 82,938 9.5 81,018 8.8 + 1,920 + 2.4
Vietnam era 17,411 2.0 16,049 1.7 + 1,362 + 8.5
Spanish-American 85 * 135 * 50 -37.0
Mexican Border 151 * 191 * 40 -20.9
Total 874,783 100.0 921,602 100.0 -46,819 - 5.1
*Less than 0.1 percent
The following table shows that for the third year in a row the number of death pension cases decreased in all eight periods of service. The overall decrease of 6.1 percent is a smaller decline than that recorded during the previous fiscal year (6.5 percent).
Death Pension Cases
Period of Service FY 1981 FY 1980 Change
Cases Percent of Total Cases Percent of Total Number Percent
World War 1 434,320 42.3 464,327 42.5 - 30,007 - 6.5
World War II 471,151 45.9 497,073 45.5 -25,922 - 5.2
Korean conflict 81,914 8.0 89,753 8.2 - 7,839 - 8.7
Vietnam era 26,834 2.6 27,861 2.6 - 1,027 - 3.7
Spanish-American 11,326 1.1 13,027 1.2 - 1,701 -13.1
Mexican Border 487 * 527 * 40 - 7.6
Indian War 38 * 45 * 7 -15.6
Civil War 158 * 184 * 26 -14.1
Total 1,026,228 100.0 1,092,797 100.0 -66,569 - 6.1
Period of Service
Vietnam Era
*Less than 0.1 percent
There were 14,908 more Vietnam veterans receiving compensation at the end of FY 1981 than at the end of the previous year. The chart shows the general trend in new Vietnam era compensation cases since 1971. The total number of Vietnam era veterans receiving compensation continues to increase and, with new cases exceeding losses, the trend is expected to continue.
A total of 17,411 Vietnam era veterans were receiving disability pension at the end of the fiscal year, an increase of 1,362 or 8.5 percent over a year ago. Since the average age of these veterans is 33 years, no appreciable increase in those applying for
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VIETNAM ERA VETERANS RECEIVING COMPENSATION
Korean Conflict
World War II
World War I
Other Periods
disability pension is expected. The number of service connected death cases increased by nearly 2 percent to 66,815. The non-service connected death pension cases numbered 26,834 at the end of the fiscal year, a decrease of 1,027 cases or almost 4 percent.
The number of Korean conflict veterans receiving compensation decreased to 233,820 during FY 1981, the eighth consecutive annual drop in that figure. The high mark on the rolls (240,765) was reached in June 1973, 18 years after that conflict ended. For comparison, the highest number of World War II veterans receiving compensation was reached in FY 1953, only 8 years after the end of the war.
In contrast, the number of Korean conflict veterans receiving pension continued to rise. At the end of the fiscal year there were 82,938 Korean conflict veterans on the pension rolls, nearly a 2.5 percent increase over FY 1980. As this group grows older, their increase in number on the pension rolls can be expected to continue.
The number of service connected death cases remained virtually the same at the end of the fiscal year, and the number of death pension cases decreased 9 percent to 81,914.
Veterans of World War II still constitute the largest single group receiving compensation for service connected disabilities although their numbers continued to decline in FY 1981. Non-service connected pension showed a decrease of nearly 4 percent to 633,279. Service connected death cases declined by 3,495 cases or about 2 percent in FY 1981. The non-service connected death pension caseload decreased 25,922 to 471,151 or 5.2 percent in FY 1981.
The number of World War I veterans receiving disability compensation declined during the past fiscal year about 14.5 percent. World War I disability pension also decreased (16 percent in the past fiscal year). The advanced age of this group of veterans will accelerate these decreases in the next few years. Decreases were also recorded for service connected death cases (about 5 percent) and death pension cases (6 percent).
In addition to the recipients of disability compensation and pension payments from the wars and armed conflicts cited above, there was one veteran of the Spanish-American War receiving disability compensation as of September 30, 1981, and 85 were receiving disability pension in FY 1981, a decline of 37 percent. The service con-
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Burial Allowance
nected death and death pension caseloads were 120 and 11,326 respectively. There were five veterans of Mexican Border service receiving disability compensation. Disability pensioners totaled 151 in FY 1981, down 40 from last fiscal year. There was one service connected death case while the death pension cases decreased 7 percent to 487. Although there are no living veterans of the Indian Wars and the Civil War, 29 widows and nine helpless children are receiving death pension benefits based on service in those periods. One widow and three helpless children receive service connected death benefits with Civil War entitlement and 47 widows and 112 helpless children receive death pension. There were 284,113 peacetime veterans receiving compensation as of September 30, 1981, an increase of 9 percent over the previous year. Beneficiaries of deceased peacetime veterans increased 414 to 50,357 in FY 1981.
Statutory burial allowances are designed to assist in providing a respectable burial for deceased veterans, separated from the armed service under other than dishonorable conditions. During FY 1981, the allowance was payable for all veterans separated from wartime service. It was also payable in the cases of peacetime veterans discharged or retired for disabilities incurred in or aggravated by service in the line of duty, veterans in receipt of compensation for service connected disabilities, and veterans whose deaths occurred while they were properly admitted to certain VA health care facilities.
Generally, the VA paid a sum not exceeding $300 (plus transportation charges when death occurred while the veteran was under VA care or entitled to disability compensation) to help cover burial and funeral expenses. An additional allowance of $150 for a burial plot when a veteran was not buried in a national cemetery was also payable. An award of $1,100 in lieu of these basic allowances was authorized for an eligible veteran who died of a service connected disability.
In FY 1981 basic burial allowance was paid for 361,494 claims in an amount in excess of $113.5 million. Cemetery plot allowances amounting to over $47.9 million were paid to claimants; service connected burial benefits amounting to $9.8 million were paid to 10,105 claimants. A total of 346,640 burial flags were issued, an increase of 27 percent from FY 1980. The cost of each flag was $18.57, making a total of $6.4 million.
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Educational
Benefits
Comparative Highlights Item FY 1981 FY 1980 Percent Change
Education benefit costs (millions) $ 2,291 $ 2,350 - 2.5
Post-Korean trainees 875,862 1,106,889 - 20.9
Post-Vietnam trainees 8,324 1,947 + 327.5
Sons and daughters 82,646 82,632 *
Spouses 11,940 12,952 - 7.8
*Less than 0.1 percent
Summary
Education and Training
Veterans Educational Assistance (Gl Bill)
Education benefits administered by the DVB Education Service include educational assistance for veterans and service personnel, commonly termed the "Gl Bill;" dependents' educational assistance for eligible spouses and children of veterans who died of service connected causes, whose service connected disability is rated permanent and total, or who are missing in action or prisoners of war for more than 90 days; and post-Vietnam era veterans' educational assistance for veterans and servicepersons entering active duty after December 31, 1976.
Other education benefits administered include payments to eligible veterans, survivors, and dependents to aid in defraying expenses of tutoring, and an education loan program for veterans or other eligible persons who are enrolled full-time in approved educational institutions and who have unused entitlement after their period of eligibility for education benefits has passed. Education loans are also available to persons pursuing flight training if they are entitled to be reimbursed at the 60 percent level. A work-study program permits eligible veterans to perform services for the VA in return for a monetary allowance.
Over 948,000 veterans and active duty personnel received educational benefits in FY 1981 under the post-Korean Gl bill. This figure is down 14 percent from FY 1980 and is expected to continue its decline in coming years.
Veterans and service personnel who have neither completed high school nor received an equivalency certificate are considered to be educationally disadvantaged. They may, without charge to their basic entitlement, receive training to overcome their educational handicaps. At the end of September 1981, nearly 874,000 veterans and servicepersons had participated in these "free entitlement" programs.
Through September 1981, the total number of veterans trained under the current Gl bill exceeded 7.8 million, of whom 73 percent have been Vietnam era veterans. More than half have trained at the college level (excluding correspondence). The remainder pursued vocational and technical training, correspondence training, flight training, cooperative training, and on-the-job training.
At year's end the participation rate was 65 percent among Vietnam era veterans and servicepersons, and 58 percent for Vietnam era veterans only. This compares to a
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VETERANS EDUCATIONAL ASSISTANCE: PERSONS IN TRAINING DURING YEAR
Millions
0 1____I______L______1______I_____1_______1_____1______J_____J
72 73 74 75 76 77 78 79 80 81
Fiscal Year
Post-Vietnam Era Veterans' Educational Assistance
Dependents' Educational Assistance
participation rate of 51 percent for veterans who trained under the World War II program.
At the end of FY 1981, cumulative expenditures on veterans educational assistance for post-Korean conflict trainees exceeded $34 billion. This compares to expenditures of $4.5 billion for the Korean conflict program and $14.5 billion for the World War II program.
Through the veteran student services program (work-study) in FY 1981, the VA paid for nearly 7.7 million hours of work by veterans enrolled under veterans' educational assistance or vocational rehabilitation programs. Services were performed at VA regional offices, schools, hospitals, cemeteries, and other designated sites.
Just over 6,000 education loans were granted in FY 1981, compared to 7,800 in FY 1980 and approximately 11,000 in FY 1979. Costs declined from $6.7 million in FY 1980 to approximately $5.8 million in FY 1981 due to more stringent eligibility requirements. Public Law 95-476 limits the program to loans for attendance at high-cost schools and shortens the repayment period. Public Law 96-466 authorizes the VA to grant education loans for enrollments in flight training for eligible veterans who will be reimbursed at 60 percent of the approved course charges. Public Law 97-35 restricts loans for persons enrolled in educational institutions to only those persons who have remaining entitlement and whose period of eligibility for educational benefits has passed. The high rate of defaults (over 70 percent at year's end) continues to be a problem as an increasing number of loans granted earlier in the program reach maturity.
At the end of FY 1981 there were over 188,000 active participants (in-service contributors) in the post-Vietnam era veterans' educational assistance fund. However, more than 126,000 contributors have disenrolled. The number of trainees during FY 1981 exceeded 8,300, with 2,807 enrolled at the end of the fiscal year. The program is under continuing review by both the VA and the Department of Defense who prepare a joint annual progress report.
This program provides educational assistance for survivors of veterans who died from service connected causes and for dependents of veterans whose service connected disabilities are rated total and permanent. Spouses and children of service personnel who are prisoners of war, missing in action, or interned by a foreign government for more than 90 days are also eligible under this program. Up to 45 months of full-time
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DEPENDENTS EDUCATIONAL ASSISTANCE: BENEFICIARIES IN TRAINING DURING YEAR
Children
Spouses/Widow(er)s
State Approving Agencies
School Liability
training is provided in approved schools. Nearly 83,000 children and 12,000 spouses took advantage of the program during FY 1981. Approximately 90 percent used their entitlement to acquire college level training.
State approving agencies were created originally to meet requirements of the World War II programs. Courses offered for training to veterans and other eligible persons must be approved by the approving agency of the state where the training facility is located, or by the Administrator. A number of states have designated two or more agencies to carry out this function. In FY 1981, the VA negotiated contracts with state approving agencies at a cost to the agency of about $11.2 million.
A school may be held liable for overpayment to a veteran or eligible person when the overpayment was a result of willful or negligent failure of the school to report excessive absences, discontinuances, or interruptions of a course. Each regional office has a Committee on School Liability which holds hearings prior to liability determinations. Appeals are forwarded to the Central Office School Liability Appeals Board in the Department of Veterans Benefits. Since the moratorium on processing of school liability cases was lifted in March 1979, outright recoveries have totaled nearly $423,000 and compromises have resulted in the collection of nearly $100,000.
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Housing Assistance
Comparative Highlights
Fiscal Year Percent Change
1981 1980
Number of loans Guaranteed home 178,239 289,164 -38.4
Guaranteed mobile home 9,389 8,283 + 13.4
Direct 140 1,160 -87.9
Average loan amount Gl primary home1 $54,947 $50,511 + 8.8
Mobile home $19,934 $19,576 + 1.8
Direct $25,826 $26,576 -2.8
Maximum interest rate2 Gl and direct home 17.5% 14.0%
Mobile home unit 19.5% 17.5% —
Gl home loans outstanding3 4,103,071 4,100,165 + 0.1
Gl home loans in default3 67,071 60,062 + 11.7
As a percent of loans outstanding 1.63 1.46 + 11.6
Substitutions of entitlement 8,932 9,097 -1.8
Properties on hand 11,515 9,023 + 27.6
'Includes condominiums
2During year
3End of year
Summary
The Loan Guaranty Program provides housing credit assistance whereby mortgage credit needs of veterans and service personnel may be satisfied by private capital on more liberal terms than are generally available to nonveterans, without the assumption of undue risks by the Federal government.
Assistance is primarily through substituting the government's guaranty on loans in lieu of substantial downpayments, relatively short terms, and other investment safeguards applicable to conventional mortgage transactions.
Loans may be used to purchase a home; to purchase a residential unit in certain condominium projects; to build a home; to repair, alter or improve a home; to refinance an existing home loan; to improve a home by installing solar heating or other energy
67
conservation measures; to buy a mobile home, with or without a lot; or to buy a lot for a mobile home the veteran already owns.
Loans are available to veterans with sufficient qualifying service since September 16, 1940; to unmarried surviving spouses of veterans who died from service connected causes; to spouses of service personnel officially listed as missing in action, or captured, for more than 90 days; and to service personnel who have served at least 181 days.
The volume of activity in the VA housing program during any given year is related to general economic conditions and more specifically to conditions in the financial and housing markets. As in FY 1980, these markets in FY 1981 were disrupted by high inflation rates, shortages of mortgage funds, escalating prices of homes, increasing ownership costs, and the highest interest rates in history. As a reflection of these conditions during FY 1981, the VA housing program experienced a significant decline from prior year activity. The number of loans guaranteed during the year was the lowest since FY 1970.
VA GUARANTEED AND INSURED LOANS 1972-1981
Thousands
100,000
01______1______I_____J______I______I_____I______I_____I______I
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Over 197,000 veterans were assisted with home ownership during FY 1981. The VA guaranteed 187,628 home loans in the amount of $10 billion; disbursed 140 direct loans amounting to $3.6 million; made 610 grants for specially adapted housing totaling $15.7 million; and approved 8,932 substitutions of entitlement.
Mobile Home Loans1 Since the inception of the mobile home loan program in February 1971, the VA has guaranteed 51,783 mobile home loans, thereby assisting lenders in providing nearly $753 million in loans to veterans who probably would have been unable to afford a home in the conventional market. During FY 1981, 10,050 applications were received and 9,389 mobile home loans amounting to more than $187 million were guaranteed. The number of loans guaranteed during the fiscal year represents an increase of over 13 percent from FY 1980. Of these loans, almost 71 percent were made by non-supervised lenders approved for automatic processing as provided by the Veterans Housing Act of 1974. Of the loans guaranteed during the fiscal year, 8,971 were for the purchase of new mobile homes while 418 were for used units. Loans for the purchase of single-wide mobile homes accounted for more than 73 percent of the FY 1981 total. The average loan amount for single-wides was $18,006 while for double-wides it was $25,310. These amounts are higher than previous years partially because the Veterans' Housing Benefits Act of 1978 removed the statutory loan maximums for mobile home units and lots.
Plant Inspections At least quarterly, each plant producing mobile home units to be sold to veterans is inspected to see that the units produced and the manufacturing processes are in compliance with the Federal Mobile Home Construction and Safety Standards. The inspection of the manufacturing process in mobile home plants involves observing the handling of materials and the assembly operation at all stages of construction. In addition, the quality control program is checked, including the type of materials used and the provision for protecting materials during storage. A total of 442 mobile home plant inspections were made by VA during FY 1981, up from 417 in the prior period. Third party inspections were accepted by VA in 1,061 instances as suitable evidence of compliance with manufacturing standards. This is up from 1,033 similar inspections accepted in the prior period. No evidence of non-compliance with the Federal standards was noted. The enforcement of inspection requirements set forth in the National Mobile Home Construction and Safety Standards Act of 1974, as implemented by the Department of Housing and Urban Development, has had the effect of improving the performance of manufacturers. The VA inspections showed a high degree of conformity with Federal requirements. Mobile home manufacturers cooperate with VA by permitting inspectors to view plant operations, and by responding to questions about operators, marketing areas, and other matters related to plant operations. Experience with the mobile home industry in general has been good.
Onsite Inspections During FY 1981, VA randomly selected for inspection 1,956 mobile homes secured by Gl loans. Each inspection covered the home and its site, and included, where possible, an interview with the veteran owner or spouse, or both. In some instances the inspectors were unable to check certain items. Therefore total responses relating to a particular item do not always equal the total number of inspections. The percentage figures given below relate to the total number of responses for a particular item. • The average size of the mobile home units was 1,255 square feet. 'This information is included in compliance with Section 1819, Title 38, U.S.C.
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73 percent of the mobile homes had skirting and 72 percent had tiedowns installed.
• 68 percent of the homes were connected to community or public water facilities and 66 percent disposed of their sewage through public or community disposal systems. • 75 percent of the units were located in mobile home parks; 25 percent occupied individual sites. • 97 percent of the mobile homes have remained at their original location as specified in the loan applications. • Nearly all sites were judged to be adequate. Interviews were conducted with occupants of 75 percent of the units inspected. Their units had been occupied an average of about 6 months at the time of the interviews. Following are their responses. • 99 percent were satisfied with the treatment received from VA. • 93 percent were satisfied with their lenders. • 65 percent were satisfied with their dealers. • 82 percent of those located in a mobile home park were satisfied with their park operators. As for future housing plans, 66 percent plan to remain in their mobile homes at their current location, 22 percent wish to move into conventional housing and 12 percent prefer to move their homes to other sites.
Compliance With Warranty Every new mobile home financed by a Gl loan must have a written warranty from the manufacturer to the purchaser, which includes a specific statement that the mobile home meets the standards prescribed by the VA. During FY 1981, VA field stations reported 207 complaints from veterans expressing dissatisfaction in some manner with their mobile home unit. Of these complaints 203 were considered justified and four were determined to be unjustified. By the end of the fiscal year, 167 (82 percent) of the justified complaints had been resolved and 36 (18 percent) were pending resolution. Of these complaints, 142 (70 percent) were under warranty; one (less than 1 percent) was due to faulty setup; and 60 (29 percent) were attributed to both warranty and faulty setup. The nature of the complaints covered under warranty varied from minor defects to severely defective items to be repaired. A total of 90 justified (44.3 percent) complaints were reported because of flawed construction of the unit; complaints received on both the construction and furnishings of the mobile home accounted for 108 (53.2 percent) of the complaints; and five (2.5 percent) expressed dissatisfaction with only the furniture and appliances in the mobile home. VA field stations are continuing to act promptly in determining the validity of complaints. Complaints are widely distributed among manufacturers and models, with no single manufacturer accounting for a significant percentage of the total complaints.
Profile of Mobile Home Market vs. Gl Home Market The primary beneficiaries of the VA mobile home program are, for the most part, the younger, lower income veterans and servicepersons who cannot afford conventional housing. Although the number of mobile home loans guaranteed represents only a small percentage of the total loans guaranteed, it is noted that veterans obtaining mobile home loans are those for whom the program is intended. The table compares selected characteristics of mobile home loans to those of Gl loans on conventional homes. Income, housing expense, and asset figures shown are based only on loans which were
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submitted for VA approval prior to loan disbursement. Condominium loans are not included with home loans.
Characteristics Mobile Home Loans Home Loans
Average maturity (months) 182 357
Average loan amount $19,941 $54,660
Average purchase price $20,871 $57,911
Average gross monthly income $ 1,639 $ 2,338
Average net monthly income $ 1,132 $ 1,558
Average monthly housing expense $ 464 $ 807
Average assets $ 1,730 $ 8,018
Housing expense as a percent of gross monthly income 28.3 34.5
Housing expense as a percent of net monthly income 41.0 51.8
Defaults
Direct Loans
Gl Home Loans
In addition, the mobile home buyers were somewhat younger. Nearly 36 percent were 28 years old or less, compared to only 19 percent of conventional home purchasers. Forty-eight percent of them were Vietnam era veterans.
When the VA mobile home loan program was established, it was anticipated that the incidence of defaults and claims would be greater than that experienced for loans on conventional homes. During FY 1981, claims paid, as a percent of the average number of outstanding mobile home loans, dropped to 2.2 percent from 2.7 percent during FY 1980. The rate for guaranteed loans on conventional homes was 0.29 percent during FY 1981.
During the early stages of the loan guaranty program, there was little private money available to veterans who resided in rural and remote areas of the country. In order to place these veterans on a parity with those living in metropolitan areas, where funds were in ample supply, Congress authorized the direct loan program. It was intended to be a supplement to the guaranteed loan program in those areas where private financing was not generally available. The foundation for the program was Public Law 81-475, enacted April 20, 1950.
The most productive years for the program occurred from 1950 through 1970 when almost 310,000 loans were made (an average of over 14,000 per year). From January 1971 through December 1979 only 23,000 loans were made (fewer than 2,600 per year on average). This precipitous drop beginning in 1971 was due, generally, to increased availability of private capital in rural and remote areas of the country. Such organizations as the Federal National Mortgage Association and the Government National Mortgage Association had created a secondary market which made it feasible for mortgage bankers to expand their geographic areas of operation to include rural and remote areas.
A review of the program in 1980 revealed that over 98 percent of all VA loans made in rural and remote areas during 1979 were funded by the private sector with direct loans representing less than 2 percent of the total. In 1980 the percentage of VA loans funded by the private sector in rural and remote areas rose to 99.7 percent and direct loans amounted to only 0.3 percent. Because of the availability of mortgage funds in these areas the Direct Loan Program was suspended by Congressional action for FY 1981, with the exception of loans to severely disabled veterans for specially adapted housing. During the year, the VA made 17 such loans for a total of $533,150.
During FY 1981, 178,239 home loans were guaranteed. This total includes refinancing loans, condominium loans, alteration and repair loans, and direct loans sold and guaranteed, in addition to loans for the purchase of the traditional single-family home.
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Over 67 percent of the veterans purchasing a home with a guaranteed loan were able to obtain no downpayment loans. Loans to finance the purchase of previously occupied housing accounted for nearly 71 percent of the primary home loans guaranteed during the fiscal year. These loans averaged $51,756 and financed homes with an average purchase price of $54,541. On newly constructed homes, the average loan was $62,623 and the average purchase price was $66,888. Of the total home loans guaranteed during FY 1981, slightly over 72 percent went to Vietnam and post-Vietnam era veterans and servicepersons, 11 percent to veterans whose entitlement was restored, 9 percent to post-Korean veterans, 4 percent to World War II veterans and 3 percent to Korean veterans. Veterans whose only period of service was between World War II and the Korean conflict became eligible for loan benefits October 1, 1976, but accounted for only 0.2 percent of the total volume. Unmarried surviving spouses also accounted for 0.2 percent of the loans guaranteed during the year. Four loans were guaranteed for spouses of service personnel classified as prisoners of war or missing in action. These percentages were essentially unchanged from FY 1980. Between June 22, 1944 and September 30, 1981, veterans obtained over 10.8 million home loans totaling over $195 billion under the Gl home loan program.
Credit Market Conditions During FY 1981 the VA home loan program operated under very restrictive credit market conditions. As a result of restrictive monetary policy and concern over inflation, both short-term and long-term interest rates registered sizable increases. Mortgage interest rates continued to reach new peaks during the fiscal year and, at the end, averaged around 18 percent, compared to 14 percent at the start. The high cost of mortgage money brought about a substantial drop in new mortgage lending by thrift institutions which, in the aggregate, experienced net outflows of deposits and erosion of earnings position. The high cost and relative scarcity of mortgage credit forced VA to increase the interest rate ceiling on VA-guaranteed loans six times from 13 percent to 171/2 percent, during the fiscal year. Homebuying and homebuilding are the most credit-dependent activities in the economy. Veterans, more than other homebuyers, depend upon borrowed funds to meet their housing needs. The VA interest rate ceiling, therefore, is the single most important determinant of the home loan program's effectiveness. During the fiscal year, VA made every effort to keep the interest rate ceiling competitive in order to assure lender support of the program.
Funding Operations No appropriations are required to pay claims and fund property management operations. Both the guaranteed and direct loan programs are financed from revolving funds derived from principal and interest payments made to VA and proceeds of VA loan sales. During FY 1981 VA collected $250.3 million in principal and interest payments, with the interest portion amounting to $142.1 million. Loan sales from VA's own portfolio of loans totaled $42.9 million.
Specially Adapted Housing Assistance The lack of mobility and the psychological problems associated with paraplegia often impose tremendous burdens on its victims. The simplest tasks become difficult, and some procedures, such as acquiring a suitable home, are almost impossible without assistance. Frequently VA representatives escort the veteran or take his place during contacts with builders, lenders, and architects. Severely disabled veterans declared eligible for grants for specially adapted housing have distinctive housing needs such as wide doorways to accommodate wheelchairs, ramps instead of steps, oversized and specially equipped bathrooms, etc. VA extends whatever help is required, as determined on an individual basis. Assuring that structural requirements are met is only one aspect of the specially adapted housing program. Because of the difficulty such veterans experience in obtaining loans from private
72 lenders on some occasions, the VA is authorized to make direct loans for specially
Fair Housing Program
adapted housing without regard to geographic location. Since this authorization was granted in the Veterans Housing Act of 1970, direct loans for specially adapted housing have been made to 339 disabled veterans for $7.4 million.
During FY 1981, 527 severely disabled veterans, who may be wheelchair bound, received grants totaling $15.4 million to buy, build, or modify homes specially adapted for their use.
Public Law 96-385, The Veterans' Disability Compensation and Housing Benefits Amendments of 1980, effective October 1, 1980, authorized a new category of specially adapted housing grants. Under this amendment, a disabled veteran who is either blind in both eyes or who has lost the use of both hands, qualifies for a benefit of up to $5,000 to make minor adaptations to his or her house. During the first year for this benefit, 83 veterans received grants totaling $355,819.
A significant aspect of VA's equal housing opportunity program is its home counseling service. The VA conducts this home counseling service in 23 cities to provide prospective home buying veterans advice and assistance in practical aspects of home buying and home ownership. Minority veterans accounted for 7,703 of the 11,730 veterans counseled in FY 1981, reflecting the thrust of the program toward aiding minority veterans. Since the inception of the program in 1973, nearly 42,000 minority veterans, out of 73,000 veterans overall, have been assisted by this home counseling service.
Another important aspect of VA's fair housing program is the statistical monitoring of minority participation in the VA guaranteed home loan program. This monitoring includes both quantitative and qualitative analysis.
Quantitatively, minority veterans continued to obtain a significant share of VA guaranteed loans during FY 1981. While comprising 11 percent of the veteran population, minority veterans obtained over 18 percent of the home loans closed. Black veterans obtained 12.4 percent, Hispanic veterans 4.3 percent, Asian/Pacific Island veterans 1.0 percent, and American Indian/Alaskan native veterans 0.5 percent of the total loans.
Qualitative indexes show a continued trend of increasing reliance on spouses' income in order to qualify for home loans. A significant 46 percent of the VA guaranteed loans closed in FY 1981 were approved because of the supplemental income of the spouse. This compares with 44 percent a year ago and 39 percent three years earlier. Spouses' income was especially important for minority buyers; 65 percent of the Asian/Pacific Islanders, 56 percent of the black, 54 percent of the Hispanic, and 48 percent of the American Indian/Alaskan natives who obtained VA guaranteed home loans relied upon help from spouses' income.
From FY 1980 to FY 1981, there was a sizable increase in the average annual income of home buyers using VA guaranteed loans to finance their home purchases. As shown in the table, average income for all groups went up substantially in FY 1981. Average incomes ranged from a high of $29,800 for Asian/Pacific Islanders to a low of $25,800 for blacks and Hispanics.
Average Annual Income
FY 1981 FY 1980
Asian/Pacific Islander $29,800 $25,700
White (not Hispanic) $28,400 $24,700
American Indian/Alaskan Native $27,100 $24,300
Black (not Hispanic) $25,800 $22,900
Hispanic $25,800 $22,600
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VA guaranteed home loans covering the full purchase price of the home (no downpayment) were obtained by 83 percent of the black, 77 percent of the Hispanic, 76 percent of the American Indian/Alaskan native, 69 percent of the white, and 61 percent of the Asian/Pacific Islander participants in FY 1981.
VA's fair housing program includes an ongoing effort to increase minority business participation in work related to the loan guaranty program. This includes assigning appraisers and compliance inspectors, and engaging the service of repair contractors, management brokers and sales brokers. During FY 1981, minority businesses received an increased share of all commissions and fees paid and assignments made by VA. They received $11.4 million or 14.9 percent, up from $11.1 million or 14.4 percent the previous year. The minority business portion has increased steadily in each of the four years since FY 1977 when it was 11.5 percent.
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Life Insurance
Comparative Highlights Program (thousands) Fiscal Year Percent Change
1981 1980
USGLI Policies 91 99 - 8.1
Amount $368,784 $404,926 - 8.9
Death benefits $31,943 $32,910 - 2.9
NSLI1 Policies 3,481 3,579 - 2.7
Amount $24,056,246 $24,596,423 - 2.2
Death benefits $345,884 $338,636 + 2.1
VSLP Policies 523 533 - 1.9
Amount $4,604,899 $4,682,545 - 1.7
Death benefits $19,887 $18,525 + 7.4
SDVI Policies 191 189 + 1.1
Amount $1,728,016 $1,711,415 + 1.0
Death benefits $18,468 $17,774 + 3.9
VRI1 Policies 164 167 - 1.8
Amount $1,136,535 $1,161,620 - 2.2
Death benefits $14,801 $14,282 + 3.6
SGLI Policies 3,209 3,178 + 1.0
Amount 63,930,890 $63,341,689 + 0.9
Death benefits $86,771 $88,634 - 2.1
VGLI Policies 443 484 - 8.5
Amount $8,732,385 $9,541,195 - 8.5
Death benefits $23,210 $27,938 -16.9
VMLI Policies 6 6
Amount $162,323 $152,880 + 6.2
Death benefits $5,275 $4,398 + 19.9
'Includes paid-up additional insurance purchased by dividends.
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Program Abbreviated Reference Policy Prefix Letter Program Beginning Ending Date Of New Issues
U.S. Government Life Insurance (USGLI) K 01-01-19 04-24-51
National Service (NSLI) V 10-08-40 04-24-51
Life Insurance H 08-01-46 12-31-49
Veterans Special Life Insurance (VSLI) RS,W 04-25-51 12-31-56
Service Disabled Veterans Insurance (SDVI) RH 04-25-51 Open
Veterans Reopened Insurance (VRI) J,JR, JS 05-01-65 05-02-66
Servicemen's Group Life Insurance (SGLI) — 09-29-65 Open
Veterans Mortgage Life Insurance (VMLI) — 08-11-71 Open
Veterans Group Life Insurance (VGLI) — 08-01-74 Open
Summary
Government
Administered Programs United States Government Life Insurance (USGLI)
National Service Life Insurance (NSLI)
Life insurance protection for the nation's service personnel and veterans is provided under five separate programs administered by the VA and three programs supervised by the VA.
The first five programs shown in the table are entirely VA administered and the latter three are supervised through a contractual relationship with private companies. The SGLI and VGLI programs are administered by the Prudential Insurance Company of America, Newark, New Jersey, and the VMLI program by the Bankers Life Insurance Company of Lincoln, Nebraska.
At the end of FY 1981 these eight programs provided coverage exceeding $104 billion to over 7.7 million insureds.
This is the oldest government administered insurance program, established in 1919 to handle the conversion of World War I Risk Term Insurance. At the end of FY 1981, 91,000 of these policies remained in force, a decline of approximately 8 percent from the previous year. The program is self-supporting except for administrative expenses, and claims traceable to the extra hazards of military service, which are paid by the government. There has been a steady decline in the number of policyholders which will continue to accelerate as the average age of these insureds is now over 77 years. Dividends are paid to USGLI policyholders from excess earnings of the trust fund. The 1981 dividend payments will average $296 per insured, compared to $298 in 1980.
This program was established October 8, 1940 to serve the insurance needs of World War II service personnel. By the end of FY 1981, 3.5 million of these policies remained in force with a face value of $24.1 billion. The program is also self-supporting except for administrative expense and claims traceable to the extra hazards of military service, which are paid by the government. The 1981 dividend payments from the excess earnings of the trust fund averaged nearly $168 per insured compared to $149 last year.
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Approximately 33 percent of the NSLI policies are term insurance renewed every five years at the current attained age; premiums increase with each renewal. As the policyholders grow older, the premiums can become prohibitive, causing many to reduce the face amount of their policies. The VA makes continuous efforts to alert term policyholders about the high premium rates if they retain these policies to the older ages and encourages them to convert to a permanent plan of insurance.
Legislation establishing the Modified Life Age 65 and Age 70 plans of insurance has been beneficial to the term policyholders as the premium rates are lower than for any previous plans in existence. As of September 30, 1981, there were nearly 450,000 Modified Life policies in force with a face value of over $3 billion.
NSLI policyholders may use dividends to buy more insurance as paid-up additions to their policy, permitting policyholders to have more than $10,000 of government life insurance in force. A total of 804,000 policies have paid-up additions with a face value over $1.5 billion, an increase of 15 percent over 1980.
Veterans Special Life Insurance (VSLI)
Service Disabled Veterans Insurance (SDVI)
This insurance program was made available within 120 days following separation to veterans separated from service on or after April 25, 1951 through December 31, 1956. VSLI was a means of providing post-service government life insurance for Korean conflict veterans for whom there was no premium paying insurance during service. The government provided insurance protection with a $10,000 Servicemen's Indemnity. During the stated period, about 800,000 policies were issued, of which 523,000 remained in force on September 30, 1981, with a face value of $4.6 billion. Initially, only renewable term insurance was available. Effective January 1, 1959, legislation modified this program to permit exchange to a lower cost term policy which was nonrenewable after age 50, or to permit conversion to a permanent plan of insurance. This program was originally nonparticipating (no dividends payable), but Public Law 93-289, effective May 24, 1974, changed this insurance to participating. The 1981 dividend payments will amount to $34 million. The payments will average $67 per insured compared to $62 in 1980. A total of 100,000 policies have paid-up additions with a face value of nearly $56 million.
The only government administered insurance program remaining open to new issues, SDVI was designed to assure that service disabled veterans could obtain life insurance at standard rates. Every veteran separated from service on or after April 25, 1951, who receives a service connected disability rating for which compensation would be payable if 10 percent or more in degree, and who is otherwise insurable, has one year
from the date of notice of the VA rating to apply for this coverage. The VA makes a special effort to assure that all eligible veterans are made aware of this coverage, by issuing a notice of eligibility at the time a VA service connected rating is granted; a reminder notice is sent about six months later. In addition, the program is publicized through veterans' organizations and periodic information releases to the press, and radio and television stations. Since the program insures substandard risks at standard premium rates, it is not self-supporting and requires periodic appropriations to meet the costs. At the end of FY 1981 there were approximately 191,000 policies in force with a face value of nearly $1.7 billion.
Veterans Reopened Insurance (VRI)
Total Disability Income Provision (TDIP)
Death Claim Settlement
Under Option 2
This program was a limited reopening of National Service Life Insurance for certain disabled World War II and Korean conflict veterans who because of their disability, would be unable to obtain commercial life insurance or could not obtain it at a reasonable cost. Applications for this insurance were accepted from May 1, 1965 through May 2, 1966. About 210,000 policies were issued of which 164,000 remained in force at the end of FY 1981 with a face value over $1 billion. The Administrator may adjust premium rates up or down at intervals of not less than two years to keep the program self-supporting.
Public Law 96-128, enacted in 1979, makes all Veterans Reopened Insurance policies participating, with dividends payable for the first time in 1980. Dividends are paid to VRI policyholders from excess earnings of the fund. The 1981 dividend payments averaged $96 per insured compared to $94 in 1980.
This is an optional rider that an insured may add to the basic policy to provide a monthly income in case of disability. By paying an extra premium and meeting the age and good health requirements, this rider may be added to any government administered policy except SDVI.
TDIP provides a monthly benefit of $5.75 per $1,000 of USGLI insurance for total disability, and as of September 30, 1981, nearly 2,400 riders were in force with a face value of $17.6 million. TDIP riders have been issued on NSLI policies under three different versions of the law. Under the original provisions, these riders paid $5 per $1,000 of insurance with coverage to age 60. Subsequent changes first increased the payment to $10 per $1,000 of insurance with coverage up to age 60 and later extended the coverage to age 65. The table shows the modifications to the law affecting NSLI policies and the current status of these three riders.
Effective Date of Modification Monthly Income Per 1,000 of Insurance Coverage To Age In Force as of Sept. 30, 1981
No. of Policies Amount of Insurance (in thousands)
Aug. 1, 1946 $ 5.00 60 8,830 $ 64,465
Nov. 1, 1958 10.00 60 101,215 744,638
Jan. 1, 1965 10.00 65 423,449 3,366,416
Under this option insurance proceeds are paid to the beneficiary in a specified number of equal monthly installments, ranging in number from 36 to 240. As a result of Public Law 96-128, the Administrator has the authority to adjust the amount of monthly income paid to beneficiaries under Settlement Option 2. These adjustments will be made based on the investment earnings on the reserve held to make future payments. Beginning in December 1979, these monthly payments were increased for the first time. The guaranteed rates range from 2.5 percent to 3.5 percent. In 1981 the actual rates paid ranged from 6.5 percent to 7.5 percent. The payments will never be lower than the guaranteed payments shown in the life insurance policy.
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Government Supervised Programs Servicemen's Group Life Insurance (SGLI) This program, which provides insurance coverage for members of the uniformed services, is supervised by the VA, but administered by the Prudential Insurance Company of America as primary insurer through the Office of Servicemen's Group Life Insurance, Newark, New Jersey. During FY 1981, 363 other commercial companies also participated in the SGLI program on a reinsurer/converter or converter only basis. By the end of FY 1981, over 3 million active duty service personnel and reservists were insured in the amount of $64 billion, and death benefits paid during the year amounted to $87 million compared to $89 million for FY 1980. Effective December 1, 1981, the maximum coverage is $35,000 and the serviceperson is automatically insured for this amount in the absence of a written request for less ($30,000; $25,000; $20,000; $15,000; $10,000; or $5,000), or no coverage. Coverage was previously limited to $20,000. Full-time or part-time SGLI coverage is available to certain members of the Reserve, National Guard, and ROTC. Members in the four service academies (U.S. Military Academy, U.S. Naval Academy, U.S. Air Force Academy, and U.S. Coast Guard Academy) as well as uniformed members of the Public Health Service and National Oceanic and Atmospheric Administration are entitled to full-time coverage.
Veterans Group Life Insurance (VGLI) This program, which provides for the conversion of SGLI to a 5-year nonrenewable term policy, was designed to provide low cost insurance immediately following separation or release from service. Prior to establishment of the VGLI program, SGLI could be converted directly to an individual policy with one of the participating commercial companies immediately upon separation from service. Studies had shown that very few veterans were taking advantage of the conversion privilege, possibly due to limited income immediately after service, completion of schooling, or lack of family responsibility. VGLI was therefore designed to provide low cost protection during the period of transition into civilian life. This group coverage was effective August 1, 1974, and as of December 1, 1981, became available in multiples of $5,000, up to $35,000, but for not more than the amount of SGLI which was in force at the time of separation. VGLI has no cash, loan, paid-up or extended insurance values, but can be converted to a permanent policy with one of the participating companies at the end of the five-year period. As of September 30, 1981, 443,000 veterans were insured for nearly $8.8 billion. Shortly following release from duty, all eligible veterans receive an informational pamphlet and an application for VGLI from the VA. This program is also available to reservists who, while performing active or inactive duty for training under a call or order specifying a period of less than 31 days, suffer an injury or disability which renders them uninsurable at standard premium rates.
Veterans Mortgage Life Insurance (VMLI) This program is supervised by the VA, administered by the Bankers Life Insurance Company of Lincoln, Nebraska, and provides mortgage protection life insurance to a maximum of $40,000 for any veteran who receives a VA grant for specially adapted housing, unless he or she declines, fails to furnish information to establish the premium, or does not pay the premium. Any unused portion is transferable to a subsequent home mortgage after the preceding one is disposed of, and coverage ceases when the mortgage is paid off, the home is sold, or the veteran reaches age 70. The monthly premium paid by the disabled veteran is the same as that charged for standard lives, with the government paying the extra mortality costs and administrative expenses. The premiums collected under this program are not sufficient to pay claims and the deficit is made up by transfers from the compensation and pension appropriation. As of September 30, 1981, there were nearly 6,000 VMLI policyholders; death benefits paid during the fiscal year totaled over $5 million.
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Veterans Assistance
Comparative Highlights
FY 1981 FY 1980 Percent Change
Public telephone calls— toll-free 4,972,848 5,017,377 - 0.9
Public telephone calls— other 9,618,682 9,722,875 - 1.1
Interviews away from office 151,910 127,921 + 18.8
Interviews at office 1,814,095 2,287,362 -20.7
Patient interviews 530,311 537,589 - 1.3
Correspondence 2,354,096 2,503,018 - 5.9
Summary
Outreach
Veterans assistance personnel in VA field stations conducted almost 14.6 million telephone interviews during FY 1981. Toll-free public telephone calls alone accounted for more than 4.9 million calls during FY 1981. Correspondence actions totaled 2,354,096. Interviews conducted outside the office increased by more than 18 percent, reflecting greater activity in the outreach program.
Compliance surveys of establishments approved for the education or training of veterans totaled 10,167.
Nearly 40 Central Office staff visits were made to field stations to improve management practices and to appraise local compliance with current requirements and directives.
As mandated by Title 38, U.S.C., the VA conducts an outreach program to inform veterans of the benefits and services to which they may be entitled. This outreach program was originally designed to reach recently separated veterans, particularly the educationally disadvantaged. It also embraces other categories of veterans including the aging, the incarcerated, the disabled, and all other veterans, dependents of veterans, and survivors who may be entitled to benefits but are unaware of them.
Toll-free telephone service makes outreach services available in all 50 states. The use of toll-free lines decreased 0.9 percent in FY 1981. The 944 local, Foreign Exchange (FX), and 800 Service lines provide fast, easy, inexpensive access to the VA for veterans' benefits information and assistance. Enterprise Service is provided in Hawaii and Rhode Island, and Zenith Service in Alaska. The availability of the VA through toll-free numbers is widely publicized in commercial telephone directories and in newspaper, radio, and TV announcements. Toll-free telephone service is also advertised by posters displayed in appropriate locations or by enclosures inserted in outgoing mail. Several members of Congress have assisted in publicizing the service, and VA pamphlets encourage its use.
The VA, with safeguards to assure proper use, also provides lists of veterans' names and addresses to local governments wishing to notify veterans of benefits available locally.
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Prisoner of War Outreach Program Recent legislation providing expanded service connected eligibility and medical benefits to former prisoners of war requires the VA to seek out possible beneficiaries and provide them with information about their entitlement to various VA benefits and services. The agency estimates that 43 percent of the over 100,000 former POW's from World War I, World War II, the Korean conflict, and the Vietnam era who may be eligible are already on compensation and pension rolls. The remaining 57 percent are to be identified through contact with national veterans' service organizations, state directors of veterans affairs, and military unit organizations. In this effort, over 500 organizations are being sent a letter by the Chief Benefits Director asking their help in locating and identifying former POWs. A brochure is being prepared for mailing to all who can be located. It is anticipated that POW outreach will result in a large increase in telephone inquiries to VA offices.
Elderly Beneficiaries Special efforts in all areas assure that benefit information and services are available to elderly veterans and their dependents. The VA is an active participant in the Working Agreement on l&R (Information and Referral) Services for Older People Among Federal Departments and Agencies. The pamphlet, "Veterans Benefits for Older Americans," has been developed and, along with other informational material, has been widely distributed. Such information was sent to more than 600 AAA's (Area Agencies on Aging). VA participation in the White House Conference on Aging included an exhibit highlighting benefits and services available. The development of a videocassette presentation on veterans benefits for older Americans is currently under consideration.
Incarcerated Veterans Service to incarcerated veterans began soon after World War II and has received new emphasis since April 1975. Since then over 11,006 scheduled visits have been made to correctional facilities. Regularly scheduled visits or "on-call" service is provided to 718 Federal and state prisons and to 201 city or county jails in all 50 states. Information about VA benefits has been provided in group sessions to over 49,509 incarcerated veterans. More than 107,784 incarcerated veterans have been counseled individually. Additionally, 5,480 briefings have been held for over 11,580 correctional facility officials to acquaint them with available veterans' benefits and services. The Presidential Review Memorandum of October 1978 charged the Law Enforcement Assistance Administration (LEAA) and the Bureau of Prisons with the responsibility for developing reliable statistics regarding the numbers and characteristics of Vietnam era veterans in prisons and jails. Both agencies were directed to launch an information dissemination program aimed at informing personnel and inmates in the criminal justice system about veterans' benefits and services and how they can be used effectively to help in the prisoners' rehabilitation programs. VA representatives have worked closely with representatives of the LEAA, the Bureau of Prisons, the American Correctional Association (ACA), and the National Institute of Corrections (NIC) to launch and perpetuate this major outreach effort. The pamphlet entitled, "Veterans Benefits—Inside . . . Outside," designed specifically for incarcerated veterans, is distributed nationally. Restrictions in FY 1981 travel funds required an adjustment in operations to suspend required semiannual visits to Federal and state correctional facilities and briefings for correctional facility officials. However, field stations continue to provide informational material, such as pamphlets or available audiovisual aids, upon request by correctional facility officials. During FY 1981 the VA's Department of Veterans Benefits and Department of Medicine and Surgery continued sharing resources in a cooperative effort to edit a videocassette presentation for use in supplementing the counseling of incarcerated veterans, those on probation or parole, and correctional facility officials, about available veterans' benefits and services. Plans are being made to have the revised videocassette available for distribution to VA field stations and for purchase by correctional facilities early in FY 1982. The videocassette, entitled "The First Step," includes information about benefit payment limitations imposed by legislation enacted in October 1980.
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U.S. Veterans Assistance Centers These Centers, generally referred to as USVACs, were developed in 1968 pursuant to a mandate of the Congress that all veterans, particularly recently discharged veterans, be made aware of all the benefits and services available from the Veterans Administration. Special efforts were made to communicate directly with those veterans who are considered educationally disadvantaged. One of the objectives of the Centers was to maintain "one stop" service and provide information on benefits available not only from the VA but also from other Federal agencies. Because of the sharp reduction in the number of veterans discharged who were eligible for these benefits, it was necessary to modify some of the existing procedures, although the mission itself has not changed. Most of the Centers have been integrated into the VA regional offices. Referral systems have been established to assist veterans regarding benefits not offered by the VA. Every effort is still made to contact veterans in person, by phone, or by letter to advise them of VA benefits. Particular emphasis was placed on reaching the 7,828 educationally disadvantaged veterans who were discharged in FY 1981.
Employment Assistance Although the principal responsibility for employment assistance to veterans belongs to the DOL (U.S. Department of Labor), the delivery of services requires close interagency cooperation. The VA has continued to work closely with DOL to improve the coordination of job and on-the-job (OJT/apprenticeship) training programs, and other employment services. Veterans with employment problems are given counseling and job assistance at U.S. Veterans Assistance Centers and Career Development Centers at VA regional offices; they are also encouraged to register at the State Employment Security Agency (SESA) job service office in their community. The VA cooperates in the DOL's Disabled Vietnam Era Veterans Outreach Program (DVOP) and the Comprehensive Employment and Training Act (CETA) program by providing names and addresses and veterans' benefits training. VA also provides lists of names and addresses of on-the-job training employers to be used by the SESAs in developing job opportunities. Also, local Veterans Employment Representatives and DVOP representatives are stationed in some VA regional offices. In FY 1981, 52,049 veterans requested that VA provide employment assistance, and through various referrals, 7,828 obtained employment. Of this total, 462 obtained employment through the Office of Personnel Management; 6,132 through SESAs; 878 through VA contacts; and 356 through other contacts.
Fiduciary and Field Examination Activity The Fiduciary and Field Examination (F&FE) activity supervised the payment of benefits to fiduciaries on behalf of nearly 130,000 adult beneficiaries who were incompetent or under some other legal disability during FY 1981. In addition, the activity supervised the payment of benefits to 19,689 minor beneficiaries. This supervision translated into 95,269 fiduciary program field examinations, 44,325 fiduciary account audits, 23,702 legal actions prepared, 4,650 court appearances, and 4,705,341 miles traveled. The F&FE activity was also responsible for performing 9,346 non-fiduciary program field examinations, and 3,799 special investigations. It is projected that the rise in the average age of the veteran population will cause the number of adults under supervision to increase slightly.
Equal Opportunity Compliance VA field station personnel conducted an equal opportunity compliance program to ensure that education and training offered to veterans and other eligible beneficiaries were provided without discrimination on the grounds of race, color, national origin, sex, or handicap. The compliance program was conducted to implement Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973. As of September 1981, there were 281 field station employees assigned to conduct equal opportunity compliance functions in conjunction with their VA education compliance activities. They conducted 2,507 onsite equal opportunity compliance reviews during FY 1981 in proprietary schools below college level and in apprenticeship programs and other on-the-job training establishments. This represents a decrease of 54.6 percent from the 5,525 on-site reviews conducted during FY 1980. The compliance specialists found one instance of noncompliance during the on-site compliance reviews. The VA investigated four complaints of discrimination in FY 1981, none of which was found valid. Three other complaints were referred to the appropriate Federal agencies.
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Vocational
Rehabilitation andCounseling
Comparative Highlights
Item FY 1981 FY 1980 Percent Change
Vocational rehabilitation counselees 46,730 41,099 + 13.7
Vocational rehabilitation trainees 29,818 28,666 + 4.0
Summary
Vocational
Rehabilitation
Effective in FY 1981, the counseling and rehabilitation activity in Central Office was separated from the Education and Rehabilitation Service creating a new Vocational Rehabilitation and Counseling Service (VR&C). In regional offices, these activities became the separate Vocational Rehabilitation and Counseling Division. This organizational realignment was made to improve managerial control and to provide for greater program accountability.
During FY 1981, VR&C staff efforts were directed toward implementing the provisions of Public Law 96-466. Revised policies and procedural instructions were formulated and special training was designed for field staff and implemented through a national conference.
As provided in the new law, a program in independent living services and assistance for the severely disabled veteran is now available when a vocational goal is not feasible. Comprehensive planning for this program concerns both the Department of Veterans Benefits and the Department of Medicine and Surgery, and was undertaken during FY 1981. In FY 1982, a limited number of veterans from various geographic regions will enter into a pilot program in independent living.
The Agency maintained its commitment to coordinated and comprehensive rehabilitation programs in both medical centers and regional offices through continued implementation of the case manager system. In addition, after three years, Career Development Centers are now operational in regional offices in 29 major cities.
Counseling caseloads under Chapters 34 and 35 decreased from the previous year, although vocational rehabilitation evaluation and training caseloads increased significantly. Emphasis on the seriously disabled veteran continued, including outreach, motivation, and employment assistance.
The work measurement system was revised significantly to reflect new legislative provisions and administrative emphasis of the past several years.
Rehabilitation of disabled veterans has long been an important role of the VA, and on October 17, 1980, the VA's vocational rehabilitation program entered a new era with the enactment of Public Law 96-466 (Veterans Rehabilitation and Education Amendments of 1980). This complete revision of Chapter 31, the first since its inception in 1943, improves the vocational rehabilitation program and assures that service connected disabled veterans will benefit from the latest concepts and methods developed in the field of rehabilitation. Handicapped persons eligible for specialized vocational training or special restorative training under Chapter 35, may also receive certain services and assistance similar to those provided disabled veterans.
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The rehabilitation program was expanded to assist service disabled veterans in achieving maximum independence in daily living, and to the extent feasible, to become employable, and to obtain and maintain suitable employment. Previously, vocational rehabilitation was limited to restoration of employability through training. Other provisions of the rehabilitation amendments are summarized below. 1) Employment handicap must be shown in each case as part of the determination of basic entitlement. The basic period of eligibility has been extended to 12 years, while the duration of rehabilitation programs will not exceed 48 months in most instances. However, a finding of a serious employment handicap may justify extensions of these time limits. 2) Veterans for whom feasibility of vocational rehabilitation cannot be determined will enter extended evaluation programs and receive pretraining services. Such evaluation will determine if the veteran may attain a level necessary to enter either vocational rehabilitation training or a program to achieve maximum independence in daily living. A pilot program enables severely disabled veterans to undergo an intensive and innovative program of independent living services. 3) Rehabilitation planning includes not only those services needed to improve the veteran's ability to function in employment, but also in his or her family and community. An individual, written rehabilitation plan, developed jointly by the VA and the veteran, spells out goals and the approach to achieving them. 4) Financial provisions include a significant percent increase in subsistence allowance, an increase in the revolving fund loan maximum, an increase in subsistence allowance during periods of extended evaluation or while in programs at specialized facilities, and liberalization of post-rehabilitation payment. Under a new option, participants with remaining Chapter 34 entitlement may elect to receive the higher educational allowance, in lieu of subsistence allowance and other training costs, while still receiving most Chapter 31 services. 5) Employment assistance has become an integral part of the program for veterans who are or have been in vocational rehabilitation. The majority of the new provisions were effective April 1, 1981. Comprehensive inservice training was provided to all VR&C and other staff, to assure familiarity and compliance with the revised policies and procedures for the new program. Vocational rehabilitation services were provided to 29,818 veterans during FY 1981, a 4 percent increase. This reverses a downward trend which had developed over the last several fiscal years.
Independent Living Program During FY 1981, policies and procedures were drafted to implement a program of independent living services to enable service disabled veterans to achieve maximum independence in daily living as authorized by Public Law 96-466. Independent living services and assistance are now provided when needed to service connected veterans training for a vocational goal under Chapter 31. A pilot program to provide independent living services and assistance to severely disabled veterans for whom a vocational goal is not feasible will be implemented during FY 1982. The pilot program will continue through FY 1985, serving a limited number of new veterans each year. A study of the accomplishments and cost effectiveness of the pilot program will be conducted and the results submitted to Congress prior to October 1, 1984.
Work Measurement Public Law 96-466 so significantly modified the direct labor work activities associated with the rehabilitation program that the entire work measurement system was redesigned. Work measurement data permit more effective monitoring of the program, and facilitate planning and budgeting. A work measurement performance study, the first since 1977, was completed at ten field stations during June 1981. The data gathered were utilized to establish new work-rate standards and to develop new procedures which were initially installed in April 1981. Final modifications and new work-rate standards were put into effect on September 28, 1981, for FY 1982.
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Veterans' Advisory Committee on Rehabilitation The Veterans' Advisory Committee on Rehabilitation was established by Public Law 96-466 to provide advice and consultation to the Administrator regarding administration of veterans' rehabilitation programs under Title 38, U.S.C. The Administrator has approved the Committee's charter. Membership will include disabled veterans and persons distinguished in the field of rehabilitation medicine, vocational guidance, vocational rehabilitation, and employment and training. Also, membership will include five ex-officio members: two representatives from the VA, two from the Department
* of Education, and one from the Department of Labor. The Committee's annual report to the Administrator will include an assessment of the rehabilitation needs of veterans and a review of VA programs and activities designed to meet those needs.
Coordination With Other Federal Programs* The VA conducts some aspects of the rehabilitation program in coordination with other Federal agencies having related objectives. During FY 1981, the Agency collaborated with the Departments of Education and Labor, the U.S. Postal Service, and the Office of Personnel Management. A joint statement of cooperation between VA and the Department of Education's Rehabilitation Services Administration (RSA) established principles to guide state directors of vocational rehabilitation, and directors of VA regional offices and medical facilities in developing operational plans to deliver rehabilitation services with a minimum of expense and duplication. Cooperative efforts with the RSA staff concern rehabilitation activities in independent living, joint staff training, and implementation of Public Law 96-466. During FY 1981 VA consulted with United States Postal Service staff concerning the establishment of a demonstration project in Baltimore, Maryland. The purpose of the project is to select, evaluate, train, and employ seriously physically disabled veterans for postal service jobs. This is an ongoing project that will continue in FY 1982. Coordination with the Department of Labor focused primarily on two programs. The Targeted Job Tax Credit Program offers employers a tax credit if they employ certain target groups, including veterans determined by VR&C staff to be handicapped. VR&C provided its field staff with current information and recommended utilization of this DOL activity. The Disabled Veterans Outreach Program (DVOP) became a permanent program with passage of Public Law 96-466, which also requires that at least a quarter of the total DVOP staff be placed at facilities other than State Employment Service Agency (SESA) offices. The primary mission of the DVOP program is to identify disabled veterans in need of employment assistance, and to help them obtain employment services, including counseling, job development, and placement. To these ends, VA and Department of Labor staff worked together in FY 1981, and jointly planned implementation of Public Law 96-466. The VA also coordinated efforts during the year with Office of Personnel Management staff concerning ongoing programs for the hiring, placement, and advancement of handicapped veterans in the Federal government. Special certification procedures permit time-limited trial, or excepted appointment of severely disabled veterans to Federal positions on the basis of certification by a VA counseling psychologist.
Counseling The educational and vocational counseling program authorized under Title 38, U.S.C., assists veterans, servicepersons, and other eligible persons to select and plan programs of education or training. Counseling services may be requested or, under certain conditions, required prior to initiation or continuation of benefits. Counseling was provided primarily by VA counseling psychologists, supplemented on a fee basis by contract guidance center personnel. Mandatory counseling under the Gl Bill and Dependents' Educational Assistance programs was terminated, except in specific circumstances, at the beginning of the fiscal year. In FY 1981, 68,231 beneficiaries were counseled under all programs. This is a 42 percent decrease from the previous year. Because of the emphasis on providing *This information is included in compliance with Section 220, Title 38, U.S.C.
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rehabilitation services to disabled veterans, the vocational rehabilitation program accounted for 46,730, or over 60 percent of all counseling and evaluation cases for FY 1981.
Under the Gl Bill program (Chapter 34), 15,383 veterans were counseled, 23 percent of all cases. Counseling is still available upon request to assist veterans to develop appropriate plans for using their educational benefits.
Post-Vietnam era (Chapter 32) veterans and servicepersons could request counseling during FY 1981. Sixty-six Chapter 32 counseling cases were seen during the year.
CASES COUNSELED
Counseling is also provided upon request to any eligible dependent (child, spouse, widow, or widower). In FY 1981, mandatory counseling for dependents prior to training, for a change of program, or to resolve difficulties experienced during training, was eliminated. Therefore, counseling cases under the Survivors' and Dependents' Educational Assistance program decreased approximately 67 percent from the previous year. Approximately 5,597 dependents were counseled, accounting for 8 percent of all counseling cases seen.
Counseling and evaluation services were available at over 142 locations including 58 VA regional offices, 43 decentralized VA offices, and 41 contract guidance centers. The number and geographical dispersion of guidance centers and VA counseling offices make counseling more readily accessible to eligible veterans and dependents.
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Cemeteries
Memorials
Comparative Highlights FY 1981 FY 1980 Percent Change
Interments in national cemeteries 41,811 41,120 + 1.7
Applications for headstone/markers 289,960 274,235 + 5.7
Canceled 53,991 37,352 + 44.5
Headstone/markers ordered 247,756 230,703 + 7.4
National cemeteries 49,954 51,973 - 3.9
Private cemeteries 197,802 178,730 + 10.7
Replacement headstones/markers 6,577 13,058 -49.6
Summary
The Department of Memorial Affairs administers veterans' interment benefits that include the national cemetery, headstone and marker, memorial marker and plot, and state cemetery grants programs.
In FY 1981, DMA accomplished 41,811 interments and ordered nearly 248,000 headstones and markers for the graves of eligible persons. Applications were submitted by six states for grant assistance and four grants were awarded. Among the other significant events that took place during the year were the following:
• The Administrator canceled the previously selected Region IV Cemetery site at Fort Gillem, Georgia, and announced Fort Mitchell, Alabama, in its place. Milestone schedules have not been developed.
• Construction began on the Region III national cemetery at Indiantown Gap, Pennsylvania, in May 1981. Opening is planned for the fall of 1982.
• Construction began on the national cemetery at Quantico, Virginia, in August 1981. Opening is planned for the spring of 1983.
• The master plan for the Region V national cemetery at Fort Custer, Michigan, was completed. Construction will start in early 1982.
• Evaluation and ranking of the contractor bids for the headstone and marker program were performed on the ADP equipment procured in December, 1980 for automation of the application process.
• Improvements were completed at two Maryland state veterans' cemeteries—Eastern Shore and Rocky Gap—through assistance provided by the state cemetery grants program.
At the end of FY 1981, the National Cemetery System consisted of 108 cemeteries (57 open, 48 closed, two under construction, and one in master planning) totaling over 8,200 acres, and 32 soldiers' lots and plots totaling 30.2 acres. Nearly 3,000 acres of land have been developed for burials. There were approximately 145,000 gravesites
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available for burials in open cemeteries, and 69,500 reserved gravesites. Potential gravesites, including undeveloped acreage in five cemeteries not yet open for interments, amount to over 2 million.
Construction Projects
Headstones and Markers
The FY 1981 construction program included three major and three minor construction or development projects at six national cemeteries, as shown in the table.
National Cemetery Project Cost (in Thousands)
Calverton Design 70 acres including landscaping previous developments $ 574
Quantico Design 50 acres including one committal service shelter 1,084
Massachusetts Design 60 acres 291
Springfield Design and develop 3.7 acres 300
Willamette Design and develop 20 acres, including one committal service shelter 1,340
Leavenworth Design and develop 15 acres and administration building 1,533
$ 5,122
The second phase of a three-year project to provide barrier-free access to existing buildings was completed at eight national cemeteries. Design criteria and directives are being used to provide barrier-free access in all new cemetery design and construction. The conceptual approach is to omit barriers by design rather than make special adaptations.
During FY 1981, the Department of Memorial Affairs continued to stress energy efficiency in all structures within the national cemetery system.
All national cemeteries are eligible for or are listed on the National Register for Historic Preservation. Each project having a visual impact on the cemetery must be reviewed and approved by the appropriate state historic preservation officer. In FY 1981 all such projects were approved, including renovation of the administration building at Fort Sam Houston National Cemetery. A passive heating and cooling system design for White City National Cemetery is in the design stage.
The Department of Memorial Affairs, administers the largest program of its kind in the world in the issuance of government headstones and markers for the graves of eligible veterans and their dependents. Memorial headstones and markers are also furnished.
Headstones and markers are provided for graves of all veterans and dependents buried in national cemeteries, military post cemeteries, and state-owned veterans' cemeteries. When requested, headstones and markers are furnished for eligible deceased veterans buried in private cemeteries.
Fiscal year 1981 was the most active year for Monument Service since the VA began operating the program. A total of 247,756 orders were placed. This was 17,053 more than fiscal year 1980, also a record year.
The number of applications for headstones or markers received was also higher than any prior period in VA history. The total was 289,960. This was 15,725 above the number received in FY 1980.
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HEADSTONES AND MARKERS: ORDERS PLACED
The number of applications remaining to be processed at the close of the fiscal year was 5,980 compared to 17,767 for the same period last year.
HEADSTONES AND MARKERS:
APPLICATIONS RECEIVED
The total purchase and shipping costs of headstones and markers in FY 1981 amounted to almost $13 million. The average cost per monument was $52.43.
The table is a breakdown by type of monument furnished. Bronze monuments accounted for 51 percent of all orders, continuing a trend started years ago. The number of niche markers increased over last year because of the additional columbarium space available at Arlington National Cemetery.
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Type Headstone/Marker Number Ordered
FY 1981 FY 1980
Total 247,756 230,703
Upright marble 43,396 44,821
Flat marble 11,634 8,056
Flat granite 66,498 58,661
Flat bronze 125,156 118,861
Niche covers 1,030 200
Special purchase orders 42 104
Most headstones and markers (80 percent) were placed at private cemeteries. The remainder were sent for placement at other cemeteries under Federal jurisdiction.
Fiscal year 1981 saw 3,513 headstones and markers shipped to cemeteries overseas. These include private, national, and post cemeteries. The following table gives an indication of the large number of overseas destinations for government headstones and markers. Each such shipment requires complex transportation arrangements often made through embassy offices.
DESTINATION NUMBER DESTINATION NUMBER
Alaska 169 Ireland 12
American Samoa 10 Korea 1
Australia 1 Mexico 18
Canada 29 Norway 3
Costa Rica 1 Panama 741
Cuba 4 Philippines 294
Dom. Republic 2 Puerto Rico 1,157
England 2 Scotland 1
France 4 Switzerland 1
Germany 16 Trinidad 1
Guam 46 Virgin Islands 37
Hawaii 963 TOTAL 3,513
State Cemetery Grants
The VA's relationship to state veterans' cemeteries is based on a Federal assistance program to aid any state in establishing, expanding, or improving veterans' cemeteries owned by it. The program became operational on October 1, 1979. As of September 30, 1981, the VA had received 12 applications totaling $3.9 million from six states; four grants were awarded. The table provides details on these applications.
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Location Project Grant (Thousands)
Request Funds Committed Award
Arizona Phoenix a) Establish cemetery; construct admin, building $ 104 $ 104 $ 1041
b) Construct columbarium & water distribution system 104
California Yountville Cemetery renovation 600
Illinois Quincy a) Construct roadway and entrance gate 60 60 60
b) Construct storage and maintenance shed 70
Maryland Cheltenham Construct admin, maintenance bldgs, and chapel 404 404 404
Crownsville Site development and construct admin., maintenance bldgs., and chapel 593
Eastern Shore Construct chapel and storm drainage system 163 163 1631
Rocky Gap Construct admin, bldg., chapel; repair drainage system 277 277 2771
Garrison Forest Site development; construct admin., maintenance bldgs., and chapel 7572
Maine Augusta Cemetery improvement/ expansion 2003 2002
Rhode Island Exeter Cemetery improvement/ expansion 6002 6002
TOTAL: $3,932 $1,808 $1,008
'Project completed
2Grant award pending completion of review process
3Revision of grant rquest
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Administration and Management
Comparative Highlights FY 1981 FY 1980 Percent Change
Total appropriations (millions) $22,455 $20,552 + 9.3
General Operating Expenses 643 612 + 5.1
Benefit programs 14,893 13,531 + 10.1
Medical programs 6,548 6,015 + 8.9
Construction programs 371 395 - 6.1
Total Employment 232,417 228,285 + 1.8
Minority (full-time) 63,431 63,096 + 0.5
Women 122,079 119,823 + 1.9
Veterans preference 84,554 85,164 - 0.7
Vietnam era veterans 42,600 41,091
Disabled veterans 12,890 13,697
Records holdings (thousands of cubic feet) 1,460 1,449 + 0.7
Forms and form letters 11,864 11,516 + 3.0
Appeals filed 68,183 63,700 + 7.0
Appeals disposed of 58,068 58,790 - 1.2
Appeals allowed 13,820 13,418 + 3.0
Agency Funding
Congress appropriated $22.5 billion in FY 1981 to fund benefits and services administered by the VA. This represents an increase over FY 1980 of more than $1.9 billion. Most of this increase was in the medical and benefit program areas.
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Monthly compensation and pension benefits paid to some 4.8 million veterans and survivors in FY 1981 totaled $12.5 billion, an increase of $1.3 billion over FY 1980. During FY 1981, a rate increase of 14.3 percent was provided under both the compensation and pension programs. More than $6.3 billion was appropriated for medical care and treatment of veterans in 1981, an increase of $507 million over 1980. Medical and prosthetic research efforts to improve the delivery of health care to veterans and to improve the treatment of the disabilities and diseases most common to veterans were funded by a $140 million appropriation in 1981. Inpatient care and treatment were provided to over 1.3 million veterans in 1980 and 18 million outpatient care visits were made. The increased medical workloads were manageable due to a reduced average inpatient census as VA hospital turnover rates increased and lengths of stay became shorter in 1981.
Personnel Management During FY 1981, the VA's Office of Personnel and Labor Relations gave priority to implementing several major provisions of recent legislation. Developing a new performance appraisal system was a major undertaking involving all VA departments and staff offices, and implementation of this system was a significant milestone in the area of civil service reform. VA managers and supervisors formulated a valid system to measure performance, identify and reward outstanding employees, and assist in making promotion decisions, identifying training needs, and taking corrective action. Several aspects of the system were developed and implemented during FY 1981, including: • A comprehensive new performance appraisal policy, linking performance with other personnel functions. • Training sessions on the performance appraisal system for personnel specialists, supervisors, and employees throughout the agency. • Job-related written performance standards for approximately 175,000 employees. • Prototype performance standards for approximately 200 common VA occupations. • Comprehensive job analyses of over 90 occupations. • Model rating criteria for placement actions and performance standards. Also during FY 1981, implementation of the VA Health Care Amendments of 1980 (Public Law 96-330) continued, including the following actions: • Implementing a permanent special pay program to promote the recruitment and retention of physicians and dentists. • Converting medical center directors from the Senior Executive Service to the Title 38 personnel system, and establishing a new director/chief of staff pay plan based on responsibility and performance. • Establishing a program for authorizing special salary rates for registered nurses and nurse anesthetists as necessary to alleviate staffing problems caused by higher non-Federal pay rates. The VA's merit pay system was approved by the Office of Personnel Management and placed into effect on October 4, 1981. Briefings on the merit pay system were held for field personnel officers and for merit pay employees in Central Office. On-site reviews of personnel management were conducted at 33 facilities to monitor local progress toward implementing civil service reform initiatives. Particular attention was given to classification and position management programs, and overall adherence to personnel laws, regulations, and merit system integrity. In addition, VA's personnel management program evaluation guidelines were revised. New guidance was provided
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Staffing
to field station directors for conducting self-evaluations of personnel management at their facilities.
The increased demands for management information and the additional requirements of the Civil Service Reform Act necessitated an expansion of the Agency's automated personnel and accounting data system. The preliminary work leading to a complete redesign of the system was initiated.
Last year, a significant portion of activity concerning civil service reform centered on the Senior Executive Service. By the beginning of FY 1981, the basic systems governing VA's SES operations were in place. Refinement of SES policies and procedures continued during FY 1981.
Some 62,000 employees were hired during FY 1981. There were sufficient applicants available to meet staffing needs except for certain health care positions in some geographical areas (e.g., nurses in some large metropolitan areas and on the West Coast, and physicians in isolated communities).
Recruitment efforts included national and local advertising; attendance at national professional conventions, job fairs, and career days; an active college liaison program; direct mail contact with prospects; and good relationships with professional organizations.
The VA Recruitment Bulletin, which lists shortage category positions at VA stations, continued to receive wide distribution in FY 1981 and was augmented by special supplements developed to emphasize employment opportunities for physicians and engineers. The Bulletin is published twice monthly.
Recruitment efforts contributed to generally improved health care facility staffing. For example, the number of nurses on VA rolls on September 30, 1981, totaled over 30,500, a slight increase from the previous year. Although some medical centers experience difficulty in recruiting, the trend in VA nursing employment is upward. The table shows the numbers of various health care professionals on the rolls at the end of the past two fiscal years.
Position September 30, 1981 September 30, 1980
Total Full-Time Part-Time Total Full-Time Part-Time
Physician 11,391 6,849 4,542 11,096 6,551 4,545
Dentist 942 906 36 935 901 34
Podiatrist 139 50 89 124 44 80
Optometrist 99 45 54 87 40 47
Nurse 30,557 27,605 2,952 30,273 27,957 2,316
Nurse anesthetist 553 500 53 564 516 48
Physician assistant 481 434 47 451 403 48
Expanded-function dental auxiliary 9 9 - 4 4 -
Efforts continued during 1981 to coordinate more closely management of staffing and funds by relating staffing, workloads, and program impacts in the budget process. FY 1981 accomplishments include development of improved productivity indicators for a number of Department of Medicine and Surgery activities, further refinement of the medical manpower tracking system, and the establishment of programs to refine performance measurement in departments and staff offices.
In keeping with the Federal Employees Part-Time Career Employment Act of 1978, employment of part-time workers increased by 4 percent during the past fiscal year.
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The VA has been authorized by OPM to appoint rehabilitation technicians in drug and alcoholism rehabilitation units without civil service competition. Applicants must be former drug or alcoholism patients who have been rehabilitated through a prescribed treatment program. As of September 30, 1981, there were 308 rehabilitation technicians employed under this authority. Of these, 200 had veteran preference including 89 Vietnam era veterans. To facilitate the recruitment of candidates for the Vietnam era veterans readjustment counseling program, the VA has OPM approval to appoint up to 400 persons at grades GS-3 through GS-11 under Schedule A authority. This authority has been used to fill more than two-thirds of the positions in the readjustment counseling program. As of September 30, 1981, over 85 percent of those appointed under this authority were veterans. Of this group, 93 percent were Vietnam era veterans.
Employment of Veterans The VA has consistently been one of the major Federal employers of veterans; new hires in FY 1981 included 15,401 veterans. As of September 30, 1981, 6 percent of all VA employees were disabled veterans and 18 percent were Vietnam era veterans. Veterans constituted 68 percent of all male employees; of these, 53 percent served during the Vietnam era and 17 percent were disabled. The VA made full use of greater flexibility in hiring Veterans Readjustment Appointment (VRA) eligibles under the expanded provisions of Public Law 95-520. The VRA authority allows eligible Vietnam era veterans to be hired directly, then serve a two-year period during which they also pursue training or education. Following successful completion of these requirements, VRA appointees may be converted to competitive civil service status. The 65,766 Vietnam era veterans hired by the VA under this authority since it was established in April 1970 represent more than a third of the VRA appointments made throughout the Federal government. The VA hired 6,693 under this authority during the past year and continues to rank first among Federal agencies in the use of VRA authority. Those converted to competitive status in this fiscal year numbered 2,087 for an overall total of nearly 20,000 conversions since the program began. To help meet short-term staffing needs, the VA temporarily employed 3,270 Vietnam era veterans in FY 1981. Linder the Civil Service Reform Act, Federal agencies are authorized to employ non-competitively veterans with service connected disabilities of 30 percent or more in positions for which they qualify. The VA has hired 637 veterans under this new authority. Training and work experience have also been provided to 409 disabled veterans, and 51 have been converted noncompetitively to career-conditional appointments in the VA under civil service regulations. A sizable number of Vietnam era veterans serve in VA jobs where they meet, work closely with, and provide services to other Vietnam era veterans and their families. About 62 percent of the veterans benefits counselors are Vietnam era veterans, as are 43 percent of veterans claims examiners. Vietnam era veterans also account for over half of all prosthetic representatives, 43 percent of the vocational rehabilitation specialists, and 21 percent of the medical technicians. Among the first VA representatives a patient encounters are the medical administrative assistants in medical center admission areas, 28 percent of whom are Vietnam era veterans.
Executive Development and Training Executive and management development continued to be a high priority. Early in the year, 37 competitively selected men and women began the first Senior Executive Service candidate development program class. With some mid-course corrections to make it more specific to individual development needs, the program continued throughout the year. Completion of the program is targeted for the spring of 1982. At the end of FY 1981, plans were underway for announcement of the next round of the program, retitled the VA executive development program. This program embraces both the Senior Executive Service as well as the medical center director positions removed from the SES by Public Law 96-330. The Office of Personnel and Labor Relations assumed responsibility in FY 1981 for the conduct of Leadership VA which previously had been administered through private contract. Leadership VA is an innovative program in which 60 outstanding managers
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at middle and senior levels undertake, during the course of five one-week seminars throughout the year, a probing examination of the VA, its programs and administration, and the various political, social, economic, and other outside influences which bear on the Agency. The transfer of the program in 1981 from contract to "in-house” administration was accomplished with no increase in staff, resulting in savings of approximately $85,000. Programs in the Four-Tier System for executive and management development continued. Training in various management areas was provided to 525 managers and executives.
Labor Management Relations Approximately 164,000 VA employees are represented by unions. During FY 1981, the National Federation of Federal Employees (NFFE) and the Service Employees International Union (SEIU) consolidated their local units of recognition in the VA. The American Federation of Government Employees (AFGE) and the National Association of Government Employees (NAGE) had previously consolidated their units. NFFE and SEIU now represent approximately 14,000 and 11,000 VA employees, respectively, in consolidated units. Negotiations with the AFGE for a master agreement covering approximately 102,000 non-professional employees were conducted during FY 1981. The VA concluded extensive union/management training in FY 1981 on the master agreement with the National Association of Government Employees (NAGE) covering a consolidated unit of approximately 10,700 non-professional employees. We expect to begin negotiations with NAGE for a second master agreement covering approximately 650 professional employees who make up the other NAGE consolidated units in FY 1982. Twelve additional labor organizations represent other VA employees at local field facilities and nearly all unionized VA employees are covered by negotiated agreements.
Employee Recognition Every day, many deeds of kindness take place in VA medical facilities across the nation as Federal employees serve America's veterans—the sick, the disabled, or their anxious families. Once a year, each facility may choose an outstanding individual who combined compassion with the best in patient care to receive the Administrator's Hands and Heart Award. One hundred and sixty-one employees were recognized in 1981. The third annual Olin E. Teague Award for achievement in the rehabilitation of war-injured veterans was presented to Eric D. Blom, Ph.D., Chief, Audiology and Speech Pathology Service and Mark I. Singer, M.D., Staff Surgeon, who, while working at the VA medical center in Indianapolis, Indiana, developed a simple surgical technique and a replaceable prosthesis which provides voice restoration after total laryngectomy. Almost 90 percent of laryngectomized veterans are expected to benefit from this procedure. There will also be considerable savings to the government. The annual Sam Rose Awards recognize exemplary assistance provided to veterans and their beneficiaries in obtaining veterans benefits. Stephen W. Phillips, a medical clerk at the VA Medical Center in San Francisco, California, serves as receptionist and central coordinator for the Mental Hygiene Clinic in Psychiatry Service. He was honored for his ability to deal with many troubled veterans—making them feel deeply cared for, respected, and better understood. LeRoy E. Hatcher, a field examiner at the VA regional office in Pittsburgh, Pennsylvania, was recognized for giving exceptional service to an aged veteran in need of financial and medical benefits in an emergency. Two employees received honors from outside the agency. William H. Oldendorf, M.D., senior medical investigator at the VA medical center in Brentwood, California became the third VA employee to receive the President's Award for Distinguished Federal Civil Service. Dr. Oldendorf was recognized for his work in the field of diagnostic radiology. Charles V. Yarbrough, Director, Management Support, Depart-
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Presentation of the Olin E. Teague Award. From left, Administrator Nimmo, Mrs. Olin E. Teague, Dr. Eric S. Blom, and Dr. Mark I. Singer.
ment of Medicine and Surgery, received the Roger W. Jones Award for Executive Leadership. This award is sponsored by the the American University College of Public and International Affairs, School of Government and Public Administration.
Equal Employment Opportunity Minority Employment
Suggestions and other achievements beyond job requirements by VA employees saved the Federal government $5,748,819, an increase of 35 percent over FY 1980. More than 11,000 suggestions were received, and over 3,500 of these were adopted with 935 resulting in tangible benefits. High level performance and special contributions were also recognized when 6,846 employees received quality increases and 12,317 others were awarded special achievement awards including cash payments.
During FY 1981, the total full-time employment of minorities in the VA increased from 30.9 percent to 32.0 percent. Blacks made up 25.9 percent of the work force;
Hispanics, 3.3 percent; American Indians, 0.3 percent; and Orientals, 2.2 percent. Total full-time employment throughout the VA decreased by 2.3 percent, while employment of minorities increased by 0.5 percent. Minority women constituted 17.5 percent of the work force, minority men, 14.3 percent.
In the VA, minorities accounted for 28.6 percent of all employees in General Schedule and equivalent positions in FY 1981. Minorities were generally well represented among Title 38 positions with 21.3 percent of the nurses, 22.5 percent of the physicians, and 4.1 percent of the dentists. In all instances, these figures represent increases from the previous year. Minority employment under the wage system decreased from 46.4 percent to 45.9 percent.
Agencywide, minorities accounted for 22.3 percent of the accessions, 18.3 percent of the promotions, and 21.2 percent of the separations during the last year.
Advances were realized by minorities at all except the highest levels (GS-16-18). At the GS-9 level and above, 18.1 percent of the work force were minority employees, up 1.3 percent from the previous year. At GS-15 and equivalent, 20.0 percent were minorities, up 3.9 percent from FY 1980.
Minorities were represented in several top policy-making and managerial positions in the VA. A total of 22 minority members served as directors of field facilities and 16 were assistant directors.
As of November 30, 1981, 30.9 percent of veterans employed by the VA were minorities: 25.9 percent black, 3.9 Hispanic, 0.3 American Indian, and 0.8 Oriental. Among the Vietnam era veterans, 32.4 percent were minorities: 26.0 percent black, 5.0 Hispanic, 0.3 American Indian, and 1.0 Oriental.
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VA EMPLOYMENT WOMEN AND MINORITIES
FY 1981
Employment of Women
Employment of Disabled Veterans and Handicapped Individuals
The number of women employed in VA increased by more than 2,000 over FY 1981. They have also made progress in attaining higher level positions. As of September 30, 1981, women occupied 122,079 or more than 52 percent of all VA positions. Of the Agency's higher level positions, grades GS-12 and equivalent and above, 4,436 or 20.7 percent were occupied by women. Latest available statistics show women in 9.5 percent of these positions throughout government. Women occupy 1,944 or 13.9 percent of all full-time positions in grades GS-13 through GS-15 and equivalent. The government-wide percentage is 7.0 percent. During the year, women received approximately 58 percent of all promotions and nearly 58 percent of all training of eight hours or more.
Part-time employment of women continued at a high rate in a wide range of profes sional, administrative, and technical positions in various occupational specialties and at many grade levels. As of September 30, 1981, total part-time employment was 30,958 of which 13,534 or 43.7 percent were women.
Women held many high-level positions in the Department of Medicine and Surgery: Assistant Chief Medical Director (ACMD) for Administration, Deputy ACMD for Academic Affairs, Deputy ACMD for Nursing Programs, and Special Assistant to the CMD. In addition, three women were medical center directors, one an outpatient clinic director, another a domiciliary director. Eight women were assistant chief medical center directors, four chiefs of staff, and two were in training to become assistant hospital directors.
In the Department of Veterans Benefits, a woman is serving as Chief Benefits Director, another as a regional office director and three as assistant directors. In addition, four women serve in the Senior Executive Service (SES) and 27 as personnel directors at VA field stations.
As of the end of FY 1981, 24,(XX) of VA's more than 232,000 employees were disabled persons including 12,890 disabled veterans. Affirmative action efforts for FY 1981 emphasized the utilization of special appointment authorities to hire severely handicapped individuals and disabled veterans. During FY 1981, the VA hired nearly 800 severely handicapped persons. One of the Agency's priority projects is the removal of architectural barriers from buildings in which VA employees are located. Projects for removal of architectural barriers to the physically handicapped have been computerized to facilitate review and evaluation. These projects are assigned priority for a five-year period, based on accessibility surveys of existing VA-owned and leased buildings. The VA approved 126 barrier removal projects for fiscal years 1981 and 1982 at an
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estimated cost of approximately $13 million. During FY 1981, a VA film, "Equal Access," regarding barrier-free design was awarded special recognition at the First North American Consumer Film Festival held in Washington, D.C., by the Council for the Advancement of Consumer Policy. In addition to internal program initiatives, the VA maintained membership on the President's Committee on Employment of the Handicapped and the Interagency Committee on Handicapped Employees, providing full support in the achievement of the goals and objectives of each. In support of the rehabilitation and employment of disabled veterans, the VA also maintained active liaison with veterans' organizations, state rehabilitation agencies, state employment services, educational institutions for disabled persons, on-campus organizations of disabled students and other organizations of and for disabled persons. Approximately 930 potential recruitment sources serving handicapped persons are on the distribution list for the semimonthly VA recruitment bulletin. In observance of the International Year of Disabled Persons-1981, and in response to a request from the White House, the VA assumed the lead throughout the United States in developing programs intended to make both disabled persons, and the public as a whole, aware of efforts being made by both the Federal and private sectors to train and assist physically as well as psychologically disabled persons. Programs ranged from sports activities and employer information projects, to community involvement and participation in the activities of local committees. During the International Year of Disabled Persons, the VA's vocational rehabilitation program was expanded to include assisting service connected disabled veterans in achieving maximum independence in daily living, including becoming employable and ultimately obtaining suitable employment. A VA employee was named as one of the 10 Outstanding Handicapped Federal Employees for FY 1981.
Automatic Data Processing Virtually all VA beneficiaries are affected by the Agency's extensive computer network and related facilities. To improve timeliness and accuracy of service, efforts are continuing to replace older computer systems with newer equipment and methods. Most prominent is the continued development of the VA's Target system and an upgrade of the Beneficiary Identification and Records Locator System (BIRLS). All of VA's regional offices (except Manila) have the capability to process original and supplemental awards for compensation, pension, and education claims under the Target System. During FY 1981 the capability to process original Chapter 32 education claims for post-Vietnam era veterans was added. The VA is continuing to reduce the amount of operator input required for processing award actions. The redesign of processing for Chapters 34 and 35 education claims to accept minimal input, resulted in manhour savings at regional offices. The feasibility study for the conversion of the insurance system for processing on Target equipment was completed in FY 1981. The detailed design for a system to provide initial inquiry functions began in 1981, with implementation planned for late FY 1982 or early FY 1983. A full replacement system is planned for FY 1985.
Computer System Improvements During FY 1981, existing ADP procedures, standards, support activities, and computer system hardware were improved. An ADP security program was established to achieve the most economical and effective security for VA automated information systems. A network of security officers from VA Central Office and field stations was organized to provide user input throughout the development and implementation of the program. Interim policy and a set of general procedures for agency systems development were instituted. Additional guidelines were published in a Systems Development Management Handbook for senior and mid-level VA project managers. A series of operational documentation standards were approved in May 1981 for operation of data processing centers (DPCs) and for maintenance of new and redesigned VA computer application systems. The procurement and installation of Uninterruptible Power Systems (UPS) for VA DPCs was completed during FY 1981. These power systems maintain a steady supply of power to computers during electrical failures or "brownouts" in the commercial network. To improve UPS service, maintenance contract administration was turned
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over to the individual DPCs. Significant cost savings have been realized at Austin DPC by performing UPS maintenance with VA personnel. The design to upgrade the UPS system at Hines DPC with standby diesel generators was completed and a construction contract was awarded. The installation of an additional UPS module for the Los Angeles DPC was studied and found to be not cost-effective. At the Hines and Austin DPCs, existing data storage devices were replaced with modern, state-of-the art equipment. This action proved cost-effective and substantially improved computer service to system users. An evaluation of Agency-operated time sharing facilities was begun as a step toward providing wider and more cost-effective time sharing for VA systems users. A Computer Resource Management (CRM) program was implemented to assist management in effectively utilizing computer equipment. In the continuing effort to improve ADP equipment resource management, the Office of Data Management and Telecommunications (ODM&T) five-year ADP equipment plan covers (1) the disposition of the ADP equipment inventory at each DPC, (2) the disposition of user application executing on each ODM&T computer system, and (3) the costs associated with the procurement, lease, and maintenance of each. The plan also forecasts each of these items five years into the future. ODM&T will eliminate as excess, antiquated small-scale computer systems at each of its five DPCs. Transferring necessary user applications to more modern ADP equipment will result in significant cost savings.
Medical Applications Fiscal year 1981 was another year of significant increases in the use of ADP technology in support of health care delivery at VA medical centers. Automated clinical laboratory systems were upgraded and installed in eight VA medical centers throughout the nation. All of these systems now provide automated clinical scheduling capability as well as clinical laboratory and admissions/dispositions capability. The Engineering Management Information System (EMIS) serves the Engineering Service at 164 VA facilities. Its reports assist in managing resources, planning work, and monitoring the effectiveness of labor. It also schedules preventive maintenance and equipment inspections and maintains official cost accounting records for all building service equipment as well as maintenance costs for all other VA-owned equipment. During FY 1981 EMIS was upgraded and centralized from second-generation equipment at five VA DPCs to the triplex configuration at the Austin DPC. The Automated Prescription Processing, Labeling, Editing, and Storage (APPLES) system is an on-line outpatient prescription processing system which has successfully eliminated large backlogs and significantly reduced patient waiting time at pharmacies in VA medical centers in the southern California region. Computer equipment was purchased to extend this capability to 21 VA medical districts which include 180 VA medical facilities. Existing APPLES programs had to be converted to run on this more modern computer equipment. During fiscal year 1981, the conversion of the APPLES programs was completed and installed in three medical centers in Medical District 17 (Chicago area) for testing and live production. Plans for FY 1982 call for the continued development of the enhanced pharmacy system to include inpatient medication processing and inventory capabilities. The enhanced system when completed, will be installed at the Hines VA medical center for a pilot test. Procurements necessary to implement the enhanced pharmacy system at the remaining VA medical districts are expected to be completed during fiscal year 1982. The VA is committed to obtaining and disseminating accurate information with regard to possible correlation between Agent Orange exposure and long-term effects on human health. As part of this commitment, an automated registry is maintained of demographic, exposure, and medical data for each veteran examined for Agent Orange exposure. During FY 1981, several reports were developed and interfaces with existing VA data bases were established to respond to Congressional inquiries, identify areas that need further research, and facilitate future Agent Orange decisions.
Veterans Benefits Applications During FY 1981, payment processing for both the compensation and pension, and education systems was optimized to process two cycles per week. Also during the
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year, education reenrollments and compensation and pension amended award processing by Optical Character Recognition (OCR) were replaced with on-line capability through the Target System. All Annual Income Questionnaire (AIQ) and education supplemental award input was transferred from the Hines to the Philadelphia DPC thus centralizing all DVB OCR processing at the Philadelphia DPC. The elimination of some OCR and the centralization of the remainder achieved a significant reduction in paperwork. The Centralized Accounts Receivable System (CARS) provides information on the status of accounts receivable and overpayments (compensation, pension, education, and loan guaranty). CARS is processed daily, and currently maintains data on approximately 500,000 accounts with a value exceeding $500 million. Legislation passed in FY 1981 increased the scope of CARS to almost 1.8 million accounts with expanded features such as interest charging, reactivation of uncollectable or terminated accounts, increased litigation, and referral to commercial credit bureaus. Current program development will expand the CARS master record to accommodate these legislative items. Actions are also underway to secure increased computer capacity for collection of debts owed to the VA (mostly education overpayments). The Automated Diary and Index System (ADIS) aids DVB fiduciary and field examination staffs in serving approximately 160,000 incompetent veterans and their beneficiaries. Processing for this system was upgraded and centralized in the Philadelphia DPC in FY 1981. The system is now being studied for further improvement and possible incorporation into the Target network.
Other Applications During the year, a computer system was procured for the Department of Memorial Affairs (DMA) Monument Service. The system will be developed to operate on a pilot basis in FY 1982, automating certain claims evaluation and procurement functions. It will also provide a cost/benefit base for determining whether a total Monument Service automation effort should be initiated in FY 1983. The computer will significantly reduce the time it takes to install a headstone/marker and to answer inquiries. The hardware analysis and procurement phase of the Correspondence Tracking System (CTS) was completed during FY 1981. The CTS will support the word processing and tracking needs of the Office of the Administrator. CTS provides a method for controlling task, correspondence, and memorandum assignments through quick and easy access to mini-computer records, reducing dependence on manual searches in document tracking and control, and automatically tabulating data for management information. Shortly after the start of FY 1981, the Automated Management Information System (AMIS) installed a major redesign project providing field stations with a less stringent time frame for many types of input, more precise error codes to help identify errors, and more flexibility in producing final reports. The simplified processing was in operation for 11 months, and feedback from field stations indicated a high degree of satisfaction. The Merit Pay System computer programs were developed and installed at the Austin DPC during FY 1981. The various programs and reports insured that Merit Pay employees were properly identified and paid based on their performance ratings. The Race and Ethnic Data System (REDS), designed to comply with the Uniform Guidelines on Employee Selection Procedures, was in the final stages of development in FY 1981. Field facilities began submitting data in September 1980 which has been stored on tape at the Austin DPC. Case file data will provide the basis for the Agency's legal defense in affirmative action litigation. Design specifications were completed in FY 1981 to expand the Financial Management System (FMS) to produce a VA Service Summary and Medical Center Profile report for all VA medical centers. These managerial productivity reports are designed to aid service chiefs, directors, and Central Office in the identification of costs, productivity by hospital department, and work units performed by full-time employee equivalent (FTEE).
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Telecommunications
Telephone Service
Broadband Integrated Telecommunications System (BITS)
Closed Circuit Television
Radio
Nurse Call Communications
Telecommunications play a vital role in carrying out VA administrative and medical responsibilities. Areas such as telephone, nurse call communications, radio, and video systems already play a major role. Telecommunications specialists must increase their expertise in such areas as laser, fiberoptic transmission, and active satellite systems so the agency can take advantage of the latest technology.
Extensive efforts continued during FY 1981 to upgrade service and modernize obsolete telephone systems at VA medical centers. Fourteen competitively-procured, large electronic private branch exchange telephone systems were installed, tested, and activated in VA medical centers. Contracts for replacement telephone systems were awarded for installation at others. Telephone engineering studies and functional specifications were prepared to upgrade telephone systems and service at other selected VA locations.
Additional toll-free telephone facilities were installed to enable veterans to call veterans benefits counselors located at VA regional offices to obtain benefit information and assistance.
The use of facsimile (FAX) equipment has grown with new applications for handling intra- and interfield exact copy communications.
During the past year, research efforts on BITS continued. Of particular significance, was a loading demonstration conducted at the VA medical center in Salem, Virginia, to determine whether BITS can reliably carry multiple telecommunications systems in the medical center environment. Integrated on BITS were nurse call, dedicated voice, facsimile, patient entertainment TV, educational TV, security TV, environmental control, fire alarm, fire watch, and word processing systems. The 60-day demonstration was a total success. As a result, BITS networks are planned for the VA Office of Construction's new facility, and the Little Rock, Arkansas, replacement medical center.
The VA continues to use more closed circuit television to meet surveillance needs, from security to patient observation in intensive care units. New lower cost and more sensitive television cameras, and video recorders make these systems economical. It is expected that the use of television will continue to increase over the next few years. In a Central Office test facility, VA is continuing to evaluate and identify latest state-of-the-art television and other communications equipment to meet Agency needs at the lowest possible cost.
The popularity and demand for two-way radio systems continued to increase during the past year. Of great significance has been the requirement for extended range. The most recent use of radio is as a personal security device for employees working in high risk areas, such as psychiatric wards. Demand for radio systems is expected to continue in the future.
Efforts continue to reduce the number of radio frequency allocations needed to meet expanding radio requirements. This is accomplished through careful planning for reuse of radio frequencies on a regional basis. A second aim is to provide maximum radio interaction capability between VA facilities within a reasonable geographical area. Implementation of these plans is accomplished through the normal equipment replacement cycle.
Nurse call systems installed in VA facilities are the latest audiovisual type, allowing two-way voice communications between nurse and patient, and permitting patients to receive and control television and radio entertainment through pillow speakers/microphones. In each case, the nurse call system is designed to meet the special needs of the specific facility, assuring all necessary features are available, but eliminating unneeded options.
The first VA centralized nurse call system will be installed in the near future at the VA medical center in White River Junction, Vermont. This system will allow one operator to answer the calls from all patients or staff from within the medical center. It should prove to be a valuable management tool.
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Data Transmission-Pharmacy
Supplies and Equipment
Development of specifications for the terminal systems and telecommunications facilities to support the automated pharmacy system have been completed. A Delegation of Procurement Authority was submitted to GSA and subsequently approved. Three Requests for Proposal (RFPs) were issued: one for the telecommunications facilities, and two for the terminal systems. Evaluation of proposals will occur during FY 1982. The automated pharmacy system will support local and remote VA medical centers and outpatient clinics with on-line medication information, prescription filling, and drug inventory data. This system is part of the larger VA effort to improve medical care for the veteran through the use of telecommunications and computers.
The VA Office of Procurement and Supply renders supply support to the most extensive medical program in the Federal government. A marketing center, three supply depots, 172 supply services in VA medical centers and a prosthetic distribution center furnish support to 300 VA and 2,700 other government installations throughout the United States, the Republic of the Philippines, and the Commonwealth of Puerto Rico. Supply expenditures for FY 1981 came to an estimated $1.6 billion. About $1.1 billion was expended for supplies and equipment for VA activities; $465 million was expended for utilities, equipment rental, and other contractual services; and the remaining $34 million was expended for supplies and equipment for other government agencies.
A self-sustaining revolving fund without fiscal year limitation finances depot and medical center inventories which, in major part, are purchased centrally at volume discounts. During FY 1981, the VA Marketing Center participated in procurements of $540 million, resulting in an annual savings of $129 million to the serviced appropriations. Since FY 1976, total supply fund sales have risen 47 percent, an increase of $145 million. Currently, the supply fund is operating with a net worth of $201 million, supporting an average inventory of $110 million at three depots and 160 medical center warehouses. It also financed direct delivery purchases of $58 million in FY 1981, including $14 million for other government agencies. Yearly sales from FY 1976 through FY 1981 are shown on the chart. Support to other government agencies, both in numbers of customers serviced and amount of stock sales, increased in FY 1981.
The VA continues to be a leader among government agencies in the recovery of precious metals. In a recent Comptroller General's Report to the Congress, the VA was cited as a fine example of effective silver recovery. Silver is collected from x-ray processing solutions and scrap medical x-ray film throughout VA medical centers. As shown on the chart, through the sale of 140 thousand troy ounces of silver bullion and 882 thousand pounds of scrap medical film, the VA received $5.8 million in FY
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1981. This is $7.8 million less than the amount received in FY 1980 due to the significant decrease in silver prices in FY 1981 when the value of silver dropped by more than half. The money received from these sales was used in FY 1981 to partially offset increased costs of inventory supplies.
INCOME FROM VA SILVER RECOVERY PROGRAM
VA's equipment assets increased 7 percent in FY 1981 to $1.4 billion. This increase in acquisition value of $95 million reflects continued requirements for state-of-the-art equipment and activation of new facilities. The relatively low percentage increase, compared to the general inflation rate, can be attributed in part to continued centralized control.
VA Equipment Assets September 30, 1981
Equipment on Hand Value (Millions) Percent of Total
Lab $ 276 18.8
Dietetic, housekeeping and laundry $ 84 5.7
X-Ray $ 306 20.8
Hospital furnishings and equipment $ 138 9.4
Medical, surgical, dental and optical $ 273 18.6
Office machines $ 83 5.7
Furniture $ 16 1.1
Motor vehicles, tractors, material $ 44 3.0
handling, and firefighting
Communications $ 71 4.8
Musical instruments, recreational and $ 15 1.0
athletic equipment
Maintenance and repair—tools and hardware $ 5 .4
Refrigeration $ 19 1.3
All other $ 140 9.5
Grand total $1,469
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The VA/DOD Shared Procurement Program is continuing the move toward the establishment of a single procurement system for medical items. The Marketing Center has implemented joint sharing with the Defense Personnel Support Center to prevent duplication and overlap of acquisitions between the two agencies. This effort has provided means to streamline purchasing and restructure inspections and quality assurance. The shared procurement program has resulted in savings of $14.6 million over the past two years. The Marketing Center purchases CAT scanner, X-ray, nuclear, radiation therapy, and ultrasound equipment for the VA and for other agencies through special requests and supply support agreements. During FY 1981, equipment valued at $9 million was purchased for other government agencies. Among the VA's own requirements were purchases of 11 CAT scanners. Consolidated procurement resulted in an award that saved the VA, in aggregate, over $1 million when compared with the single unit price. The Marketing Center also assumed contracting responsibility for pacemakers and pacemaker ancillary items, awarding decentralized schedule contracts to 12 manufacturers with discounts ranging from 5 to 30 percent. These will provide savings in excess of $1 million annually. During FY 1981 the VA Marketing Center assumed management responsibility from GSA for four Federal supply schedules covering diverse medical items valued in excess of $94 million. In conjunction with the reassignment, medical stock items were transferred to the VA by GSA. The Marketing Center also undertook a major expansion of Federal supply schedules for pharmaceuticals to encompass as many generic drugs as possible. The resulting increase in vendor participation is expected to reduce acquisition costs.
Construction The Office of Construction is responsible for the planning, design and construction of new buildings, additions, and alterations, and for major repairs of existing buildings and structures at nearly 280 facilities including medical centers, domiciliaries, nursing homes, and over 100 cemeteries located throughout the U.S. This office also is responsible for real property management which includes acquisition and disposal of real estate, and space management in VA facilities and those GSA facilities occupied by VA in either government-owned buildings or government-leased space.
Contracts In fiscal year 1981 the Office of Construction awarded 61 construction contracts with a total value of about $289 million. Thirty-six procurements were Small Business Set-Asides with 53 contracts totaling about $150 million awarded to small business firms, and eight contracts totaling $139 million awarded to big businesses. Included in these figures were ten contracts negotiated with disadvantaged firms under the SBA 8(a) Program with a total value of $17.9 million and 11 Labor Surplus Area Set-Asides totaling $39 million. Major construction projects obligated were: Bronx, New York, demolition and site development; West Roxbury, Massachusetts, spinal cord injury; New Orleans, Louisiana, expanded clinical and outpatient clinic, phase I; Gainesville, Florida, clinical improvements, and research and education; Mountain Home, Tennessee, clinical addition; Little Rock, Arkansas, replacement medical center, phase II; and Oklahoma City, Oklahoma, clinical addition, modernization, and safety and fire. There were 68 architect-engineer contracts covering 75 projects with the fees totaling $30 million. Fifty-seven of the selected firms were small business, ten were big business, and one was a minority firm. Major architectural and engineering contracts awarded were: Bronx, New York, nursing home; East Orange, New Jersey, correction of environmental deficiencies; New Orleans, Louisiana, expanded clinical and outpatient clinic, phase II; Minneapolis, Minnesota, replacement medical center; Portland, Oregon, replacement medical center, phase I; and Vancouver, Washington, medical center and nursing home care bed building, warehouse, and laundry.
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Energy Engineering
In addition, major construction was begun at the following locations: Massachusetts National Cemetery, Calverton National Cemetery (Phase IB), Indiantown Gap National Cemetery (Phase I), and Quantico National Cemetery (Phase I).
During FY 1981, 14 new solar energy systems were put into operation. These systems are expected to achieve a savings of almost $100,000 per year in equivalent oil energy. All of the systems were designed to provide domestic hot water and were for applications ranging from nursing homes to clinical additions.
Executive Order 12003 calls for a 45 percent reduction in design energy usage by 1985 compared to usage by similar facilities in 1975. Based on new construction contract awards in FY 1981, an average reduction of 49 percent was achieved. Reduction was based on computer simulations of the design of these facilities compared to simulations of similar facilities using 1975 criteria, standards, and practices. This reduction can be expected to change further each fiscal year depending upon the type of facilities and the geographic location of construction awards. Experience this year indicates that the goals of this Executive Order can and will be achieved.
The energy aspects of new construction will continue to be addressed in a cost-effective manner through the use of renewable energy sources and by the efficient use of non-renewable sources. To ensure that the economics of potential energy conservation and renewable energy investments in new VA construction are properly addressed, they are evaluated using methods and procedures mandated by the National Energy Conservation Policy Act. Only those alternatives which result in a superior lifecycle cost analysis are adopted.
505-Bed Replacement Hospital VAMC, Little Rock, Arkansas
Construction Research
Barrier-Free Design
The construction research and development program covers a range of architectural and engineering projects in health care building technology. These projects are accomplished by contracts with private firms, educational institutions, other Federal agencies, or by the VA staff. Findings are incorporated in the VA construction program where appropriate, and reports are published and made available to the public.
The 16 projects underway during FY 1981 involved means of controlling smoke in stairways, energy conserving light fixture ballasts, smoke control in elevators, evaluation of sound control methods for hospital rooms, a solar steam-generation application and determination of total electrical loads by type of health care building.
The mandate of the Architectural Barriers Act of 1968 (Public Law 90-480) has been met. All new VA construction and renovation projects are accessible and usable by the physically handicapped. An annual accessibility review is made of each VA-owned
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State Veterans' Homes
Real Estate and Space Management
or leased facility to determine the existing architectural barriers. Based upon this review, projects to remove barriers are planned in order of priority over a five-year period. The Architectural Barriers Compliance Office has assisted all departments in barrier-free design and in determining priorities of projects for the elimination of barriers in existing facilities. During FY 1981 priorities were established for 53 nonrecurring maintenance projects at a cost of $4.9 million.
The Office of Architecture provides technical assistance to the Office of the Assistant Chief Medical Director for Geriatrics and Extended Care for state domiciliary, nursing home, and hospital facilities in 35 states. During FY 1981, 12 state home projects were approved at an obligated cost of $13 million. New requests, which total $36.7 million, were received from 13 states and have been reviewed. A total grant request estimated to be $85.4 million and covering 36 projects is being held pending Federal funding in future years.
In fiscal year 1981, the VA concluded the acquisition of 5.7 acres of additional land at the VA medical center in Hot Springs, South Dakota; 1.1 acres at the VA medical center in Nashville, Tennessee, and 1.1 acres at the VA medical center in New Orleans, Louisiana. Historic Fort Meade National Cemetery in South Dakota, comprising 1.8 acres, was acquired by transfer from the Bureau of Land Management for inclusion in the VA national cemetery system. The VA also acquired 5.5 acres of additional land at Fort Snelling National Cemetery in Minnesota.
The Real Estate Division issued 117 outgrants such as leases, licenses, permits, and easements authorizing use of VA real property by individuals, organizations, and Federal and local government agencies during FY 1981.
The VA paid $62.7 million for the rental of 8.9 million square feet of space during FY 1981. Three outpatient facilities which totaled 102,000 square feet, were completed during the fiscal year. During FY 1981 work was begun on one relocation outpatient clinic project totaling 14,000 square feet, and two newly authorized outpatient clinics totaling 62,000 square feet. A project also was initiated to acquire 48,000 square feet in Austin, Texas, for use by the VA Finance Division. At the end of the fiscal year there were two outpatient clinic facilities under construction, totaling 36,000 square feet.
CONSTRUCTION STATUS 1981
Total Completed Under Construction Authorized but not Under Construction
Estimated Estimated Estimated Estimated
Description Number Construction Cost (millions) Number Construction Cost (millions) Number Construction Cost (millions) Number Construction Cost (millions)
Totals* 885 $3,286.88 205 $274.36 324 $1,120.41 356 $1,892.11
Replacement & relocation hospital 8 $1,057.76 1 $ 94.33 5 $536.80 2 $426.63
Modernization 8 276.12 0 0 4 81.04 4 195.08
Cemeteries 46 89.01 6 7.06 19 24.33 21 57.62
Nursing home care units 34 263.07 6 22.19 7 39.13 21 201.75
Research & education 17 72.67 4 4.41 6 17.73 7 50.53
Domiciliaries 4 39.34 1 7.17 0 0 3 32.17
Other improvements 768 1,488.91 187 139.20 283 421.38 298 928.33
Air conditioning 8 $ 51.03 3 $ 14.65 4 $ 35.79 1 $ .59
Other 760 1,437.88 184 124.55 279 385.59 297 927.74
*Tota!s not exact due to rounding.
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Management Improvement The VA continued to refine the Agency planning process introduced in 1978 to more effectively meet the needs of top management. This year for the first time, the VA developed an overall strategic plan for the current year, budget year, and five subsequent years, covering major Agency priorities. These included such program areas as the aging veteran, comprehensive rehabilitation, spinal cord injury, and the Vietnam veteran. During this past year, several studies were undertaken to improve management efficiency. Major dollar savings were identified through an analysis of the costs and benefits of the redesign of the automated insurance system. A cost-benefit analysis of the concept of a centralized computer development center resulted in significant avoidance of costs. Also, studies of automated pharmacy and an automated hospital information system identified alternatives that would provide effective service to veterans at the least cost to the taxpayer. Two other studies produced recommendations that would enhance telephone service to veterans while saving money. The VA evaluates its programs for their impact on veterans, their effectiveness in accomplishing their objectives and their efficiency in using resources. Seven program evaluations were completed in 1981 including readjustment counseling, manpower grants, automobile and adaptive equipment, blind rehabilitation and radiation therapy. As programs are reevaluated, data describing the impact, effectiveness, and efficiency of the delivery of services to beneficiaries will be updated and made available to managers for use in administering VA programs. Significant actions regarding the Agency's emergency preparedness activities during FY 1981 included participation in the joint civilian/military readiness exercise REX 80 BRAVO, development of alternate emergency relocation site capability, designation and training of VA representatives to interagency emergency teams, improvements to emergency communications system for major disasters, cooperation with the Department of Defense in planning for civilian/military contingency hospital system, and interagency coordination to plan emergency responsibilities in time of major disaster or national emergency. The VA Consumer Affairs Program is a cooperative effort among departments and staff offices to improve VA's service to its consumers, i.e., veterans and their dependents. Major projects this year included implementing a VA-wide reporting system for compiling and analyzing complaints and compliments, and participating in the second annual Constituent Resource Exposition to explain Federal agency complaint-handling procedures to Congressional caseworkers. Sixty VA medical center patient representatives and Central Office staff attended a national conference on improving service to hospital patients. The conference was jointly sponsored by private and government health care concerns. Throughout the year, Central Office consumer personnel assisted individual veterans by responding directly to their inquiries or by directing them to the appropriate office.
Records and Information Management The moratorium on the destruction of veterans' medical records which was imposed during July 1979 remained in effect through FY 1981. Medical Administration Service is continuing its study to develop options regarding these sensitive records. On September 30, 1981, VA's year-end records holdings were 1,459,655 cubic feet, an increase of 10,199 cubic feet or 0.7 percent over previous year-end holdings. The volume of new records created during FY 1981 was 209,399 cubic feet. A total of 653,073 inactive claims folders representing approximately 19,000 cubic feet were transferred to low cost storage within VA, and an additional 36,674 cubic feet of records were retired to Federal Archives and Records Centers. The volume of records destroyed under authority of the National Archives and Records Service (NARS) amounted to 139,070 cubic feet.
Certain initiatives on the part of the Department of Veterans Benefits to relocate claims folders resulted in cost-avoidance savings. The relocation of 653,073 inactive claims folders to the VA Records Processing Center has freed 2,557 five-drawer file
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cabinets valued at $409,252 and 17,909 square feet of prime office space costing $165,832. The estimated cost-avoidance savings less the relocation costs amounted to $428,345. A change in the selection criteria for claims folders of deceased veterans (XC-folders) to be retired to Federal Archives and Records Centers was implemented during FY 1981. The revised selection criteria allow XC-folders to be identified for retirement after only 12 months of inactivity rather than the previous requirement of 24 months. It is estimated that the number of XC-folders selected will double for the initial retirement under the new selection criteria. This action will free a significant amount of prime office space and file cabinets, and additional savings will be realized. During FY 1981 the VA continued to cooperate with the Department of Defense and other government agencies in the exchange of records and information. A significant pilot program was established with the United States Air Force Accounting and Finance Center to exchange by automated means military retired pay and VA disability compensation payment data. This project will reduce reliance on the flow of paper between the two agencies and promote more timely and accurate benefit payments to military retirees and their survivors. Office information processing technologies, word processing and micrographics, were more aggressively promoted, managed, and controlled to ensure the Agency received the full benefits of these technologies. In FY 1981 nearly 200 VA organizational elements implemented office automation technologies to make their operations more efficient and effective. On September 30, 1981, there were 11,864 different VA forms and form letters in use, of which 35.2 percent were standardized for VA-wide use. During the year, 319 standardized forms and form letters were eliminated as no longer necessary, 142 were created to meet new requirements, and 505 were updated and improved.
Test of Metered Mailing Systems A six-month test study on the use of metered mailing systems was initiated on July 1, 1981. This study involves 19 different VA facilities that have been fully equipped with metered mailing systems for the test period. At the conclusion of the test period, mail cost data accumulated during the study will be compared to mail costs under the standard government indicia mailing system. Evaluation of this comparative cost data along with other factors such as personnel impact and mail service continuity will provide a basis for determining whether conversion to metered mailing would be advantageous. The Information and Regulations Staff sends copies of approved proposed and final VA regulations published in the Federal Register to service organizations with a strong interest in veterans' affairs. Copies of these documents are also forwarded to the congressional veterans' affairs committees for their immediate information.
Reports Management During the fiscal year, 65 new recurring report plans were approved and 57 were eliminated for a net increase of eight. The inventory of recurring reports consists of 523 approved internal VA plans and 128 approved interagency plans for a total of 651. In addition, 47 internal VA non-recurring reports were cleared during the fiscal year. Studies of the total information needs of the Department of Memorial Affairs and the DM&S Engineering, Building Management, Dietetic, and Prosthetic and Sensory Aids Services were completed. A similar study for the DM&S Office of Geriatrics and Extended Care was in progress at the close of the year. The Patient Treatment File is an automated system providing data on inpatient treatment under VA auspices. Eight new recurring reports were approved. One recurring report was changed from quarterly to annual production and one was cancelled. Eighteen recurring reports were changed from the large-size three-part computer paper output to more compact standard-size paper. Accuracy and timeliness of the system's reports continued to improve. The Automated Management Information System (AMIS) is an agencywide system
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Financial Management
An all-time high of approximately 1,100 requests for new reports or changes to existing reports were accommodated by AMIS during the fiscal year. Major accomplishments during the year included:
• A complete revision of the Medical Care Distribution Cost Reports and development of an additional 135 reports;
• Revision of reports which compare planned and actual obligations by program and appropriation; and
• Automation of selected statistical tables for major recurring publications.
Title 38 authorizes the Administrator to release names and addresses of recently discharged veterans, and veterans in receipt of compensation, pension, or education benefits to nonprofit organizations provided the intended use is directly connected to programs and benefits in Title 38. Approximately 174 such requests were processed during the fiscal year.
The VA cash management policy, implemented in line with the President's Reorganization Project, produced savings in the amount of $2.9 million, an increase of $1.1 million over the previous year.
The Direct Deposit/Electronic Funds Transfer program for recurring compensation and pension payments increased to 1,057,690 participants during FY 1981. This represents a participation rate of nearly 24 percent at the end of the fourth full year of the program. Participation is increasing at an average of 17,000 accounts per month. Also included in the program are VA employee salaries which at the end of the second full year represent more than 65,000 payments, or over 28 percent of all VA employees. The program ensures that a benefit or salary payment is deposited in a checking or savings account at a designated financial organization automatically. This eliminates checks being late, lost or stolen. The government realizes considerable monetary savings, and both the government and the payees benefit from a reduction in the number of replacement checks.
The VA is developing a cost/productivity indicator reporting system that will furnish individual medical center, district and regional comparisons to the VA nationwide average by service (e.g., radiology, fiscal, nursing). The quarterly reports will rank each department at each VA medical center in three measurement areas:
• total direct cost per work unit,
• personal services cost per work unit, and • work units per departmental FTEE.
The reports can be generated at minimal cost by using the computerized data reporting systems already in existence.
The reports will indicate both over- and underutilized departments and provide quantitative information that will support the reallocation of resources within each medical center. The reports will enable in-house competition models to be established which will result in more efficient utilization of staff and funds. The cost/productivity reports will provide trend data that can be used in projecting current year, budget year, and forecast year workloads and staffing needs.
A management by exception report will also be produced, highlighting the departments that are the highest and lowest in total cost per work unit. Top management will have a quick indicator of potential problem areas that can be analyzed for further management action.
Eventually, every department in every medical center will be included in the reporting system. Initially, two reports will be generated: the VA Service Summary (VASS) and the Medical Center Profile (MCP). The VASS report will list every medical center and depict the rankings of each based on the three measurement areas. The MCP report will be tailored to illustrate each service within each medical center and will compare the services to the VA nationwide average by the three measurement areas.
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Audits and Investigations
Audiovisuals
The Office of Inspector General has statutory responsibility to promote the economy, efficiency, and effectiveness of VA programs and to prevent and detect fraud and abuse in such programs and operations. During FY 1981, audit and investigative activities had an overall dollar impact of $93.1 million. Several significant joint investigations with other Federal, state, and local law enforcement authorities resulted in indictments and convictions. Fraud prevention and awareness efforts were expanded.
Internal cyclical audits were conducted at 144 medical centers, regional offices, and cemeteries. Program audits, covering areas such as procurement of cardiac pacemakers, billings for fee-basis prescriptions, educational reenrollment overpayments, erroneous benefits payments, unjustified construction and equipment projects, and underutilized cardiac catheterization laboratories, electron microscopes, and leased space also were conducted. Cost avoidance recommended by these internal audits was $55.2 million and cost recovery was $1.2 million. External audit reports were issued covering 444 contracts or activities having audited costs of $285.9 million. These external audits questioned costs of $26 million and identified $13.6 million in unsupported costs.
The Office of Investigations opened 149 cases and closed 130 during FY 1981. Investigations resulted in 84 referrals to the Justice Department for prosecution and 60 for agency administrative action. There were 54 indictments and 14 convictions. Over 115 other administrative actions resulting from investigations were also taken. Investigative efforts accounted for $9.9 million in savings or cost avoidance and nearly $500,000 in fines, recoveries or penalties from prosecutions or administrative actions. Significant cases included unauthorized sale of human organs, illicit drug activities, submission of false research documents, business and correspondence school fraud, contracting, time and attendance, and property management broker irregularities.
Significant attention was given to assessing vulnerability to fraud, waste, and mismanagement of Agency programs, functions, and activities. Financial disclosure systems and employee conduct regulations were evaluated. A computer-assisted matching project was completed that identified Federal civilian employees who are indebted to the VA or may be inappropriately receiving benefits. Approximately $37 million in potential recoveries for debt collection was identified. Collection efforts have been undertaken.
The VA is the lead agency for the President's Council on Integrity and Efficiency project, "Federal Employees Receiving Government Assistance." This computer-assisted matching project should identify Federal personnel who are indebted to the government with delinquent debts or are inappropriately receiving other benefits. To further assist in recognizing inefficiency, an Inspector General Advisory Council, with membership limited to VA supervisors, was established to review selected VA operations and recommend improvements.
A complaint center was established to combine complaints received on the employee hot line, through the Administrator's mail, and from other sources. The consolidation of complaints has provided less duplication of effort and improved screening and control. During FY 1981, there were 475 hot line contacts and 538 other complaints primarily from the Administrator's mail.
The Office of Inspector General reviewed 66 legislative and 52 regulatory proposals and submitted substantive comments on 10 legislative and two regulatory proposals. Testimony was also given before three Senate and House committees during the year.
As a result of a recent analysis, we are consolidating activities performed in several offices in a new Office of Policy, Planning, and Resources in Central Office. The new office will develop overall audit and investigation policy, provide planning of audits and investigations, develop applicable audit and investigative standards and procedures, and provide management support necessary to accomplish scheduled audits and investigations.
The VA completed production of two motion picture films during the fiscal year. A film on ridesharing was completed in June. Entitled, "A Better Way To Go," the film
114
Presidential Memorial
Certificate Program
Legal Matters
was produced with VA's transportation coordinator as advisor and consultant and is designed to inform and promote this program VA-wide. The film is widely used to encourage employees to carpool, vanpool, and utilize public transportation. It emphasizes the necessity to conserve energy and lessen air pollution.
An historical documentation of the 1980 National Veterans Day Ceremonies at Arlington National Cemetery was produced. The videotape titled ''Service and Sacrifice" features the Administrator of Veterans Affairs as personal representative of the President, placing the Presidential Wreath at the Tomb of the Unknowns and delivering the Veterans Day address to the nation.
Two videotapes were produced for use in exhibit presentations. The exhibit titled "Comprehensive Care of the Aging Veteran" contains a five-minute videotape visualizing the VA's geriatric programs, and another titled "International Year of the Disabled" contains a five-minute videotape showing disabled persons participating in vocational, therapeutic, and recreational activities. These exhibits have been and will continue to be presented at appropriate meetings, ceremonies, and other events.
The slide-sound show "Incentive Awards Program" produced by the Office of Personnel Management was revised and edited under OPM authority and with VA incentive awards staff guidance to adapt it to VA requirements in that area of personnel management.
A variety of TV slides was produced for the Office of Public and Consumer Affairs throughout the fiscal year. "Veterans Day November 11," announced ceremonies being held nationwide on Veterans Day, "National Salute to Hospitalized Veterans" informed veterans of their benefit entitlements, and "VA Signature" also gave information on benefits and service entitlements. "Veterans Day November 11" and "National Salute to Hospitalized Veterans" were distributed to television stations nationwide and "VA Signature" was distributed to 36 selected TV stations.
The audiovisual activity maintains the VA's centralized motion picture film library consisting of 802 titles and 4,062 prints for use in medical and scientific research, orientation, training and information, and rehabilitation programs. During FY 1981, 3,490 distributions were made to VA stations, other Federal and state agencies, veterans' organizations, educational institutions, and professional and scientific groups.
The exhibits activity designed and produced 20 new exhibits on eight program titles for the Department of Medicine and Surgery, the Department of Veterans Benefits, and the Equal Employment Opportunity Staff. Fifty-seven new and existing exhibits were displayed during the year at 192 meetings and conventions for a total of 784 presentation days at VA facilities, national and state veterans' organization conventions, educational institutions, and professional, medical, scientific, and minority group meetings.
The Presidential Memorial Certificate Program honors the memory of honorably discharged deceased veterans. Statutory authority for the program is contained in Section 112, Title 38, U.S.C. The President approved continuation on February 4, 1981. The VA issues to the next of kin certificates which bear the President's signature and express the country's grateful recognition of the veteran's service in the armed forces. Eligibility for the certificate is determined by the VA when notice of the veteran's death is received and next of kin information is available. Certificates may also be issued upon request to other relatives and friends of the deceased veteran.
Over 4 million certificates have been issued since the program was initiated in March 1962. The VA now issues an average of 1,100 certificates daily. A total of 256,000 were issued during FY 1981.
The Office of the General Counsel experienced a 13 percent increase in demand for legal advice and assistance in FY 1981. Because of the increase, particularly in the area of debt collection, the position of Associate Deputy General Counsel was established to coordinate the agency-wide debt collection program and VA's legislative program.
115
Public Law 96-466, and an interagency agreement between VA and the Department of Justice, direct the VA to conduct a debt collection program, including litigation where necessary. The VA has sole responsibility for all collection activities involving debts from VA benefits.
By November 1981, cases representing $68 million had been referred to District Counsel offices for enforced collection. Of this number, 16,(XX) cases have been resolved, representing $10.8 million. Complaints filed in Federal and state courts totaled 11,557 as of November 1981.
Medical malpractice claims under the Federal Tort Claims Act increased 35 percent in FY 1981, while funds paid out in the settlement of administrative tort claims under $2,500 increased 12 percent, to $213,481.
Collection of reimbursements for medical care amounted to $8,791,695 in FY 1981. Of that total $4,071,564 was collected from third-party tort feasors, $270,346 under medical insurance policies, and $4,449,785 for treatment of industrial injuries. These collections were often impeded by state laws precluding payment of hospital costs to the Federal government. Similarly, numerous insurance companies have drafted health insurance policies to preclude payment to the Federal government. Recently enacted legislation is expected to aid in recovery efforts for injuries when no tort liability need be shown, such as, under workers' compensation, automobile no-fault insurance, or a state crime-victims compensation program.
Education litigation this year centered on three areas: first, recovery of surplus funding of schools under the Predischarge Education Program (PREP), second, the statutory authority and constitutionality of VA regulations and policy concerning alcoholism as "willful misconduct," and third, the constitutionality of legislation establishing particular rates of educational benefits for certain incarcerated veterans.
In the PREP area, five schools brought action to enjoin the VA from pursuing recovery of PREP revenues they were determined by agency audit to have accumulated in excess of reasonable program costs. They further sought declaratory judgment of nonliability for such overfunding. The government counterclaimed for the $7 million surplus. Court decision is pending.
Two cases were brought by veterans who were denied extension of their delimiting dates for using educational benefits on the basis that alcoholism, claimed as the disability preventing educational pursuit, was the result of their own "willful misconduct." In the first case, the plaintiff has pursued extensive discovery concerning VA policy on alcoholism. Cross-motions for summary judgment are pending. The second case is in the pre-trial stage.
Several cases were filed by incarcerated veterans convicted of felonies, challenging a recent change in law which reduces or eliminates their educational assistance. The plaintiffs have generally claimed that this deprives them of due process and equal protection of the law, and breaches a vested right to benefits. The VA has prevailed in all cases which have reached a decision stage, the courts dismissing most of them on motion. A few remaining cases are pending decision.
The VA continued to successfully defend suits seeking to prevent holders of defaulted loans from foreclosing, based upon alleged failure of both VA and the holder to adequately service the loan. During the past year, two more Federal Courts of Appeal and several lower courts ruled that neither the basic VA statute nor VA internal publications may form the basis of a suit challenging a foreclosure. Some of these opinions noted that, even had the statute permitted a suit, VA's servicing was adequate. Two courts have characterized as "unpersuasive" the decision by the Federal District Court in California which permitted suits challenging the loan servicing. That decision, the only one to date adverse to VA on this point, is currently on appeal.
In the medical area, a Federal District Court in the District of Columbia invalidated a long-standing regulation against providing hospital care during a normal, uncomplicated pregnancy or delivery of a child. In doing so, the court essentially over
116
ruled the VA's traditional interpretation that childbirth does not involve a disability under the statutory definition ("disease, injury, or defect"). The case is currently on appeal.
There was an increase in FY 1981 in legal actions relating to procurement of construction, supplies, and services. Disputes with contractors have resulted in a substantial increase in the number and complexity of cases appealed to the VA Board of Contract Appeals. There were 102 new appeals filed in FY 1981. To deal with the increase, the General Counsel conducted a procurement law course in Washington, D.C., attended by 51 VA attorneys from District Counsel offices throughout the nation.
The VA's Office of Congressional Affairs consists of three offices located in the Senate, the House of Representatives, and VA Central Office. During FY 1981, the office maintained a close working relationship with members of Congress, committees, and their staffs. In a combined effort, the three offices provided to the Congress, information on VA's budget, legislation, and programs; major changes in personnel; organizational changes within the agency; and developments in the construction program. Also provided were assistance and information concerning veterans' rights and benefits to aid Congressional offices in providing help to their constituents.
During the course of FY 1981, the Congressional Affairs office received approximately 15,500 pieces of correspondence, responded to approximately 52,500 telephone inquiries, and received about 6,500 walk-in visits. This constituted a 5 percent increase in workload.
The issues that generated the most Congressional interest in FY 1981 were Agent Orange, contracting out work under 0MB Circular A-76, the Vet Center program, consolidation of the data processing centers, and the status and administration of the VA health care system.
A number of environmental assessments and impact statements concerning preservation of historic sites and interpretation of environmental regulations were reviewed. The VA also provided significant support to the Justice Department in the case of Coalition for Better Veterans Care, Inc. v. Administrator of the Veterans Administration, where the Federal District Court in Oregon refused to enjoin construction of a replacement VA medical center in Portland, Oregon. The injunction was sought on the ground that VA had failed to consider in its environmental impact statement all reasonable alternatives to the new construction project. The plaintiffs argued that the placement of veterans in private medical facilities, commonly referred to as mainstreaming, was a reasonable alternative to constructing a new hospital, and should have been considered in the environmental impact statement. The Court found that the VA acted properly in not considering mainstreaming, citing as the basis of its opinion, the Congressional authorization for a hospital, and the fact that in the absence of new legislation, the money earmarked for the project could not be spent for private care.
The Agency has engaged in extensive collective bargaining with the consolidated national unions representing VA employees. Negotiations are nearing completion. VA District Counsels played an increasingly active role in representing local management in administrative litigation of unfair labor practice cases.
The VA established improved procedures for the review of financial disclosure reports required of senior level employees under the Ethics in Government Act of 1978. The new procedures, and the entire program for administering the Act, were reviewed favorably by the Office of Government Ethics.
The long-term health effects of exposure to Agent Orange and to radiation from nuclear devices continued to be an area of considerable attention. Legal actions challenging Agency claims instructions for both Agent Orange and radiation-related disability claims were pending during FY 1981. At the close of the fiscal year, the U.S. District Court for the District of Columbia had invalidated the procedures for use in radiation claims, and the government was preparing to appeal.
117
Appellate Review
Several Congressional hearings were conducted on the response of the Federal government, the VA in particular, to the Agent Orange issue. The Interagency Work Group to Study the Possible Long-term Health Effects of Phenoxy Herbicides and Contaminants was reorganized with an expanded membership. Now called the Agent Orange Working Group, this Committee reports directly to the White House Cabinet Council on Human Resources, chaired by the Secretary of Health and Human Services.
The VA altered its position on the issue of judicial review of VA decisions by returning to a position which opposes court review of individual benefits decisions as unnecessary and costly. With regard to court review of other questions, such as the validity of VA regulations and procedures, the VA opposed specific legislation because of a belief that case law, already allowing such review, is sufficiently clear. The trend of cases, almost without exception, has been against use of the nonreviewability statute for other than individual benefits decisions. Every U.S. Court of Appeals considering the issue in recent years has held that VA regulations are subject to the same review by a Federal court as the regulations in other Federal agencies. Other courts have made similar rulings with regard to nonregulatory VA procedures.
VA determinations regarding benefits eligibility generally remain unreviewable by the courts. However, considerable resources were expended in litigation challenging the adequacy of the Agency's procedural protections for claimants, e.g., the nature and timing of notices of benefits reductions or terminations. Such actions have usually included allegations that VA's procedures fail to provide due process of law.
During FY 1981, two additional veterans' service organizations were recognized, for purposes of presenting claims for benefits before the VA: the American Gl Forum and the Vietnam Veterans of America.
An increase in activity under the requirements of the Administrative Procedure Act (APA) occurred during the fiscal year. This involved the review of proposed VA issuances to determine their potential public effect, possible classification as rules, and the resultant need for their publication in accordance with APA criteria. Additionally, all proposed regulations were reviewed to assure compliance with Executive Order 12291, and the Regulatory Flexibility Act.
During FY 1981, the General Counsel made 379 final decisions regarding complaints of discrimination. Those decisions involved questions of acceptability of the complaints for further processing, as well as whether discrimination actually occurred. During that period, 77 decisions were appealed to the Equal Employment Opportunity Commission (EEOC). The EEOC upheld Agency decisions in approximately 86 percent of cases where the question of discrimination was decided. Where the case involved acceptability of a complaint, the agency was upheld approximately 60 percent of the time.
Veterans and other claimants for VA benefits who are not satisfied with determinations made by field offices may file a written notice of disagreement with the office taking the action. If, after reviewing the case in light of the claimant's disagreement, the field office is not able to grant the benefits sought, it sends the appellant a statement of the case. This statement outlines the issue, the evidence of record, the pertinent laws and regulations, and the reason for the decision. If the appellant, after reading the statement of the case, still disagrees with the field office, he or she submits an appeal to the Board of Veterans Appeals (BVA). Again the field office reviews the case. If still unable to resolve the appeal to the satisfaction of the claimant, the field office sends the case to the BVA for review and final decision.
There was a sharp increase in new appeals filed in 1981—more than 7 percent greater than 1980. According to available records, 1981 had the third highest number of new appeals since the formation of the BVA in 1933. Only 1949 and 1950—the peak years after World War II —were higher.
Coupled with the large carryover from the previous year, the appellate workload of the VA was nearly 120,000 cases. About 29,400 appeals were resolved in field offices—another 33,500 were decided by the Board of Veterans Appeals. These include
118
more than 58,000 final dispositions on appeals—nearly 24 percent of which were allowances of benefits sought by claimants. The chart shows FY 1981 appellate activities along with FY 1980 for comparison.
The VA improved its appeals management and control system. The Department of Veterans Benefits creates an appeal record in VARMS (Veterans Appeals Record Management System) when a claimant files a notice of disagreement. VARMS then tracks the appeal until final disposition.
The BVA, through VARMS, keeps its caseload at the best level of operations. Each month the Board determines the number of appeals to be called in. DVB, through its computer, selects the cases, oldest first, and sends them to Washington. These callup procedures have held average response time in Washington to about 100 days. Also, by keeping records until the BVA calls for them, field offices are better able to serve veterans and other claimants by responding to inquiries and assisting them in other matters as well as in developing their appeals.
Appellate Processing* FY 1981 FY 1980
Appeals pending, start of period 51,337 47,488
Undocketed, in field stations (43,525) (35,852)
Docketed, in BVA (7,812) (11,636)
Notices of disagreement filed during period 68,183 63,700
Settled in field stations 29,391 29,645
Allowed (9,638) (9,192)
Closed (12,639) (14,135)
Withdrawn (7,114) (6,318)
Submitted to BVA 34,686 30,206
Decided by BVA 33,461 34,030
Allowed (4,149) (4,226)
Remanded (4,787) (4,892)
Withdrawn (247) (282)
Denied (24,278) (24,630)
Appeals pending, end of period 55,443 51,337
Undocketed, in field stations (45,406) (43,525)
Docketed, in BVA (9,037) (7,812)
Summary
Final dispositions 58,068 58,783
Allowed 23.8% 22.8%
Closed 21.7% 24.0%
Withdrawn 12.7% 11.2%
Denied 41.8% 41.9%
'Some figures differ from those reported last year to adjust for the counting method instituted in FY 1980.
Average overall response time to appeals, measured from the date of notice of disagreement until BVA decision, was 408 days at the end of FY 1981. This is up sharply from 337 days at the start of the year. The biggest increase was the time ap
119
peals were held for call-up by the Board. We estimate this delay to be about 100 days.
Case advocates continued to show great interest in claims for disabilities involving Agent Orange, exposure to radiation, and incarceration as prisoners of war. The Board made each of these categories a specialty area and assigned one or two sections to handle them. This permits BVA to develop expertise in these sensitive areas and to ensure consistency in the application of laws and regulations. In FY 1981 the Board received 288 appeals involving Agent Orange, 205 involving radiation, and 251 from former prisoners of war or their beneficiaries.
Personal hearings before the Board dropped to 1,506 from 1,791 a year earlier. This despite the fact the BVA continued to schedule nearly 40 hearings per week. There was a sharp increase in the portion of appellants who requested a formal hearing, had it scheduled, then failed to show up. In past years about 70 percent of the appellants appeared for their hearings. In FY 1981 that dropped to about 56 percent.
By providing a copy of hearing recordings to appellants on request, and by transcribing only those for which there were specific requests, the Board further reduced the time between hearings and BVA decisions. This was satisfactory in more than 60 percent of the hearings held in Washington. All travel board hearings continued to be transcribed.
At the end of FY 1981 the waiting time on the hearing docket was about 10 weeks. Unfortunately, most appellants who fail to show up for their scheduled hearings do not notify us in time to schedule a replacement.
The portion of appellants who chose to be represented by one of the veterans' service organizations continued to grow. In FY 1981 more than 87 percent selected one of the accredited organizations; just over 2 percent used attorneys or agents; and approximately 12 percent chose to puruse their appeals without representation. Appellants handling their appeals without representation has declined steadily from about 25 percent to less than 12 percent over the past decade.
At year's end there were more than 46,406 appeals in process in VA field stations. These were evenly divided between those in the initial (notice of disagreement) stage, and those in the final stages of field processing. With 9,037 cases on the BVA docket, the total number of appeals pending at the end of FY 1981 was 55,443.
The Board of Veterans Appeals had an average employment level of 327 during the year. Headed by a Chairman, a Vice Chairman, and a Deputy Vice Chairman, the Board had 15 sections with 31 legal and 14 medical members. Supporting the sections was a medical adviser, 105 staff attorneys, and an administrative service. Other professional support available within the VA included advisory medical opinions from the Chief Medical Director and legal opinions from the General Counsel. In addition, under the authority of Section 4009, Title 38, U.S.C., the Board requested 184 opinions from independent medical experts who were not VA employees. The chart shows a breakout of the medical specialties covered by these opinions.
AIRS (Appellate Index and Retrieval System) indexes covered the period from July 1, 1977 through December 31, 1980—about 120,000 BVA decisions. Developed in compliance with the Freedom of Information Act, AIRS includes quarter and cumulative annual subject indexes on microfiche, and BVA decisions, stripped of personal identifiers, on microfilm. Appellants and others interested in decisions of the Board are able to check AIRS to locate specific types of cases. They can then request copies of the decisions they want.
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Medical Specialty Number of Advisory Opinions Requested
Fiscal year 1980 Fiscal year 1981
All specialties 211 184
Number requested in connection with: Appellate consideration 199 164
Reconsideration 12 20
Internal Medicine: General 7 7
Cardiovascular 20 13
Gastroenterology 4 6
Pulmonary diseases 10 12
Surgery: General 0 0
Orthopedic 17 6
Thoracic 0 0
Otolaryngology & Ophthalmology 8 8
Psychiatry 68 34
Neurology—Medical and/or Surgical 16 8
Pathology— Medical and/or Surgical 51 70
Other 10 20
121
Statistical Tables
Veteran Population
Health Care
Inpatient Care
Page No.
127
128
129
130
131
132-137
138
139
140
141
142
143-145
146-147
148
149
150-153
154
155-157
158
Table No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Estimated Number, State, Period of Service Estimated Number, Regional Office, Period of Service Estimated Age, Period of Service
Hospital Care and Extended Care: Average Daily Census - Fiscal years 1 972-1981
Hospital Care and Extended Care: Admissions - Fiscal years 1972-1981
VA Medical Centers: Average Operating Beds - Fiscal years 1 972-1981
Hospital Care and Extended Care: Patients Remaining (on Rolls) at End of Period - Fiscal years 1972-1981 Hospital Care and Extended Care: Total Discharges -Fiscal years 1972-1981
Hospital Care and Extended Care: Patients Treated -Fiscal years 1972-1981
Inpatient and Ambulatory Care: Program Summary Applications for Medical Care
Total Health Care: Operating Costs by Program
VA and Non-VA Facilities: Average Costs
VA Medical Centers - Hospital Care Component, Non-VA (Contract) and State Home Hospitals: Admissions, Discharges and Remaining by Type of Hospital and Bed Section
VA Medical Centers - Hospital Care Component and Non-VA Hospitals: Patient Movement - By Type of Bed Section
VA Medical Centers - Hospital Care Component and Non-VA Hospitals: Patient Movement By Type of Hospital
VA Medical Centers - Hospital Care Component: Selected Data
Non-VA Hospitals: Selected Data
VA Medical Centers - Hospital Care Component: Patients Remaining, Type of Patient, Percent Hospitalized in Reported State of Residence - June 24, 1981
VA Medical Centers - Hospital Care Component: Patients Remaining, Percent By Attained Stay, Diagnostic Grouping June 24, 1981
VA Medical Centers - Hospital Care Component: Patients Remaining, Diagnostic Category, Period of Service, Average Age and Age Group - June 24, 1 981 VA Medical Centers - Hospital Care Component: Patients Remaining, Age, Diagnostic Grouping - June 24, 1 981 VA Medical Centers - Hospital Care Component: Patients Remaining, Age Groups By State - June 24, 1981
VA Medical Centers - Hospital Care Component: Patients Remaining, Compensation and Pension Status, Type of Patient, Age - June 24, 1 981
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STATISTICAL TABLES -Continue d
Extended Care
Ambulatory Care
Pharmacy Construction
Page No. Table No.
1 59 25 VA Medical Centers - Hospital Care Component: Patients Discharged, Manner of Disposition, Diagnostic Grouping
160-163 26 VA Medical Centers - Hospital Care Component: Patients Discharged, Age, Diagnostic Category
164-165 27 VA Medical Centers - Hospital Care Component: Patients Discharged, Type of Patient, Age, Length of Stay
166 28 VA Medical Centers - Hospital Care Component: Patients Discharged, Age, Marital Status, Diagnostic Grouping
167 29 VA Medical Centers - Hospital Care Component: Patients Discharged, Compensation and Pension Status, Type of Patient, Age
168 30 VA Medical Centers - Hospital Care Component: Patients Discharged, Compensation and Pension Status, Type of Patient, Sex
169 31 VA Medical Centers - Hospital Care Component: Patients Discharged, Type of Patient, Percent Hospitalized in Reported State of Residence
170-174 32 VA Medical Centers - Hospital Care Component: Patients Discharged, Diagnostic Grouping, Average and Median Length of Stay Distribution
175-176 33 Surgical Procedures Performed in VA Medical Centers -Hospital Care Component
177 34 Cost of Operation of Medical Inpatient Facilities
35 VA Nursing Homes, Community Nursing Homes, and VA Domiciliaries: Patient Movement
178 36 State Home Hospitals, State Nursing Homes and State Domiciliary Homes: Patient Movement
37 VA Medical Centers - Domiciliary Care Component: Selected Data
179-180 38 VA Medical Centers - Nursing Home Care Component: Selected Data
181 39 State Nursing Care Homes: Selected Data
182-184 40 Community Nursing Homes: Selected Data
185 41 State Domiciliary Homes: Selected Data
42 State Home Hospitals: Selected Data
186 43 Outpatient Medical Program: Visits to VA Staff and Private Physicians on a Fee-For-Service Basis - Fiscal years 1 972-1 981
44 Outpatient Dental Care: Applications for Care (Eligibility Classes I - VI) - Fiscal years 1 975-1 981
45 Outpatient Dental Care: Workload by VA Staff and on a Fee-For-Service Basis - Fiscal years 1 972-1 981
187 46 Pharmacy Activity
188 47 Replacement and Relocation Hospital Construction Projects
48 Modernization Construction Projects
189 49 Nursing Home Care Units Construction Projects
50 Research and Education Construction Projects
190-193 51 Other Improvement Construction Projects
194 52 National Cemetery Projects
53 Domiciliary Construction Projects
124
STATISTICAL TABLES -Continued
Guardianship and Veterans Page No. Table No.
Assistance 195 54 Incompetent and Minor Beneficiaries Served
Special Acts 55 Death: Special Acts, Class of Beneficiary, Period of Service
National Cemetery System 196-197 56 National Cemeteries: Location, Interments and Status of Gravesites
Compensation and Pension 198 57 Disability, Death: Number of Cases, Amount, Period of Service
199 58 Disability, Age Group, Period of Service
200 59 Termination of Awards, Disability, Death
201 60 Veterans Receiving Compensation or Pension Compared with Estimated Veteran Population by Period of Service
61 Veterans Receiving Compensation or Pension Compared with Estimated Veteran Population by Geographic Area of Residence
62 Death Benefit (Compensation, Dependency & Indemnity Compensation or Pension) Cases on Rolls Compared to the Number of Deceased Veterans Who Participated in each Period of Service
Compensation 202 63 Disability: Class of Dependent, Period of Service
203 64 Death: Total, Class of Beneficiary, Period of Service
204-206 65 Disability: Degree of Impairment, Type of Major Disability, Period of Service
Pension 207 66 Disability: Total, Period of Service, Type of Major Disability
67 Death: Total, Class of Beneficiary, Period of Service
Educational Assistance 208 68 Persons in Training During Fiscal Year by Program and Period of Service
Housing Assistance 209 69 Guaranteed or Insured Loans, Direct Loans, Property Management
Insurance 70 VA Administered Insurance Programs - Assets and Liabilities
210 71 Summary of Operations (Accrual Basis)
72 In Force
211 73 Servicemen's and Veterans' Group Life Insurance -Statement of Operations
Employment 74 Employment: Full, Part-Time and Intermittent by Installation
75 Employment: Full, Part-Time and Intermittent by Pay System
212 76 Employment: Sex and Veteran Preference - September 30, 1981
77 Employment: Minority Groups by Grade - May 31, 1981
78 Employment of Women - Full-Time and Part-Time -May 31, 1981
Fiscal 213 79 Appropriations, Expenditures and Balances - Cash Basis
214 80 Veterans Administration Comparative Consolidated Balance Sheet
125
STATISTICAL TABLES -Continue d
Page No. Table No.
215 81 VA Supply Fund Comparative Balance Sheet
216-217 82 VA Gross Expenditures - Fiscal Years 1972-1981
218 83 VA Supply Fund - Statement of Income and Expense
219-233 84 Estimated Selected Expenditures by State
126
TABLE 1
VETERAN POPULATION
Estimated Number, State, Period of Service—September 30, 1981
(In Thousands)
State Total Veterans Veterans per 1,000 Civilian Population t War Veterans Post- Vietnam Era5 Service Between Korean Conflict and Vietnam Era Only
Total 2 Vietnam Era Korean Conflict World War II World War 1
Total 3 No Service in Korean Conflict Total 3 4 No Service in World War II
Total 30,083# X 25,789# 9,087 8,537 5,781 4,633 12,170 449 1,254 3,040
State Total 29,829 132.6 25,581 8,984 8,436 5,717 4,576 12,124 445 1,239 3,009
Alabama 422 109.2 362 127 119 92 75 162 6 17 43
Alaska 39 103.3 32 15 14 7 6 12 (8) 2 5
Arizona 347 128.9 299 109 103 69 51 140 5 14 34
Arkansas 277 121.7 242 83 79 49 38 120 5 10 25
California 3,348 143.0 2,888 1,002 931 717 515 1,399 43 140 320
Colorado 382 134.1 323 135 129 70 52 137 5 18 41
Connecticut 463 149.6 398 133 124 100 83 185 6 19 46
Delaware 78 132.2 62 24 22 11 8 31 1 4 12
District of Columbia 96 152.4 82 20 18 26 21 42 1 3 11
Florida 1,397 144.6 1,230 376 348 283 195 656 31 47 120
Georgia 641 118.8 542 220 209 132 106 220 7 29 70
Hawaii 92 101.3 75 31 29 20 16 29 1 4 13
Idaho 105 111.9 89 34 32 17 13 42 2 4 12
Illinois 1,519 133.5 1,301 431 404 302 264 610 23 63 155
Indiana 725 132.2 614 235 222 129 111 271 10 35 76
Iowa 378 129.8 320 116 110 62 55 147 8 17 41
Kansas 311 133.1 269 95 90 54 43 130 6 12 30
Kentucky 412 113.6 355 126 119 76 60 169 7 15 42
Louisiana 447 107.1 385 132 123 91 76 180 6 18 44
Maine 156 139.9 134 48 45 25 20 66 3 5 17
Maryland 629 150.7 538 198 187 134 102 242 7 28 63
Massachusetts 871 152.2 751 261 246 172 143 348 14 36 84
Michigan 1,180 127.6 996 372 351 212 186 443 16 57 127
Minnesota 560 137.4 471 194 185 84 71 205 10 29 60
Mississippi 240 96.0 208 67 63 45 36 105 4 7 25
Missouri 708 144.6 610 214 201 131 109 288 12 28 70
Montana 98 125.3 81 29 27 14 11 41 2 4 13
Nebraska 203 130.3 173 67 64 32 27 78 4 8 22
Nevada 97 122.8 83 28 27 20 15 40 1 5 9
New Hampshire 125 136.3 103 36 34 20 15 52 2 5 17
New Jersey 1,102 150.1 950 305 284 224 186 465 15 41 111
New Mexico 137 106.7 116 42 39 26 20 55 2 5 16
New York 2,422 138.1 2,110 608 564 496 431 1,078 37 89 223
North Carolina 618 107.0 527 210 197 110 91 231 8 23 68
North Dakota 58 90.3 48 16 15 7 6 26 1 2 8
Ohio 1,463 135.6 1,241 450 423 256 218 580 20 69 153
Oklahoma 417 139.2 358 130 124 77 59 168 7 17 42
Oregon 393 149.4 337 123 117 65 48 165 7 18 38
Pennsylvania 1,729 145.8 1,489 494 461 314 262 740 26 71 169
Rhode Island 150 159.2 126 41 38 28 21 65 2 6 18
South Carolina 337 110.2 289 119 114 65 53 118 4 14 34
South Dakota 72 105.2 59 17 16 11 9 32 2 3 10
Tennessee 541 118.4 462 169 161 104 89 204 8 23 56
Texas 1,673 118.8 1,434 530 498 310 237 677 22 70 169
Utah 155 106.5 130 61 58 24 19 51 2 8 17
Vermont 64 125.2 53 21 20 9 7 25 1 4 7
Virginia 664 127.7 568 217 204 139 97 259 8 26 70
Washington 617 151.2 524 204 193 115 79 244 8 29 64
West Virginia 233 119.5 203 64 61 39 34 103 5 8 22
Wisconsin 593 126.1 503 192 181 96 82 229 11 28 62
Wyoming 45 96.3 38 13 13 6 5 19 1 2 5
Outside U.S. — Total6 254 X 208 103 101 64 57 46 4 15 31
NOTE: These estimates have been developed from “benchmark" veteran population statistics for the states as of June 30,1970, based on 1970 Census of Population data on veterans' place of residence, extended to September 30, 1981, on the basis of (1) 1965-1970 veteran interstate migration statistics from the 1970 Census; (2) Bureau of the Census provisional estimates of 1970-71 net civilian migration of the states, Current Population Reports, Series P-25, No. 468, October 5, 1971; and (3) mobility of the United States population, 1975-1976, Current Population Reports, Series P-20, No. 305, January 1977. They are independent of,
and therefore not directly comparable with, estimates for June 30, 1970 through June 30. 1974, previously published. Excluded are an estimated 137 thousand who served only between World War I and World War II, and 238 thousand who served only between World War II and the Korean conflict.
See footnotes at end of Table 3.
127
TABLE 2
VETERAN POPULATION
Estimated Number, Regional Office, Period of Service —September 30, 1981
(In Thousands)
War Veterans Service
Vietnam Era Korean Conflict Between Korean
Regional Office Total Veterans Total 2 Total 3 No Service in Korean Conflict Total 3 4 No Service in World War II World War II World War 1 Vietnam Era5 Conflict and Vietnam Era Only
30,083# 25,789# 9,087 8,537 5,781 4,633 12,170 449 1,254 3,040
Alabama Alaska Montgomery Anchorage 422 39 362 32 127 15 119 14 92 7 75 6 162 12 6 (8) 17 2 43 5 34 25 165
Arizona Arkansas . Phoenix . Little Rock Los Angeles 347 282 1,727 299 247 1,492 109 84 503 103 81 469 69 50 365 51 39 274 140 122 728 5 5 21 10 70
San Diego San Francisco 314 1,307 269 1,127 107 392 97 365 75 277 40 201 127 544 5 17 15 55 125
Colorado Connecticut Delaware District of Columbia . . . Florida Georgia Denver 382 323 135 129 70 52 137 5 18 41
. Hartford . Wilmington . Washington . . St. Petersburg Atlanta 463 78 444 1,397 641 398 62 378 1,230 542 133 24 143 ■ 376 220 124 22 133 348 209 100 11 105 283 132 83 8 71 195 106 185 31 171 656 220 6 1 3 31 7 19 4 19 47 29 46 12 47 120 70
Hawaii . Honolulu . . Boise 92 105 75 89 31 34 29 32 20 17 16 13 29 42 1 2 4 4 13 12 155 76
Illinois . . Chicago Indianapolis 1,519 725 1,301 614 431 235 404 222 302 129 264 111 610 271 23 10 63 35
. . Des Moines 378 320 116 110 62 55 147 8 17 41 30
Wichita 311 269 95 90 54 43 130 6 12
Kentucky . , Louisville 412 355 126 119 76 60 169 7 15 42
Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri New Orleans Togus Baltimore 447 156 422 788 385 134 362 679 132 48 127 237 123 45 120 224 91 25 88 156 76 20 70 129 180 66 166 314 6 3 6 12 18 5 18 33 44 17 42 76
. . Detroit St Paul 1,180 528 996 444 372 184 351 175 212 79 186 67 443 193 16 9 57 27 127 57
. . Jackson St. Louis Ft. Harrison 240 708 98 208 610 81 67 214 29 63 201 27 45 131 14 36 109 11 105 288 41 4 12 2 7 28 4 25 70 13
Nebraska 203 173 67 64 32 27 78 4 8 22
Reno 97 83 28 27 20 15 40 1 5 9
New Hampshire Manchester 125 103 36 34 20 15 52 2 5 17
New Jersey New Mexico New York North Carolina North Dakota Newark . . Albuquerque Buffalo New York . . Winston-Salem . . Fargo . . Cleveland 1,102 137 635 1,787 618 90 1,463 950 116 550 1,560 527 75 1,241 305 42 171 437 210 26 450 284 39 159 405 197 25 423 224 26 130 366 110 12 256 186 20 112 319 91 10 218 465 55 270 808 231 38 580 15 2 9 28 8 2 20 41 5 25 64 23 4 69 111 16 60 163 68 11 153
Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina , . Muskogee . . Portland Philadelphia Pittsburgh . . San Juan . . Providence . . Columbia 417 393 1,099 656 181 233 337 358 337 944 568 149 198 289 130 123 322 179 49 65 119 124 117 300 168 48 60 114 77 65 203 115 63 44 65 59 48 167 99 57 35 53 168 165 461 291 42 99 118 7 7 16 10 2 4 4 17 18 46 26 11 9 14 42 38 109 62 21 26 34
South Dakota . t Sioux Falls Nashville 72 541 59 462 17 169 16 161 11 104 9 89 32 204 2 8 3 23 10 56
Houston 744 637 236 221 140 107 300 9 31 76
924 792 293 275 169 129 375 13 39 93
Utah Salt Lake City 155 130 61 58 24 19 51 2 8 17
Vermont White River Jet 64 53 21 20 9 7 25 1 4 7
Virginia Washington West Virginia Wisconsin Wyoming Roanoke 523 448 165 156 106 79 206 7 20 55
Seattle 617 524 204 193 115 79 244 8 29 64
Huntington 207 180 57 54 35 30 91 5 7 20
593 503 192 181 96 82 229 11 28 62
45 38 13 13 6 5 19 1 2 5
Philippines Manila 8 4 (8) (8) (8) (8) 3 1 1 3
65 55 54 53 1 (8) 1 1 3 7
-1
NOTE: For all regional offices whose jurisdiction includes only part of a state or extends into another state, the estimates of veterans are computed by applying the most recent veteran population ratio factors for the counties or urban places involved. These factors
were developed from county veteran population estimates as of June 30, 1970 based on the 1970 Census of Population. Refer to general note below Table 1.
See footnotes at end of Table 3.
128
TABLE 3
VETERAN POPULATION
Estimated Age, Period of Service—September 30, 1981
(In Thousands)
Age Total Veterans War Veterans Post- Vietnam Era5 Service Between Korean Conflict and Vietnam Era Only
Total 2 Vietnam Era Korean Conflict World War II World War 1
Total 3 No Service in Korean Conflict Total 3 4 No Service in World War II
All Ages 30,083# 25,789# 9,087 8,537 5,781 4,633 12,170 449 1,254 3,040
Under 20 yrs 35 35
20-24 yrs 917 88 88 88 829
25-29 yrs 1,863 1,528 1,528 1,528 335
30-34 yrs 3,424 3,375 3,375 3,375 46 3
35-39 yrs 3,293 2,755 2,755 2,755 8 530
40-44 yrs 2,429 770 683 670 100 100 1 1,658
45-49 yrs 2,905 2,120 254 95 2,024 2,023 2 (8) 785
50-54 yrs 3,682 3,626 211 18 2,580 2,314 1,294 56
55-59 yrs 4,488 4,481 104 6 593 161 4,314 7
60-64 yrs 3,727 3,726 62 2 306 24 3 700 1
65-69 yrs 1,759 1,759 22 (8) 121 10 1,749
70-74 yrs 794 794 5 (8) 40 1 793
75-79 yrs 243 243 (8) 13 (8) 243 (8)
80-84 yrs 214 214 3 69 145
85 yrs & Over 310 310 1 6 304
Average Age7 48.0 49.9 34.3 33.1 51.1 49.3 60.5 85.3 23.4 42.2
NOTE: Excludes an estimated 137 (thousand) who served only between World War 1 and World War II, all of whom are 65 years of age or older, and 238 (thousand) who served only between World War II and the Korean conflict who are 45-59 years of age. 1 2 *
1 Based on civilian population estimates for April 1, 1980, provided by the U.S. Department of Commerce, Bureau of the Census.
2 Veterans who served in both World War II and the Korean conflict, and in both the Korean
conflict and the Vietnam era are counted once.
3 Includes 550 (thousand) who served in both the Korean conflict and the Vietnam era.
4 Includes 1,148 (thousand) who served in both World War II and the Korean conflict.
5 Service only after May 7, 1975.
6Includes Commonwealth of Puerto Rico, U.S. possessions and outlying areas, and foreign countries.
1 Computed from data by single years of age.
8 Less than 0.5 (thousand).
#There are also 86 living Spanish-American War veterans whose average age is 101.0years.
X Not applicable.
129
HEALTH CARE
TABLE 4
Hospital Care and Extended Care: Average Daily Census1 Fiscal Years 1972—1981
Fiscal Years Total Hospitals Domiciliaries Nursing Homes
Total VA Medical Centers— Hospital Care Component3 Non-VA State Total VA Medical Centers— Domiciliary Care Component2 State Total VA Medical Centers— Nursing Home Care Component Community State
1981 . . 102,751 68,479 66,376 1,222 881 11,925 7,353 4,572 22,347 8,145 8,348 5,855
1980 . . 105,085 70,251 68,109 1,213 929 12,786 7,894 4,892 22,048 7,933 8,529 5,586
1979 . . 106,816 71,983 69,821 1,182 980 13,744 8,448 5,296 21,089 7,760 8,126 5,203
1978 . . 109,769 75,390 73,008 1,378 1,004 13,957 8,721 5,236 20,422 7,480 7,997 4,945
1977 . . 111,164 77,671 75,285 1,344 1,042 14,214 8,933 5,281 19,279 7,166 7,507 4,606
1976 . . 113,055 80,519 78,264 1,233 1,022 14,652 9,090 5,562 17,884 6,993 6,646 4,245
1975 . . 114.384 82,253 79,973 1,267 1,013 15,030 9,181 5,849 17,101 6,739 6,239 4,123
1974 . . 114,426 83,534 81,453 1,053 1,028 15,584 9,723 5,861 15,308 6,418 4,885 4,005
1973 . . 115,170 84,556 82,479 1,031 1,046 16,286 10,261 6,025 14,328 6,094 4,572 3,662
1972 . . 113,907 83,185 80,971 1,154 1,060 17,957 11,988 5,969 12,765 5,440 3,990 3,335
1 Fiscal year averages based on total patient bed days during year divided by the number of days in year.
2 Includes restoration center program data for fiscal year 1972.
3 Beginning with FY 1973, patients coming to VA hospitals for chronic dialysis are considered inpatients; there was an average daily patient census of 637 with one day duration of stay during FY 1981.
HEALTH CARE
TABLE 5
Hospital Care and Extended Care: Admissions1 Fiscal Years 1972—1981
Fiscal Years Total Hospitals Domiciliaries Nursing Homes
Total VA Medical Centers— Hospital Care Component1 3 Non-VA State Total VA Medical Centers— Domiciliary Care Component2 State Total VA Medical Centers-Nursing Home Care Component Community State
1981 . . 1,258,648 1,217,342 1,183,458 29,397 4,487 11,142 6,571 4,571 30,164 5,368 20,265 4,531
1980 . . 1,256,186 1,216,367 1,182,603 28,760 5,004 10,746 6,115 4,631 29,073 4,666 19,610 4,797
1979 . . 1,236,987 1,196,169 1,162,566 28,403 5,200 12,278 6,920 5,358 28,540 4,428 19,925 4,187
1978 . . 1,233,818 1,193,613 1,157,787 30,369 5,457 12,382 7,230 5,152 27,823 4,157 19,314 4,352
1977 . . 1,211,029 1,170,563 1,133,380 31,449 5,734 12,998 7,755 5,243 27,468 3,966 19,340 4,162
1976 . . 1,175,148 1,136,285 1,102,271 28,238 5,776 14,134 8,169 5,965 24,729 4,023 16,553 4,153
1975 . . 1,107,808 1,069,757 1,036,101 27,710 5,946 14,478 7,831 6,647 23,573 3,767 16,056 3,750
1974 . . 1,028,502 991,473 964,466 21,091 5,916 15,558 8,522 7,036 21,471 3,834 13,598 4,039
1973 . . 968,203 932,481 905,545 20,816 6,120 17,459 10,365 7,094 18,263 4,002 10,774 3,487
1972 . . 829,305 793,538 765,786 21,578 6,174 18,712 12,103 6,609 17,055 3,785 10,135 3,135
'Interhospital transfer data are excluded. are considered inpatients; there were 232,644 admissions for one day duration
2 Includes restoration center program data for fiscal year 1972. of stay during FY 1981.
3 Beginning with FY 1973, patients admitted to VA hospitals for chronic dialysis
HEALTH CARE
TABLE 6
VA Medical Centers: Average Operating Beds1 Fiscal Years 1972-1981
Fiscal Years All VA Facilities Hospital Care Component Domiciliary Care Component2 Nursing Home Care Component
Total Bed Section
Medical Surgical Psychiatric
1981 99,169 82,079 40,501 17,533 24,045 8,390 8,700
1980 101,740 84,129 41,203 18,040 24,886 9,217 8,394
1979 105,469 87,713 42,772 18,542 26,402 9,389 8,357
1978 108,891 91,215 44,372 19,175 27,669 9,792 7,884
1977 109,879 92,370 44,587 19,610 28,173 9,936 7,573
1976 111,574 94,075 44,943 19,854 29,278 10,101 7,398
1975 112,143 94,801 44,893 19,725 30,183 10,310 7,032
1974 113,714 96,106 45,331 19,597 31,178 10,839 6,769
1973 115,369 97,689 45,261 19,640 32,788 11,172 6,508
1972 115,268 96,352 40,003 19,212 37,137 13,097 5,819
1 Fiscal year averages are based on the number of operating beds at the end of each month for 13 consecutive months, beginning with June of the prior year and ending with June of the indicated fiscal year. Beginning with FY 1977 averages are based on the number of operating beds at the end of each month for 13
consecutive months, beginning with September of the prior year and ending with September of the indicated fiscal year.
2Includes restoration center program data for fiscal year 1972.
130
TABLE 7
HEALTH CARE
Hospital Care and Extended Care: Patients Remaining (On Rolls) At End of Period1—Fiscal Years 1972—1981
Fiscal Years Total Hospitals Domicil iaries Nursing Homes
Total VA Medical Centers— Hospital Care Component Non-VA State Total VA Medical Centers— Domiciliary Care Component 3 State Total VA Medical Centers— Nursing Home Care Component Community State
Total Bed Occupants ABO 2 Total Bed Occupants ABO 2
1981 104,617 67,837 66,118 65,420 698 827 824 3 892 12,573 8,063 4,510 24,207 8,641 9.492 6,074
1980 105,831 70,519 68,626 67,862 764 999 996 3 894 12,986 8,306 4,680 22,326 8,289 8,330 5,707
1979 106,349 69,828 67,897 66,914 983 945 923 22 986 14,245 9,061 5,184 22,276 8,092 8,836 5,348
1978 108,529 72,283 70,134 69,062 1,072 1,164 1,162 2 985 14,858 9,595 5,263 21,388 7,893 8,336 5,159
1977 111,267 75,271 73,116 72,010 1,106 1,138 1,123 15 1,017 15,282 9,902 5,380 20,714 7,603 8,310 4,801
1976 112,114 77,750 75,786 74,413 1,373 957 942 15 1,007 15,317 10,120 5,197 19,047 7,419 7,196 4,432
1975 113,422 79,499 77,432 76,007 1,425 1,031 1,008 23 1,036 15,882 10,226 5,656 18,041 7,075 6,869 4,097
1974 114,174 80,526 78,640 76,847 1,793 852 811 41 1,034 16,415 10,653 5,762 17,233 6,828 6,287 4,118
1973 113,496 81,146 79,336 77,356 1,980 793 762 31 1,017 17,322 11,373 5,949 15,028 6,526 4,695 3,807
1972 113,492 81,489 79,406 77,344 2,062 1,053 820 233 1,030 18,107 12,235 5,872 13,896 5,627 4,740 3,529
1 Patients remaining (on rolls) on June 30 of each fiscal year through 1976, and September 30 thereafter.
2 Denotes absent bed occupants, i.e., patients on authorized absence.
3 Includes restoration center program data for fiscal year 19 72.
TABLE 8
HEALTH CARE
Hospital Care and Extended Care: Total Discharges1— Fiscal Years 1972—1981
Fiscal Years Total Hospitals Domiciliaries Nursing Homes
Total VA Medical Centers— Hospital Care Component 2 4 Non-VA State Total VA Medical Centers— Domiciliary Care Component 3 State Total VA Medical Centers— Nursing Home Care Component Community State
1981 1,255,639 1,216,359 1,182,384 29,524 4,451 11,606 6,814 4,792 27,674 4,913 18,750 4,011
1980 1,253,427 1,212,447 1,178,890 28,457 5,100 11,969 6,874 5,095 29,011 4,461 20,206 4,344
1979 1,235,811 1,195,884 1,162,355 28,323 5,206 12,832 7,480 5,352 27,095 4,190 18,971 3,934
1978 1,233,634 1,194,367 1,158,621 30,253 5,493 12,914 7,680 5,234 26,353 3,778 18,660 3,915
1977 1,211,506 1,173,740 1,136,647 31,378 5,715 13,173 8,103 5,070 24,593 3,714 17,048 3,831
1976 1,174,973 1,137,231 1,103,108 28,316 5,807 14,635 8,288 6,347 23,107 3,522 15,802 3,783
1975 1,106,685 1,069,945 1,036,441 27,573 5,931 14,668 8,262 6,406 22,072 3,457 14,880 3,735
1974 1,026,576 991,599 964,653 21,047 5,899 15,959 9,269 6,690 19,018 3,496 11,850 3,672
1973 968,469 933,237 906,015 21,084 6,138 17,471 10,721 6,750 17,761 3,009 11,592 3,160
1972 830,697 794,785 766,892 21,682 6,211 20,215 14,201 6,014 15,697 2,959 10,049 2,689
1 Includes deaths.
2 Interhospital transfer data are excluded.
3 Includes restoration center program data for fiscal year 1972.
4Beginning with FY 1973, patients coming to VA hospitals for chronic dialysis are considered inpatients. There were 232,644 patients treated for one day during fiscal year 1981.
TABLE 9
HEALTH CARE
Hospital Care and Extended Care: Patients Treated1— Fiscal Years 1972-1981
Fiscal Years Total Hospitals Domiciliaries Nursing Homes
Total VA Medical Centers— Hospital Care Component 3 Non-VA State Total VA Medical Centers— Domiciliary Care Component 2 State Total VA Medical Centers— Nursing Home Care Component Community State
1981 1,360,256 1,284,196 1,248,502 30,351 5,343 24,179 14,877 9,302 51,881 13,554 28,242 10,085
1980 1,359,269 1,282,966 1,247,516 29,456 5,994 24,966 15,180 9,786 51,337 12,750 28,536 10,051
1979 1,342,161 1,265,712 1,230,252 29,268 6,192 27,077 16,541 10,536 49,372 12,283 27,807 9,282
1978 1,342,164 1,266,650 1,228,755 31,418 6,478 27,772 17,275 10,497 47,741 11,671 26,966 9,074
1977 1,322,773 1,249,011 1,209,763 32,516 6,732 28,455 18,005 10,450 45,307 11,317 25,358 8,632
1976 1,287,087 1,214,981 1,178,894 29,273 6,814 29,952 18,408 11,544 42,154 10,941 22,998 8,215
1975 1,220,107 1 j 49,444 1,113,873 28,604 6,967 30,550 18,488 12,062 40,113 10,532 21,749 7,832
1974 1,140,750 1,072,125 1,043,293 21,899 6,933 32,374 19,922 12,452 36,251 10,324 18,137 7,790
1973 1,081,965 1,014,383 985,351 21,877 7,155 34,793 22,094 12,699 32,789 9,535 16,287 6,967
1972 944,189 876,274 846,298 22,735 7,241 38,322 26,436 11,886 29,593 8,586 14,789 6,218
1 Fiscal year data based on number of discharges and deaths during year plus number of patients on the rolls at the end of the year.
2 Includes restoration center program data for fiscal year 1972.
3 Beginning with FY 1973, patients coming to VA hopsitals for chronic dialysis are considered inpatients. There were 232,644 patients treated for one day during fiscal year 1981.
131
132
HEALTH CARE TABLE 10
Inpatient and Ambulatory Care: Program Summary—Fiscal Year 1981
Inpatient Care — Patients Treated Ambulatory Care
Hospitals Nursing Homes Domiciliaries Medical Visits Dental Care
VA VA VA VA Staff Fee Basis
Locat,onof , Medical Medical ---------------------
VA Facility Medical _
Centers- State Centers- comrnu. State Centers- State Fee Treat- Net
Hospital Non-VA Home Nursing njty Home Domicili- Home VA Basis ment Cases
Care 13 Home 12 13 ary 13 Staff 1 4 Exami’ Cases Author
Compo- Care Care nati°nS Com- ized
nent CompO‘ Compo' pleted * 5
nent nent
All facilities - Total.................. 1,248,502 30,351 5,343 13,554 28,242 10,085 14,877 9,302 15,825,064 2,104,486 90,406 85,982 90,661
Alabama:
Birmingham............................... 13,231 .... ....... ....... 225 ..... ...... ....... 113,926 .... 2,043 2,067 ....
Montgomery................................ 3,193 299 ............ 34 .................... 40,266 39,445 595 668 958
Montgomery.............................. 3,193 299 ............ 34 .................... 33,248 39,445 595 668 958
Mobile................................................................................ 7,018 ..... ...... ....... ......
Tuscaloosa ............................... 4,377 8 .... 158 108 .................... 53,463 ..... 558 519 ....
Tuskegee.................................. 6,203 ............ 140 62 .................... 39,606 ..... 147 146 ....
Alaska: Anchorage................................. 4,055 ............ 31 ................... 743 12,939 ............ 335
Arizona:
Phoenix ................................... 9882 254 .... 174 498 .................... 115,885 28,504 1,183 1,462 1,346
Prescott ............................. 3 730 .................... 28 ..... 399 ..... 29,578 ..... 148 1 44 ....
Tucson.................................... 9,679 97 .... 60 232 .................... 121,410 ..... 245 241 ....
Arkansas:
Fayetteville............................... 3856 ................... 48 .................... 27,795 .... 294 345 ....
Little Rock.............................. 19,303 391 .... 249 262 ............ 121 160,714 42,100 701 623 1,166
Little Rock............................ 19,303 391 .... 249 262 .................... 99,607 42,100 676 413 1,166
No. Little Rock.................................................................................... 61,107 .... 25 210 ....
California:
Fresno.................................... 5,395 1 ........... 166 .................... 65,137 .... 168 320 ....
Livermore................................. 2,220 ................... 68 .................... 30,390 .... 219 221 ....
Loma Linda................................ 9,602 131 .... 204 173 .................... 130,735 .... 1,122 917 ....
Long Beach............................... 18,743 ............ 429 508 .................... 342,834 .... 1,815 314 ....
Los Angeles — Brentwood .................. 3,194 .... ....... ...... 130 ..... ...... ....... 161,172 .... 35 88 ....
Los Angeles - Wadsworth ................. 15,847 ................... 397 ..... 629 ..... 205,723 .... 524 394 ....
Los Angeles...................................... 860 .......................................... 173,122 88,132 1,343 976 4,681
Martinez.................................. 7,227 31 ........... 114 .................... 174,063 ..... 927 928 ....
Martinez................................ 7,227 31 ........... 114 .................... 94,915 .... 235 238 ....
Oakland............................................................................................ 30,944 ...........................
Sacramento........................................................................... 48,204 .... 692 690 ....
Palo Alto ............................... 12,530 5 .... 462 173 .................... 184,386 .... 477 516 ....
Palo Alto Div.......................... 12,530 5 .... 462 173 .................... 100,030 .... 419 465 ....
Menlo Park Div ...................................................................... 84,356 .... 58 51 ....
San Diego................................ 14,531 133 .... 187 88 .................... 201,742 8,803 3,346 1,882 2,178
San Diego (La Jolla Village Dr.)....... 14,531 133 .... 187 88 .................... 143,646 8,803 1,132 1,109 ....
San Diego (Camino Del Rio No.)...................................................... 58,096 .... 2,214 773 2,178
San Francisco ........................... 10,220 1,031 1,260 .... 185 826 .... 1,308 188,917 93,107 445 508 10,540
Sepulveda................................ 11,734 ............ 286 148 .................... 189,672 .... 1,096 1,172 ....
Colorado:
Denver................................... 12,068 168 ........... 246 198 .... 116 141,797 14,078 544 751 1,280
Ft. Lyon.................................. 1,216 12 ..... 47 54 ................... 23,061 .... 48 47 ....
Grand Junction ........................... 2,406 ............ 64 76 .................... 18,050 .... 106 100 ....
133
Connecticut:
Newington ................................ 4,043 48 843 .... 121 ............ 905 53,715 22,694 567 490 433
West Haven............................... 11,394 ............ 96 122 ................... 108,190 .... 696 699 ....
Delaware: Wilmington........................ 4,406 47 111 225 285 .... 30 43,377 3,509 466 544 83
District of Columbia:
Washington............................. 17,913 41 ........... 188 ............ 572 176,927 1,736 1,066 677 2,554
Florida:
Bay Pines............................. 9 602 2,518 .... 300 801 ..... 413 ..... 176,598 137,727 2,537 1,826 5,878
Bay Pines............................... 9,602 2,518 .... 300 801 .... 413 ..... 77,950 137,727 652 1,000 ....
Ft. Myers.......................................................................................... 25,312 .... 1,207 151 ....
St. Petersburg .................................................................................... 73,336 .... 678 675 5,878
Gainesville.............................. 13,393 15 ........... 222 .................... 146,836 .... 905 889 ....
Gainesville............................ 13,393 15 ........... 222 .................... 103,153 .... 192 217 ....
Jacksonville....................................................................................... 43,683 .... 713 672 ....
Lake City................................. 7,789 3 48 61 26,273 196 178 ....
Miami...................................... 17,246 494 191 331 282,259 1,863 1,964 ....
Miami.................................... 17,246 494 191 331 232,007 1,036 1,059 ....
Riviera Beach...................................................................................... 50,252 .... 827 905 ....
TamPa.................................... 21,509 58 ............ 570 .................... 200,290 .... 1,221 1,555 ....
TamPa.................................. 21,509 58 ............ 570 .................... 139,519 .... 679 870 ....
Orlando ........................................................................................... 60,771 .... 542 685 ....
Georgia:
Atlanta.................................. 13,277 416 ........... 380 .................... 159,860 47,472 864 1,043 3,801
Augusta ................................. 11,139 25 .... 53 288 357 ........... 95,303 .... 623 602 ....
Forest Hills Div ...................... 11,139 25 .... 53 288 ................... 66,470 .... 509 498 .....
Lenwood Div........................................................................................ 28,833 .... 114 104 .....
Dublin.................................... 5,282 ............ 117 94 256 538 437 22,139 .... 136 150 ....
Hawaii: Honolulu.................................. 2,082 ............ 48 .................... 49,186 7,985 379 560 430
Idaho: Boise ........................... 3,320 309 ............ 120 109 .... 258 47,882 18,308 483 517 877
Illinois:
Chicago (LakeSide) ...................... 12,376 18 ........... 339 .................... 131,190 .... 121 113 ....
Chicago (West Side) .................. 7,614 283 ........... 300 ................... 199,175 59,988 1,092 1,058 1,626
Danville ................................. 5,222 ............ 165 133 ................... 61,414 .... 244 220 ....
Danville ............................... 5,222 ............ 165 133 ................... 39,386 .... 144 123 ....
Peoria............................................................................................. 22,028 .... 100 97 ....
Hines.................................... 22,586 ................... 655 ................... 213,430 .... 277 244 ....
Marion.................................... 3,711 24 ........... 187 .................... 46,914 .... 266 245 ....
Marion.................................. 3,711 24 ........... 187 ................... 22,988 .... 266 245 ....
Evansville.......................................................................... 23,926
North Chicago............................. 6,798 ............ 235 309 .................... 104,083 .... 197 293 ....
Indiana:
Ft. Wayne................................. 3,155 ............ 77 130 .................... 19,661 .... 196 157 ....
Indianapolis............................. 12,035 311 .... 132 188 227 .... 116 106,188 67,720 736 689 558
Cold Spring Road Div............................................................................... 16,531 ...........................
West 10th Street Div................... 12,035 311 .... 132 188 .................... 89,657 67,720 736 689 558
Marion.................................... 2,961 ............ 90 122 .................... 29,597 .... 150 198 ....
Iowa:
Des Moines................................ 5,772 66 268 ..... 227 512 .... 169 76,720 25,635 361 341 819
Iowa City................................ 11,403 197 503 ..... 323 857 .... 223 65,567 .... 202 235 ....
Knoxville ................................ 1,846 ............ 244 92 .................... 27,678 .... 88 85 ....
Kansas:
Leavenworth............................... 5,468 ............ 61 145 ..... 1,735 ..... 27,632 .... 150 133 ....
Topeka.................................... 5,490 ............ 96 141 .................... 89,507 ..... 356 338 ....
Wichita................................... 4,364 89 ............ 63 72 .... 69 44,198 15,118 349 374 451
Kentucky:
Lexington................................ 12,834 64 190 246 .................... 102,134 .... 323 339 ....
Leestown Div........................... 12,834 64 .... 190 246 .................... 36,524 .... 42 70 ....
Cooper Dr. Div..................................................................................... 65,610 ..... 281 269 ....
Louisville ............................... 7,848 126 ............ 224 .................... 79,136 15,849 692 889 532
See footnotes at end of table.
134
HEALTH CARE TABLE 10—Continued
Inpatients and Ambulatory Care: Program Summary—Fiscal Year 1981
Inpatient Care—Patients Treated Ambulatory Care
Hospitals Nursing Homes Domiciliaries Medical Visits Dental Care
VA VA VA Staff Fee Basis
Location of VA .. . .. .. .
... c ..._ ,, ,. , Medical Medical ----------------------
VA Facility Medical Centers- Centers-
Centers— ... State Commu- State . ... State Fee Treat- Net
Hospital NonVA Home Nuurs,ng nity Home Dom,C,,,■ Home Basis c . ment Cases
Care 13 Home 12 13 arY 13 Staff * 4 Examl’ Cases Author-
Comoo- Care „ nati°nS Com- ized
™nP° ComP°- ComP°- pleted 1 5
nent nent
Louisiana:
Alexandria ............................... 6,043 2 .... 129 124 .................... 29,190 .... 141 151 .....'
New Orleans ............................. 12,777 149 ............ 167 ............ 152 211,106 40,149 845 673 546
New Orleans............................ 12,777 149 ........... 167 .................... 182,986 40,149 457 511 546
Baton Rouge........................................................................................ 28,120 ..... 388 162 .....
Shreveport ............................ 9,652 62 ............ 171 .................... 72,813 14,366 612 592 558
Maine: Togus................................ 7,594 136 ..... 70 120 .................... 42,450 24,766 374 350 524
Maryland:
Baltimore................................. 6,734 105 ........... 96 .................... 161,681 9,804 590 777 425
Baltimore (Loch Raven) ................. 6,734 105 ........... 96 .................... 99,634 9,804 159 142 .....
Baltimore (Federal Building)....................................................................... 62,047 ..... 431 635 425
Ft. Howard................................ 2,126 ............ 58 88 .................... 18,561 ..... 34 35 .....
Perry Point............................... 2,907 ............ 103 41 .................... 40,485 ..... 96 96 .....
Massachusetts:
Bedford .................................. 3,428 8 .... 208 130 .................... 104,326 ..... 273 266 .....
Boston................................... 14,440 1 ........... 214 .................... 166,738 ..... 53 124 .....
Boston (So. Hunting Ave.).............. 14,440 1 ........... 214 .................... 136,164 ..... 53 124 .....
Lowell............................................................................................. 30,574 ...........................
Boston (Cort Street)............................. 407 1,646 ............ 234 .... 614 195,408 53,506 1,496 1,360 696
Brockton ................................. 4,392 ............ 130 111 .................... 100,964 ..... 740 671 .....
Northampton............................... 2,464 34 208 66 97 371 .... 70 82,274 ..... 474 481 .....
Northampton............................. 2,464 34 ..... 66 97 .................... 59,870 ..... 474 481 .....
Springfield ...................................................................................... 22,404
West Roxbury.............................. 4,592 .................... 18 .................... 59,565 ..... 230 343 .....
West Roxbury............................ 4,592 ................... 18 .................... 39,158 ..... 230 343 .....
Worcester......................................................................................... 20,407
Michigan:
Allen Park............................... 12,761 290 .... 99 232 695 .... 227 181,826 43,158 757 242 2,190
Ann Arbor ............................... 12,657 .................... 205 .................... 102,591 ..... 423 513 .....
Ann Arbor ............................. 12,657 ................... 205 .................... 70,826 ..... 129 229 .....
Toledo, OH......................................................................................... 32,009 ..... 294 284 .....
Battle Creek ............................. 4,653 ............ 243 141 .................... 95,387 ..... 941 884 .....
Battle Creek ........................... 4,653 ............ 243 141 .................... 71,450 ..... 148 178 .....
Grand Rapids....................................................................................... 23,937 ..... 793 706 .....
Iron Mountain............................. 4,517 51 ..... 172 43 ............ 47 21,530 4,212 76 63 503
Saginaw .................................. 4,429 ............ 69 171 .................... 32,177 .... 308 347 .....
Minnesota:
Minneapolis.............................. 19,255 346 ........... 547 180 .... 685 222,923 45,050 1,274 943 4,437
Minneapolis............................ 19,255 346 ............ 547 .................... 190,102 45,050 1,274 943 4,437
St. Paul........................................................................................... 32,821 ............................
St. Cloud ................................ 3,268 ............ 50 151 .................... 49J16 ..... 247 241 .....
Mississippi:
Biloxi.................................... 7,455 ............ 42 246 ..... 789 ..... 70,808 ..... 368 332 .....
Biloxi Div.............................. 7,455 ............ 42 246 ..... 789 ..... 37,486 ..... 253 224 .....
Gulfport Div....................................................................................... 33,322 ..... 115 108 .....
Jackson ................................. 14,967 109 ..... 137 127 .................... 80,553 25,574 442 494 1,299
See footnotes at end of table.
Missouri:
Columbia ................................. 7,576 193 .... 68 141 ................... 61,440 .... 134 133 .....
Kansas City............................. 11,811 106 ............ 259 ................... 115,639 27,716 467 477 493
Poplar Bluff.............................. 4,224 ............ 109 132 ................... 28,088 .... 211 221 .....
St. Louis................................ 14,940 36 .... 112 330 247 ..... 143 211,967 10,005 639 645 668
John Cochran Div....................... 14,940 36 .... 112 330 ................... 157,836 10,005 466 487 668
Jefferson Barracks Div.,............................................................................ 54,131 .... 173 158
Montana:
Ft. Harrison.............................. 3,168 246 ............ 94 58 ..... 85 15,425 25,761 82 71 690
Miles City................................ 2,012 ........... 36 58 ................... 11,186 .... 25 27 .....
Nebraska:
Grand Island.............................. 2,778 3 .... 68 11 609 ..... 215 17,212 .... 93 100 .....
Lincoln................................... 4,621 47 ............ 66 ................... 37,960 11,696 234 252 .....
Omaha..................................... 8,118 16 ............ 211 ................... 77,845 .... 354 506 333
Nevada:
Las Vegas............................................................................................ 51,860 .... 534 532 .....
Reno...................................... 4,418 57 .... 34 52 ................... 51,340 3,405 360 362 46
New Hampshire: Manchester.................. 3,671 107 ..... 326 99 108 ........... 53,910 16,266 548 456 498
New Jersey:
East Orange.............................. 15,415 136 .... 81 355 324 .... 97 180,518 35,155 1,026 865 831
East Orange............................ 15,415 ............ 81 355 ................... 114,779 35,155 1,026 865 831
Newark.......................................... 136 .......................................... 65,739 ...........................
Lyons..................................... 4,135 ............ 118 82 ................... 43,953 .... 244 295 .....
New Mexico: Albuquerque..................... 8,894 147 ..... 111 211 ................... 111,140 19,700 883 901 978
New York:
Albany.................................... 9,147 58 .... 148 71 ................... 113,743 25,714 351 399 711
Batavia................................... 2,260 .................... 22 ................... 71,958 .... 173 192 .....
Batavia................................. 2,260 .................... 22 ................... 24,229 .... 173 192 .....
Rochester........................................................................................... 47,729 ...........................
Bath...................................... 1,511 23 .... 266 35 .... 786 .... 14,578 800 133 100 6
Bronx.................................... 15,117 .................... 87 ................... 138,818 .... 294 294 .....
Brooklyn ................................ 18,082 4 .... 469 84 ................... 184,405 .... 391 371 .....
Brooklyn Div........................... 18,082 ............ 469 84 ................... 159,306 .... 295 287 .....
St. Albans Div...................................................................................... 25,099 .... 96 84 .....
Brooklyn .......................................... 79 .......................................... 107,224 1,984 989 1,066 39
Buffalo.................................. 14,218 130 .... 64 98 ................... 157,229 22,952 900 920 159
Canandaigua.............................. 3,064 ........... 132 15 ................... 38,922 .... 175 197 .....
Castle Point.............................. 2,998 ........... 157 20 ................... 24,284 .... 203 281 .....
Montrose ................................ 4,465 ............ 156 13 ................... 78,209 .... 488 373 .....
New York................................ 14,144 370 ............ 59 ................... 291,522 20,824 1,189 2,225 887
New York (First Ave.)................. 14,144 .................... 59 ................... 124,941 20,824 1,189 2,225 887
New York........................................ 370 .......................................... 166,581 ...........................
Northport............................... 11,872 ................... 66 ................... 184,273 .... 856 781 .....
Syracuse.................................. 5655 138 .... 68 43 127 ..... 98 87,037 43,913 634 463 781
North Carolina:
Ashevil,e................................. 8,683 25 .... 114 148 ................... 73,345 .... 345 348 ....
Durham .................................. 10,100 ................... 172 ................... 96,373 .... 274 362 .....
Fayetteville........................... 5,654 ........... 59 143 ................... 55,851 .... 323 368 .....
SalisburV................................ 5,840 186 .... 145 107 ................... 79,228 60,907 600 579 2,308
Salisbury............................ 5,840 ........... 145 107 ................... 54,327 60,907 311 383 ....
Winston-Salem.................................. 186 .......................................... 24,901 .... 289 196 2,308
North Dakota: Fargo...................... 4,551 364 .... 111 96 ............ 147 27,131 31,775 244 271 611
Ohio:
Chillicothe ........................... 5,409 ............ 188 415 ................... 46,720 .... 201 146 ....
Cincinnati................................ 9,873 136 .... 325 208 ................... 108,131 11,231 302 367 1,085
Cleveland ............................... 16,611 130 ..... 152 357 336 ..... 598 229,658 43,231 1,142 1,311 483
Wade Park Div......................... 16,611 130 ..... 152 357 ................... 137,336 43,231 584 721 ....
Brecksville......................................................................................... 65,843 .... 393 536 483
03,1X0,1 ........................................................................................... 26,479 .... 165 54 ....
Columbus.......................................... 160 .......................................... 50,688 23,768 379 198 635
Columbus (Clinic Dr.).......................... 160 .......................................... 42,129 23,768 379 198 635
Columbus............................................ _ _ _ 8 55g
Dayton.................................... 6,931 ............ 372 142 .... 1,240 ’...... 52,997 446 407 ......
135
136
HEALTH CARE TABLE 10 -Continued
Inpatient and Ambulatory Care: Program Summary—Fiscal Year 1981
Inpatient Care—Patients Treated Ambulatory Care
Hospitals Nursing Homes Domiciliaries Medical Visits Dental Care
Location of VA VA VA VA Staff Fee Basis
VA Facility Medical Medical Medical ----------------------
Centers- State Centers- commu. State Centers- State Fee Treat- Net
Hospital N°,"-2VA Home Nours'"9 nity Home Domicili' Home VA Basis c ment Cases
Care 1 3 H°me 12 13 ar* ' 3 Staff . 4 Exam.- Ca$es Authof
rnmnn. Care Care nations „ . .
uompo Com- .zed
nent ComP°- ComP°- p|eted ' 5
nent nent
Oklahoma:
Muskogee................................... 4,225 150 ............ 176 .................... 82,137 21,903 1,071 1,145 866
Muskogee................................. 4,225 150 ............ 176 .................... 43,045 21,903 459 489 866
Tulsa................................................................... 326 .................... 39,092 .... 612 656 .....
Oklahoma City............................. 13,780 9 615 ............ 1,178 .... 777 136,043 .... 649 571 .....
Oregon:
Portland.................................. 16,145 538 ............ 566 .................... 144,034 48,569 543 458 1,490
Portland (Marquam Hill) ................ 16,145 538 ............ 566 .................... 73,639 48,569 368 295 1,490
Vancouver............................................................................................. 42,595 .... 175 163 .....
Portland (SW. Stark St.).............................................................................. 27,800 ............................
Roseburg .................................. 3,796 1 .... 110 224 .................... 38,236 .... 86 80 ....
White City.......................................... 92 ............................ 1,812 .... 6,892 .... 93 104 .....
Pennsylvania:
Altoona ................................... 2,170 122 .... 62 62 76 .... 116 19,844 18,434 182 199 425
Butler..................................... 2,990 7 145 67 30,883 3,174 346 310 109
Coatesville................................ 4,123 14 82 328 52,310 3,893 101 111 43
Erie....................................... 2,889 64 .... 60 44 94 .... 104 29„435 4,642 184 168 143
Lebanon.................................... 3,152 95 158 69 53,988 29,731 159 177 503
Lebanon.................................. 3,152 95 158 69 42,713 29,731 159 177 503
Harrisburg............................................................................................ 11,275 ............................
Philadelphia.............................. 9,649 520 ............ 270 .................... 264,579 49,237 1,223 1,165 713
Philadelphia (Univ. & Woodland Ave.) .... 9,649 520 ............ 270 .................... 169,459 49,237 .... 285 .....
Philadelphia (Cherry St.)............................................................................. 95,120 .... 1,223 880 713
Pittsburgh (Highland Dr.).................. 3,084 30 ............ 107 .................... 52,476 5,361 408 478 117
Pittsburgh................................ 11,979 29 .... 309 307 .................... 133,166 11,324 347 413 108
Pittsburgh (Univ. Dr.) Div ............. 11,979 29 .... 309 307 .................... 115,969 11,324 281 323 108
Aspinwall Div ......................................................................................... 3,197 ..... 66 90 .....
Pittsburgh (Liberty Ave.)............................................................................. 14,000 ............................
Wilkes-Barre .............................. 5,706 202 ............ 141 .................... 114,561 29,735 1,637 1,779 533
Wilkes-Barre ............................ 5,706 202 ............ 141 .................... 82,991 29,735 1,312 1,256 533
Allentown............................................................................................. 31,570 ..... 325 523 .....
Philippines: Manila............................... 1,011 ........................................... 14,620 1,207 ............ 28
Puerto Rico:
SanJuan................................... 16,561 3,689 ............ 163 .................... 243,057 77,461 2,476 858 1,926
SanJuan................................. 16,561 3,689 ............ 163 .................... 195,925 77,461 1,940 416 1,831
Mayaguez.............................................................................................. 47,132 ..... 536 442 95
Rhode Island:
Providence ................................ 8,387 136 ............ 130 330 .... 149 130,296 16,407 855 1,144 256
Providence .............................. 8,387 136 ............ 130 .................... 121,633 16,407 855 1,144 256
New Bedford, MA...................... ............................................................... 8 663
South Carolina:
Charleston................................. 6,959 ........................ 131 .................... 72,142 .... 460 459 .....
Columbia ................................... 9238 371 .... 219 185 180 ............ 100,956 26,424 1,472 1,465 1,527
Columbia ................................ 9,238 371 .... 219 185 .................... 77,446 26,424 610 559 1,527
Greenville............................................................................................ 23,510 ..... 862 906 .....
South Dakota:
Ft. Meade.............................. 3,494 6 ............ 29 .................... 32,967 ..... 141 136
HotSprings............................. 4,443 ................... 24 41 859 112 17,461 .... 44 53
Sioux Falls............................ 4,309 44 ..... 99 125 .................... 28,526 10,499 157 125 305
Tennessee:
MemPhis................................... 16,062 ............ 88 147 .................... 155,648 .... 676 748
Mountain Home.......................... 6 081 ............ 78 334 ..... 1,377 .... 49 198 ... 231 297
Murfreesboro........................... 2,100 ............ 73 73 .................... 26*407 .... 181 197 ......
Nashv,lle.............................. 14,347 430 ............ 201 .................... 135,101 20,260 562 563 2,281
Nashville............................ 14,347 430 ............ 201 .................... 97,533 20,260 562 563 2 281
Chattanooga ......................... ...................................................... 20 940
Knoxville ........................................... . , 16*628
Texas:
Amarillo............................... 3,457 9 ........... 99 .................... 26,882 .... 124 125
Big Spring............................. 3,783 ............ 146 156 .................... 20,951 .... 97 80 .....
Bonham................................. 1,941 ............ 140 132 ..... 407 .... 15,891 .... 265 268 .....
Dallas................................. 17,961 255 ............ 545 .................... 178,814 43,114 1,117 1,014 2,722
El Paso........................................... 817 ........................................... 42,459 12,472 605 566 688
Houston................................ 17,786 130 ..... 105 419 .................... 257,821 9,877 680 799 633
Houston.............................. 17,786 130 ..... 105 419 .................... 239,631 9,877 517 634 633
Beaumont............................................................................................ 18,190 .... 163 165 .....
Kerrville.............................. 4,981 ............ 45 170 .................... 27,177 ..... 22 43
Lubbock........................................... 241 ........................................... 29,302 15,049 414 200 479
Marlin ................................ 1,990 ................... 65 .................... 9,278 .... 70 52 .....
San Antonio ........................... 19,121 293 ............ 422 .................... 187,850 10,365 1,347 1,583 876
San Antonio (Merton Minter Blvd.) ... 19,121 293 ............ 422 .................... 134,293 10,365 960 1,277 876
Corpus Christi..................................................................................... 18,063
McAllen............................................................................................. 11,366 ...........................
San Antonio (Dwyer Ave.)............................................................................ 24,128 .... 387 306
Temple................................. 10,555 ............ 63 251 ..... 1,038 .... 74,152 .... 633 619 .....
Waco................................... 5,309 100 .... 121 145 .................... 95,108 15,579 387 474 724
Waco (Memorial Dr.).................. 5,309 ............ 121 145 .................... 89,046 15,579 387 474 724
Waco (No. Valley Mills Dr.) .................... 100 ..... ...... ....... ....... ...... ....... 6 062
Utah: Salt Lake City..................... 10,411 54 .... 72 278 ................... 109,310 9,613 594 660 222
Vermont: White River Junction............ 4,288 76 .... 153 64 265 ..... 36 52,796 11,446 282 265 191
Virginia:
HamPton ............................... 6,054 19 ..... 177 125 ..... 895 ..... 70,564 ..... 969 715
Richmond............................... 14,187 5 ............ 227 .................... 122,751 ..... 1,063 1,047 .....
Sa,em.................................. 8,219 266 ..... 199 171 .................... 117,896 43,059 504 427 2 285
Washington: '
American Lake (Tacoma)................. 2,893 149 ..... 94 61 .................... 50,664 .... 477 477
SeatJle................................ 8,364 508 ............ 418 360 .... 396 142,118 35,191 179 458 2,693
Spokane................................ 4,079 ................... 157 .................... 39,282 .... 417 410 .....
Walla Walla............................ 2,183 ................... 82 .................... 23,406 .... 107 88 .....
West Virginia:
BeckleV ............................... 5,307 ............ 59 96 .................... 25,086 595 142 187 .....
Clarksburg............................. 6,179 ................... 175 .................... 33,454 ..... 230 228 .....
Huntington............................. 3,085 65 ............ 230 .................... 42,858 18,040 198 261 977
Martinsburg............................ 6,170 3 ..... 157 211 ..... 854 .... 57,438 3,154 147 105 62
Wisconsin:
Madison................................ 9,344 ................... 110 573 .... 46 55,752 .... 62 64 .....
Tomah.................................. 3,101 ............ 123 88 .................... 34,656 .... 23 17 .....
Wood................................... 13,585 448 ..... 243 393 ..... 1,135 .... 210,360 45,964 1,658 481 2,601
Wyoming:
Cheyenne............................... 2,952 16 ..... 61 62 .................... 18,056 4,470 164 215 189
Sheridan............................... 1,963 30 ............ 57 ............. 64 19,710 .... 14 17
lAs reported by VA authorizing facility.
2 Authorized and paid for by VA.
3Supported by VA.
4 Medical visits to private physicians authorized by VA on a fee-for-service basis.
5 Net number of dental cases authorized by VA to private dentists on a fee-for-service basis.
137
HEALTH CARE
TABLE 11
Applications For Medical Care—Fiscal Years 1980—1981
Item FY 1981 FY 1980
Total applications 2,835,577 2,744,861
Pending determination of need at beginning of period 3,368 2,762
Received during period 2,832,209 2,742,099
Processed — Total 2,765,391 2,671,089
In need of care 2,437,719 2,298,880
Hospital care 904,478 898,849
Ambulatory care 1,523,610 1,391,052
Nursing home care 4,619 4,241
Domiciliary care 5,012 4,738
Not in need of care 327,672 372,209
Cancelled 65,900 71,260
Pending determination of need at end of period 1,893 3,788
Acceptance rate 88.2% 86.1%
HEALTH CARE
TABLE 12
Total Health Care: Operating Costs by Program
Cost (000)
Total Operating Costs............................................................................................................................... $6,642,163
Medical Care............................................................................................................................................... 6,446,985
Inpatient Care.......................................................................................................................................... 4,668,405
Hospitals............................................................................................................................................ 4,170,959
VA hospitals...................................................................................................................................... 4,078,563
Contract hospitals................................................................................................................................... 87,339
State home hospitals.................................................................................................................................. 5,057
Nursing homes.......................................................................................................................................... 399,295
VA nursing homes ................................................................................................................................... 242,955
Community nursing homes............................................................................................................................. 129,217
State nursing homes ................................................................................................................................. 27,123
Domiciliaries........................................................................................................................................... 98,151
VA domiciliaries..................................................................................................................................... 86,000
State domiciliaries ............................................................................................................................... 12,151
Outpatient care .................................................................................................................................... 1,248,327
CHAMPVA.................................................................................................................................................... 45,110
Education and training ................................................................................................................................... 335,356
Miscellaneous benefits and services....................................................................................................................... 149,787
Miscellaneous Operating Expenses.............................................................................................................................. 50,453
Medical administration .................................................................................................................................... 39,145
Post graduate & inservice training ......................................................................................................................... 9,637
Exchange of medical information ............................................................................................................................ 1,671
Medical & Prosthetic Research ............................................................................................................................... 144,725
Medical research.......................................................................................................................................... 134,257
Rehabilitative research..................................................................................................................................... 7,441
Health services research.................................................................................................................................... 3,027
138
TABLE 13
HEALTH CARE
VA and Non-VA Facilities: Average Costs—Fiscal Years 1980—1981
Type of Facility Average Cost per Patient Treated Average Cost per Patient Day
FY 1981 FY 1980 FY 1981 FY 1980
VA hospitals
All bed sections $3,267 $3,077 $168.36 $154.00
Medical bed sections 2,870 2,688 175.10 159.10
Surgical bed sections 3,270 3,101 228.38 208.65
Psychiatric bed sections 4,838 4,548 119.62 111.03
Non-VA (contract) hospitals 2,731 2,412 185.83 160.03
VA nursing home care units 17,925 17,169 81.72 75.40
Community nursing homes 4,429 4,043 41.05 36.97
VA domiciliaries 5,781 5,594 32.04 29.39
State homes
Hospital care 800 597 13.25' 10.52
Nursing home care 2,543 2,067 12.00 10.16
Domiciliary care 1,159 1,100 6.35* 5.501
1 Per diems reflect statutory limitations.
139
INPATIENT CARE
TABLE 14
VA Medical Centers—Hospital Care Component, Non-VA (Contract), and State Home Hospitals: Admissions, Discharges, and Remaining by Type of Hospital and Bed Section—Fiscal Yea: 1981
Item Type of Bed Section
Total Medical Surgical Psychiatric
ADMISSIONS1
All hospitals 1,217,342 2 738,620 2 308,631 2 165,604
VA medical centers — Total 1,183,458 ’720,449 ^305,076 157.933
Non-VA (contract) hospitals — Total 29,397 18,171 3,555 7,671
Federal government hospitals — Total . . . . 2,490 1,482 632 376
Army 2,020 1,026 628 366
Air Force 382 379 3
Navy 57 56 1
Public Health Service 23 19 4
Other1 2 3 8 2 6
State and local government hospitals 7,472 4,476 724 2,272
Non-Public hospitals 18,477 11,518 2,028 4,931
Foreign government hospital4 958 695 171 92
State home hospitals 4,487 (5) (5) (5)
DISCHARGES1 6
All hospitals 1,216,359 2720,103 2 320,056 2 171,749
VA medical centers — Total 1,182,384 701,934 316,493 163,957
Non-VA (contract) hospitals — Total .................................. 29,524 18,169 3,563 7,792
Federal government hospitals — Total 2,501 1,485 638 378
Army 2,033 1,031 634 368
Air Force 380 377 3
Navy 58 57 1
Public Health Service 22 18 4
Other3 8 2 6
State and local government hospitals 7,493 4,473 724 2,296
Non-Public hospitals 18,587 11,525 2,036 5,026
Foreign government hospitals4 943 686 165 92
State home hospitals 4,451 (s) (5) (5)
BED OCCUPANTS REMAINING
Total occupants remaining on September 30, 1981 67,136 2 32,251 2 12,887 221,106
VA medical centers - Total 65,420 32,049 12,824 20,547
Non-VA (contract) hospitals — Total 824 202 63 559
Federal government hospitals — Total 85 44 27 14
Army 75 34 27 14
Air Force 9 9
Navy
Public Health Service 1 1
Other3
State and local government hospitals 65 22 7 36
Non-Public hospitals 625 97 24 504
Foreign government hospital4 49 39 5 5
State home hospitals 892 (5) (s) (5)
ABSENT BED OCCUPANTS REMAINING
Total absent bed occupants (i.e., patients on leave absence) remaining on September 30, 1981 701 137 163 401
VA medical centers — Total 698 136 163 399
All other hospitals 3 1 2
1 Excludes interhospital transfers for VA medical centers; includes transfers for all other hospitals.
2 Excludes State Home Hospitals; data by bed section.
3 U.S. health care facilities in the Canal Zone area; and St. Elizabeth Hospital,
Washington, D.C., which is operated by the Department of Health and Human
Services.
4 Veterans Memorial Medical Center, Manila, Republic of the Phillippines.
5 Data not available.
6 Includes deaths.
140
TABLE 15 INPATIENT CARE
VA Medical Centers—Hospital Care Component and Non-VA Hospitals: Patient Movement By Type of Bed Section—Fiscal Year 1981
Item VA Medical Centers Non-VA Hospitals
Total Patients Type of Bed Section* Total Patients Type of Bed Section
Medical1 2 Surgical Psychiatric Medical Surgical Psychiatric
Total on Rolls (bed occupants and patients on leave of absence) remaining on September 30,
1980 68,766 33,560 13,975 21,231 993 199 66 728
Gains —Total 1,356,795 810,084 361,880 184,831 29,445 18,189 3,575 7,681
Admissions 1,183,458 720,449 305,076 157,933 29,397 18,171 3,555 7,671
Transfers in from other hospitals3 29,177 12,893 9,113 7,171 (4) (4) (4) (4)
Change in bed section (+) 144,160 76,742 47,691 19,727 48 18 20 10
Losses — Total 1,358,169 810,196 362,872 185,101 29,650 18,196 3,576 7,878
Regular discharges — Total 1,136,798 701,934 316,493 163,957 29,524 18,169 3,563 7,792
To Ambulatory Care 770,419 476,543 239,250 54,626 (5 6 *) (s) (s) (5)
Other 366,379 187,758 69,559 109,062 28,767 17,523 3,485 7,759
Deaths 45,586 37,633 7,684 269 757 646 78 33
Transfers out to other hospitals3 31,675 17,729 8,469 5,477 (5) (5) (5) (5)
Changes in bed sections (-) 144,110 90,533 37,910 15,667 126 27 13 86
Remaining on September 30,1981 — Total 66,118 32,185 12,987 20,946 827 203 63 561
Bed occupants 65,420 32,049 12,824 20,547 824 202 63 559
On leave of absence 698 136 163 399 3 1 2
Patients treated 67 1,248,502 734,119 329,480 184,903 30,351 18,372 3,626 8,353
Episodes of care8 Average daily census9 Total Excluding days while patients on authorized leave of absence of 96 hours or less .... 1,392,612 824,652 367,390 200,570 30,477 18,399 3,639 8,439
66,376 65,040 32,963 32,522 12,923 12,617 20,490 19,901 1,222 383 107 732
1 Beds are classified according to their intended use; patients are classified according to the classification of the beds they occupy, rather than on a diagnostic basis.
2Medical bed sections include medicine, neurology, intermediate care, spinal cord injury, medical rehabilitation, and blind rehabilitation.
3 Includes only patients transferred as VA beneficiaries.
^Included with the data on admissions.
5Included with the data on “other" regular discharges.
6 Based on the number of discharges and deaths during FY 1981, plus the number
remaining on the rolls on September 30, 1981. Interhospital and intrahospital
transfers are excluded.
7Patients coming to VA hospitals for chronic dialysis are considered to be inpatients; there were 232,644 such patients with one day duration of stay treated during the fiscal year.
8 Based on the number of discharges and deaths during FY 1981, plus the number remaining on the rolls on September 30, 1981. Interhospital transfers are excluded but intrahospital transfers are included.
9 Based on the number of patient days divided by the number of days in the fiscal year.
141
INPATIENT CARE TABLE 16
VA Medical Centers—Hospital Care Component and Non-VA Hospitals: Patient Movement By Type of Hospital—Fiscal Year 1981
Item VA Medical Centers-Hospital Care Component Non-VA (Contract) Hospitals
Total Type of Hospital
Federal Government* State and Local Government NonPublic Foreign Government1 2
Total on rolls (bed occupants and patients on
leave of absence) remaining on September 30, 1980 68,766 993 93 65 800 35
Gains — Total 1,356,795 29,445 2,499 7,482 18,485 979
Admissions 1,183,458 29,397 2,490 7,472 18,477 958
Transfers in from other hospitals3 29,177 (4) (4) (4) (4) (4)
Changes in bed section (+) 144,160 48 9 10 8 21
Losses —Total 1,358,169 29,650 2,510 7,502 18,674 964
Regular discharges — Total 1,182,384 29,524 2,501 7,493 18,587 943
To Ambulatory Care 770,419 (s) (s) (s) (5) 18,143 (’) 922
Other 366,379 28,767 2,401 7,301
Deaths Transfers out to other hospitals3 45,586 31,675 757 (s) 100 (5) 192 (s) 444 (5) 21 (5)
Changes in bed sections (—) 144,110 126 9 9 87 21
Remaining on September 30,1981 — Total 66,118 827 85 67 625 50
Bed occupants 65,420 824 85 65 625 49
On leave of absence 698 3 2
Patients treated 6 7 1,248,502 30,351 2,586 7,560 19,212 993
Episodes of care8 1,392,612 30,477 2,595 7,569 19,299 1,014
Average daily census9 914 45
Total 66,376 1,222 87 176
Excluding days while patients on authorized 65,040
leave of absence of 96 hours or less
1 Includes Department of Defense and Public Health Service hospitals, U.S. health care facilities in the Canal Zone area; and St. Elizabeths Hospital, Washington, D.C., which is operated by the Department of Health and Human Services.
2 Veterans Memorial Medical Center, Manila, Republic of the Philippines.
3Includes only patients transferred as VA beneficiaries.
* Included with the data on admissions.
5 Included with the data on “other" regular discharges.
6 Based on the number of discharges and deaths during the fiscal year, plus the
number on the rolls on September 30,1981.
7Patients coming to VA medical centers for chronic dialysis are considered to be inpatients; there were 232,644 such patients with one day duration of stay treated during the fiscal year.
8 Based on the number of discharges and deaths during FY 1981, plus the number remaining on the rolls on September 30, 1981. Interhospital transfers are excluded but intrahospital transfers (i.e., changes in bed sections) are included.
9 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
142
TABLE 17
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Selected Data —Fiscal Year 1981
Location Average Operating Beds1 Patients T reated Total 2 3 Episodes of Care4 Average Daily Census s
Total Bed Section6 Bed Section6
Medical 7 Surgical Psychiatric Medical 7 Su rgical Psychiatric
All hospitals8 82,079 40,501 17,533 24,045 1,248,502 842,381 375,859 205,949 66,376
Alabama:
Birmingham 398 186 213 13,231 8,974 5,708 296
Montgomery 186 158 28 3,193 3,099 578 153
Tuskegee 880 429 77 374 6,203 3,595 1,675 2,284 697
Tuscaloosa Arizona: 561 137 424 4,377 1,273 3,604 457
Phoenix 470 220 114 136 9,882 5,143 3,262 2,172 359
Prescott 211 132 48 30 3,730 2,442 1,105 439 149
Tucson 325 157 120 48 9,679 6,039 3,360 796 248
Arkansas:
Fayetteville 162 106 55 3,856 2,624 1,503 131
Little Rock 1,317 474 292 551 19,303 10,933 7,871 3,833 1,022
California:
Fresno 246 115 97 35 5,395 2,894 2,214 738 192
Livermore Loma Linda 133 431 92 197 41 166 68 2,220 9,602 1,621 6,435 682 3,302 842 96 345
Long Beach 1,177 766 261 150 18,743 13,254 4,600 1,959 862
Los Angeles (Brentwood) 450 30 420 3,194 321 3,155 393
Los Angeles (Wadsworth) Martinez 710 487 223 15,847 12,773 5,525 501
400 196 143 61 7,227 3,860 2,969 1,071 307
Palo Alto 1,277 405 135 736 12,530 6,583 2,756 4,428 1,039
San Diego 572 265 202 105 14,531 9,885 4,729 1,404 386
San Francisco 357 134 173 50 10,220 5,903 4,206 723 253
Sepulveda 650 318 123 209 11,734 8,403 2,148 2,010 457
Colorado:
Denver 368 109 172 86 12,068 6,656 4,563 1,549 289
Ft. Lyon 374 142 232 1,216 705 918 326
Grand Junction 110 58 26 26 2,406 1,598 684 321 91
Connecticut:
Newington 184 71 79 34 4,043 2,496 1,496 386 148
West Haven 641 351 156 134 11,394 8,598 3,062 1,009 489
Delaware: Wilmington 315 165 150 4,406 2,385 2,425 239
District of Columbia: Washington 708 327 201 180 17,913 14,468 3,178 1,763 603
Florida:
Bay Pines 673 396 151 126 9,602 6,049 3,439 1,635 572
Gainesville 463 157 216 90 13,393 6,553 6,261 1,281 380
Lake City 341 256 85 7,789 6,035 2,139 284
Miami 744 369 208 167 17,246 11,980 4,825 2,434 561
Tampa 697 299 248 150 21,509 15,067 5,865 2,014 545
Georgia:
Atlanta 493 205 192 96 13,277 8,305 4,085 1,461 408
Augusta 987 411 149 426 11,139 6,023 3,434 3,387 826
Dublin 348 312 36 5,282 5,231 937 270
Idaho: Boise 141 88 42 11 3,320 2,221 1,098 274 104
Illinois:
Chicago (Lakeside) 458 257 180 21 12,376 10,173 2,726 303 363
Chicago (West Side) 450 219 147 84 7,614 3,991 2,849 1,596 402
Danville 879 495 85 299 5,222 3,064 1,663 2,099 700
Hines 1,264 708 316 240 22,586 16,731 4,911 3,239 983
Marion 171 129 42 3,711 2,881 1,131 134
North Chicago 1,151 388 85 679 6,798 4,529 1,294 3,205 979
Indiana:
Ft. Wayne 133 89 44 3,155 3,311 1,082 105
Indianapolis9 479 195 188 96 12,035 7,530 4,529 1,139 386
Marion Iowa: 830 602 228 2,961 2,537 1,644 726
Des Moines 276 148 128 5,772 3,384 2,727 183
Iowa City 320 139 139 41 11,403 7,415 4,046 641 254
Knoxville Kansas: 436 120 316 1,846 690 1,789 385
Leavenworth 427 182 106 138 5,468 2,973 1,717 1,459 345
Topeka 872 332 57 483 5,490 2,921 1,362 2,160 711
Wichita Kentucky: 159 85 74 4,364 3,251 1,401 128
Lexington10 91f 492 130 289 12,834 8,774 3,910 2,194 784
Louisville 389 173 167 49 7,848 4,110 3,491 1,027 294
Louisiana:
Alexandria 357 212 106 39 6,043 4,524 2,227 595 280
New Orleans 481 217 181 84 12,777 8,753 3,848 1,057 397
Shreveport 402 189 142 71 9,652 5,056 3,611 1,451 297
Maine: Togus 525 185 78 261 7,594 3,898 1,587 2,905 450
Maryland:
Baltimore 284 135 109 40 6,734 3,618 2,436 1,332 207
Ft. Howard 226 209 17 2,126 2,072 229 198
Perry Point Massachusetts: 847 451 395 2,907 2,351 1,558 715
Bedford 748 337 22 389 3,428 1,936 191 2,168 688
Boston 777 405 286 86 14,440 11,416 6,136 955 585
Brockton 822 345 12 465 4,392 2,075 131 2,812 737
See footnotes at end of table.
143
INPATIENT CARE
TABLE 17—Continued
VA Medical Centers—Hospital Care Component: Selected Data—Fiscal Year 1981
Location Average Operating Beds* Patients Treated Total 2 3 Episodes of Care4 Average Daily Census 5
Total Bed Section6 Bed Section6
Medical Surgical Psychiatric Medical 7 Surgical Psychiatric
Northampton 593 270 323 2,464 1,451 1,618 510
279 202 77 4,592 3,181 2,049 200
Michigan:
Allen Park 536 266 150 120 12,761 9,190 3,045 1,611 428
Ann Arbor 314 139 89 86 12,657 9,756 3,313 1,145 255
908 382 526 4 653 1 936 3,814 805
Iron Mountain 204 121 83 4 517 3,340 1.352 144
Saginaw 156 111 44 4,429 3,274 1,283 118
Minnesota:
Minneapolis 738 321 318 99 19,255 11,886 7,420 1,427 563
St. Cloud 819 417 402 3,268 1,720 2,452 698
Mississippi:
Biloxi 824 261 73 490 7,455 2,616 2,440 3,257 733
Jackson 460 221 169 70 14,967 10,252 4,115 1,199 381
Missouri:
Columbia 368 167 141 60 7,576 4,160 3,646 543 258
Kansas City 420 178 153 89 11,811 7,550 4,343 1,205 375
Poplar Bluff 176 123 43 10 4,224 3,031 1,097 358 138
St. Louis 853 395 203 255 14,940 9,884 4,142 2,981 682
Montana:
153 100 54 3 168 2,296 1,097 106
94 64 30 2’012 1,536 547 54
Nebraska:
162 118 44 2 778 2 283 655 109
Lincoln 176 57 66 53 4,621 2,404 1,481 1,310 130
Omaha 379 189 123 67 8,118 5,497 2,669 1,028 298
Nevada: Reno 178 88 70 20 4,418 2,587 2,025 399 123
154 97 58 3,671 2,333 1,497 141
New Jersey:
East Orange 890 555 222 113 15,415 11,782 3,698 1,564 754
Lyons 1,193 486 28 679 4,135 1,999 559 3,033 1,064
New Mexico: Albuquerque 339 143 134 62 8,894 5,494 3,319 861 263
New York:
Albany 668 363 179 126 9,147 5,317 3,269 1,689 553
239 209 30 2 260 2 344 592 210
Bath 208 197 11 1,511 1 560 186 196
Bronx 702 391 247 63 15,117 11,429 3,541 861 517
Brooklyn” 1 001 619 266 116 18 082 13 935 3,519 1,784 789
Buffalo 754 432 197 125 14,218 9'624 3’945 2,035 679
Canandaigua 944 528 416 3,064 1,746 2,030 817
Castle Point 236 170 66 2 998 1 991 1,275 195
Montrose 1 277 457 820 4,465 1,789 3,881 1,096
New York 865 364 355 145 14J44 8,200 4,922 1,940 681
Northport 912 360 158 394 11,872 9,729 3,129 2,410 782
Syracuse 368 138 166 64 5,655 2,838 2,807 484 252
North Carolina:
Asheville 530 348 152 30 8,683 5,741 3,460 575 456
Durham 459 184 205 70 10,100 5,801 4,257 841 365
Fayetteville 300 196 73 31 5,654 4,036 1,553 416 250
Salisbury 853 359 40 455 5,840 2,817 861 3,134 760
210 143 67 4,551 3,782 1,206 146
Ohio:
840 473 367 5 409 4,858 2 742 734
Cincinnati 387 132 171 84 9,873 6,086 3,506 981 278
Cleveland 1,316 469 252 595 16,611 10,472 3,677 4,059 993
Dayton 538 333 161 45 6,931 4,485 2,162 910 437
Oklahoma:
207 115 92 4,225 2 878 1 589 138
Oklahoma City 423 169 154 100 13'780 1o’o6O 4,052 1,527 304
Oregon:
Portland 759 422 261 76 16,145 11,145 5,343 1,206 541
Roseburg 342 161 22 159 3,796 2,660 715 1,358 282
Pennsylvania:
143 108 35 2 170 1 582 786 118
320 320 2,990 3,125 248
Coatesville 1,088 320 769 4,123 1,049 3,664 963
Erie 131 94 36 2,889 1,975 1,288 116
Lebanon 825 398 29 398 3,152 2’314 571 1,163 792
Philadelphia 432 200 198 34 9,649 6,496 3,485 549 364
Pittsburgh (Highland Drive) 771 308 463 3 084 1 341 2 666 666
Pittsburgh (University Drive)12 654 433 191 30 11 979 8 955 3 683 445 489
Wilkes-Barre 462 229 121 112 5,706 3J21 L552 1,507 379
Puerto Rico: San Juan 692 279 173 240 16,561 9,641 4,028 3,558 615
Rhode Island: Providence 342 219 84 39 8,387 7,174 1,788 420 250
South Carolina:
Charleston 267 132 99 36 6,959 3,988 2,769 666 211
Columbia 457 229 168 60 9,238 5,788 3,247 1,005 344
South Dakota:
Ft. Meade 379 212 17 150 3,494 1,410 757 1,693 322
Hot Springs 232 151 41 40 4,443 3,939 852 714 180
Sioux Falls 248 126 84 38 4,309 2,522 1,758 470 173
See footnotes at end of table.
144
TABLE 17—Continued
INPATIENT CARE
VA Medical Centers—Hospital Care Components: Selected Data—Fiscal Year 1981
Location Average Operating Beds1 Patients Treated Total 2 3 Episodes of Care1 2 3 4 5 Average Daily Census 5
Total Bed Section6 Bed Section6
Medical Surgical Psychiatric Medical 7 Surgical Psychiatric
Tennessee:
Memphis 882 499 203 180 16,062 9,807 5,673 1,717 680
Mountain Home 510 295 142 73 6,081 3,623 1,911 1,369 402
Murfreesboro 532 217 315 2,100 555 1 728 481
Nashville 480 229 205 46 14,347 10,925 4,230 727 379
Texas:
Amarillo 139 76 63 3,457 2 399 1 328 113
Big Spring 223 119 60 44 3783 2,428 1/99 1,170 142
Bonham 78 39 24 15 1,941 1,366 785 224 71
Dallas 708 308 253 147 17,961 10,959 6.091 2,051 535
Houston 1,050 458 238 354 17,786 10,419 6,270 3,302 896
Kerrville 304 241 63 4,981 4,091 1,231 220
Marlin 222 222 1 990 2 061 148
San Antonio 670 286 204 180 19J21 13,960 4,995 1,842 559
Temple 604 312 202 90 10,555 6,288 3,516 1,580 473
Waco 985 400 585 5 309 1 792 4 168 842
Utah: Salt Lake City 454 229 115 110 10,411 6,628 2,876 1,875 307
Vermont: White River Junction 193 94 79 20 4,288 2,448 1,730 307 151
Virginia:
Hampton 409 221 95 93 6,054 4,148 1,584 1,131 317
Richmond 756 503 188 65 14,187 10,844 3,902 959 576
Salem 745 289 76 380 8,219 4,285 2,324 4,115 632
Washington:
American Lake 450 144 306 2 893 1 546 1 687 370
Seattle 303 139 98 66 8764 5,567 2,545 857 250
Spokane 209 116 93 4,079 2,741 1,852 150
Walla Walla .... 130 105 25 2,183 1,924 578 104
West Virginia:
174 114 60 5 307 4 227 1 513 132
Clarksburg 216 93 86 37 6J 79 3’896 1748 773 179
131 73 58 3,085 1 957 1 458 109
Martinsburg 467 375 70 22 6,170 4754 1,595 388 409
Wisconsin:
Madison 353 179 153 20 9,344 6,493 3,187 300 244
798 428 370 3,101 1 867 2 008 684
Wood 739 356 237 146 13785 9,015 4,478 1751 560
Wyoming:
129 94 35 2,952 2,518 534 102
Sheridan 314 127 187 1,963 1,281 1,199 259
1 Based on the number of operating beds at the end of each month for 13 consecutive months (September 1980 - September 1981).
2 Based on the number of discharges and deaths during FY 1981, plus the number on the rolls (bed occupants and patients on authorized leave of absence) on September 30, 1981. Interhospital transfers are excluded from the overall total but are included in the individual hospital totals.
3 Beginning with FY 1973, patients coming to VA hospitals for chronic dialysis are considered to be inpatients; there were 232,644 such patients during FY 1981.
4 Based on the number of discharges and deaths during FY 1981, plus the number on the rolls (bed occupants and patients on authorized leave of absence) on September 30, 1981. Interhospital transfers are excluded from the overall totals but are included in the individual bed section totals. Intrahospital transfers (i.e., movement of patients from one type of bed section to another) are included in both the overall bed section totals and in the individual hospital bed section totals.
5 Based on total patient days during FY 1981 divided by the number of days in the fiscal
year.
6 Beds are classified according to their intended use; patients are classified according to the classification of the beds they occupy, rather than on diagnostic basis.
7Medical bed sections include medicine, neurology, intermediate care, spinal cord injury, medical rehabilitation, and blind rehabilitation.
8Data for the VA Medical Centers at Augusta (Lenwood), GA; Brecksville, OH; Gulfport, MS; Jefferson Barracks, MO; North Little Rock, AR; Palo Alto (Menlo Park), CA; and Vancouver, WA are included, respectively, with the data for the VA Medical Centers at Augusta, Cleveland, Biloxi, St. Louis, Little Rock, Palo Alto, and Portland, Oregon.
9Includes data for the two VA Medical Centers at Indianapolis, IN, (Cold Spring Road and West 10th Street).
10Includes data for the two VA Medical Centers at Lexington, KY. (Cooper Drive and Leestown).
"includes data for the VA Medical Centers at Brooklyn and St. Albans, NY.
12Includes data for the VA Medical Centers at Pittsburgh (University Drive) and Aspinwall, PA.
145
TABLE 18
INPATIENT CARE
Non-VA Hospitals1 : Selected Data—Fiscal Year 1981
Patients Treated4
Average Daily State and Remaining on
Location of Authorizing Admissions Discharges Federal Local Non-Public Sept. 30, 1981
VA Facility Census Total Hospitals Government Hospitals
Hospitals i
Total 1,222 29,397 29,524 30,351 3,579s 7,560 19,212 827
Medical Bed Sections 383 18,171 18,169 18,372 2,254 4,496 11,622 203
Surgical Bed Sections 106 3,555 3,563 3,626 835 731 2,060 63
Psychiatric Bed Sections 732 7,671 7,792 8,353 490 2,333 5,530 561
Alabama: 186 113
Montgomery 4 294 295 299 4
T uscaloosa 8 7 8 8 3,675 I
Alaska: Anchorage (RO) 84 3,981 4,042 4,055 173 207 13
Arizona: 36 218
Phoenix 6 251 251 254 3
Tucson 1 97 94 97 97 391 3
Arkansas: Little Rock 4 391 391 391
California:
Fresno 2 1 1 1
Loma Linda 2 127 131 131 131 615 •
Los Angeles (OPC) 16 860 860 860 245
Martinez 29 30 31 31 1
Palo Alto 1 4 4 5 5 130 1
San Diego 1 133 133 133 3
San Francisco 14 1,006 1,031 1,031 1 642 388
Colorado:
Denver 1 168 168 168 1 53 114
Fort Lyon 11 11 12 12 1
Connecticut: Newington 5 46 47 48 39 9 1
Delaware: Wilmington 1 47 47 47 47
District of Columbia: Washington 1 41 40 41 19 22 1
Florida: 1,507
Bay Pines 32 2,496 2,496 2,518 11 1,000 22
Gainesville 15 15 15 15
Lake City 3 3 3 494 3
Miami 9 493 491 494 58 3
Tampa 1 56 57 58 1
Georgia: Atlanta 5 415 415 416 1 415 1
25 25
Augusta 24 25 1,324 293 125 85
Hawaii: Honolulu (RO) Idaho: Boise 96 3 1,998 309 1,997 309 2,082 309 465 184
Illinois:
Chicago (L.S.) 18 18 18 18
Chicago (W.S.) 18 283 283 283 76 207
Marion 24 23 24 24 245 1
Indiana: Indianapolis 8 309 308 311 66 3
Iowa: 29
Des Moines 1 66 66 66 37
Iowa City 1 197 196 197 158 39 1
Kansas: Wichita 1 87 88 89 89 1
Kentucky: 64
Lexington 64 64 64
Louisville 2 126 126 126 1 88 37
Alexandria 2 2 2 2
New Orleans 5 148 149 149 21 128
Shreveport 1 62 62 62 2 60
Maine: Togus 2 136 136 136 136
Maryland: Baltimore 8 104 100 105 7 98 5
Massachusetts:
Bedford 8 7 8 8 1 1
Boston 1 1 1
Boston (OPC) 9 407 407 407 27 380
Northampton 1 34 31 34 34 3
Michigan: 169
Allen Park 9 290 290 290 121
Iron Mountain 1 51 51 51 51 210
Minnesota: Minneapolis 8 346 346 346 136
Mississippi: Jackson 3 109 108 109 78 31 1
Missouri: 193
Columbia 3 193 191 193 106 2
Kansas City 2 106 106 106
St. Louis 3 36 35 36 3 33 1
Montana: Ft. Harrison 4 246 245 246 246 1
Nebraska:
Grand Island 3 3 3 3
Lincoln 2 46 46 47 17 30 1
Omaha 16 15 16 14 2 1
Nevada: Reno 1 57 57 57 41 16
New Hampshire: Manchester 1 106 107 107 14 93
New Jersey: East Orange 3 135 132 136 6 130 4
New Mexico: Albuquerque 2 146 147 147 1 6 140
See footnotes at end of table.
146
TABLE 18—Continued
INPATIENT CARE
Non-VA Hospitals1 : Selected Data—Fiscal Year 1981
Location of Authorizing VA Facility Average Daily Census 2 Admissions Discharges 3 Patients Treated1 2 3 4 Remaining on Sept. 30, 1981 s
Total Federal Hospitals State and Local Government Hospitals Non-Public Hospitals
New York:
Albany 3 58 58 58 58
Bath 23 21 23 23 2
Brooklyn Brooklyn (OPC) Buffalo 4 4 4 4
3 79 79 79 72 7
2 122 129 130 35 95 1
New York 12 362 368 370 225 145 2
Syracuse 2 136 136 138 138 2
North Carolina:
Asheville 24 24 25 25 1
Salisbury 7 186 186 186 54 132
North Dakota: Fargo 7 360 350 364 257 107 14
Ohio:
Cincinnati 3 136 136 136 47 89
Cleveland 2 130 130 130 4 126
Columbus (OPC) 6 159 157 160 60 100 3
Oklahoma:
Muskogee 6 150 149 150 3 147 1
Oklahoma City 9 9 9 9
Oregon:
Portland 8 538 538 538 1 35 503
Roseburg 1 1 1
White City (DOM) 1 91 91 92 92 1
Pennsylvania:
Altoona 3 116 116 122 122 6
Butler 7 7 7 7
Coatesville 14 14 14 14
Erie 1 64 64 64 64
Lebanon 1 95 94 95 6 89 1
Philadelphia 9 516 518 520 12 65 443 2
Pittsburgh (UD) 1 26 29 29 6 23
Pittsburgh (PSY) 29 29 30 30 1
Wilkes-Barre 8 202 201 202 37 165 1
Philippines: Manila (RO) 50 972 957 1,011 3,689 136 993 18 54
Puerto Rico: San Juan 595 3,101 130 3,169 136 39 3,650 119 520
Rhode island: Providence 3 17
South Carolina: Columbia 9 366 370 371 152 219 1
South Dakota:
Ft. Meade 6 5 6 6 1
Sioux Falls 2 44 44 44 44
Tennessee: Nashville 8 429 429 430 228 202 1
Texas:
Amarillo 9 8 9 6 3 1
Dallas 5 254 255 255 143 112
El Paso (OPC) 23 794 794 817 555 76 186 23
Houston 2 130 130 130 38 92
Lubbock (OPC) 5 241 239 241 241 2
Marlin
San Antonio 6 287 291 293 79 31 183 2
Waco 4 100 100 100 ... 50 50
Utah: Salt Lake City 54 54 54 54
Vermont: White River Junction 2 69 76 76 76
Virginia:
Hampton 19 18 19 19 1
Richmond 5 5 5 5
Salem 12 261 263 266 6 260 3
Washington:
American Lake 3 147 145 149 141 6 2 4
Seattle 7 513 502 508 237 271 6
West Virginia:
Huntington 2 65 65 65 65
Martinsburg 3 3 3 3
Wisconsin: Wood 9 448 447 448 27 421 1
Wyoming:
Cheyenne 16 15 16 16 1
Sheridan 30 30 30 30
1 Excludes State Home hospitals.
2 Based on the number of patient days during the fiscal year divided by the number of days in the year.
3 Includes deaths.
4Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
5 Total on rolls (bed occupants and patients on authorized leave of absence).
6 993 patients ( 725 in medical, 170 in surgical, and 98 in psychiatric bed sections) treated in Non-Federal hospitals.
147
INPATIENT CARE
TABLE 19
VA Medical Centers—Hospital Care Component: Patients Remaining, Type of Patient, Percent Hospitalized in
Reported State of Residence1 —June 24, 1981
Type of Patient
All Patients
General Medical n . o , Psychotic Other and Surgical
Reported State of Residence Hospitalized Percent Percent Percent
in Same State Hospital- Hospital- Hospital-
Total Total ized In Total ized In Total ized In
State State State
T otal 65,450 56,969 87.0 36,972 88.1 17,508 85.1 10,970 86.4
United States .. * 64,810 56,349 86.9 36,573 88.1 17,329 85.0 10,908 86.4
1,351 1,172 86.8 707 86.8 444 87.4 201 85.1
6 6
Arizona * 750 683 91.1 529 91.7 74 81.1 147 93.9
Arkansas 1,119 996 89.0 733 88.9 209 88.5 177 89.3
California 4,761 4,681 98.3 3,042 98.8 862 97.1 857 98.0
Colorado 551 497 90.2 276 90.6 178 97.2 97 75.3
Connecticut 704 558 79.3 411 94.6 213 45.1 79 92.4
Delaware 268 171 63.8 177 94.4 71 5.6 21 ....
District of Columbia 342 285 83.3 213 97.7 83 43.4 46 89.1
Florida 2,415 2,115 87.6 1,676 95.7 346 53.2 393 83.2
Georgia 1,649 1,236 75.0 1,003 76.5 313 73.5 333 71.8
6 6 ....
Idaho 168 90 53.6 132 62.1 19 21.1 17 23.5
Illinois 3,472 3,121 89.9 1,985 90.6 983 87.0 505 92.7
Indiana . . 1,433 1,159 80.9 568 74.5 617 86.4 248 81.9
Iowa 770 652 84.7 448 80.6 242 92.1 81 84.0
Kansas 959 681 71.0 443 63.9 326 84.0 190 65.3
Kentucky 1,141 974 85.4 641 86.0 258 80.6 242 88.8
Louisiana . 1,007 776 77.1 637 92.6 193 24.9 178 77.5
Maine 408 378 92.6 172 85.5 161 100.0 76 92.1
Maryland 1,208 869 71.9 653 65.5 269 87.7 286 72.0
Massachusetts 2,506 2,303 91.9 1,125 86.5 974 98.7 406 90.9
Michigan 1,762 1,639 93.0 753 91.5 785 95.2 224 90.6
Minnesota 1,205 1,109 92.0 618 88.7 372 95.7 215 95.3
Mississippi 941 710 75.5 560 75.4 252 80.2 129 66.7
Missouri 1,475 1,159 78.6 1,016 81.8 265 69.1 194 75.3
Montana 297 167 56.2 198 74.2 46 17.4 53 22.6
Nebraska 625 435 69.6 376 83.2 143 26.6 106 79.2
Nevada 244 111 45.5 186 49.5 18 100.0 40 ....
New Hampshire 296 124 41.9 240 49.6 32 .... 24 20.8
New Jersey 1,947 1,685 86.5 918 81.2 838 90.7 190 95.3
New Mexico 221 179 81.0 146 79.5 45 82.2 30 86.7
New York 6,554 6,417 97.9 3,715 98.6 1,784 96.2 1,055 98.4
North Carolina 1,800 1,674 93.0 1,034 94.0 463 94.8 303 87.1
North Dakota 160 90 56.3 60 100.0 49 .... 51 58.8
Ohio 2,512 2,216 88.2 1,309 89.5 813 87.9 389 84.6
Oklahoma 555 385 69.4 372 83.1 88 30.7 94 53.2
Oregon 731 527 72.1 507 69.2 129 74.4 95 84.2
Pennsylvania 3,913 3,632 92.8 1,698 92.4 1,524 93.1 690 93.5
Rhode Island 245 138 56.3 136 81.6 74 31.1 35 11.4
South Carolina 900 500 55.6 613 64.9 162 24.7 125 49.6
South Dakota ........ 507 422 83.2 232 79.7 149 82.6 126 91.3
Tennessee 1,529 1,428 93.4 829 95.2 443 90.7 256 92.2
Texas 4,061 3,783 93.2 2,458 93.4 769 90.9 835 94.5
Utah 284 229 80.6 166 90.4 64 37.5 54 100.0
Virginia 1,639 1,304 79.6 1,019 79.9 313 81.8 307 76.2
Washington 901 844 93.7 455 94.9 261 96.6 184 87.0
West Virginia 774 517 66.8 562 77.8 125 31.2 88 46.6
Wisconsin 1,349 1,209 89.6 619 88.0 376 85.4 354 96.9
Wyoming . . . . 267 223 83.5 113 72.6 82 87.8 72 94.4
Outside United States . 640 620 96.9 399 96.5 179 100.0 62 90.3
Canal Zone
Philippines, Republic of . .
Puerto Rico 626 620 99.0 385 100.0 179 100.0 62 90.3
Others 15 15
NOTE: The changes to this table reflect the new ICD-9-CM Codes.
1 Figures shown are estimates based on tabulations of a 20 percent systematic random sample of records for patients remaining on June 24, 1981. The figures shown in the column for ‘all patients’do not necessarily equal the sum of the component parts due to machine rounding of sample data.
148
TABLE 20
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Percent By Attained Stay, Diagnostic Grouping1—June 24, 1981
Percent in Each Diagnostic Category for Specified Length of Stay
Diagnostic Composition of Patients Number of Patients 90 Days or Less 91 Days or More Inpatient Stay More Than (Years)
1 2 5 10 20
All patients 65,450 69.4 30.6 18.0 12.6 5.9 2.6 1.4
Psychotic 17,508 40.2 59.8 42.0 31.3 16.3 8.0 4.6
Alcohol psychoses (291) 1,138 37.2 62.8 44.5 33.6 14.7 3.3
Drug psychoses (292) 34 58.8 41.2 14.7
Other psychoses (290, 293-299) 16,336 40.4 59.6 41.9 31.2 16.5 8.4 4.9
Other psychiatric 10,970 72.7 27.3 14.9 10.0 3.8 1.2 .5
Alcohol dependence and abuse (303, 305.0) 5,259 91.4 8.6 2.9 1.9 .9 .2 .1
Drug dependence and abuse (304, 305.1-305.9) 785 80.1 19.7 3.3
Other nonpsychotic mental disorders (300-302, 306-319) 4,927 51.6 48.4 29.5 20.2 7.6 2.4 1.1
Medical and surgical 36,972 82.2 17.8 7.6 4.5 1.6 .5 .2
All infectious and parasitic diseases (001-139) 551 72.6 27.4 4.5 2.7 1.6 .9 .9
Malignant neoplasms (140-208, 230-234) 5,381 90.2 9.8 1.1 .6
Benign and unspecified neoplasms (210-229, 235-239) .... 527 96.8 3.2 .9 .9
Diabetes mellitus (250) 1,065 81.9 18.1 5.7 2.8 1.4 .8
Other endocrine, nutritional and metabolic diseases (240-246,251-278) 404 87.6 12.4 2.2 2.2
Disorders involving the immune mechanisms (279) Diseases of the blood and blood-forming organs (280-289) . . . 251 89.6 10.4 2.0
Quadriplegia (344.0) 426 32.2 67.8 39.0 28.9 16.2 4.7
Paraplegia (344.1) 343 66.5 33.5 14.6 10.2 4.1 1.5
Other diseases of the nervous system (320-343, 344.2-359) 2,622 44.0 56.0 34.6 23.4 9.5 4.0 1.7
Diseases of the sense organs (360-389) 732 93.7 6.3 1.4
Heart diseases (391-392.0, 393-398, 402, 404, 410-414, 420-429) . . 3,368 90.6 9.4 4.5 3.5 .6
Cerebrovascular diseases (430-438) 2,864 61.2 38.8 20.8 12.5 4.3 .6 .2
Other diseases of the circulatory system (390, 392.9, 401, 403,405,415-417,440-459) 1,933 85.3 14.7 3.5 1.1 .9 .3 .3
Acute respiratory diseases (460-466, 480-487) 532 86.3 13.9 3.9 1.9
Chronic bronchitis and emphysema (491-492) 217 75.6 24.4 17.5 6.5
Other respiratory diseases (470-478, 490, 493-519) 2,155 80.7 19.3 8.5 2.4 .5 .2
Diseases of the oral cavity, salivary glands, and jaws (520-529) 68 100.0
Hernia of the abdominal cavity (550-553) 688 98.7 1.3
Alcohol related liver diseases (571.0-571.3) 401 96.5 3.5
Other diseases of the digestive system (530-543, 555-570,571.4-579) 2,285 94.9 5.1 .4 .4 .2 .2
Diseases of the male genital organs (600-608) 545 94.9 5.1 1.1
Other diseases of the genitourinary system (580-599) 1,218 89.0 11.0 3.3 1.6 .7 .3 .3
Diseases of the breast, gynecological disorders and complications of pregnancy (610-676) 17 100.0
Diseases of the skin and subcutaneous tissue (680-709) 1,107 83.8 16.2 2.3 .5
Diseases of the musculoskeletal system and connective tissue (710-739) 2,227 85.9 14.1 3.7 2.0 .2
Congenital anomalies (740-759) 140 84.3 15.7 11.4 11.4 4.3
Symptoms, signs and ill-defined conditions (780-799) 2,000 93.2 6.9 4.1 2.4 .3
Injuries and poisonings (800-904, 910-999) 2,304 84.2 15.8 4.1 2.1 1.1 .4
Late effects of injuries, poisonings, toxic effects, and other external causes (905-909) 149 38.9 61.1 40.9 27.5 14.8 3.4
Factors influencing health status and contact with health service (V01-V82) 451 90.0 10.0 6.0 1.3
Supplementary classification of external causes of injury and poisoning (E800-E999)
1 Figures shown are estimates based on tabulations of a 20 percent random sample of records for patients remaining on June 24, 1981. The figures shown in the column for “number of patients” do not necessarily equal the sum of the component parts due to machine rounding of sample data.
NOTE: The changes to this table reflect the new ICD-9-CM codes.
149
INPATIENT CARE TABLE 21
VA Medical Centers—Hospital Care Component: Patients Remaining, Diagnostic Category, Period of Service,
Average Age and Age Group1—June 24, 1981
Period of Service Age Group
Aver-
o • • ■ n- • 2 All Viet- Post Korean ..... All .. . Qc .
Principal Diagnosis „ . „ WW WW age Under „ ... 85 and
Patients nam Korea Con- .. Others «n„ 35-44 45-54 55-64 65-74 75-84 _
-> , i c oo over
Era J Flict 5 6
4
All diseases and conditions7 ........................ 65,450 10,033 4,366 7,668 34,998 4,301 4,084 56.1 8,432 5,570 11,731 22,122 10,930 3,656 3,008
I.............................Infective and parasitic diseases........................ 551 76 49 74 305 14 34 56.3 24 65 107 250 79 16 9
Pulmonary tuberculosis (011) 284 45 16 52 156 15 53.4 10 46 73 131 25 .........
Tuberculosis, other (010,012-018) ........................................... 10 . 10 ........... (6) .......... 5 ........... 5 ..........
Tuberculosis, late effects (137)........................................................................................................ .....
All other infectious and parasitic diseases (001-009,020-136). 257 31 32 22 139 14 19 59.2 14 19 29 119 50 16 9
Late effects of other infectious and parasitic diseases (138-139) ...........................................................................
II......................................................Neoplasms............................................ 5 909 313 260 554 4,128 397 257 61.8 124 198 890 2,556 1,491 368 282
Malignant neoplasm of lip, oral cavity and pharynx (140-149,230.0).......... 522 13 51 69 332 21 36 59.2 9 6 145 213 119 20 10
Malignant neoplasm of digestive organs and peritoneum (150-159,230.1-230.9). 818 22 39 71 616 60 9 63.8 5 16 101 351 240 54 51
Malignant neoplasm of bronchus and lung (162.2-162.9,231.2) .............. 1,442 53 57 116 1,079 56 82 61.7 11 53 200 689 381 72 36
Malignant neoplasm of other respiratory system and intrathoracic organs (160-162.0,163 165,231.0,231.1,231.8,231.9) ................ 267 5 5 25 211 10 11 62.2 ............ 39 142 71 11 5
Malignant neoplasm of lymphatic and hematopoietic tissue (200-208) . 406 46 9 39 257 35 21 60.0 22 15 80 147 108 20 15
Malignant neoplasm of genitourinary organs (179-189,233)............ 942 41 19 63 644 143 32 66.2 17 9 91 374 214 132 106
Malignancies of all other systems (170-175,190-199,232,234) ................ 985 78 38 116 644 47 63 59.1 50 60 152 423 217 44 40
Neoplasms, benign (210-229)................................. 171 31 21 8 106 5 .... 55.5 10 26 20 76 29 5 5
Neoplasms of unspecified nature (235-239)................................... 356 26 20 47 239 20 5 61.8 ... 14 62 141 114 10 15
III. Endocrine, nutritional and metabolic diseases and immunity disorders. 1,469 105 56 138 968 139 63 61.5 86 29 221 618 312 89 114
Diabetes mellitus (250) .......................................... 1,065 70 40 122 717 78 37 60.3 57 19 174 482 240 31 63
Diseases of the endocrine glands (240-246,251 259).................. 136 22 . 82 22 11 62.0 21 6 ....... 65 6 21 18
Gout (274)........................................................... 22 . 5 ...... 17 .......... (6) .......... 12 5 ........ 4 .....
Obesity (278.0-278.1)................................................ 40 9 .... 6 25 ......... (6) 4 ...... 10 14 12 ..........
Nutritional deficiencies and all other metabolic diseases (260-273, 275-277,278.2-278.8)........................................ 206 4 11 10 126 39 15 68.1 4 4 24 52 55 32 34
Disorders involving the immune mechanisms (279)...............................................................................................
IV..............Diseases of the blood and blood-forming organs......... 251 . 14 21 165 45 6 66.2 ......... 37 99 46 40 29
Anemias (280-282.4,282.7-285)............................... 201 . 14 15 131 34 6 65.7 .......... 31 75 46 30 19
Sickle-cell trait and sickle-cell anemia (282.5-282.6)........................................................................................
Other diseases of the blood and blood-forming organs (286-289). 49 ........ 5 34 10 .... (6) .......... 5 24 ...... 10 10
150
V..............................................Mental disorders ...................................... 28,478 6,838 2,445 3,729 11,573 1,619 2,275 51.2 6,266 3,490 5,748 7,488 3,138 1,235 1,114
Alcohol psychosis (291).................................... 1,138 58 67 123 841 15 35 59.3 15 58 256 477 279 47 5
Drug psychosis (292).......................................................... 34 15 10 9 ........ (6) 10 5 15 4 ................
Organic psychotic conditions, excluding alcohol and drug psychosis (290,293-294).............................................. 2,608 98 139 167 1,569 581 53 67.2 47 79 283 761 643 388 407
Schizophrenic disorders (295)............................. 11,521 2,848 1,203 1,735 4,301 329 1,104 48.1 2,918 1,592 2,625 3,090 825 301 169
Other psychoses (296-299).................................. 2,208 449 199 349 967 94 150 52.0 359 312 459 648 309 56 65
Neurotic disorders (300) .................................. 1,017 306 94 128 414 4 71 47.9 285 127 184 318 64 32 8
Personality disorders (301).................................................. 504 262 31 39 83 6 83 38.0 281 81 64 60 12 ....... 6
Alcohol dependence or abuse (303,305.0) ................... 5,259 1,667 576 898 1,719 20 379 46.8 1,183 975 1,480 1,263 308 40 10
Drug dependence or abuse (304,305.1-305.9)................... 785 544 32 25 12 . 172 30.7 654 87 36 3 4 ..........
Other nonpsychotic mental disorders (302,306-319) ......... 3,406 591 104 255 1,659 569 229 60.8 515 174 346 864 693 371 444
VI...............Diseases of the nervous system and sense organs........ 4,123 422 267 557 2,525 175 175 57.2 327 325 761 1,599 807 217 86
Quadriplegia (344.0)......................................... 426 59 53 84 181 . 49 49.7 82 48 126 112 39 18 ....
Paraplegia (344.1)........................................... 343 58 35 45 153 16 36 51.3 70 29 80 111 28 21 5
Epilepsy (345)................................................ 95 15 9 25 41 ... 4 (6) ... 24 19 40 11 ..........
Disorders of the peripheral nervous system (350-359)......................... 320 15 30 35 222 . 18 56.2 22 25 66 145 57 5
Other diseases of the central nervous system (320-343,344.2-344.9,346-349). 2,207 206 111 281 1,490 66 54 58.5 128 153 358 897 529 111 32
Glaucoma (365)................................................ 39 8 .............. 10 21 ....... (6) ........ 16 23 ................
Cataract (366)............................................... 268 9 .............. 35 163 56 5 66.8 ........ 38 92 68 35 35
Blindness (369) ............................................................. 110 16 17 5 62 10 .. 55.5 11 22 10 52 5 5 5
Disorders of the eye and adnexa (360-364,367-368,370-379) ... 213 20 5 24 132 27 5 62.3 5 11 28 92 45 23 10
Diseases of the ear and mastoid process (380-389) ........... 101 16 8 11 61 ..... 5 53.8 10 12 20 35 23 ..........
VII...........................Diseases of the circulatory system.................... 8,165 402 347 738 5,585 838 254 63.1 117 248 1,182 3,459 1,869 719 571
Chronic rheumatic heart disease (393-398) .................... 47 11 ............. 36 ........... (6) 5 ....... 16 25 ................
Hypertensive disease without heart involvement (401,403,405)................. 339 40 39 50 180 20 10 56.9 16 34 110 90 43 31 15
Hypertensive heart disease (402,404).......................... 76 ................ 60 10 6 (6) ............... 47 14 11 5
Acute myocardial infarction (410)................................ 503 30 19 68 322 25 39 59.2 10 20 106 256 78 19 16
Other ischemic heart disease (411-414)......................... 1,312 54 63 164 841 150 39 62.4 .. 31 253 611 206 118 94
Other forms of heart disease (391,392.0, 420-429).............. 1,429 75 69 69 954 229 33 66.0 20 25 160 553 334 146 192
Cerebrovascular diseases (430-438) ........................ 2,864 75 96 233 2,101 279 80 64.5 14 50 340 1,220 807 243 189
Atherosclerosis (440) ........................................... 162 5 ....... 16 93 31 17 65.9 .... 5 21 64 20 42 10
Other diseases of arteries, arterioles and capillaries (441-448). 846 33 26 74 650 49 15 62.5 10 25 93 387 243 74 15
Varicose veins of lower extremities (454) ................... 106 15 ........ 5 70 10 5 62.8 5 4 6 41 32 7 10
Hemorrhoids (455)............................................. 55 19 10 14 5 6 ...... (6) 10 25 15 .................. 6
Other diseases of the circulatory system (390, 392.9, 415-417, 451-453,456-459).............................................. 425 46 24 45 271 29 10 59.5 28 29 63 167 91 29 19
VIII..........................Diseases of the respiratory system................... 2,904 106 98 257 2,093 228 123 63.2 79 80 361 1,121 868 240 156
Acute respiratory infections (460-466)............................ 26 ...... 5 16 6 .... (6) .......... 5 5 5 12
Pneumonia and influenza (480-487)............................ 506 24 26 44 301 92 20 65.7 10 15 82 150 124 58 67
Chronic bronchitis (491).......................................... 56 ...... 6 39 11 . (6) .... 6 ........... 22 16 6 5
Emphysema (492) ............................................. 161 13 ........ 6 127 16 . 64.4 .. 5 10 89 35 10 12
Other diseases of the respiratory system and upper respiratory tract (470-478,490,493-519)...................................... 2,155 70 72 196 1,611 103 103 62.4 69 54 264 854 687 154 72
See footnotes at end of table.
152
INPATIENT CARE TABLE 21-Continued
VA Medical Centers—Hospital Care Component: Patients Remaining, Diagnostic Category, Period of Service,
Average Age and Age Group1— June 24, 1981
Period of Service Age Group
All Aver-
PHndp., Dfagnofl.1 patjents V£ post Ko™„ A|| 85 and
" Korea „ . II I Others 35 O«er
Era 3 flict 5 6
IX............................Diseases of the digestive system..................... 3,443 415 273 471 1,948 166 170 56.9 294 322 665 1,285 574 167 137
Diseases of oral cavity, salivary glands and jaws (520-529) .............. 68 24 9 . 29 ... 5 (6) 14 16 9 25 5 ..........
Ulcers of the digestive system (530.2,531-534)........................... 293 39 15 83 147 5 5 55.4 20 30 85 92 57 5 5
Other diseases of the esophagus, stomach and duodenum (530.0, 530.1, 530.3-530.9,535-537)........................................ 227 13 15 9 180 5 5 59.0 19 . 19 140 36 4 10
Hernia of the abdominal cavity (550-553)................... 688 53 37 92 420 51 37 60.8 37 20 141 254 138 62 36
Other diseases of the intestine and peritoneum (540-543,555-569,578-579). 970 114 53 63 590 76 73 58.6 113 82 100 333 213 56 72
Alcohol related liver disorders (571.0-571.3).............. 401 39 61 103 187 ...... 11 52.5 14 59 141 161 25 .........
Other diseases of the liver, gallbladder and pancreas (570,571.4-577). 795 133 82 120 395 30 35 54.6 76 114 170 281 100 39 15
X.........................Diseases of the genitourinary system.................. 1,779 125 66 149 1,138 196 105 62.2 99 85 250 619 444 137 146
Nephritis, nephrotic syndrome and nephrosis (580-589)...... 458 58 26 76 220 52 26 58.5 35 45 92 155 63 20 48
Other diseases of the urinary system (590-599) ....................... 760 46 31 39 512 80 52 62.3 56 31 96 241 211 65 60
Diseases of the prostate (600-602).......................... 431 10 5 14 329 59 14 67.4 .......... 29 169 152 46 34
Other diseases of the male genital organs (603-608)....................... ^4 12 5 20 61 4 13 56.4 8 9 28 45 15 5 4
Disorders of breast and gynecological diseases (610-629) ... 17 ............... 17 ............ ( ) .......... 4 8 4 ..........
XI.............................................................................................Complications of pregnancy, childbirth and puerperium (630-676) ............................ (6) .
XII.........................Diseases of the skin and subcutaneous tissue.................. 1,107 183 68 137 616 67 36 55.5 128 83 208 477 130 52 29
Infections and inflammatory conditions of skin and subcutaneous tissue (680-698)........................................... 501 80 26 71 282 11 31 53.9 54 45 124 194 73 6 5
Other diseases of skin and subcutaneous tissue (700-709).............. 606 104 41 66 334 56 5 56.8 74 38 84 282 57 46 24
XIII........Diseases of the musculoskeletal system and connective tissue. 2,227 343 151 319 1,188 70 156 55.2 232 247 446 783 372 84 62
Osteoarthrosis and allied disorders (715)............................. 266 25 . 34 160 34 13 63.5 11 ...... 49 93 69 20 24
Other arthropathies and related disorders (710-714,716-719). 481 72 44 49 284 11 20 54.4 57 36 113 185 74 10 5
Dorsopathies (720-724)..................................... 693 126 59 141 320 12 35 53.0 80 96 146 264 73 23 12
Rheumatism, excluding the back (725-729)................... 223 20 9 21 140 4 28 54.7 30 19 40 75 44 15 ....
Osteopathies, chondropathies and acquired musculoskeletal deformities (730-739)....................................... 564 100 38 74 283 10 59 54.7 54 96 99 165 112 17 21
XIV............................Congenital deformities (740-759) ....................... 140 22 10 9 80 . 19 51.8 18 27 14 37 44 .
XVI. Symptoms, signs and ill defined conditions (780-799). 2,000 175 129 234 1,179 153 131 58.9 116 148 350 824 314 122 125
XVII. Injury and poisoning... -> tir/i ncn mi
........................ 2,454 460 103 213 1,276 156 245 53.9 472 204 411 761 343 142 121
Fracture of skull (800-804) . c c _
_ ...................................... 66 6 5 5 32 ..... 19 (6) 25 5 1fi ifi r
Fracture of neck and trunk (805-809) .............................................. QO .. b b 6 .................
e t ' ............................... 1bb 33 ............ 10 88 11 25 52.0 43 10 28 40 25 20
Fracture of upper and lower limb (810-829 .................. 947 113 20 7K R7d 1n7 co _n „ b ZU .......
, ................... 1 '6 574 107 58 60.0 93 44 141 346 149 76 or
Dislocations, sprains and strains of joints and adjacent muscles (830-848). 99 39 9 4 38 9 (6) 33 25
Intracranial injury, excluding those with skull fracture (850-854) . 210 59 5 15 7k o >10 tec 4 27 11 ..........
, . . ........... 03 0 lb /b 8 48 46.5 83 14 30 45 26 5 r
Internal Injury of chest, abdomen and pelvis (860-869)........ 9 9 ,6.
Open wounds (870-897) ...................................................... 917 m ’ .... 4 5 ..........................
Burns 040-949)............................................................... M ’’’ 5 35 23 33 <'.....
............................................................. 76 10 14 37 14 (6) 9 6 23 14 r Poisoning by drugs, medicinal and biological substances (960-979).......... 44.9 29 6 (6) g 0 ..........................
Toxic effects of substances chiefly nonmedical as to source 080-909)............................................... 5 19 6 6 ....
All other injuries 000-904. 9W-939. 950-959. 990-995)." i i" 249 " 86 ' 14 " 27 84 .6 ’' 33 46 6 ..93 ' ’ ’ 20 ' « " "55 ’ 28 ......«
Complications of surgical and medical care, N EC (996-999). 221 5 „ 3 • —■ «
Late effects of injuries, poisonings, toxic effects and other external DU u 4
causes (905-909) ............. .AQ __
........................... 149 56 12 29 29 9 15 45.2 30 47 34 29 ....... 5 5
XVIII. Factors influencing health status and contact with health services (V01-V82) ... 451 40 7q RQ 7,n on »
_______________________________________________________a b9 230 39 36 58-3 50 21 82 145 100 28 26
Figures shown are estimates based on tabulations of a 20 percent systematic random sample of records of 3Service between February 1,1955 and August 4 1964
patients remaining on June 24, 1981. The figures shown in the column for “All Patients" do not necessarily 4 Service between June 22,1950 and January 31 ’1955
9"' ReViS‘°,l C'fiC‘L l'CD-1-CM)." DHHS Pub. No. 80-1260. The "Average age not calculated fo, totals lose than lOOeases.
tden Oyins code numbers of this diagnostic classification. Category 'The changes in this report reflect the new ICD-9-CM codes
XV, Conditions Originating in Ifie Prenatal Period, ’ in which no cases occurred, is not included in this
table.
153
TABLE 22
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Age, Diagnostic Grouping1 June 24, 1981
Diagnostic Composition of Patients AH Patients Age Distribution
Under 55 55-64 65-74 75 and Over
Number Percent Number Percent Number Percent Number Percent Number Percent
65,450 100.0 25,734 100.0 22,122 100.0 10,930 100.0 6,664 100.0
17,508 26.8 9,033 35.1 4,981 22.5 2,057 18.8 1,438 21.6
Alcohol psychoses (291) 1,138 1.7 329 30 8,674 1.3 .1 33.7 477 4 4,500 2.2 279 2.6 52 .8
Drug psychoses (292) Other psychoses (290, 293-299) 34 16,336 .1 25.0 20.3 1,777 16.3 1,386 20.8
10,970 16.8 6,471 25.1 2,507 11.3 1,081 9.9 911 13.7
Alcohol dependence and abuse (303,305.0) 5,259 8.0 3,638 14.1 1,263 5.7 308 2.8 50 .8
Drug dependence and abuse 785 1.2 778 3.0 3 4
(304,305.1-305.9)
Other nonpsychotic mental disorders (300-302, 306-319) 4,927 7.5 2,056 8.0 1,241 5.6 769 7.0 861 12.9
Medical and surgical 36,972 56.5 10,230 39.8 14,634 66.2 7,793 71.3 4,316 64.8
All infectious and parasitic diseases (001-139) Malignant neoplasms (140-208, 230-234) .... 551 5,381 .8 8.2 196 1,079 .8 4.2 250 2,339 1.1 10.6 79 1,348 .7 12.3 26 615 .4 9.2
Benign and unspecified neoplasms (210 229, 235-239) Diabetes mellitus (250) 527 1,065 .8 1.6 132 250 .5 1.0 217 482 1.0 2.2 143 240 1.3 2.2 35 94 .5 1.4
Other endocrine, nutritional and metabolic diseases (240-246, 251-278) 404 .6 86 .3 137 .6 72 .7 110 1.7
Disorders involving the immune
mechanisms (279)
Diseases of the blood and blood-forming organs (280-289) Quadriplegia (344.0) Paraplegia (344.1) 251 426 343 .4 .7 .5 37 256 179 .1 1.0 .7 99 112 111 .4 .5 .5 46 39 28 .4 .4 .3 69 18 26 1.0 .3 .4
Other diseases of the nervous system (320-343,344.2-359) Diseases of the sense organs (360-389) 2,622 732 4.0 1.1 796 183 3.1 .7 1,082 295 4.9 1.3 597 142 5.5 1.3 148 112 2.2 1.7
Heart diseases (391-392.0, 393-398, 402,404,410-414,420-429) Cerebrovascular diseases (430-438) 3,368 2,864 5.1 4.4 645 404 2.5 1.6 1,491 1,220 6.7 5.5 632 807 5.8 7.4 600 432 9.0 6.5
Other diseases of the circulatory system (390, 1,933 3.0 497 1.9 748 3.4 430 3.9 258 3.9
392.9, 401,403, 405, 415-417,440-459) . .
Acute respiratory diseases 532 .8 112 .4 155 .7 129 1.2 137 2.1
(460-466, 480-487)
Chronic bronchitis and emphysema (491-492) 217 .3 21 .1 112 .5 51 .5 33 .5
Other respiratory diseases (470-478, 490,493-519) 2,155 3.3 387 1.5 854 3.9 687 6.3 226 3.4
Diseases of the oral cavity, salivary glands, 39 197 .2 8 25 254 .1 1.1 5
and jaws (520-529) Hernia of the abdominal cavity (550-553) .... 68 688 .1 1.1 138 25 1.3 .2 98 1.5
215 .8 161 .7
Alcohol related liver diseases (571.0-571.3) . . . 401 .6
Other diseases of the digestive system (530-543,555-570,571.4-579) 2,285 3.5 829 3.2 .3 845 215 3.8 1.0 406 167 3.7 1.5 206 89 3.1 1.3
Diseases of the male genital organs (600-608) . . 545 .8
Other diseases of the genitourinary system (580-599) Diseases of the breast, gynecological 1,218 1.9 355 1.4 396 1.8 273 2.5 194 2.9
disorders and complications of 4
pregnancy (610-676) 17
Diseases of the skin and subcutaneous tissue (680-709) 1,107 1.7 419 1.6 477 2.2 130 1.2 81 1.2
Diseases of the musculoskeletal system and connective tissue (710-739) 2,227 3.4 925 59 3.6 .2 783 37 3.5 .2 372 44 3.4 .4 146 2.2
Congenital anomalies (740-759) 140 .2
Symptoms, signs and ill-defined conditions (780-799) Injuries and poisonings (800-904, 910-999) . . . Late effects of injuries, poisonings, toxic 2,000 2,304 3.1 3.5 614 974 2.4 3.8 824 732 3.7 3.3 314 343 2.9 3.1 248 254 3.7 3.8
effects, and other external causes 149 .2 111 .4 29 .1 9 .1
(905-909) Factors influencing health status and contact with health service (V01-V82) .... Supplementary classification of external 145 100 .9 53 .8
451 .7 153 .6 .7
causes of injury and poisoning (E800-E999)
' Figures shown are estimates based on tabulations of a 20 percent random sample column for “number of patients’’ do not necessarily equal the sum of the
of records for patients remaining on June 24, 1981. The figures shown in the component parts due to machine rounding of sample’ data.
J J ' NOTE- The changes to this table reflect the new ICD-9-CM codes.
154
TABLE 23
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Age Groups ByState1
June 24, 1981
Location Total all Patients Age Group
Under 25 25-34 35-44 45-54 55-64 65 and Over
All VA medical centers 65,452 1,437 6,993 5,571 11,731 22,125 17,595
Alabama:
Birmingham 274 4 16 20 41 119 74
Montgomery 141 9 9 9 48 66
Tuscaloosa 434 18 76 59 94 127 60
T uskegee 698 18 90 59 118 224 189
Arizona:
Phoenix 351 4 41 54 33 123 96
Prescott 139 3 3 6 36 49 42
Tucson 221 31 10 41 72 67
Arkansas:
Fayetteville 156 29 75 52
Little Rock (Little Rock) 412 8 16 25 82 194 87
Little Rock (N. Little Rock) 664 5 94 78 120 235 132
California:
Fresno 188 13 9 18 24 65 59
Livermore 81 6 25 25 25
Loma Linda 328 6 24 23 36 133 106
Long Beach 895 22 64 106 168 347 188
Los Angeles (Brentwood) 402 24 150 72 43 72 41
Los Angeles (Wadsworth) 479 10 31 72 232 134
Martinez 402 19 17 31 56 145 134
Palo Alto (Palo Alto) 568 12 61 69 64 204 158
Palo Alto (Menlo Park) 465 11 134 78 89 121 32
San Diego 362 15 65 31 44 153 54
San Francisco 244 5 17 19 70 62 71
Sepulveda 454 9 81 41 73 97 153
Colorado:
239 29 30 50 60 70
Fort Lyon 329 4 46 52 70 96 61
101 9 13 14 19 46
Connecticut:
Newington 153 9 9 12 29 59 35
West Haven 468 31 68 32 75 152 110
252 13 17 47 90 85
District of Columbia: Washington 593 25 75 91 113 197 92
Florida:
Bay Pines 595 7 47 32 72 200 237
Gainesville 362 10 49 30 74 124 75
Lake City 294 7 7 7 37 133 103
518 49 16 67 207 179
Tampa 478 12 58 26 84 154 144
Georgia:
Augusta (Downtown) 312 9 19 95 128 61
Augusta (Uptown) 552 21 88 41 165 146 91
Decatur 387 5 66 42 87 158 29
290 5 9 68 113 95
99 9 5 18 36 31
Illinois:
Chicago (Lakeside) 354 14 14 52 170 104
Chicago (Westside) 389 18 29 20 90 123 109
Danville 705 6 70 41 76 242 270
Hines 947 25 103 98 202 321 198
128 14 14 5 57 38
North Chicago 952 21 99 127 170 329 206
Indiana:
Fort Wayne 120 13 6 25 57 19
Indianapolis (W. Tenth St.) 269 6 18 31 24 147 43
Indianapolis (Cold Spr. Rd.) 123 25 15 15 37 18 13
Marion 744 12 18 92 202 185 235
Iowa:
Des Moines 187 11 23 6 17 51 79
Iowa City 251 9 25 21 38 107 51
Knoxville 371 14 61 54 77 74 91
Kansas:
Leavenworth 332 17 29 47 131 108
Topeka 712 16 130 66 136 178 186
Wichita 125 18 13 13 45 36
Kentucky:
Lexington (Leestown) 523 27 48 108 135 205
Lexington (Cooper Drive) 270 31 25 42 89 83
Louisville 280 11 23 29 57 86 74
Louisiana:
Alexandria 262 ...... 33 22 16 104 87
New Orleans 358 6 75 45 46 131 55
Shreveport 321 15 30 51 113 112
See footnotes at end of table.
155
TABLE 23—Continued
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Age Groups By State1 June 24, 1981
Total all Age Group
Location Patients 55-64
Under 25 25-34 35-44 45-54 Over
Maine: Togus 406 9 51 31 83 110 122
Maryland: 199 6 67 72 46
40 84 53
195 721 4
Fort Howard Perry Point 241
6 49 66 120 239
Massachusetts: 690 21 78 46 105 214 149 235 190 105 226 157 168 111 47
Boston 552 16 101 55 74 165
Brockton 758 4 96 90
Northampton West Roxbury 499 189 27 16 60 5 40 11 71 5
Michigan: Allen Park 432 4 85 46 41 63 166 89 90 39
231 33 7
58 197 248 114 34
Battle Creek 801 24 160
Iron Mountain 132 135 4 17 77
12 12 29 35 47
Minnesota: Minneapolis St. Cloud 545 713 17 12 50 79 48 74 73 147 197 199 160 202
Mississippi: 161 549 375 11 22 61 61
Biloxi (Biloxi) Biloxi (Gulfport) Jackson 209 159
15 5 54 49 63 22 131 63 77 77
Missouri: Columbia 244 14 14 11 59 100 131 56 46 75
Kansas City 365 144 260 10 5 37 36 23 76 14 46
Poplar Bluff 10 10 15 39 116 103 75 83 92
St. Louis (Jefferson Barracks) 405 5 83 34
Montana: 114 8 15 8 68 39 15 10
Miles City 59 5 5
Nebraska: Grand Island 92 8 13 17 54
138 16 16 12 53 51 78 44 46 43 64 39 69
Omaha 266 5 42 24
121 9 5 24
New Hampshire: Manchester 148 5 5 23
34 54 63 81 303 225
New Jersey: 760 1,042
East Orange [yons 18 98 63 242 347 79 274 53
New Mexico: Albuquerque 232 5 21
5 9 42 126 188 187
New York: 557
Albany 49 58 94 114 202
210 9
Rath 192 31 47 180
Bronx 573 5 60 44 82 121 5
244 42 161 65
Brooklyn (Brooklyn) 659 117 672 5 5 17 71 57
Brooklyn (St. Albans) Buffalo 59 18 104 157 20 205 186 80 350 229 296 57 269 327 67 198 152 193 98
Canandaigua 783 187 10 36 20 67
Montrose 1,094 18 159 105 264 103 106 50
New York 654 10 62 98
Northport 772 21 97 59
Syracuse 245 15 10 15
North Carolina: Asheville 481 5 24 29 63 63 58 177 175 111 107 256 35 185 58 45 247 45
326 41 53
Fayetteville Salisbury 268 782 9 9 40 37 9 56
125
North Dakota: Fargo
Ohio: Chillicothe 717 20 85 68 165 200 94 156 176 179 63 87 46
237 6 24 20 30 82 118
Cleveland (Wade Park) 412 24 42 138 28 21 84
Cleveland (Brecksville) Dayton 580 448 9 28 55 180 148
Oklahoma: 135 10 16 57 89 52 64
Oklahoma City 269 13 22 24 57
Oregon: Portland (Portland) Roseburg 296 283 17 21 52 26 39 32 26 86 82 114 84
See footnotes at end of table.
156
TABLE 23—Continued
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Age Groups By State1
June 24, 1981
Location Total all Patients Age Group
Under 25 25-34 35-44 45-54 55-64 65 and Over
Pennsylvania:
Altoona 101 5 40 56
Butler 237 11 5 32 54 135
Coatesville 942 26 158 102 182 309 165
Erie 130 5 14 51 60
Lebanon 792 25 63 30 133 235 306
Philadelphia 361 19 23 22 82 122 93
Pittsburgh (Highland Drive) 635 14 83 33 121 220 164
Pittsburgh (University Drive) 328 10 5 59 130 124
Pittsburgh (U. Dr. Aspinwall) 143 12 18 113
Wilkes-Barre 382 4 16 28 78 110 146
Puerto Rico: San Juan 631 24 109 71 192 181 54
Rhode Island: Providence 206 8 10 38 86 64
South Carolina:
Charleston 205 24 19 34 93 35
Columbia 339 6 20 14 78 124 97
South Dakota:
Fort Meade 331 6 40 34 32 109 110
Hot Springs 175 4 19 33 74 45
Sioux Falls 156 3 6 12 50 35 50
Tennessee:
Memphis 663 39 101 87 90 212 134
Mountain Home 384 12 29 12 62 185 84
Murfreesboro 473 6 49 18 83 182 135
Nashville 351 31 26 57 124 113
Texas:
Amarillo 117 25 12 62 18
Big Spring 140 13 19 17 52 39
Bonham 69 3 19 28 19
Dallas 529 18 51 32 119 160 149
Houston 902 24 146 87 179 320 146
Kerrville 229 4 4 33 94 94
Marlin 142 5 5 5 58 69
San Antonio 534 14 102 42 117 141 118
Temple 467 11 49 27 76 181 123
Waco 820 5 81 55 214 294 171
Utah: Salt Lake City 290 5 45 33 36 85 86
Vermont: White River Junction 164 32 9 14 59 50
Virginia:
Hampton 336 5 53 23 66 114 75
Richmond 557 14 56 34 106 222 125
Salem 661 21 74 68 120 185 193
Washington:
American Lake 391 19 74 73 54 102 69
Portland (Vancouver) 222 9 39 19 32 57 66
Seattle 231 6 30 15 55 60 65
Spokane . 147 6 6 25 55 55
Walla Walla 103 17 9 9 38 30
West Virginia:
Beckley 133 9 14 41 55 14
Clarksburg 175 7 20 6 12 66 64
Huntington 108 8 8 12 48 32
Martinsburg . . 347 26 20 58 100 143
Wisconsin:
Madison 241 24 21 39 112 45
Tomah 662 11 78 78 81 164 250
Wood 520 17 77 59 64 181 122
Wyoming:
Cheyenne 103 10 5 10 42 36
Sheridan 297 25 40 44 44 68 76
1 Figures shown are estimates based on a tabulation of a 20 percent systematic random sample of records for patients remaining on June 24, 1981.
The figures shown in the column for ‘All Patients' do not necessarily equal the sum of the component parts due to machine rounding of sample data.
157
TABLE 24
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Remaining, Compensation and Pension Status, Type of Patient, Age1— June 24, 1981
Type of Patient and Age Group Total All Patients Service Connected Veterans Non-Service Connected Non- Veterans3
Total 10% or More Less than 10% NSC with SC2 Total Pension Other
All patients 65,450 19,287 9,921 507 8,859 45,910 16,993 28,918 252
Under 25 1,436 406 323 13 70 911 71 839 119
25-34 6,996 2,679 1,841 78 760 4,287 534 3,753 30
35-44 5,570 1,779 1,226 11 542 3,758 523 3,235 33
45-54 11,731 2,965 1,701 64 1,200 8,737 3,075 5,662 30
55-64 22,122 6,999 3,182 224 3,594 15,103 6,227 8,876 20
65 and over 17,595 4,459 1,648 118 2,693 13,115 6,563 6,553 21
Psychotic 17,508 7,085 5,801 206 1,079 10,370 4,491 5,878 53
Under 25 613 221 201 5 15 355 10 345 37
25-34 2,736 1,454 1,288 29 137 1,266 218 1,048 16
35-44 2,046 954 865 11 77 1,092 205 886
45-54 3,638 1,281 1,061 39 181 2,357 1,244 1,112
55-64 4,981 2,120 1,670 68 383 2,861 1,542 1,319
65 and over 3,494 1,055 716 54 285 2,439 1,272 1,167
Other psychiatric 10,970 2,492 1,100 76 1,316 8,455 2,132 6,323 23
401 77 47 30 314 28 286 10
2 516 638 274 35 329 1 878 159 1 719
35-44 1 444 239 80 158 1J92 71 l’l21 13
45-54 2,110 369 138 5 226 1,741 388 1,353
55-64 2,507 765 379 27 359 1,742 622 1,120
65 and over 1,992 405 182 10 213 1,587 864 723
Medical and surgical 36,972 9,710 3,020 225 6,464 27,086 10,369 16,717 176
Under 25 422 108 76 7 24 241 33 208 73
25-34 1,744 587 279 15 294 1,143 157 986 14
35-44 2 080 587 281 306 1,474 246 1,228 19
45-54 5^983 1,315 502 20 793 4,639 1,443 3,196 30
55-64 14,634 4,114 1,133 129 2,852 10,500 4,063 6,437 20
65 and over 12,108 2,999 749 54 2,196 9,089 4,427 4,662 21
'Figures shown are estimates based on tabulations of a 20 percent systematic random sample of records of patients >remaining on June 24, 1981. The figures shown in the column for ‘All Patients’ do not necessarily equal the sum of the component parts due to the machine rounding of sample data.
2 Veterans with compensable SC disabilities but treated for non-service connected disabilities only.
3 This group includes all patients other than veterans, such as active military, humanitarian emergencies, reimbursable cases, allied beneficiaries, donors, etc. If veteran is admitted as an office of workers compensation case, he is coded as a non-veteran.
NOTE: The changes to this table reflect the new ICD-9-CM codes.
158
TABLE 25
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Discharged, Manner of Disposition, Diagnostic Grouping1— Fiscal Year 1981
Type of Patient Total All Discharges Type of Disposition Unavailable2
Regular Irregular Total Deaths Transfers to Further VA Inpatient Care at VA or Non-VA Hospital
All discharges 945,245 824,137 46,457 43,494 30,508 649
Psychotic 78,538 58,930 13,244 1,039 5,259 66
Alcohol psychoses (291) 7,743 6,501 851 95 285 11
Drug psychoses (292) Other psychoses (290, 293-299) 643 467 154 1 21
70,152 51,962 12,239 943 4,953 55
Other psychiatric 129,853 104,119 21,742 898 3,056 38
Alcohol dependence and abuse (303, 305.0) 86,347 69,974 14,515 411 1,429 18
Drug dependence and abuse (304, 305.1-305.9) 10,783 7,260 3,325 11 182 5
Other nonpsychotic mental disorders (300-302, 306-319) . 32,723 26,885 3,902 476 1,445 15
Medical and surgical 727,420 652,860 11,132 40,884 22,022 522
All infectious and parasitic diseases (001-139) 10,242 8,906 221 904 207 4
Malignant neoplasms (140-208, 230-234) 86,296 68,279 645 13,837 3,465 70
Benign and unspecified neoplasms (210-229,235-239) . . . 11,092 10,340 109 155 482 6
Diabetes mellitus (250) Other endocrine, nutritional and metabolic diseases 20,883 19,542 423 532 364 22
(240-246,251-278) 9,121 8,422 116 415 161 7
Disorders involving the immune mechanisms (279) Diseases of the blood and blood-forming organs 73 70 1 2
•
(280-289) 6,416 5,987 118 181 127 3
Quadriplegia (344.0) 1,600 1,430 15 41 113 1
Paraplegia (344.1) Other diseases of the nervous system (320-343, 1,827 1,646 43 33 105
344.2-359) 20,345 18,188 344 848 947 18
Diseases of the sense organs (360-389) Heart diseases (391 -392.0, 393-398, 402, 404, 24,835 24,154 110 21 526 24
410-414,420-429) 88,275 75,523 1,235 7,336 4,110 71
Cerebrovascular diseases (430-438) Other diseases of the circulatory system (390, 392.9, 20,279 17,121 181 2,064 883 30
401,403,405,415-417,440-459) 39,582 36,484 520 1,558 992 28
Acute respiratory diseases (460-466, 480-487) 15,489 12,891 213 2,194 177 14
Chronic bronchitis and emphysema (491-492) 5,509 5,077 70 315 46 1
Other respiratory diseases (470-478, 490, 493-519) Diseases of the oral cavity, salivary glands, and jaws 41,493 37,806 587 2,393 683 24
520-529) 4,935 4,829 38 12 54 2
Hernia of the abdominal cavity (550-553) 19,103 18,638 131 48 275 11
Alcohol related liver diseases (571.0-571.3) Other diseases of the digestive system (530-543, 7,192 5,543 298 1,189 161 1
555-570,571.4-579) 56,931 52,156 1,100 2,274 1,376 25
Diseases of the male genital organs (600-608) 20,213 19,722 93 65 326 7
Other diseases of the genitourinary system (580-599) .... Diseases of the breast, gynecological disorders and 23,915 22,059 229 908 704 15
complications of pregnancy (610-676) 1,845 1,791 12 2 39 1
Diseases of the skin and subcutaneous tissue (680-709) . . . Diseases of the musculoskeletal system and connective 21,457 20,561 361 186 332 17
tissue (710-739) 42,548 40,613 586 225 1,105 19
Congenital anomalies (740-759) 2,840 2,675 17 38 109 1
Symptoms, signs and ill-defined conditions (780-799) .... 48,722 43,446 1,683 2,061 1,494 38
Injuries and poisonings (800-904, 910-999) Late effects of injuries, poisonings, toxic effects, 43,375 39,428 1,032 734 2,147 34
and other external causes (905-909) Factors influencing health status and contact with 2,346 2,155 47 22 119 3
health service (V01-V82) Supplementary classification of external causes of injury and poisoning (E800-E999) Unavailable2 28,641 27,378 554 291 393 25
9,434 8,228 339 673 171 23
1 Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approximately 232,644 one-day dialysis discharges.
2 This column/line includes all records for which required data is unavailable. NOTE: The changes to this table reflect the new ICD-9-CM codes.
159
(D CXI
UJ -J m <
VA Medical Centers—Hospital Care Component: Patients Discharged, Age, Diagnostic Category1 —Fiscal Year 1981
Unavailable5 478 6 3 2 1 40 5 6 6 1 10 10 2 18 14 2 2 1 1
“O in o 00 36,074 446 50 12 2 382 4,662 116 720 471 69 362 1,692 887 198 147 1,112 499 74 50 3 486 648 557 1 90
o 75-84 43,838 445 79 12 9 345 6,373 231 977 1,122 134 489 1,906 951 343 220 1,335 774 104 67 12 378 553 448 105
ct co Q "co Q. U c 65-74 156,884 1,322 262 48 4 1,005 3 25,068 1,360 3,517 6,176 771 1,834 5,395 3,620 1,759 636 5,517 3,819 500 236 115 846 1 1,380 979 7 394
o 3 O 5 55-64 332,828 3,122 902 96 27 2,082 15 42,690 3,115 5,739 11,630 1,665 3,647 5,918 6,551 3,409 1,016 12,608 9,148 1,086 463 431 1,457 23 2,320 1,588 19 713
0) CT < 45-54 165,554 1,848 596 64 13 1,166 9 13,088 1,305 1,477 3,608 515 1,101 1,060 2,210 1,466 346 5,997 4,321 527 220 298 620 11 746 465 36 245
35-44 79,316 913 176 26 3 707 1 2,721 151 230 383 49 397 243 607 527 134 1,892 1,245 211 53 142 225 16 287 132 36 119
Under 35 130,273 2,140 122 27 1 1,989 1 2,746 88 142 62 29 643 366 527 749 140 1,598 1,063 272 28 60 153 22 481 152 153 176
average Age 55.5 52.7 56.1 56.5 (6) 51.5 (6) 62.1 59.9 63.6 61.8 61.1 59.5 66.6 61.6 57.4 61.3 58.5 58.0 56.3 60.5 53.6 63.1 (6) 62.0 64.9 37.3 58.5
Associated Diagnoses4 1,489,590 31,310 1,792 290 465 28,688 75 67,583 1,918 2,939 4,179 951 2,648 5,915 40,067 6,590 2,376 110,326 56,670 7,754 6,057 15,374 24,349 122 41,879 31,433 448 9,998
rrincipai Diagnosis3 945,245 10,242 2,190 285 59 7,678 30 97,388 6,371 12,808 23,458 3,233 8,473 16,590 15,363 8,451 2,641 30,077 20,883 2,776 1,117 1,061 4,167 73 6,416 4,322 252 1,842
i oiai Diagnoses 2,434,835 41,552 3,982 575 524 36,366 105 164,971 8,289 15,747 27,637 4,184 11,121 22,505 55,430 15,041 5,017 140,403 77,553 10,530 7,174 16,435 28,516 195 48,295 35,755 700 11,840
Diagnostic Category and ICDA Codes2 All diseases and conditions I. Infectious and parasitic diseases Pulmonary tuberculosis (011) Tuberculosis, other (010,012-018) Tuberculosis, late effects (137) All other infectious and parasitic diseases (001-009, 020-136) Late effects of other infectious and parasitic diseases (138-139) II. Neoplasms Malignant neoplasm of lip, oral cavity and pharynx (140-149,230.0) Malignant neoplasm of digestive organs and peritoneum (150-159,230.1-230.9) Malignant neoplasm of bronchus and lung (162.2-162.9, 231.2) Malignant neoplasm of other respiratory system and intrathoracic organs (160-162.0,163-165, 231.0, 231.1,231.8, 231.9) Malignant neoplasm of lymphatic and hematopoietic tissue (200-208) Malignant neoplasm of genitourinary organs (179-189, 233) Malignancies of all other systems (170-175,190-199, 232, 234) Neoplasms, benign (210-229) Neoplasms of unspecified nature (235-239) III. Endocrine, nutritional and metabolic diseases and immunity disorders Diabetes mellitus (250) Diseases of the endocrine glands (240-246, 251-259) Gout (274) Obesity (278.0-278.1) Nutritional deficiencies and all other metabolic diseases (260 273, 275-277, 278.2-278.8) Disorders involving the immune mechanisms (279) IV. Diseases of the blood and blood-forming organs Anemias (280-282.4, 282.7-285) Sickle-cell trait and sickle-cell anemia (282.5-282.6) Other diseases of the blood and blood-forming organs (286-289)
160
161
V.....................................Mental disorders ............................ 356,935 208,390 148,545 45.1 67,393 35,042 43,642 45,152 11,829 2,725 2,496 111
Alcohol psychosis (291).......................... 13,366 7,743 5,623 52.5 783 1,011 2,186 2,772 873 85 25 8
Drug psychosis (292).............................................. 1,171 643 528 35.6 439 60 54 54 19 7 8 2
Organic psychotic conditions, excluding alcohol and drug psychosis (290,293-294)............................ 9,024 4,664 4,360 68.6 177 117 361 1,182 1,137 806 881 3
Schizophrenic disorders (295).................... 59,228 49,556 9,672 39.3 24,169 9,106 7,906 6,670 1,336 184 149 36
Other psychoses (296-299)........................ 22,302 15,931 6,371 47.6 4,390 2,330 3,112 4,255 1,329 270 235 10
Neurotic disorders (300) ........................ 27,309 11,056 16,253 46.8 3,202 1,690 2,104 3,059 797 121 79 4
Personality disorders (301)...................... 23,102 6,841 16,261 35.7 4,191 1,257 707 539 109 18 18 2
Alcohol dependence or abuse (303,305.0) ........ 134,491 86,347 48,144 47.2 17,917 15,947 24,552 23,094 4,365 315 125 32
Drug dependence or abuse (304,305.1-305.9)......... 30,886 10,783 20,103 32.8 8,031 1,673 671 319 54 4 24 7
Other nonpsychotic mental disorders (302,306-319) . 36,056 14,826 21,230 51.5 4,094 1,851 1,989 3,208 1,810 915 952 7
VI..........Diseases of the nervous system and sense organs. 136,282 48,607 87,675 57.8 4,678 3,508 7,785 18,202 9,572 2,798 2,039 25
Quadriplegia (344.0)................................ 3,404 1,600 1,804 43.9 537 308 332 324 76 16 6 1
Paraplegia (344.1)................................ 4,893 1,827 3,066 46.4 525 294 379 455 146 18 10 .....
Epilepsy (345).............................................. 7,063 2,643 4,420 48.2 649 368 532 782 234 47 29 2
Disorders of the peripheral nervous system (350-359). 18,640 6,310 12,330 54.9 663 536 1,282 2,645 903 176 100 5
Other diseases of central nervous system (320-343, 344.2-344.9,346-349).............................. 40,344 11,392 28,952 56.7 1,055 1,075 2,074 4,124 2,141 576 340 7
Glaucoma (365).................................... 6,686 1,852 4,834 63.7 33 47 200 783 508 178 101 2
Cataract (366)....................................... 15,115 10,410 4,705 66.0 89 117 940 4,137 3,090 1,089 945 3
Blindness (369) .................................. 3,471 813 2,658 59.6 54 47 138 321 143 55 53 2
Disorders of the eye and adnexa (360-364,367-368,370-379) . 23,359 7,624 15,735 60.3 488 346 1,078 3,098 1,708 546 358 2
Diseases of the ear and mastoid process (380-389) ............... 13,307 4,136 9,171 54.0 585 370 830 1,533 623 97 97 1
VII..................Diseases of the circulatory system......... 470,146 148,136 322,010 61.5 3,121 5,661 25,142 64,355 31,875 9,609 8,313 60
Chronic rheumatic heart disease (393-398) ............ 4,506 1,818 2,688 57.3 72 115 416 859 287 40 29 .....
Hypertensive disease without heart involvement (401,403,405)..... 84,236 11,319 72,917 57.7 469 755 2,486 5,100 1,911 356 239 3
Hypertensive heart disease (402,404)............. 12,136 5,151 6,985 62.4 35 130 804 2,354 1,225 356 245 2
Acute myocardial infarction (410).......................... 13,979 8,502 5,477 61.1 68 359 1,598 3,822 1,761 539 353 2
Other ischemic heart disease (411414)..................... 115,710 39,696 76,014 60.9 249 1,490 8,063 18,402 7,474 2,152 1,851 15
Otherformsof heart disease (391,392.0,420-429)............ 116,875 33,108 83,767 63.7 613 983 4,621 13,257 7,819 2,897 2,902 16
Cerebrovascular diseases (430-438) ........................ 43,960 20,279 23,681 64.0 189 355 2,556 8,697 5,359 1,654 1,460 9
Atherosclerosis (440) ............................... 12,224 3,367 8,857 65.5 8 40 387 1,397 887 320 327 1
Other diseases of arteries, arterioles and capillaries (441-448). 27,397 11,063 16,334 62.3 165 257 1,460 5,115 2,920 692 447 7
Varicose veins of lower extremities (454) ............ 4,534 1,772 2,762 59.0 118 119 308 717 308 115 86 1
Hemorrhoids (455)................................. 9,870 4,083 5,787 52.1 588 498 938 1,501 431 79 47 1
Other diseases of the circulatory system (390,392.9,415-417,451-453,456-459).............. 24,719 7,978 16,741 58.3 547 560 1,505 3,134 1,493 409 327 3
VIII.................Diseases of the respiratory system........ 171,428 62,491 108,937 61.3 3,580 2,272 8,385 25,150 14,784 4,642 3,646 32
Acute respiratory infections (460-466)...................... 9,123 2,992 6,131 56.8 462 182 441 960 566 198 180 3
Pneumonia and influenza (480487)........................... 27,413 12,497 14,916 64.3 681 479 1,556 4,070 2,588 1,399 1,718 6
Chronic bronchitis (491).............................. 8,734 3,144 5,590 62.3 42 71 404 1,490 839 196 101 1
Emphysema (492) .................................. 9,211 2,365 6,846 63.7 9 28 287 1,075 680 187 96 3
See footnotes at end of table.
162
INPATIENT CARE TABLE 26-Continued
VA Medical Centers—Hospital Care Component: Patients Discharged, Age, Diagnostic Category1—Fiscal Year 1981
Age Group of Principal Diagnosis
, Total Principal Associated Average --------------------------------------------------------
Diagnostic Category and ICDA Codes Diagnoses Diagnoses. Age
Under 35 35-44 45-54 55-64 65-74 75-84 „ . .
Over able
Other diseases of the respiratory system and upper respiratory tract (470-478,490,493-519).................. 116,947 41,493 75,454 60.5 2,386 1,512 5,697 17,555 10,111 2,662 1,551 19
IX.................Diseases of the digestive system........ 240,385 88,161 152,224 56.4 8,846 7,033 17,460 33,173 14,686 3,887 3,034 42
Diseases of oral cavity, salivary glands and jaws (520-529) . 56,933 4,935 51,998 50.6 1,110 440 865 1,738 599 116 64 3
Ulcersof the digestive system (530.2,531-534) .. 17,528 8,600 8,928 57.5 648 608 1,637 3,530 1,478 410 286 3
Other diseases of the esophagus, stomach and duodenum (530.0,530.1,530.3-530.9,535-537)............. 25,254 9,108 16,146 57.1 703 720 1,840 3,574 1,582 408 277 4
Hernia of the abdominal cavity (550-553)...... 31,981 19,103 12,878 58.4 1,516 1,092 3,205 7,578 3,987 1,017 697 11
Other diseases of the intestine and peritoneum (540-543,555-569,578-579)..................... 56,713 25,060 31,653 56.9 3,062 1,961 4,361 8,411 4,467 1,424 1,359 15
Alcohol related liver disorders (571.0-571.3)............ 20,098 7,192 12,906 54.4 300 667 2,272 3,171 705 61 14 2
Other diseases of liver, gallbladder and pancreas (570,571.4-577) .... 31,878 14,163 17,715 54.4 1,507 1,545 3,280 5,171 1 868 451 337 4
X...............Diseases of the genitourinary system...... 125,059 45,940 79,119 60.6 3,380 2,299 5,912 17,361 10,846 3,278 2,832 32
Nephritis, nephrotic syndrome and nephrosis (580-589).... 17,796 5,518 12,278 57.7 396 386 1,083 2,225 956 239 223 10
Other diseases of the urinary system (590-599) .......... 62,468 18,397 44,071 60.8 1,463 1,107 2,513 6,206 4,102 1,447 1,548 11
Diseases of the prostate (600-602)....................... 29,168 14,013 15,155 65.6 136 128 923 6,016 4,596 1,331 878 5
Other diseases of the male genital organs (603-608)..... 12,373 6,200 6,173 54.4 917 484 1,129 2,332 979 212 144 3
Disorders of breast and gynecological diseases (610-629). 3,254 1,812 1,442 49.6 468 194 264 582 213 49 39 3
XI..Complications of pregnancy, childbirth and puerperium (630-676)........................................ 54 33 21 (6) 32 1 ..................................
XII.........Diseases of skin and subcutaneous tissue . 56,501 21,457 35,044 53.5 3,612 2,098 3,984 7,297 3,048 743 659 16
Infections and inflammatory conditions of skin and subcutaneous tissue (680-698).............................. 28,072 11,057 17,015 52.8 1,953 1,107 2,140 3,761 1,424 342 320 10
Other diseases of skin and subcutaneous tissue (700-709). 28,429 10,400 18,029 54.2 1,659 991 1,844 3,536 1,624 401 339 6
XIII. Diseases of the musculoskeletal system and
connective tissue ..................... 106,466 42,548 63,918 52.7 7,214 4,402 8,081 15,116 5,631 1,240 844 20
Osteoarthrosis and allied disorders (715)..... 19,204 4,835 14,369 61.0 210 199 647 2,167 1,059 323 230
Other arthropathies and related disorders (710-714,716-719). 24,011 10,736 13,275 50.1 2,673 1,025 1,747 3,539 1,345 238 161 8
Dorsopathies (720-724)........................ 29,645 12,488 17,157 51.9 1,791 1,751 2,845 4,329 1,307 273 187 5
Rheumatism, excluding the back (725-729)..................... 15,899 7,538 8,361 53.2 1,115 721 1,546 2,808 1,057 196 93 2
Osteopathies, chondropathies and acquired musculoskeletal deformities (730-739)......................... 17,707 6,951 10,756 51.8 1,425 706 1,296 2,273 863 210 173 5
XIV................Congenital deformities (740-759) ......... 7,428 2,840 4,588 53.7 423 283 541 996 427 108 60 2
163
XVI..........Symptoms, signs and ill defined conditions (780-799). 140,570 48,722 91,848 56.8 5,048 3,834 9,181 17,926 8,081 2,439 2,194 19
XVII...............................Injury and poisoning....................... 96,089 45,721 50,368 50.7 11,727 4,704 7,689 12,669 5,250 1,813 1,842 27
Fracture of skull (800-804) ...................... 3,393 2,140 1,253 41.6 923 332 385 369 85 23 23 ......
Fracture of neck and trunk (805-809) ............ 6,539 2,548 3,991 54.7 469 201 432 816 327 132 171 ......
Fractureof upper and lower limb (810-829) ....... 16,282 10,915 5,367 55.5 2,020 856 1,746 3,186 1,541 711 847 8
Dislocations, sprains and strains of joints and adjacent muscles
(830-848).................................................. 6,183 3,962 2,221 44.5 1,524 503 578 941 296 65 52 3
Intracranial injury, excluding those with skull fracture (850-854) .... 3,017 2,052 965 48.3 637 220 357 485 205 73 75 ......
Internal injury of chest, abdomen and pelvis (860-869)..... 1,347 617 730 48.4 158 74 141 167 52 17 7 1
Open wounds (870-897) ........................... 10,164 5,520 4,644 44.4 2,159 676 940 1,189 366 104 82 4
Burns (940-949)............................................ 2,587 1,193 1,394 50.7 279 117 239 357 122 46 33 ......
Poisoning by drugs, medicinal and biological substances (960-979).......................................... 7,175 2,157 5,018 47.4 724 291 308 476 213 79 65 1
Toxic effects of substances chiefly nonmedical as to source (980-989).......................................... 1,114 364 750 47.1 93 57 76 108 25 4 1 .....
All other injuries (900-904,910-939,950-959,990-995)...... 12,777 4,661 8,116 50.5 1,201 480 828 1,278 521 180 171 2
Complications of surgical and medical care, NEC (996-999). 16,613 7,246 9,367 56.7 831 514 1,179 2,773 1,315 349 280 5
Late effects of injuries, poisonings, toxic effects and other external causes (905-909).......................... 8,898 2,346 6,552 46.1 709 383 480 524 182 30 35 3
XVIII. Factors influencing health status and contact
with health services (V01-V82) ........... 122,836 28,641 94,195 57.5 2,980 1,622 4,514 11,248 5,935 1,414 912 16
Unavailable5 ..................................... 9.435 9,435 ..... 55.8 1,274 744 1,559 3,443 1,633 436 335 11
1 Patient treatment file. This table, as well as all others in this discharge series, excludes approximately 232,644 3Principal diagnosis is that diagnosis designated by the discharge physician as responsible for the major portion
one-day dialysis discharges. of the patients length of stay.
2 The diagnostic categories and selected diagnoses included in this table are based on the ‘International 4Associated diagnoses are established diagnoses for which treatment was given, other than the principal
Classification of Diseases 9th Revision Clinical Modification, ’ DHHS Publication No. (PHS) 80-1260. The diagnosis,
numbers following the diagnoses are the identifying code numbers of this diagnostic classification. Category 5 This column/line includes all records for which required data is unavailable.
XV, ‘Certain Conditions Originating in the Prenatal Period’ in which no cases occurred, is not included in this 6 Average age not calculated for totals of less than 100 cases.
table.
Note: The changes to this report reflect the new ICD-9-CM codes.
164
INPATIENT CARE TABLE 27
VA Medical Centers—Hospital Care Component: Patients Discharged, Type of Patient, Age,
Length of Stay1—Fiscal Year 1981
Type of Patient Total „ Short Short Term Length of Stay Distribution (Days)
and Patients Average Madl™ „Term Discharges as ----------------------------------------------- Tota)
Age Group Days Days A*era^ PeWay 2-3 4-7 8-14 15-21 22-30 31-60 61-90 91-180 181' 271’ 366‘ 731 Una»«''- days4
..............Days Discharges 270 365 730 Plus able3 AH Patients... 945,245 27.3 10.4___15.0 97.0 99,064 132,093 172,436 201,269 104,459 80,269 96,938 25,797 19,868 4,874 2,165 3,104 2,801 108 25,833,873
Under20 ........ 986 28.2 7.0 12.4 96.9 148 207 185 173 80 44 89 22 25 8 2 1 2 27
26-24........ 19,828 19-9 7.5 14.2 96.7 2,956 3,477 3,992 3,112 1,471 1,409 1,981 649 556 117 52 ’ ’ 51 3 2 393 877
2529 .......... 43-189 21 3 8,1 146 96.9 6,182 7,132 8,172 7,102 3,436 3,495 4,747 1,321 1 108 228 100 127 37 2 919396
353g........... 66,2™ 91 153 989 8,901 10,140 12-191 11,229 5,719 5,815 7,816 2,013 1,627 423 154 180 52 10 1 451 547
3n3®......... I3,229 one no 972 5,432 6,662 7,874 7,598 3846 3948 5,148 1,283 942 217 94 123 59 3 979 052
40-44........ 36,087 24.6 9.8 15.2 97.0 4,030 5,615 6,632 7,031 3,382 2,945 4,144 1 042 812 190 72 117 72 3 888033
45-49......... 64,522 25.1 9.9 14.7 97.3 6,672 9,768 12,194 13,224 6>48 5,502 6,799 <607 1 224 303 142 172 162 5 1 wS 355
50-54......... 101,032 25.5 10.2 14.9 97.3 9,917 14,535 18,867 21,814 11,082 8,550 10 494 2 600 1 969 464 198 300 235 7 2 576 754
|5t9........ I!3,236 26,2 I6-3 14-7 97 4 15,183 22,904 30,122 36,721 18742 4:07? S 2“ 117 4M 16 4§S
66-64.......... 69,592 25,7 05 48 973 17.057 23,031 30,893 38,824 20,235 14,163 15,881 4,241 3,217 736 319 503 472 20 4 361 326
6569 ....... 166,348 283 169 156 969 9869 12,920 17.941 22,981 12,244 8,570 9,531 2,783 1,988 563 248 363 333 14 2'835798
7674 .......... 56,536 368 1,4 5-6 964 5-237 6'716 9853 13092 7,096 4,954 5,616 1,671 1,299 329 169 232 265 7 1 742 690
80 4............ 21,494 37,5 26 6,3 95 1 1,854 2,481 3,585 4,899 2,779 1,972 2,303 664 528 131 73 101 121 3 '804 948
86-84 .......... 22,344 49,8 12,1 18,1 954 1,886 2,522 3,787 5,132 2,830 2,026 2,353 662 553 171 99 135 181 7 1 107 986
Unav^lX'3..... 3 MOT rn urn. 956 2,691 3,92° 6,654 8,249 4,722 3,382 3,948 1,145 948 301 137 221 353 5 1 828 492
Unavallab,e .... 478 NOT COMPUTED 16.4 96.0 49 63 94 88 47 38 52 23 13 2 4 2 1 2 ' 24^450
Psychotic . 78,538 88.4 21.7 24.4 88.6 5,205 6,204 8,400 11,404 8,463 8,727 14,608 5,496 5,208 1,556 800 1,124 1,330 13 6,944,803
“"11'20 .......... ™ 323 18,2 24,4 934 8 1 8 22 31 25 1 2 36 14 1 2 3 ... 5 843
25jn.......... 4,781 35 1 18,9 23,8 92,6 422 427 543 709 511 524 855 367 315 59 30 17 1 ' " i 167 978
3034 ......... I6,825 36,4 17,5 22,3 93,1 971 1,019 1,336 1,679 1,116 1,202 1,935 690 598 134 54 68 23 .............. 394312
353g.......... 14,172 38,3 18,3 225 92,5 1,230 1,243 1,710 2,151 1,576 1,630 2,524 881 797 217 95 80 32 6 542011
35 39 .......... 7,815 46.6 19.8 23.5 92.0 638 619 893 1,159 857 930 1,484 511 437 120 49 80 37 1 364 264
4614 .......... 4,809 82,8 20,9 24.6 89.4 294 410 548 720 512 483 915 348 331 90 46 68 44 Ml 277
50M.............. 734? 773 21 2 24,2 893 344 528 707 9°9 727 716 1,158 428 393 121 83 69 96 1 485447
55 5„......... 7,341 98 0 23.3 25.3 87.4 394 567 804 1,030 762 792 1,418 553 497 165 84 132 143 704 381
60-64 ........ 6477 i 28 2 275 82 R 261 aak III 1'15° 891 953 1,671 665 762 224 110 187 245 1 1,°89^914
65 69 ............. ™ lol] on lln 82,8 261 465 559 830 853 759 1,278 517 547 178 109 156 227 .. 978 453
70.74 ........ 3,126 8?-4 28,9 27 0 79,8 105 170 258 440 342 309 570 247 239 103 60 122 144 1 582;683
7f- 7Q......... 1,584 192.9 32.2 28.1 78.6 73 86 84 218 166 150 326 117 150 47 24 44 99 305 504
7579 ............ 839 282.8 29.6 26.5 76.2 21 30 48 86 78 67 111 35 52 24 10 29 48 2 7 0
85 and over... ! 298 399 ! 26 3 24 6 ^3 53 70 T 94 71 62 122 44 52 28 15 36 75 1 351,771
u—>■::::::: X9i>mir¥o Sf K s43 75° ” ™ « ’« 7‘ » « 2’ « j
Other Psychiatric . . 129,853 30.3 14.1 19.5 96.7 11,691 15,994 19,610 20,084 11,910 16,544 24,034 4,782 3,359 763 331 411 326 14 3,927,811
................ 189 199 107 15,9 97,4 25 26 32 29 20 18 30 4 3 2 3755 25 2g.......... 4,337.25? 19,7 98,8 512 489 803 648 393 557 787 176 124 24 8 16 ... 108 260
3034 ......... I2,622 2]-6 ?-5 I9? 969 1,505 1,431 1,713 1,745 1,084 1,881 2,093 453 356 56 23 28 3 1 295 611
3539.......... 26,88Z 21-5 14 0 19,4 97,1 2,497 2,427 2,"3 2,945 1,837 2,794 3,859 770 544 135 38 39 6 3 511 226
............. 12,882 23,8 14 0 19,8 97,8 1,387 1,650 1,888 1,762 1,065 1,799 2,449 476 297 60 25 20 4 307 091 4549........... 9,536 23-5 I35 19,4 97 7 907 1,388 1,438 1,348 756 1,219 1,894 331 213 40 9 12 3 2 224 291
45-49 ........ 13,745 25.6 13.8 19.4 97.7 1,185 1,866 2,174 1,984 1,185 1,809 2,674 465 283 57 21 26 16 351 492
I559.......... I6,278 25-8 13,7 19 2 97,3 1,230 2,102 2,659 2,589 1,408 2,096 3,139 529 356 79 33 33 23 ""2 419845
|om............... ]'39fi a M 95 9Z? 'l2% 2,264 2,829 3,617 1,759 2,139 3,368 638 405 93 82 80 37 4 530,149
66 .......... 12,325 35 5 14,4 19,8 98-1 749 1,439 1,933 2,214 1,335 1,434 2,168 494 344 79 34 45 58 437 739
65-69 ........ 8,087 44,1 18-3 20.0 94.3 261 549 748 950 566 623 841 215 162 44 36 37 35 223 296
Z6Z4.......... 2,088 87 0 16.8 20.6 90.7 99 171 316 388 239 217 335 92 89 31 17 25 48 ..1 ?38M3
K................. “I “■? ”1 33 » 7’ 124 35 79 93 3, 4, S ” n “ ................’ (Sg
85 and over... i I37 0 II I l^l 6] 9 32 53 61 120 76 73 108 43 81 20 11 17 25 1 95,387
m 1 ui 3....... 1,198 137 9 22,3 23,2 82,5 37 78 I48 211 120 128 190 62 91 30 19 34 50 165 24R
Una’'a,lable ......... 52 NOT COMPUTED 19.7 98.1 4 9 6 10 2 8 9 3 ............. . 1 <<< 14175
165
Medical and Surgical 727,420 20.2 9.3 13.3 98.0 80,999 108,753 142,863 167,804 83,021 54,234 57,281 15,229 11,035 2,480 1,004 1,524 1,115 78 14,669,998
Under 20 ......... 607 30.0 5.0 8.1 97.7 110 160 131 112 35 14 23 4 10 3 2 ........ 1 2 18,125
20-24 ......... 10,526 10.9 5.0 7.9 98.5 1,987 2,527 2,789 1,731 562 316 331 100 116 33 14 17 2 1 114,707
25-29 ......... 19,882 11.0 5.4 8.2 98.9 3,614 4,611 5,040 3,593 1,224 709 685 168 142 35 20 30 10 1 219,417
30-34 ......... 30,591 12.6 6.1 9.4 98.8 5,071 6,382 7,387 6,016 2,238 1,342 1,370 345 279 66 21 59 14 1 386,745
35-39 ......... 22,104 13.5 6.7 10.3 98.9 3,332 4,336 5,009 4,596 1,888 1,189 1,179 288 193 36 18 20 18 2 298,430
40-44 ......... 21,426 16.5 7.6 11.4 98.4 2,783 3,804 4,600 4,892 2,078 1,221 1,302 348 263 57 17 36 24 1 354,171
45-49 ......... 43,910 17.5 8.2 12.0 98.4 5,075 7,294 9,214 10,207 4,781 2,932 2,891 699 532 122 37 74 49 3 769,906
50-54 ......... 76,443 18.7 9.1 13.1 98.3 8,184 11,729 15,261 17,981 8,798 5,581 5,836 1,489 1,095 211 75 130 68 5 1,428,177
55-59 ........ 135,256 19.4 9.5 13.4 98.3 14,388 19,887 26,288 32,219 15,897 10,237 10,809 2,722 1,905 363 137 226 167 11 2,629,223
60-64 ........ 148,977 19.5 9.9 13.7 98.1 15,828 20,972 28,121 35,391 18,038 11,816 12,245 3,168 2,266 464 170 295 184 19 2,899,650
65-69 ......... 91,149 21.8 10.4 14.4 97.7 9,396 12,090 16,771 21,383 11,207 7,545 8,000 2,292 1,552 407 151 196 147 12 1,984,238
70-74 ......... 52,273 24.5 11.0 15.1 97.2 5,016 6,398 9,358 12,332 6,614 4,539 4,884 1,438 1,044 244 124 161 115 6 1,279,577
75-79 ......... 19,921 25.6 11.6 15.9 97.1 1,778 2,354 3,426 4,637 2,575 1,807 2,071 589 428 92 56 51 54 3 510,705
80-84 ......... 20,756 31.0 11.6 15.6 96.6 1,820 2,419 3,633 4,874 2,654 1,874 2,105 570 443 122 73 85 79 5 642,373
85 and over.... 33,243 33.9 12.1 16.2 96.2 2,577 3,744 5,758 7,769 4,393 3,085 3,520 996 762 223 87 142 183 4 1,127,201
Unavailable3 ..... 356 NOT COMPUTED 14.0 96.9 40 46 77 71 39 27 30 13 5 2 2 2 ........ 2 7,353
Unavailable3 . 9,434 30.9 10.9 15.6 95.9 1,169 1,142 1,563 1,977 1,065 764 1,015 290 266 75 30 45 30 3 291,261
Under 20 ........... 9 2.4 .... 2.4 100.0 5 3 .... 1 ........................................................ 22
20-24 ............ 184 15.9 5.6 10.2 98.4 35 34 57 24 5 12 8 6 1 1 ........ 1 .......... 2,932
25-29 ............ 460 21.9 7.2 12.1 96.3 92 71 83 85 32 33 34 10 12 3 3 1 1 ........ 10,056
30-34 ............ 620 18.7 9.1 14.6 98.2 103 88 101 117 68 49 63 17 7 5 ........ 2 .......... 11,565
35-39 ............ 428 21.7 7.9 13.2 95.8 75 57 84 81 36 30 36 8 15 1 2 3 .............. 9,277
40-44 ............ 316 26.2 10.8 16.2 97.2 46 35 48 71 36 22 33 15 5 3 ........ 1 1 ......... 8,294
45-49 ............ 589 23.0 10.5 16.0 96.8 68 82 99 124 55 45 76 15 16 3 1 3 1 1 13,510
50-54 ............ 970 25.1 11.1 15.7 96.3 109 137 143 214 114 81 101 29 21 9 6 5 1 ..... 24,351
55-59 .......... 1,631 32.0 11.1 15.7 96.3 202 178 288 335 195 127 188 46 49 11 3 4 5 ..... 52 138
60-64 .......... 1,812 25.1 11.4 15.8 95.5 219 215 280 389 209 154 192 62 60 15 6 7 3 1 45,484
65-69 .......... 1,022 44.6 12.3 16.6 94.7 107 111 164 208 129 93 120 29 35 9 1 8 7 1 45,581
70-74 ............ 611 31.5 12.6 17.1 95.3 49 61 95 154 77 48 71 24 16 7 4 2 3 ..... 19,216
75-79 ............ 249 46.8 13.3 17.2 94.4 22 23 40 52 41 19 28 9 7 2 2 2 2 11 660
80-84 ............ 187 98.7 13.6 17.4 93.6 12 16 30 44 29 17 21 5 7 1 ....... 3 2 ' " 18455
85 and over....... 335 54.8 14.0 18.3 92.5 24 28 50 77 39 34 42 13 14 5 2 3 4 . \ 18 355
Unavailable3 ...... 11 NOT CO MPUTED 26.3 90.9 1 3 1 1 .......... 2 2 1 ................................. 365
1 Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approximately 3 This column/line includes all records for which required data is unavailable.
232,644 one-day dialysis discharges. 4 TVzZs column excludes those cases for which the number of days is unavailable
One-half of the discharges in the given category have length of stay greater than the median; the other half, 5 Includes hospital stays of 1 to 99 days and conforms to the definition adopted by the
less than the median. commission on professional and hospital activities.
NOTE: The changes to this report reflect the new ICD-9-CM codes.
166
INPATIENT CARE TABLE 28
VA Medical Centers—Hospital Care Component: Patients Discharged, Age, Marital Status,
Diagnostic Grouping1—Fiscal Year 1981
Age Group Marital Status
Diagnostic Composition of Patients Total
Discharged Under rr_rzi rk 74 75 and Unavail- Never .. . . _ . ,
45 4b b4 55-64 65-74 ab)e2 Married Marned Separated Widowed Divorced Unknown2
All discharges........................... 945,245 209,589 165,554 332,828 156,884 79,912 478 131,972 504,941 47,844 60,741 164,078 35,669
Psychotic . . . . .......................... 78,538 42,583 13,619 14,933 4,694 2,650 59 30,396 21,645 5,217 2,459 15 431 3 390
Alcohol psychoses (291) ............................. 7,743 1,794 2,186 2,772 873 110 8 1,219 2,607 700 515 2 398 304
Drug psychoses (292) .......................... 643 499 54 54 19 15 2 259 177 43 9 '117 38
Other psychoses (290,293-299) ...................... 70,152 40,290 11,379 12,107 3,802 2,525 49 28918 18 861 4 474 1 935 12916 3 048
Ae.r PtV .hJatr,%.LL" ............... 129'853 59'853 30'023 30'219 7'135 2'571 52 24,093 46^680 1<471 5,619 3<362 3628
Alcohol dependence and abuse (303,305.0) ... 86,347 33,864 24,552 23,094 4,365 440 32 14 274 28 460 7 914 4 030 29 532 2'l37
Drug dependence and abuse (304,305.1-305.9)......... 10,783 9,704 671 319 54 28 7 3524 3 177 <253 *101 2248 480
Other nonpsychotic mental disorders (300-302,306-319) . 32,723 16,285 4,800 6,806 2,716 2 103 13 6295 15043 2'304 1 488 6582 1 011
Med'ca! and surgical ...... .... ........... 727,420 105,136 120,353 284,233 143,422 73,920 356 76J)10 431*703 30/60 5<001 108940 28306
All infectious and parasitic diseases (001-139) .......... 10,242 3,053 1,848 3,122 1,322 891 6 1 726 4 902 568 676 1 823 547
Malignant neoplasms (140-208,230-234) .............. 86,296 3,917 11,276 38,265 22,673 10,127 38 7*476 53572 3 142 7 164 11 488 3 454
Benign and unspecified neoplasms (210-229,235-239) . 11,092 1,550 1,812 4,425 2,395 908 2 1 080 7 095 447 688 1 445 ',->7
Diabetes melhtus (250) . ............................... 20,883 2,308 4,321 9,148 3,819 1,273 14 2,043 12^684 931 1,348 3*132 745
Other endocrine, nutritional and metabolic diseases
(240-246,251-278)... . . . ........... 9,121 1,144 1,665 3,437 1,697 1,174 4 1,019 5,150 426 826 1 309 391
Disorders involving the immune mechanisms (279)............ 73 38 11 23 1 7 49 1 14 2
Diseases of the blood and blood-forming organs (280-289). 6,416 768 746 2 320 1 380 1 201 .1 695 3 715 264 644 843 255
Quadriplegia (344.0).................................... 1,600 845 332 324 *76 *22 1 390 '734 82 40 274 80
Paraplegia (344 1) ................................. 1,827 819 379 455 146 28 . 352 929 91 47 328 80
Other diseases of the nervous system (320-343,344.2-359) . 20,345 4,346 3,888 7,551 3,278 1 268 14 2 165 12 736 763 1 004 2 946 731
Diseases of the sense organs (360-389)................. 24,835 2,176 3,186 9,872 6,072 3,519 10 2245 15098 930 2 143 3353 1 066
Heart diseases (391-392.0,393-398,402,404,410-414, ' ' '
420429) .... .............'............. 88,275 4,114 15,502 38,694 18,566 11,364 35 5,799 58,585 2,822 6,852 10 964 3 253
Cerebrovascular diseases (430-438) ....................... 20,279 544 2,556 8,697 5,359 3,114 9 1 576 12 946 744 1 735 2 558 '?20
Other diseases of the circulatory system (390,392.9,401, ' ' '
403,405,415-417,440-459) ............................... 39,582 4,124 7,084 16,964 7,950 3,444 16 3,529 24 092 1 720 2 809 6 054 1 378
Acute respiratory diseases (460-466,480-487)..... 15,489 1,804 1,997 5,030 3,154 3,495 9 1 839 8034 *762 1 820 2377 657
Chronic bronchitis and emphysema (491-492)........ 5,509 150 691 2,565 1 519 580 4 438 3 236 253 502 951 129
Other respiratory diseases (470-478,490,493-519). 41,493 3,898 5,697 17,555 10,111 4,213 19 3 898 24*133 1 816 3 329 6 800 1 517
Diseases of the oral cavity, salivary glands, and jaws (520-529) .... 4,935 1,550 865 1,738 599 180 3 803 2682 *214 '235 *721 *280
Hernia of the abdominal cavity (550-553)............... 19,103 2,608 3,205 7,578 3,987 1 714 11 2 261 11 235 758 1 326 3 025 498
Alcohol related liver diseases (571.0-571.3)...... 7,192 967 2,272 3,171 705 75 2 770 3*088 508 *492 2*012 322
Other diseases of the digestive system (530-543, 555-570 571.4-579). ...................... 56'931 10-754 11>r>8 20,686 9,395 4,952 26 6,541 32,227 2,752 3,742 9,619 2 050
Diseases of the male genital organs (600-608)............. 20,213 1,665 2,052 8,348 5,575 2,565 8 1 938 13 188 688 1 460 2 284 655
Other diseases of the genitourinary system (580-599) ..... 23,915 3,352 3,596 8,431 5,058 3,457 21 2 291 14*834 924 1*855 2*907 1 104
Diseases of the breast, gynecological disorders and ' ' ' ' ’
complications of pregnancy (610-676)..................... 1,845 695 264 582 213 88 3 322 914 108 112 328 61
Diseases of the skin and subcutaneous tissue (680-709). 21,457 5,710 3,984 7,297 3,048 1 402 16 3 361 11 128 1 054 1 247 3 733 934
Diseases of the musculoskeletal system and connective ' ’ ' ' '
tissue (710-739) 42,548 11,616 8,081 15,116 5,631 2,084 20 4,450 26,640 1,738 1,976 6,415 1 329
Congenital anomalies (740-759) .............. 2,840 706 541 996 427 168 2 337 1 667 112 135 457 132
Symptoms, signs and ill-defined conditions (780-799). 48,722 8,882 9,181 17,926 8,081 4,633 19 5,163 28*474 2 196 3 228 7 760 1 901
Injuries and poisonings (800-904,910-999).............. 43,375 15,339 7,209 12,145 5,068 3,590 24 7,761 19 653 2*462 2*668 8 408 2 423
Late effects of injuries, poisonings, toxic effects, and ' ' ' ' '
other external causes (905-909)............ 2,346 1,092 480 524 182 65 3 446 1 086 146 108 471 89
Factors influencing health status and contact with
health service (V01-V82).................. 28,641 4,602 4,514 11,248 5,935 2,326 16 3,289 17,197 1 038 1 790 4 141 1 186
Supplementary classification of external causes of ' ' '
injury and poisoning (E800-E999)........
Unavailable2 ................................. 9,434 2,017 <559 3*443 ’ ”<633 ” 771 ...11 ” 1/73 ”<913 ” ”696 "”662 ” <345 ""345
treatrfent fite-. table, as well as all others in this hospital discharge series, excludes approximately 2 This column/line includes all records for which required data is unavailable
232,644 one-day dialysis discharges. NOTE: The changes to this report reflect the new ICD-9-CM codes.
TABLE 29
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Discharged, Compensation and Pension Status, Type of Patient, Age1—Fiscal Year 1981
Type of Patient and Age Group Total All Patients Service-Connected Veterans Non-Service-Connected Non Veterans3 Unavailable4
Total 10% or more Less Than 10% NSC With SC2 Total Pension Other
All patients 945,245 269,259 99,240 3,853 166,166 662,741 192,815 469,926 5,465 7,780
Under 25 20,814 4,784 3,344 87 1,353 14,100 750 13,350 1,772 158
25-34 109,459 37,651 23,082 480 14,089 69,602 6,159 63,443 1,386 820
35-44 79,316 23,943 12,995 245 10,703 54,023 4,981 49,042 735 615
45-54 165,554 40,940 16,413 534 23,993 122,762 29,299 93,463 563 1,289
55-64 332,828 99,903 28,735 1,503 69,665 229,530 73,661 155,869 555 2,840
65 and over 236,796 61,903 14,610 1,003 46,290 172,426 77,897 94,529 415 2,052
Unavailable4 478 135 61 1 73 298 68 230 39 6
Psychotic 78,538 36,177 29,356 353 6,468 41,778 11,507 30,271 565 18
Under 25 4,962 2,049 1,826 23 200 2,530 162 2,368 377 6
25-34 24,997 13,917 12,099 124 1,694 10,936 1,668 9,268 138 6
35-44 12,624 6,197 5,282 44 871 6,402 918 5,484 24 1
45-54 13,619 5,264 4,086 65 1,113 8,344 3,047 5,297 9 2
55-64 14,933 6,436 4,684 60 1,692 8,494 3,431 5,063 2 1
65 and over 7,344 2,293 1,360 37 896 5,045 2,278 2,767 5 1
Unavailable4 59 21 19 2 27 3 24 10 1
Other Psychiatric 129,853 29,721 10,980 362 18,379 99,655 17,543 82,112 447 30
Under 25 4,526 664 370 8 286 3,678 127 3,551 183 1
25-34 32,909 7,799 3,455 110 4,234 24,984 1,542 23,442 121 5
35-44 22,418 4,473 1,702 31 2,740 17,884 1,112 16,772 53 8
45-54 30,023 5,588 1,787 73 3,728 24,383 4,583 19,800 50 2
55-64 30,219 8,634 2,829 105 5,700 21,549 6,758 14,791 29 7
65 and over 9,706 2,553 833 35 1,685 7,139 3,418 3,721 7 7
Unavailable4 52 10 4 6 38 3 35 4
Medical and surgical 727,420 202,779 58,658 3,131 140,990 519,884 163,393 356,491 4,443 314
Under 25 11,133 2,061 1,141 55 865 7,856 459 7,397 1,206 10
25-34 50,473 15,821 7,462 245 8,114 33,492 2,933 30,559 1,126 34
35-44 43,530 13,210 5,972 169 7,069 29,636 2,940 26,696 657 27
45-54 120,353 30,012 10,509 396 19,107 89,789 21,615 68,174 504 48
55-64 284,233 84,629 21,145 1,337 62,147 198,971 63,325 135,646 523 110
65 and over 217,342 56,942 12,391 928 43,623 159,913 72,060 87,853 402 85
Unavailable4 356 104 38 1 65 227 61 166 25
Unavailable4 9,434 582 246 7 329 1,424 372 1,052 10 7,418
Under 25 193 10 7 1 2 36 2 34 6 141
25-34 1,080 114 66 1 47 190 16 174 1 775
35-44 744 63 39 1 23 101 11 90 1 579
45-54 1,559 76 31 45 246 54 192 1,237
55-64 3,443 204 77 1 126 516 147 369 1 2,722
65 and over 2,404 115 26 3 86 329 141 188 1 1,959
Unavailable4 11 6 1 5 5
'Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approximately 232, 644 one-day dialysis discharges.
2 Veterans with compensable service-connected disabilities but treated for non-service connected disability only.
3 This group includes all patients other than veterans, such as active military, humanitarian emergencies, reimbursable cases, allied beneficiaries, donors, etc. If a veteran is admitted as an office of workers compensation program case, he is coded as a non-veteran.
‘'This column/line includes all records for which required data is unavailable.
NOTE: The changes to this table reflect the new ICD-9-CM codes.
167
168
INPATIENT CARE TABLE 30
VA Medical Centers-Hospital Care Component: Patients Discharged, Compensation and Pension Status,
Type of Patient, Sex1—Fiscal Year 1981
All Patients Female4 Male4
Compensationand --------------------------------------------------------------------------------------------------------------
Pension Status p Other Medical Un- p Other Medical Un- p Other Medical Un-
Total ohotie Psychi- and avail- Total *** Psych i- and avail- Total ,s^' Psychi- and Avail-
ch0t,C atric Surgical able3 chot,c atric Surgical able3 chot,c atric Surgical able2
VA Hospitals—Totals. 945,245 78,538 129,853 727,420 9,434 16.545 2,176 1,664 12,560 145 928,578 76,356 128,177 714,760 9,285
Service connected................. 103,093 29,709 11,342 61,789 253 2,189 777 260 1,144 8 100,880 28,929 11,081 60,625 245
10% or more.......... 99,240 29,356 10,980 58,658 246 2,119 763 253 1,096 7 97,099 28,590 10J26 57^544 239
Less than 10%......... 3,853 353 362 3,131 7 70 14 7 48 1 3,781 339 355 3^081 6
Non-service connected with SC .. . 166,166 6,468 18,379 140,990 329 2,371 132 187 2,048 4 163,783 6,336 18,189 138 933 325
NSC with pension...... 192,815 11,507 17,543 163,393 372 2,812 385 183 2,239 5 189,981 11,122 17 360 161 133 366
NSC no claim pending.............. 469,926 30,271 82,112 356,491 1,052 8,007 847 985 6,149 26 461,858 29,421 81 119 350 293 1 025
Non-veterans ........... 5,465 565 447 4,443 10 1,038 35 48 955 .... 4,427 530 399 3 488 ' 10
Unavailable ........................ 7,780 18 30 314 7,418 128 .... 1 25 102 7,649 18 29 288 7,314
1 Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approx- reimbursable cases, allied beneficiaries, donors, etc. If a veteran is admitted as an office of workers
imately 232,644 one-day dialysis discharges. compensation program case, he is coded as a non-veteran.
2 This column/line includes all records for which required data is unavailable. 4 The total female and male discharges will not equal the total discharges since 122 records did not have
3 This group includes all patients other than veterans, such as active military, humanitarian emergencies, sex data available.
NOTE: The changes to this table reflect the new ICD-9-CM codes.
TABLE 31
INPATIENT CARE
VA Medical Centers—Hospital Care Component: Patients Discharged, Type of Patient, Percent Hospitalized in Reported State of Residence1 3 —Fiscal Year 1981
Reported State of Residence All Discharges Type of Patient
Total2 Hospitalized in Same State General Medical And Surgical Psychotic Other Psychiatric Unavailable
Number Percent Total Percent Hospitalized In Same State Total Percent Hospitalized In Same State Total Percent Hospitalized In Same State Total Percent Hospital ized In Same State
Total 944,973 833,520 88.2 727,207 88.4 78,519 88.5 129,819 87.1 9,428 90.3
United States 933,656 822,603 88.1 719,246 88.3 76,205 88.2 128,791 87.0 9,414 90.2
Alabama 20,964 18,735 89.4 15,280 90.2 1,966 87.8 3,604 86.6 114 95.6
Alaska 141 117 11 13
Arizona 19,281 18,634 96.6 15,667 97.0 1,262 95.1 2,293 95.0 59 98.3
Arkansas 20,642 17,086 82.8 17,197 82.2 813 85.0 2,565 87.8 67 20.9
California 76,200 74,143 97.3 60,630 97.6 6,766 96.5 8,624 95.9 180 96.7
Colorado 10,559 9,664 91.5 7,770 93.3 841 90.0 1,874 84.7 74 95.9
Connecticut 9,307 8,751 94.0 7,453 96.4 694 77.2 1,123 88.6 37 89.2
Delaware 2,303 1,981 86.0 1,891 94.4 114 41.2 227 34.8 71 98.6
District of Columbia 4,676 4,482 95.9 3,585 97.4 425 82.8 641 95.9 25 92.0
Florida 52,490 49,985 95.2 43,957 96.3 3,655 88.6 4,838 90.3 40 75.0
Georgia 24,643 19,311 78.4 19,240 78.2 1,815 76.9 3,479 80.2 109 75.2
Hawaii 31 19 4 8
Idaho 4,701 2,785 59.2 3,958 59.9 205 68.8 531 50.7 7 42.9
Illinois 43,144 35,891 83.2 32,228 81.4 3,983 87.1 6,724 89.7 209 69.4
Indiana 16,773 12,482 74.4 12,544 73.6 1,608 76.4 2,473 76.1 148 95.9
Iowa 14,125 11,740 83.1 11,765 83.3 946 88.2 1,408 78.3 6 33.3
Kansas 12,997 10,557 81.2 10,042 79.7 878 82.0 2,059 88.6 18 72.2
Kentucky 18,952 14,828 78.2 15,438 77.7 1,432 83.4 1,857 77.2 225 93.3
Louisiana 20,383 18,739 91.9 16,555 95.0 1,266 66.6 2,545 84.4 17 88.2
Maine 5,633 5,170 91.8 3,147 87.2 756 97.6 1,720 98.0 10 40.0
Maryland 13,544 9,119 67.3 10,132 66.7 888 64.9 2.469 71.6 55 38.2
Massachusetts 21,831 19,440 89.0 15,467 87.1 2,774 95.4 3,520 92.6 70 88.6
Michigan 26,948 25,666 95.2 19,344 95.3 3,435 96.0 4,088 94.8 81 71.6
Minnesota 18,120 15,256 84.2 14,460 83.4 1,462 89.2 2,161 87.0 37 37.8
Mississippi 16,957 13,564 80.0 14,056 79.7 1,074 82.8 1,763 82.9 64 7.8
Missouri 27,851 23,830 85.6 22,997 86.3 1,694 85.2 3,027 80.0 133 88.7
Montana 6,493 4,691 72.2 5,141 75.4 275 42.5 1,069 65.0 8 25.0
Nebraska 11,609 10,046 86.5 8,711 88.6 733 82.7 2,154 80,0 11 27.3
Nevada 4,826 3,135 65.0 4,147 66.3 227 59.0 445 56.0 7 42.9
New Hampshire 5,813 3,100 53.3 4,860 54.1 235 15.7 708 60.2 10 70.0
New Jersey 14,846 12,172 82.0 9,573 80.4 2,238 87.9 2,764 84.4 271 64.2
New Mexico 6,424 5,730 89.2 5,084 91.4 422 77.3 906 82.1 12 100.0
New York 55,888 54,838 98.1 39,553 98.4 4,868 95.4 8,800 97.9 2,667 99.9
North Carolina 24,429 22,883 93.7 19,190 94.3 1,582 92.3 3,638 91.1 19 63.2
North Dakota 2,746 2,122 77.3 2,020 84.8 176 35.2 509 60.3 41 97.6
Ohio 27,140 22,998 84.7 18,429 82.6 3,306 91.0 4,165 88.7 1,240 86.2
Oklahoma 14,126 12,126 85.8 11,511 89.0 673 65.4 1,776 72.4 166 94.0
Oregon 13,997 12,836 91,7 11,314 91.8 867 91.8 1,717 91.0 99 96.0
Pennsylvania 31,826 29,378 92.3 21,558 91.4 4,007 94.8 4,632 92.2 1,629 98.2
Rhode Island 3,812 3,369 88.4 3,255 92.0 307 71.3 247 62.8 3
South Carolina 18,046 13,161 72.9 14,981 76.2 1,041 59.7 1,978 55.7 46 54.3
South Dakota 8,612 7,701 89.4 5,982 87.0 532 92.3 2,085 95.5 13 84.6
Tennessee 22,449 21,648 96.4 17,648 97.0 1,633 95.2 2,884 93.4 284 97.9
Texas 72,919 68,470 93.9 57,803 93.9 5,438 95.8 9,356 92.6 322 96.0
Utah 5,630 5,438 96.6 3,823 97.3 707 94.9 1,098 95.4 2 100.0
Vermont 2,475 2,266 91.6 2,077 93.5 110 80.0 285 82.1 3 100.0
Virginia 22,999 19,004 82.6 16,758 82.3 2,235 89.5 3,896 80.0 110 95.5
Washington 15,918 12,493 78.5 12,370 77.9 1,285 87.3 2,224 76.8 39 66.7
West Virginia 14,605 12,405 84.9 11,368 89.2 745 58.3 2,364 77.3 128 4.7
Wisconsin 19,113 16,093 84.2 14,572 82.8 1,585 88.5 2,543 87.0 413 99.8
Wyoming 3,719 2,661 71.6 2,579 66.5 211 82.0 914 83.7 15 53.3
Outside United States 11,317 10,917 96.5 7,961 95.6 2,314 98.9 1,028 98.0 14 92.9
Canal Zone
Philippines, Republic of Puerto Rico 2 10,947 10,917 99J 2 7,626 99^8 2,296 99.7 T6l2 99’5 13 100 0
Others 368 333 .... 18 16 1
'Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approximately 232,644 one-day dialysis discharges.
Note: The changes to this table reflect the new ICD-9-CM codes.
2 This column includes all records for which required data is unavailable.
3 This table excludes 272 case)s) for which residence data is unavailable.
169
170
INPATIENT CARE
TABLE 32
VA Medical (.enters—Hospital Care Component: Patients Discharged, Diagnostic Grouping, Average and Median Length of Stay, Length of Stay Distribution1—Fiscal Year 1981
T . . Short
1 otal Short Term Length of Stay Distribution (Days)
Principal Diagnoses2 Term Discharges------------------------------------------------------------------------------- Total
a .. Average Percent Days
Patients ''erage ® lan Days’ of Total 1 Day 2-3 4-7 8-14 15-21 22-30 31-60 61-90 91-180 181‘ 271‘ 366‘ 731 Un‘
Days Days Discharged 270 365 730 Plus knowns
All diseases and conditions7 . 945,245 27.3 10.5 15.0 96.0 99,064 132,093 172,436 201,269 104,459 80,269 96,938 25,797 19,868 4,874 2,165 3,104 2,801 108 25,833,873
I.........Infectious and parasitic diseases. 10,242 27.8 10.0 14.8 95.0 1,272 1,492 1,797 1,983 1,112 810 957 310 312 89 46 41 19 2 284 880
Pulmonary tuberculosis (011)..... 2,190 47.8 21.6 24.8 88.0 61 86 186 416 371 273 372 137 169 67 29 20 3 ..... 104 666
Tuberculosis, other (010,012-018) . 285 30.8 17.0 20.4 94.0 11 35 24 59 49 40 33 15 14 1 2 2 8 772
Tuberculosis, late effects (137).... 59 15.7 10.1 15.7 100.0 3 9 13 15 5 7 5 1 1 928
All other infectious and parasitic diseases
(001-009,020-136).................. 7,678 21.6 7.3 12.0 97.0 1,195 1,356 1,570 1,490 682 486 546 156 127 19 15 19 15 2 166,001
Late effects of other infectious and parasitic diseases (138-139) ............................. 30 150.4 15.0 14.6 86.0 2 6 4 3 5 4 1 1 1 2 1 4 513
II..........................Neoplasms.................. 97,388 23.0 11.9 17.6 97.0 13,181 13,028 13,527 16,245 11,286 9,653 13,470 4,106 2,272 309 88 152 60 11 2,243,161
Malignant neoplasm of lip, oral cavity and pharynx
(140-149,230.0) ............. 6,371 34.5 18.2 24.4 92.0 473 707 752 958 661 610 1,035 605 475 60 15 14 5 1 219,806
Malignant neoplasms of digestive organs and
peritoneum (150-159, 230.1-230.9). 12,808 27.0 17.0 21.3 97.0 1,208 1,122 1,744 1,892 1,612 1,689 2,480 647 334 44 7 19 10 345,796
Malignant neoplasm of bronchus and lung
(162.2-162.9,231.2)........... 23,458 24.9 15.8 20.2 98.0 2,034 2,391 2,927 4,031 3,384 2,959 4,075 1,065 462 63 21 33 9 4 584,968
Malignant neoplasm of other respiratory system and intrathoracic organs (160-162.0, 163-165, 231.0,231.1,231.8,231.9)......... 3,233 32.1 18.6 24.6 94.0 230 388 337 464 388 310 616 270 190 26 6 7 1 103 856
Malignant neoplasm of lymphatic and
hematopoietic tissue (200-208)....... 8,473 19.6 7.9 13.4 98.0 1,772 1,311 1,179 1,460 876 699 832 201 107 16 5 11 4 166 258
Malignant neoplasm of genitourinary organs
(179-189,233)................. 16,590 21.1 11.9 17.2 98.0 1,819 2,046 2,582 3,349 2,033 1,557 2,172 634 315 39 12 23 6 3 350,407
Malignancies of all other systems
(170-175,190 199,232,234)..... 15,363 20.8 9.0 15.3 97.0 2,941 2,330 2,093 2,414 1,557 1,291 1,746 557 323 43 19 28 19 2 319 865
Neoplasms, benign (210-229) ............. 8,451 9.7 3.6 7.6 99.0 2,160 2,319 1,520 1,197 497 339 281 75 37 10 ...... 12 3 1 81 718
Neoplasmsof unspecified nature (235-239). 2,641 26.7 7.7 12.7 98.0 544 414 393 480 278 199 233 52 29 8 3 5 3 70 487
III.. Endocrine, nutritional and metabolic diseases and immunity disorders. 30,077 21.8 11.4 14.6 97.0 2,337 3,426 5,443 8,147 4,114 2,502 2,516 656 607 170 54 62 38 5 657,019
Diabetes mellitus (250)......... 20,883 24.1 12.0 15.2 96.0 1,529 2,013 3,588 5,898 3,014 1,778 1,812 486 489 142 46 54 32 2 503,842
Diseases of the endocrine glands
(240-246,251-259).................. 2,776 16.5 9.9 12.8 98.0 251 405 540 735 350 219 205 37 21 6 . 4 2 1 45 676
Gout (274) ...................... 1,117 11.1 7.5 10.1 99.0 78 224 296 278 123 52 51 6 8 1 ................... 12 351
Obesity (278.0-278.1)............ 1,061 21.6 12.6 17.2 97.0 56 122 184 260 154 92 115 43 26 6 1 1 1 . . . . . . 22,917
Nutritional deficiencies and all other metabolic
diseases (260-273,275-277, 278.2-278.8) .... 4,167 17.2 9.6 13.5 98.0 395 647 825 965 470 360 330 83 62 15 7 3 3 2 71 602
Disorders involving the immune mechanisms
<2....................................79>................................. 73 8.6 2.3 7.1 98.0 28 15 10 11 3 1 3 1 1 ............................ 631
IV.........Diseases of the blood and blood-forming organs .......... 6,416 15.2 8.1 11.4 98.0 1,148 1,116 932 1,415 767 448 437 67 69 10 4 7 5 ..... 97,752
Anemias (280-282.4,282.7-285)............ 4,322 16.1 8.4 11.7 98.0 828 739 544 918 540 328 317 45 42 8 4 6 3 ....... 69,752
Sickle-cell trait and sickle-cell anemia (282.5-282.6) .................... 252 8.9 6.1 8.0 99.0 34 56 68 60 16 9 5 2 2 ............................ 2,242
Other diseases of the blood and blood-forming organs (286-289) ............... 1,842 14.0 8.0 11.2 99.0 286 321 320 437 211 111 115 20 16 2 ....... 1 2 ...... 25,758
V....................Mental disorders........... 208,390 52.2 17.0 21.2 93.0 16,896 22,198 28,010 31,488 20,373 25,271 38,642 10,278 8,566 2,319 1,131 1,535 1,656 27 10,872,464
Alcohol psychosis (291).................. 7,743 53.1 11.0 16.1 93.0 426 1,102 1,716 1,488 698 593 892 227 235 103 59 94 107 3 410,756
Drug psychosis (292)........................ 643 21.3 10.2 16.7 98.0 76 73 138 110 69 58 69 34 11 1 . 2 1 1 13,681
Organic psychotic conditions, excluding alcohol and drug psychosis (290,293-294). 4,664 185.7 29.4 26.8 77.0 142 228 339 681 549 481 829 292 395 166 107 162 292 1 866,147
Schizophrenic disorders (295)... 49,556 98.0 22.7 25.0 87.0 3,442 3,864 4,858 6,864 5,313 5,524 9,334 3,669 3,531 1,044 525 738 844 6 4,854,670
Other psychoses (296-299)...... 15,931 50.2 24.1 26.4 91.0 1,119 937 1,349 2,261 1,834 2,071 3,484 1,274 1,035 242 109 128 86 2 799,399
Neurotic disorders (300) ................ 11,056 31.2 15.4 20.9 94.0 1,196 1,082 1,356 1,829 1,216 1,215 1,866 612 477 99 45 47 16 . 345,040
Personality disorders (301).... 6,841 29.0 13.2 18.7 95.0 725 781 1,026 1,210 776 680 932 333 252 69 22 22 13 . 198,720
Alcohol dependence or abuse (303,305.0) . 86,347 23.7 14.0 19.4 98.0 7,007 11,486 13,844 12,662 7,205 11,867 17,573 2,692 1,501 262 98 105 37 8 2,045,415
Drug dependence or abuse (304, 305.1-305.9) ... 10,783 24.8 12.0 17.4 95.0 1,502 1,211 1,582 1,931 1,088 1,181 1,374 387 344 112 35 30 3 3 267,022
Other nonpsychotic mental disorders (302,306-319).................. 14,826 72.3 17.0 20.8 90.0 1,261 1,434 1,802 2,452 1,625 1,601 2,289 758 785 221 131 207 257 3 1,071,614
VI..Diseases of the nervous system and sense organs.................. 48,607 28.3 7.6 12.1 96.0 4,738 8,092 12,715 10,008 4,214 2,701 3,015 1,075 1,128 338 131 210 238 4 1,373,398
Quadriplegia (344.0)...................... 1,600 86.6 21.7 22.4 81.0 115 135 181 222 154 157 218 96 167 78 23 30 24 . 138,604
Paraplegia (344.1).............. 1,827 59.9 18.9 22.8 86.0 148 212 183 288 151 167 251 149 182 55 13 17 10 1 109,347
Epilepsy (345).................. 2,643 22.2 8.8 11.7 98.0 261 428 555 665 342 163 155 25 30 6 3 3 7 ..... 58,684
Disorders of the peripheral nervous system (350-359)....................... 6,310 15.4 7.6 11.4 98.0 541 1,328 1,440 1,340 663 398 387 99 73 20 3 16 2 ........ 97,163
Other diseases of the central nervous system (320-343,344.2-344.9,346-349).. 11,392 63.4 14.9 19.2 91.0 868 1,114 1,382 2,360 1,508 1,128 1,443 499 535 162 79 127 185 2 722,414
Glaucoma (365).................. 1,852 8.9 5.7 8.0 99.0 409 324 452 387 126 84 57 8 2 . 1 1 1 .. 16,425
Cataract (366)........................... 10,410 9.5 6.6 7.5 99.0 533 1,271 5,211 2,497 514 200 131 22 15 5 1 7 3 ..... 98,860
Blindness (369) ........................... 813 40.6 22.8 30.0 90.0 68 104 66 110 55 43 147 123 90 2 3 1 1 ......... 33,040
Disorders of the eye and adnexa (360-364,367-368,370-379)....... 7,624 8.7 5.3 7.4 99.0 1,276 1,896 2,010 1,455 494 247 160 41 25 8 3 5 3 1 66,229
Diseases of the ear and mastoid process (380-389)....................... 4,136 7.9 4.9 6.6 99.0 519 1,280 1,235 684 207 114 66 13 9 2 2 3 2 ........ 32,632
VII....................................Diseases of the circulatory system. 148,136 22.3 10.9 14.1 97.0 10,431 19,100 28,243 39,163 20,328 12,279 11,695 2,910 2,417 599 270 374 312 15 3,303,007
Chronic rheumatic heart disease (393-398). 1,818 14.0 9.4 12.7 99.0 129 296 395 449 233 143 133 22 11 5 1 1 . 25,524
Hypertensive disease without heart involvement
(401,403,405)................ 11,319 14.8 7.7 10.9 98.0 1,430 1,955 2,466 2,706 1,194 702 603 126 77 16 12 23 8 1 167,535
Hypertensive heart disease (402,404). 5,151 16.8 10.7 13.2 98.0 218 565 1,185 1,581 725 389 346 60 49 13 5 11 4 . 86,736
Acute myocardial infarction (410)........ 8,502 18.6 12.6 13.9 99.0 699 510 995 3,116 1,797 803 441 61 40 4 8 15 13 .... 158,439
Other ischemic heart disease (411-414) . 39,696 15.7 8.9 11.4 98.0 2,562 6,639 9,244 10,877 5,001 2,626 1,922 342 249 65 37 75 56 1 624,466
Other forms of heart disease (391,392.0,420-429)............ 33,108 19.5 9.5 12.5 98.0 2,513 4,666 7,428 9,024 4,041 2,356 2,160 449 277 62 21 49 59 3 644,870
Cerebrovascular diseases (430-438) ...... 20,279 45.7 17.3 21.8 92.0 836 1,345 2,467 4,498 3,030 2,230 3,043 1,118 1,034 265 128 144 136 5 926,819
Atherosclerosis (440) .......... 3,367 40.4 18.9 22.4 93.0 98 293 347 650 537 441 578 161 166 51 19 12 14 . 135,909
See footnotes at end of table.
171
172
INPATIENT CARE TABLE 32—Continued
VA Medical Centers—Hospital Care Component: Patients Discharged, Diagnostic Grouping, Average and Median Length of Stay, Length of Stay Distribution1—Fiscal Year 1981
Short
ota Short Term Length of Stay Distribution (Days)
Principal Diagnoses' Term Discharges ------------------------------------------------------- Total
D , Average Median A*era®e Parcent 1R1 ,71 7„ .. Days8
Patients _ Davs3 Days of Total 1 Day 2-3 4-7 8-14 15-21 22-30 31-60 61-90 91-180 181’ Z71‘ 366’ 731 Un'
y Discharges9 270 365 730 Plus known5
Other diseases of arteries, arterioles and capillaries
(441448)..................... 11 063 277 160 190 950 626 1,160 1,212 2,290 1,861 1,457 1,536 369 377 95 34 31 13 2 306 015
Varicose veins of lower extremities (454) . 1,772 23.8 13.5 18.9 97.0 115 156 280 428 225 190 240 80 46 9 2 1 42219
Hemorrhoids (455)................ 4,083 8.0 6.3 8.0 99.0 712 752 1,005 1,026 355 142 79 7 4 ..., 32 753
Other diseases of the circulatory system (390,
392.9,415-417,451-453,456-459). 7,978 19.0 12.3 14.8 98.0 493 763 1,219 2,518 1,329 800 614 115 87 14 5 11 8 2 151 722
VIII....................................Diseases of the respiratory system. 62,491 22.3 9.9 13.0 98.0 3,115 8,580 14,943 17,232 7,546 4,574 4,171 1,022 672 209 103 157 158 9 1,391,979
Acute respiratory infections (460-466). 2,992 14.1 7.0 9.0 99.0 208 584 937 765 253 131 84 14 8 3 1 2 2 42 193
Pneumonia and influenza (480-487)......... 12,497 31.4 11.8 14.5 97.0 443 1,008 2,724 3,902 1,781 1,093 942 220 163 62 20 58 79 2 392 563
Chronic bronchitis (491)............... 3,144 22.2 10.6 13.4 98.0 138 314 785 914 418 263 206 47 26 12 6 10 4 1 69 812
Emphysema (492) ................. 2,365 24.1 12.6 16.1 97.0 92 182 479 665 364 215 232 64 43 9 7 7 5 1 57^06
Other diseases of the respiratory system and upper respiratory tract (470-478,490,493-519) .... 41,493 20.0 9.3 12.6 98.0 2,234 6,492 10,018 10,986 4,730 2,872 2,707 677 432 123 69 80 68 5 830,405
IX.........Diseases of the digestive system. 88,161 16.3 9.3 12.4 99.0 7,532 12,067 20,022 23,856 10,376 6,295 5,795 1,183 709 121 46 97 58 4 1,435,962
Diseases of oral cavity, salivary glands and jaws
(520-529)...................... 4,935 12.4 4.0 6.3 99.0 1,212 1,265 1,228 755 228 103 93 29 10 6 3 2 1 60 952
Ulcers of the digestive system (530.2,531-534)... 8,600 21.2 9.4 12.1 99.0 942 1,172 1,732 2,331 1,046 634 563 80 67 11 4 9 8 ...1 181977
Other diseases of the esophagus, stomach and
duodenum (530.0, 530.1, 530.3-530.9, 535'537)....................... 9,108 13.9 7.0 10.3 99.0 1,342 1,801 1,874 2,048 907 508 450 82 71 7 4 9 5 126 489
Hernia of the abdominal cavity (550-553). 19,103 11.8 8.8 10.3 99.0 673 1,877 6,252 6,674 1,977 892 589 78 50 13 5 13 9 1 224 762
Other diseases of the intestine and peritoneum (540-543,555-569,578-579)....... 25,060 15.5 8.5 11.6 98.0 2,553 4,014 5,577 6,359 2,773 1,728 1,416 320 190 41 21 42 25 1 387 829
Alcohol related liver disorders (571.0-571.3) .... 7,192 24.4 16.2 20.2 97.0 251 550 919 1,675 1,249 930 1,155 263 155 23 5 12 4 1 175428
Other diseases of the liver, gallbladder and pancreas (570,571.4-577)........ 14,163 19.7 12.8 16.3 98.0 559 1,388 2,440 4,014 2,196 1,500 1,529 331 166 20 4 10 6 278,525
X......................................Diseases of the genitourinary system. 45,940 14.1 8.0 11.0 99.0 5,240 8,207 9,538 11,847 4,977 2,762 2,401 517 264 61 25 59 37 5 649,122
Nephritis, nephrotic syndrome and nephrosis
(580-589)...................... 5,518 20.1 9.7 14.7 97.0 558 968 971 1,124 569 485 539 165 96 13 11 12 7 110 689
Other diseases of the urinary system (590-599) .. 18,397 14.6 8.0 11.0 98.0 2,058 3,307 3,855 4,614 2,059 1,107 980 196 122 37 8 31 21 ...2 269 447
Diseases of the prostate (600-602). 14,013 13.8 9.6 11.4 99.0 1,712 1,808 2,507 4,346 1,821 938 694 124 35 7 5 11 5 193 544
Other diseases of the male genital organs
J603’608*....................... 6-200 100 6.1 8.0 99.0 555 1,631 1,785 1,414 417 182 166 28 9 4 1 3 3 2 61 785
Disorders of breast and gynecological diseases
,61............................0’629>....................... L812 7.5 4.6 6.5 99.0 357 493 420 349 111 50 22 4 2 .............. 2 1 1 13,657
XI..Complications of pregnancy, childbirth and puerperium (630-676)............ 33 4.5 2.5 4.5 100.0 11 9 8 3 1 1 ................................................ 149
XII. Diseases of skin and subcutaneous tissue . 21,457 18.9 6.5 11.7 97.0 5,276 3,224 3,610 3,713 1,730 1,285 1,582 465 377 81 43 46 25 . 405,181
Infections and inflammatory conditions of skin and subcutaneous tissue (680-698).. 11,057 17.7 9.1 12.9 98.0 1,043 1,538 2,568 2,695 1,166 831 850 192 121 20 9 17 7 .... 195,785
Other diseases of skin and subcutaneous tissue (700-709)........................ 10,400 20.1 2.3 10.3 96.0 4,233 1,686 1,042 1,018 564 454 732 273 256 61 34 29 18 .... 209,396
XIII.............Diseases of the musculoskeletal system and connective tissue ........... 42,548 18.2 10.5 14.0 98.0 3,768 6,052 8,045 10,012 5,466 3,861 3,791 789 523 119 33 62 19 8 773,336
Osteoarthrosis and allied disorders (715). 4,835 20.9 13.7 16.5 98.0 342 525 687 1,059 803 653 589 93 50 19 3 10 1 1 101,217
Other arthropathies and related disorders (710-714,716-719).................. 10,736 17.3 9.5 13.2 98.0 1,096 1,433 2,322 2,577 1,226 812 839 205 154 42 9 15 5 1 186,021
Dorsopathies (720-724)............. 12,488 18.6 12.1 15.0 98.0 1,006 1,498 1,830 3,239 1,960 1,355 1,243 195 116 19 8 11 6 2 231,784
Rheumatism, excluding the back (725-729). 7,538 11.2 6.4 9.3 99.0 897 1,728 1,912 1,586 641 363 309 51 35 8 ........ 4 2 2 84,354
Osteopathies, chondropathies, and acquired musculoskeletal deformities (730-739). 6,951 24.5 12.1 16.8 97.0 427 868 1,294 1,551 836 678 811 245 168 31 13 22 5 2 169,960
XIV........Congenital deformities (740-759) . 2,840 15.0 8.6 12.5 98.0 283 466 624 667 306 203 200 52 27 6 1 4 1 ...... 42,535
XVI. Symptoms, signs and ill defined conditions (780-799) ............ 48,722 14.6 7.5 10.6 98.0 5,476 9,182 11,089 11,749 4,901 2,791 2,317 499 447 93 47 81 45 5 711,044
XVII. Injury and poisoning....... 45,721 22.5 8.1 13.4 97.0 6,927 7,475 8,447 8,563 4,435 3,189 3,847 1,273 1,012 232 86 137 92 6 1,030,179
Fracture of skull (800-804) .......... 2,140 18.4 7.0 10.2 98.0 249 386 574 534 153 80 76 37 31 3 2 7 6 2 39,313
Fracture of neck and trunk (805-809) . 2,548 39.9 12.6 17.9 94.0 165 294 475 521 304 215 282 121 106 30 13 14 8 ..... 101,765
Fracture of upper and lower limb (810-829) .... 10,915 30.8 13.7 18.3 95.0 1,171 1,252 1,443 1,986 1,431 1,187 1,404 491 363 79 32 44 31 1 335,922
Dislocations, sprains and strains of joints and adjacent muscles (830-848) ................... 3,962 12.5 7.2 10.2 99.0 542 688 952 967 354 184 202 44 17 2 3 5 2 ...... 49,719
Intracranial injury, excluding those with skull fracture (850-854) ............... 2,052 34.8 6.8 13.1 95.0 456 384 268 293 166 112 208 62 51 21 6 12 13 ..... 71,456
Internal injury of chest, abdomen and pelvis (860-869)........................... 617 14.8 8.5 12.1 98.0 38 98 163 153 66 40 42 7 6 1 1 2 ............ 9,133
Open wounds (870-897) ............ 5,520 10.2 3.0 7.5 98.0 1,932 1,118 1,003 692 273 167 184 67 53 13 8 8 2 ..... 56,516
Burns (940-949)........................... 1,193 25.8 14.7 20.1 96.0 86 102 177 244 148 136 204 47 37 5 1 4 1 1 30,800
Poisoning by drugs, medicinal and biological substances (960-979).......................... 2,157 12.4 5.7 9.6 99.0 450 445 441 377 163 117 115 23 20 ........ 1 4 1 ..... 26,741
Toxic effects of substances chiefly nonmedical as to source (980-989).............. 364 10.6 4.7 8.9 98.0 89 80 76 55 21 13 19 6 5 ............................. 3,845
All other injuries (900-904,910-939,950-959,990-995)..... 4,661 16.1 5.3 10.0 97.0 964 1,077 883 768 295 218 253 86 80 18 1 11 6 1 75,071
Complications of surgical and medical care, NEC (996-999)......................... 7,246 18.0 9.1 13.9 97.0 610 1,193 1,588 1,517 814 545 607 192 141 22 6 6 4 1 130,234
Late effects of injuries, poisonings, toxic effects and other external causes (905-909). 2,346 42.5 11.6 16.4 92.0 175 358 404 456 247 175 251 90 102 38 12 20 18 ..... 99,664
See footnotes at end of table.
173
174
INPATIENT CARE TABLE 32-Continued
VA Medical Centers—Hospital Care Component: Patients Discharged, Diagnostic Grouping, Average and Median Length of Stay, Length of Stay Distribution1—Fiscal Year 1981 Total _. Short Length of Stay Distribution (Days)
Short Term
Principle Diagnoses2 Term Discharges Total
Average Median A“era^ Percent 181- 271. 366. 731 Un.
Patient$ DayT Days3 DayS of Tota' 1 Day 2 3 4 7 8'14 15 21 22 30 3160 6190 91’180 270 365 730 Plus known5
Discharges9
XVIII. Factors influencing health status and contact with health services (V01-V82)........................ 28,641 9.5 2.3 7.1 99.0 10,264 7,237 3,880 3,201 1,462 880 1,087 305 208 43 27 35 8 4 271,294
Unavailable5 ........................ 9,435 30.9 11.0 15.6 95.0 1,169 1,142 1,563 1,977 1,065 764 1,015 290 267 75 30 45 30 3 291,411
1 Patient treatment file. This table, as well as all others in this hospital discharge series, excludes approximately 232,644 4 No median computed since more than one-half of the cases had one day of stay.
one-day dialysis discharges. s This column/line includes records for which required data is unavailable.
2 The diagnostic categories and selected diagnoses included in this table are based on the “International Classification of 6 In excess of 731 days and over.
Diseases 9th Revision Clinical Modification," DHHS Publication No. (PHS) 80-1260. The numbers following the 7Note: The changes to this report reflect the new ICD-9-CM codes.
diagnoses are the identifying code numbers of this diagnostic classification. Category XV, “Certain Conditions 8 This column excludes those cases for which the number of days is unavailable.
Originating in the Prenatal Period" in which no cases occurred, is not included in this table. 9Includes hospital stays of 1 to 99 days and conforms to the definition adopted by the Commission on Professional and
3 One-half of the discharges in the given category have length of stay greater than the median; the other half, less than the Hospital Activities.
median.
TABLE 33
INPATIENT CARE
Surgical Procedures Performed in VA Medical Centers-Hospital Care Component1—Fiscal Year 1981
Operations and ICDA Codes All Hospitals Affiliated Hospitals Non-Affiliated Hospitals
Surgical procedures (01-86)2 327 351 3114 43F>
Operations on the nervous system (01-05) 7,954 7,730 224
Incision and excision of skull, brain and cerebral meninges (01) 1,626 1,621 5
Other operations on skull, brain and cerebral meninges (02) 687 683 4
Operations on spinal cord and spinal canal structures (03) . 1,371 1,361 10
Operations on cranial and peripheral nerves (04) 3,795 3,663 132
Operations on sympathetic nerves or ganglia (05) 475 402 73
Operations on the endocrine system (06-07) 1,132 1,074 58
Operations on thyroid and parathyroid glands (06) 947 890 57
Operations on other endocrine glands (07) 185 184 1
Operations on the eye (08-16) 21,984 21,420 564
Operations on eyelids (08) 3,246 3,112 134
Operations on lacrimal system (09) 182 176 6
Operations on conjunctiva (10) 185 185
Operations on cornea (11) 834 794 40
Operations on iris, ciliary body, sclera and anterior chamber (12) 1,633 1,611 22
Operations on lens (13) 12,765 12,423 342
Operations on retina, choroid, vitreous and posterior chamber (14) 2,086 2,080 6
Operations on extraocular muscles (15) 366 366
Operations on orbit and eyeball (16) 687 673 14
Operations on the ear (18-20) 4,580 4,371 209
Operations on external ear (18) 1,653 1,482 171
Reconstructive operations on middle ear (19) 1,602 1,588 14
Other operations on middle and inner ear (20) 1,325 1,301 24
Operations on the nose, mouth and pharynx (21-29) 16,791 16,059 732
Operations on nose (21) 5,428 5,186 242
Operations on nasal sinuses (22) 1,436 1,420 16
Removal and restoration of teeth (23) 1,809 1,694 115
Other operations on teeth, gums and alveoli (24) 1,319 1,267 52
Operations on tongue (25) 1,117 1,087 30
Operations on salivary glands and ducts (26) 867 823 44
Other operations on mouth and face (27) 2,742 2,561 181
Operations on tonsils and adenoids (28) 775 742 33
Operations on pharynx (29) 1,298 1,279 19
Operations on the respiratory system (30-34) 25,100 23,700 1,400
Excision of larynx (30) 1,593 1,569 24
Other operations on larynx and trachea (31) 8,891 8,658 233
Excision of lung and bronchus (32) 2,528 2,395 133
Other operations on lung and bronchus (33) 8,208 7,493 715
Operations on chest wall, pleura, mediastinum and diaphragm (34) 3,880 3,585 295
Operations on the cardiovascular system (35-39) 32,407 31,453 954
Operations on valves and septa of heart (35) 884 884
Operations on vessels of heart (36) 4,028 4,027 1
Other operations on heart and pericardium (37) 4,015 3,932 83
Incision, excision and occlusion of vessels (38) 7,777 7,259 518
Other operations on vessels (39) 15,703 15,351 352
Operations on the hemic and lymphatic system (40-41) 5,726 5,470 256
Operations on lymphatic system (40) 4,982 4,763 219
Operations on bone marrow and spleen (41) 744 707 37
Operations on the digestive system (42-54) 72,150 64,908 7,242
Operations on esophagus (42) 4,923 4,574 349
Incision and excision of stomach (43) 2,699 2,522 177
Other operations on stomach (44) 6,598 5,933 665
Incision, excision and anastomosis of intestine (45) 10,878 9,790 1,088
See footnotes at end of table.
175
INPATIENT CARE
TABLE 33—Continued
Surgical Procedures Performed in VA Medical Centers —Hospital Care Component1— Fiscal Year 1981
Operations and ICDA Codes All Hospitals Affiliated Hospitals Non-Affiliated Hospitals
Other operations on intestine (46) 3,736 3,502 234
Operations on appendix (47) 2,078 1,851 227
Operations on rectum and perirectal tissue (48) 3,757 3,200 557
Operations on anus (49) 5,239 4,573 666
Operations on liver (50) 1,410 1,308 102
Operations on gallbladder and biliary tract (51) 6,349 5,768 581
Operations on pancreas (52) 743 712 31
Repair of hernia (53) 18,202 16,115 2,087
Other operations on abdominal region (54) 5,538 5,060 478
Operations on the urinary system (55-59) 35,785 32,411 3,374
Operations on kidney (55) 2,205 2,128 77
Operations on ureter (56) 1,704 1,599 105
Operations on urinary bladder (57) 27,274 24,496 2,778
Operations on urethra (58) 4,208 3,822 386
Other operations on urinary tract (59) 394 366 28
Operations on the male genital organs (60-64) 25,389 23,180 2,209
Operations on prostate and seminal vesicles (60) 16,042 14,728 1,314
Operations on scrotum and tunica vaginalis (61) 878 773 105
Operations on testes (62) 1,983 1,832 151
Operations on spermatic cord, epididymis and vas deferens (63) 2,943 2,540 403
Operations on penis (64) 3,543 3,307 236
Operations on the female genital organs (65-71) 697 621 76
Operations on ovary (65) 174 159 15
Operations on fallopian tubes (66) 14 12 2
Operations on cervix (67) 53 46 7
Other incision and excision of uterus (68) 171 151 20
Other operations on uterus and supporting structures (69) 201 183 18
Operations on vagina and cul-de-sac (70) 60 49 11
Operations on vulva and perineum (71) 24 21 3
Obstetrical procedures (72-75)
Forceps, vacuum and breech delivery (72)
Other procedures inducing or assisting delivery (73)
Cesarean section and removal of fetus (74)
Other obstetric operations (75)
Operations on the musculoskeletal system (76-84) 47,669 45,162 2,507
Operations on facial bones and joints (76) 2,641 2,602 39
Incision, excision and division of other bones (77) 5,569 5,307 262
Other operations on bones, except facial bones (78) 3,136 2,964 172
Reduction of fracture and dislocation (79) 6,371 5,958 413
Incision and excision of joint structures (80) 8,110 7,792 318
Repair and plastic operations on joint structures (81) 7,924 7,608 316
Operations on muscle, tendon and fascia of hand (82) 3,003 2,787 216
Operations on muscle, tendon, fascia and bursa, except hand (83) 3,621 3,387 234
Other procedures on musculoskeletal system (84) 7,294 6,757 537
Operations on the integumentary system (85-86) 29,987 26,876 3,111
Operations on the breast (85) 1,443 1,326 117
Operations on skin and subcutaneous tissue (86) 28,544 25,550 2,994
1 Patient treatment file. The procedures included in this table are grouped on the ‘International Classification of Diseases 9th Revision Clinical Modification’, (ICD-9-CM) DHHS Publication No. (PHS) 80-1260: The numbers following the operations are the identifying code numbers of this operation classification.
2 For purposes of this table, therapeutic and certain procedures are excluded.
176
TABLE 34
INPATIENT CARE
Cost of Operation of Medical Inpatient Facilities — Fiscal Year 1981
(Dollars in Thousands)
Activity Total VA Hospital Care VA Nursing Care VA Domiciliaries
Medical Bed Section Surgical Bed Section Psychiatric Bed Section
Total Costs $4,702,884 $2,264,926 $1,170,676 $932,936 $247,075 $87,271
Professional and ancillary: Medical services1 1,228,077 621,443 351,309 211,507 30,183 13,635
Nursing services 1,152,837 550,855 284,583 237,936 76,684 2,779
Chaplain services 21,506 9,405 3,809 5,263 1,645 1,384
Dietetics services 345,403 147,908 60,426 83,063 31,916 22,090
Dental services 42,568 18,717 8,350 11,483 2,196 1,822
Audiology & speech pathology 6,193 3,764 1,199 425 595 210
Direct care. Total 2,796,584 1,352,092 709,676 549,677 143,219 41,920
Administrative support 568,319 275,924 137,239 114,947 28,831 11,378
Engineering support 527,195 222,100 108,500 130,260 41,406 24,929
Building management2 250,532 112,375 55,370 58,485 19,958 4,344
Research support 89,461 53,796 22,595 11,355 1,428 287
Education & training support 295,367 158,246 93,439 38,291 4,120 1,271
Asset acquisitions 175,426 90,393 43,857 29,921 8,112 3,143
Support, Total 1,906,300 912,834 461,000 383,259 103,855 45,352
1 Professional medical services include laboratory, pharmacy, blind rehabilitation, clinical nuclear medicine, rehabilitation medicine, social service, clinical psychology, radiology, medical illustration and library.
2 Includes operation of laundry.
TABLE 35
EXTENDED CARE
VA Nursing Homes, Community Nursing Homes, and VA Domiciliaries: Patient Movement Fiscal Year 1981
Item VA Community VA
Nursing Homes Nursing Homes Domiciliaries
Total on rolls (bed occupants and in absent status) remaining on September 30, 1980 8,289 8,330 8,306
Gains, Total 9,856 5,368 24,541 20,265 10,994 6,571
Direct gains — Total
Admissions after rehospitalization 5041 1,9072 6312
Other admissions 4,864 18,358 5,940
Transfers in from similar facilities3 66 4,422 625 30
Returns from absent sick in hospital status 3,651 4,393
Losses, Total 9,564 23,524 11,272
Discharges and deaths while in bed occupant or authorized leave of absence status — Total . . 3,372 14,000 4,879
Discharges 2,559 11,116 4,800
Deaths 813 2,884 79
Discharges and deaths while in absent sick in hospital status-Total 1,541 4,750 1,935
Discharges 923 3,546 1,796
Deaths 618 1,204 139
Transfers out to similar facilities3 118 6,074 587 8,937 29 6,364
Losses to absent sick in hospital status
Remaining on September 30,1981 — Total 8,641 9,492 8,063
Bed occupants 8,330 8,967 7,317
On authorized leave of absence 44 86 434
Absent sick in hospital 267 439 312
Patients treated4 13,554 8,145 28,242 8,348 14,877 7,353
Average daily census5
1 Admissions after rehospitalization of more than 30 days.
2 Admissions after rehospitalization of more than 15 days.
3 Includes only patients transferred as VA beneficiaries.
* Discharges and deaths during Fiscal Year 1981 plus the number remaining on the rolls on September 30, 1981.
5Based on the number of patients days during the fiscal year divided by the number of days in the fiscal year.
177
EXTENDED CARE
TABLE 36
State Home Hospitals, State Nursing Homes, and State Domiciliary Homes: Patient Movement1—Fiscal Year 1981
State Home Hospitals State Nursing Homes State Domiciliary Homes
Bed occupants remaining on September 30,1980 885 5,711 4,694
Gains, Total 4,837 9,179 11,091
Direct gains — Total 4,487 4,531 4,571
Admissions from state facilities 2,206 1,972 1,650
Other admissions 2,281 2,559 2,921
Returns from leave of absence status 350 4,648 6,520
Losses, Total 4,827 8,790 11,251
Discharges and deaths — Total 4,451 401 4,792
Discharges to state facilities 2,013 1,666 2,080
Other discharges 2,022 1,316 2,570
Deaths 416 1,029 142
Losses to leave of absence status 376 4,779 6,459
Bed occupants remaining on September 30,1981 892 6,074 4,510
Patients treated1 2 5,343 881 10,085 5,855 9,302 4,572
Average daily census3 4
1 Data include only patients supported by VA.
2Based on discharges and deaths during Fiscal Year 1981, plus the number on the rolls on September 30, 1981.
3 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
EXTENDED CARE
TABLE 37
VA Medical Centers —Domiciliary Care Component: Selected Data Fiscal Year 1981
Location Average Operating Beds 1 Bed Occupancy Rate (%) 2 Average Daily Census 3 Admissions 4 Discharges 4 5 Patients T reated 4 6 Remaining on Sept. 30, 1981 7
Total 8,390 87.6 7,353 6,571 6,814 14,877 8,063
Arizona: Prescott 225 81.3 183 159 192 399 207
California: Los Angeles 400 80.8 323 298 296 629 333
Florida: Bay Pines 201 86.1 173 229 225 413 188
Georgia: Dublin 344 89.0 306 200 221 538 317
Kansas: Leavenworth 719 90.0 647 966 1,005 1,735 730
Mississippi: Biloxi 430 93.5 402 338 343 789 446
New York: Bath 525 89.9 472 271 265 786 521
Ohio: Dayton 789 89.0 702 442 482 1,240 758
Oregon: White City 1,040 85.5 889 798 822 1,812 990
South Dakota: Hot Springs 475 79.8 379 416 419 859 440
Tennessee: Mountain Home 614 94.1 578 728 635 1,377 742
Texas: Bonham 225 90.7 204 160 182 407 225
Temple 528 82.0 433 583 588 1,038 450
Virginia: Hampton 595 84.2 501 306 393 895 502
West Virginia: Martinsburg 541 91.7 496 297 335 854 519
Wisconsin:Wood 739 89.9 664 410 440 1,135 695
1 Based on the number of operating beds at the end of each month of 13 consecutive months (September 1980 - September 1981).
2 Average daily census as a percent of the average operating beds.
3Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
4 Transfers included in individual facility totals; excluded from overall total.
5 Includes deaths.
6 Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
7 Total on rolls (bed occupants, patients on authorized leave of absence, and patients absent sick in hospital).
178
TABLE 38
EXTENDED CARE
VA Medical Centers—Nursing Home Care Component: Selected Data—Fiscal Year 1981
Location Average Operating Beds 1 Bed Occupancy Rate (%) 2 Average Daily Census 3 Admissions 4 Discharges 4 5 Patients Treated 4 6 Remaining on Sept. 30, 1981 7
Total Alabama: 8,700 93.6 8,145 5,368 4,913 13,554 8,641
Tuscaloosa 120 94.2 113 38 37 158 121
Tuskegee Arizona: 112 95.5 107 27 28 140 112
Phoenix 120 95.0 114 55 57 174 117
Tucson 41 95.1 39 33 19 60 41
Arkansas: Little Rock California: 200 96.0 192 53 51 249 198
Loma Linda 60 95.0 57 145 145 204 59
Long Beach 180 93.3 168 247 253 429 176
Palo Alto 150 94.7 142 318 319 462 143
San Diego 58 87.9 51 129 135 187 52
Sepulveda Colorado: 200 88.0 176 119 109 286 177
Ft. Lyon 37 35 10 11 47 36
Grand Junction 42 92.9 39 25 24 64 40
Connecticut: West Haven 90 97.8 88 6 8 96 88
Delaware: Wilmington Florida: 60 93.3 56 59 51 111 60
Bay Pines 203 80.8 164 181 81 300 219
Lake City 40 95.0 38 10 9 48 39
Miami Georgia: 120 80.0 96 109 93 191 98
Augusta 40 95.0 38 16 14 53 39
Dublin Illinois: 86 94.2 81 33 31 117 86
Danville 120 95.0 114 46 47 165 118
North Chicago Indiana: 190 96.3 183 46 46 235 189
Ft. Wayne 54 94.4 51 23 23 77 54
Indianapolis 60 96.7 58 80 71 132 61
Marion 69 97.1 67 20 20 90 70
Iowa: Knoxville Kansas: 192 96.4 185 47 47 244 197
Leavenworth 45 93.3 42 17 18 61 43
Topeka 79 92.4 73 25 17 96 79
Kentucky: Lexington 100 97.0 97 89 92 190 98
Louisiana: Alexandria 93 93.5 87 39 36 129 93
Maine: Togus Maryland: 60 98.3 59 11 11 70 59
Ft. Howard 47 95.7 45 10 11 58 47
Perry Point Massachusetts: 80 93.8 75 27 25 103 78
Bedford 162 95.7 155 48 48 208 160
Brockton 100 94.0 94 30 51 130 79
Northampton Michigan: 50 96.0 48 16 16 66 50
Allen Park 72 98.6 71 27 31 99 68
Battle Creek 205 96.1 197 45 41 243 202
Iron Mountain 40 92.5 37 134 132 172 40
Saginaw 18 83.3 15 71 39 69 30
Minnesota: St. Cloud Mississippi: 44 93.2 41 6 12 50 38
Biloxi 35 97.1 34 8 8 42 34
Jackson Missouri: 120 93.3 112 16 21 137 116
Columbia 54 96.3 52 15 14 68 54
Poplar Bluff 49 91.8 45 60 62 109 47
St. Louis 93 96.8 90 19 19 112 93
Montana: Miles City 26 96.2 25 11 10 36 26
Nebraska: Grand Island 42 90.5 38 26 30 68 38
Nevada: Reno 22 95.5 21 12 12 34 22
New Hampshire: Manchester New Jersey: 120 93.3 112 207 206 326 120
East Orange 60 96.7 58 21 21 81 60
Lyons 90 97.8 88 29 29 118 89
See footnotes at end of table.
179
EXTENDED CARE
TABLE 38—Continued
VA Medical Centers—Nursing Home Care Component: Selected Data—Fiscal Year 1981
Location Average Operating Beds i Bed Occupancy Rate (%) 2 Average Daily Census 3 Admissions 4 Discharges 4 5 Patients T reated 4 6 Remaining on Sept. 30,1981 7
New Mexico: Albuquerque 44 90.9 40 67 64 111 47
New York:
Albany 72 93.1 67 81 54 148 94
Bath 172 89.5 154 92 99 266 167
Brooklyn 300 96.3 289 172 169 469 300
Buffalo 36 97.2 35 29 28 64 36
Canandaigua 100 99.0 99 34 32 132 100
Castle Point 141 95.7 135 12 31 157 126
Montrose 122 93.4 114 40 34 156 122
Syracuse 38 84.2 32 36 28 68 40
North Carolina:
Asheville 82 96.3 79 32 32 114 82
Fayetteville 39 94.9 37 20 20 59 39
Salisbury 93 97.8 91 52 53 145 92
North Dakota: Fargo 46 97.8 45 62 61 111 50
Ohio:
Chillicothe 99 97.0 96 87 89 188 99
Cincinnati 206 93.7 193 136 122 325 203
Cleveland 100 96.0 96 50 52 152 100
Dayton 284 94.4 268 98 92 372 280
Oregon: Roseburg 75 97.3 73 36 36 110 74
Pennsylvania:
Altoona 33 97.0 32 29 30 62 32
Butler 104 92.3 96 42 45 145 100
Coatesville 46 104.3 48 32 32 82 50
Erie 40 92.5 37 20 21 60 39
Lebanon 120 97.5 117 40 36 158 122
Pittsburgh (U.D.) 228 93.4 213 97 93 309 216
South Carolina: Columbia 120 98.3 118 98 88 219 131
South Dakota: Sioux Falls 75 94.7 71 25 27 99 72
Tennessee:
Memphis 65 27.7 18 88 33 88 55
Mountain Home 58 93.1 54 21 23 78 55
Murfreesboro 48 97.9 47 25 26 73 47
Texas:
Big Spring 40 100.0 40 104 103 146 43
Bonham 100 97.0 97 40 41 140 99
Houston 78 96.2 75 31 27 105 78
Kerrville 35 97.1 34 11 10 45 35
Temple 28 32.1 9 63 6 63 57
Waco 84 97.6 82 37 36 121 85
Utah: Salt Lake City 28 75.0 21 28 72 72 (8)
Vermont: White River Junction 30 96.7 29 126 122 153 31
Virginia:
Hampton 120 88.3 106 82 63 177 114
Salem 100 96.0 96 85 104 199 95
Washington: American Lake 76 94.7 72 23 18 94 76
West Virginia:
Beckley 42 95.2 40 19 18 59 41
Martinsburg 55 96.4 53 156 36 157 121
Wisconsin:
Tomah 100 97.0 97 24 23 123 100
Wood 200 96.0 192 44 46 243 197
Wyoming: Cheyenne 47 95.7 45 14 15 61 46
'Based on the number of operating beds at the end of September 1981.
2 Average daily census as a percent of the average operating beds.
3 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
4 Transfers included in individual facility totals excluded from overall total.
5 Includes deaths.
6Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
7 Total on rolls (bed occupants, patients on authorized leave of absence, and patients sick in hospital).
8 Closed at end ofFY 1981.
180
EXTENDED CARE
State Nursing Care Homes: Selected Data—Fiscal Year 1981
TABLE 39
Location of State Home Hospital Location of Authorizing VA Facility Average Daily Census 1 Admissions Discharges 2 Patients T reated 3 Remaining on September 30, 1981 4
Total 5,855 4,531 4,011 10,085 6,074
California: Yountville Colorado: San Francisco, CA 308 555 521 826 305
Florence Denver, CO . . . 110 55 59 165 106
Homelake Georgia: Denver, CO 20 19 13 33 20
Augusta Augusta, GA 177 183 180 357 177
Milledgeville Dublin, GA 194 103 58 256 198
Idaho: Boise Boise, ID ... . 50 112 34 109 75
Illinois: Quincy Iowa City, IA 305 593 544 857 313
Indiana: Lafayette Indianapolis, IN . . 176 51 51 227 176
Iowa: Marshalltown Des Moines, IA . . 292 206 213 512 299
Kansas: Fort Dodge Massachusetts: Wichita, KS 52 22 19 72 53
Chelsea Boston, MA (OPC) . . . 55 178 181 234 53
Holyoke Northampton, MA . . 241 133 124 371 247
Michigan: Grand Rapids Allen Park, Ml 521 170 174 695 521
Minnesota: Minneapolis Minneapolis, MN . . . 80 97 97 180 83
Missouri: St. James St. Louis, MO 119 147 115 247 132
Montana: Columbia Falls Ft. Harrison, MT 39 18 18 58 40
Nebraska: Grand Island Grand Island, NE 395 272 178 609 431
New Hampshire: Tilton New Jersey: Manchester, NH 90 17 19 108 89
Menlo Park East Orange, NJ 243 68 76 324 248
Vineland Wilmington, DE 251 75 26 285 259
New York: Oxford Syracuse, NY 63 78 55 127 72
Ohio: Sandusky Oklahoma: Cleveland, OH 246 50 120 336 216
Ardmore Oklahoma City, OK .... 76 73 76 153 77
Clinton Oklahoma City, OK 147 131 136 277 141
Norman Oklahoma City, OK .... 88 178 25 228 203
Sulphur Oklahoma City, OK 126 68 78 197 119
Talihina Pennsylvania: Oklahoma City, OK 148 183 173 323 150
Hollidaysburg Altoona, PA 36 37 39 76 37
Erie Erie, PA 68 26 24 94 70
Rhode Island: Bristol Providence, Rl 256 90 66 330 264
South Carolina: Columbia Columbia, SC 109 70 72 180 108
South Dakota: Hot Springs Hot Springs, SD 28 14 6 41 35
Vermont: Bennington Washington: White River Junction, VT 123 139 136 265 129
Orting Seattle, WA 86 48 44 130 86
Retsil Seattle, WA 95 138 126 230 104
Wisconsin: King Madison, Wl 443 134 135 573 438
1 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
2 Includes deaths.
3Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
4 Total on rolls (bed occupants, patients on leave of absence, and patients absent sick in hospital).
181
EXTENDED CARE TABLE 40
Community Nursing Homes: Selected Data—Fiscal Year 1981
Location of Authorizing VA Facility Average Daily Census i Admissions 2 Discharges 2 3 Patients Treated 2 4 Remaining on September 30,1981 s
Total 8,348 56 13 41 20,265 18,750 28,242 9,492
Alabama: Birmingham Montgomery Tuscaloosa 163 17 55 179 19 69 225 34 108 46 15 39
Tuskegee Alaska: Anchorage Arizona: Phoenix 21 6 146 42 29 346 36 20 318 62 31 498 26 11 180
Prescott Tucson Arkansas: Fayetteville Little Rock California: Fresno Livermore Loma Linda Long Beach Los Angeles (Brentwood) Los Angeles (Wadsworth) Martinez Palo Alto San Diego San Francisco Sepulveda Colorado: Denver Ft. Lyon Grand Junction 8 59 10 91 31 24 50 113 62 96 36 63 31 42 82 62 36 21 19 183 38 269 132 51 162 398 71 293 81 153 45 136 96 192 19 51 21 165 34 164 133 45 121 371 66 289 81 107 47 137 61 173 18 55 28 232 48 262 166 68 173 508 130 397 114 173 88 185 148 246 54 76 7 67 14 98 33 23 52 137 64 108 33 66 41 48 87 73 36 21
Connecticut: Newington West Haven 34 34 110 93 89 85 121 122 32 37
Delaware: Wilmington District of Columbia: Washington Florida: Bay Pines Gainesville Lake City 72 64 160 63 19 97 158 134 443 166 43 159 143 118 439 159 38 238 225 188 801 222 61 331 82 70 362 63 23 93
131 416 435 570 135
Georgia: Atlanta 94 259 276 380 104
Augusta Dublin 95 23 194 62 184 66 288 94 104 28
Hawaii: Honolulu 10 39 36 48 12
Idaho: Boise Illinois: Chicago (Lakeside) Chicago (West Side) Danville Hines 33 83 103 41 144 88 270 234 94 510 88 254 185 86 526 120 339 300 133 655 32 85 115 47 129
Marion North Chicago Indiana: Ft. Wayne Indianapolis Marion Iowa: Des Moines Iowa City Knoxville Kansas: Leavenworth Topeka Wichita Kentucky: Lexington Louisville 52 133 28 44 65 51 65 39 39 50 13 61 48 158 191 102 146 62 182 259 50 110 96 47 188 193 119 143 104 128 45 183 249 45 106 82 46 172 163 187 309 130 188 122 227 323 92 145 141 63 246 224 68 166 26 60 77 44 74 47 39 59 17 74 61 (
See footnotes at end of table. S
182
TABLE 40—Continued
EXTENDED CARE
Community Nursing Homes: Selected Data—Fiscal Year 1981
Location of Authorizing VA Facility Average Daily Census i Admissions 2 Discharges 2 3 Patients Treated 2 4 Remaining on September 30, 1981 5
Louisiana: Alexandria 23 110 81 124 43
New Orleans 50 135 123 167 44
Shreveport 42 108 118 171 53
Maine: Togus 42 79 45 120 45
Maryland: Baltimore 30 71 65 96 31
Ft. Howard 28 51 59 88 29
Perry Point 21 19 19 41 22
Massachusetts: Bedford 71 63 52 130 78
Boston 67 167 149 214 65
Brockton 47 80 49 111 62
Northampton 51 44 48 97 49
West Roxbury 7 12 12 18 6
Michigan: Allen Park 62 176 165 232 67
Ann Arbor 42 164 145 205 60
Battle Creek 57 84 62 141 79
Iron Mountain 11 35 29 43 14
Saginaw 44 141 114 171 57
Minnesota: Minneapolis 145 371 396 547 151
St. Cloud 54 87 91 151 60
Mississippi: Biloxi 77 164 153 246 93
Jackson 33 94 90 127 37
Missouri: Columbia 31 105 114 141 27
Kansas City 67 175 178 259 81
Poplar Bluff 29 105 103 132 29
St. Louis 86 248 227 330 103
Montana: Ft. Harrison 30 63 59 94 35
Miles City 15 42 45 58 13
Nebraska: Grand Island 4 7 7 11 4
Lincoln 16 55 50 66 16
Omaha 37 178 169 211 42
Nevada: Reno 16 33 35 52 17
New Hampshire: Manchester 31 63 67 99 32
New Jersey: East Orange 137 203 211 355 144
Lyons 39 48 37 82 45
New Mexico: Albuquerque 44 138 176 211 35
New York: Albany 28 43 47 71 24
Batavia 8 20 15 22 7
Bath 10 29 22 35 13
Bronx 21 63 58 87 29
Brooklyn 24 68 67 84 17
Buffalo 31 73 60 98 38
Canandaigua 3 10 7 15 8
Castle Point 7 17 11 20 9
Montrose 12 5 2 13 11
New York 14 49 38 59 21
Northport 27 35 24 66 42
Syracuse 16 26 24 43 19
North Carolina: Asheville 55 132 79 148 69
Durham 52 135 124 172 48
Fayetteville 36 105 99 143 44
Salisbury 41 69 68 107 39
North Dakota: Fargo 25 69 71 96 25
Ohio: Chillicothe 158 254 229 415 186
Cincinnati 37 164 166 208 42
Cleveland 132 215 222 357 135
Dayton 54 84 90 142 52
See footnotes at end of table.
EXTENDED CARE
TABLE 40—Continued
Community Nursing Homes: Selected Data—Fiscal Yeai 1981
Location of Authorizing VA Facility Average Daily Census i Admissions 2 Discharges 2 3 Patients Treated 2 4 Remaining on September 30, 1981 5
Oklahoma:
Muskogee 35 130 138 176 38
Oklahoma City 50 251 272 326 54
Oregon:
Portland 149 437 400 566 166
Roseburg 67 154 153 224 71
Pennsylvania:
Altoona 24 39 36 62 26
Butler 21 49 39 67 28
Coatesville 165 182 121 328 208
Erie 14 32 32 44 12
Lebanon 35 37 29 69 40
Philadelphia 93 202 152 270 118
Pittsburgh (University Dr) 79 253 203 307 104
Pittsburgh (Highland Dr) 53 61 35 107 72
Wilkes-Barre 50 83 83 141 58
Puerto Rico: San Juan 49 128 106 163 57
Rhode Island: Providence 40 96 82 130 48
South Carolina:
Charleston 33 98 95 131 36
Columbia 58 165 126 185 59
South Dakota:
Ft. Meade 6 23 17 29 12
Hot Springs 7 16 19 24 5
Sioux Falls 27 115 99 125 26
Tennessee:
Memphis 37 109 105 147 42
Mountain Home 106 253 220 334 114
Murfreesboro 23 55 39 73 34
Nashville .... 65 161 127 201 74
Texas:
Amarillo 24 82 76 99 23
Big Spring 47 109 96 156 60
Bonham 30 97 97 132 35
Dallas 115 392 415 545 130
Houston 109 321 300 419 119
Kerrville 43 133 135 170 35
Marlin 15 52 45 65 20
San Antonio 106 335 306 422 116
Temple 69 178 185 251 66
Waco 75 78 69 145 76
Utah: Salt Lake City 62 227 184 278 94
Vermont: White River Junction 17 51 46 64 18
Virginia:
Hampton 36 95 87 125 38
Richmond 60 188 152 227 75
Salem 78 151 94 171 77
Washington:
American Lake 28 34 27 61 34
Seattle 105 318 295 418 123
Spokane 38 120 106 157 51
Vancouver - —
Walla Walla 22 72 57 82 25
West Virginia:
Beckley 14 78 77 96 19
Clarksburg 56 147 118 175 57
Huntington 62 174 184 230 46
Martinsburg 77 137 141 211 70
Wisconsin:
Madison 30 95 70 110 40
Tomah 39 66 45 88 43
Wood 102 274 275 393 118
Wyoming:
Cheyenne 12 48 45 62 17
Sheridan 27 29 27 57 30
1 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
2 Transfers included in individual facility totals; excluded from overall total.
3 Includes deaths.
4Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
5 Total on rolls (bed occupants, patients on authorized leave of absence, and patients absent sick in hospital).
184
EXTENDED CARE
State Domiciliary Homes: Selected Data—Fiscal Year 1981
TABLE 41
Location of State Home Domiciliary Location of Authorizing VA Facility Average Daily Census i Admissions Discharges 2 Patients T reated 3 Remaining on September 30, 1981
Total 4,572 4,571 4,792 9,302 4,510
Arkansas: Little Rock Little Rock, AR 29 110 76 121 45
California: Yountville San Francisco, CA 579 713 707 1,308 601
Colorado: Homelake Denver, CO 64 51 48 116 68
Connecticut: Rocky Hill Newington, CT 404 495 507 905 398
Georgia: Milledgeville Dublin, GA 219 250 218 437 219
Idaho: Boise Boise, ID 118 142 135 258 123
Illinois: Quincy Iowa City, IA 82 153 144 223 79
Indiana: Lafayette Indianapolis, IN 89 27 28 116 88
Iowa: Marshalltown Des Moines, IA 98 60 90 169 79
Kansas: Fort Dodge Wichita, KS 56 18 17 69 52
Louisiana: Jackson New Orleans, LA 108 76 45 152 107
Massachusetts:
Chelsea Boston, MA (OPC) 266 350 346 614 268
Holyoke Michigan: Northampton, MA 38 33 35 70 35
Grand Rapids Allen Park, Ml 157 66 68 227 159
Iron Mountain Minnesota: Allen Park, Ml 9 49 9 47 38
Hastings Minneapolis, MN 121 101 107 237 130
Minneapolis Minneapolis, MN 260 143 204 448 244
Missouri: St. James St. Louis, MO 57 68 91 143 52
Montana: Columbia Falls Ft. Harrison, MT 62 27 22 85 63
Nebraska: Grand Island New Jersey: Grand Island, NE 127 89 94 215 121
Menlo Park East Orange, NJ 73 26 23 97 74
Vineland Wilmington, DE 6 30 30
New York: Oxford Syracuse, NY 41 51 55 98 43
North Dakota: Lisbon Fargo, ND 108 51 39 147 108
Ohio: Sandusky Oklahoma: Cleveland, OH 405 93 188 598 410
Ardmore Oklahoma City, OK 92 295 304 396 92
Clinton Oklahoma City, OK 31 94 81 120 39
Norman Oklahoma City, OK 123 22 189 190 1
Sulphur Oklahoma City, OK 24 48 53 71 18
Pennsylvania:
Hollidaysburg Altoona, PA 67 49 48 116 68
Erie Erie, PA 74 19 41 104 63
Rhode Island: Bristol Providence, Rl 91 56 53 149 96
South Dakota: HotSprings Hot Springs, SD 70 37 32 112 80
Vermont: Bennington White River Jet., VT 12 22 25 36 11
Virginia: Occoquan5 Washington, DC 118 473 438 572 134
Washington:
Orting Seattle, WA 79 47 47 126 79
Retsil Seattle, WA 129 138 126 270 144
Wisconsin: King Madison, Wl 30 14 12 46 34
Wyoming: Buffalo Sheridan, WY 47 15 17 64 47
1 Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
2Includes deaths.
3Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
4 Total on rolls (bed occupants, patients on leave of absence, and patients absent sick in hospital).
s Operated by the government of the District of Columbia.
EXTENDED CARE
State Home Hospitals: Selected Data—Fiscal Year 1981
TABLE 42
Location of State Home Hospitals Location of Authorizing VA Facility Average Daily Census i Admissions Discharges 2 Patients T reated 3 Remaining on September 30, 1981 4
Total 881 4,487 4,451 5,343 892
California: Yountville San Francisco, CA 322 976 941 1,260 319
Connecticut: Rocky Hill Newington, CT 313 524 528 843 315
Illinois: Quincy Iowa City, IA 25 479 475 503 28
Iowa: Marshalltown Des Moines, IA 84 185 186 268 82
Massachusetts:
Chelsea Boston, MA (OPC) 108 1,530 1,535 1,646 111
Holyoke Northampton, MA 9 199 195 208 13
Oklahoma: Sulphur Oklahoma City, OK 20 594 591 615 24
'Based on the number of patient days during the fiscal year divided by the number of days in the fiscal year.
2 Includes deaths.
3Discharges and deaths during the fiscal year plus the number of patients on the rolls at the end of the fiscal year.
4 Total on rolls (bed occupants and patients on leave of absence.)
185
AMBULATORY CARE
TABLE 43
Outpatient Medical Program:
Visits to VA Staff and Private Physicians on a Fee-For-Service Basis-Fiscal Years 1972—1981
Fiscal Year Purpose of Visit
All Purposes Examinations for Compensation for Pension Purposes Examinations to Determine Need for Medical Care All Other Purposes
Total Staff Fee Total Staff Fee Total Staff Fee Total Staff Fee
1981. . 17,929,550 15,825,064 2,104,486 377,559 283,539 94,020 2,463,349 2,435,466 27,883 15,088,642 13,106,059 1,982,583
1980. . 17,971,407 15,751,690 2,219,717 373,300 287,724 85,576 2,435,856 2,403,684 32,171 15,162,251 13,060,282 2,101,969
1979. . 17,262,408 15,053,332 2,209,076 372,077 290,695 81,382 2,239,313 2,213,770 25,543 14,651,058 12,548,867 2,102,151
1978. . 17,416,275 15,069,573 2,346,702 405,301 321,372 83,929 2,244,929 2,227,915 17,014 14,766,045 12,520,286 2,245,759
1977. . 17,045,079 14,675,284 2,369,795 421,425 337,252 84,173 2,205,165 2,193,258 11,907 14,418,489 12,144,774 2,273,715
1976.. 16,409,850 14,222,804 2,187,046 388,674 345,152 43,522 2,126,614 2,124,362 2,252 13,894,452 11,753,290 2,141,272
1975. . 14,629,517 12,595,514 2,034,003 353,590 323,085 30,505 1,951,618 1,948,907 2,711 12,324,309 10,323,522 2,000,787
1974. . 12,266,476 10,457,830 1,808,646 316,359 290,728 25,631 1,692,876 1,691,695 1,181 10,257,241 8,475,407 1,781,834
1973.. 10,858,491 9,165,094 1,693,397 339,557 310,686 28,871 1,577,282 1,576,143 1,139 8,941,652 7,278,265 1,663,387
1972. . 9,526,881 7,930,080 1,596,801 406,065 342,035 64,030 1,494,491 1,492,548 1,943 7,626,325 6,095,497 1,530,828
AMBULATORY CARE
TABLE 44
Outpatient Dental Care: Applications for Care (Eligibility Classes I-VI) 1 Fiscal Years 1975-1981
Fiscal Year Pending Fee Case Load Beginning of Year Received During The Year Total Dispositions During The Year Pending Fee Case Load At End of Year
1981 46,641 211,205 257,846 229,845 28,001
1980 37,281 243,277 280,558 233,917 46,641
1979 40,751 191,308 232,059 194,778 37,281
1978 36,096 197,338 233,434 192,683 40,751
1977 40,254 216,863 257,117 221,021 36,096
1976 45,910 233,392 279,302 241,003 38,299
1975 41,611 239,182 280,793 234,883 45,910
'As provided for in Title 38 USC, Sec. 612, and VA Regulations 6120-6129.
AMBULATORY CARE
TABLE 45
Outpatient Dental Care: Workload by VA Staff and on a Fee-For-Service Basis — Fiscal Years 1972-1981
Fiscal Year VA Staff Non-VA Dentists on a Fee-for-Service Basis
Examinations Completed Treatment Cases Completed Examinations Completed Treatment Cases Completed Net Cases Authorized
1981 155,493 155,151 90 675
1980 157 601 143 345 109 801
1979 128,195 134 769 89 848
1978 127,278 127,167 110 081
1977 107,987 100 305 107 265
1976 93,230 94 097 121 956
1975 85 802 83 670 130 891
1974 79,674 79^498 (’) (') 156’467
1973 114,199 82,916 113,578 165,472
1972 142,919 82,873 113,819 165,819
1 Reporting of fee-basis workload changed to the net number of cases authorized by VA.
186
TABLE 46
PHARMACY
Pharmacy Activity—Fiscal Years 1980—1981
Activity FY 1981 FY 1980
VA Pharmacies
Prescriptions dispensed — Total 39 265 391 36 687 165
Inpatient 1 444 007 1 426 484
Ambulatory — Total 37 R?1 384 260 6R1
Methadone 1 100 R47 1 027 700
All other 36 720 537 ?4 2?2 Q21
Unit doses 70 04? Q0? 62 4R1 ROQ
Primary intravenous admixtures 1 507 000 1 210 4Q4
Secondary intravenous admixtures ("piggy backs") 4 837 430 3 695 973
Hyperalimentation 355 451 R6R Q74
Fluids and sets 9 878 145 R 606 OR1
Fee-Basis
Prescriptions filled by participating pharmacies 1,305,827 1,018,537
187
CONSTRUCTION
TABLE 47
Replacement and Relocation Hospital Construction Projects, Fiscal Year 1981 — Completions And Year End Status
Location Total Number of Beds and Hospital Type1 Estimated Construction Cost2 Value of Work in Place Percent Complete3 Date Construction Completed (C)4or Contract Awarded (A)
TOTAL . . 8 Projects 5,473 1,057,763,087 305,128,528 29
A. Projects Completed in Fiscal Year 1981
Total 1 Project 702 94,331,275 94,331,275 100
New York : Bronx 702 94,331,275 (s) 100 October 1980(C)
B. Projects Under Construction
Total 5 Projects 3,316 536,804,300 210,797,253 39
Arkansas : Little Rock 505 130,601,000 42,690,974 32 July 1980 (A)
Florida : Bay Pines 830 104,045,300 46,407,176 44 August 1978 (A)
Virginia : Richmond 814 113,500,000 69,151,251 61 November 1976(A)
Washington : Seattle 490 119,679,000 15,500,314 13 May 1980 (A)
West Virginia : Martinsburg 677 68,979,000 37,047,538 54 July 1977 (A)
C. Projects Authorized — Not Under Construction
Total 2 Projects 1,455 426,627,512
Minnesota : Minneapolis 845 (General)
Oregon : Portland/Vancouver 610 (General)
1 Included receiving, recovery and nursing home care beds, domiciliaries and injury beds.
2 Construction anticipated, issued, awarded, including contingencies.
3 Based on general construction only.
4Major general construction contract completed, minor construction and landscaping may remain to be accomplished.
5 Same as value of construction issued or awarded when project is financially complete.
6 Under construction when major general construction contract has been awarded.
7Authorized when funds are appropriated for construction, technical services, or site acquisition.
CONSTRUCTION
TABLE 48
Modernization Construction Projects,1—Fiscal Year 1981 — Completions and Year End Status
Location Description Estimated Construction Cost Value of Work in Place Percent Complete Date Construction Complete (C) or Contract Awarded (A)
TOTAL A. Projects completed. Total B. Projects under construction, Total Projects $1,000,000 and over. Total Kansas : Wichita Louisiana : New Orleans Massachusetts : West Roxbury Projects C. Project not under construction. Total Projects $1,000,000 and over. Total Alabama : Birmingham California : San Francisco New Mexico : Albuquerque Ohio : Chillicothe Projects under $1,000,000, Total 8 Projects 0 Projects 4 Projects 3 Projects Modernization Expand Clinical/OP/R827^321 3,194,288 44 November 1980 (A)
I CT W 3 Des Moines . . Ambulatory Care Addition & Renovation 2 727 044 0 August 1981 (A)
Idaho Boise Renovate Wards 2 & 4 Building #67 1,932,165 749,947 39 February 1981 (A)
Illinois Chicago Correction of Electrical Defic. 1,196,273 1,157,116 97 September 1980 (A)
Kansas Wichita Underground Drain Culvert 1,543,973 1,274,033 82 January 1981 (A)
Kentucky Louisville Renovate OR Rooms 1,598,987 448,529 28 July 1980 (A)
Massachusetts Boston Secondary Gen. & Update Wiring 1,997,000 0 June 1981 (A)
Michigan Allen Park Expand/Renovate Lab 1,268,000 0 July 1981 (A)
Battle Creek Fire & Safety Improvements 1,058,000 236,531 22 May 1981 (A)
Missouri St. Louis Safety & Fire Improvements 1,280,000 0 September 1981 (A)
St. Louis Relocate Admin, to Bldg. 1,071,436 97,576 9 June 1981 (A)
St. Louis Safety & Fire Improvements 1,280,000 0 September 1981 (A)
Mississippi Biloxi Clinical Addition and Outpatient 15,215,000 0 September 1981 (A)
Biloxi Renovation of Building #2 4,444,486 4,048,824 91 June 1980 (A)
Nebraska Grand Island Emergency Gen.& Electrical Defic. 1,057,235 1,022,767 97 September 1979 (A)
New York Albany Update Primary Distribution (Ph-2) 1,150,616 358,716 23 June 1981 (A)
Albany Patient Support System "AOV" 1,670,099 503,445 30 November 1980 (A)
Albany Radiation Therapy 1,347,800 0 August 1981 (A)
Bath Ambulatory Care Addition B-76 2,658,000 0 September 1981 (A)
Canandaigua Safety and Fire Improvements 7,304,565 2,490,096 34 September 1980 (A)
Castle Point Relocate and Replace Boiler Plant 1,953,000 0 August 1981 (A)
New York Safety & Fire Improvements 4,303,623 1,188,192 28 September 1980 (A)
Northport Safety & Fire Improvements 1,440,912 0 September 1981 (A)
St. Albans Primary Distr. & 2nd Generator Systems 1,649,711 0 June 1981 (A)
Syracuse Correction of Electrical Defic. 1,112,679 1,088,424 98 November 1978 (A)
Ohio Cincinnati Clinical Exp., Reloc., 2 Addl. Elev. 9,630,794 0 July 1981 (A)
Oklahoma Oklahoma City Clinical Addn./modern./Safety & Fire Defic. 33,474,412 9,158,739 27 December 1980 (A)
Pennsylvania Philadelphia Fire & Safety Improvements 4,209,000 0 September 1981 (A)
Wilkes Barre Three Additional Elevators 1,749,000 114,597 6 June 1981 (A)
South Carolina Charleston Correction of Seismic Defic. 8,670,372 1,866,421 22 September 1980 (A)
Columbia Renovate Building #22 (Admin.) 1,349,000 0 September 1981 (A)
South Dakota Sioux Falls New Boiler Plant 2,201,298 2,021,523 92 September 1979 (A)
Tennessee Mountain Home Clinical Addition 10,472,200 654,179 6 March 1981 (A)
1 253 000 0 September 1981 (A)
Murfreesboro Remodel Ward 5A and 5B 1,351J75 1,180,161 87 September 1980 (A)
Nashville Ambulatory Care, Research & Educ. Addn. 11,506,217 10,820,389 94 January 1979 (A)
Texas Dallas Ambulatory Care Addition & Renovation 5,804,579 3,891,584 67 July 1980 (A)
Utah Salt Lake City Clinic & Amb. Care Addn. Lab Addn. & R&E 20,766,022 13,190,743 64 September 1979 (A)
1 767 600 0 September 1981 (A)
Washington American Lake Renovate Wards - Building #7 +450^216 1,296,100 89 November 1980 (A)
Wisconsin Madison 2nd Emergency Distr. & Generator 1,393,472 1,137,196 82 September 1980 (A)
Wood 8" High Temp. Hot Water Line - Bldg. #112E & 111 1,167,428 1,118,666 96 September 1980 (A)
West Virginia Huntington Addition to Building #1 (Ph-1) 6,698,022 6,219,755 93 March 1978 (A)
Projects under $1,000,000, Total 224 Projects $93,212,415 $50,742,104 54
See footnotes at end of table.
192
TALBE 51—Continued
CONSTRUCTION
Other Improvement Construction Projects,1 Fiscal Year 1981 —Completions And Year End Status
Location Description Estimated Construction Cost Value of Work in Place Percent Complete Date Construction Completed (C) or Contract Awarded (A)
C. Projects not under construction. Total 297 Projects 927,737,951
Projects $1,000,000 and over. Total 84 Projects 861,692,000
Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Iowa Idaho Illinois Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Missouri North Carolina North Dakota Nebraska New Hampshire New Jersey New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico South Carolina South Dakota Tennessee Texas Virginia Washington Wisconsin Tuscaloosa Tuskegee Fayetteville Tucson Fresno Long Beach Palo Alto Palo Alto Palo Alto Palo Alto San Diego San Diego Sepulveda Denver Newington Wilmington Lake City Miami Tampa Atlanta Atlanta Augusta Dublin Dublin Iowa City Iowa City Boise Chicago Danville Hines Hines Hines North Chicago North Chicago Leavenworth Wichita Louisville Alexandria Togus Togus Perry Point Brockton Battle Creek Battle Creek Poplar Bluff St. Louis Asheville Durham Durham Fayetteville Salisbury Fargo Lincoln Manchester East Orange Brooklyn Buffalo Northport St. Albans Chillicothe Cincinnati Dayton Muskogee Roseburg White City Pittsburgh Pittsburgh Wilkes Barre Wilkes Barre San Juan Charleston Sioux Falls Sioux Falls Memphis Memphis Murfreesboro Murfreesboro Nashville Amarillo San Antonio Temple Salem American Lake Wood Outpatient Clinic Addition Sewage Treatment Plant Clinical Addition Clinical Addn. for Lab, Surgery, Pad & Etc. Correct Seismic Defic. Addition & Renovation SPD Correct Seismic Def. Correct Electrical Defic. Surgical Addition Deadend Corridor Stairs Spinal Cord Injury Unit/SCI/OP Clinic CCU/MICU - Remodel S. Fire & Safety Improvements Clinical Support Wing Addn. Bldgs. #1 & 2, HVAC, Pat., Priv. Support Patient Privacy Outpatient and Clinical Addition Outpatient Addn./Renov. & SCI Relocation Two Elevators Warehouse and Engineering Office Two Additional Elevators Ldry. Addn. for Consolidation Bldg. #95 Renovate Building #19 for Patient Privacy Renovate Wards - Building #17 Safety & Fire Improvements Addn. to Bldg. #1 Primary Dist. Secondary Dist. & Generator OP Addn. & Renov. of Bldg. #11A & B Relocate and Expand SPD New Central Incinerator New Warehouse/Service Building Supply Depot Expansion Bldg. #37 Sprinkler Systems Replace/Upgrade Fire Alarm System Fire & Safety Improvements Renovation for Outpatient Clinic Medical Gas & Nurse Call & Patient Priv. Clinical Improvements Reloc. Support Function DVB Building Renovate Bldg. #207 1st and 3rd Floor Elev. B-11,13,14,15, 22, 80 & 82 Addn. & Renovate for SCI Renov. B-82 Replace Administration Bldg. Correct Seismic Defic. Cl. Addn./Ward Renov./New Ambul. Care Bldg. Energy Mgt. & Heat Run-Around Clin. Addn. (Ambu. Care, Lab, Pharm.) Sprinkler Additional Elevators Clinical Addition Renovate Ward Areas - Patient Privacy Addition for Clinical Improvements Outpatient Clinic Addition Laundry, Warehouse & Engineering Facility Improve & Correct Envir. Def. Medical Gas System Renovate SPD 10 Bed SICU Laundry Consolidation Elim, of Exit Defs. Renovate 7th Floor Psych. Ward Consolidate Kitchen Bldgs. #300 and 411 Outpatient Addition Elevators Renovate/Consolidate RMS Outpatient Clinic Addition Canteen Renovation Correct Electrical Defic. Kitchen Remodel Section-A Update RO Space for Outpatient Clinic Clinical Services Addition & Renovation Reg. Office Act. Bldg. Clinical & Support Services Addition 120 Bed SCI Unit Ambulatory Care Addition Renovate Building #3 Safety & Fire Improvements Renovate Laboratory Service Addn. & Renov. for Amb. Care Cl. & Edu. Sprinkler System Hortizonal Exit Clinical Expand & Reloc. of Support Facil. Safety & Fire Improvements Remodel Ward Bldg. #5 Including Seismic Relocate Nuclear Medicine 14,767,000 2,000,000 3,871,000 13,828,000 3,896,000 2,446,000 26,367,000 1,626,000 18,200,000 4,000,000 10,000,000 1,260,000 6,908,000 56,513,000 46,894,000 1,117,000 5,300,000 42,792,000 1,076,000 1,677,000 2,506,000 1,538,000 1,232,000 1,696,000 2,155,000 11,000,000 3,084,000 45,000,000 5,593,000 1,777,000 9,337,000 6,994,000 2,963,000 1,073,000 7,810,000 9,025,000 3,228,000 64,000,000 2,742,000 4,404,000 1,515,000 11,000,000 4,200,000 2,705,000 9,143,000 37,475,000 1,080,000 14,000,000 3,700,000 30,000,000 1,556,000 21,200,000 7,966,000 9,800,000 28,033,000 2,928,000 2,069,000 1,100,000 10,187,000 1,481,000 1,410,000 1,578,000 8,815,000 1,409,000 1,192,000 24,700,000 1,489,900 1,171,000 1,435,000 4,237,000 19,000,000 2,397,000 21,000,000 30,292,000 7,936,000 3,993,000 1,980,000 1,649,000 38,400,000 4,397,000 24,045,000 3,988,400 1,080,000 1,265,000
Projects under $1,000,000, Total 213 Projects $66,045,951
'Projects included in table if approved for development by Administrator’s Office or if there has been an appropriation of funds available for financing all or part of the project.
2 Same as value of construction issued or awarded when projects financially complete.
3 For Purchase & Hire Projects, the date the station reports construction started.
193
CONSTRUCTION
TABLE 52
National Cemetery Projects,1 Fiscal Year 1981—Completions and Year End Status
Location Description Estimated Construction Cost Value of Work in Place Percent Complete Date Construction Completed (C) or Contract Awarded (A)
TOTAL .. . 46 Projects 89,011,826 19,085,648 21
A. Projects completed. Total 6 Projects 7,056,176 7,056,176 100
Massachusetts : Massachusetts Develop 20 Acres/Const. Adm. & Svc. Bldg. 2,801,928 (2) 100 November 1980 (C)
Oklahoma : Ft. Gibson Develop 5 Acres 186,690 (2) 100 September 1981 (C)
Oregon : Willamette 20 Acre Development & Service Bldg. 1,247,746 (2) 100 September 1981 (C)
Tennessee : Chattanooga 5 Acre Development & Additional Facility 1,258,581 (2) 100 May 1981 (C)
: Chattanooga Construct Service Bldg. 726,051 (2) 100 May 1981 (C)
: Chattanooga Pond Related Road and Fill 835,180 (2) 100 May 1981 (C)
B. Projects under construction. Total 19 Projects 24,330,970 12,029,472 49
Projects $1,000,000 and over. Total 8 Projects 18,756,993 8,322,231 44
California : Riverside Develop 45 Acres 2,314,469 2,223,999 96 September 1980 (A)
Colorado : Ft. Logan ; . . . Develop 35 Acres 2,045,734 2,024,405 99 June 1980 (A)
Hawaii National Memorial Cemetery . . Columbarium on Crater Rim 1,357,061 268,219 20 May 1981 (A)
Massachusetts Massachusetts Develop 32 Acres Phase #2 1,887,900 September 1981 (A)
New York : Calverton Admin. Bldg. & Committal Service Complex 2,406,200 August 1981 (A)
: Calverton Develop 50 Acres (Phase 1) 2,831,633 2,714,259 96 December 1979 (A)
Pennsylvania : Indiantown Gap Develop 20 Acres/Constr. Adm. & Svc. Bldg. 2,508,996 1,091,349 44 March 1981 (A)
Virginia : Quantico Develop 5 000 Graves & Constr. Adm. Bldg 3,405,000 September 1981 (A)
Projects under $1,000,000, Total 11 Projects 5,573,977 3,707,241 67
C. Projects not under construction. Total 21 Projects 57,624,680
Projects $1,000,000 and over, Total 12 Projects 53,408,600
California : Riverside Develop 28,000 Gravesites & Addl. Fac. 4,561,000
Massachusetts : Massachusetts Develop 11,000 Gravesites 1,817,000
Michigan : Ft. Custer Develop 115 Acres/Admin. & Service Bldg. 5,064,000
Minnesota : Ft. Snelling Develop 14,800 Gravesites & Addl. Fac. 1,868,000
: Ft. Snelling Admin. Bldg. & Service Bldg. 3,763,000
New York : Calverton Develop 25 Acres & Service Bldg. 2,248,000
: Calverton Develop 53,000 Gravesites & Addl. Fac. 7,775,000
Pennsylvania : Indiantown Gap Develop 63 Acres and Addl. Facilities 3,900,000
Tennessee : Chattanooga Relocate Drives 1,062,600
Texas : Ft. Sam Houston Develop 10,500 Gravesite & Reloc. Utilities 1,832,000
Virginia : Quantico Develop 50 Acres — Ph-3 15,485,000
: Quantico Develop 26,400 Graves & Constr. Svc. Bldg. 4,033,000
Projects under $1,000,000, Total 9 Projects 4,216,080
'Projects in table include those approved by the Administrator and those in some stage of 2 Same as value of construction issued or awarded when projects is financially complete,
design for construction for which funds have been approved.
CONSTRUCTION
Dom iciliary Construction Projects,1 Fiscal Year 1981—Completions and Year End Status
TABLE 53
Location Projects Number of Nursing Home Care Beds Estimated Construction Cost Value of Work in Place Percent Complete Date Construction Completed (C) or Contract Awarded (A)3
TOTAL A. Projects completed. Total Ohio : Dayton B. Projects under construction. Total Projects $1,000,000 and over, Total Projects under $1,000,000, Total C. Projects not under construction, Total Projects $1,000,000 and over. Total California : Los Angeles New York : Bath Virginia : Hampton Projects under $1,000,000, Total 4 Projects 958 39,343,081 7,167,081 18 March 1981 (C)
1 Project 200 7,167,081 7,167,081 100
200 7,167,081 7,167,081 100
0 Projects 0 Projects 0 Projects
3 Projects 758 32,176,000
3 Projects 0 Projects 758 350 208 200 32,176,000 14,928,000 8,915,000 8,333,000
1 Projects included in table if approved for development by Administrator’s office or if there 2 Same as value of construction issued or awarded when project is financially complete,
has been an appropriation of funds available for financing all or part of the project. 3 For Purchase & Hire Projects, the date the station reports construction started.
194
GUARDIANSHIP AND VETERANS ASSISTANCE
Incompetent and Minor Beneficiaries Served
TABLE 54
Fiscal Year Total Beneficiaries Incompetent Adults Minors
Total Type of Fiduciary Total Type of Fiduciary
State Court Appointed Fiduciaries Federal Fiduciaries Supervised Direct Payment State Court Appointed Federal Fiduciaries
1981 132,446 112,757 38,708 67,826 6,223 19,689 4,002 15,687
1980 138,797 114,905 40,917 67,930 6,058 23,892 5,490 18,402
1979 143,286 115,933 42,890 67,283 5,760 27,353 7,022 20,331
1978 145,891 115,187 44,759 65,029 5,399 30,704 9,184 21,520
1977 149,843 114,262 46,960 62,258 5,044 35,581 11,685 23,896
1976 141,218 100,044 49,208 46,505 4,331 41,174 16,154 25,020
1975 146,471 97,272 52,662 40,995 3,615 49,199 21,971 27,228
1974 177,950* 107,636 58,328 46,618 2,690 70,314 33,856 36,458*
1973 669,028 115,495 61,399 52,251 1,845 583,533 43,857 539,676
1972 730,532 114,092 64,635 48,740 717 616,440 53,941 562,499
1 Decrease represents cases where approved, close relative/custodians receive payments for the benefit of minors.
TABLE 55
SPECIAL ACTS
Death: Special Acts, Class of Beneficiary, Period of Service - September 30, 1981
Class of Beneficiary Total Regular Establishment Civil War Spanish-American War
Number Monthly Value Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total cases 17 296 17.41 8 14.25 3 20.00 6 20.33
Surviving spouse alone 10 164 16.40 8 14.25 2 25.00
Surviving spouse and children
Children alone 7 132 18.86 3 20.00 4 18.00
Total dependents .... 17 8 3 6
Surviving spouses 10 8 2
Children 7 3 4
195
NATIONAL CEMETERY SYSTEM
TABLE 56
National Cemeteries—Location, Interments, and Status of Gravesites September 30, 1981
National Cemetery FY 1981 Interments Cumulative Gravesites Used Gravesites Reserved Gravesites1 Available Close-out Date2 (Fiscal Year)
123 6,266 153 416 1987
Alexandria, VA 4 4,062 25 1 Closed
Alton, IL 1 489 37 6 Closed
Annapolis MD 5 2,918 35 2 Closed
Balls Bluff VA 0 25 0 0 Closed
Baltimore, MD 397 33,922 3,463 843 Closed
592 13,054 589 3,557 1988
Bath NY 141 8,822 0 542 1991
Baton Rouge, LA 17 5,019 57 6 Closed
Bay Pines, FL 4 4,223 1 2 Closed
137 11,556 172 5,526 2000+
Beverly NJ 364 36,373 4,150 176 Closed
243 2,698 469 674 2000+
Black Hills, SD 338 6,358 464 10,336 2000+
Bourne, MA 560 553 0 8,996 2000+
Calverton, NY 6,450 19,150 4,150 7,572 2000+
Camp Butler IL 292 8,583 319 715 2000+
Camp Nelson, KY 148 6,015 67 2,320 2000+
Cave Hill, KY 0 5,634 3 25 Closed
Chattanooga, TN 471 24,362 581 125 2000+
City Point VA 13 5,480 81 36 Closed
Cold Harbor, VA 0 968 0 4 Closed
Corinth MS 32 6,257 22 7,235 2000+
Crown Hill, IN 0 795 0 0 Closed
Culpeper, VA 327 4,899 16 2,228 1998
Cypress Hills, NY 22 18,561 60 82 Closed
Danville, IL , 105 6,285 0 172 2000+
Danville, KY 0 393 1 5 Closed
Danville, VA 14 2,148 29 29 Closed
Dayton, OH 445 25,410 2 2,562 2000+
Fayetteville, AR 100 3,427 114 214 1984
Finn's Point, NJ 0 2,703 2 0 Closed
Florence, SC 95 4,562 71 327 1982
Ft. Bayard, NM 41 1,894 0 752 2000+
Ft. Bliss, TX 753 15,514 1,237 9,103 2000+
Ft. Custer, Ml 0 0 0 0 Not Yet Open
Ft. Gibson, OK 221 7,704 139 742 2000+
Ft. Harrison, VA 6 1,110 2 14 Closed
Ft. Leavenworth, KS 585 18,068 610 688 1983
Ft. Logan, CO 1,640 25,609 770 38 2000+
Ft. Lyon, CO 21 941 0 839 2000+
Ft. McPherson, NE 118 3,656 97 1,926 2000+
Ft. Meade, SD 0 188 0 0 Closed
Ft. Mitchell, AL 0 0 0 0 Not Yet Open
Ft. Rosecrans, CA 421 44,169 2,327 0 Closed
Ft. Sam Houston, TX 1,888 39,418 3,193 4,078 1995
Ft. Scott, KS 71 3,029 101 2,878 2000+
Ft. Smith, AR 161 5,606 230 2,967 2000+
Ft. Snelling, MN 3,011 71,932 14,056 8,685 2000+
Glendale, VA 4 1,308 0 3 Closed
Golden Gate, CA 854 97,234 8,578 0 Closed
Grafton, WV 1 2,079 50 2 Closed
Hampton, VA 39 20,931 489 227 Closed
Hampton VAMC, VA 0 22 0 0 Closed
Hot Springs, SD 0 1,481 0 1 Closed
Houston, TX 1,185 13,112 36 1,350 2000+
Indiantown Gap, PA 0 0 0 0 Opens FY 1982
Jefferson Barracks, MO 2,496 64,609 2,425 4,675 2000+
Jefferson City, MO 1 460 71 12 Closed
Keokuk, IA 45 2,566 61 2,699 2000+
Kerrville, TX 0 460 0 0 Closed
Knoxville, TN 27 7,335 245 181 Closed
Leavenworth, KS 236 13,963 2 1,470 2000+
Lebanon, KY 14 1,997 32 56 2000+
Lexington, KY 0 1,388 0 9 Closed
Little Rock, AR 363 16,057 339 1,524 1986
Long Island, NY 2,898 233,648 13,365 6,720 Closed
Los Angeles, CA 542 69,787 2 992 Closed
Loudon Park, MD 6 6,493 5 140 Closed
Marietta, GA 46 16,300 421 114 Closed
Marion, IN 76 4,666 0 299 2000+
Memphis, TN 682 29,521 616 3,960 1988
Mill Springs, KY 27 1,756 34 565 2000+
Mobile, AL 14 3,587 269 8 Closed
Mound City, IL 41 6,801 73 1,036 2000+
Mountain Home, TN 140 6,183 0 377 2000+
Nashville, TN 479 25,450 412 5,360 1995
Natchez, MS 58 4,947 53 226 1986
Nat. Memorial Cemetery of the Pacific, HI 663 27,139 671 1,363 1984
New Albany, IN 8 4,936 163 212 Closed
See footnotes at end of table.
196
TABLE 56—Continued
NATIONAL CEMETERY SYSTEM
National Cemeteries—Location, Interments, and Status of Gravesites September 30, 1981
National Cemetery FY 1981 Interments Cumulative Gravesites Used Gravesites Reserved Gravesites Available* Close-out Date2 (Fiscal Year)
New Bern, NC 110 5 385 100 1983
Philadelphia, PA 34 10,368 38 15 Closed
Port Hudson, LA 134 6 340 31 821 1989
Prescott, AZ 17 2 966 0 0
Puerto Rico, PR 826 12 886 1 383 507 2000+
Quantico, VA 0 0 0 0 Open FY 1983
Quincy, IL 7 463 1 114 2000+
Raleigh, NC 138 3 869 86 1 423 1991
Richmond, VA 24 7 231 255 4
Riverside, CA 4 025 10 438 0 10 059 2000+
Rock Island, IL 356 10 948 283 2 621 1994
Roseburg, OR 123 2 379 0 1
St. Augustine, FL 3 1 159 22 0
Salisbury, NC 103 14’382 72 1,133 1993
San Antonio, TX 2 3,007 28 197 Closed
San Francisco, CA 131 22,870 699 0 Closed
Santa Fe, NM 685 12 606 444 1 536 2000
Seven Pines, VA 1 1 130 1 4
Sitka, AK 16 626 1 60 1982
Springfield, MO 245 7 490 232 1 135 1984
Staunton, VA 3 841 6 12
Togus, ME 0 5,371 0 0 Closed
White City, OR 149 1,596 0 250 2000+
Willamette, OR 2,340 53,096 2,293 1,488 1994
Wilmington, NC 128 4,436 67 234 1983
Winchester, VA 8 5,050 39 99 Closed
Wood.WI 795 21,199 1 1,864 Closed
Woodlawn, NY 18 6,257 232 27 Closed
Zachary Taylor, KY 69 8,395 1,121 162 Closed
Totals 41,812 1,449,808 73,742 145,053
1 Includes concurred gravesites and gravesites/niches suitable for cremated remains.
2Most cemeteries indicated as “closed” will continue to make interments of eligible family members in occupied gravesites and previously reserved gravesites.
197
COMPENSATION AND PENSION
Disability, Death: Number of Cases, Amount, Period of Service
TABLE 57
Period of Service Number of Cases Sept. 1981 Average Annual Expenditure Per Case Total Expenditures (in Thousands)
Sept. 1980 Sept. 1981 Fiscal Year 1981 Cumulative Through Sept. 1981
Grand total 4,535,285 2,369.71 2,683.68 12,225,027 188,662,266
Living veterans 3,154,029 2,599.80 2,931.96 9,319,207
Service connected 2,279,070 2,668.99 3,010.53 6,937,798
Retired Reserve or Emergency Officers 160 6,650.76 7,501.95 1,224 515,699
Non-service connected 874,783 2,428.31 2,726.48 2,380,181
Special acts 16 236.57 253.50 4
Deceased veterans 1,381,256 1,862.93 2,116.75 2,905,820
Service connected 355,011 3,801.32 4,368.94 1,534,942
Non-service connected 1,026,228 1,227.98 1,337.67 1,370,875
Special acts 17 203.29 208.94 3
Civil War 165 1,150.81 1,122.84 193 8,223,019
Deceased veterans 165 1,150.81 1,122.84 193
Service connected 4 3,792.00 3,966.00 15
Non-service connected Special acts Indian wars 158 3 1,093.90 240.00 1,210.40 1,067.62 240.00 1,153.89 178
38 41 119,060
Deceased veterans Service connected 38 1,210.40 1,153.89 41 58,634
Non-service connected 38 1,210.40 1,153.89 41
Spanish-American War 11,538 1,439.81 1,562.95 17,706 5,276,916
Living veterans 86 2,948.09 3,359.44 354 3,372,754
Service connected 1 4,744.00 12,936.00 30
Non-service connected 85 2,908.18 3,246.78 324
Deceased veterans 11,452 1,424.00 1,549.46 17,352 1,904,162
Service connected 120 4,386.31 4,970.80 589
Non-service connected 11,326 1,393.40 1,513.90 16,762
Special acts 6 228.00 244.00 1
Mexican border service 644 1,382.78 1,429.94 1,010 10,865
Living veterans 156 2,412.98 2,560.38 444 6,235
Service connected 5 3,187.20 1,012.80 46 740
Non-service connected 151 2,392.72 2,611.63 398 5,474
Deceased veterans 488 1,001.08 1,068.60 566 4,596
Service connected 1 4,404.00 5,028.00 7 92
Non-service connected 487 988.16 1,060.44 559 4,504
World War I 629,548 1,682.81 1,821.11 1,158,949 46,436,586
Living veterans 166,497 2,669.33 2,956.54 505,253 31,559,951
Service connected 25,417 3,403.07 3,821.24 99,766 10,260,034
Retired emergency officers 160 6,640.68 7,501.95 1,220 189,955
Non-service connected Special acts 140,919 1 2,535.08 120.00 2,795.44 120.00 404,267 21,109,963
Deceased veterans 463,051 1,288.34 1,422.36 653,696 14,876,035
Service connected 28,731 4,241.03 4,851.67 141,160 3,595,986
Non-service connected 434,320 1,096.75 1,195.51 512,536 11,280,649
World War II 2,441,702 2,307.12 2,606.34 6,363,532 89,454,583
Living veterans 1,800,760 2,461.99 2,775.40 5,027,073 68,689,073
Service connected 1,167,481 2,535.52 2,871.33 3,392,715 53,612,553
Non-service connected 633,279 2,328.32 2,598.55 1,634,358 15,076,520
Deceased veterans 640,942 1,879.82 2,131,35 1,336,459 20,765,509
Service connected 169,791 3,465.11 4,005.57 651,066 11,618,295
Non-service connected 471,151 1,327.18 1,455.93 685,393 9,147,214
Korean conflict 437,864 2,691.16 3,073.37 1,360,455 14,580,329
Living veterans 316,758 2,976.61 3,383.43 1,079,181 10,993,078
Service connected 233,820 3,013.14 3,393.48 804,521 9,338,959
Non-service connected 82,938 2,870.36 3,355.09 274,660 1,654,119
Deceased veterans 121,106 1,990.10 2,262.41 281,274 3,587,251
Service connected 39,192 3,566.92 4,105.33 162,774 2,051,936
Non-service connected 81,914 1,301.66 1,380.66 118,500 1,535,315
Regular establishment 334,492 3,079.73 3,417.19 1,149,531 10,646,217
Living veterans 284,127 2,827.98 3,130.83 892,543 7,682,910
Service connected Retired reserve officers 284,112 2,828.18 8,484.00 242.40 3,130.98 892,535 4 325,745
Special acts 15 262.40 4
Deceased veterans 50,365 4,398.67 5,032.67 256,988 2,963,307
Service connected 50,357 4,399.36 5,033.44 256,986
Special acts 8 171.00 171.00 2
Vietnam era 679,294 2,795,32 3,162.93 2,173,881 13,720,480
Living veterans 585,645 2,708.80 3,065.74 1,814,361 11,211,926
Service connected 568,234 2,695.54 3,042.44 1,748,186 10,937,775
Non-service connected 17,411 3,165.77 3,825.85 66,175 274,151
Deceased veterans 93,649 3,324.25 3,770,72 359,250 2,508,285
Service connected 66,815 4,172.77 4,737.50 322,344 2,235,155
Non-service connected 26,834 1,336.01 1,363.50 36,906 273,130
198
TABLE 58
COMPENSATION AND PENSION
Disability, Age Group, Period of Service —Sept. 1981
Age Group Grand Total World War I World War II
Total3 Service-Connected Non-Service-Connected Total Service-Connected Non-Service-Connected Total Service-Connected Non-Service-Connected
Average age Total veterans Under 20 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 Under 65 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95 and over 65 and over 57.8 3,154,013 151 20,631 77,908 224,744 155,275 102,046 190,239 302,014 603,668 634,176 2,310,852 369,276 209,323 72,657 61,766 106,955 21,617 1,567 843,161 54.6 2,279,070 151 20,570 75,915 218,098 148,891 98,932 160,611 227,827 456,447 465,807 1,873,249 234,096 106,547 29,705 16,022 16,477 2,647 327 405,821 66.2 874,783 61 1,993 6,646 6,384 3,114 29,628 74,187 147,221 168,369 437,603 135,180 102,776 42,952 45,730 90,372 18,937 1,233 437,180 86.4 166,336 410 38,862 104,597 21,202 1,265 166,336 85.8 25,417 54 7,953 14,889 2,338 183 25,417 86.5 140,919 356 30,909 89,708 18,864 1,082 140,919 63.1 1,800,760 58,670 530,047 579,772 1,168,489 343,871 198,628 67,328 20,475 1,599 208 162 632,271 62.2 1,167,481 29,141 388,615 412,524 830,280 209,313 96,111 24,785 5,705 1,029 161 97 337,201 64.6 633,279 29,529 141,432 167,248 338,209 134,558 102,517 42,543 14,770 570 47 65 295,070
Age Group Korean Conflict Vietnam Era Regular Establishment Spanish-American War’ Mexican Border Service1 R.E.O. and R.R.O.1 2
Total Service-Connected Non- Service-Connected Total Service-Connected Non-Service-Connected
Average age Total veterans Under 20 20 to 24 25 to 29 30 to 34 35 to 39 40 to 44 45 to 49 50 to 54 55 to 59 60 to 64 Under 65 65 to 69 70 to 74 75 to 79 80 to 84 85 to 89 90 to 94 95 and Over 65 and over 52.4 316,758 1,853 88,464 162,545 31,970 17,141 301,973 8,460 3,943 1,530 600 215 32 5 14,785 53.0 233,820 650 59,112 117,965 26,216 16,035 219,978 7,845 3,688 1,478 586 210 30 5 13,842 50.8 82,938 1,203 29,352 44,580 5,754 1,106 81,995 615 255 52 14 5 2 943 38.7 585,645 913 48,835 215,327 134,067 42,337 47,604 46,451 24,394 18,057 577,985 6,196 1,179 259 26 7,660 38.9 568,234 852 46,842 208,681 127,683 40,426 47,328 46,373 24,359 18,042 560,586 6,189 1,175 258 26 7,648 34.8 17,411 61 1,993 6,646 6,384 1,911 276 78 35 15 17,399 7 4 1 12 45.1 284,112 151 19,718 29,073 9,417 21,208 57,856 54,171 34,348 17,257 19,207 262,405 10,749 5,573 3,130 1,752 344 118 41 21,707 101.0 86 86 86 86.7 156 37 94 24 1 156 87.7 160 14 106 33 7 160
1 Service connected and non-service connected are combined in S.A.W. and Mexican Border service.
2 Emergency, provisional, probationary, temporary or reserve officers in receipt of retired pay under Public Law 2-73, 743, 262-77 or 351-81.
3R.E.O. and R.R.O. included in grand total but not in service connected and non-service grand totals.
199
COMPENSATION AND PENSION
Terminations of Awards, Disability, Death —Fiscal Year 1981
TABLE 59
Reasons for Terminations Total World War I World War II Korean Conflict Vietnam Era Regular Estab-Ment Old Wars2 Mexican Border Service
Service-Connected Non-Service-Connected Service-Connected Non- Service-Connected Service-Connected Non-Service-Connected Service-Connected Non-Service-Connected
Disability, total 194,595 4,233 33,813 30,196 86,353 3,716 9,135 11,424 2,126 13,472 77 50
Death of veteran 123,504 1,365 312 4,175 30,646 29,420 50 45,482 3,356 40 2,856 3,412 698 222 3,819 577
Disability less than 10 percent
Disability less than permanent and total 120 109 83
Estate in excess of $1,500 132 4 9 29 39 8 6 20 6 11
Excessive corpus of estate 363 107 220 30 4 2
Failure to cooperate Income provision 1,862 41,760 138 4 145 2,071 13 745 33,549 76 10 137 4,812 27 419 74 1,324 31 315 4
Person entitled is incarcerated 4
Veteran on active duty or in receipt of
retirement pay 1,744 4 56 5 45 4 819 1 810
Failure to return questionnaire 5,071 18,344 146 3,938 2,179 742 244 1
Miscellaneous1 50 685 628 257 412 6,056 137 7,936 2 2
Death, total 213,118 2,084 41,502 12,310 99,031 3,006 34,148 9,132 4,537 5,230 2,089 49
Dependency not established or discontinued . . 88,003 13 472 1,106 52,017 758 26,134 3,899 1,746 1,855 3
Payee incarcerated 41 27 12 2
Death of payee 56,686 1,928 30,970 9,348 8,426 1,472 359 937 45 1,440 1,726 35
Income provisions 38,690 2 5,784 124 26,246 69 4,089 597 1,509 256 4 10
Excess corpus of estate 282 133 6 127 3 7 3 3
Person entitled (widow, child, parent) married . 8,632 20 607 510 3,973 151 1,361 954 590 458 8
Failure to return questionnaire 6,048 3 816 183 3,696 78 602 323 204 126 16 1
Miscellaneous1 14,736 118 2,720 1,033 4,519 475 1,584 2,422 438 1,092 333 3
1 Includes temporary terminations.
2Civil War, Indian Wars, Spanish American War.
200
TABLE 60
COMPENSATION AND PENSION
Veterans Receiving Compensation or Pension Compared With Estimated Veteran Population by Period of Service
Period of Service Estimated Veteran Population Number Receiving Compensation, Pension or Retirement Percent Receiving Compensation, Pension or Retirement Receiving Compensation Only Percent Receiving Compensation Receiving Pension and/or Retirement Percent Receiving Pension
Total 30,083,000 3,154,029 10.48 2,279,070 7.58 874,783 2.91
World War 1 449,000 166,497 37.08 25,417 5.66 140,919 31.39
World War II 12,170,000 1,800,760 14.80 1,167,481 9.59 633,279 5.20
Korean Conflict 4,633,000 316,758 6.84 233,820 5.05 82,938 1.79
Vietnam Era 8,537,000 585,645 6.86 568,234 6.66 17,411 .20
Peacetime 4,294,000 284,127 6.62 284,127 6.62 NA
Old Wars2 (’) 242 6 236
'Less than 1000
2Includes Spanish-American War and Mexican War
TABLE 61
COMPENSATION AND PENSION
Veterans Receiving Compensation or Pension Compared With Estimated Veteran Population by Geographic Area of Residence—September 1981
U.S. Geographic Location Estimated Veteran Population Receiving Compensation or Pension Percent Receiving Compensation or Pension
Total 30,083,000 3,154,029 10.48
East 8,117,000 829,211 10.22
South 6,248,000 820,051 13.13
Midwest 7,770,000 694,425 8.94
Southwest 2,724,000 350,202 12.86
West 5,224,000 460,140 8.81
Composition of Geographic Locations:
East - CT, DE, DC, ME, MD, MA, NH, NJ, NY. PA, RI, VT.
South - AL, AR, FL, GA, KY, LA, MS, NC, PR, SC, TN, VA, WV.
Midwest - IL, IN, IA, KS, MI, MN, MO, NE, ND, OH, SD, WI.
Southwest - AZ, NM, OK, TX, UT.
West - AK, CA, CO, HI, ID, MT, NV, OR. WA, WY and Philippines.
TABLE 62 COMPENSATION AND PENSION
Death Benefit (Compensation, Dependency & Indemnity Compensation or Pension) Cases on the Rolls Compared to the Number of Deceased Veterans Who Participated In Each Period of Service
Period of Service Participants Total Death Benefit Cases Percent on Rolls Death Compensation and DIC Cases Percent on Rolls Death Pension Cases Percent of Total
Total 12,479,000 1,381,256 11.07 355,011 2.84 1,026,228 8.22
World War I 4,295,000 463,051 10.78 28,731 .67 434,320 10.11
World War II 4,365,000 640,942 14.68 169,791 3.89 471,151 10.79
Korean Conflict 698,000 121,106 17.35 39,192 5.61 81,914 11.74
Vietnam Era 410,000 93,649 22.84 66,815 16.30 26,834 6.54
Indian War 106,000 38 (3) (3) 38 (3)
Mexican Border (2) 488 1 487
Civil War 2,213,000 165 .01 4 (3) 161 .01
Peacetime (2) 50,365 50,357 8
Spanish-American War 392,000 11,452 2.92 120 .03 11,326 2.89
'Includes 19 Special Act Cases.
2 Data not available.
3Less than 0.005 Percent.
201
COMPENSATION
TABLE 63
Disability: Class of Dependent, Period of Service—Sept. 1981
Class of Dependent Total World War I World War II Korean Conflict
Number Monthly Value Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total veterans 2,279,070 571,766,567 250.88 25,417 318.44 1,167,481 239.28 233,820 282.79
Veterans less than 30 percent disabled
(no dependency benefit) 1,271,791 85,733,364 67.41 11,675 97.75 643,400 66.58 124,628 68.20
Veterans 30 percent or more disabled 1,007,279 486,033,203 482.52 13,742 529.19 524,081 451.28 109,192 527,70
Without dependents 301,826 122,358,702 405.39 6,550 504.54 161,830 370.72 31,168 433.04
With dependents 705,453 363,674,501 515.52 7,192 551.63 362,251 487.26 78,024 565.51
Spouse only 426,773 214,143,595 501.77 7,054 550.28 297,063 482.36 40,952 573.06
Spouse, child or children 239,166 124,005,455 518.49 102 618.89 55,232 487.32 31,551 533,82
Spouse child or children and parent or parents .... 2,862 2,525 392 882.39 728 707.31 394 942.60
Spouse parent or parents 2,252 1,826,592 811.10 1,309 745.92 427 938.35
Child or children only 28,075 15’l17’l27 538.46 36 625.19 5,683 491.11 3,548 530.24
Child or children and parent or parents . . 588 551,550 938.01 86 747.02 63 932.90
Parent or parents only 5,737 5,504,789 959.52 2,150 910.25 1,089 1010.66
Total dependents on whose account additional
compensation was being paid 1,190,460 7,313 449,692 137,138
Spouses 671 053 7,156 354,332 73,324
Children 506 463 157 90,841 61,613
Parents 12^944 4^519 2,201
s
Vietnam Era Regular Establishment Spanish-American War Mexican Border Service
Class of Dependent Average Average Average Average
Number Monthly Number Monthly Number Monthly Number Monthly
Value Value Value Value
Total veterans 568,234 253.54 284,112 260.92 1 1,078.00 5 84.40
Veterans less than 30 percent disabled
(no dependency benefit) Veterans 30 percent or more disabled 324,036 244,198 68.02 499.69 168,048 116,064 66.95 541.74 4 1 54.00 206.00
Without dependents 64,376 425.84 37,901 485.87 1 206.00
With dependents 179,822 526.13 78,163 568.83 1 1,078.00
Spouse only Spouse, child or children 49,468 116,263 501.31 507.54 32,235 39,018 580.17 542.73 1 1,078.00
Spouse, child or children, and parent or parents .... 1,334 939.59 406 949.92
Spouse, parent or parents 324 833.74 192 934.22
Child or children only 13,625 554.35 5,183 553.61
Child or children and parent or parents 331 986.76 108 943.65
Parent or parents only 1,477 948.00 1,021 1,025.42
Total dependents on whose account additional
compensation was being paid 432,777 163,539 ..J,
Spouses 164,389 71,851 1
Children 264,136 89,716
Parents 4,252 1,972
202
TABLE 64
COMPENSATION
Death: Total, Class of Beneficiary, Period of Service —September 1981
Class of Beneficiary Total World War I World War II Korean Conflict Vietnam Era
Number Monthly Value Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total cases 355,011 129,251,806 364.08 28,731 404.31 169,791 333.80 39,192 342.11 66,815 394.79
Compensation 52,167 4,119,134 78.96 29 97.97 39,663 79.24 10,353 78.00 10 79.40
Dependency and indemnity
compensation 299,872 123,675,208 412.43 28,702 404.61 128,001 410.13 28,176 435.45 66,793 394.82
Dependency and indemnity
compensation and
compensation 2,972 1 457,464 490.40 2 127 486 88 663 499 42 12 483 33
Surviving spouse alone 207,252 92,491,512 446.28 27,785 404.41 103 716 430.60 20 692 485 99 22 520 488 46
Surviving spouse and children 28,614 15,081,864 527.08 335 591.71 4 383 515.77 2 121 514 70 16 160 528 03
Surviving spouse, children and mother . 1,843 1,176,333 638.27 101 672.35 47 650.23 <376 632.43
Surviving spouse, children and father . . 225 139,597 620.43 13 664.46 7 561.29 169 620.15
Surviving spouse, children, mother
and father 490 314 332 641.49 3 701 67 6 601 83 395 639 18
Surviving spouse, and mother 6,932 3 886 770 560.70 2 754.00 3 401 555.50 928 548 12 1 456 572 77
Surviving spouse, and father 800 488J56 560.20 460 566.76 92 524.21 147 548.63
Surviving spouse, mother and father . . . 702 405,095 577.06 223 608.40 76 530.76 260 574.23
Children alone 17 439 4 063 723 233 03 520 303.32 1 818 266 58 876 243 66 11 611 222 36
Children and mother 1 421 494 217 347 80 65 423 23 51 335 12 1 140 343 58
Children and father 158 50 999 322.78 5 501 80 7 362 57 133 313 37
Children, mother and father 389 133 997 344.47 5 569 80 6 382 50 335 339 90
Mother alone . . . . 71,474 8,277,100 115.81 87 251.38 46 425 118 91 11 271 97 04 7 747 126 44
Father alone 8 040 1 034 212 128 63 2 132.50 5 335 144 16 1 209 94 74 826 102 60
Mother and father 9,232 <253’899 135.82 3 838 152.42 1 803 101.18 2 540 143.09
Total dependents 433,931 29,126 184,527 45,803 109 363
Surviving spouses 246,837 28 122 112 286 23 967 42,482
Children 74,571 910 8,298 4,441 46,827
92,487 92 54 061 14 189 15 249
Fathers . . 20,036 2 9^882 <206 <805
Class of Beneficiary Regular Establishment Civil War Spanish-American War Mexican Border Service
Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total cases 50,357 419.45 4 330.50 120 414.23 1 419.00
Compensation 2,122 78.10
Dependency and indemnity compensation 48,075 434.17 4 330.50 120 414.23 1 419.00
Dependency and indemnity compensation and compensation .... 170 499.75
Surviving spouse alone 32,430 477.95 1 419.00 107 418.53 1 419.00
Surviving spouse and children 5,613 533.90 2 807.00
Surviving spouse, children and mother 319 650.92
Surviving spouse, children and father 36 617.33
Surviving spouse, children, mother and father 86 652.81
Surviving spouse, and mother 1,145 570.65
Surviving spouse, and father 101 579.91
Surviving spouse, mother and father 143 557.92
Children alone 2,600 239.18 3 301.00 11 301.00
Children and mother 165 351.12
Children and father 13 328.85
Children, mother and father 43 348.47
Mother alone 5,944 111.31
Father alone 668 98.14
Mother and father 1,051 117.05
Total dependents 64,983 4 124 1
Surviving spouses 39,869 1 109 1
Children 14,077 3 15
Mothers 8,896
Fathers 2,141
203
204
COMPENSATION TABLE 65
Disability, Degree of Impairment, Type of Major Disability, Period of Service—Sept. 1981
Total Tuberculosis (Lungs and Pleura) Psychiatric and Neurological Diseases General Medical and Surgical Conditions
„ Percent „ Percent
Percent , T x . Percent x -r * , Percent
Percent of of Total of Total
Degree of Impairment _ .... Average , T _ Average Psychi- , Average General _ Average
Number ercent ont y Monthly Number ° Ota egree Monthly Number atric and egree Monthly Number Medical egree Monthly of Total Value Va|ue Tuber- of Im- Va|ue Neuro- of im- and Sur. of Im- Va|ue
CU,OSIS pa,r’ logical pair’ gical Con- pa,r-
ment ment .... ment
Diseases ditions
TOTAL
Total.......... 2,279,070 100.0 571,766,567 250.88 47,219 100.0 2.1 193.45 ;66,125 100.0 20.4 441.69 1,765,726 100.0 77.5 202.10
No disability....... 26,654 1.2 1,778,247 66.72 24,894 52.7 93.4 67.01 ............................ 1,760 .1 6.6 62.59
10 percent......... 887,477 38.9 48,280,229 54.41 1,486 3,2 0.2 61.72 130,835 28.1 14.7 54.15 755,156 42.8 85.1 54.44
20 percent......... 357,713 15.7 35,674,888 99.73 3,191 6.8 0.9 120.27 24,715 5.3 6.9 100.06 329,807 18.7 92.2 99.51
30 percent......... 317,872 14.0 53,569,756 168.53 9,442 20.0 3.0 166.79 77.081 16.5 24.2 165.49 231,349 13.1 72.8 169.61
40 percent......... 186,679 8.2 43,866,719 234.99 1,107 2.3 0.6 231.63 26,222 5.6 14.0 231.77 159,350 9.0 85.4 235.54
50 percent......... 114,799 5.0 38,162,713 332.43 1,198 2.5 1.0 338.45 43,215 9.3 37.6 326.30 70,386 4.0 61.3 336.10
60 percent......... 123,519 5.4 79,789,964 645.98 1,253 2.7 1.0 613.92 19,652 4.2 15.9 548.65 102,614 5.8 83.1 665.01
70 percent.......... 76,428 3.4 59,018,855 772.22 914 1.9 1.2 588.27 33,900 7.3 44.4 783.89 41,614 2.3 54.4 766.75
80 percent.......... 38,898 1.7 32,945,249 846.97 1,568 3.3 4.0 694.42 10,770 2.3 27.7 872.91 26,560 1.5 68.3 845.45
90 percent.......... 14,086 .6 13,109,739 930.70 124 .3 0.9 874.79 3,801 .8 27.0 952.76 10,161 .6 72.1 923.11
100 percent........ 134,945 5.9 165,570,208 1,226.95 2,042 4.3 1.5 1,101.89 95,934 20.6 71.1 1,178.02 36,969 2.1 27.4 1,361.50
WORLD WAR I
Total........... 25,417 100.0 8,093,713 318.44 3,634 100.0 14.3 241.96 4,790 100.0 18.8 491.36 16,993 100.0 66.9 287.22
No disability.......... 341 1.3 22,291 65.37 195 5.4 57.2 68.35 ..... ...................... 146 .9 42.8 62.00
10 percent........... 4,999 19.7 319,290 63.87 13 .4 0.3 67.36 354 7.4 7.1 68.39 4,632 27.3 92.7 64.33
20 percent........... 6,380 25.1 758,721 118.93 2,578 70.9 40.4 125.18 765 16.0 12.0 127.00 3,037 17.9 47.6 111.53
30 percent........... 3,593 14.1 608,360 169.32 256 7.0 7.1 180.39 649 13.6 18.1 172.87 2,688 15.8 74.8 167.79
40 percent........... 2,206 8.7 517,596 234.64 115 3.2 5.2 241.88 388 8.1 17.6 240.97 1,703 10.0 77.2 232.87
50 percent........... 1,782 7.0 584,806 328.18 35 1.0 2.0 330.37 647 13.5 36.3 331.79 1,100 6.5 61.7 327.36
60 percent........... 2,009 7.9 1,281,163 637.72 39 1.1 1.9 694.88 293 6.1 14.6 472.28 1,677 9.9 83.5 667.25
70 percent............. 973 3.8 709,662 729.36 9 .2 0.9 733.20 350 7.3 36.0 737.51 614 3.6 63.1 726.50
80 percent............. 632 2.5 487,490 771.35 6 .2 0.9 836.00 163 3.4 25.8 738.94 463 2.7 73.3 781.27
90 percent............. 168 .7 146,730 873.40 5 .1 3.0 756.60 16 .3 9.5 898.94 147 .9 87.5 873.62
100 percent.......... 2,334 9.2 2,657,604 1,138.65 383 10.5 16.4 1,065.25 1,165 24.3 49.9 1,098.70 786 4.6 33.7 1,157.89
WORLD WAR II
Total.......... 1,167,481 100.0 279,351,966 239.28 26,758 100.0 2.3 211.06 264,538 100.0 22.7 380.67 876,185 100.0 75.0 197.52
No disability....... 15,149 1.3 1,011,668 66.79 14,409 53.8 95.1 67.00 ............................ 740 0.1 4.9 62.52
10 percent......... 456,478 39.1 24,769,161 54.27 633 2.4 0.1 64.81 86,319 32.6 18.9 54.10 369,526 42.2 81.0 54.29
20 percent......... 171,776 14.7 17,059,268 99.32 370 1.4 0.2 99.71 13,657 5.2 8.0 99.14 157,749 18.0 91.8 99.33
30 percent......... 172,561 14.8 28,412,420 164.66 5,673 21.2 3.3 165.22 47,876 18.1 27.7 162.86 119,012 13.6 69.0 165.35
40 percent.......... 98,409 8.4 22,526,677 228.91 600 2.2 0.6 229.59 15,353 5.8 15.6 226.26 82,456 9.4 83.8 229.40
50 percent.......... 62,142 5.3 20,304,583 326.75 822 3.1 1.3 339.87 23,201 8.8 37.3 322.06 38,119 4.4 61.3 329.32
60 percent.......... 66,836 5.7 43,412,363 649.54 888 3.3 1.3 610.10 10,726 4.1 16.0 532.90 55,222 6.3 82.6 672.83
70 percent.......... 40,965 3.5 32,510,407 793.62 778 2.9 1.9 578.93 19,372 7.3 47.3 848.06 20,815 2.4 50.8 750.97
80 percent.......... 20,981 1.8 17,268,891 823.08 1,414 5.3 6.7 688.10 5,705 2.2 27.2 863.53 13,862 1.6 66.1 820.20
90 percent........... 6,810 .6 6,182,771 907.90 112 0.4 1.6 876.98 1,611 0.6 23.7 913.97 5,087 0.6 74.7 906.66
100 percent......... 55,374 4.7 65,893,757 1,189.98 1,059 4.0 1.9 1,120.28 40,718 15.4 73.5 1,163.92 13,597 1.6 24.6 1,277.41
205
KOREAN CONFLICT
T°ta*............. 233,820 100.0 66,121,922 282.79 9,971 100.0 4.3 125.54 42,784 100.0 18.3 582.99 181,065 100.0 77.4 220.57
No disability........ 7,099 3.0 474,598 66.86 6,816 68.4 96.0 67.00 ............................ 283 0.2 4.0 63.35
10 percent.......... 81,593 34.9 4,449,319 54.53 243 2.4 0.3 66.19 8,902 20.8 10.9 54.17 72,448 40.0 80 54^54
20 percent.......... 35,938 15.4 3,575,803 99.50 78 0.8 0.2 99.00 1,868 4.4 5.2 99.48 33^992 18.8 94.6 99.51
percent............ 31,593 13.5 5,361,186 169.70 1,989 19.9 6.3 167.51 5,869 13.7 18.6 168.47 23 735 13 1 75 1 170 19
*°perCen*........... 19>647 84 4,661,948 237.29 209 2.1 1.1 229.22 2,233 5.2 11.4 236.23 17^05 9.5 87*6 23153
percen............. 11,421 4.9 3,862,823 338.23 225 2.3 2.0 334.56 3,546 8.3 31.0 333.99 7 650 4 2 67 0 340 30
60 percent.......... 14,145 6.0 9,334,407 659.91 164 1.6 1.2 584.39 2,188 5.1 15.5 568.71 11J93 6^5 83^4 677.88
70 percent........... 8,512 3.6 6,667.201 783.27 68 0.7 0.8 619.45 3,050 7.1 35.8 766.12 5 394 3.0 63.4 795.04
Percent............. 4,519 1.9 3,958,801 876.04 64 0.6 1.4 778.66 1,214 2.8 26.9 895.02 3 241 1.8 71 7 870 85
90 percent............ 1654 .7 1,535,572 928.40 5 0.1 0.3 1,014.40 465 1.1 28.1 951.24 1 184 0^7 716 919.07
100 percent......... 17,699 7.8 22,240,264 1,256.59 110 1.1 0.6 1,109.09 13,449 31.4 76.0 1,224.18 4J40 2.3 23.4 1,367.97
VIETNAM ERA
Total............. 568,234 100.0 144,068,380 253.54 1,973 100.0 .3 232.80 99,391 100.0 17.5 492.52 466,870 100.0 82.2 209.23
No disability.......... 849 .1 55,523 65.40 570 28.9 67.1 67.00 ............................ 279 0.1 32.9 62.13
10 percent........... 225,157 39.6 12,242,540 54.38 431 21.8 0.2 54.57 22,740 22.9 10.1 54.10 201,986 43^3 89*7 54^41
20 percent.......... 98,030 17.3 9,744,174 99.40 64 3.2 0.1 99.00 5,849 5.9 6.0 99.21 92,117 19.7 94.0 99.42
30 percent.......... 72,886 12.8 12,746,037 174.88 492 24.9 0.7 170.80 14,112 14.2 19.4 171.93 58,282 12.5 80.0 175.63
40 percent.......... 47,385 8.3 11,542,873 243.60 99 5.0 0.2 235.69 5,855 5.9 12.4 241.85 41431 8.9 87.4 243^87
50 percent.......... 28,104 5.0 9,616,969 342.20 39 2.0 0.1 335.80 10,210 10.3 36.3 333.61 17^855 3.8 63.5 347.12
60 percent.......... 26,906 4.7 16,192,294 601.81 55 2.8 0.2 615.66 4,660 4.7 17.3 556.80 22,191 4.8 82.5 611.23
70 percent.......... 18,776 3.3 13,662,933 727.68 16 0.8 0.1 725.50 7,600 7.6 40.5 670.83 11,160 2.4 59.4 766.40
80 percent........... 9,488 1.7 8,274,604 872.12 12 0.6 0.1 958.09 2,682 2.7 28.3 877.50 6J94 1.5 716 869^84
90 percent........... 4,314 .8 4,133,010 958.05 1 0.1 0.0 690.00 1,369 1.4 31.7 988.97 2^944 0.6 68.2 943 76
100 percent......... 36,339 6.4 45,857,423 1,261.94 194 9.8 0.5 1,098.70 24,314 24.5 66.9 1,171.87 11831 2.5 32.6 1,451.79
REGULAR
ESTABLISHMENT Total............. 284,112 100.0 74,129,086 260.92 4,883 100.0 1.7 185.09 54,621 100.0 19.2 529.75 224,608 100.0 79.1 197.23
No disability..... 3 216 1.1 214,167 66.60 2,904 59.5 90.3 67.01 ............................ 312 0.1 9.7 62 74
10 percent......... 119,246 42.0 6,499,703 54.51 166 3.4 0.1 60.96 12,520 22.9 10.5 54.20 106,560 47^4 89^4 54^54
20 percent............ 45,589 16.0 4,536,922 99.52 101 2.1 0.2 100.03 2,576 4.7 5.7 99.28 42^912 19.1 94.1 99 54
30 percent............ 37,239 13.1 6,441,753 172.99 1,032 21.1 2.8 168.71 8,575 15.7 23.0 166.99 27 632 12 3 742 17501
*°perCen*........... 19'031 67 4,617,419 242.63 84 1.7 0.4 232.87 2,392 4.4 12.6 236.80 16^555 7.4 87.0 243.52
percen............. 11,350 4.0 3,793,532 334.24 77 1.6 0.7 338.67 5,611 10.3 49.4 325.04 5,662 2.5 49 9 343 28
60 percent............ 13,623 4.8 9,569,737 702.47 107 2.2 0.8 664.03 1,785 3.3 13.1 610.04 11,731 5 2 86 1 716 89
/U percent............. 7 202 2.5 5,468,652 759.33 43 0.9 0.6 634.61 3,528 6.5 49.0 694.90 3,631 1.6 50.4 823.41
percent.............. 3 278 1.2 2,955,463 901.61 72 1.5 2.2 689.03 1,006 1.8 30.7 908.63 2^200 1.0 67.1 905.36
90 percent............. 1 140 .4 1,111,683 975.16 1 0.0 0.1 707.00 340 0.6 29.8 996.74 799 0.4 70.1 966 32
100 percent........... 23,198 8.2 28,920,055 1,246.67 296 6.1 1.3 1,083.07 16,288 29.8 70.2 1,190.18 6,614 2.9 28.5 1,394.43
SPANISH-
AMERICAN WAR Total.................... 1 1000 1<078 1078.00 ..... ....... ...... .............. ....... ....... ...... 1 100.0 100.0 1,078.00
No disability.....
10 percent........
20 percent........
30 percent........
40 percent........................................................ • • • ■ ........... ....... ...... ....... ........ ....... ...... ..........
50 percent........ ....................................................................... ...... ....... ....... ........ ....... ...... .......
60 percent........ . .... .............. ...... ....... ....... ........ ....... ...... .......
70 percent........
206
COMPENSATION TABLE 65 -Continued
Disability, Degree of Impairment, Type of Major Disability, Period of Service—Sept. 1981 —Continued
Total Tuberculosis (Lungs and Pleura) Psychiatric and Neurological Diseases General Medical and Surgical Conditions
_ Percent _ Percent
Percent , T . Percent , T „ . Percent
_ , of Total . of Total
_ . , . Percent of . „ . ■ of . „ . of .
Degree of Impairment n .. .. Average , _ _ Average Psychi- Average General Average
.. ■_ Percent Monthly .. x,. .. , of Total Degree .. i.. ... . Degree .. _k,1 .. . .. .. . Degree .. .
Number , ... Monthly Number T . ,, Monthly Number atric and Monthly Number Medical Monthly
of Total Value ,, , Tuber- of Im- , .. of Im- ... .„ of Im- .. .
Value . . . Value Neuro- Value and Sur- Value
culosis pair- . . pair- . „ pair-
logical gical Con-
tinent _.. ment ment
Diseases ditions
80 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
90 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
100 percent............... 1 100.0 1,078 1,078.00 .... .............................. ....................... 1 100.0 100.0 1,078.00
MEXICAN BORDER
SERVICE Total................... 5 100.0 422 84.40 ............................. 1 100.0 20.0 206.00 4 100.0 80.0 54.00
No disability..... ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
10 percent................ 4 80.0 216 54.00 ........................................................... 4 100.0 100.0 54.00
20 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
30 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
40 percent................ 1 20.0 206 206.00 ..... ....................... 1 100.0 100.0 206.00 .............................
50 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
60 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
70 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
80 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ........ ...... .......
90 percent........ ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
100 percent....... ......... ....... ........ ............... ....... ....... .............. ....... ....... ....... ........ ....... ....... .......
TABLE 66
PENSION
Disability: Total, Period of Service, Type of Major Disability—Sept. 1981
Type of Pension and Disability Total World War World War II
Number Percent of Total Monthly Value Average Monthly Value Number Percent of Total Average Monthly Value Number Percent of Total Average Monthly Value
Total cases Type of disability Tuberculosis (lungs and pleura) Psychiatric and neurological diseases Psychoses Other psychiatric and neurological diseases . General medical and surgical conditions No disability shown Type of pension Old Law Sec 306 PL 95-588 874,783 10,340 197,644 52,616 145,028 551,844 114,955 29,721 504,600 340,462 100.0 1.2 22.6 6.0 16.6 63.1 13.1 3.4 57.7 38.9 198,756,732 2,855,744 54,777,309 13,578,022 41,199,287 123,664,693 17,458,986 2,478,215 72,591,595 123,686,922 227.21 276.18 277.15 258.06 284.08 224.09 151.88 83.38 143.86 363.29 140,919 1,043 15,970 1,463 14,507 111,703 12,203 25,043 76,391 39,485 100.0 .7 11.3 1.0 10.3 79.3 8.7 17.8 54.2 28.0 232.95 316.43 371.23 396.68 368.66 214.44 220.83 82.66 172.94 444.38 633,279 7,915 138,574 31,820 106,754 384,751 102,039 4,105 378,985 250,189 100.0 1.2 21.9 5.0 16.9 60.8 16.1 .7 59.8 39.5 216.55 263.53 264.51 250.66 268.63 218.44 143.25 87.14 137.31 338.69
Korean Conflict Vietnam Era Spanish-American War Mexican Border Service
Number Percent of Total Average Monthly Value Number Percent of Total Average Monthly Value Number Percent of Total Average Monthly Value Number Percent of Total Average Monthly Value
Total cases Type of disability Tuberculosis (lungs and pleura) Psychiatric and neurological diseases Psychoses Other psychiatric and neurological diseases . General medical and surgical conditions No disability shown Type of pension Old Law Sec 306 PL 95-588 82,938 1,299 32,299 12,920 19,379 48,835 505 526 41,794 40,618 100.0 1.6 38.9 15.6 23.4 58.9 .6 .6 50.4 49.0 279.59 315.30 275.37 245.78 295.10 282.85 209.90 86.02 147.22 418.30 17,411 83 10,773 6,411 4,362 6,517 38 tOO.O .5 61.9 36.8 25.1 37.4 .2 318.82 365.05 305.47 287.80 331.43 342.06 243.95 85 100.0 16.5 279.95 351.66 151 100.0 9.3 1.3 8.0 11.2 79.5 220.43 372.21 460.50 357.50 384.06 176.56
14 14 2 12 17 120
14 21 50 47 20 18 16.5 24.7 58.8 55.3 23.5 21.2 351.00 331.38 223.22 112.21 372,20 571.11
7,305 10,106 42.0 58.0 159.68 433.85 105 46 69.5 30.5 139.50 396.00
TABLE 67
PENSION
Death: Total, Class of Beneficiary, Period of Service—Sept. 1981
Class of Beneficiary Total World War I World War II Korean Conflict
Number Monthly Value Average Monthly Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total cases Surviving spouse alone Surviving spouse and children Children alone Total dependents Surviving spouses Children 1,026,228 783,352 76,933 165,943 1,218,029 860,288 357,741 114,396,026 90,110,979 12,252,298 12,032,749 111.47 115.03 159.26 72.51 434,320 417,756 6,777 9,787 442,490 424,531 17,959 99.63 99.78 166.04 63.10 471,151 334,292 46,915 89,944 568,210 381,210 187,000 121.33 130.76 155.86 69.55 81,914 18,244 15,350 48,320 138,315 33,594 104,721 115.05 175.47 165.70 76.40
Class of Beneficiary Vietnam Era Civil War Indian Wars Spanish-American War Mexican Border Service
Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value Number Average Monthly Value
Total cases Surviving spouse alone Surviving spouse and children Children alone Total dependents Surviving spouses Children 26,834 2,133 7,793 16,908 56,859 9,928 46,931 113.62 190.14 160.57 82.56 158 47 111 159 47 112 88.97 126.53 73.21 38 29 9 38 29 9 96.16 103.38 73.11 11,326 10,377 90 859 11,461 10,467 994 126.16 129.88 211.58 73.07 487 474 8 5 497 482 15 88.37 88.20 137.50 61.00
207
EDUCATIONAL ASSISTANCE
TABLE 68
Persons in Training During Fiscal Year by Program and Period of Service
Fiscal Year
Program 1981 1980 1979 1978 1977
POST-KOREAN EDUCATIONAL ASSISTANCE PROGRAM
In training during year — Total 948,526 1,106,889 1,278,538 1,521,840 1,937,874
Institutions of higher learning 736,018 842,088 967,790 1,144,075 1,380,025
Resident schools other than college 122,448 148,551 175,098 211,241 313,646
Correspondence schools 34,849 42,102 51,383 72,945 131,811
On-job training 55,211 74,148 84,267 93,579 112,392
CHILDREN'S EDUCATIONAL ASSISTANCE PROGRAM
In training during year — Total 82,646 82,632 85,696 88,299 88,158
Institutions of higher learning 74,619 75,530 77,915 80,402 80,257
Schools other than college 7,541 6,538 7,180 7,291 7,363
Special restorative training 70 61 73 94 82
On-job training 416 503 528 512 456
Period of service of beneficiary's parent
World War 1 959 1,129 1,108 1,099 1,225
World War II 22,462 25,246 28,899 31,756 33,228
Korean conflict 12,332 12,759 13,519 13,848 13,676
Vietnam era 37,552 33,451 31,225 29,507 27,437
Other 9,341 10,047 10,945 12,089 12,592
EDUCATIONAL ASSISTANCE FOR SPOUSES OF
TOTALLY DISABLED OR DECEASED VETERANS
In training during year — Total 11,940 12,952 17,260 19,394 19,470
Institutions of higher learning 10,078 10,752 13,977 15,548 15,461
Schools other than college 1,837 2,162 3,239 3,801 3,964
Special restorative training 2 2 6
On-job training 25 38 42 43 39
Period of service of beneficiary's spouse
World War 1 90 111 183 205 227
World War II 1,690 2,088 3,553 4,300 4,285
Korean conflict 1,029 1,232 1,854 2,250 2,314
Vietnam era 7,943 8,303 9,758 10,184 9,995
Other 1,188 1,218 1,912 2,455 2,649
VOCATIONAL REHABILITATION PROGRAM
FOR DISABLED VETERANS
In training during year — Total 29,818 25,543 29,470 31,018 33,231
Institutions of higher learning 21,730 18,854 21,672 23,145 24,728
Schools other than college 6,717 5,371 6,195 6,233 6,703
On-job training 998 943 1,116 1,160 1,038
Institutional on-farm 106 119 149 173 199
Unknown 267 256 338 307 563
Period of service of veterans
World War II 295 350 395 353 90
Korean conflict 356 376 440 456 308
Vietnam era 27,357 23,073 26,870 28,809 31,601
Post-Korean and between wars 1,810 1,744 1,765 1,400 1,232
208
TABLE 69
HOUSING ASSISTANCE
Guaranteed or Insured Loans, Direct Loans, Property Management
Item Cumulative Through Sept. 30, 1981 Fiscal Year 1981 Fiscal Year 1980
Guaranteed or Insured Loans
Number of loans, total 10,846,689 187,628 297,447
Home 10,794,906 178,239 289,164
Mobile home 51,783 9,389 8,283
Amount of loans ($000), total $195,622,594 $10,008,945 $14,815,266
Home $194 RfiO 6Q9 $9 891 789 $14 RR2 112
Mobile home $752^985 $187,156 $162,154
Amount of guaranty and insurance ($000), total $94,293,571 $4,248,382 $6,370,076
Home $93 954 870 102
Mobile home $338 701 $93 280
Defaults and claims total:
Defaults reported 3,129,848 146,455 138,323
Loans in default-end of period 67 089 60 080
Defaults disposed of, total 3,062,759 139^446 126784
Cured or withdrawn 2,639,452 126,800 115,349
Percent 86.2
Claims vouchered for payment 423,307 12,646 11,035
Rate per 1000 loans outstanding 3.08 2 71
Average number of loans outstanding . . . 4,104,535 4,072,456
Direct Loans
Number of loans fully disbursed 333,137 140 1,160
Amount of loans fully disbursed ($000) $3,435,860 $3,616 30,828
Property Management
Number acquired 459,292 13,436 11,606
Number sold 442 167 10 731 11 822
Number redeemed 6 583 210 210
Number on hand-end of period 11,515 9,023
TABLE 70
INSURANCE
VA Administered Insurance Programs Assets and Liabilities - Fiscal Year 1981
United States Government Life Insurance Fund National Service Life Insurance Fund Veterans Special Life Insurance Fund Service-Disabled Veterans Insurance Fund Veterans Reopened Insurance Fund
ASSETS
U.S. Treasury securities $388,265 $8,206,726 $709,699 $ $468,415
Policy loans ; 42,255 1,219,714 78,982 32,810 45,081
Liens and receivables 28 407 47 553 36
Cash 1,061 9,215 652 3,554 855
Accrued interest 8,055 197,410 14,788 766 11,056
Due from U.S. Government 20
Total $439,664 $9,633,492 $804,168 $37,683 $525,443
LIABILITIES
Policy reserves $296,738 $6,968,153 $584,725 $189,032 $430,114
Reserve for payments under optional income settlements 78,270 797,266 7,414 6,313 2,899
Disability premium waiver reserves 380 445 029 77 656 15 819
Disability income reserves 3,208 279,545 34^601 13 210
Reserve for pending and unreported claims 6,587 70,443 4,340 4,394 2,845
Reserve for dividends 22,264 568,260 35,129 15 966
Reserve for undelivered checks and payments due 579 6,861 94 15 ' 31
Reserve for dividends left on credit or deposit . 20,862 350,014 23,602 4 328
Reserve for unearned premiums 1,299 80,543 16,280 1,214 2>57
Unassigned funds (surplus) 9,477 67,378 20,327 -163,285* 37,474
Total $439,664 $9,633,492 $804,168 $37,683 $525,443
""Total loss to date is $244,472 of which $81,187 has been met by Government appropriation.
209
INSURANCE
TABLE 71
Summary of Operations (Accrual Basis) (In thousands)
U.S. Government Life Insurance National Service Life Insurance Veterans Special Life Insurance Service-Disabled Veterans Insurance Veterans Reopened Insurance
Fiscal Year 1981 Cumulative Totals From Origin January 1919 to September 30, 1981 Fiscal Year 1981 Cumulative Totals From Origin October 1940 to September 30, 1981 Fiscal Year 1981 Cumulative Totals From Origin April 1951 to September 30, 1981 Fiscal Year 1981 Cumulative Totals From Origin April 1951 to September 30, 1981 Fiscal Year 1981 Cumulative Totals From Origin May 1965 to September 30, 1981
INCOME
Premiums $3,884 $2,082,163 $656,207 $21,032,449 $64,721 $976,791 $28,634 $324,946 $23,912 $500,387
Policy proceeds left to be paid in installments 1,695 781,420 24,316 5,405,533 972 39,369 714 25,328 644 13,857
Dividends left on credit or deposit 3,650 79,092 67,064 1,447,257 7,892 32,699 2,706 5,516
Investment income 31,655 2,166,758 708,069 10,131,235 52,412 398,748 1,432 11,558 40 J 37 297,721
Extra Hazard contributions from the
U.S. Government 21 142,370 1 992 4 813 554
Total 40,905 5,251,803 1,457,648 42,830,028 125,997 1,447,607 30,780 361,832 67,399 817,481
DISPOSITION OF INCOME
Death benefits 32,510 1,500,502 354,533 10,278,592 20,539 285,051 19,072 272,041 15,279 164,654
Matured Endowments 492 498,148 53,065 730,402 1,133 19,842 386 2,893 7,634 27,317
Surrender benefits 2,591 321,122 56,201 896,270 5,512 50,734 3,621 23,313 2,550 19,827
Disability benefits 614 386,927 65,774 862,169 3,108 23,761 8,572 89,884 3,233 23,139
Payments from policy proceeds left to be
paid in installments 13,044 1,044,505 100,910 7,703,098 1,614 36,062 904 22,719 812 12,470
Dividends withdrawn 5,196 77,478 76,735 1,362,765 4,346 13 041 1 002 1,519
Net deposits for policy reserves -36,118 379,259 151,799 8,501,414 46,977 704^557 13,825 195,454 20 J 67 462^088
Reserve for dividends left on credit or deposit -208 20,862 13,750 350,014 4,885 23,602 1 948 4 328
Administrative costs 1,069 19,474
Total 18,121 4,228,803 872,767 30,684,724 88,114 1,156,650 46,380 606,304 53,694 734,816
Net gain or loss (—) from operations before
dividends and transfers 22,784 1,023,000 584,881 12,145,304 37,883 290,957 -15,600 -244,472 13,705 82,665
Dividends to policyholders 21,646 1,013,523 581,631 12,077,926 35,564 215,017 15,735 45,191
Transfers to U.S. Government 55,613
Gain or loss (—) after dividends and transfers 1,138 9,477 3,250 67,378 2,319 20>27 -15,600 -244,472 -2,030 37,474
INSURANCE
In Force — Fiscal Year 1981
TABLE 72
Item Participating Nonparticipating
U.S. Government Life Insurance National Service Life Insurance Veterans Special Life Insurance Veterans Reopened Insurance Service-Disabled Veterans Insurance
Number of Policies Amount of Insurance (000 Omitted) Number of Policies Amount of Insurance (000 Omitted' Number of Policies Amount of Insurance (000 Omitted) Number of Policies Amount of Insurance (000 Omitted) Number of Policies Amount of Insurance (000 Omitted)
In force at beginning of year 99,446 $404,926 3,575,341 $23,231,484 532,989 $4,640,705 167,326 1,157,421 189,150 $1,711,415
Insurance issued during year 8 065 75,317
Insurance reinstated during year 1 10 11,222 47,055 330 2,871 1,142 4,135 67 628
Insurance terminated during year by:
Death 7,134 31,943 53,696 327,838 2,304 19,669 2,283 14,801 2,071 18,468
Maturity as endowment 96 491 8,721 48,623 201 1,095 1,240 7,658 77 383
Permanent total disability 10 53
Lapse, expiry, and net changes .... 170 811 33,274 327,801 6,554 62,860 377 7,709 2,939 28,230
Cash surrender 676 2,854 14,015 79,427 1,356 10,919 533 3,805 1,413 12,263
Total terminated 8,086 36,152 109,706 783,689 10,415 94,543 4,433 33,973 6,500 59,344
In force at end of year 91,361 368,784 3,476,857 22,494,850 522,904 4,549,033 164,035 1,127,583 190,782 1,728,016
Selected year end items:
In force on 5 year term plan 476 3 062 1,114,777 8 736,494 287 764 2 645,780 87,828 844,581
In force on all other plans 90,885 365J22 2,362,080 13,758,356 235,140 1,903,253 164,035 1,127,583 102,954 883,435
In force with disability income rider. . . 2,422 17,629 434,784 3,299,228 87,574 793,315 10,669 79,727
In force under disability
premium waiver 193 1,170 157,645 1,085,146 8,084 69,322 15,046 101,320 41,281 388,404
210
TABLE 73
INSURANCE!
Servicemen’s and Veterans’ Group Life Insurance Statement of Operations (Accrual Basis)
Policy Year Ending June 30, 1981
Cumulative From Sept. 29, 1965
INCOME
Premiums...................................
Extra hazard payments .....................
Interest earned............................
Total................................
DISPOSITION OF INCOME
Death claims...............................
Net cost of extra mortality on conversions . . . Expense of administration..................
Taxes and fees.............................
Term to age 60 reserve (Retired Reserves) .... 5-Year Term and conversion cost reserve (VGLI) Contingency reserve........................
Total................................
$131,510,807 769 21,460,314 $152,971,890 $1,673,398,272 511,621,301 110,166,389 $2,295,185,962
$114,041,764 $1,919,283,435
3,370,737 51,972,685
7,255,861 44,431,862
2,577,230 36,356,062
-499,108 18,271,442
-3,113,423 32,232,994
29,338,829 192,637,482
$152,971,890 $2,295,185,962
TABLE 74
EMPLOYMENT
Employment: Full, Part-Time and Intermittent by Installation
Installation Sept. 30, 1981 Sept. 30, 1980
Total 232,417 228,285
Central Office 4,474 4,300
Field 227,943 223,985
Medical centers (separate) 182,328 178,961
Domiciliaries and medical centers 17,565 16,934
Regional offices (separate) 13,492 13,742
Regional office and medical centers 7,659 7,612
Regional office and insurance centers 1,838 1,723
Independent outpatient clinics 1,516 1,428
Data processing centers 1,699 1,695
National cemeteries 874 857
Supply depots and marketing center 450 483
Miscellaneous activities (VCS field offices, prosthetic center, national cemetery area offices, IG field audit offices) 522 550
TABLE 75
EMPLOYMENT
Employment: Full, Part-Time and Intermittent by Pay System
Pay System Sept. 30, 1981 Sept. 30, 1980
Total 232 417 92ft 9ftR
GS 1 fion 121 122
IJ 1, I JO
Title 38 (excludes Canteen) 54 237 A9 7ftA
Wage system 2Q 2RA J4,/Ov 2ft 7AR
Canteen 3 629 jO,/Uj
Nationals (Manila) 211 209
Senior executive service 96 252
Others (includes stay-in-school) 1,388 1,490
211
EMPLOYMENT
TABLE 76
Employment: Sex and Veteran Preference - September 30, 1981
Total All Employees Male Employees Female Employees
Number Percent Number Percent Number Percent
232,417 100.0 110,338 100.0 122,079 100.0
With Preference 84,554 36.4 75,030 68.0 9,524 7.8
Without Preference 147,863 63.6 35,308 32.0 112,555 92.2
EMPLOYMENT
Employment: Minority Groups By Grade - September 30, 1981
TABLE 77
Grade or Supervisory Level Total Employment (Full-time) Percent Minority Employment Black Hispanic American Indian or Alaskan Native Asian or Pacific Islander Oriental
Total All Pay Plans 199,189 31.8% 51,691 6,623 726 4,391
GS and Equivalent 161,592 28.7% 36,800 4,824 581 4,103
GS-1 thru GS-4 40,161 39.2% 13,781 1,440 202 334
GS-5 thru GS-8 56,267 33.2% 16,085 1,701 212 699
GS-9 thru GS-11 43,983 19.8% 5,731 1,147 120 1,740
GS 12 thru GS-13 11,862 11.5% 936 193 30 202
GS-14 thru GS-15 9,145 19.1% 258 340 17 1,127
GS 16 thru GS-18 174 7.5% 9 3 1
Other Pay Systems2 450 16.2% 26 18 4 25
Wage Administration 37,147 45.9% 14,865 1,781 141 263
Non-Supervisory 30,958 47.2% 12,737 1,522 118 231
Leader 746 49.0% 322 36 2 3
Supervisory 3,493 43.4% 1,371 125 8 11
Production Facilitating 116 4.3% 1 4 0 0
Other Wage Systems 1,834 30.5% 434 94 13 18
1 Excludes Nationals (Manila), San Juan and Hawaii employees.
2Includes Senior Executive Service and Statutory Pay Plans.
EMPLOYMENT
TABLE 78
Employment of Women — Full-time, Part-time and Intermittent
Type of Employment Total Employment Women
Number Percent
Total 232,417 122,079 52.5
GS Total 133,600 75,828 56.8
GS-1 thru GS-6 87,091 58,429 67.1
GS-7 thru GS-12 40,283 16,612 41.2
GS-13 and above 6,226 787 12.6
Title 38 54,237 32,373 59.7
Wage Systems 39,256 10,257 26.1
Canteen 3,629 2,726 75.1
Foreign Nationals 211 102 48.3
Other 1,484 793 53.4
212
TABLE 79
Appropriations, Expenditures and Balances —Cash Basis
FISCAL
Appropriations Expenditures Nonexpenditure Transfers (—) Covered into U.S. Treasury (+) or restored Investments Cash Balances
Fiscal Year 1981 Cumulative through $eptember 30, 1981
General and Special Funds:
Compensation and pensions Readjustment benefits Veterans insurance and indemnities Medical care, current year Medical care, 1954—80 Medical and prosthetic research, current year . . $176,250,091,000 61,942,330,904 367,311,036 6,339,396,000 56,438,513,226 1,450,476,131 $12,389,002,348 2,332,120,515 8,713,666 5,779,424,708 540,662,898 135,287,542 $175,188,504,148 61,728,125,155 416,609,771 5,779,424,708 55,692,968,125 1,425,985,704 $ 16,969 71,709,000 49,746,500 $ -12,047,510 -684,256,339 -1,189,948 $ $1,061,603,823 142,496,750 447,766 547,923,782 61,288,761 23,300,475
Assistance for health manpower training
institutions, 1973—85 Medical administration and miscellaneous 296,693,000 47,175,058 235,410,171 -3,975 61,278,852
operating expenses, current year Medical administration and miscellaneous 52,809,000 44,239,865 44,239,865 -1,778,340 6,790,795
operating expenses, 1954—80 General operating expenses, current year General operating expenses, 1954—80 Construction of hospital and domiciliary 716,222,481 643,251,000 7,600,115,650 5,221,596 589,793,288 34,339,818 681,505,022 589,793,288 7,478,109,239 -33,443,725 -18,290,059 -113,422,448 1,273,733 35,167,654 8,583,964
facilities Construction, major projects 1,042,596,863 2,506,623,000 307,557,510 1,032,915,863 1,271,277,282 * 9,681,000 7,734,760 1,243,080,478
Construction, minor projects Construction, minor porjects (Corps of 726,339,000 95,772,910 562,041,047 2,019,442 166,317,397
Engineers) Grants for construction of state extended 2,126,796 2,126,796
care facilities, 1966-83 Grants to the Republic of the Philippines .... Grants to the Republic of the Philippines, 117,200,000 863,000 9,002,259 8,907 85,255,671 721,675 -1,699,092 30,245,236 141,326
current year Grants to the Republic of the Philippines, 1,150,000 1,002,503 1,002,503 -11,614 135,883
1950-1980 Grants for the construction of state veterans 50,820,537 191,072 37,541,246 -13,277,330 1,961
cemeteries 1980—1983 Loan guaranty revolving fund Direct loan revolving fund Canteen service revolving fund 10,000,000 32,420,742 1,733,055,599 4,965,000 674,057 277,820,229 *124,273,895 *1,632,293 908,532 1,117,773,475 *850,357,353 *26,697,958 1,335,819,119 *2,211,464,207 -12,068,086 9,091,468 250,466,384 371,948,746 19,594,872
Rental, maintenance and repair of quarters . . . Service-disabled veterans insurance fund Soldiers' and sailors’ civil relief Veterans reopened insurance fund Special therapeutic and rehabilitation 4,500,000 3,528,000 *484,754 *13,778,107 *97,127 617,232 2,011,031 *469,432,079 *16,969 -97,127 -1,500,000 468,415,000 3,882,768 1,017,079
activities fund Vocational rehabilitation revolving fund Education Loan fund Servicemen's group life insurance fund Supply fund Construction and operation of garage and 3,447,000 130,000,000 *47,780 *37,076 987,475 118,474 *840,794 *639,622 445,782 65,657,757 *27,468 7,097,565 71,709,000 *71,400 -1,600,000 -15,677,579 639,622 1,401,217 6,051,244 27,468 107,153,457
parking facilities *134,170 *256,349 256,349
Consolidated working fund Total: Appropriations and funds $318,464,718,169 86 $22,453,887,915 216 $312,100,560,913 $*823,769,990 $-910,363,172 $468,415,000 *216 $4,161,609,094
Deduct proprietary receipts from the public . . Total: Federal funds $318,464,718,169 2,941,205 $22,450,946,710 $312,100,560,913 $*823,769,990 $-910,363,172 $468,415,000 $4,161,609,094
Trust Funds:
Post-Vietnam era veterans education General post fund, national homes National service life insurance fund 359,554,045 97,600,459 32,984,375,109 62,777,045 6,886,676 965,147,419 109,418,013 85,760,343 24,762,316,759 -386 -89 3,666,000 8,206,726,000 250,136,033 8,173,730 15,332,261
U.S. government life insurance fund Veterans special life insurance fund 3,965,564,225 250,000 70,047,808 *44,193,858 3,574,020,981 *765,790,758 *51,150,000 -1,811,199 -4,250,000 388,265,000 709,699,000 1,467,044 941,758
Sub-Total: Trust funds 37,407,343,838 1,060,665,090 27,765,725,338 *51,150,000 -6,061,674 9,308,356,000 276,050,826
Deduct: Proprietary receipts from the public . . Total: Trust funds Deduct: Intragovernmental transactions Total: Veterans Administration 37,407,343,838 355,872,062,007 600,966,501 459,698,589 2,045,107 22,908,600,192 27,765,725,338 339,866,286,251 *51,150,000 *874,919,990 -6,061,674 -916,424,846 9,308,356,000 9,776,771,000 276,050,826 4,437,659,920
Appropriations and funds not included above:
Personal funds of patients Funds due incompetent beneficiaries Miscellaneous administrative and construction *787,323 10,801 *60,867,684 *29,095 60,867,684 29,095
expenses Miscellaneous benefit and insurance expenses. . Miscellaneous trust funds Miscellaneous transfer appropriations and 10,855,083,789 25,110,301,012 4,700,842,392 10,476,102,823 24,621,740,653 4,658,621,658 -378,980,966 -488,560,359 -42,220,735
working funds Total: Other appropriations and funds . . 38,634,996 40,704,862,190 *973,300 31,269,691 39,726,838,046 -7,365,305 -917,127,365 60,896,779
*Indicates Credit.
FISCAL
TABLE 80
Veterans Administration Comparative Consolidated Balance Sheet1
ASSETS September 30, 1981 September 30, 1980 I ncrease (Decrease)
Current assets:
Cash and disbursing authority2 $4,521,757,613.05 $4,603,217,395.79
Accounts receivable 613,589,489.80 554,437,324.18
Interest receivable 238,728,441.15 221,089,620.13
Advance for bidding at public sales 269,025.90 269,794.78
Inventories 169,727,685.98 140,851,788.23
Acquired security or collateral property 353,774,636.83 234,449,071.08
Accrued reimbursements due from insurance appropriations 20,000.00 1,942.00
Total current assets 5,897,866,892.71 5,754,316,936.19 $143,549,956.52
Other assets:
Loan receivable 1,921,264,498.01 1,873,913,168.02
Vendee accounts receivable 1,409,407,809.36 1,240,062,377.23
Investments 9,776,771,000.00 9,612,263,000.00
Policy liens 844,006.81 761,481.40
Deposits with trustee 29,430,786.04 71,170,474.34
Total other assets 13,137,718,100.22 12,798,170,500.99 339,547,599.23
Fixed assets:
Land, buildings and plants 3,197,791,845.35 2,957,157,994.26
Construction and betterments in process 1,154,281,337.06 929,153,548.71
Leasehold improvements 4,048,919.25 2,909,721.85
Equipment 1,492,135,015.98 1,408,960,562.08
Total fixed assets 5,848,257,117.64 5,298,181,826.90 550,075,290.74
Deferred charges:
Construction advance 32,978,512.17 18,805,893.65
Advance payments on undelivered supplies and services 38,510,941.30 37,089,699.24
Advance to employees for travel expenses 2,513,403.21 1,818,588.21
Value of ADP equipment purchases options 3,290,119.96 3,290,119.96
Advance for educational benefits 17,375,741.26 16,089,594.82
Total deferred charges 94,668,717.90 77,093,895.88 17,574,822.02
Total assets 24,978,510,828.47 23,927,763,159.96 1,050,747,668.51
LIABILITIES AND CAPITAL Current liabilities:
Accounts payable 1,355,586,542.32 1,159,724,007.92
Accrued salaries and wages 154,743,436.64 173,007,620.96
Accrued services and benefits 236,242,776.40 251,526,482.10
Undelivered orders - personal funds of patients 107,534.44 162,449.63
Employees payroll allotments for U.S. Savings Bonds 897,522.00 979,290.83
Federal, state, city and territorial income taxes withheld and FICA taxes 13,549,084.22 12,872,613.81
Canteen Service unredeemed coupons 104,181.30 256,814.76
Other miscellaneous liabilities - Canteen Service
Accrued interest - U.S. Treasury 1,381,224.71 2,112,005.51
Accrued interest on policy liens due general fund 47,224.85 65,068.50
Accrued interest on dividend deposits 13,416,682,.84 12,316,720.28
Premiums paid in advance 101,399,000.00 92,073,500.00
Matured contracts payable 44,630,544.05 43,011,780.85
Undeposited general fund receipts Accrued reimbursement due insurance fund 1,415.214.11 20,000.00 1,051,011.50
Total current liabilities 1,923,540,987.88 1,749,195,366.65 174,345,621.23
Other liabilities:
Participation certificates outstanding, net 248,737,609.30 330,850,903.01
Insurance program operating reserves 10,915,988,354.00 10,642,914,824.00
Total other liabilities 11,164,725,963.30 10,973,765,727.01 190,960,236.29
Unfunded liabilities:
Accrued annual leave 578,424,183.74 412,125,201.57
Unredeemed coupons 267,476.41 267,476.41
Total unfunded liabilities 578,691,660.15 412,392,677.98 166,298,982.17
Total liabilities 13,666,958,611.33 13,135,353,771.64 531,604,839.69
Accountabilities:
Funds of patients and incompetent beneficiaries 59,278,601.20 58,793,433.76
Policyholders insurance dividend deposit 381,217,723.34 363,817,855.86
Borrowers deposits for taxes and insurance 53,787,456.92 52,447,815.94
Unapplied insurance collections 2,784,861.30 2,702,860.76
Bid deposits and other suspense items 5,299,832.82 4,665,600.65
Total accountabilities 502,368,475.58 482,427,566.97 19,940,908.61
Capital reserves:
Insurance fund retained earnings (reserve for contingencies) -30,693,462.37 6,735,262.89
Direct loan and loan guaranty programs ■ reserve for losses 810,281,164.02 757,936,508.36
Total reserves 779,587,701.65 764,671,771.25 14,915,930.40
Capital borrowings from U.S. Treasury - interest bearing - direct loan program 1,730,077,996.00 1,730,077,996.00
Capital residual 8,299,518,043.91 7,815,232,054.10 484,285,989.81
Total liabilities and capital $24,978,510,828.47 23,927,763,159.96 1,050,747,668.51
1 Contingent liabilities with respect to the guaranty or insurance of loans not shown.
2 Cash and disbursing authority for annual appropriations reduced by the unobligated balance returned to the Treasury in accordance with Section 18, Title 7, GAO Policy and Procedures Manual.
214
TABLE 81
FISCAL
VA Supply Fund Comparative Balance Sheet
ASSETS September 30, 1981 September 30, 1980 Increase (Decrease)
Cash $107,153,456.91 $106,312,662.90
Advance payments on undelivered orders 82,651.39 127,979.03
Advances to employees 26,662.73 19,404.40
Accounts receivable 18,622,341.33 23,269,466.94
Inventories 109,112,756.33 99 052 210.70
Work in process — Service & Reclamation division 172,306.34 110 945.09
Work in process — Printing & Reproduction 38,590.24 25 735.44
Supply Depot operating equipment fess reserve for depreciation 1,020,624.53 964,622.04
Printing & Reproduction equipment less reserve for depreciation 724,624.80 547,695.03
Marketing center equipment less reserve for depreciation 67,853.01 68,100.72
Total Assets $237,021,867,61 $230,498,823,19 $6,523,044.42
LIABILITIES AND CAPITAL
Accrued salaries and wages 509,961.93 489,050.51
Accrued transportation and service costs 306^829.11 732,386.76
Accounts payable 36,457,582.07 41,273,361.03
Advances from other government agencies 147,419.32 202’946.21
Total Liabilities $35,849,363,56 $42,697,744,51 $(6,848,380.95)
Capital at beginning of period 172,998,878.12 172,998,878.12
Property acquired without cost to VA
Adjusted capital $172,998,878.12 $172,998,878.12
Operating profit or loss — Current fiscal year 14,802,200.56 15,146,795.26
Operating profit or loss - Prior fiscal year 13,371,425.37 344,594.70*
Capital at end of period 201,172,504.05 $187,801,078.68 $13,371,425,37
Total Liabilities and Capital $237,021,867,61 $230,498,823.19 $6,523,044.42
•Denotes loss
215
216
FISCAL TABLE 82
VA Gross Expenditures1—Fiscal Years 1972—1981
Medical and Administrative Expenses ,. . , „ ....
____________________________________________________ ______________________________ Hospital and Construction Health National Fiscal Year Grand Total_________General Medical and Medical Domiciliary Grants for Manpower Cancer
Total Medical Care Operating Prosthetic Administration Construction State Training Institute
Expenses Research Expenses Costs Homes Facilities (transfer to VA)
1981 ..................... 525,203,253,183 $7,199,253,633 $6,378,209,474 $627,611,969 $142,385,166 $51,047,024 $399,733,392 $9,022,259 $46,958,172 .
1980 ...................... 23,186,845,618 6,646,752,559 5,857,450,290 605,216,938 137,038,522 47,046,809 286,094,889 14,223,186 41,416,112 .
1979 ...................... 22,178,870,841 6,205,941,745 5,408,251,895 625,740,917 125,577,137 46,371,796 240,304,876 14,190,947 38,321,902 .
1978 ...................... 20,937,106,741 5,683,811,346 4,948,297,375 575,213,971 117,563,185 42,736,815 245,081,811 5,031,278 38,143,438 .
1977 ...................... 20,284,739,028 5,072,993,821 4,402,752,024 522,061,364 108,745,374 39,435,059 224,546,309 3,670,801 33,875,869 .
T.Q. 9-30-76 ............... 4,524,304,469 1,195,770,956 1,033,503,297 123,644,945 27,373,991 11,248,723 49,196,439 2,064,709 3,749,462 .....
1976 ...................... 20,167,672,990 3,996,765,600 3,831,942,636 479,213,633 101,130,244 34,479,087 185,569,710 11,616,975 26,950,826 .
1975 ...................... 18,002,858,455 3,919,256,993 3,348,139,083 438,660,271 95,794,770 36,662,859 119,579,730 3,153,684 12,926,229 .
1974 ...................... 15,281,999,263 3,290,194,883 2,833,622,391 343,916,399 81,581,682 31,034,411 106,364,406 2,484,814 .............
1973 ...................... 13,973,824,241 2,966,237,960 2,545,676,531 317,104,838 78,412,475 25,044,116 92,635,174 2,448,163 ..............
1972 ...................... 12,723,327,251 2,650,982,373 2,269,185,623 290,516,258 68,958,723 22,321,769 107,335,950 2,553,288 .. $ 702
Compensation and Pension
Fiscal Year Compensation Statutory Clothin Mortgage and Interment Invalid Lifts, Headstones -j-ort q|
Total and Burial nr»t3 Group and Devices, and Markersand _ al*P Other5
Pensions Awards a S Insurance Plot Awards4 Polio Rentals3 Burial Flags3 e emen s
1981 ..................... $12,492,329,634 $12,225,973,619 $113,579,173 $18,417,970 $3,815,667 $60,408,283 $10,427,759 $18,850,432 $40,856,731
1980 ...................... 11,256,935,680 11,046,637,368 101,078,125 15,070,089 3,200,000 53,954,538 7,886,835 16,830,344 ... 12^278^381
1979 ...................... 10,540,134,325 10,324,258,064 94,218,175 13,763,407 4,260,424 50,436,396 12,306,114 15,243,853 .. 25,647,892
1978 ....................... 9,630,679,653 9,455,752,982 85,881,083 12,709,134 2,600,000 51,369,656 7,497,994 13,469,609 1,399,195
1977 ....................... 9,038,803,014 8,874,719,650 80,034,069 11,471,325 2,844,000 47,647,466 6,630,520 14,050,489 1,405,495
T.Q. 9-30-76 ............... 2,087,912,845 2,040,460,373 19,849,033 9,524,355 1,283,940 11,888,226 1,557,711 3,348,447 ....... 7602
1976 ....................... 8,242,088,546 8,074,488,426 130,505,883 10,623,546 3,740,397 ...... 6,361,164 13,079,492 ...... 3,289,638
1975 ....................... 7,551,176,877 7,385,070,190 130,590,145 8,794,394 1,600,000 ....... 5,304,048 13,007,763 ...... 6,810,337
1974 ....................... 6,734,790,004 6,615,598,931 101,607,099 740,193 2,200,000 ....... 3,929,569 2,644,410 $ 1,228 8,068,574
1973 ....................... 6,568,081,137 6,426,646,756 77,701,419 759,462 1,249,917 48,959,907 3,340,854 2,559,306 15,324 6,848,192
1972 ....................... 6,167,996,446 6,045,214,262 75,753,044 663,017 1,850,000 42,051,401 3,007,622 2,257,664 37,254 2,837,8182
Educational Assistance and Readjustment Benefits
Post-Korean Dependents Vocational Subsistence Automobiles, Housing Post-Vietnam Era
isca ear Total7 Veterans (Ch. 34) (Chapter 35) Rehabilitation Allowance etc., for for Changes in Veterans (Ch. 32)
Educational Educational (Ch. 31, Books, (Voc. Rehab. Disabled Paraplegic Receivables Educational
Assistance Assistance Supplies, etc.) Chapter 31 )6 Veterans Veterans Assistance
1981 ...................... $2,332,820,985 $1,968,295,623 $204,779,070 $37,213,213 $76,662,855 $11,909,278 $15,849,848 $13,960,530 $4,150,568
1980 ....................... 2,383,912,487 2,066,583,779 194,146,792 31,924,840 56,055,388 12,470,395 19,467,885 2,341,866 921,542
1979 ....................... 2,800,897,985 2,449,924,173 204,061,042 32,333,777 64,071,095 12,457,080 22,607,775 15,212,423 230,620
1978 ....................... 3,336,618,918 3,026,928,408 216,981,694 32,767,736 67,285,440 13,757,956 14,299,168 35,409,3872 ........
1977 ....................... 3,891,448,932 3,567,244,475 202,161,088 32,679,339 68,016,591 13,306,986 14,254,830 6 214.3772 ........
T.Q. 9-30-76 ................. 738,178,540 667,905,838 28,229,888 6,800,966 13,454,828 3,446,095 3,351,014 14,989,911 ...............
1976 ....................... 5,543,354,200 5,028,843,708 185,582,673 27,502,222 58,077,759 19,073,015 14,553,425 209,721,398 ........
1975 ....................... 4,529,227,472 4,164,774,846 163,277,716 22,500,293 50,565,594 17,251,021 14,322,011 96,535,991 ........
1974 ....................... 3,268,556,875 3,005,746,476 115,546,256 22,593,495 45,151,941 5,005,085 11,254,178 63,259,444 ........
1973 ....................... 2,696,239,516 2,513,214,849 99,879,139 22,995,825 48,959,907 6,789,579 12,890,667 40,469,457 ........
1972 ....................... 1,935,797,731 1,812,434,284 76,631,860 22,937,790 42,051,401 10,539,775 7,068,429 6,185,593 ........
Insurance and Indemnities
v„,. _ . . „ ,, „ . . Service-disabled Veterans Servicemen's Military Soldiers'
Fiscal Year U.S. Government National Service Veterans Special po„r.or.<»H i Servicemens .... ers
... .... Veterans Reopened Group Lite and Nava and Sailors'
Life Insurance Life Insurance Life Insurance i„,,iro„„„ ■ Idemnities , a a:>allors
Insurance Insurance Insurance runcl Insurance Civil Relief
1981 ............................ $81,051,871 $1,336,751,521 $83,498,342 $31,733,638 $56,116,017 $103,009,270 ........ $342,096 $7,922
1980 .............................. 87,086,482 1,290,320,168 79,460,717 29,483,042 50,544,569 99,727,203 ........ 402,000 ........
1979 .............................. 84,395,143 1,109,596,880 77,173,601 26,108,688 29,240,377 105,653,392 3,000 488,000 830
1978 .............................. 70,401,933 745,611,702 29,913,010 21,547,719 21,977,962 118,539,000 1,000 567,000 3,178
1977 ............................ 75,022,139 763,278,062 28,307,779 21,393,447 21,367,900 118,089,380 5,574 666,788 6,698
T.Q. 9-30-76 ...................... 15,284,568 168,012,046 7,869,537 6,077,136 5,366,324 25,927,221 2,786 181,462 ........
1976 .............................. 88,805,893 949,901,617 38,287,346 23,150,102 22,218,746 126,001,104 191 752,714 9,417
1975 ............................. 104,128,105 1,028,933,065 34,256,480 22,388,592 21,672,793 132,272,330 9,476 887,627 2,078
1974 .............................. 96,269,929 879,961,278 26,758,014 21,346,577 19,389,713 83,241,810 4,268 1,006,426 4,887
1973 .............................. 85,585,286 736,065,715 24,346,142 20,082,876 18,408,675 79,426,528 28,827 1,090,058 2,602
1972 ............................. 104,217,996 958,006,040 22,629,652 18,909,369 16,021,871 113,341,078 5,683 1,227,405 9,957
Miscellaneous Funds and Expenditures
Fiscal Year Vocational Grants to Rental Loan
Rehabilitation The Republic Maintenance Supply Fund General Consolidated Direct Loans Guaranty AH otners
Revolving of The and Repair of Post Fund Working Fund to Veterans Revolving
Fund Philippines Quarters Fund
1981 ............................... $932,622 $1,165,011 $449,933,820 $7,031,302 $18,698,447 $552,883,229 ........
1980 .................................. 985,779 1,390,088 418,130,463 6,186,030 49,160,273 444,633,891 .......
1979 .................................. 986,491 268,790 389,165,552 5,600,648 57,375,851 453,021,818 .......
1978 .............................. 1,007,173 1,672,105 ........ 392,897,095 5,030,407 1,177,107 73,296,267 514,097,639 .......
1977 ................................ 992,362 2,013,640 387 364,926,821 4,374,619 1,558,753 96,587,591 520,808,342 .......
T.Q. 9-30-76 ......................... 242,704 543,402 61,709 80,745,157 1,053,625 599,754 19,168,327 116,295,760 .......
1976 ................................ 833,532 1,869,576 217,101 330,636,825 4,661,975 1,531,704 88,649,371 483,799,919 .......
1975 ................................ 992,277 2,019,325 205,320 8,554,095 3,912,665 1,059,537 83,694,151 422,549,554 .......
1974 ................................ 884,041 1,952,900 200,342 213,261,928 3,674,147 795,145 81,861,265 449,102,008 .......
1973 ................................ 627,319 1,816,967 179,495 199,030,568 3,171,917 502,089 104,064,742 372,580,455 841,346
1972 ................................ 378,464 1,954,474 180,281 182,937,825 2,603,569 419,666 113,126,877 322,052,753 556,150
1 Data are on an accrued expenditures basis. 5 Changes in receivables and WWI adjusted service certificates. TQ 9/30/76 WWI adjusted service certificates
2 Credit. anly.
3 Clothing Allowance, Polio Rentals, Headstones/Markers included in their respective columns beginning with 6 Data for FY 1973 and prior years included in Compensation and Pension appropriations.
FY 1975; previously included under “All Others. ” 7 Grand totals for FY 1973 include $37,628for construction of a Corregidor-Bataan
4 Reported separately for the first time Transition Quarter ending 9/30/76. memorial.
217
FISCAL
TABLE 83
VA Supply Fund—Statement of Income and Expense Fiscal Year 1981
INCOME
Sales of supplies and equipment Less: Cost of Goods sold $455,301,471.20 441,739,720.47
Income on Sales 13,561,750.73
Other Income: Income-station transfers Discounts on purchases Reimbursable earnings Donated income Credit allowances Variances and adjustments Increased valuation Miscellaneous income $9,165,762.48 3,019,743.51 4,070,044.64 6,005,548.81 1,590,827.08 481,307.26 122,809.50 7,616.89 24,463,660.17
Total income $ 38,025,410.90
EXPENSES
Maintenance and operation of supply depots Other operating expenses Net transportation costs Completed S&R projects Depot storage, handling, etc Donations, reappraisals and Write offs Disposal of operating equipment 9,576,588.35 9,793,710.66 3,081,045.21 1,659,158.92 57,072.17 489,317.94 *(—>2,907.50
Total expense $ 24,653,985.75
Operating Profit $ 13,371,425.15
""Negotiation.
218
TABLE 84
FISCAL
Estimated Selected Expenditures by State—Fiscal Year 1981
State Total Expenditures All Programs Readjustment Benefits
Total Educational Assistance
Post-Korean Conflict Veterans (Title 38, U.S.C., Ch. 34) Sons and Daughters of Deceased & Totally Disabled Veterans (Title 38, U.S.C., Ch. 35) Widows/Widowers and Spouses of Totally Disabled Veterans (Title 38, U.S.C., Ch. 35)
Total Number Who Trained During Year Amount Total Number Who Trained During Year Amount Total Number Who Trained During Year Amount Total Number Who Trained During Year Amount
World Totals $23,449,430,880 3 1,072,930 $2,314,709,887 948,526 $1,968,295,623 82,646 $182,582,900 11,940 $22,196,170
Philippines 117,978,542 4,257 8,906,320 1,998 7,010,352 2,209 1,813,220 45 57,123
Other foreign areas 76,334,748 905 10,066,204 705 9,603,790 164 429,353 10 31,937
Puerto Rico 313,627,135 7,706 23,537,499 4,654 14,690,804 2,254 6,118,930 363 942,642
Other U.S. areas 4,362,912 934 772,964 884 742,260 39 18,699 4 4,037
Total U.S $22,937,127,543 1,059,007 2,271,426,900 940,285 1,936,248,417 77,980 174,202,698 11,518 21,160,431
Alabama 470,982,309 28,638 65,426,845 24,823 54,283,530 2,314 5,043,543 370 742,514
Alaska 36,406,366 2,931 4,478,313 2,837 4,254,837 66 138,395 8 14,266
Arizona 349,191,020 24,282 48,912,526 21,414 41,192,645 1,913 3,896,989 369 615,589
Arkansas 401,381,092 12,563 29,971,095 10,585 24,639,860 1,407 3,075,442 247 471,131
California 2,192,202,433 142,424 296,177,304 131,225 267,247,226 8,030 17,907,074 1,557 2,931,084
Colorado 308,636,276 21,460 49,019,809 18,578 39,842,888 1,482 3,300,299 245 448,522
Connecticut 229,067,028 9,390 17,809,210 8,582 15,489,673 459 1,159,059 49 73,631
Delaware 62,019,909 3,312 5,573,892 2,973 4,608,798 202 420,253 21 36,963
District of Columbia 527,370,337 9,865 5,875,353 9,215 4,350,756 347 512,081 39 42,584
Florida 1,348,746,269 55,425 123,434,084 47,192 101,027,160 6,064 13,325,355 1,338 2,342,347
Georgia 616,507,441 29,063 68,764,864 24,732 55,467,879 2,750 6,573,087 420 885,160
Hawaii 71,084,449 8,485 15,002,823 7,791 12,975,011 405 921,687 71 154,696
Idaho 79,423,816 5,019 10,939,125 4,413 9,342,589 343 679,038 52 89,367
Illinois 837,943,215 37,532 77,511,105 35,465 71,175,495 1,255 3,101,210 155 258,860
Indiana 387,309,444 20,496 45,736,749 18,347 38,696,373 1,077 2,192,848 90 156,730
Iowa 258,064,469 9,122 20,096,487 8,197 17,142,646 542 1,214,164 40 54,357
Kansas 238,018,976 11,309 24,656,749 10,029 21,028,975 807 1,715,871 85 156,325
Kentucky 377,495,641 15,353 37,326,521 13,440 31,699,206 1,387 3,146,315 151 277,053
Louisiana 407,964,703 14,887 33,608,939 13,200 29,076,898 1,273 3,064,437 156 289,153
Maine 140,071,479 5,869 12,742,709 4,968 10,007,478 461 985,754 79 143,341
Maryland 333,281,851 21,234 36,304,299 19,236 30,838,651 1,225 2,796,757 159 285,171
Massachusetts 699,021,630 22,746 47,467,186 19,647 38,876,577 2,416 5,524,829 206 348,757
Michigan 634,471,599 32,860 67,695,928 29,700 58,734,305 1,958 4,296,576 199 315,718
Minnesota 382,689,179 17,539 39,337,744 16,176 35,309,341 955 2,124,985 66 113,284
Mississippi 322.090,065 9,249 21,888,818 7,775 17,930,362 1,131 2,531,267 131 254,686
Missouri 511,892,424 23,238 48,613,266 21,316 43,268,208 1,339 2,909,393 157 299,375
Montana 79,494,976 3,962 9,145,503 3,523 7,638,338 256 584,179 32 57,228
Nebraska 164,322,289 9,315 19,558,536 8,336 16,604,744 636 1,419,544 79 130,509
Nevada 86,741,688 5,272 9,997,591 4,789 8,645,226 205 461,122 56 88,138
New Hampshire 100,007,228 5,293 12,001,124 4,413 9,077,426 416 863,398 56 98,613
New Jersey 508,875,106 16,238 34,899,306 14,242 28,396,156 1,128 3,127,465 149 280,367
New Mexico 172,566,975 9,466 21,803,514 8,105 17,931,133 937 1,978,616 128 229,615
New York 1,633,294,592 41,693 88,588,224 36,181 72,604,247 3,896 9,308,159 401 747,862
North Carolina 617,227,592 32,532 79,607,811 28,470 68,495,325 2,950 6,929,255 473 959,826
North Dakota 57,992,280 3,474 7,238,414 3,176 6,351,912 174 370,020 13 29,836
Ohio 870,766,082 36,345 77,932,799 32,704 66,735,403 1,987 4,420,675 192 343,735
Oklahoma 398,373,091 18,607 39,737,755 15,728 31,968,357 1,853 3,855,528 337 626,171
Oregon 300,843,663 14,869 33,501,575 13,220 28,273,145 803 1,647,722 106 194,505
Pennsylvania 1,071,179,101 32,697 63,304,546 29,112 52,994,713 2,308 5,403,903 193 308,271
Rhode Island 110,988,344 4,846 8,972,898 4,082 7,246,145 538 1,058,733 38 69,479
South Carolina 324,893,140 21,946 52,811,070 19,702 46,612,249 1,492 3,240,209 229 434,016
South Dakota 108,154,218 3,669 8,457,126 3,133 6,765,806 233 540,768 22 41,908
Tennessee 539,898,074 23,308 53,842,228 21,043 47,649,470 1,640 3,500,058 160 307,578
Texas 1,578,562,607 83,097 178,889,718 71,618 148,088,916 7,415 16,249,217 1,427 2,573,852
Utah 128,984,047 8,313 20,063,096 7,275 17,020,443 643 1,359,927 44 84,449
Vermont 61,699,634 1,493 3,266,508 1,138 2,186,363 185 394,424 11 17,409
Virginia 627,725,726 32,258 70,692,777 28,324 59,848,026 2,793 6,558,312 395 766,927
Washington 443,209,893 29,532 66,877,859 26,512 58,837,785 2,076 4,430,864 372 725,952
West Virginia 265,575,298 7,190 16,232,292 6,173 13,322,880 595 1,152,839 64 113,592
Wisconsin 411,636,613 16,881 35,196,449 15,215 30,377,223 1,078 2,522,206 65 103,704
Wyoming 50,781,866 2,420 4,436,438 2,215 4,069,619 135 268,847 16 26,225
'Excludes the following which are not distributable by State: adjusted service and dependents pay; statutory burial awards and burial flags; special allowances under ch. 23, title 38 U.S.C., invalid lifts, devices, equipment, etc.; death gratuities; adjusted service certificates World War I; tort claim settlements; mortgage life insurance; funds transferred to Veterans' Administra-
tion by National Cancer Institute; vocational rehabilitation revolving fund; loan guaranty revolving fund; rental, maintenance and repair of quarters; supply revolving fund; general post fund; and personal funds of patients.
219
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures by State—Fiscal Year 1981
State Readjustment Benefits-Continued Direct Loans Insurance and Indemnities Hospital and Domiciliary Construction2 3 Medical Services and Administrative Costs
Vocational Rehabilitation Automobiles and Other Conveyances for Disabled Veterans Homes for Paraplegics
Subsistence, Equipment and Supplies, Books and Tuition (Title 38, U.S.C., Ch. 31)
Total Number Who Trained During Year Amount
World Totals 3 29,818 $113,876,068 $11,909,278 $15,849,848 $9,403,908 $1,290,319,483 $408,735,666 7,201,234,595
Philippines 5 25,625 1,849,075 2,374,959
Other foreign areas 26 1,124 3,630,407
Puerto Rico 435 1,608,027 120,349 56,747 1,854,477 251,045 81,953,875
Other U.S. areas 7 7,968 42,336 319,786
Total U.S 29,224 112,233,324 11,788,929 15,793,101 9,361,572 1,282,665,738 408,484,621 7,116,905,761
Alabama 1,131 4,867,044 176,809 313,405 25,068 21,805,318 7,785,854 128,145,510
Alaska 20 65,070 5,745 2,754 1,282,666 20,516,051
Arizona 586 2,172,712 434,591 600,000 4,215 20,604,743 1,341,469 98,803,626
Arkansas 324 1,278,696 276,006 229,960 275,026 14,109,324 42,241,087 99,950,924
California 1,612 5,815,031 1,227,645 1,049,244 14,730 147,506,560 22,965,031 720,327,725
Colorado 1,155 4,792,866 197,267 437,967 20,522,652 4,649,932 88,250,363
Connecticut 300 925,704 101,143 60,000 19,239,986 1,179,831 77,907,403
Delaware 116 472,842 35,036 3,847,998 295,629 25,798,240
District of Columbia 264 646,149 192,333 131,450 4,470.294 2,708,990 27,711,994 442,086,654
Florida 831 3,657,234 1,068,592 2,013,396 24,302 82,090,608 35,995,572 298,253,995
Georgia 1,161 5,096,522 341,514 400,702 63,722 27,320,781 8,329,272 151,930,846
Hawaii 218 815,839 45,590 90,000 6,413,329 266,988 15,301,821
Idaho 211 761,722 66,409 85,736 3,976,264 938,595 19,098,959
Illinois 657 2,368,044 292,496 315,000 117,612 62,850,622 10,025,601 352,668,181
Indiana 982 4,354,825 156,523 179,450 37,075 21,933,585 2,330,289 105,969,931
Iowa 343 1,428,845 101,475 155,000 11,265 16,674,655 7,976,943 94,535,562
Kansas 388 1,482,846 113,595 159,137 12,776 14,109,324 1,931,546 87,454,512
Kentucky 375 1,567,691 217,035 419,221 157,015 15,^20,256 1,486,836 93,879,714
Louisiana 258 930,425 188,026 60,000 61,959 21,805,826 5,055,176 112,464,453
Maine 361 1,402,399 48,737 155.000 171,862 5,643,730 1,291,780 36,524,365
Maryland 614 2,209,311 111,381 63,028 4,608 24,370,649 1,319,163 86,483,511
Massachusetts 477 1,853,943 224,295 638,785 41,173,570 4,259,595 218,365,975
Michigan 1,003 3,490,434 303,934 554,961 152,290 30,014,379 3,098,355 170,523,702
Minnesota 342 1,236,809 105,001 448,324 1,025,690 24,371,753 1,686,136 132,460,508
Mississippi 212 895,398 94,625 182,480 53,375 12,826,658 5,858,531 86,145,625
Missouri 426 1,675,260 239,250 221,780 41,151 25,653,315 3,879,418 175,874,779
Montana 151 758,261 17,497 90,000 257,122 5,130,663 1,414,405 21,648,119
Nebraska 264 1,043,622 120,117 240,000 43,845 7,952,528 1,764,475 60,248,625
Nevada 222 720,665 82,440 3,091,225 4,584,158 26,523,610
New Hampshire 408 1,667,743 83,944 210,000 190,533 6,413,329 25,210 21,397,349
New Jersey 719 2,562,837 248,911 283,570 50,023,964 1,608,181 128,088,702
New Mexico 296 1,207,463 184,294 272,393 463 8,080,795 556,480 42,210,441
New York 1,215 4,607,174 698,604 622,178 61,507 101,330,594 19,910,215 609,307,959
North Carolina 639 2,610,159 277,944 335,302 37,493 22,190,118 1,118,120 144,262,336
North Dakota 111 447,466 39,180 71,150 3,989,091 634,495 21,020,568
Ohio 1,462 5,069,562 552,121 811,303 124,328 52,756,042 9,463,299 261,324,546
Oklahoma 689 2,705.574 248,437 333,688 199,171 19,240,037 11,863,478 75,871,042
Oregon 740 2,913,375 110,655 362,173 14,216 15,391,989 6,129,425 104,085,579
Pennsylvania 1,084 3,631,049 452,265 514,345 42,413 69,074,909 14,140,333 327,829,927
Rhode Island 188 505,354 93,187 3,860,824 1,201,536 35,065,396
South Carolina 523 2,017,845 262,733 244,018 29,260 16,674,743 2,556,643 78,044,598
South Dakota 281 1,059,927 48,717 165,050 3,976,264 1,315,710 52,611,137
Tennessee 465 1,660,517 440,750 283,855 11,860 17,957,321 10,971,309 178,140,348
Texas 2,637 10,419,790 611,496 946,447 483,577 79,525,276 11,242,837 407,894,626
Utah 351 1,499,981 44,680 53,616 151,673 3,989,091 8,603,039 49,385,234
Vermont 159 514,408 58,904 95,000 53,732 1,667,466 2,627,368 23,008,881
Virginia 746 2,765,524 269,521 484,467 231,716 31,168,778 45,680,237 149,612,333
Washington 572 2,339,834 178,424 365,000 22,340 29,501,312 20,428,096 106,214,627
West Virginia 358 1,445,778 109,135 88,068 92,642 10,261,326 22,155,317 85,605,950
Wisconsin 523 1,744,097 169,831 279,388 228,171 29,629,579 4,104,510 143,127,651
Wyoming 54 51,658 20,089 36,785 1,410,933 485,122 24,653,242
2 Includes $9,002,259 in Grants for Construction of state extended care facilities.
3Includes 121 not identified by location.
220
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State—Fiscal Year 1981
State Compensation and Pension
All Periods of Service
Living and Deceased Veterans Living Veterans
Total Service Connected Non-Service Connected Total
Number Amount Number Amount Number Amount Number Amount
World Total 4,535,310 $12,225,027,341 2,634,250 $8,473,964,270 1,901,060 $3,751,063,071 3,154,030 $9,319,207,376
Philippines 36,470 104,848,188 28,376 71,564,353 8,094 33,283,835 13,619 42,098,637
Other Foreign Areas 20,805 62,638,137 8,819 34,311,309 11,986 28,326,828 8,503 28,606,792
Puerto Rico 46,857 206,030,239 21,880 129,333,557 24,977 76,696,682 34,627 175,075,417
Other U.S. Areas 1,254 3,227,826 854 2,318,597 400 909,229 830 2,352,462
Total U.S 4,429,924 11,848,282,951 2,574,321 8,236,436,454 1,855,603 3,611,846,497 3,096,451 9,071,074,068
Alabama 93,941 247,793,714 50,443 158,059,490 43,498 89,734,224 61,850 179,655,964
Alaska 4,298 10,126,582 3,566 8,633,496 732 1,493,086 3,588 8,324,084
Arizona 58,294 179,524,441 39,235 142,110,064 19,059 37,414,377 43,348 141,296,186
Arkansas 68,899 214,833,636 33,582 136,423,018 35,317 78,410,618 47,657 170,717,956
California 377,717 1,005,211,083 236,357 745,899,051 141,360 259,312,032 266,504 741,683,667
Colorado 51,052 146,193,520 36,062 118,025,733 14,990 28,167,787 37,862 112,290,519
Connecticut 48,104 112,930,598 31,454 84,692,074 16,650 28,238,524 35,467 88,648,650
Delaware 10,663 26,504,150 6,520 19,048,310 4,143 7,455,840 7,432 19,858,341
District of Columbia 15,094 44,517,052 9,081 32,689,480 6,013 11,827,572 9,982 30,539,733
Florida 254,756 808,947,708 160,266 616,524,380 94,490 192,423,328 186,716 639,282,059
Georgia 123,184 360,097,956 66,603 236,970,722 56,581 123,127,234 83,302 267,660,887
Hawaii 11,988 34,099,488 9,393 29,406,495 2,595 4,692,993 9,071 25,698,964
Idaho 16,447 44,385,137 9,848 31,491,206 6,599 12,893,931 12,136 35,648,056
Illinois 150,020 334,770,094 78,845 207,418,774 71,175 127,351,320 99,257 247,139,574
Indiana 86,448 211,301,815 46,967 139,858,438 39,481 71,443,377 58,826 162,274,187
Iowa 47,280 118,769,557 24,894 76,431,536 22,386 42,338,021 32,337 92,415,684
Kansas 42,929 109,854,069 24,328 74,927,986 18,601 34,926,083 29,452 82,469,191
Kentucky 85,301 229,125,299 42,049 135,843,123 43,252 93,282,176 56,506 171,372,316
Louisiana 88,572 234,968,350 43,756 138,353,998 44,816 96,614,352 58,226 171,919,975
Maine 29,758 83,697,033 15,753 54,961,753 14,005 28,735,280 20,805 66,071,919
Maryland 71,260 184,799,621 44,434 137,651,131 26,826 47,148,490 48,411 133,303,817
Massachusetts 145,033 387,755,304 99,635 305,341,247 45,398 82,414,057 108,715 312,406,169
Michigan 146,645 362,986,945 88,560 262,182,927 58,085 100,804,018 103,259 286,417,258
Minnesota 75,423 183,807,348 44,748 124,699,987 30,675 59,107,361 54,287 143,988,206
Mississippi 68,013 195,317,058 31,252 111,149,518 36,761 84,167,540 44,427 145,606,194
Missouri 100,946 257,830,495 51,171 160,490,932 49,775 97,339,563 67,830 195,352,369
Montana 15,914 41,899,164 9,328 29,383,260 6,586 12,515,904 11,657 33,818,841
Nebraska 27,360 74,754,280 15,691 52,065,746 11,669 22,688,534 19,119 57,907,378
Nevada 16,410 42,545,104 11,234 33,235,338 5,176 9,309,766 12,565 33,521,916
New Hampshire 21,379 59,979,683 13,427 44,809,805 7,952 15,169,878 15,919 48,545,200
New Jersey 129,777 294,254,953 82,219 217,981,275 47,558 76,273,678 93,372 228,710,383
New Mexico 31,706 99,915,282 19,712 74,411,174 11,994 25,504,108 22,931 78,902,871
New York 325,438 814,096,093 192,360 574,484,607 133,078 239,611,486 231,565 640,569,769
North Carolina 130,740 370,011,714 67,371 234,357,488 63,369 135,654,226 88,490 281,382,532
North Dakota 10,155 25,038,562 6,091 16,854,290 4,064 8,184,272 7,302 19,753,921
Ohio 194,701 469,165,068 113,769 322,912,533 80,932 146,252,535 136,059 361,507,908
Oklahoma 81,449 251,461,608 46,019 172,740,494 35,430 78,721,114 56,814 196,277,679
Oregon 53,139 141,720,879 29,714 96,667,487 23,425 45,053,392 38,325 112,123,042
Pennsylvania 247,357 596,786,973 139,143 402,043,201 108,214 194,743,772 169,012 454,917,787
Rhode Island 23,740 61 887 690 14 725 46 709 574 9 015 15 178 116
South Carolina 66,901 174,776,826 33,138 105,808,365 33,763 68,968^461 43/137 124,076,153
South Dakota 14,975 41,628,931 7,399 25,561,481 7,576 16,067,450 10,379 33,048,796
Tennessee 105,887 278,975,008 50,990 164,283,264 54,897 114,691,744 69,967 208,172,187
Texas 302,765 900,526,573 179,523 635,527,186 123,242 264,999,387 212,697 688,021,947
Utah 17,888 46,791,914 12,356 36,997,987 5,532 9,793,927 13,238 36,676,404
Vermont 10,495 31,075,679 5,832 22,226,508 4,663 8,849,171 7,380 24,690,335
Virginia 113,491 330,339,885 68,265 240,761,403 45,226 89,578,482 78,430 243,732,633
Washington 78,292 220,165,659 52,802 172,305,786 25,490 47,859,873 57,255 169,796,746
West Virginia 49,938 131,227,771 24,583 79,421,143 25,355 51,806,628 33,073 99,252,684
Wisconsin 80,694 199,350,253 45,148 130,878,704 35,546 68,471,549 57,687 158,494,338
Wyoming 7,268 19,759,346 4,680 14,723,486 2,588 5,035,860 5,434 16,047,635
221
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State—Fiscal Year 1981
State Compensation and Pension — Continued
All Periods of Service
Living Veterans Deceased Veterans
Service Connected Non-Service Connected Total Service Connected
Number Amount Number Amount Number Amount Number Amount
World Total 2,279,232 6,939,021,840 874,798 2,380,185,536 1,381,280 2,905,819,965 355,018 $1,534,942,430
Philippines 10,611 23,799,682 3,008 18,298,955 22,851 62,749,551 17,765 47,764,671
Other Foreign Areas 5,464 17,774,125 3,039 10,832,667 12,302 34,031,345 3,355 16,537,184
Puerto Rico 19,236 118,846,416 15,391 56,229,001 12,230 30,954,822 2,644 10,487,141
Other U.S. Areas 718 1,793,961 112 558,501 424 875,364 136 524,636
Total U.S 2,243,203 6,776,807,656 853,248 2,294,266,412 1,333,473 2,777,208,883 331,118 1,459,628,798
Alabama 42,426 124,003,913 19,424 55,652,051 32,091 68,137,750 8,017 34,055,577
Alaska 3,325 7,531,118 263 792,966 710 1,802,498 241 1,102,378
Arizona 34,045 117,055,161 9,303 24,241,025 14,946 38,228,255 5,190 25,054,903
Arkansas 28,181 114,896,629 19,476 55,821,327 21,242 44,115,680 5,401 21,526,389
California 201,366 572,006,164 65,138 169,677,503 111,213 263,527,416 34,991 173,892,887
Colorado 31,270 94,819,143 6,592 17,471,376 13,190 33,903,001 4,792 23,206,590
Connecticut 28,545 71,971,914 6,922 16,676,736 12,637 24,281,948 2,909 12,720,160
Delaware 5,785 15,558,003 1,647 4,300,338 3,231 6,645,809 735 3,490,307
District of Columbia 7,647 24,103,799 2,335 6,435,934 5,112 13,977,319 1,434 8,585,681
Florida 138,145 507,352,885 48,571 131,929,174 68,040 169,665,649 22,121 109,171,495
Georgia 55,143 185,031,966 28,159 82,628,921 39,882 92,437,069 11,460 51,938,756
Hawaii 8,129 23,324,836 942 2,374,128 2,917 8,400,524 1,264 6,081,659
Idaho 8,708 26,704,357 3,428 8,943,699 4,311 8,737,081 1,140 4,786,849
Illinois 69,915 172,251,933 29,342 74,887,641 50,763 87,630,520 8,930 35,166,841
Indiana 41,323 117,611,825 17,503 44,662,362 27,622 49,027,628 5,644 22,246,613
Iowa 21,737 64,382,983 10,600 28,032,701 14,943 26,353,873 3,157 12,048,553
Kansas 20,728 60,142,963 8,724 22,326,228 13,477 27,384,878 3,600 14,785,023
Kentucky 35,433 110,522,955 21,073 60,849,361 28,795 57,752,983 6,616 25,320,168
Louisiana 37,168 110,604,882 21,058 61,315,093 30,346 63,048,375 6,588 27,749,116
Maine 13,627 46,245,500 7,178 19,826,419 8,953 17,625,114 2,126 8,716,253
Maryland 38,330 107,311,573 10,081 25,992,244 22,849 51,495,804 6,104 30,339,558
Massachusetts 90,435 264,252,818 18,280 48,153,351 36,318 75,349,135 9,200 41,088,429
Michigan 80,252 229,385,276 23,007 57,031,982 43,386 76,569,687 8,308 32,797,651
Minnesota 40,113 106,308,162 14,174 37,680,044 21,136 39,819,142 4,635 18,391,825
Mississippi 25,814 88,710,641 18,613 56,895,553 23,586 49,710,864 5,438 22,438,877
Missouri 43,901 131,596,228 23,929 63,756,141 33,116 62,478,126 7,270 28,894,704
Montana 8,402 25,601,184 3,255 8,217,657 4,257 8,080,323 926 3,782,076
Nebraska 13,587 43,207,663 5,532 14,699,715 8,241 16,846,902 2,104 8,858,083
Nevada 10,082 27,555,353 2,483 5,966,563 3,845 9,023,188 1,152 5,679,985
New Hampshire 12,060 38,488,176 3,859 10,057,024 5,460 11,434,483 1,367 6,321,629
New Jersey 74,862 186,059,134 18,510 42,651,249 36,405 65,544,570 7,357 31,922,141
New Mexico 17,088 62,670,566 5,843 16,232,305 8,775 21,012,411 2,624 11,740,608
New York 174,852 500,985,641 56,713 139,584,128 93,873 173,526,324 17,508 73,498,966
North Carolina 56,846 189,716,378 31,644 91,666,154 42,250 88,629,182 10,525 44,641,110
North Dakota 5,517 14,744,404 1,785 5,009,517 2,853 5,284,641 574 2,109,886
Ohio 102,220 276,395,846 33,839 85,112,062 58,642 107,657,160 11,549 46,516,687
Oklahoma 39,211 144,465,996 17,603 51,811,683 24,635 55,183,929 6,808 28,274,498
Oregon 26,264 81,689,798 12,061 30,433,244 14,814 29,597,837 3,450 14,977,689
Pennsylvania 123,753 340,546,556 45,259 114,371,231 78,345 141,869,186 15,390 61,496,645
Rhode Island 13,215 39,704,691 3,876 9,378,367 6,649 12,804,632 1,510 7,004,883
South Carolina 27,190 79,144,646 16,247 44,931,507 23,464 50,700,673 5,948 26,663,719
South Dakota 6,515 22,164,215 3,864 10,884,581 4,596 8,580,135 884 3,397,266
Tennessee 42,791 132,257,717 27,176 75,914,470 35,920 70,802,821 8,199 32,025,547
Texas 152,207 509,672,169 60,490 178,349,778 90,068 212,504,626 27,316 125,855,017
Utah 11,018 31,165,184 2,220 5,511,220 4,650 10,115,510 1,338 5,832,803
Vermont 5,041 18,729,985 2,339 5,960,350 3,115 6,385,344 791 3,496,523
Virginia 57,428 186,517,352 21,002 57,215,281 35,061 86,607,252 10,837 54,244,051
Washington 46,000 139,796,486 11,255 30,000,260 21,037 50,368,913 6,802 32,509,300
West Virginia 20,917 66,365,984 12,156 32,886,700 16,865 31,975,087 3,666 13,055,159
Wisconsin 40,422 112,696,860 17,265 45,797,478 23,007 40,855,915 4,726 18,181,844
Wyoming 4,224 12,778,045 1,210 3,269,590 1,834 3,711,711 456 1,945,441
222
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State — Fiscal Year 1981
Compensation and Pension—Continued
State All Periods of Service Vietnam Era
Deceased Veterans Living Veterans
Non-Service Connected Total Service Connected Non-Service Connected
Number Amount Number Amount Number Amount Number Amount
World Total 1,026,262 $1,370,877,535 585,645 $1,814,360,434 568,234 $1,748,185,470 17,411 $66,174,964
Philippines 5,086 14,984,880 325 1,486,836 318 1,429,320 7 57,516
Other Foreign Areas 8,947 17,494,161 1,650 5,023,662 1,630 4,946,469 20 77,193
Puerto Rico 9,586 20,467,681 7,875 51,240,235 7,320 49,027,397 555 2,212,838
Other U.S. Areas 288 350,728 221 797,871 216 776,982 5 20,889
Total U.S 1,002,355 1,317,580,085 575,574 1,755,811,830 558,750 1,692,005,302 16,824 63,806,528
Alabama 24,074 34,082,173 10,674 30,262,223 10,334 28,934,720 340 1,327,503
Alaska 469 700,120 1,504 3,332,046 1,482 3,214,174 22 117,872
Arizona 9,756 13,173,352 10,230 32,188,491 9,988 31,271,932 242 916,559
Arkansas 15,841 22,589,291 6,724 26,162,159 6,406 24,947,430 318 1,214,729
California 76,222 89,634,529 55,243 158,517,892 53,801 152,981,699 1,442 5,536,193
Colorado 8,398 10,696,411 10,361 31,424,373 10,201 30,834,646 160 589,727
Connecticut 9,728 11,561,788 5,578 16,188,467 5,396 15,496,253 182 692,214
Delaware 2,496 3,155,502 1,707 4,595,720 1,678 4,463,632 29 132,088
District of Columbia 3,678 5,391,638 2,129 6,388,602 2,084 6,200,528 45 188,074
Florida 45,919 60,494,154 38,265 134,482,387 37,365 130,886,942 900 3,595,445
Georgia 28,422 40,498,313 18,584 61,491,161 17,931 59,170,121 653 2,321,040
Hawaii 1,653 2,318,865 3,124 8,868,905 3,091 8,757,472 33 111,433
Idaho 3,171 3,950,232 2,287 6,375,434 2,251 6,241,506 36 133,928
Illinois 41,833 52,463,679 15,139 40,170,471 14,524 37,828,967 615 2,341,504
Indiana 21,978 26,781,015 10,103 31,406,254 9,715 29,967,197 388 1,439,057
Iowa 11,786 14,305,320 4,928 13,913,627 4,758 13,298,810 170 614,817
Kansas 9,877 12,599,855 5,125 14,097,339 4,953 13,417,213 172 680,126
Kentucky 22,179 32,432,815 7,837 25,277,553 7,471 24,001,537 366 1,276,016
Louisiana 23,758 35,299,259 8,771 26,647,242 8,400 25,276,983 371 1,370,259
Maine 6,827 8,908,861 3,771 12,268,425 3,627 11,754,801 144 513,624
Maryland 16,745 21,156,246 10,525 30,641,088 10,338 29,905,609 187 735,479
Massachusetts 27,118 34,260,706 16,609 49,495,904 16,145 47,823,035 464 1,672,869
Michigan 35,078 43,772,036 19,844 61,193,375 19,313 59,392,631 531 1,800,744
Minnesota 16,501 21,427,317 8,623 21,426,684 8,408 20,658,534 215 768,150
Mississippi 18,148 27,271,987 6,234 21,196,233 6,021 20,300,055 213 896,178
Missouri 25,846 33,583,422 9,783 29,949,378 9,407 28,532,123 376 1,417,255
Montana 3,331 4,298,247 2,390 7,002,759 2,318 6,720,000 72 282,759
Nebraska 6,137 7,988,819 3,234 9,924,179 3,138 9,557,106 96 367,073
Nevada 2,693 3,343,203 3,176 7,567,786 3,135 7,410,204 41 157,582
New Hampshire 4,093 5,112,854 4,062 13,080,379 3,995 12,800,055 67 280,324
New Jersey 29,048 33,622,429 14,057 40,004,369 13,705 38,757,417 352 1,246,952
New Mexico 6,151 9,271,803 5,666 18,129,575 5,467 17,393,623 199 735,952
New York 76,365 100,027,358 34,954 104,473,944 33,616 99,422,208 1,338 5,051,736
North Carolina 31,725 43,988,072 17,027 57,649,556 16,513 55,599,414 514 2,050,142
North Dakota 2,279 3,174,755 1,287 2,973,517 1,251 2,845,532 36 127,985
Ohio 47,093 61,140,473 22,542 65,548,193 21,803 62,837,536 739 2,710,657
Oklahoma 17,827 26,909,431 11,356 39,590,479 10,875 37,654,475 481 1,936,004
Oregon 11,364 14,620,148 7,844 23,123,932 7,641 22,289,913 203 834,019
Pennsylvania 62,955 80,372,541 23,714 67,690,635 22,958 65,002,148 756 2,688,487
Rhode Island 5,139 5,799,749 2,828 8,484,385 2,761 8,204,032 67 280,353
South Carolina 17,516 24,036,954 8,782 23,845,501 8,552 22,998,457 230 847,044
South Dakota 3,712 5,182,869 1,840 5,804,665 1,754 5,477,864 86 326,801
Tennessee 27,721 38,777,274 10,720 33,983,306 10,285 32,354,747 435 1,628,559
Texas 62,752 86,649,609 50,310 162,009,272 49,324 158,078,516 986 3,930,756
Utah 3,312 4,282,707 3,038 7,746,183 2,988 7,513,766 50 232,417
Vermont 2,324 2,888,821 1,341 5,103,164 1,260 4,767,701 81 335,463
Virginia 24,224 32,363,201 19,686 61,900,781 19,253 60,305,603 433 1,595,178
Washington 14,235 17,859,613 15,615 45,599,417 15,294 44,424,572 321 1,174,845
West Virginia 13,199 18,919,928 4,807 15,310,417 4,599 14,458,714 208 851,703
Wisconsin 18,281 22,674,071 10,167 27,246,209 9,772 25,652,331 395 1,593,878
1,378 1,766,270 1,429 4,057,794 1,405 3,920,818 24 136,976
223
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State—Fiscal Year 1981
Compensation and Pension—Continued
State Vietnam Era Korean Conflict
Deceased Veterans Living Veterans
Total Service Connected Non-Service Connected Total
Number Amount Number Amount Number Amount Number Amount
Worid Total 93,650 $359,250,209 66,816 $322,344,318 26,834 $36,905,891 316,758 $1,079,181,114
Philippines 320 1,835,071 245 1,659,128 75 175,943 117 861,850
Other Foreign Areas 1,401 6,523,705 1,205 6,207,933 196 315,772 755 2,858,271
Puerto Rico 927 3,034,326 645 2,483,936 282 550,390 8,793 44,168,101
Other U.S. Areas 75 212,519 42 196,779 33 15,740 136 385,810
Total U.S 90,927 347,644,588 64,679 311,796,542 26,248 35,848,046 306,957 1,030,907,082
Alabama 2,406 9,245,998 1,729 8,316,169 677 929,829 6,079 20,841,524
Alaska 161 583,636 116 532,077 45 51,559 362 925,906
Arizona 1,570 6,399,402 1,126 5,778,475 444 620,927 4,331 16,980,473
Arkansas 1,284 4,602,292 936 4,100,739 348 501,553 4,131 17,514,316
California 9,837 40,987,170 7,254 37,578,342 2,583 3,408,828 29,057 94,500,986
Colorado 1,707 7,473,188 1,331 6,961,387 376 511,801 3,806 12,793,472
Connecticut 523 1,903,856 363 1,688,000 160 215,856 3,574 9,784,288
Delaware 282 1,149,965 212 1,055,443 70 94,522 726 2,219,504
District of Columbia 292 1,197,030 205 1,082,725 87 114,305 1,267 4,707,966
Florida 5,645 24,876,966 4,466 23,271,716 1,179 1,605,250 17,157 73,450,773
Georgia 3,820 15,662,286 2,911 14,470,340 909 1,191,946 8,226 31,095,052
Hawaii 510 2,390,087 425 2,275,166 85 114,921 1,301 4,291,451
Idaho 414 1,446,325 266 1,268,635 148 177,690 1,096 3,738,869
Illinois 2,507 7,782,385 1,479 6,359,286 1,028 1,423,099 9,397 26,388,954
Indiana 1,607 5,144,703 1,013 4,355,421 594 789,282 5,906 18,296,407
Iowa 653 2,085,288 421 1,766,367 232 318,921 2,944 9,620,954
Kansas 937 3,529,025 642 3,137,542 295 391,483 2,567 8,700,815
Kentucky 1,757 6,145,740 1,253 5,436,588 504 709,152 5,537 18,979,697
Louisiana 2,013 7,059,605 1,354 6,131,854 659 927,751 5,693 18,307,593
Maine 591 2,177,817 417 1,942,739 174 235,078 2,153 8,000,737
Maryland 1,847 7,725,922 1,368 7,112,999 479 612,923 5,134 15,853,111
Massachusetts 1,518 5,876,862 1,086 5,242,689 432 634,173 13,812 41,715,871
Michigan 2,499 7,653,095 1,432 6,094,052 1,067 1,559,043 10,311 33,149,659
Minnesota 937 2,853,254 596 2,405,921 341 447,333 5,075 14,793,500
Mississippi 1,322 4,928,184 966 4,438,538 356 489,646 3,985 14,956,819
Missouri 1,907 6,265,768 1,237 5,365,192 670 900,576 6,436 21,116,625
Montana 335 1,043,702 209 879,095 126 164,607 1,075 3,512,088
Nebraska 545 1,914,519 362 1,690,998 183 223,521 1,895 6,337,004
Nevada 438 1,866,346 320 1,711,963 118 154,383 1,309 4,442,513
New Hampshire 346 1,351,118 254 1,231,493 92 119,625 1,622 5,673,592
New Jersey 1,641 6,168,424 1,128 5,442,961 513 725,463 10,237 27,245,505
New Mexico 901 3,205,791 584 2,764,411 317 441,380 2,425 9,664,283
New York 3,415 11,157,036 2,138 9,294,096 1,277 1,862,940 23,355 71,897,275
North Carolina 3,609 14,233,292 2,709 13,017,602 900 1,215,690 8,300 30,968,254
North Dakota 153 496,738 105 437,117 48 59,621 626 2,001,189
Ohio 3,205 10,451,828 2,004 8,780,208 1,201 1,671,620 13,668 40,554,250
Oklahoma 1,913 7,294,217 1,411 6,584,410 502 709,807 5,160 20,866,234
Oregon 964 3,240,598 605 2,792,218 359 448,380 3,240 11,090,129
Pennsylvania 3,293 10,983,880 2,099 9,290,767 1,194 1,693,113 16,556 50,596,390
Rhode Island 311 1,280,190 220 1,140,289 91 139,901 1,657 5,108,952
South Carolina 2,193 8,930,287 1,660 8,197,685 533 732,602 4,018 13,595,509
South Dakota 258 809,168 167 685,186 91 123,982 1,080 3,939,049
Tennessee 2,368 8,401,396 1,679 7,480,970 689 920,426 6,111 21,289,292
Texas 8,236 33,915,910 6,281 31,251,522 1,955 2,664,388 18,423 69,835,552
Utah 456 1,637,631 309 1,445,808 147 191,823 1,272 4,380,056
Vermont 167 640,068 120 582,410 47 57,658 826 3,113,040
Virginia 3,462 16,162,757 2,781 15,244,669 681 918,088 7,901 29,218,049
Washington 2,159 8,874,688 1,617 8,180,724 542 693,964 5,814 20,310,899
West Virginia 869 2,785,455 603 2,435,408 266 350,047 3,789 12,893,401
Wisconsin 964 3,058,700 592 2,548,938 372 509,762 6,037 17,899,822
Wyoming 180 595,000 118 517,192 62 77,808 498 1,749,433
224
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State — Fiscal Year 1981
Compensation and Pension—Continued
Korean Conflict
State Living Veterans Deceased Veterans
Service Connected Non-Service Connected Total Service Connected
Number Amount Number Amount Number Amount Number Amount
World Total 233,820 $804,520,881 82,938 $274,660,233 121,109 $281,273,959 39,195 $162,774,356
Philippines 102 692,348 15 169,502 158 736,668 105 609,121
Other Foreign Areas 654 2,489,303 101 368,968 697 2,212,540 345 1,621,494
Puerto Rico 4,904 29,034,230 3,889 15,133,871 2,475 6,652,954 871 2,973,740
Other U.S. Areas 115 316,776 21 69,034 73 115,758 16 47,599
Total U.S 228,045 771,988,224 78,912 258,918,858 117,706 271,556,039 37,858 157,522,402
Alabama 4,228 14,528,535 1,851 6,312,989 2,890 6,635,961 1,015 3,865,524
Alaska 348 868,812 14 57,094 108 208,805 19 83,502
Arizona 3,469 14,252,973 862 2,727,500 1,493 4,049,277 576 2,773,104
Arkansas 2,554 12,631,462 1,577 4,882,854 1,372 3,180,533 593 2,044,207
California 23,244 74,825,872 5,813 19,675,114 10,959 31,245,827 4,428 22,320,528
Colorado 3,221 10,853,920 585 1,939,552 1,379 3,637,016 508 2,505,705
Connecticut 2,896 7,745,134 678 2,039,154 1,252 2,544,463 277 1,165,565
Delaware 590 1,768,473 136 451,031 308 756,730 87 441,769
District of Columbia 1,005 3,776,946 262 931,020 548 1,973,898 235 1,512,211
Florida 12,874 58,710,898 4,283 14,739,875 6,059 18,572,721 2,758 14,097,568
Georgia 5,061 20,131,736 3,165 10,963,316 3,437 8,338,631 1,291 5,256,249
Hawaii 1,179 3,950,419 122 341,032 437 1,135,986 212 827,201
Idaho 898 3,075,438 198 663,431 381 756,680 101 368,583
Illinois 6,990 18,684,018 2,407 7,704,936 4,734 8,630,627 953 3,189,957
Indiana 4,131 12,775,793 1,775 5,520,614 2,457 4,460,333 561 1,829,264
Iowa 2,196 7,148,250 748 2,472,704 1,213 2,267,403 333 1,036,144
Kansas 1,966 6,888,448 601 1,812,367 1,107 2,381,433 381 1,388,783
Kentucky 3,367 11,480,685 2,170 7,499,012 2,239 4,475,018 736 2,282,369
Louisiana 3,825 12,253,890 1,868 6,053,703 2,371 5,407,441 817 3,043,218
Maine 1,451 5,576,545 702 2,424,192 697 1,541,458 229 844,945
Maryland 4,146 12,775,834 988 3,077,277 2,311 5,900,575 758 3,727,860
Massachusetts 11,713 34,453,862 2,099 7,262,009 3,137 7,198,102 935 3,859,108
Michigan 7,964 25,953,611 2,347 7,196,048 4,316 7,874,735 804 2,838,784
Minnesota 4,240 12,029,566 835 2,763,934 1,915 3,625,699 465 1,568,612
Mississippi 2,392 9,587,946 1,593 5,368,873 1,689 3,836,117 643 2,281,293
Missouri 4,479 14,851,676 1,957 6,264,949 2,714 5,582,512 843 2,948,531
Montana 813 2,668,272 262 843,816 398 752,536 87 323,283
Nebraska 1,492 4,935,646 403 1,401,358 816 1,632,805 228 858,562
Nevada 1,065 3,681,618 244 760,895 428 1,034,868 128 637,353
New Hampshire 1,170 4,105,099 452 1,568,493 501 1,143,388 157 646,591
New Jersey 8,233 21,409,971 2,004 5,835,534 3,442 7,020,739 770 3,221,299
New Mexico 1,797 7,596,502 628 2,067,781 865 2,210,684 308 1,369,132
New York 17,305 52,162,939 6,050 19,734,336 7,972 15,819,080 1,689 6,568,141
North Carolina 5,393 20,801,827 2,907 10,166,427 3,441 7,702,209 1,183 4,433,042
North Dakota 502 1,617,628 124 383,561 326 539,448 74 184,490
Ohio 10,251 30,175,777 3,417 10,378,473 5,189 9,727,221 1,182 3,964,120
Oklahoma 3,654 15,530,635 1,506 5,335,599 1,826 4,407,742 777 2,927,976
Oregon 2,331 8,209,064 909 2,881,065 1,130 2,581,876 363 1,544,191
Pennsylvania 12,267 37,022,393 4,289 13,573,997 6,574 13,063,581 1,644 5,718,347
Rhode Island 1,295 3,961,239 362 1,147,713 547 1,242,076 150 649,459
South Carolina 2,530 8,682,974 1,488 4,912,535 2,124 5,002,372 717 2,866,927
South Dakota 700 2,674,850 380 1,264,199 431 853,361 103 362,227
Tennessee 3,625 13,203,619 2,486 8,085,673 2,760 5,604,551 970 3,080,216
Texas 14,028 54,793,859 4,395 15,041,693 7,562 20,953,990 3,180 14,695,869
Utah 1,101 3,843,648 171 536,408 541 1,106,009 139 590,376
Vermont 533 2,221,660 293 891,380 235 528,463 73 289,528
Virginia 5,657 21,802,465 2,244 7,415,584 3,319 9,387,824 1,390 6,732,266
Washington 4,882 17,183,822 932 3,127,077 2,159 6,148,497 901 4,496,526
West Virginia 2,146 7,775,466 1,643 5,117,935 1,329 2,504,216 473 1,236,459
Wisconsin 4,464 12,925,237 1,573 4,974,585 2,097 4,016,629 567 1,828,307
Wyoming 384 1,421,272 114 328,161 171 353,893 47 197,131
225
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State—Fiscal Year 1981
Compensation and Pension—Continued
State Korean Conflict World War II
Deceased Veterans Living Veterans
Non-Service Connected Total Sen/ice Connected Non-Service Connected
Number Amount Number Amount Number Amount Number Amount
World Total 81,914 $118,499,603 1,800,762 $5,027,072,728 1,167,483 $3,392,715,151 633,279 $1,634,357,577
Philippines 53 127,547 12,002 30,807,600 9,811 19,230,895 2,191 11,576,705
Other Foreign Areas 352 591,046 3,441 10,229,304 2,100 6,801,479 1,341 3,427,825
Puerto Rico 1,604 3,679,214 12,942 54,056,810 3,606 22,874,310 9,336 31,182,500
Other U.S. Areas 57 68,159 363 793,018 284 338,159 79 454,859
Total U.S 79,848 114,033,637 1,772,014 4,931,185,996 1,151,682 3,343,470,308 620,332 1,587,715,688
Alabama 1,875 2,770,437 36,923 102,644,212 21,983 62,876,665 14,940 39,767,547
Alaska 89 125,303 1,074 2,679,879 879 2,156,337 195 523,542
Arizona 917 1,276,173 21,432 68,575,583 14,774 51,901,318 6,658 16,674,265
Arkansas 779 1,136,326 30,339 100,181,207 15,296 59,949,562 15,043 40,231,645
California 6,531 8,925,299 139,884 363,582,757 92,844 246,457,456 47,040 117,125,301
Colorado 871 1,131,311 16,585 46,887,171 12,161 35,780,900 4,424 11,106,271
Connecticut 975 1,378,898 21,296 49,707,013 16,609 38,758,539 4,687 10,948,474
Delaware 221 314,961 3,959 10,022,121 2,699 6,876,994 1,260 3,145,127
District of Columbia 313 461 687 5 060
Florida 3,301 4,475,153 100,686 327,207,743 65,972 237,290,305 34,714 89,917,438
Georgia 2,146 3,082,382 45,334 136,090,942 23,577 76,151,858 21,757 59,939,084
Hawaii 225 308,785 2,971 8,149,152 2,373 6,736,983 598 1,412,169
Idaho 280 388,097 6,626 19,334,954 4,229 13,427,073 2,397 5,907,881
Illinois 3,781 5,440,670 61,666 146,900,060 40,964 96,097,344 20,702 50,802,716
Indiana 1,896 2,631,069 34,164 87,937,673 22,356 59,235,642 11,808 28,702,031
Iowa 880 1,231,259 19,092 52,760,824 12,180 35,449,237 6,912 17,311,587
Kansas 726 992,650 16,830 45,314,634 10,975 30,905,805 5,855 14,408,829
Kentucky 1,503 2,192,649 36,067 103,032,991 20,236 59,658,994 15,831 43,373,997
Louisiana 1,554 2,364,223 36,909 103,644,547 20,460 58,674,327 16,449 44,970,220
Maine 468 696,513 11,857 36,298,530 6,579 22,536,801 5,278 13,761,729
Maryland 1,553 2,172,715 25,219 66,270,182 17,850 47,849,865 7,369 18,420,317
Massachusetts 2,202 3,338,994 64,413 182,181,766 52,052 150,917,531 12,361 31,264,235
Michigan 3,512 5,035,951 59,644 153,873,969 44,134 116,780,070 15,510 37,093,899
Minnesota 1,450 2,057,087 32,089 83,426,575 22,488 59,431,364 9,601 23,995,211
Mississippi 1,046 1,554,824 29,208 90,257,982 14,191 46,657,058 15,017 43,600,924
Missouri 1,871 2,633,981 41,866 113,095,370 24,557 69,690,429 17,309 43,404,941
Montana 311 429,253 6,352 18,182,419 4,035 12,590,664 2,317 5,591,755
Nebraska 588 774,243 10,820 31,676,570 7,079 22,181,280 3,741 9,495,290
Nevada 300 397,515 6,199 15,956,756 4,275 11,633,904 1,924 4,322,852
New Hampshire 344 496,797 7,775 22,681,873 5,054 15,970,973 2,721 6,710,900
New Jersey 2,672 3,799,440 57,156 132,331,346 44,505 103,941,489 12,651 28,389,857
New Mexico 557 841,552 11,498 39,891,621 7,252 28,838,422 4,246 11,053,199
New York 6,283 9,250,939 145,764 387,118,210 105,091 291,750,615 40,673 95,367,595
North Carolina 2,258 3,269,167 51,641 152,837,593 26,995 85,532,120 24,646 67,305,473
North Dakota 252 354,958 4,300 11,654,711 3,053 8,211,721 1,247 3,442,990
Ohio 4,007 5,763,101 82,551 206,631,764 58,757 149,132,657 23,794 57,499,107
Oklahoma 1,049 1,479,766 31,563 104,288,966 18,501 68,610,926 13,062 35,678,040
Oregon 767 1,037,685 20,644 58,164,454 12,270 38,267,531 8,374 19,896,923
Pennsylvania 4,930 7,345,234 107,575 276,968,914 74,785 196,648,379 32,790 80,320,535
Rhode Island 397 592,617 10,245 28,750,443 7,562 22,576,628 2,683 6,173,815
South Carolina 1,407 2,135,445 25,254 70,070,526 12,331 36,353,839 12,923 33,716,687
South Dakota 328 491,134 5,696 17,664,751 3,183 11,026,103 2,513 6,638,648
Tennessee 1,790 2,524,335 44,540 123,415,786 23,525 68,237,731 21,015 55,178,055
4,382 6,258,121 111,981 349,791,101 65,341 219,882,605 46,640 129,908,496
402 515,633 6,666 18,345,149 5,281 15,009,393 1,385 3,335,756
Vermont 162 238,935 4,119 13,025,049 2,477 9,103,844 1,642 3,921,205
Virginia 1,929 2,655,558 38,531 113,457,617 22,742 72,930,266 15,789 40,527,351
Washington 1,258 1,651,971 25,742 74,156,432 18,315 55,093,027 7,427 19,063,405
West Virginia 856 1,267,757 20,298 57,696,569 11,601 35,715,751 8,697 21,980,818
Wisconsin 1,530 2,188,322 31,322 84,590,707 20,172 56,911,242 11,150 27,679,465
Wyoming 124 156,762 2,589 7,595,470 1,784 5,476,792 805 2,118,678
226
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State — Fiscal Year 1981
Compensation and Pension—Continued
State World War II World War I
Deceased Veterans Living Veterans
Total Service Connected Non-Service Connected Total
Number Amount Number Amount Number Amount Number Amount
World Total 640,957 $1,336,459,052 169,793 $651,066,414 471,164 $685,392,638 166,496 $505,252,518
Philippines 18,392 46,598,418 16,615 41,592,797 1,777 5,005,621 802 6,552,311
Other Foreign Areas 2,820 6,406,390 709 3,087,829 2,111 3,318,561 1,658 7,394,955
Puerto Rico 4,359 10,659,741 660 2,857,304 3,699 7,802,437 1,638 7,947,507
Other U.S. Areas 181 289,666 38 106,869 143 182,797 6 25,911
Total U.S 615,205 1,272,504,837 151,771 603,421,615 463,434 669,083,222 162,392 483,331,834
Alabama 14,780 30,156,560 3,299 12,257,016 11,481 17,899,544 2,656 9,616,988
Alaska 272 568,284 56 239,007 216 329,277 36 120,363
Arizona 6,336 15,054,444 2,040 8,930,308 4,296 6,124,136 2,042 6,193,297
Arkansas 9,066 19,176,573 2,525 9,107,004 6,541 10,069,569 2,917 11,307,229
California 46,834 106,859,467 13,825 62,252,517 33,009 44,606,950 13,854 39,396,939
Colorado 5,122 11,426,285 1,556 6,442,558 3,566 4,983,727 1,856 5,884,272
Connecticut 6,196 12,732,565 1,578 6,347,886 4,618 6,384,679 1,759 4,325,973
Delaware 1,649 3,163,630 296 1,290,731 1,353 1,872,899 255 706,068
District of Columbia 2,293 6,138,445 596 3,571,328 1,697 2,567,117 343 1,056,633
Florida 29,208 70,631,514 9,297 41,786,563 19,911 28,844,951 10,578 31,680,858
Georgia 18,009 39,106,041 4,489 18,400,987 13,520 20,705,054 3,004 11,158,335
Hawaii 1,020 2,373,221 336 1,362,575 684 1,010,646 191 549,557
Idaho 1,831 3,812,212 525 1,940,655 1,306 1,871,557 895 2,660,121
Illinois 24,779 45,767,341 4,842 17,846,631 19,937 27,920,710 6,495 16,686,363
Indiana 12,814 23,988,709 2,774 10,037,421 10,040 13,951,288 4,117 10,986,312
Iowa 6,572 12,819,244 1,766 6,226,880 4,806 6,592,364 3,129 9,105,347
Kansas 5,771 11,848,340 1,728 6,260,865 4,043 5,587,475 2,393 6,533,518
Kentucky 12,951 25,711,313 3,143 10,730,727 9,808 14,980,586 3,255 10,719,952
Louisiana 14,826 30,447,223 2,884 11,237,084 11,942 19,210,139 2,618 10,042,898
Maine 3,985 8,071,221 1,055 3,831,982 2,930 4,239,239 1,193 3,678,048
Maryland 10,534 22,294,000 2,445 11,080,333 8,089 11,213,667 1,912 5,084,067
Massachusetts 18,202 39,381,645 5,070 21,378,596 13,132 18,003,049 4,416 12,630,474
Michigan 21,386 40,771,581 4,573 16,873,437 16,813 23,898,144 5,343 13,213,919
Minnesota 9,172 18,480,188 2,420 9,052,072 6,752 9,428,116 4,364 13,593,692
Mississippi 10,183 21,343,729 2,305 8,470,654 7,878 12,873,075 2,214 8,939,486
Missouri 14,597 28,307,211 3,510 12,625,624 11,087 15,681,587 4,915 15,093,863
Montana 1,830 3,544,577 410 1,551,861 1,420 1,992,716 744 2,078,275
Nebraska 3,430 7,300,787 1,049 4,016,615 2,381 3,284,172 1,484 4,283,840
Nevada 1,596 3,488,215 429 1,894,571 1,167 1,593,644 354 1,044,013
New Hampshire 2,567 5,294,842 633 2,747,705 1,934 2,547,137 716 1,902,084
New Jersey 19,047 36,842,384 4,101 16,520,617 14,946 20,321,767 4,055 9,033,180
New Mexico 3,609 8,264,233 1,098 4,410,487 2,511 3,853,746 973 3,407,824
New York 49,169 96,709,710 10,656 42,896,457 38,513 53,813,253 10,137 24,785,401
North Carolina 19,640 39,721,933 4,322 16,288,925 15,318 23,433,008 3,951 13,985,286
North Dakota 1,106 2,117,183 264 935,901 842 1,181,282 471 1,471,782
Ohio 29,027 55,231,215 6,022 22,679,980 23,005 32,551,235 7,030 18,186,248
Oklahoma 9,731 20,851,592 3,006 10,929,755 6,725 9,921,837 2,974 10,916,022
Oregon 5,933 12,249,679 1,609 6,325,519 4,324 5,924,160 2,929 8,249,463
Pennsylvania 42,685 81,576,600 8,842 32,923,011 33,843 48,653,589 8,764 22,463,048
Rhode Island 3,289 6,714,396 793 3,393,255 2,496 3,321,141 890 2,289,312
South Carolina 11,095 22,087,423 2,134 8,358,574 8,961 13,728,849 1,802 6,122,500
South Dakota 1,678 3,290,062 414 1,444,417 1,264 1,845,645 1,013 3,123,861
Tennessee 16,174 31,805,016 3,669 12,818,137 12,505 18,986,879 3,682 12,847,062
Texas 40,005 90,238,579 11,359 46,359,787 28,646 43,878,792 9,596 34,721,134
Utah 1,959 4,181,789 591 2,301,473 1,368 1,880,316 736 1,831,401
Vermont 1,454 3,103,315 415 1,685,950 1,039 1,417,365 404 1,141,858
Virginia 15,030 33,072,301 3,862 16,749,690 11,168 16,322,611 2,959 9,482,806
Washington 7,883 17,959,254 2,527 10,653,065 5,356 7,306,189 3,045 8,585,441
West Virginia 8,052 15,589,162 1,962 6,536,056 6,090 9,053,106 1,831 5,689,226
Wisconsin 10,136 19,455,236 2,492 8,726,519 7,644 10,728,717 4,773 13,814,822
Wyoming 692 1,384,368 179 691,847 513 692,521 329 911,373
227
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State — Fiscal Year 1981
Compensation and Pension
World War I
State Living Veterans Deceased Veterans
Service Connected Emergency Officer Retirement Pay Non-Service Connected Total Service Connected
Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 25,417 $99,765,838 160 $1,219,605 140,919 $404,267,075 463,055 $653,696,097 28,731 $141,159,690
Philippines 8 73,777 794 6,478,534 2,716 8,513,590 125 662,751
Other Foreign Areas 80 436,274 1 1,577 6,958,681 6,405 14,305,192 260 1,275,846
Puerto Rico 27 255,118 1,611 7,692,389 3,983 8,701,286 93 489,879
Other U.S. Areas 1 12,192 5 13,719 50 81,198 3 4,476
Total U.S 25,301 98,988,477 159 1,219,605 136,392 383,123,752 449,901 622,094,831 28,250 138,726,738
Alabama 361 1,360,888 3 19,672 2,292 8,236,428 10,472 15,244,228 586 2,916,358
Alaska 4 25,905 32 94,458 124 216,976 6 24,059
Arizona 501 2,242,632 4 32,886 1,537 3,917,779 4,519 7,738,876 546 2,749,063
Arkansas 379 1,812,782 2 14,187 2,536 9,480,260 8,686 13,815,381 661 3,155,349
California 3,011 11,958,699 29 217,433 10,814 27,220,807 35,184 44,359,141 2,830 14,073,534
Colorado 430 2,021,851 3 27,074 1,423 3,835,347 3,982 6,482,471 525 2,589,149
Connecticut 387 1,330,676 1 5,885 1,371 2,989,712 4,187 5,127,176 359 1,722,287
Delaware 32 124,462 1 9,514 222 572,092 866 1,003,614 33 162,077
District of Columbia 75 297,385 5 38,373 263 720,875 1,587 2,673,902 105 553,666
Florida 1,916 7,984,837 14 98,576 8,648 23,597,445 22,396 32,640,781 1,628 8,084,915
Georgia 419 1,727,963 5 44,420 2,580 9,385,952 12,468 19,408,220 864 4,219,500
Hawaii 7 40,063 184 509,494 661 967,641 19 104,474
Idaho 98 421,662 797 2,238,459 1,483 1,869,610 85 413,498
Illinois 880 2,633,769 6 40,360 5,609 14,012,234 17,450 20,803,853 751 3,654,821
Indiana 600 1,995,501 1 9,709 3,516 8,981,102 9,755 12,046,294 634 3,082,276
1 owa 363 1,478,948 1 6,536 2,765 7,619,863 6,095 7,671,184 348 1,674,145
Kansas 301 1,118,304 2,092 5,415,214 4,962 6,871,259 304 1,470,922
Kentucky 557 2,022,731 2 15,011 2,696 8,682,210 10,759 17,292,012 648 3,136,559
Louisiana 247 1,115,124 1 6,863 2,370 8,920,911 10,042 15,419,817 576 2,815,645
Maine 137 538,973 2 12,201 1,054 3,126,874 3,355 4,466,886 167 819,093
Maryland 373 1,291,937 3 37,990 1,536 3,754,140 6,810 8,926,094 415 2,080,903
Massachusetts 1,061 4,650,442 5 36,485 3,350 7,943,547 12,234 17,497,549 1,111 5,508,881
Michigan 730 2,285,094 4,613 10,928,825 14,029 16,062,181 663 3,206,377
Minnesota 838 3,411,723 4 30,200 3,522 10,151,769 8,537 12,810,649 731 3,524,090
Mississippi 425 1,911,787 1,789 7,027,699 9,539 16,000,691 774 3,805,489
Missouri 622 2,374,134 7 58,408 4,286 12,661,321 12,690 17,663,078 778 3,720,833
Montana 141 579,851 603 1,498,424 1,529 2,123,844 100 474,862
Nebraska 198 862,766 1 6,863 1,285 3,414,211 3,111 4,559,922 195 945,341
Nevada 79 312,611 1 6,168 274 725,234 1,147 1,496,106 73 342,049
New Hampshire 104 423,580 2,242 612 1,476,262 1,815 2,563,995 134 677,616
New Jersey 554 1,846,816 2 20,880 3,499 7,165,484 11,115 10,819,659 481 2,396,081
New Mexico 207 1,027,382 2 14,304 764 2,366,138 2,976 5,353,290 261 1,284,689
New York 1,485 5,324,243 7 51,201 8,645 19,409,957 31,180 41,536,093 1,463 7,173,155
North Carolina 381 1,857,616 1 14,936 3,569 12,112,734 13,632 18,827,890 624 3,089,231
North Dakota 93 416,801 378 1,054,981 1,181 1,822,898 58 266,364
Ohio 1,142 3,646,903 5 38,298 5,883 14,501,047 19,551 26,016,399 1,124 5,505,056
Oklahoma 419 2,044,193 1 11,915 2,554 8,859,914 9,958 17,299,794 564 2,723,431
Oregon 358 1,428,036 2 14,873 2,569 6,806,554 6,064 8,813,108 386 1,915,025
Pennsylvania 1,332 4,649,598 8 57,779 7,424 17,755,671 23,753 28,151,747 1,232 6,088,116
Rhode Island 130 518,860 760 1,770,452 2,226 2,221,316 104 521,724
South Carolina 200 653,526 3 25,241 1,599 5,443,733 6,893 9,376,998 424 12,133,837
South Dakota 128 468,928 885 2,654,933 2,113 3,223,542 111 535,472
Tennessee 446 1,812,857 4 30,516 3,232 11,003,689 13,130 19,431,341 738 3,596,643
Texas 1,134 5,230,705 10 71,042 8,452 29,419,387 29,061 42,325,071 1,908 9,365,381
Utah 122 424,762 614 1,406,639 1,479 2,164,598 106 503,949
Vermont 83 330,773 321 811,085 1,126 1,557,928 86 427,267
Virginia 426 1,762,886 7 53,639 2,526 7,666,281 10,758 14,943,931 574 2,830,347
Washington 474 1,956,382 2 11,770 2,569 6,617,289 7,244 10,147,796 483 2,356,340
West Virginia 223 751,641 1 7,521 1,607 4,930,064 6,090 9,252,032 232 1,136,982
Wisconsin 627 2,259,427 2 12,098 4,144 11,543,297 7,644 11,951,720 592 2,939,760
Wyoming . . . . 61 219,062 1 6,536 267 685,775 513 1,034,249 50 230,057
228
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State—Fiscal Year 1981
Compensation and Pension
State World War 1 Regular Establishment
Deceased Veterans Living Veterans
Non-Service Connected Total Service Connected Reserve Officers Special Acts
Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 434,324 $512,536,407 284,127 $892,543,137 284,112 $892,534,911 $4,270 15 $3,956
Philippines 2,591 7,850,839 372 2,373,342 372 2,373,342
Other Foreign Areas 6,145 13,029,346 999 3,100,600 999 3,100,600
Puerto Rico 3,890 8,211,407 3,379 17,655,361 3,379 17,655,361
Other U.S. Areas 47 76,722 102 349,852 102 349,852
Total U.S 421,651 483,368,093 279,275 869,063,982 279,260 869,055,756 4,270 15 3,956
Alabama 9,886 12,327,870 5,517 16,283,433 5,517 16,283,433
Alaska 118 192,917 612 1,265,890 612 1,265,890
Arizona 3,973 4,989,813 5,290 17,413,651 5,289 17,413,533 1 118
Arkansas 8,025 10,660,032 3,544 15,541,300 3,544 15,541,253 47
California 32,354 30,285,607 28,459 85,509,762 28,457 85,509,503 2 259
Colorado 3,457 3,893,322 5,254 15,299,579 5,254 15,299,579
Connecticut 3,828 3,404,889 3,256 8,635,774 3,256 8,635,774
Delaware 833 841,537 785 2,314,928 785 2,314,928
District of Columbia 1,482 2,120,236 1,180 4,195,913 1,180 4,195,874 39
Florida 20,768 24,555,866 20,005 72,380,123 20,004 72,380,005 1 118
Georgia 11,604 15,188,720 8,150 27,797,865 8,149 27,797,747 1 118
Hawaii 642 863,167 1,478 3,839,899 1,478 3,839,899
Idaho 1,398 1,456,112 1,232 3,538,678 1,232 3,538,678
Illinois 16,699 17,149,032 6,551 16,967,475 6,551 16,967,475
Indiana 9,121 8,964,018 4,521 13,628,219 4,520 13,628,101 1 118
Iowa 5,747 5,997,039 2,239 7,001,202 2,239 7,001,202
Kansas 4,658 5,400,337 2,534 7,816,327 2,533 7,814,760 1 1,567
Kentucky 10,111 14,155,453 3,804 13,345,537 3,800 13,344,767 4 770
Louisiana 9,466 12,604,172 4,235 13,277,695 4,235 13,277,695
Maine 3,188 3,647,793 1,831 5,826,179 1,831 5,826,179 •
Maryland 6,395 6,845,191 5,620 15,450,338 5,620 15,450,338
Massachusetts 11,123 11,988,668 9,458 26,363,464 9,458 26,363,464
Michigan 13,366 12,855,804 8,111 24,973,870 8,111 24,973,870 *
Minnesota 7,806 9,286,559 4,135 10,746,775 4,135 10,746,775
Mississippi 8,765 12,195,202 2,785 10,253,937 2,785 10,253,866 71
Missouri 11,912 13,942,245 4,829 16,089,458 4,829 16,089,458
Montana 1,429 1,648,982 1,095 3,042,397 1,095 3,042,397
Nebraska 2,916 3,614,581 1,679 5,664,002 1,679 5,664,002
Nevada 1,074 1,154,057 1,527 4,510,848 1,527 4,510,848
New Hampshire 1,681 1,886,379 1,737 5,186,227 1,737 5,186,227
New Jersey 10,634 8,423,578 7,863 20,082,561 7,863 20,082,561
New Mexico 2,715 4,068,601 2,363 7,800,333 2,363 7,800,333
New York 29,717 34,362,938 17,350 52,274,907 17,348 52,274,671 2 236
North Carolina 13,008 15,738,659 7,563 25,910,937 7,563 25,910,701 236
North Dakota 1,123 1,556,534 618 1,652,722 618 1,652,722
Ohio 18,427 20,511,343 10,261 30,538,347 10,260 30,538,229 1 118
Oklahoma 9,394 14,576,363 5,761 20,613,852 5,761 20,613,852
Oregon 5,678 6,898,083 3,662 11,480,381 3,662 11,480,381
Pennsylvania 22,521 22,063,631 12,402 37,162,100 12,402 37,162,100
Rhode Island 2,122 1,699,592 1,467 4,443,932 1,467 4,443,932
South Carolina 6,469 7,243,161 3,574 10,427,609 3,574 10,427,609
South Dakota 2,002 2,688,070 750 2,516,470 750 2,516,470
Tennessee 12,392 15,834,698 4,906 16,618,247 4,906 16,618,247
Texas 27,153 32,959,690 22,370 71,616,936 22,370 71,612,666 4,270
Utah 1,373 1,660,649 1,526 4,373,615 1,526 4,373,615
Vermont 1,040 1,130,661 688 2,306,007 688 2,306,007
Virginia 10,184 12,113,584 9,344 29,652,055 9,343 29,651,914 1 141
Washington 6,761 7,791,456 7,033 21,105,462 7,033 21,105,462
West Virginia 5,896 8,115,050 2,347 7,661,791 2,347 7,661,791
Wisconsin 8,561 9,011,960 5,385 14,934,365 5,385 14,934,365
Wyoming 656 804,192 589 1,730,608 589 1,730,608
229
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State — Fiscal Year 1981
Compensation and Pension
State Regular Establishment Mexican Border Services
Deceased Veterans Living Veterans
Total Service Connected Special Acts Total Service Connected
Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 50,366 $256,988,080 50,358 $256,985,940 8 $2,140 156 $443,909 5 $45,925
Philippines 673 3,232,786 673 3,232,786
Other Foreign Areas 836 4,344,082 836 4,344,082
Puerto Rico 374 1,676,509 374 1,676,509
Other U.S. Areas 37 168,913 37 168,913
Total U.S 48,446 247,565,790 48,438 247,563,650 8 2,140 156 443,909 5 45,925
Alabama 1,385 6,624,488 1,385 6,624,488 1 7,371
Alaska 44 223,733 44 223,733
Arizona 902 4,823,953 902 4,823,953 3 4,804
Arkansas 685 3,115,039 685 3,115,039 1 3 287
California .... 6,644 37 662,776 6,644 37 662 776 16 49 844
Colorado. . . 872 4,706,086 872 4 706 086 1 173 1,173
Connecticut. 332 1,796,422 332 1,796,422 4 7,135
Delaware 107 538,289 107 538,289
District of Columbia . 293 1,862,727 293 1,862,727 1 2 314
Florida 3,952 21,832,420 3,952 21 832,420 13 33 913 1 1 440
Georgia 1,902 9,573,114 1,902 9,573,114 2 9,503 1 8,239
Hawaii 271 1.508,474 271 1,508,474
Idaho 163 795,478 163 795,478
Illinois 903 4 111,673 903 4,111,673 7 15 992
Indiana 655 2,910,897 654 2,910,676 1 221 2,044
Iowa 288 1,342,485 288 1,342,485 4 7,298
Kansas 545 2,526,911 545 2,526,911
Kentucky 829 3,698,667 828 3,698,402 1 265 3 11,711
Louisiana 956 4,517,371 956 4,517,371
Maine 258 1,277,494 258 1,277,494
Maryland 1,114 6,314,699 1,113 6,314,478 1 221 1 5,031
Massachusetts 997 5,091,001 996 5,090,780 1 221 5 14,491 1 7,999
Michigan 833 3,766,635 832 3,766,414 1 221 6 10,135
Minnesota 420 1,829,001 420 1,829,001 77
Mississippi 750 3,440,578 750 3,440,578
Missouri 900 4,225,584 900 4,225,584 1 7,675
Montana 120 552,975 120 552,975
Nebraska 269 1,341,439 269 1,341,439 6 12,491
Nevada 202 1,094,049 202 1,094,049
New Hampshire 187 1,011,859 187 1,011,859 7 21 045
New Jersey 876 4,337,239 876 4,337,239 1 2 078
New Mexico 373 1,911,889 373 1,911,889 4 9 235
New York 1,558 7,538,773 1,557 7,538,552 1 221 4 12 294
North Carolina 1,684 7,798,971 1,684 7,798,971 7 27,592
North Dakota 73 286,014 73 286,014
Ohio 1,213 5,567,236 1,213 5,567,236 4 17,442 1 5,452
Oklahoma 1,049 5,104,982 1,049 5,104,982
Oregon 487 2,395,670 487 2,395,670 3 7,581
Pennsylvania 1,570 7,458,082 1,570 7 458 082 12 22 975 1 4,159
Rhode Island 242 1,296,212 242 1,296,212 4 6,034
South Carolina 1,011 5,099,570 1,011 5,099,570 6 7,113
South Dakota 89 369,964 89 369,964
Tennessee . . 1,135 5,010,670 1,134 5,010,449 3 11 669
Texas 4,585 24,161,045 4,584 24,163,496 1 221 15 45,672
Utah 193 991,197 193 991,197 1 549
Vermont 96 506,717 96 506,717 1 1 217
Virginia 2,224 12,656,406 2,224 12,656,406 6 16 682 720
Washington 1,269 6,801,072 1,269 6,801,072 3 20^917 16,743
West Virginia 396 1,710,254 396 1,710,254
Wisconsin 483 2,135,296 483 2,135,296 1 5 117
Wyoming 62 309,214 62 309,214 1 2^957
2 30
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State —Fiscal Year 1981
Compensation and Pension
State Mexican Border Service Spanish-American War
Living Veterans Deceased Veterans Living Veterans
Non-Service Connected Total Service Connected Non-Service Connected Total
Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 151 $397,984 488 $566,247 1 $7,365 487 $558,882 86 $353,536
Philippines 1 16,698
Other Foreign Areas
Puerto Rico 2 7,403
Other U.S. Areas
Total U.S 151 397,984 488 566,247 1 7,365 487 558,882 83 329,435
Alabama 1 7,371 4 7,850 1 6,243 3 1,607 213
Alaska 6,557 6,557 ......
Arizona 3 4,804 6 6
Arkansas 1 3,287 7 8,466 7 8,466 1 11 8,505 60,525 479
California 16 49,844 24 18,130 24 18,130 5,469
Colorado 2 5,469
Connecticut 4 7,135 12 6,009 12 6,009 5,354
Delaware 2,314 1 5,354 1 4,982
District of Columbia 1
Florida 12 32,473 29 31,538 29 31,538 13 46,380 18,147
Georgia 1 1,264 5 8,692 5 8,692 2
Hawaii
Idaho 8,180 10,259 17,396
Illinois 7 15,992 7 8,180 7 2
Indiana 2,044 25 20,289 25 20,289
Iowa 4 7,298 18 20,178 18 20,178 1 6,432
Kansas 7 7,267 • 7 7,267 3 8,125 5,645
Kentucky 3 11,711 3 5,815 3 5,815 3
Louisiana 3 3,215 3 3,215
Maine 6 5,199 6 5,199
Maryland 1 5,031 18 22,980 18 22,980
Massachusetts 4 6,492 26 20,742 26 20,742 2 4,199
Michigan 6 10,135 11 21,476 11 21,476 2,331
Minnesota 77 12 13,784 12 13,784 1 903
Mississippi 1 1,119 1 1,119 1 1,808
Missouri 1 7,675 17 20,877 17 20,877 903
Montana 1 2,639 1 2,639 1
Nebraska 6 12,491 1 5,033 1 5,033 1 9,292
Nevada ...... 10 10,954
New Hampshire 7 21,045 10 10,954
New Jersey 1 2,078 16 16,297 16 16,297 3 11,344
New Mexico 4 9,235 4 6,577 4 6,577 7,974
New York 4 12,294 25 22,405 25 22,405 3
North Carolina 7 27,592 15 19,873 15 19,873 1 3,550
North Dakota 2 3,453 2 3,453 31,782
Ohio 3 11,990 16 21,742 16 21,742 3
Oklahoma 8 7,462 1,122 8 7,462 2,126
Oregon 3 7,581 13 14,236 13 13,114 3 7,102
Pennsylvania 11 18,816 35 28,982 35 28,982 6 13,725
Rhode Island 4 6,034 2 3,517 2 3,517 4,395
South Carolina 6 7,S?3 12 20,234 12 20,234 1
South Dakota 2 2,778 2 2,778
Tennessee 3 11,669 10 15,904 10 15,904 5 6,825
Texas 15 45,672 25 45,906 ...... 25 45,906 2 6,550
Utah 3 4,406 3 4,406
Vermont 1 1,217 4 3,679 4 3,679 4,784
Virginia 6 15,962 8 5,021 8 5,021 4
Washington 3 4,174 8 8,315 8 8,315 3 18,178
West Virginia 7 4,814 7 4,814 1 1,280
Wisconsin 1 5,117 17 22,834 17 22,834 2 3,296
Wyoming 1 2,957
231
FISCAL
TABLE 84—Continued
Estimated Selected Expenditures By State—Fiscal Year 1981
State Compensation and Pension
Spanish-American War
Living Veterans Deceased Veterans
Service Connected Non-Service Connected Total Service Connected Non-Service Connected
Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 1 $29,789 85 $323,747 11,452 $17,352,540 120 $589,331 11,332 $16,763,209
Philippines 1 16,698 592 1,833,018 2 8,088 590 1,824,930
Other Foreign Areas 142 238,558 142 238,558
Puerto Rico 7,403 112 230,006 1 5,773 111 224,233
Other U.S. Areas 2 8 7,310 8 7,310
Total U.S 1 29,789 82 299,646 10,598 15,043,648 117 575,470 10,481 14,468,178
Alabama 213 147 215,767 2 9,779 145 205,988
Alaska 1 1,064 1 1,064
Arizona 114 151,395 114 151,395
Arkansas 1 8,505 136 212,325 1 4,651 135 207,674
California 193 11 60,332 1,716 2,360,210 10 49,030 1,706 2,311,180
Colorado 479 124 170,924 1,705 124 169,219
Connecticut 135 171,457 135 171,457
Delaware 17 27,270 1,998 17 25,272
District of Columbia 783 2 4,199 96 128,094 3,024 96 125,070
Florida 13 46,380 739 1,059,571 20 93,636 719 965,935
Georgia 2 18,147 238 337,521 3 20,105 235 317,416
Hawaii 18 25,115 1 4,432 17 20,683
Idaho 38 56,558 38 56,558
Illinois 2 10,259 376 524,075 2 7,888 374 516,187
Indiana 2 17,396 301 455,212 7 39,202 294 416,010
Iowa 1 6,432 101 145,539 1 3,944 100 141,595
Kansas 3 8,125 144 214,392 144 214,392
Kentucky 3 5,645 252 419,745 8 35,520 244 384,225
Louisiana 133 192,108 1 3,944 132 188,164
Maine 59 82,129 59 82,129
Maryland 213 306,503 4 19,009 209 287,494
Massachusetts 2 4,199 197 275,283 2 8,375 195 266,908
Michigan 2,331 304 412,815 4 18,586 300 394,229
Minnesota 1 903 142 200,163 3 12,129 139 188,034
Mississippi 1 1,808 96 152,366 2,325 96 150,041
Missouri 281 401,732 2 8,944 279 392,788
Montana 1 903 44 60,050 44 60,050
Nebraska 1 9,292 68 90,703 1 5,128 67 85,575
Nevada ; 24 43,604 24 43,604
New Hampshire 44 58,327 2 6,365 42 51,962
New Jersey 3 11,344 265 338,014 1 3,944 264 334,070
New Mexico . . . . ; 44 57,690 44 57,690
New Y ork 3 7,974 550 738,687 5 28,565 545 710,122
North Carolina 1 3,550 222 317,434 3 13,339 219 304,095
North Dakota 12 18,907 12 18,907
Ohio 1 21,112 2 10,670 434 635,245 4 20,087 430 615,158
Oklahoma 2,126 149 217,342 1 3,944 148 213,398
Oregon 3 7,102 222 302,007 3,944 222 298,063
Pennsylvania 6 13,725 431 602,057 3 18,322 428 583,735
Rhode Island 30 45,170 1 3,944 29 41,226
South Carolina 1 4,395 132 180,737 2 7,126 130 173,611
South Dakota 23 27,773 23 27,773
Tennessee 5 6,825 326 510,152 7 33,201 319 476,951
Texas 2,776 2 3,774 581 850,110 4 19,413 577 830,697
Utah 19 29,880 19 29,880
Vermont 33 45,174 1 4,651 32 40,523
Virginia 4 4,784 255 374,036 6 30,674 249 343,362
Washington 4,708 3 13,470 312 426,898 5 21,573 307 405,325
West Virginia 217 1 1,063 84 124,157 84 124,157
Wisconsin 2 3,296 153 215,174 3,024 153 212,150
Wyoming 23 34,987 23 34,987
232
TABLE 84—Continued
FISCAL
Estimated Selected Expenditures By State —Fiscal Year 1981
Compensation and Pension
State Indian Wars Civil War
Deceased Veterans Deceased Veterans
Total Service Connected Non-Service Connected Total Service Connected Non-Service Connected
Number Amount Number Amount Number Amount Number Amount Number Amount Number Amount
World Total 38 $40,636 $ 38 $40,636 165 $193,145 4 $15,016 161 $178,129
Philippines 878 878
Other Foreign Areas 1 1
Puerto Rico
Other U.S. Areas
Total U.S 38 40,636 38 40,636 164 192,267 4 15,016 160 177,251
Alabama 7 6,898 7 6,898
Alaska 2,756 ...... 1,595 1,595
Arizona 2 2,756 2 2 2
Arkansas 6 5,071 6 5,071
California 5 5,464 5 5,464 10 9,531 10 9,531
Colorado 2 1,562 2 1,562
Connecticut 957 957
Delaware 1 1
District of Columbia 3 3,223 3 3,223
Florida 2 2,202 2 2,202 10 17,936 2,475 10 15,461
Georgia 1 663 1 663 2 1,901 2 1,901
Hawaii
Idaho 1 218 1 218
Illinois 2 2,386 2 2,386 5 5,801 5 5,801
Indiana 1 1,412 1 1,412 8 9,528 1 2,855 7 6,673
Iowa 3 2,552 3 2,552
Kansas 4 6,251 4 6,251
Kentucky 5 4,938 5 4,938
Louisiana 2 1,595 2 1,595
Maine 2 2,910 3,976 2 2,910
Maryland 2 5,252 1 1 1,276
Massachusetts 138 138 7 8,034 7 8,034
Michigan 5 7,390 ...... 5 7,390
Minnesota 3 4,490 4,490 1 1,914 1 1,914
Mississippi 6 8,080 6 8,080
Missouri 3 2,998 3 2,998 7 8,366 7 8,366
Montana
Nebraska 1 1,694 1 1,694
Nevada ......
New Hampshire
New Jersey 1,459 1,459 3 1,814 3 1,814
New Mexico 2 2 1 798 1 798
New York 2 2,242 2 2,242 3 2,519 3 2,519
North Carolina 2 1,626 2 1,626 5 5,954 5 5,954
North Dakota ...... 5,709
Ohio 1 565 1 565 6 5,709 6
Oklahoma 663 1 798 1 798
Oregon 1 663 1 3,594 ...... 3,594
Pennsylvania 1 663 1 663 3 3
Rhode Island 2 1,755 2 1,755
South Carolina 1 692 1 692 3 2,360 3 2,360
South Dakota 2 3,487 2 3,487
Tennessee 1 663 1 663 16 23,128 2 5,710 14 17,418
Texas 5 4,373 5 4,373 8 9,642 8 9,642
Utah
Vermont 4,977
Virginia 5 5 4,977
Washington 3 2,393 3 2,393
West Virginia 4 4,997 4 4,997
Wisconsin 326 ...... ...... 326
Wyoming
233
Index
Administrative scholars program......................38
Affiliations, VA medical centers.....................32
Age:
VA hospital patients................................51
Veterans.............................................2
Agent Orange......................................21,117
Alcohol dependence treatment.........................18
Ambulatory care...................................... 1 1
Appeals............................................. 118
Appropriations, VA....................................95
Audiology and speech pathology........................20
Audiovisuals........................................ 114
Audits and investigations........................... 114
Automatic data processing........................... 102
Awards: Compensation and pension..............................57
Employee............................................99
For handicapped persons........................... 102
For medical research.............................39, 40
Barrier-free design............................ 101,109
Biomedical equipment................................. 50
Blind rehabilitation..................................20
Building management................................. 50
Burial allowances.....................................62
Canteen...............................................30
Case management...................................... 19
Cemeteries............................................89
CHAMPVA.............................................. 15
Chaplains.............................................30
Compensation and pension:
Death compensation and dependency and indemnity
compensation..................................... 57
Death pension.......................................60
Disability compensation.............................58
Disability pension................................. 60
Period of service...................................60
VA patients receiving...............................52
Construction: Cemeteries............................................90
Costs.............................................. 108
Hospitals, replacement and relocation............. 108
Projects, current status of....................... 110
Consumer affairs..................................... 1 11
Cooperative studies...................................40
Counseling....................................... 1 8, 87
Data processing..................................... 102
Dentistry.............................................24
Dependents educational assistance.....................64
Diagnoses............................................ 53
Dietetics............................................ 29
Disabled veterans: Barrier-free design...............................101,109
Blind rehabilitation...................................20
Disability, compensation and pension...................57
Driver training....................................... 19
Life insurance........................................ 77
Prosthetics............................................20
Rehabilitation medicine................................19
Rehabilitation engineering research and development .... 41
Specially adapted housing..............................72
Spinal cord injury.....................................21
VA employment of......................................101
Vocational rehabilitation..............................85
Domiciliary care.........................................13
Driver training......................................... 19
Drug dependence treatment............................... 18
Education assistance: Counseling.............................................. 87
Educationally disadvantaged ...........................63
Free entitlement.......................................63
Litigation............................................115
Loans..................................................64
Post-Vietnam education fund............................64
Sons and daughters, wives and widows...................64
Veterans, servicepersons...............................63
Vocational rehabilitation..............................85
Education and training in health care:
Assistance for health manpower training institutions..38
For health care professionals..........................33
Emergency preparedness..............................48, 111
Employment, veterans: Assistance with..........................................83
Status of...............................................6
VA.....................................................98
Energy conservation.....................................109
Engineering ............................................ 49
Environmental medicine...................................21
Equal employment opportunity............................100
Exchange of medical information..........................37
Executive development and training.......................98
Extended care........................................... 11
Facilities, construction of............................ 108
Fair housing program.....................................73
Fellowship programs......................................34
Female veterans...........................................3
Financial management....................................1 13
Funding, agency..........................................95
Geriatric care: Extended care........................................... 11
Geriatric Research, Education and Clinical Centers....12
235
INDEX — Continued
Gl Bill ............................................... 63
Grants:
Health manpower training institutions.................38
Specially adapted housing.............................72
State homes.......................................... 14
State cemetery....................................... 92
Guardianship .......................................... 83
Handicapped persons............................... 28, 101
Headstones and markers..................................90
Health care..............................................9
Health services research and development................40
Hospital care...........................................10
Hospital-based home care............................... 14
Housing assistance: Credit market conditions................................72
Direct loans..........................................71
Fair housing program..................................73
Gl loans............................................. 71
Grants for specially adapted housing .................72
Mobile homes......................................... 69
Independent living program..............................85
Insurance:
Death benefits....................................... 75
National service life.................................76
Service disabled veterans insurance...................77
Servicemen's group life insurance.....................79
Total disability income provision.....................78
United States Government life insurance...............76
Veterans group life insurance.........................79
Veterans mortgage life insurance......................79
Veterans reopened insurance...........................78
Veterans special life insurance.......................77
Investigations......................................... 1 14
Judicial review........................................ 1 18
Labor management relations..............................99
Law and legislation:
Litigation...........................................115
New legislation....................................... 6
Leadership VA.......................................... 98
Library.................................................36
Life Insurance (see Insurance)
Loans: Education...............................................64
Housing (see Housing assistance)
Long-range planning................................47, 11 1
Management improvement................................. 1 11
Medical care: Costs of operation......................................42
Employment .......................................... 44
Facilities in operation..............................9
For dependents (CHAMPVA)............................. 15
Outpatient medical care.............................. 1 1
Medical centers, VA: Affiliation of......................................... 32
Construction of..................................... 108
Number of..............................................9
Medical district planning..............................47
Medical education and training (see Education and Training)
Medical media..........................................37
Medical research.......................................40
Medical services...................................... 15
MEDIPP................................................ 47
Memorial markers.......................................90
Mental health and behavioral sciences................. 17
Mental hygiene clinics................................ 17
Metered mail..........................................112
Minorities: Employment of.....................................100
Home loans to........................................73
Mobile homes.......................................... 69
Monitored Professional Services Program................31
National Cemetery System: Construction.......................................90
Headstones and markers...............................90
National cemeteries................................. 89
Neurology ............................................ 22
Nuclear medicine.......................................23
Nursing................................................26
Nursing home care..................................... 12
Optometry ............................................ 24
Outpatient medical care............................... 11
Outreach: Activities ....................................... 81
ForPOWs..............................................82
Paperwork management................................ 111
Patient satisfaction survey............................46
Pathology..............................................25
Pension (see Compensation and Pension) Performance appraisal..................................96
Personnel: Employee recognition and incentives................99
Executive development and training...................98
Health care employment...............................97
Staffing and recruitment.............................97
Veterans, employment of..............................98
Pharmacy...............................................28
Podiatry...............................................24
POWs.............................................. 19, 82
Presidential Memorial Certificate Program............ 115
Program evaluations.................................111
Prosthetic research....................................41
Prosthetics............................................20
Psychiatric care...................................... 17
Quality of care........................................45
Radiology..............................................22
Records management.................................. 1 11
Recreation.............................................28
Recruitment............................................97
Rehabilitation medicine............................... 19
Reorganization, DVB....................................85
Reports management.................................. 1 11
236
INDEX — Continued
Research:
Awards................................................39
Construction.........................................108
Cooperative studies...................................40
Medical...............................................40
Prosthetic .......................................... 41
Rehabilitation engineering............................41
Residents at VA medical centers.........................33
School liability........................................65
Security and law enforcement............................50
Sharing of specialized medical resources................49
Sickle cell anemia..................................... 16
Social work.............................................29
Specially adapted housing...............................72
Spinal cord injury:
Care..................................................21
Research..............................................41
Staffing ...............................................97
State approving agencies................................65
State cemetery grants...................................92
State home programs.................................... 14
Supplies and equipment.................................106
Surgery.................................................16
Telecommunications.................................... 105
Telephone services to veterans......................81
Training: Employee............................................98
Health care.......................................33
Veterans..........................................63
Unions..............................................99
Veterans: Age..................................................2
Education and income...............................5
Employment status..................................6
Female ........................................... 3
Number, by period of service.......................2
Work experience....................................6
Veterans assistance centers.........................83
Veterans canteen service............................30
Vietnam era veterans: Characteristics......................................6
Compensation and pension..........................60
Education assistance..............................63
VA employment of..................................98
Voluntary service...................................45
Women: Employment of......................................101
Veterans...........................................3
* U. S. GOVERNMENT PRINTING OFFICE : 1982 375-430
237