1. Veterans: The Other 1% AIRS Conference –New Orleans May 21, 2012 Bill York Chief Operating Officer 2-1-1 San Diego

2. The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by their nation. ~ George Washington "The spirit of service and selflessness that is seen in military communities across our country represents what is best about America, and as a Nation we owe our brave service members and their families more than gratitude we owe them the support they have earned. Joining Forces will ask all Americans to take action, because each of us has a role to play in reconnecting with military families in our communities. ~ First Lady Michelle Obama A LL V OLUNTEER S ERVICE

3. Over two million service members have deployed to fight the Global War on Terror, many for multiple tours of duty. These veterans return home not to the Department of Defense or the Department of Veterans Affairs, but to the communities in which they live and to the homes of their families. It is the responsibility of the community to recognize the sacrifice these men and women have made on our behalf and to help those veterans who are in need. 1% of Americans may be fighting our wars, but we need 100% of Americans to be supporting our troops and their families. O UR 1%

4. Courage To Call 2-1-1 San Diego Courage to Call Military, Veterans and Family Access Program Serves as a gateway to care 24 hours, 7 days a week by simply dialing 2- 1-1. Targeting military service members, active duty, Reservists, National Guard, veteransand their familiesthe program provides a peer-to-peer referral service program before, during and after deployment to Afghanistan or Iraq (OEF/OIF). Members of OIF/OEF, active duty military members and veterans in San Diego County need only to dial the toll-free. 2-1-1- number to talk with trained, compassionate Military Call Specialists (MCSs) who will assess and direct callers in a non-judgmental and confidential manner to the appropriate resources and services they need.

5. Operation Enduring Freedom (OEF) Refers to the conflict primarily in Afghanistan, as well as other theaters of combat operations Current Conflicts Global War on Terror (GWOT) – Includes Operation New Dawn and Operation Enduring Freedom Also Known As Overseas Contingency Operations Operation New Dawn (Operation Iraqi Freedom [OIF] Prior to 9/1/2010 Refers to 50,000 U.S. troops remaining in Iraq for non-combat operations Areas of Combat Operations Around the Globe 1 OEF/OIF BY C OUNTY

6. 1.C ULTURAL COMPETENCY 2.O UTREACH AND ENGAGEMENT 3.R ESOURCES AND R EFERRALS 1.M EASUREMENTS AND O UTCOMES S ERVICE D ELIVERY : 4 K EY C OMPONENTS

7. Military / Veterans Cultural Competency Non-military affiliated staff of community-based organizations, or anyone who interacts with veterans, will communicate more effectively if they have military/veterans cultural competency. Understanding the issues, problems, values, and language associated with serving in todays military or as veteran. Military/veteran culture is significantly different than civilian culture, with different values, attitudes, goals, and terminology…Todays civilian population knows less about military culture than in years past. Community-based organizations serving military/veterans can offer a more comfortable and welcoming environment if they are committed to maintaining military/veteran competency.

8. Operation Enduring Freedom (OEF) Refers to the conflict primarily in Afghanistan, as well as other theaters of combat operations Current Conflicts Global War on Terror (GWOT) – Includes Operation New Dawn and Operation Enduring Freedom Also Known As Overseas Contingency Operations Operation New Dawn (Operation Iraqi Freedom [OIF] Prior to 9/1/2010 Refers to 50,000 U.S. troops remaining in Iraq for non-combat operations Areas of Combat Operations Around the Globe 1 K EY T ERMS AND L INGO

9. A CTIVE D UTY (AD) Full-time active service in the U.S. Military (Army, Marine Corps, Navy, Air Force, Coast Guard). This includes members of the Reserve components serving on active duty but does not necessarily include all National Guardsmen serving full-time. A CTIVATED G UARD AND R ESERVE (AGR) National Guard and Reserve members who have been moved from their reserve status (mobilized) into active duty, usually for a set period of time (six months, one year, etc.). D RILLING R ESERVE Part-time military service usually consisting of one weekend a month plus two weeks a year. Includes the Army Reserve, Marine Corps Reserve, Navy Reserve, Air Force Reserve, Coast Guard Reserve, Army National Guard and Air National Guard. When Reserve forces are mobilized for full-time active duty service they serve on active duty until demobilized, at which point they revert back to drilling reserve status. N ATIONAL G UARD A Reserve component of the U.S. Armed Forces, the National Guard is a state militia that answers first to the governor but can be put into federal service by order of the president. When activated for full-time federal service Guard members are considered active duty but are not included in total strength numbers of the active duty Army/Air Force. If not on active duty status their service obligation is one weekend a month and two weeks a year and may be called-up for full time service such as in the case of natural disaster relief efforts. However, the state call-up is not considered active duty service. C OMMON T YPES OF M ILITARY S ERVICE

10. W HO DOES THE U.S. D EPARTMENT OF V ETERANS A FFAIRS (VA) CONSIDER A VETERAN ? W HO IS A V ETERAN ? For VA services, the VA generally requires active military service AND discharge under conditions other than dishonorable. 2 However, most VA benefits require at minimum a general under honorable conditions discharge. W HO IS CONSIDERED A VETERAN IN C ALIFORNIA ? Anyone who served in the U.S. military and was discharged under conditions other than dishonorable. However, most state benefits require an honorable discharge or release from active service under honorable conditions. 3 W HO SHOULD WE CONSIDER A VETERAN ? Anyone who has ever served in the U.S. military regardless of discharge. W HO IS A V ETERAN ?

11. WHAT ARE SOME STEREOTYPES ABOUT THE VETERAN POPULATION ? All veterans are in crisis All veterans can obtain VA services All veterans have served in combat Women do not serve in combat All combat veterans have Post- Traumatic Stress (PTS) You have to be in combat to get PTS V ETERANS : M YTHS AND S TEREOTYPES

12. Over 2.2 million men and women have been deployed to the Global War on Terror (GWOT). Forty percent (867,003) have been deployed more than once. 4 Over 61% (1,346,796) of GWOT veterans are currently separated from active duty AND are eligible for VA services. 5 50% of eligible GWOT veterans have obtained VA healthcare. 6 P OST -9/11 V ETERANS : W HO A RE T HEY ?

13. The National Guard has been transformed into an operational force to be frequently deployed; this represents a shift away from its traditional role as a force primarily designed for infrequent federal use against a large nation-state. 7 Roughly 30% of all service members who have served in areas in support of the wars in Iraq and Afghanistan are Guard and Reservists, 8 and 20% of service members currently deployed are National Guard and Reservists. 9 National Guard OIF/OEF veterans tend to be older, with an average age of 37. 10 More National Guard members have deployed to OIF/OEF than drilling reservist (367,443 Guardsmen compared to 278,492 Reservists). 11 NATIONAL GUARD AND RESERVE P OST -9/11 M ILITARY AND V ETERANS

14. Women comprise 15% of our active duty force, 12 18% of National Guard and Reserve, and 20% of new recruits. 13 Women often have difficulty gaining recognition for combat service. The risk of homelessness is two to four times greater for women veterans than for non-veterans. 14 Approximately one out of every ten homeless veterans under the age of 45 is a woman. 15 Higher proportions of women veterans are diagnosed with mental health conditions by the VA, but lower proportions are diagnosed with PTS and TBI. VBA denies female veterans' disability claims for PTS more often than males. This is believed to be in part due to the struggle for recognition of combat service. 16 Many women veterans feel uncomfortable at VA facilities and feel that female-specific services are lacking. 17 Female veterans are more likely to get divorced than both male veterans and female civilians. 18 P OST -9/11 M ILITARY AND V ETERANS W OMEN V ETERANS

15. Over half of the military is married and over 40% of service members have children. 19 There is evidence that having a parent deployed can lead to anxiety, 20 mental health and behavioral problems 21 as well as academic struggles for the child. 22 Ten percent of married service members are in dual-military marriages whereby a active duty, Reserve or Guard member is married to another service member. 23 Nearly 50% of all married active duty females are in dual military marriages. 24 Sixteen percent of women in the Reserves or Guard are single parents and roughly 12% of female active duty service members are single parents. 25 Seven percent of men in the Reserves or Guard and roughly 4% of active duty men are single fathers. 26 P OST -9/11 M ILITARY AND V ETERANS M ILITARY F AMILIES

16. P OST -9/11 M ILITARY AND V ETERANS M INORITIES One-third of the military self-identifies as a racial or ethnic minority. 27 Thirty percent of Reserve and National Guard members identify themselves as a member of a racial or ethnic minority. 28 4.75 million living U.S. veterans of all eras identify as a racial or ethnic minority. 29 Thirty-two percent of the nearly 1.8 million living female veterans of all eras identify as a racial or ethnic minority. 30 Minority service members are underrepresented among officers in the military in both active duty and Guard/Reserve forces. In the active duty forces, only 10.9% of minority members are officers when they make up 36% of the active duty force. Similarly, in the Guard and Reserve forces, 10.4% of minorities are officers when they make up 30.2% of the total force. 31 Racial minorities are disproportionately affected by Dont Ask; Dont Tell (DADT). Racial minorities comprise 29.4% of the military yet account for 45% of all DADT discharges. 32 African American women are the hardest hit – they make up less than 1% of the military, yet make up 3.3% of those discharged under DADT. 33 Culturally competent care significantly affects the treatment outcomes of minority veterans. 34 African American and Latino Vietnam veterans were more likely to develop PTS than Caucasians. 35 A 2008 study on VA patients suggested that African American veterans are less likely to be screened for mental health problems. 36 Research on prior era veterans shows that African American veterans are less likely to have their PTS claim approved by the VA. 37

17. WHAT HAVE VETERANS EXPERIENCED WHILE IN COMBAT ? 38 36.7%Received small arms fire 56.9%Received incoming artillery, rocket or mortar fire 18.1%Handled or uncovered human remains 34.1%Saw dead or seriously injured Americans 57.1%Knew someone seriously injured or killed 47.4%Saw dead bodies or human remains 45.4%Had a member of their unit become a casualty T HE C OMBAT E XPERIENCE

18. For every service member killed in action (6,086) there are seven wounded in action (44,596). When including non-combat injuries (55,243), the ratio of injured to killed jumps to sixteen to one. 39 One out of four veterans of the current conflicts has filed a disability claim at the VA, and the VA has already treated 30% of veterans of the two wars. 40 The large additional number of those who are treated by the VA and other providers beyond the DoD counts of injuries indicates the true numbers of veterans with psychological and cognitive injuries not counted by official sources, either because of delayed detection, delayed onset of symptoms, or stigma of reporting while in active duty. 41 About half (53%) of GWOT veterans who need treatment for major depression or PTS seek it. 42 Slightly more than one-half of veterans who seek treatment for mental health conditions receive minimally adequate care. 43 Minimally adequate care is defined as 1) taking a prescribed medication for as long as the doctor wanted and having at least four visits with a doctor or therapist in the past 12 months or 2) having had at least eight visits with a mental health professional in the past 12 months, with visits averaging at least 30 minutes. 44 I NJURIES AND T REATMENT

19. PTS is generally defined as an anxiety condition that can develop after exposure to a traumatic event or ordeal in which grave physical harm occurred or was threatened. Veterans with PTS and/or depression face a broad range of physical, cognitive, behavioral, emotional and social challenges. Research suggests rates of mental health conditions as high as 26%, with 37% of veterans treated at the VA having a mental health diagnosis. 45 Rates of PTS are as high as 35% when factoring in delayed onset if PTS. 46 Rates of PTS and depression are higher for Reservists than active duty. 47 As of January 2011, the VA reported 11.5% of GWOT veterans diagnosed with PTS. 48 There is no report of diagnoses from non-VA community providers which often diagnose and treat veterans, so the estimates of veterans diagnosed with PTS are likely much higher. Repeated deployments and short dwell time (time between deployments) increase the likelihood of developing PTS and other mental health conditions. 49 Veterans may not know they have PTS and thus may not seek proper treatment. Total healthcare costs for combat-induced PTS for GWOT veterans are estimated to be between $1.54 to $2.69 billion. 50 PTS AND O THER M ENTAL H EALTH C ONDITIONS

20. There is a high co-morbidity of mental health issues and substance abuse among GWOT veterans. Rates of substance abuse among veterans diagnosed with PTS or other mental health issues range from 21 % to 35%. 51 In 2009, 9,199 soldiers sought treatment for alcohol related problems, a 56% increase over 2003 when the Iraq war started. In order to meet this new demand, the Army says they need twice as many substance abuse counselors. 52 Reserve and National Guard personnel who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems, and younger members of all branches are at the greatest risk for alcohol problems. 53 There is little comprehensive data on substance abuse and dependence in the military because the use and abuse of drugs often results in a less than honorable discharge status and these discharge statues are omitted from many studies. 54 S UBSTANCE A BUSE

21. Traumatic Brain Injury (TBI) is caused by blunt force injury to the head which disrupts the function of the brain. In combat TBI often results from the concussive force of explosives which causes the brain to slam against the skull, often the result of an Improvised Explosive Device (IED). An estimated 19% of GWOT veterans may have experienced a TBI ranging from mild to severe, 55 although the number of diagnosed is much smaller (195,547 troops diagnosed according to DoD counts through September 2010). The disparate numbers of reported cases to those diagnosed are perceived in part due to a lack of adequate screening. Blasts and explosions have caused most of the surviving casualties with moderate to severe TBI thus far reported. 56 Certain symptoms of TBI may mimic symptoms of PTS, leading to a difficulty in diagnosing the veteran. Also, a veteran may experience PTS as well as TBI. T RAUMATIC B RAIN I NJURY ( TBI )

22. The VA has confirmed 18 suicides per day 57 among the entire veteran population and 1,000 suicide attempts per month among all veterans seen at VA medical facilities. 58 Since the wars began in Iraq and Afghanistan, there have been 289 suicides among deployed service members. 59 Many suicides are not counted because they are either disputed or covered up (a death that appears to be a suicide is listed as an accident, for example), or are undetermined. 60 There have been suicides among non-active duty reservists are not counted by the military, and the VA does not report suicides among all veterans, only those enrolled at the VA. Of the GWOT veterans enrolled at the VA who have died since being discharged from the military, 30% of the deaths were of veterans with a mental health diagnosis, most commonly PTS. 61 Adjusted risk of suicide for male veterans is twice that of non-veteran males. 62 Women veterans are two to three times more likely to commit suicide than non-veteran women. 63 Deployed women are three times more likely to commit suicide than non-deployed women, and deployed men are 42% more likely to commit suicide than non-deployed men. 64 Being married lowers the risk of suicide. 65 Incarcerated veterans have the highest risk of suicide, exceeding the risk attributable to either veteran status or incarceration alone. 66 In July 2007 the VA established the Veterans Suicide Hotline. As of July 2011, the hotline has received over 400,00 calls from veterans. 67 S UICIDE

23. Military Sexual Trauma (MST) refers to both sexual harassment and sexual assault that occurs in military settings. MST often goes unreported due to stigma and fear of potential loss of military career. Only 13.5% of survivors report the assault. 67 In 2010, less than 21% of reported cases went to trial, with only 53% convictions. 68 Since 2002 the VA has been screening all veterans for Military Sexual Trauma. 60% of women with Military Sexual Trauma also suffer from Post-Traumatic Stress Disorder. MST is the primary causal factor of PTS for women, while combat experience is the strongest predictor of PTS for men. 69 Service members often wait until they are out of the service to seek treatment for MST. Number of Positive MST Screens in VA (2002 – 2008) 44 M ILITARY S EXUAL T RAUMA ( MST )

24. In general the term homeless includes an individual who lacks a fixed, regular, and adequate nighttime residence and an individual whose primary nighttime residence is a shelter designed to provide temporary living accommodations. 70 Post- 9/11 veterans are becoming homeless at faster rates than prior era veterans. 71 Veterans are over-represented in the homeless population. Less than 8% of the U.S. population are veterans, yet 16% of all homeless adults are veterans. 72 75,609 veterans are homeless on a given night and an estimated 136,334 veterans experience homelessness over the course of the year. 73 One out of every ten living in poverty experience homelessness each year– twice the percentage of non-veteran poor. 74 Nearly 52% of homeless veterans are disabled, compared to 36% of homeless non veterans. 75 Nearly 26% of all homeless veterans are in California. 76 One of the most striking statistics is the difference in ages of homeless veterans compared to other homeless single adults. For example, 47% of homeless veterans are aged 51 and older, compared to 19% of non-veteran homeless. 77 Women veterans and veteran families are the fastest growing cohort of the homeless veteran population. There is a shortage of housing programs to accommodate families, and a shortage of women-specific housing programs. 78 Not all homeless veterans use VA services and the VA does not count those who are couch surfing (temporarily staying with family or friends but without a stable home) as homeless. Thus, the real number of homeless veterans is significantly higher. H OUSING I NSTABILITY AND H OMELESSNESS

25. A 2008 study for the VA found that 25% of employed veterans earn less than $21,840 a year. 79 Women veterans generally earn less than male veterans and often less than they made in the military. 80 During the housing crisis in 2008, foreclosure rates in military towns increased at four times the national average. 81 Prior to The Housing and Economic Recovery Act of 2008, the VA home loan designed to offer long-term financing to eligible veterans, capped loan amounts at $417,000 which discouraged many buyers in expensive areas and allowed veterans to pursue more subprime mortgages. Military families have been heavily targeted by lenders selling subprime mortgages. Predatory lenders may operate near military bases, often under the guise of military-related names. Legislation enacted in 2007 placed a 36% interest cap on lending to service members, 82 however military members must make their status known to lenders in order to be protected by the legislation which means many veterans are still being taken advantage of. Currently, the federal Qualified Veterans Mortgage Bond Program allows veterans in Alaska, Oregon, California, Wisconsin and Texas to purchase homes, but at a high cost. The mortgages are often adjustable-rate or interest-only, which creates a recipe for debt and foreclosure. F INANCIAL I NSTABILITY

26. The switch from military to civilian workforce can be challenging. Veterans can be unsure about how to apply for and how to interview for a job and employers are often wary of seeing a lack of civilian work experience. Employers and veterans both are unclear on how skills utilized in the military can translate into a different work environment. The unemployment rate for Post-9/11 veterans in 2010 was 11.5 %. National Guard and Reservists (Post-9/11) had a higher unemployment rate at 14%. Young male veterans aged 18 - 24 had an unemployment rate of 21.9%. 83 Disabled veterans face additional challenges. Not only must the veteran learn to adjust to their disability while looking for and working in a job, they also must overcome the stigma that many employers hold when hiring a disabled individual. Post-9/11 veterans with a service-connected disability have an unemployment rate of 11.2%. 84 Veterans are more likely to work in protective services, production, transportation, material moving, installation, maintenance, and repair. Non-veterans are more likely to hold service jobs, sales and office jobs. 85 Male veterans are three times more likely to be employed in protective services occupations than male non-veterans. 86 U NEMPLOYMENT

27. Many veterans enter the military at an age when their peers are attending college and thus when they exit the military, they are educationally behind their non-veteran counterparts. Immediately after separation from service, there is an average of a one year deficit in the number of years of schooling between veterans and non-veterans. 87 The Post-9/11 GI Bill offers educational benefits for those who served since September 11, 2001. It will pay up to 36 months of tuition up to the cost of the most expensive public school in the state and will also provide for some living expenses and books. Veterans with a less than honorable discharge are not eligible for the Post-9/11 GI Bill. There has been a severe backlog in GI Bill claims. And although the VA has made strides to alleviate the backlog, as of July 2011 there were over 100,000 pending educational benefit claims, including 15,000 pending Post-9/11 GI Bill claims. 88 For-profit schools may specifically target veterans and military members for enrollment. They sometimes offer special incentives for enrolling military members and have also been known to misrepresent potential career opportunities and salary outcomes to students, while encouraging them to take classes that will have little benefit for their future. 89 Since unemployment is high among younger veterans, some use the GI Bill to pay for living expenses, and enter college before they are ready to. Others are using the GI Bill to pay for living expenses while they wait for their disability claim to be processed by the VA. There is a 36 school-month time frame in which veterans must use their benefits. The timeframe may be too short to complete school for those suffering from PTS, TBI or other mental or physical injuries. E DUCATION I SSUES

28. Veterans who return with mental health disorders are at risk for increased inter-partner violence (IPV). 90 There is a significant link between the severity of PTS and IPV severity. 91 A study of Vietnam-era veterans showed that those with PTS are more likely to commit acts of domestic violence than those without PTS. 92 A study of OIF/OEF veterans showed that 60% of veterans in families who were referred for a mental health evaluation at a VA center experienced IPV with 53.7% reporting shouting, pushing or shoving. Three quarters of the veterans had some kind of family readjustment issue such as feeling like a stranger in their own home, being unsure about their family role or having their partner afraid of them. 93 Transition phases (deployment and reintegration) cause increased stress on the family and have been linked to child mistreatment. 94 Current treatment models for veterans with IPV call for a standard Batterer Intervention Program which often treats IPV alone and doesnt consider the intersection of IPV with PTS, TBI, and other military service-related issues. Many providers are calling for individualized treatment plans which allow the veteran to be simultaneously treated for service-related issues as well. 95 D OMESTIC V IOLENCE

29. Often, learned military skills and tactics such as hyper-vigilance and rapid response to threatening encounters that enhance survival in combat may translate to aggressiveness, impulsivity, arrest, and potential for incarceration in the civilian community. 96 Roughly one out of ten incarcerated persons is a veteran. 97 The most recent national data on justice-involved veterans is from 2004, showing that Iraq/Afghanistan veterans already comprised 4% of the total veteran population incarcerated in state and federal prison. It is anticipated that the number of recent veterans engaging with the criminal justice system has and certainly will continue to rise. 98 Veterans with less than honorable discharges represent roughly 40% of the incarcerated veteran population. 99 Literature shows that the single greatest predictive factor for the incarceration of veterans is substance abuse. 100 The VAs Veteran Justice Outreach (VJO) Program allows for justice-focused activity at the medical center level (VA, 2011). A designated VJO specialist resides at each medical center, and provides direct outreach, assessment, and case management for justice-involved veterans in local courts and jails as well as outreach to state and federal prison veteran inmates, and liaisons with local justice system partners. Veteran Treatment Courts have emerged throughout the country as models for veteran diversion in the judicial system. They are a rehabilitative rather than punitive alternative to traditional court systems with a focus on low barrier entry, meaningful treatment, motivational interviewing and assertive case management. Unfortunately, legislative and regulatory rulings often restrict admission criteria to the court. Some jurisdictions currently operating Veteran Courts are limited by state statutes which govern their treatment court operations and limit their charge-based eligibility. 101 C RIMINAL J USTICE I SSUES

30. Dont Ask, Dont Tell (DADT) is the Department of Defenses policy against homosexuals serving openly in the military. The rationale is that homosexuals serving openly in the military would threaten unit cohesion and military capability. The policy was initially thought of as a way to protect homosexual service members. There are an estimated 66,000 gay troops currently serving in the military 102 and over one million lesbian, gay, bi-sexual (LGB) veterans. 103 As of 2009, 13,500 service members had been discharged as a result of DADT. 104 The 13,500 figure does not even include those who resign or avoid enlistment because of discrimination and hardships caused by DADT. Service members who are given a less than honorable discharge because of homosexual conduct may be denied access to benefits such as VA healthcare, disability compensation and the GI Bill. Veterans seeking employment who must show their discharge papers are forced to be outed to potential employers if homosexual conduct is listed as a narrative reason for their discharge. DADT policy creates financial burdens for discharged service members. Since being discharged cuts service short, the discharged veteran may fail to meet the service requirements for already received benefits and recoupments and may be required to reimburse the military when they are discharged prematurely. 105 There have been many efforts to repeal the policy: the Supreme Court found it unconstitutional in September 2010, and shortly after the judge presiding in the case issued a "worldwide injunction" against further discharges. In November 2010 the U.S. 9th Circuit Court of Appeals suspended the judges order while the case was being appealed. Congress then repealed the policy but left it in force until the President, the Defense Secretary and the Joint Chiefs of Staff could prove that training and preparation among all military branches was accomplished for the integration of openly serving members. A federal Appeals Court ruled in July 2011 the law banning openly gay people from serving in the military should no longer be enforced. D ON T A SK, D ON T T ELL ( DADT )

31. T HE B ACKLOG OF VA D ISABILITY C LAIMS The backlog of disability claims is over 800,000, with 60% of claims pending over 125 days. 106 The average wait time is over five months (166 days) for an initial decision. 107 552,215 GWOT veterans have filed disability claims, and 20% (93,963) of the claims files are pending. 108 Only 48% of GWOT veterans with a diagnosis of PTS have been granted a service-connected disability for PTS. 109 Time frame for a final claim decision, when including appeals, can exceed ten years. National Guard and Reservists are half as likely to file a disability claim than active duty veterans and are twice as likely to have their claim denied. 110 Applying for VA disability and compensation can prove so difficult that many veterans simply abandon their disability claims. V ETERANS B ENEFITS A DMINISTRATION

32. U.S. D EPARTMENT OF V ETERAN A FFAIRS V ETERANS B ENEFITS A DMINISTRATION V ETERANS H EALTH A DMINISTRATION N ATIONAL C EMETERY A DMINISTRATION T HE VA S YSTEM OF C ARE

33. The following information presents the general rules applicable to veterans seeking VA benefits; there are often exceptions to each of these rules. Veterans must first enroll in VA healthcare. Generally, veterans must have: An honorable discharge (includes general under honorable conditions discharges); Served 24 continuous months on active duty; Demonstrate financial need; and/or a service-connected disability. 111 OIF/OEF veterans are eligible for five years of free healthcare and may be eligible for 180 days of dental care after separation. 112 Because VA healthcare is rationed, an enrolled veteran is assigned to one of eight priority groups. Service-connected veterans, those with a disability which the VA has determined was incurred or aggravated during service, are given the highest priority. A CCESSING VA H EALTHCARE

34. H ONORABLE G ENERAL U NDER H ONORABLE C ONDITIONS O THER THAN H ONORABLE (OTH) B AD C ONDUCT (BCD) D ISHONORABLE (DD) C HARACTER OF S ERVICE U.S. M ILITARY D ISCHARGES

35. HOW CAN VETERANS WITH OTHER THAN HONORABLE DISCHARGES ACCESS BENEFIT S ? C HARACTER OF S ERVICE D ETERMINATION D ISCHARGE U PGRADE A determination made by the VA to grant baseline eligibility for benefits to a veteran with a discharge that is other than honorable. It does NOT change the type of discharge. A formal procedure before a military board that can change the reason for discharge, character of service or other aspects of military records. This is outside the VA system and not part of this presentation. VA B ENEFITS

36. S ERVICE C ONNECTED D ISABILITY C OMPENSATION ( SCDC OR COMP ) Monthly payment for disability that was incurred or aggravated during military service or meets requirements for presumptive disability, or VA medical treatment negligence. Payment is calculated from 0% – 100%. Percentage is the disability rating. SCDC is a tax-free benefit and is not reduced by other income. K EY T ERMS AND L INGO

37. N ON -S ERVICE C ONNECTED P ENSION ( NSCP, PEN OR PENSION ) Monthly payments to impoverished veterans who are permanently and totally disabled by conditions not related to service. Payment is offset by most other income. Requires active military service of at least 90 days, at least one day of which was served during wartime. 115 K EY T ERMS AND L INGO

38. Outreach and Engagement Community-based organizations must attract veterans to successfully deliver services. Hiring veteran and military affiliated staff who bring along their personal experiences and be trained in I&R and peer support. Creating working and referral relationships with private, public and community colleges campus police, deans, and campus health services including mental health clinicians as well as Student Veterans Associations (SVAs).* Joining local coalitions that address veterans issues. Collaborating with faith-based organizations and area ecumenical councils. The VA and its partner federal agencies, HUD, DOL and HHS, are actively seeking ways to expand services, including partnerships with community-based Organizations

39. Resources and Referrals Peer line Specialists and Data Center Community Liaison Veteran Peer Outreach Specialists Family Support Partners MHSVVSD 2-1-1MHA

40. Resources and Referrals If there was ever a time for an AIRS standard on data, the time is NOW! Maintain an up-to-date, comprehensive health and human care database that includes specific services for military service members, veterans, and their families. Verifying legitimacy of organizations – more stringent vetting processes More complete service and program descriptions and detailed eligibility criteria Work with service providers and coalitions to create a universal information exchange system Prevention and early intervention programs (PEI) are key to helping veterans, military and their loved ones lead productive and healthy lives.

41. Reports and Outcomes Collect as much data as you can on needs, referrals, demographics and trends Do 100% follow up 30, 60, 90 or longer Case manage Client satisfaction surveys Share your data to your community: elected officials, government entities, funders, board of directors

42. L EGISLATION W E S UPPORT BE SURE TO C ONTACT YOUR L OCAL R EPRESENTATIVES H.R. 865: Veteran Employment Transition Act of 2011 Amends the Internal Revenue Code to revise the definition of "qualified veteran" for purposes of the work opportunity tax credit to mean recently discharged veterans and any veteran receiving specified benefits. Defines "recently discharged veteran" to mean: 1) any individual who has served on active duty (other than active duty for training) in the Armed Forces for more than 180 consecutive days, 2) any individual who has been discharged or released from active duty for a service- connected disability, and 3) any member of the National Guard who has served for more than 180 consecutive days in active duty, full-time National Guard duty, or duty in state status. Defines "veteran receiving specified benefits" as any veteran who is certified as being a member of a family receiving assistance under a supplemental nutrition assistance program and is entitled to compensation for a service-connected disability. Requires the Department of Defense (DoD) and the National Guard to inform military personnel who are discharged or released from active duty of the work opportunity tax credit and provide them with documentation relating to eligibility for and use of such credit. H.R. 2433- Veterans Opportunity to Work Act of 2011 Would make certain improvements in the laws relating to the employment and training of veterans, including transition assistance and direct training services. S. 951- Hiring Heroes Act of 2011 A bill to improve the provision of Federal transition, rehabilitation, vocational, and unemployment benefits to members of the Armed Forces and veterans. H.R. 1133- Helping Our Homeless Veterans Act of 2011 Authorizes the Secretary of Veterans Affairs (VA) to enter into agreements with state or local government agencies, tribal organizations, and nonprofit organizations to collaborate in the provision of case management services to expand and improve the provision of supported housing services and related outreach to veterans, including veterans in rural areas or underserved veterans who live in metropolitan areas or on Indian lands. Outlines support services to be provided, including the maintenance of referral networks for homeless veterans. Requires each entity chosen to report annually to the Secretary on collaborative services undertaken. Includes within case management services personal health and development assistance and housing assistance for veterans.

43. S. 935- Veterans Outreach Enhancement Act of 2011 Directs the Secretary of Veterans Affairs (VA) to carry out a five-year program of outreach to veterans to increase: 1) their access and use of federal, state, and local programs providing compensation and other benefits for service in the Armed Forces; and 2) their awareness of and eligibility for such programs. Allows the Secretary, under the program, to enter into agreements with other federal and state agencies and specified authorities and commissions to carry out projects to further such purposes. H.R. 930 - Disability Compensation Evaluation Procedure Related To Military Sexual Trauma Directs the Secretary of Veterans Affairs (VA) to accept as proof of service-connection of post-traumatic stress disorder (PTSD) alleged to have been incurred in or aggravated by active military service a diagnosis of PTSD by a mental health professional, together with written testimony by the veteran and a written determination by the professional that such disorder is related to the veteran's service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and to resolve every reasonable doubt in favor of the veteran. Allows such service-connection to be rebutted by clear and convincing evidence to the contrary. Provides the same conditions (with the same authorized rebuttal) with respect to acceptance of proof of service-connection of certain mental health conditions alleged to have been incurred or aggravated by military sexual trauma experienced during active military service. H.R. 26- Veterans Mental Health Screening and Assessment Act Expresses the sense of Congress that: (1) the increasing rate of suicide among veterans returning from Operations Enduring Freedom and Iraqi Freedom is a serious problem; and (2) the Secretary of Defense should conduct mandatory, face-to-face, and confidential mental health and traumatic brain injury screenings for each member of the Armed Forces (member) during the period beginning 90 days after the member completes a deployment in support of a contingency operation and ending 180 days thereafter. Directs the Secretary to carry out such screenings. Prohibits the Secretary from prohibiting a member from returning to the United States due to any screening result or determination. Requires the Secretary and the Secretary of Veterans Affairs to establish a joint protocol to share existing and future reports from confidential screenings conducted to help aid members in their transition from health care and treatment provided by the Department of Defense (DOD) to health care and treatment provided by the Department of Veterans Affairs (VA). L EGISLATION W E S UPPORT BE SURE TO C ONTACT YOUR L OCAL R EPRESENTATIVES

44. Special Thanks to: A Special Thanks to All the Service providers: DOD California Department of Veterans Affairs Fleet and Family Services Navy Region Southwest SD County Veterans Service Office Multitude of community based organizations serving our military and veterans every day They have made 2-1-1 Courage to Call Program a Success!