Many NYC veterans are satisfied with the quality of healthcare they receive from VA medical facilities, while others report difficulties with VA healthcare, as noted on page 9 of this report. The results of this survey are consistent with the national veterans population, of which less than half of eligible veterans  are enrolled in the VA healthcare system and approximately one quarter of eligible veterans actively seek health care from the VA.[1] This initiative ranked fifth in receiving the strongest support of the sixteen listed in the survey. A total of 88.95% of respondents indicated that they view this as either essential or very important.

VA Medical Centers. There are four VA medical centers (VAMCs) that serve eligible veterans located in Brooklyn, Bronx, Queens, and Manhattan, plus five other medical centers serving the New York Metropolitan area: Northport (Suffolk County), Montrose (Westchester County), Wappingers Falls (Dutchess County), East Orange (Essex County, NJ), and Lyons (Somerset County, NJ). There are also VA outpatient-only clinics located in Harlem, Downtown Brooklyn, Bay Shore, Sunnyside, and Staten Island.

Current Issues at NYC VAMCs. The Manhattan VAMC suffered storm damage in 2012 and experienced closures,[2] construction,[3] and renovations that remain ongoing. The Brooklyn VAMC, as of the release of this report, faces the closure of a significant number of inpatient beds.[4] The Bronx VAMC, as of the release of this report, is under investigation for financial fraud.[5] Overall, wait times for appointments and patient satisfaction in NYC VA healthcare facilities have been better than what is reported nationally.[6] It was reported in late June, however, that the VA is currently facing a $3 billion shortfall in its national budget, which will result in a contraction of services, to include closures and expected increases in wait times that will occur at the local level.[7]

VA Vet Centers. There are Vet Centers providing stand-alone mental health resources for qualifying combat veterans located in Brooklyn, Bronx, Harlem, lower Manhattan, Queens, and Staten Island.

Disability Claims. As of May 25, 2015, there are 5,795 Disability Compensation claims pending in the Veterans Benefits Administration’s New York Regional Office. Over 45 percent of these claims are backlogged, meaning they have been pending for over 125 days. The current average wait for an original claim to be completed in the New York office is 214 days.[8] These figures do not include veterans waiting on appeals or other types of benefits claims, such as the needs-based VA Pension or GI Bill benefits.

Ambulance Service. Ambulances in NYC are required to take patients to the nearest emergency rooms, but for veteran patients for whom the VA is their only health care provider, the emergency situation may not meet the regulatory requirements for VA reimbursement of emergency treatment at a non-VA facility.

Referrals to Non-VA Service Providers.  Due to extensive wait times and lack of access to care on a national scale for rural veterans, Congress enacted legislation in 2014 that allows veterans to seek care at private healthcare facilities if they live 40 miles away from a VA facility and/or must wait for over 30 days for an appointment.[9] This does not apply, however, to difficulties with transportation, parking, and other access issues experienced by veterans traveling to NYC-area VA healthcare facilities unless they live more than 40 miles away.

Respondent Comments. Comments from respondents about local coordination with VA healthcare include:

• Make sure that all VA Centers and Clinics are well staffed
• Was denied service to the VA by a NYC ambulance on 2/28/15.
• NYC needs to support the VA, not create more bureaucracy.
• Speeding up a claim
• I'd like to see someone negotiate with the VA hospitals in the NY System to have them openly reviewed by an outside agency. I believe that in order to begin to fix things we have to admit that there is something wrong and know what those things are.
• The lack of appointments and the long wait time forces some veterans to give up on the system entirely.
• I live across the street from VA. BUT DON’T QUALIFY FOR SERVICES. But my dialysis care is taken care of by Medicare. But they (the dialysis unit) don't understand our plight nor care and we served to protect them.
• Follow up to see how the service organizations are processing our claims.
• Someone has to stay on top of the VA for veterans who live in all Boroughs.
• “PTSD has been the most commonly diagnosed mental health disorder for veterans returning from combat. Epidemiological studies of OEF/OIF veterans treated in the VA health care system have found that 14 to 22 percent of returning veterans were diagnosed with PTSD (Seal et al. 2009; Tanelian and Jaycox 2008), making it the signature psychological wound of these two wars (DOD 2007). People are diagnosed with PTSD after exposure to a trauma if they experience a strong emotional response to the event that is followed by persistent difficulty in three key areas, including reexperiencing (e.g., nightmares, flashbacks), arousal (e.g., startle response, sleep disturbance), and avoidance (e.g., withdrawal from people, places, and other reminders of the trauma). These disruptions often lead to an impaired ability to function in social, educational, and work environments, making PTSD a very debilitating condition. More recently, research has found that PTSD and related disorders, such as depression, can develop in military personnel not only as a result of combat exposure but also as a result of childhood traumas, military sexual trauma (MST), mortuary affairs duty, and training accidents (Foa et. al. 2009). In response to this need, the VA Healthcare System has taken extensive measures to address the issue of co-occurring substance use disorders and PTSD. For example, funding has been provided to establish substance use disorder–PTSD specialists who augment specialized PTSD treatment programs. The role of these specialists is to facilitate the assessment and diagnosis of these disorders in returning veterans and serve as a primary provider of mental health services for veterans with these comorbid conditions. Of note, a VA consensus panel (Department of Veterans Affairs 2009) recommended that specialists in these positions provide first-line evidence-based treatments such as Seeking Safety (Najavits 2002) or motivational interviewing (Miller and Rollnick 2002). The panel also recommended that substance use disorder treatment programs should continue to use empirically supported treatments focused on treating the substance use disorder. Likewise, the panel recommended that PTSD treatment programs should continue to provide evidence-based treatments targeting PTSD. Finally, the panel concluded that the superiority of any one given treatment approach above another is not supported by the literature to date and that no “gold standard” treatment exists at this time. This serves as a reminder that ample opportunities exist within the VA and military settings to further study these existing treatments and to develop alternative approaches to treating these comorbid conditions.” This is essential! Where are these specialists and programs in NYC? Where did the money that was allocated for this purpose go? This should be a number one policy priority.

Recommendations. MOVA currently liaises with local and national VA representatives, although the jurisdictional relationship between city and federal government does not permit a formal “watchdog” role that formally addresses issues related to services in NYC. City officials can, however, strengthen NYC government’s dialogue with VA officials to represent the interests of the veterans community and prompt them to address quality of delivery of services, facility access or closures, backlog of disability claims, or other issues of concern to NYC veterans.  We therefore make the following recommendations:

1. MOVA must represent the interests of NYC’s veterans to VA representatives both locally and in Washington, D.C., when it comes to reduced access to services, facility closures, quality of care problems, increased wait times for appointments, backlog of disability claims, or other areas that can be detrimental to the health and well-being of NYC veterans. This should include soliciting community input, studying problems and concerns, proposing solutions to VA representatives, and following up with the community to show progress and actions on the issues raised.
2. MOVA should have VA-certified veterans benefits counselors on staff who can assist veterans with problems they may have with accessing VA healthcare services for which they are eligible.[10]
3. City government should formally request that VA representatives attend City Council hearings and other government meetings that discuss the quality and delivery of VA healthcare services.
4. MOVA, in coordination with the Department of Health and Mental Hygiene (DOHMH), should keep a resource guide—a detailed, up-to-date list of the physical, mental, and behavioral health programs and services that specialize in veterans’ care across the city. Veterans who cannot or do not want to use VA services should be able to turn to MOVA as the connection hub for appropriate health resources.