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VA Utilization ProfileFY 2017

Prepared by the National Center for Veterans Analysis and Statistics

May 2020

NCVAS National Center for Veterans Analysis and Statistics

IntroductionWith a budget of $180 billion in fiscal year 2017, the Department of Veterans Affairs (VA) is committed to delivering a wide array of benefits and services to eligible Veterans, dependents, and survivors to help to ease the transition from the military to civilian life and to improve quality of life after service. Considering the magnitude of this commitment it is important for the VA and key VA stakeholders to be aware of basic characteristics of the Veteran population being served and the benefits and services provided. VA programs are overseen by three administrations:

• Veterans Health Administration (VHA) provides Health Care and Pharmacy services

• Veterans Benefits Administration (VBA) provides Compensation and Pension disability benefits, Education Assistance, Life Insurance, Vocational Rehabilitation/employment services, and Home Loan Guaranty assistance

• National Cemetery Administration (NCA) provides memorial benefits including graves, markers, flags, medallions, and burial allowances

The National Center for Veterans Analysis and Statistics (NCVAS) conducted a study on Veterans who have used at least one of 22 benefits or services provided by the VA during Fiscal Years 2008 through 2017. The analysis included a comparison by various characteristics to Veterans who did not use any VA benefits. Veterans who used at least one benefit or service are termed ‘users’ and Veterans who did not are termed ‘non-users’.

Key questions addressed in this study are:

• How many Veterans used VA benefits? How many did not?

• Which programs do Veterans use most?

• What are the demographic and socio-economic characteristics of VA users and how do they differ from non-users? We examined the following characteristics:

– Gender

– Age

– Period of Service

– Race/Ethnicity

• Compensation & Health Care

– How many Veterans receive disability Compensation and/or use VA Health Care?

– How many disabled Veterans do not use VA Health Care?

– Is the number of disabled Veterans not using VA Health Care going up or down?

2

➢ 49% (9.8 out of 20.0 million) of all Veterans used at least one VA benefit or service in FY 2017, an increase of almost 11 percentage points (39% or 9.0 out of 23.3 million) since FY 2008. Of the 9.8 million users, 45% used multiple benefits which is up from 33% in 2008

➢ The percent of female Veterans who used VA benefits increased from 36% in 2008 to 50% in 2017. The corresponding rate among male Veterans in 2008 and 2017 was 39% and 49%, respectively.

➢ VA Health Care and/or Disability Compensation users accounted for 76% of all VA users in FY 2017, up from 69% in FY 2008

• 25% of all VA users only received Health care benefits in FY 2017

• 70% of Veterans receiving Disability Compensation used VA Health Care in FY 2017, up from 60% in FY 2008

➢ Median age of male Veterans who used at least one VA benefit is 64; median age of male non-users is 58

➢ Median age of female Veterans who used at least one VA benefit is 48; median age of female non-users is 48

➢ Veterans between the ages of 25 and 34 and over age 65 are more likely to use VA benefits compared to Veterans of other ages.

Key Findings

3

* The numbers from the chart do not sum to the total number of VA users. Veterans who used multiple programs are counted in each individual program, but only once in the overall total.

** Contains Veterans who received Special Housing Allowance or Special Adaptive Housing benefits.

4

Approximately 9.8 million Veterans used at least one VA benefit or service in FY 2017. 45% of all VA users received benefits or services from multiple programs.*

Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics

VA Benefits Utilization by Program - Veterans only: FY 2017

0.1

0.2

0.6

1.1

2.9

4.8

6.1

0 1 2 3 4 5 6 7

VocationalRehab.

MemorialBenefits

Education

Life Insurance

LoanGuaranty**

Compensationor Pension

Health Care

Number of Veterans (Millions)

About 7.3 million Veterans used at least one benefit provided by the Veterans

Benefits Administration (VBA)

* The numbers from the chart do not sum to the total number of VA users each year. Veterans who used multiple programs are counted in each individual program, but only once in the overall total.

5

Health Care and Disability Compensation/Pension account for the majority of VA utilization and show significant growth since 2008.*

Number of Users by Program: FY 2008-2017

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Health Care

Compensation/Pension

Life Insurance

Loan Guaranty

EducationMemorial

Voc. Rehab.

• Health Care and Disability Compensation/Pension, the largest programs, increased by 21% and 47%, respectively, between 2008 and 2017.

• The number of Veterans with an active, VA Life Insurance policy has declined steadily at an average annual rate of 4.7%; almost 3 times the average annual rate of decline (1.7%) in the overall Veteran population over the same time period.

• Home Loan Guaranty program had a sharp decline in 2009 consistent with the overall housing market, but afterward has increased steadily through 2017

• Education benefit use among Veterans was stable through 2010, but trends upward markedly after 2011, followed by subtle decline in 2013

• Memorial Benefit and Vocational Rehabilitation use have remained relatively steady.


Millions


The number of Veterans using VA benefits is increasing despite a 14% decline in the total Veteran population since 2008.

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Benefit Use

FY 2008-2017

(millions)

9.0 8.6 8.8 8.9 9.1 9.2 9.4 9.5 9.7 9.8

14.3 14.3 13.9 13.4 13.0 12.4 11.9 11.3 10.7 10.2

23.3

20.0

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Did not use benefits

Used at least one benefit

Total Veteran population

% Users 39% 38% 39% 40% 41% 43% 44% 46% 47% 49%

The rate of growth in the number of female Veterans who used VA is over 5 times the rate of growth of the overall female Veteran population.

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GENDER 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of VA Users 8,964,124 8,579,872 8,789,694 8,908,323 9,061,299 9,240,704 9,350,828 9,526,480 9,669,748 9,828,570

Male 8,340,810 7,967,650 8,137,209 8,231,909 8,341,280 8,463,035 8,554,339 8,690,885 8,798,891 8,882,230

Female 623,314 612,222 652,485 676,414 720,019 777,669 796,489 835,595 870,857 946,340

Number of Female Veterans Who Used VA Benefits

FY 2008-2017(In Thousands)


• Number of female Veteran users increased by 51.8% since 2008 while the total number of female Veterans increased by only 9.8%

• Number of female Veterans grew at an average annual rate of 1.0% between FY 2008 and 2017, while the number who used VA benefits has grown at an average rate of 4.8%

• The utilization rate of VA benefits among female Veterans increased from 36.3% in 2008 to 50.3% in 2017

• Female Veterans made up 9.6% of all users in 2017, up from 7.0% in 2008

Veterans who Used VA Benefits and Servicesby Gender FY 2008-2017

0

200

400

600

800

1,000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age Distribution of Veterans who used VA Benefits, 2017


Female Veterans who use VA, with a median age of 48, tend to be younger than male VA users (median age of 64).

8

1.1

9.9

10.8

13.8 14.5

26.7

12.311.1

2.82

19.52

21.3220.47

17.96

9.25

3.50

5.17

Male Veteran Users Female Veteran Users


Female Veterans, for the first time in 2017, were slightly more likely to use VA benefits than male Veterans (utilization rate of 50.3% compared to 49.0%).

9

27.0

52.448.1

39.939.3

52.957.6

71.8Overall rate: 49.0

VA Benefit Utilization Rate for Male Veteransby Age Group(in percent)

33.6

55.152.4

46.9 45.7

49.1

60.8

79.3

Overall rate: 50.3

VA Benefit Utilization Rate for Female Veteransby Age Group(in percent)

Utilization Rate, 2017

VA Utilization Rate by Race/Ethnicity: FY 2017

(in percent)


Native Hawaiian/Pacific Islander, Black (AA), and Hispanic Veterans have a higher utilization rate of VA benefits than any other racial group while American Indian/Alaskan native and Other race Veterans are

the least likely to utilize VA benefits.

10

*Hispanic of any race. All other race categories are assumed to be non-Hispanic.**Includes Veterans of two or more races.

48.0

53.9

44.8

41.6

58.9

53.0

42.6

White Black/African-American

Asian American Indian/Alaskan-Native

Native Hawaiian/Pacific Islander

Hispanic* Other**

Overall rate: 49.1


Distribution of Male VA Users by Period of Military Service(in percent)

Most male Veterans served during the Vietnam Era and most female Veterans served during the Post-9/11 Gulf War era. WWII and Korean Conflict Veterans are much more likely to use VA benefits and

service than other cohorts.

11

5.1 7.2

32.8

14.7

26.5

13.7

74.169.6

51.444.7

58.5

30.6

Overall rate: 49.0

VA Benefit Utilization Rate for Male Veteransby Period of Service

(in percent)

4.1 2.68.8

22.1

49.1

13.2

Distribution of Female VA Users by Period of Military Service (in percent)

83.4 76.2

45.6 46.8

60.6

30.9

Overall rate: 50.3

VA Benefit Utilization Rate for Female Veteransby Period of Service

(in percent)

Age Distribution, 2017

Utilization Rate, 2017

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VA Health Care and Disability Compensation

VA Health Care and Disability Compensation are the two most frequently used

programs by our nation’s Veterans. In 2017, these two programs alone

accounted for 77% of all VA expenditures ($140 billion out of $181 billion).

Thus, it is critical that we understand the interaction between Veterans’

service-connected disability and their utilization of VA health care services.

Since 2014, Health Care and Disability Compensation benefits account for 76 percent of all VA utilization.

Utilization by Health Care or Compensation and all other benefits(in percent)

Source: U.S. Veterans Eligibility Trends and Statistics, 2017Prepared by the National Center for Veterans Analysis and Statistics 13

69.073.6 74.2 75.0 75.2 75.2 76.0 76.0 76.1 75.9

31.026.4 25.8 25.0 24.8 24.8 24.0 24.0 23.9 24.1

All other

benefits

Health care or

Disability

Compensation

Service-connected disabled Veterans using VA Health Care increased from 60% in 2008 to 70% in 2017. Over 93% of service-connected disabled Veterans were enrolled in VHA Health Care system in 2017.

VHA Enrollment Status and Health Care Utilization among Service-Connected Disabled Veterans(in percent)


60.2 62.1 64.0 65.1 66.0 67.2 68.4 69.4 69.7 69.6

23.724.4 24.0 24.1 24.2 24.0 23.8 23.5 23.7 24.0

16.1 13.5 12.0 10.8 9.8 8.8 7.8 7.1 6.6 6.4

Enrolled, but

did not use

health care

Enrolled &

used health

care

Not enrolled

Likelihood of Service-connected disabled Veterans seeking VA Health Care generally increases with the Veteran’s disability rating. The overall VHA utilization rate among disabled Veterans is 69.6%.

Service-connected Disabled Veterans Receiving Compensation and VA Health Care Use by Disability Rating: FY 2017

(in percent)


43.553.5 55.1 59.3

64.170.2 73.2

79.6 81.1 83.889.2

56.5 46.5 44.9 40.835.9

29.8 26.820.4 18.9 16.2

10.8

Disabled,

but did not

use health

care

Disabled &

used health

care

Average VHA utilization

rate = 69.9%

The likelihood of a disabled Veteran to seek treatment from a VA Health Care facility varies with race and ethnicity; however, rates for Black Veterans are much higher than the average utilization rate of 69.6%.

Service-connected Disabled Veterans Receiving Compensation andVA Health Care use by Race/Ethnicity: FY 2017

(in percent)


67.677.4

62.570.9 66.5

71.5 68.5

32.422.6

37.529.1 33.5

28.5 31.5Disabled,

but did not

use health

care

Disabled &

used health

care

Average VHA

Utilization rate = 69.6

*Hispanic of any race. All other race categories are assumed to be non-Hispanic.**Includes Veterans of two or more races.

Comparison ofVA Users and Non-Users

FY 2017

17Source: U.S. Veterans Eligibility Trends and Statistics, 2017 and VetPop2016Prepared by the National Center for Veterans Analysis and Statistics

Veterans who used VA Benefits:

9,828,570

Veterans who did not use VA Benefits:

10,170,229

Since, 2008 the proportion of Veterans who used VA benefits in a

given year has increased from 39% to 49% in 2017. With this

increase in demand for VA services, it is important to understand the

differences between Veterans who choose and those who do not and

what may drive some of those decisions.


Age Distribution of Male VA Users and Non-users, 2017(in percent)

Male Veterans who used VA benefits tend to be older than those who do not. However, female users and non-users are relatively similar in age.

18

1.1

9.9 10.813.8 14.5

26.7

12.3 11.1

2.8

8.611.2

20.0 21.6 22.9

8.74.2

Male Veteran Users Male Non-users

2.8

19.521.3 20.5

18.0

9.3

3.5 5.25.6

16.119.6

23.5 21.7

9.7

2.3 1.4

Female Users Female Veteran Non-Users

Age Distribution of Female VA Users and Non-users, 2017(in percent)

Utilization Status, Male

Median Age

Used VA benefits 64

Did not use VA benefits

58

Utilization Status, Female

Median Age

Used VA benefits 48

Did not use VA benefits

48


Post-9/11 Gulf War era Veterans make up almost half of all female Veterans who use VA benefits and services. Most male VA users served during either the Vietnam or Post-9/11 Gulf War era.

19

5.1 7.2

32.8

14.7

26.5

13.7

1.7 3.0

29.8

17.5 18.0

29.9

Male Veteran Users Male Veteran Non-Users

4.12.6

8.9

22.2

49.1

13.2

0.8 0.8

10.7

25.532.4 29.8

Female Users Female Veteran Non-Users

Distribution of Male VA Users and Non-Users by Period of Service, 2017(in percent)

Distribution of Male VA Users and Non-Users by Period of Service, 2017(in percent)

Data SourcesThe United States Veterans Eligibility Trends and Statistics (USVETS) is an integrated database of all living and deceased Veterans, including those that do not use any VA benefits. It is comprised of administrative records from the Veterans Benefit Administration (VBA), the Veterans Health Administration (VHA), the National Cemetery Administration (NCA), and the Department of Defense’s Defense Manpower Data Center, (DMDC). This integrated data is also augmented by commercial data sources include additional geographic and socio-economic information on the Veteran population. VA program data are included in USVETS based on the following criteria:

– Health Care: All Veterans who receive either VA inpatient care, VA outpatient care, purchased (fee basis) care, VA long-term services and support, or VA pharmacy care were included. VA Health Care enrollees who did not seek care from VA during the current year were not included. Veterans who only sought care from a VHA Vet Center were not included.

– Compensation & Pension: All Veterans who receive monthly VA Disability Compensation or Pension payments were included. Veterans who received Special Adaptive Housing benefits were also included in the analysis. Veterans with pending or denied claims were not included.

– Education: All Veterans who received benefits for Chapter 30, 32, 33, 1606, and 1607 education programs were included.

– Vocational Rehabilitation: All Veterans who participated in various stages of the Vocational Rehabilitation and Employment program were included.

– Loan Guaranty : All Veterans who have an active, new or re-financed VA-guaranteed home loan were included.

– Life Insurance: All Veterans who have an active VA life insurance policy or were in receipt of a benefit from a policy that was administered or supervised by VA were included. VA insurance programs included in the analysis were National Service Life Insurance (NSLI), United States Government Life Insurance (USGLI), Veterans’ Special Life Insurance (VSLI), Veterans’ Reopened Insurance (VRI), Service-Disabled Veterans Insurance (S-DVI), Veterans’ Mortgage Life Insurance (VMLI), Traumatic Injury Protection (TSGLI), and Veterans’ Group Life Insurance (VGLI). The analysis does not include active Service-members and spouses/dependents who participate in Service-members’ Group Life Insurance (SGLI) and Family Service-members’ Group Life Insurance (FSGLI).

– Memorial Affairs: All Veterans who were interred in a National, State, Interior, or Military cemeteries, or Veterans who were interred in private cemeteries and requested headstones/markers from VA were included. Due to data unavailability, Veterans who only received Presidential Memorial Certificates or a flag were not included.

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Methodology and Assumptions• A Veteran user is defined as any Veteran who received or used at least one VA benefit or service during the fiscal

year. Veteran spouses, Veteran dependents, and active military service members who used VA benefits and services were not included in the analysis. Each Veteran is only counted once in the overall total even if he/she used multiple programs.

• VA uses a number of methods to uniquely identify Veterans in its data systems, including social security number (SSN), scrambled SSN (SCRSSN) in VHA, claim or file numbers in VBA, and Electronic data interchange personal identifier (EDIPI) in DoD. Because each input source included SSN, records from each source were combined using the Veteran’s SSN as the primary identifier. Additional information on data integration can be found in USVETS Technical Documentation.

• Veteran records from each input source were verified against official Social Security Administration data to validate SSN, name, date of birth, and gender.

• Missing SSN or SSNs determined to be incorrect by SSA were omitted from the analysis.

• Estimates for the number Veterans who did not use any VA benefits or services were defined as the difference between total population estimates from the Veteran Population Projection Model (VetPop) 2016 and the number of VA users identified in USVETS. Non-users counts were adjusted to ensure total population estimates are consistent with VetPop16.

– The methodology used to validate Veterans’ records in USVETS was revised. Thus, the number of VA users from 2008-2016 has been revised to reflect these changes.

• Some data elements were not available for all Veteran records. A minimum of 70% coverage for any particular data element was assumed to be an appropriate sample of all Veteran users to create frequency distributions. However, at the time of this release, we have not completed an assessment of any potential bias effects as a result of missing data.

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Contact Information

Department of Veterans Affairs

Office of Enterprise Integration

Office of Data Governance and Analytics, National Center for Veterans Analysis and Statistics

For questions, please email us at [email protected]

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