Tagged: VA benefits

Veterans Will Receive 1.5 Percent COLA Increase in 2014

Posted by Debi Teter

militaryauthority.com 2014 COLA increase for veteransWASHINGTON (Dec. 4, 2013) – Veterans, their families and survivors receiving disability compensation and pension benefits from the Department of Veterans Affairs will receive a 1.5 percent cost-of-living increase in their monthly payments beginning Jan. 1, 2014.

“We’re pleased there will be another cost-of-living increase for Veterans, their families and their survivors,” said Secretary of Veterans Affairs Eric K. Shinseki. “The increase expresses in a tangible way our Nation’s gratitude for the sacrifices made by our service-disabled and wartime Veterans.”

For the first time, payments will not be rounded down to the nearest dollar. Until this year, that was required by law. Veterans and survivors will see additional cents included in their monthly compensation benefit payment. 

For Veterans without dependents, the new compensation rates will range from $130.94 monthly for a disability rated at 10 percent to $2,858.24 monthly for 100 percent. The full rates are available at www.benefits.va.gov/compensation/rates-index.asp.

The COLA increase also applies to disability and death pension recipients, survivors receiving dependency and indemnity compensation, disabled Veterans receiving automobile and clothing allowances, and other benefits. 

Under federal law, cost-of-living adjustments for VA’s compensation and pension must match those for Social Security benefits. The last adjustment was in January 2013 when the Social Security benefits rate increased 1.7 percent.

In fiscal year 2013, VA provided over $59 billion in compensation benefits to nearly 4 million Veterans and survivors, and over $5 billion in pension benefits to more than 515,000 Veterans and survivors. 

For Veterans and separating Servicemembers who plan to file an electronic disability claim, VA urges them to use the joint DoD/VA online portal, eBenefits. Registered eBenefits users with a premium account can file a claim online, track the status, and access a variety of other benefits, including pension, education, health care, home loan eligibility, and vocational rehabilitation and employment programs.

For more information about VA benefits, visit www.benefits.va.gov, or call 1-800-827-1000.

#2014COLA #VAbenefits #veteransbenefits

In Fight Against Backlog, VA Shows Signs of Progress

Posted by Jason Van Steenwyk

militaryauthority.com department of veterans affairsThe Department of Veterans Affairs is finally starting to show signs of progress in reducing the stubborn backlog of claims pending for 125 days or more. As of last week, the VA was reporting a backlog of 536,400 cases. That is still much higher than it was when Eric Shinseki took the Secretary of Veterans Affairs job in 2009. But at least the number is beginning to decline: The VA reported a backlog of 608,000 claims in March.

The Secretary has established an ambitious goal of eliminating the backlog by 2015. That looks like it’s not going to happen. But the recent progress is encouraging – and is the result of a monumental commitment of both human and technological resources. 

What’s helped? First of all, the Department has been increasingly successful in digitizing the claims process. This is a huge issue, as the old paper-based system was slow cumbersome and prone to routine errors such as transcription problems and lost documents. Merely storing the huge number of records in paper files was becoming an increasingly unmanageable problem for the VA.

Last month, though, the Veterans Administration completed its roll-out its new electronic platform – the Veterans Benefit Management System (VBMS) – in all 56 of its regional offices. Despite some significant hiccups, the rollout was completed six months ahead of schedule.

“This is a big cross-over year for us,” Shinseki said recently to a gathering of VA claims-processing employees in Manchester, New Hampshire. “We have for decades sat astride rivers of paper. Now we are in the process of turning off paper spigots and turning on electronic ones.”

This is an auspicious event for a couple of reasons:

First, the electronic system makes the claims-tracking process itself more efficient. So even if the original file is still on paper, fewer additional man-hours need be spent on the process of entering data into a system to track progress.

Second, the new electronic system means that fewer paper applications are coming in. The process on new claims becomes much more efficient.

Additionally, veterans in the backlog have benefitted from an end to the war in Iraq, which had tragically been contributing a steady stream of new combat and deployment-related claims. Furthermore, the flood of newly-initiated coming from Agent Orange-related incidents has subsided, reducing the new-claims workload. The VA had experienced a surge in claims from Vietnam War veterans once the Obama Administration indicated that they were looking favorably at Agent Orange-related claims. The VA also expanded benefits eligibility for conditions related to service during the Gulf War.

Technically, a claim is categorized as “backlogged” if it is still pending adjudication after 125 days. Appealed claims that receive an initial adjudication are not considered “backlogged.”  In September of 2009, when Shinseki came on the job, the backlog stood at 180,000 claims. Since then, the VA has been processing claims at a higher rate than ever before – but the furious pace was still not enough to keep up with the new claims piling in. 

The Veterans Administration also sought to enlist the support of organizations like Disabled American Veterans and the American Legion to help veterans in the process of documenting and preparing their claims. This led to fewer incomplete applications and quicker processing times, because these claims tended to be more complete and more fully-documented prior to even reaching the VA processing center.

Connecticut Man Charged With Scamming Veterans

Posted by Jason Van Steenwyk

militaryauthority.com man scams veteransA 66-year old Vietnam War veteran from Stafford, Connecticut has been charged with defrauding veterans and their families of thousands of dollars since 2009. According to prosecutors, John J. “Buzzy” Simon told several veterans or their family members that he would help them maximize their VA benefits or get other money from the government. Allegedly, Simon took a fee in advance for his services, but never provided any assistance or services to these families.

Prosecutors also assert that Simon falsely represented himself as a service officer with Disabled American Veterans.

Simon was charged with mail fraud, which carries a potential sentence of 20 years. He was released on a $50,000 bond. 

Maine Man Sentenced to 3 Years in Prison for Stealing VA Benefits

Posted by Jason Van Steenwyk

militaryauthority.com man steals va benefitsA Maine fisherman and clam-digger, Richard C. Ramsdell, has pled guilty to fraudulently obtaining disability benefits from the Department of Veterans Affairs. He is accused of having received up to $200,000 in benefits, though the 39-year-old’s brief service in the Marine Corps was not enough to render him eligible for VA benefits. A judged sentenced him to three years in prison.

According to court documents and local media, Ramsdell told VA officials that he had a debilitating back injury and was unable to work. Meanwhile, he was performing strenuous jobs as a fisherman, painter and clam-digger. He was also doing manual labor while imprisoned last year on a conviction for stealing copper from a Navy base.

According to Bangor Daily News, prosecutors had lined up a VA doctor to testify that Ramsdell would not have qualified for VA benefits – due to his very brief period of service – without providing false statements to the VA. The VA does not, apparently, independently verify disability applicant’s eligibility with the Department of Defense before giving away hundreds of thousands of dollars in benefits.

Also, this week, a convicted sex offender was able to steal a National Guard NCO’s identity for years and obtain care from the VA medical facility at White River Junction, Vermont.

Meanwhile, calls have been mounting all spring for Secretary of Veterans Affairs Eric K. Shinseki to step down. Concerned Veterans for America produced a 30-second commercial spot calling for his resignation or dismissal. Even the reliable Obama Administration ally, the New York Times, could not ignore the increasing criticism.

At issue, the stubborn backlog of unresolved VA benefits claims, which Ramsdell managed to get, but which seem to be nearly impossible to get for nearly everyone else.

The current backlog is over 600,000 claims – a number that as increased 2,000 percent since Shinseki, 70, took over in 2009. 70 percent of cases now take over 125 days – even including the most routine of reviews. Meanwhile, some VA centers serving urban areas are taking over 600 days to resolve claims.  

Why VA Home Loans Still Make Sense

Posted by Jason Van Steenwyk

VA Home LoansFor all the problems at the Department of Veterans Affairs, there is one bright, shining light: The VA home loan is still a godsend for veterans.

 

Easier Qualification Standards

It’s not so much the interest rate. People with excellent credit can qualify for marginally better interest rates with conventional mortgages than with VA loans. But consider this: According to mortgage software and data company Ellie Mae, it’s taking a credit score of well over 768 these days to qualify for the best rates in the conventional mortgage market. People with credit scores in the 600 range? Many of them aren’t qualifying for mortgage loans at all. 

Over the last year, mortgage rates have fallen as low as 3.35 percent last December, and again in May, before rebounding to around 3.9 percent on June 1, 2013. Think about it from a lender’s perspective: That doesn’t leave much margin for defaults. With rates that low, lenders have become extremely picky about who they are willing to lend money to – even where these loans are secured by real estate.

A VA loan, however, is guaranteed by the U.S. government. That means that the taxpayer has stepped in and guaranteed the lender that they will not experience a loss on the loan. If a VA borrower defaults, the Department of Veterans Affairs makes up the difference to the lender. 

This means that VA loans are a lot less risky to the lender than conventional loans. In turn, this means that lenders tend to be more willing to consider loans to those with less-than-stellar credit scores. 

Furthermore, since a VA loan is guaranteed, the lender will not require private mortgage insurance, or PMI. Lenders typically require borrowers to buy this insurance if their loan-to-value ratio (LTV) is 80 percent or greater.

What does this mean? It means that if you owe more than 80 percent of the current value of the home, you have to keep paying PMI premiums. For most homeowners, this will add between $1,500 and $2,500 to your first-year home ownership costs.

The worst part is that the homeowner derives no benefit from this insurance. It protects the lender, not the borrower. But for VA borrowers, there’s no PMI requirement – even on deals that require nothing down. That’s enough of a difference to offset most or all of the lower monthly payments you might get with excellent credit if you made the same deal with a conventional loan.

(Hint: Home prices have gone up quite a bit over the last two years. If you have been paying PMI premiums, think about getting your home appraised, or requesting an appraisal from the lender. If a qualified appraisal pegs your home value at 80 percent or more of the outstanding mortgage balance, the lender has to drop PMI premiums. That’s money that goes back into your pocket.

Furthermore, VA loans do not have a pre-payment penalty. Lenders occasionally charge this to other borrowers to shield themselves from reinvestment risk – the possibility that borrowers will refinance their loans if interest rates fall, forcing the lender to reinvest the money at a lower interest rate. 

But Congress realized that military families have to move a lot – and therefore have to pay off loans repeatedly with each PCS, through no fault of their own. They therefore wrote rules that prevent VA lenders from charging a pre-payment penalty. Typically, this is an amount equal to six months’ worth of interest if you try to refinance or pay off the loan within the first five years. With a VA loan, on the other hand, you can pay down the loan early and often. This makes the VA solution an ideal option if you plan to move in a relatively short period of time, and ideal for those facing PCS moves every three or four years. If you don’t go with a VA loan, then look carefully at the prepayment terms of your mortgage, because they will likely kick in when you refinance.

 

Zero-Down Option

Many people look at the fact you can get into a VA loan with no down payment as the greatest benefit to a VA loan. But if you can’t swing a 10 to 20 percent down payment on a home, that’s a pretty good sign you can’t afford it! The underwriters figured that out long ago. Furthermore, VA borrowers aren’t immune to swings in house prices, and with zero down, even a slight downward tick in house prices leaves the borrower “underwater,” meaning you will owe more on the house than it is worth. Translated into real world terms, it means that if you do need to sell, you will either need to come up with cash at closing, or you will need to get the lender to agree to a short sale – which they may not be willing to do.

If you do go with a zero down loan, try to have something stowed somewhere else, outside of a retirement account, earning interest or dividends for you. Ideally, this pot of money should be invested in something besides real estate – so that if the value of your home falls, this other stash of money doesn’t fall with it. It’s just another safety net to see you through tough times. The good news: The fact that the VA does allow for no-down-payment mortgages gives you the flexibility to keep your savings in something more liquid than home equity.

 

Vet Creates Own Path with G.I. Bill Benefits

Posted by S.E. Davidson Parker

Robert E. Lee did it in order to map the “impassible” Pedregal during the Mexican-American War.

George S. Patton did it in order to take Messina Palermo (oh, those garbled messages…).

fire fighters in trainingAnd now it’s Emmett Middaugh’s turn. It took a year of phone calls, paperwork, and determination, but Emmett Middaugh and the Forest Grove (Oregon) Fire and Rescue created the first on-the-job (OJT) training program in Oregon for students interested in firefighting that allow them to collect VA educational and training benefits.

Emmett Middaugh is studying full time for two associate degrees, fire protection and EMT-paramedics, while also volunteering for a 24-hour shift every three days at Forest Grove Fire and Rescue. That doesn’t leave much time for paying employment. By developing an approved program with the VA, student/volunteer fire fighters are eligible for not just benefits during school terms; if they continue volunteering (now an OJT program), veterans may be eligible for additional (non-school term) benefits through the VA.

Middaugh is the only person in the Oregon program so far. However, Oregon Bureau of Labor and Industry Brad Avakian is hoping to use this program as a template for other military-to-civil service transition programs in Oregon, as well as sharing these types of programs across the nation.

So what does that mean for you? It means the VA is willing to listen to ideas by veterans that can assist veterans. As the cliché goes, “the sky’s the limit.” Contact your local VA office as well as your school’s office of veterans’ services to see just how to proceed and who to speak with to make your program dreams a reality.

Chained CPI and the Battle Over Veterans’ Benefits

Posted by Jason Van Steenwyk

Veterans groups and elder advocacy organizations such as the AARP are lobbying overtime to protect their constituents from the long-term effects of a budget-saving measure designed to reduce the rate of increase of future Social Security benefits, retirement income and VA disability compensation. 

The United States Government, still smarting from a nasty recession and suffering the fiscal hangover effects of the so-called ‘Stimulus’ package, is looking for ways to rein in spending in order to preserve the long-term financial stability of Social Security. According to the Social Security Administration’s own actuaries, the program has enough in hand to pay planned benefits through approximately 2033 – after which time its portfolio of bonds will be exhausted. At that point, projected revenues coming into the program from payroll taxes would be sufficient to fund only about 75 percent of currently projected benefits. 

One proposed solution – which the President himself is said to favor – is to slow down the rate of growth in benefits by switching to a new method of accounting for inflation. Specifically, the President, and certain fiscal hawks would like to switch over to a Chained CPI measurement.

The Chained CPI is thought to be a more accurate measure of the true cost of living because it takes into account dynamic consumer reactions to changes in prices. Under current methodology, if the price of steak doubles but the price of chicken stays the same, the current measure simply assumes that the retiree or veteran will still buy the same amount of steak. The Chained CPI method, on the other hand, will assume that higher steak prices will result in less purchases of steak and more substitution of chicken.

The result, chained CPI advocates say, is a more accurate picture of the true cost of living, given that consumers are able to mitigate the effects of inflation by making smarter purchases.

It will also result in COLA adjustments being reduced by half. That means lower cost-of-living increases to Social Security recipients, veterans, and any other beneficiaries of programs affected by chained CPI methodology.

As a result, the Veterans of Foreign Wars has come out strongly against the measure, as has the American Association of Retired Persons.

According to a report issued in 2011 by a group called Strengthen Social Security, a switch to chained CPI would result in a relatively small decrease in planned benefits of less than 1 percent in the first year for a 65 year old veteran. But the reduction would become much more noticeable as he grows older: Benefits would be 9.2 percent lower than an unchained CPI would generate by the time the veteran turned 95 years old.

That’s a significant difference – both for the veteran and the taxpayer.

Moreover, a switch to chained CPI would most severely affect younger veterans, who will be reaching their retirement years decades away, or living on disability compensation payments for many decades to come. According to the same report, a disabled veteran who started receiving VA disability benefits at age 30 would have his or her benefits reduced by $1,376 at age 45, $1,821 at age 55 and $2,260 at age 65.

Reduction in VA Comp

 

 

 

 

 

 

 

 

 

 

 

 

A switch to chained CPI would also disproportionately affect women, who both live longer than men, on average, and rely on Social Security for a greater proportion of their retirement income than men. And finally, a broad switch to chained CPI would also doubly affect the young, since it would quickly result in a higher and higher tax burden. This is because the chained CPI would also reduce the annual adjustments to tax brackets every year, resulting in more and more money becoming taxable at higher tax brackets.

Ultimately, it’s up to Congress to reconcile the competing interest groups. Last week, the Senate expressed its opposition to transitioning to a chained CPI for veterans in a non-binding voice-vote. There was no roll call on the vote, so there is no real record of how your Senator voted. The measure’s sponsors were Senators Bernie Sanders (I-Vt.), Tom Harkin (D-Iowa), Mazie Hirono (D-Hawaii) and Sheldon Whitehouse (D-R.I.)

While early indications are that Senate liberals and Democrats generally oppose the adoption of chained CPI – as does the AFL-CIO, for that matter – the liberal-leaning Brookings Institution has come out in favor of considering chained CPI, and including veterans’ benefits in the equation:

“We are in an era where benefits are going to be reduced and revenues are going to rise,” said Isabel Sawhill, a Senior Fellow at the Brookings Institution, according to reporting by Federal News Radio. There’s just no way around that. We’re on an unsustainable fiscal course,” Sawhill said. “Dealing with it is going to be painful, and the American public has not yet accepted that. As long as every group keeps saying, ‘I need a carve-out, I need an exception,’ this is not going to work.”

Sawhill argued that making changes now will actually make it easier for veterans in the long run.

“The longer we wait to make these changes, the worse the hole we’ll be in and the more draconian the cuts will have to be,” she said. 

Nonsense. Veterans disability compensation, especially, needs to be carved out and protected from any move to a chained CPI, for the simple reason that these veterans have already sacrificed for the good of the Republic. In many cases, these veterans have had limbs carved off in the service of their country – something not generally true of most Social Security beneficiaries.

Social Security is a fundamentally different program than veterans’ benefits. First of all, its original design was to be self-supporting. Current benefits were to be paid by current workers. That was the deal all along. It is, at its core, an insurance program, and we are all policyholders. Because Social Security’s reach is so broad, there is no real way to ‘carve out’ segments of the population, because any decisions made for Social Security ultimately affect all of us.

This is not the case with veterans benefits. It is not a mutual aid program. It is not predicated on a veteran having paid into the system, and benefits were never meant to be actuarially driven. Any veteran who served, and some who were wounded or injured in the service to their country, did so under the understanding that they would qualify for disability compensation if they were wounded or injured in the line of duty, and that these benefits would increase with inflation.

As the Veterans of Foreign Wars points out in its own talking points memo on the issue, Chained CPI is based on changes in purchasing habits during poor economic times (buying hamburger instead of steak, renting a movie instead of going to the movies). However, military families and disabled veterans are often on fixed incomes and do not have the luxury of making these choices; they already buy hamburger and rent movies.

Study: The Faster You Get Out of a VA Hospital, the Better Off You Are

Posted by Jason Van Steenwyk

VA medical careThat wasn’t quite the headline. The real headline is “Shorter hospital stays don’t mean worse care: study.” But they work out to the same thing.

“U.S. Veterans Affairs hospitals were able to reduce their patients’ length of stay without increasing the number of people who needed to be readmitted later on, according to a new study.

“As hospitals became more efficient there was this growing concern that we were discharging patients – as some would say – sicker and quicker,” said the study’s lead author Dr. Peter Kaboli.

“In fact, we found just the opposite,” said Kaboli, who works at the Iowa City VA Health Care System.”

The average VA hospital stay fell from 5.5 days in 2007 to 4 days in 2010. The study, published in the Annals of Internal Medicine, surveyed 4 million patient records at the Department of Veterans Affairs’ 129 hospitals nationwide from 2007-2010 to see if earlier discharges resulted in an increase in admission within 30 days.

The study shockingly found that when it came to readmissions, government health care added no value beyond the third day. More than that, the survey found that a five-day stay rather than a four-day stay was actually harmful to readmission rates: Reducing the length of stay from 5.5 days to 4 days actually reduced readmissions, from 16.5 percent in 1997 to 13.8 percent in 2010.

The survey also found that getting patients out of the VA hospital in four days rather than five and a half, on average, resulted in lower post-discharge mortality rates over the 90 days following discharge.

The sample was diverse: No specific diagnosis or medical condition accounted for more than 5 percent of the patient population. It is therefore unlikely that advances in treatment of a particular condition or disease accounted for a significant change in the numbers.

Why would patient outcomes improve with shorter hospital stays? Hospital-acquired infections, or HAI (also called nosocomial infections). Hospitals are hothouses for staph infections and other communicable diseases. Infection and reinfection accounts for a significant number of hospital readmissions within 30 days of discharge. The Center for Disease Control estimates that there are 1.7 million serious infections acquired in a hospital each year, killing almost 100,000 people per year. These infections can occur when hospital staffers do not disinfect exposed surfaces or diligently practice sound hygiene.

The Veterans Administration had, during the time of the study, also engaged in a massive, successful effort to improve hygiene at its hospitals and clinics. The effort resulted in a massive, 62 percent decrease in hospital-acquired staph infections. The initiative commenced in 2007 – the same year the study began.

13.6 percent of patients admitted who were screened for methicillin-resistant Staphylococcus aureus bacteria tested positive. This alerted VA staffers, who would isolate the patient from others and who would be extra diligent in practicing universal hygiene precautions, so as to minimize the risk of patient-to-patient and patient-to-staff-to-patient infection.

With screening at admission now commonplace, VA officials could effectively calculate how many patients acquired the infection while in the hospital. The VA estimated that there were 1.62 new infections per 1,000 patient days. The rate fell to 0.6 new infections per 1,000 patient-days. Not enough to hugely affect the VA’s readmission numbers, however.

The study also included the time period in which the VA had to inform more than 10,000 patients that they were potentially exposed to hepatitis and other infections because of faulty sanitation procedures at VA facilities in Florida, Georgia and Tennessee.

Defense Bill Gets Rave Reviews from Iraq and Afghanistan Vets’ Lobbying Organization

Posted by Jason Van Steenwyk

Iraq and Afghanistan veteransIraq and Afghanistan Veterans of America, a lobbying and advocacy group representing GWOT veterans, has come out in favor of the National Defense Authorization Act of 2013 (NDAA), passed by Congress on the eve of the Christmas recess. Specifically, IAVA applauds features in the bill that favor younger veterans, specifically, as opposed to the older generation combat veterans of the Gulf War, Viet Nam and earlier wars. For example, while Viet Nam-era veterans are now beginning to enter their retirement years, Iraq and Afghanistan War veterans benefit much more from job transition and employment initiatives in the DoD, Veterans Administration and elsewhere.

The IAVA issued a press release lauding the passage of the bill on December 21st, praising the bill’s following features:

Helping Veterans Transition to the Workforce: The NDAA addresses the significant challenge many veterans face in translating their military training to state civilian licenses and certifications. The NDAA requires states to consider military training and education for civilian certifications and licenses in comparable civilian jobs. The NDAA also enhances and simplifies the Troops to Teachers Program that provides a path for veterans to continue their service as teachers.

Protecting the New GI Bill: The NDAA helps service members avoid predatory for-profit schools by requiring military bases and posts to review which for-profit schools and their recruiters are allowed access on base.

Improved Access to Mental Health Care: The NDAA is a big step forward in improving access to and the quality of mental health care for active-duty, Guard and Reserve service members, military families, and veterans. It also establishes a pilot to use community partners to provide mental health services for Guard and Reserves who often struggle to find care. In addition, the NDAA strengthens suicide prevention programs, by both standardizing some of these efforts across the VA and DoD and by creating suicide training and prevention programs for Guard, Reserves and their families.

Protecting Victims of Military Sexual Trauma: The legislation establishes a DoD Special Victims Units to respond to and investigate all reports of sexual misconduct. It also requires an independent review of all judicial proceedings and investigations on sexual misconduct. In addition, the NDAA mandates improved victim protections and reporting policies. It also requires that the military get its level of care for military sexual trauma victims up to what is done in civilian health care systems.

Focus Efforts on Traumatic Brain Injury (TBI): The bill mandates detailed planning to eliminate gaps and redundancies in DoD programs on psychological health and traumatic brain injury.

Addressing VA Claims Backlog: Recognizing the lengthy backlog for getting claims processed at the VA, the NDAA requires the VA to provide a detailed report to Congress on how the claims backlog will be solved. This report is due no later than 60 days after the president signs the bill into law.

VA Makes it Easier for Native American Veterans to Access Care

Posted by Jason Van Steenwyk

Indian Health Services and VAEarlier this month, the Department of Veterans Affairs announced an agreement with Indian Health Affairs that will make it easier for Native American veterans to access VA-sponsored health care.

The two organizations signed an agreement that will allow the Department of Veterans Affairs to directly reimburse IHS clinics and staff for services provided to qualifying veterans who are Native American or Native Alaskan.

Under the agreement, VA copays do not apply to treatments received from the IHS.

Until this point, veterans in very remote, rural areas had difficulty accessing VA care, because they were far from established VA hospitals and clinics. The agreement will make it possible for Native Americans to receive care from clinics already established on and near Indian reservations.

A listing of Indian Health Service medical services and resources is here.

This is not the first agreement between the IHS and the Department of Veterans Affairs. They also reached agreements in Memorandums of Understanding in 2003 and 2010. But this is the first time that IHS clinics were authorized direct reimbursement for services — essentially creating mini VA clinics out of them.

Indian officials believe that not only will treatment be accessible closer to home for these veterans, but also enable them to receive treatment in a more culturally sensitive setting and milieu, according to their 2003 Memorandum of Understanding.