1. The American Legion National LEAD Training
Veteran Health & Cemetery Benefits
Department of New Hampshire LEAD Training
February 28, 2015

2. Goals and Objectives
Discuss the mission of the Department of Veterans Affairs (VA) Veterans Health Administration
Provide an overview of VHA Goals and Priorities
Explain an overview of the VHA System
Discuss the MyVA Initiative
Discuss VA’s Budget
Explain the Veteran’s Choice Card

3. VA Mission
The Department of Veterans Affairs mission, as stated by President Abraham Lincoln in his second inaugural address is “ to care for him who borne the battle, his widow and orphan”

4. VHA Goals and Priorities
Align VHA to meet vision of providing exceptional care to improve veterans health and well-being
Create health care value by reducing cost while maintaining quality
Enhance the Veteran experience and access to health care
Innovate new models of health care
Eliminate Veteran homelessness
Improve Veterans’ mental health
Continue to advance research and development
Transform health care delivery through health informatics
Veterans rated at 50 % of more compensable VA service-connected disabilities are not required to pay a co-pay.

5. Overview of VHA System
In 1995 VHA created Veterans Integrated Service Networks (VISNs). Currently VHA has 21 VISNs (or regions) and also the following system of care:
152 VA Medical Centers
819 Outpatient Clinics
300 Vet Centers
98 Domiciliary Residential Programs
133 Community Living Centers
Veterans placed in this range, may not be required to pay co-pays. The veteran may be asked to submit a co-pay test to determine medication co-pay status.
In addition, an annual cap on medication co-pays applies to veterans in this category. Once the limit is reached in a calendar year, prescriptions will be free.

6. MyVA Initiative
MyVA will re-design VA around the needs of Veterans and will be the largest Department-wide transformation in VA history.
It will make VA a more customer-centric organization and deliver the highest value to veterans, family members, and tax payers.

7. MyVA Initiative
The Veterans Affairs Department says that by midsummer all offices should be coordinating efforts along a newly drawn five-region map.

8. VA Budget
The total VA 2016 budget request was $ billion, which was an increase of $4.9 billion.
The mandatory budget request was $95.3 billion, a slight increase of $0.3 billion.
The discretionary budget request was $73.5 billion, which is an increase of 7.5 percent.
The budget request provides Veterans high quality benefits and services:
•Veterans Health Administration (VHA) •9.4 million Veterans enrolled in VA healthcare
•Over 6.9 million unique patients treated
•101 million outpatient visits
•VA will continue executing the Veterans Choice Act of 2014
•Veterans Benefits Administration (VBA) •About 5.2 million Veterans and Survivors will receive disability compensation and/or pension benefits
•Nearly 1.3 million Servicemembers, Veterans, Survivors, or beneficiaries will receive education or vocational rehabilitation benefits and services
•137,000 Servicemembers and Veterans will be provided Vocational Rehabilitation and Employment services
•1.4 million disability and pension claims will be processed, 5.6% over 2015
•National Cemetery Administration (NCA) •Greater access is being provided by two new national cemeteries opening in 2015 and the opening of a new cemetery at Omaha, Nebraska in 2016
•129,200 Veterans and eligible family members will be interred in VA national cemeteries

9. The FY 2016 Budget invests in VA by:
Improving veterans’ access to medical care by providing $60.0 billion, in addition to requesting $63.3 billion in 2017 advance appropriations;
Supporting improvements in veterans mental health care, telehealth care, lifesaving treatment for Hepatitis C, specialized care for women veterans, long-term care, and benefits for veterans’ caregivers;
Providing $1.4 billion for programs that will continue VA’s gains toward ending veteran homelessness in 2015;
Strengthening veterans benefits programs by improving the timeliness of non-rating claims, reducing the inventory of veterans appeals, strengthening the fiduciary program, and further enhancing disability claims processing accuracy and efficiency through centralized mail and the national work queue.
Increasing burial access for veterans and eligible family members with the opening of new national cemeteries and a rural burial ground.

10. Veterans Choice Card

11. Veterans Choice Card
If veterans live more than 40 miles from a VA medical facility, or if they have waited longer than 30 days for medical appointments, they can use the card to get care from non-VA providers, with some restrictions.

12. Veterans Choice Card
Before using your card, VA must verify your eligibility and provide advance authorization.
To verify your eligibility, call the phone number printed on your Veterans Choice Card; if you are eligible, a VA program manager must authorize in advance each use of private care.
You can choose from a network of VA-approved providers, or select your own provider (which VA also has to approve in advance).
To be VA-approved, private health care providers must accept Medicare rates or work at: Department of Defense facilities, Indian Health Service facilities or other federally qualified health centers.
Your private-care practitioner must have a valid medical license to practice.
The Veterans Choice Card does not replace your VA identification card. Keep it.
Bear in mind that this program lasts only three years, or until funding is exhausted, at which point the cards can no longer be used.

13. Department of New Hampshire LEAD Training
Cemetery Benefits
Department of New Hampshire LEAD Training
February 28, 2015

14. Briefing Agenda NCA’s mission and responsibilities NCA’s organization
NCA’s Budget
Major programs, initiatives and accomplishments
Let me quickly list our responsibilities. As our mission indicates, we provide final resting places and lasting tributes for Veterans and eligible family members.
We maintain our cemeteries as national shrines, so each visitor departs feeling that the grounds, the gravesites and environs are worthy tributes to Veterans’ service and their sacrifice.
We administer a grants program for construction of State and Tribal Veterans cemeteries.
We furnish headstones, markers and medallions, and administer the Presidential Memorial Certificate program.
In 2009, we also assumed responsibility for the VA’s First Notice of Death program, through which we ensure timely discontinuation of payments to deceased Veterans. By issuing timely notices of death, the office frees up other VA staff to provide additional Veterans’ benefit services, and has enabled VA to avoid over $32 million in overpayments to deceased Veterans this year alone! If you include FY09 and 10, the total avoided is $84.6 million! Further, we are seeing reductions in both costs associated with collection actions and stress experienced by family members responsible for repayment. We are also issuing notices to stop automatic shipment of prescriptions from the pharmacy and to cancel unneeded medical appointments at VA Medical Centers, so those precious slots can go to other Vets.
I will touch on some of these responsibilities in more detail as we move through the presentation.

15. NCA’s History First national cemeteries established in 1862
Prior, soldiers buried
where they fell
“To care for him who
shall have borne the
battle, and for his widow and his orphan.”
As with anything, it makes sense to start at the beginning. For the national cemeteries, that means the Civil War and Abraham Lincoln.
This year, we mark the 150th anniversary of the start of the Civil War, a conflict central to NCA’s history.
The first national cemeteries were developed during the Civil War, and just under half of our national cemeteries date back to that period (the 1860s).
Before the cemeteries were established, soldiers were typically buried where they died in battle.
But Congress determined that those who died defending the Union were deemed worthy of special burial spaces for their sacrifices. So, in 1862, the Congress enacted legislation authorizing President Abraham Lincoln to purchase cemetery grounds. We manage 12 of the original 14 cemeteries established in 1862.
As commander-in-chief and a Veteran himself, Lincoln understood the sacrifices of soldiers and their families. In his Second Inaugural Address, he pledged the nation “To care for him who shall have borne the battle and for his widow and his orphan.” That remains VA’s motto today.
Most of the national cemeteries were managed by the Army Department until 1973, when Congress passed a law transferring many of the national cemeteries to the Veterans Administration, creating the National Cemetery System.
Commander in Chief Lincoln

16. NCA’s Mission The National Cemetery Administration
honors Veterans and their families
with final resting places
in national shrines and
lasting tributes that commemorate their service and sacrifice to our Nation.
We have recently updated our National Cemetery Administration strategic plan, to take us through 2015.
During that process, we also updated our mission statement. In particular, we wanted to highlight our role in honoring families as well as Veterans.
Anyone who has worn the uniform, or who has stayed behind keeping the home fires burning, knows that military families make many sacrifices that often go unrecognized. We wanted to acknowledge their contributions, as well.

17. NCA’s Responsibilities
Provide burial space for Veterans and eligible family members and maintain national cemeteries as national shrines
Administer the Federal grants program for construction of State and Tribal Veterans cemeteries
Furnish headstones, markers and medallions for the graves of Veterans around the world
Administer the Presidential Memorial Certificate program
Administer the First Notice of Death program
Let me quickly list our responsibilities. As our mission indicates, we provide final resting places and lasting tributes for Veterans and eligible family members.
We maintain our cemeteries as national shrines, so each visitor departs feeling that the grounds, the gravesites and environs are worthy tributes to Veterans’ service and their sacrifice.
We administer a grants program for construction of State and Tribal Veterans cemeteries.
We furnish headstones, markers and medallions, and administer the Presidential Memorial Certificate program.
In 2009, we also assumed responsibility for the VA’s First Notice of Death program, through which we ensure timely discontinuation of payments to deceased Veterans. By issuing timely notices of death, the office frees up other VA staff to provide additional Veterans’ benefit services, and has enabled VA to avoid over $32 million in overpayments to deceased Veterans this year alone! If you include FY09 and 10, the total avoided is $84.6 million! Further, we are seeing reductions in both costs associated with collection actions and stress experienced by family members responsible for repayment. We are also issuing notices to stop automatic shipment of prescriptions from the pharmacy and to cancel unneeded medical appointments at VA Medical Centers, so those precious slots can go to other Vets.
I will touch on some of these responsibilities in more detail as we move through the presentation.

18. Burial Benefits Gravesite Opening and closing of the grave Grave liner
Perpetual care of the gravesite
Headstone, marker or medallion
U.S. Flag
Presidential Memorial Certificate
I want to run through the benefits we provide to Veterans.
All veterans who served other than dishonorably are offered the dignity of committal or memorial services in a national cemetery.
At no cost to the family, burial at a national cemetery includes use of a committal shelter for services, the gravesite, grave liner, opening and closing of the grave, a headstone or marker, and perpetual care as part of a national shrine.
-In addition to providing burial space, NCA also offers other ways to commemorate Veterans—through our Memorial Programs Service.
A government-furnished headstone or marker is available for Veterans who are interred in private cemeteries. Approximately 2/3 of the more than 350,000 government-furnished headstones and markers we provide each year are placed on Veterans’ gravesites in private, state, or DOD cemeteries.   
Families can also receive a Presidential Memorial Certificate, expressing the Nation’s gratitude and honoring the memory of each deceased Veteran. Last year, we delivered more than 800,000 PMCs to loved ones.

19. Headstones and Markers
These are examples of government headstones, markers and niche covers.
Note that the one at the far right reads “in memory of”—for use when remains aren’t available.

20. Bronze Veteran Medallion
A new benefit as of June 2010 is a bronze medallion that can be affixed to privately purchased headstones and markers, to signify the grave belongs to a US veteran.
This is for Veterans who died after the first of November, 1990.
As you can see, a medallion is available for each branch of the Armed Services.
In lieu of headstone or marker
Death on or after November 1, 1990
Features branch of service

21. Presidential Memorial Certificate
For honorably discharged Veterans
Inscribed with
the Veteran’s name
Bears the
President’s signature
Families can also receive a Presidential Memorial Certificate, expressing the Nation’s gratitude and honoring the memory of each deceased Veteran.
These engraved certificates are inscribed with the Veteran’s name and bear the President’s signature.
This program was begun by President Kennedy and each subsequent president has carried on the tradition.
Eligibility for this benefit is slightly different from most of the others we provide, insofar as the Veteran must have been honorably discharged in order for his family to receive the certificate. In most other cases, the threshold is other than dishonorably discharged.
And that’s a perfect lead into my next slide, about eligibility.

22. Eligibility Criteria
Any member of U.S. Armed Forces who dies on active
duty
Any Veteran who was discharged under conditions other
than dishonorable
National Guard members and Reservists with 20 years of
qualifying service, who are entitled to retired pay
Spouses and minor children
Certain eligible parents (Corey Shea Act)
Today, the groups you see here are generally eligible for burial in a national cemetery.
Just recently, under the “Corey Shea Act”, Congress extended burial benefits to certain parents of eligible service members buried in a VA cemetery—when those Veterans are killed in action or during combat-related training activities.
We do not take reservations in national cemeteries.
However, we are able to do “set asides” for two-Veteran couples, so they can be buried in adjoining graves.
We have experts in our scheduling office in St. Louis to evaluate eligibility for burial.
We will find space in any national cemetery, even one generally closed to new interments, for service members killed in action.

23. NCA Fast Facts Fort Custer National Cemetery, Augusta, MI
131 National Cemeteries
20,200 acres
3.2 million gravesites
More than 7 million visitors/yr
In FY13:
- 122,000 Interments
- 360,000 Markers and
headstones processed
- 712,700 Presidential
Memorial Certificates
-8,995 Medallions provided
Here are a few “fast facts” about NCA and the cemeteries we manage.
-131 cemeteries
-3.7 million Vets, active duty and family members laid to rest in 3.1 million gravesites
-1700 employees
This photo is of the avenue of flags at Fort Custer National Cemetery in Augusta, Michigan. Families can donate burial flags to be flown on the Avenue of Flags at their local cemetery. Because we only display them on certain days throughout the year, you will even see older flags at some cemeteries with just 48 stars on them!
Fort Custer National
Cemetery, Augusta, MI

24. National Cemetery Scheduling Office 1-800-535-1117
Now serving all cemeteries except
Puerto Rico
The process of burial in a national cemetery begins when a Veteran or family members dies, and the next of kin or a funeral director contacts our National Cemetery Scheduling Office.
This office is open seven days a week, 362 days a year—we don’t staff it on Thanksgiving, Christmas and New Year’s Day.
As of this spring, the National Scheduling Office now supports all VA cemeteries but one—Puerto Rico.
Centralized scheduling frees up staff members at individual cemeteries to assist families in other ways.
As I said earlier, the center is staffed with experts to help determine eligibility for burial, so it relieves cemetery directors of the responsibility to consider eligibility and sensitive cases. These determinations, including denial of burials, are now processed by staff at the National Scheduling Office.
An appeal process is available for families to appeal denial of burial or requests for headstones and markers.

25. Field Workforce 1,500+ employees outside DC
Wage-grade and GS positions
Half work as caretakers
22% of field staff eligible to retire in FY13
Monument Care

26. Volunteer Support 150 Years of Keeping the Promise
Guardians of the Cemetery, Washington Crossing National Cemetery, Newtown, PA (above left); Vaca Valley Garden Club, Sacramento Valley National Cemetery, CA (above)
Volunteers donated 304,123 hours of service to national cemeteries in FY13
Valued at $6.5 million
150 Years of Keeping the Promise

27. % of Veterans Served Fiscal Year
One of our key performance measures is the percentage of Veterans served by a burial option in an open national or state Veterans cemetery, within 75 miles of their homes.
Our goal is to continue expanding our services, along with the number of Veterans served by a burial option.
At the beginning of Fiscal Year 04, approximately 75% of Veterans were served with a burial option.
Today, in Fiscal Year 11, 89% of Veterans—about 20 million in all–have reasonable access to a burial option. 
Our next strategic target is 94%, which we project to attain by 2015.
This is very much in keeping with the Secretary’s priority of ensuring Veterans and families have access to the benefits and services they earned through their service and sacrifice.
Fiscal Year
*By an open national, state or tribal Veterans cemetery within 75 miles of home

28. President’s Budget Request FY16
NCA has requested $266 million for operations and maintenance
This request would help expand access by opening two National Cemeteries in Florida and preparing to open two rural National Veterans Burial Grounds
For FY16, 129,200 veterans and eligible family members will be interred in VA national cemeteries
Greater access is being provided by two new national cemeteries opening in 2015 and the opening of a new cemetery at Omaha, Nebraska in 2016
•129,200 Veterans and eligible family members will be interred in VA national cemeteries

29. Development of National Cemeteries
National Cemeteries are developed in a 6-step process:
Site Selection
Environmental Assessment
Land Acquisition
Master Planning & Design Development
Construction Documents
Construction Completion
Construction of Sacramento Valley National Cemetery (Right)
One additional note about meeting future burial needs before I move on.
NCA is conducting a study to identify potential emerging trends—such as green burials–and whether they might be of interest to Veterans and eligible family members in coming years.
Options now available include inurnment at sea, or use of biodegradable urns containing cremated remains and seeds of trees or flowers. As time and weather degrade the urn material, a seedling sprouts…and eventually grows into a full-sized tree, marking the gravesite.
In national cemeteries, this might include a grove of trees where Veterans are buried, with a memorial wall alongside indicating who is buried there.
Some people think these ideas are kind of way out there, but I don’t think most of us would have predicted the huge increase in cremation burials 30 years ago, either.
We just awarded the contract for this study in early July and expect to have results within about 12 months. I’m sure we’ll find out some interesting things!
Courtesy of freedigitalphotos.net

30. Establishing a State or Tribal Veterans Cemetery
Determine the need by analyzing existing services provided by national cemeteries and other state cemeteries. Provide data on veteran population, including age.
Investigate availability of suitable land (land that is easily accessed by road and free of limitations.
Assess impacts by analyzing possible negative environmental and historic preservation impacts the cemetery location may have.
Encourage support, support comes from informing local Veterans Service Organizations in an effort to pass the necessary legislation.
Complete application for a grant establishing state or tribal veterans cemetery.
On Monday, March 10, 2014, an article from The Buffalo News explained that archaeological tests (required because of Native American artifacts buried on the Town of Pembroke’s property) have delayed the development of a National Cemetery in Western New York. The VA has an agreement to buy 132 acres in Genesee County for the cemetery, which would be located about halfway between Buffalo and Rochester and would serve the 180,000 veterans who live in those areas. The VA is hoping to close on the purchase this spring, but cautioned that design and construction of the cemetery will take an additional four or five years, and Congress still must appropriate the money for the project.

31. Veterans Cemetery Grants Program
89 operational state and tribal cemeteries in 44 states, Guam and Saipan
Over $500 million in grants awarded since the program’s inception
32,000 burials in FY13

32. 2013 Survey of Satisfaction
Conducted annually
since 2001
Mailed to next of kin and funeral directors
Ties to strategic plan goals for customer service and cemetery appearance; i.e., 100% satisfaction by 2015
Columbarium, Indiantown Gap National Cemetery, PA
150 Years of Keeping the Promise

33. Dignified Burial and Other Veteran’s Benefits Improvement Act of 2012
Since January 10, 2014, the law provides VA the authority to:
Furnish caskets or urns for deceased veterans who are unclaimed and have no resources
Expand funeral expense and transportation reimbursement benefits to remains of unclaimed veterans who have no resources
Exclude persons convicted of certain sex offenses from interment or honors
Ensure wishes of next-of-kin are respected and given appropriate deference
Allow honor guards selected by a veteran’s family access to NCA facilities

34. How to apply?
Burial Benefits: VA Form , Application for Burial Benefits
Headstone or Marker: VA Form , Claim for Standard Government Headstone of Marker
Burial Flags: VA Form , Application for United States Flag for Burial Purposes
Presidential Memorial Certificates: VA Form , Application for Presidential Memorial Certificate

35. Questions?
If you need additional information regarding veteran burial benefits contact Edward Lilley at (202) or
Thank you!