VA, VISN 20, and NW MIRECC History

VA, VISN 20, and NW MIRECC History

The United States has the most comprehensive system of assistance for Veterans of any nation in the world, with roots that can be traced back to 1636, when the Pilgrims of Plymouth Colony were at war with the Pequot Indians. The National Guard is the oldest component of the nation’s armed forces, tracing its history back to the earliest English colonies in North America. The Pilgrims passed a law that stated that disabled soldiers would be supported by the colony. The first shots of what would become war for American independence were fired in April 1775. The American colonies had relied on the militia system for 150 years, but in June of 1775, the Second Continental Congress authorized the creation of a Continental Army, with George Washington serving as commander in chief.

On October 13, 1775, a resolution of the Continental Congress established what is now the United States Navy with “a swift sailing vessel, to carry ten carriage guns, and a proportionable number of swivels, with eighty men, be fitted, with all possible despatch, for a cruise of three months...". The Second Continental Congress resolved in 1775 to raise two battalions of Continental Marines on November 10, 1775. Later, the Continental Congress of 1776 encouraged enlistments during the Revolutionary War, providing pensions to disabled soldiers. General George Washington established the "Badge of Merit" on August 7, 1782. In its shape and color, the Badge anticipated and inspired the modern Purple Heart. In the early days of the Republic, individual states and communities provided direct medical and hospital care to Veterans.

Following their role in the American Revolution, the Marines were abolished following the Treaty of Paris in April 1783. President George Washington issued a proclamation naming Thursday, November 26, 1789, as an official holiday of "sincere and humble thanks." The nation then celebrated its first Thanksgiving under its new Constitution. On October 3, 1863, President Lincoln made the traditional Thanksgiving celebration a nationwide holiday to be commemorated each year on the fourth Thursday of November. After the American War of Independence, the U.S. Constitution empowered the new Congress “to provide and maintain a navy.” Acting on this authority, Congress established the Department of the Navy on April 30, 1798. Since its beginning in the American Revolution, the U.S. Navy has evolved from a fleet of sail and steam-powered ships to a high-tech fleet with nuclear-powered vessels and supersonic aircraft. Congress ordered the creation of the Marine Corps on July 11, 1798, and directed that it be available for service under the Secretary of the Navy. The first hospital for men who made their living at sea was built in Norfolk County, Virginia in the town of Washington.

In 1798, President John Adams established U.S. Marine Hospitals with the "Act For the Relief of Sick and Disabled Seamen" and in 1800 the Federal government purchased the Virginia hospital. The Marines still perform their original task of serving as landing forces for the naval fleet, but in more than two centuries of service, the Corps has evolved to take on other tasks too, such as guarding U.S. embassies around the world and functioning as quick strike forces sent in to hold trouble spots while reinforcements are gathered and deployed. On August 4, 1790, Congress authorized Secretary of the Treasury Alexander Hamilton's proposal to build ten cutters. This date marks the officially recognized birthday of the U.S. Coast Guard. In 1811, the U.S. Navy urged Congress to pass legislation to create a Home in Philadelphia "for destitute Navy sailors and Marines."

An interim Naval Hospital opened in the former country mansion of the renowned Pemberton family in Philadelphia. On April 3, 1827, the occasion of the cornerstone laying of the U.S. Naval Asylum was led by Commodore William Bainbridge. Commodore Bainbridge said in his dedicatory speech, "A home will be established for the faithful (seaman) who has been worn out or maimed in fighting the battles of his country. A comfortable harbor will be secured where he may safely moor and ride out the ebb of life free from cares and storms, by which he has been previously surrounded". Established in 1834, the U.S. Naval Asylum was the first federal Veterans' retirement facility in America. The United States Naval Home was funded completely by Navy appropriations. In 1889 the name was changed to the U.S. Naval Home and remained in continuous operation until 1976.

The United States Soldiers' Home was authorized by Congress in 1851. The Soldiers Home historically relied upon monthly contributions from active-duty U.S. Army (and later U.S. Air Force) enlisted personnel and warrant officers, fines, and forfeitures collected as a result of disciplinary actions. President Abraham Lincoln loved visiting the United States Soldiers Home, as did U.S. Presidents before him. After it grew, he asked to use the cottage as a summer home to escape the humidity and political pressures of DC. All told, Lincoln spent one quarter of his presidency in the cottage including the months when he penned the Emancipation Proclamation. President Lincoln's Cottage, a part of the U.S. Military Asylum; The Old Soldiers’ Home (now called the Armed Forces Retirement Home), located at the intersection of Upshur Street and Rock Creek Church Road NW, Washington, DC, has been designated a National Historic Landmark.

Established in June of 1863, Fort Boise was redesignated as Boise Barracks in 1879. Military units continued to serve and protect the citizens of Boise and southwestern Idaho until the Fort was formally abandoned in 1912. Soldiers returned briefly in 1916 to prepare for the Mexican border campaign. Fort Boise was approved as a Public Health Hospital in 1919. On February 7, 1938, 110 acres were transferred from the War Department to the VA by Executive Order. Aside from early settlers' 1863 log cabins preserved as relics, the oldest buildings in Boise are those constructed for the Fort. The sandstone buildings erected in 1864 are still in use by the Boise VA Medical Center today. From 1950 to the present, Boise VA Medical Center has occupied the main part of the grounds of the former Fort Boise. The Idaho State Veterans Home in Boise operates on land excessed from the VA. Idaho State Veterans Homes are also located in Lewiston, Pocatello, and Post Falls.

On March 3, 1865, a month before the Civil War ended, President Abraham Lincoln authorized the first-ever national soldiers’ and sailors’ asylum to provide medical and convalescent care for discharged members of the Union Army and Navy volunteer forces. The asylum was the first of its kind in the world to provide civilian medical care to Veterans of temporary volunteer forces. As the first-ever government institution created specifically for honorably discharged volunteer soldiers, it would later be renamed the National Home for Disabled Volunteer Soldiers (NHDVS). In 1991, Congress merged the U.S. Naval Home with the U.S. Soldiers’ and Airmen’s Home and renamed it Armed Forces Retirement Home (AFRH). President Lincoln's Cottage at the Old Soldiers Home began restoration in 2001 and was open to the public for the first time in history on President's Day in 2008.

Also in the 19th century, the nation's Veterans assistance program was expanded to include benefits and pensions not only for Veterans but for their widows and dependents. On March 4, 1865, as the Civil War entered its final weeks, President Abraham Lincoln delivered his second inaugural address from the East Portico of the U.S. Capitol. He ended his address with a stirring call for healing and reconciliation, to which he added a solemn promise to those who had fought to restore the Union, "With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us strive on to finish the work we are in; to bind up the nation’s wounds; to care for him who shall have borne the battle, and for his widow, and his orphan—to do all which may achieve and cherish a just and a lasting peace, among ourselves, and with all nations".

While the U.S. Naval and Soldiers Homes served retired members of the Regular Navy and Army, the federal government did not operate volunteer soldiers' homes until after the Civil War. Two earlier soldiers’ homes, operated by the U.S. Army and Navy for Veterans of the Regular military forces, were very small and housed only up to 300 men each. From 1866 to 1930, branches of the NHDVS opened throughout the country. The National Homes housed tens of thousands of Veterans. The National Homes were often called “soldiers’ homes” or “military homes.” Each National Home contained a hospital, barracks, dining hall, recreational facilities, and a cemetery. Memorial Day, initially referred to as Decoration Day, was observed by many communities after the Civil War when the nation suffered more than 620,000 military deaths, roughly 2 percent of the total population at the time. In 1967, U.S. Congress asserted that “Memorial Day” was the official name of the holiday. Memorial Day is now designated as an annual day of remembrance to honor all those who have died in service to the United States during peace and war.

Following the Civil War, many state Veterans homes were established. Beginning in the late 1800's, National and State Homes opened in Idaho, Oregon, and Washington. The first Soldiers' Home of the Pacific Northwest was located in Orting, Washington. In 1894, the Idaho State Soldiers' Home opened in Boise and the Oregon State Soldiers' Home opened in Roseburg. Also in 1894, the Roseburg National Cemetery was established. Later in 1907, the state of Washington passed legislation for the establishment of the Washington Veterans' Home in Retsil. Overlooking the Sinclair Inlet in Kitsap County, Washington Veterans Home Port Orchard (Retsil) situated on 31 acres, was built in 1910. As the U.S. entered World War I in 1917, Congress established a new system of Veterans benefits, including programs for disability compensation, insurance for service personnel and Veterans, and vocational rehabilitation for the disabled. In 1918, Congress tasked two Treasury agencies - the Bureau of War Risk Insurance and Public Health Service - with operating hospitals specifically for returning World War I Veterans. They leased hundreds of private hospitals and hotels for the rush of returning injured war Veterans and began a program of building new hospitals.

World War I is regarded as the first “total war” because the combatants devoted all their resources — military, industrial, and human — on a scale never before thought possible. On November 6, 1919, Native Americans who served in World War I became eligible for American citizenship, and full Veterans benefits, including health care. Sixty-five million men and women took part in the war, and historians estimate that as many as 10 million men lost their lives while another 20 million were wounded. World War I was the first fully mechanized war, and as a result, soldiers who were exposed to mustard gas and other chemicals and fumes required specialized care after the war. In April of 1921, a Presidential committee recommended consolidating the Bureau of War Risk Insurance, Federal Board of Vocational Education, and Public Health Service into an independent federal agency led by an executive who reported directly to the president. Congress took up the committee’s proposal and by summer passed Public Law 67-47, popularly known as the Sweet Act after the name of the legislator who introduced it, establishing the Veterans Bureau. President Warren G. Harding signed Public Law 67-47 establishing the Veterans Bureau by merging the three World War I Veterans programs.

A majority of existing VA hospitals and medical centers began as National Home, Public Health Service, U.S. Marine Hospitals, or Veterans Bureau Hospitals. In the Pacific Northwest, there were U.S. Marine Hospitals located in Seattle, Port Townsend/Port Angeles, Knappton Cove, and Portland. After World War I, Tuberculosis and Neuropsychiatric hospitals opened to accommodate Veterans with respiratory or mental health problems. In Washington, Fort Walla Walla was one of the longest-occupied military posts in the Northwest. Originally part of Fort Walla Walla, which dates back to 1856, land was transferred to the then U.S. Veterans Bureau in 1921 for a hospital in the Walla Walla area. On Veterans Day 1996, VA Walla Walla Medical Center was renamed Jonathan M. Wainwright Memorial VA Medical Center. Wainwright was born on Fort Walla Walla grounds on August 23, 1883. During World War II, Wainwright commanded U.S. troops in the Philippines and ultimately surrendered himself and his troops on May 8, 1942, to the Japanese. A survivor of the Bataan Death March, he was liberated from the POW camp on August 16, 1945. Wainwright received numerous medals, including the Medal of Honor September 10, 1945, which was presented to him by President Harry S. Truman. The Walla Walla Veterans Home is co-located on the campus of the Jonathan M. Wainwright Memorial VA Medical Center.

In 1923, American Lake VA Medical Center opened in Tacoma, Washington as the 94th Veterans Hospital to be built by the War Department for the provision of care to World War I Veterans. The Secretary of the Army authorized, under a revocable license, the Veteran Bureau's use of 377 acres of the 87,000 acre Fort Lewis property in Washington state. On March 15, 1924, the first 50 patients were admitted to the hospital, by transfer, from Western State Hospital at Fort Steilacoom to American Lake VA Medical Center. Upon closure of Fort Steilacoom, Washington Territory maintained the hospital in what was named, Insane Asylum of Washington Territory. Through land acquisitions, auctions, and authorized donations from the U.S. Army, Western State Hospital continues its operation as the sixth-largest psychiatric hospital in the United States. The construction of VA's first facilities for women Veterans were constructed at American Lake VA in 1948.

Barnes General Hospital, built in 1941 was located on Vancouver Barracks, the first U.S. Army base located in the Pacific Northwest, Fort Vancouver. Vancouver Barracks is significant for its association with World War II U.S. Army hospital operations and early Veterans Administration hospital history. In May of 1946, President Harry S. Truman authorized the transfer of the U.S. Army Barnes General Hospital in Vancouver Washington to the Veterans Administration. Vancouver Barracks operated as a Veterans' hospital until the new construction of the Vancouver VA Medical Center (VVAMC) was completed in the 1980s. The Vancouver VA Medical Center opened as an annex to VA Portland Medical Center. On the campus of VA Vancouver Medical Center, a UH-1 Huey "Lady Bell" flown by the U.S. Navy Helicopter Attack Squadron Light (HAL) 3, is on display at the Military Museum. Pearson Air Museum, a part of Fort Vancouver National Historic Site, tells the story of Pearson Field, one of the country's oldest continuously operating airfields. VA's Vancouver Military Museum, housed in a World War II-era building, was once used as radio transmission for Pearson Field.

In the early 1900s, Charles Samuel ("Sam") Jackson, publisher of Oregon Journal, donated land in Portland Oregon to the United States Veterans Bureau. Initial site preparation for a Veterans hospital started in February of 1927, with construction commencing one year later. The first 13 buildings of the new Veterans hospital were activated in December 1928 and formally dedicated later in 1929. Expansion and construction was completed and dedicated in 1987 and opened to patients in February 1988. Building #16, built in 1932, is the only building remaining of the original Veterans hospital. Situated on a 450-foot-tall basalt-rock hill, Portland VA Medical Center (PVAMC) and Oregon Health and Science University (OHSU) became physically connected in 1992 with the construction of a 660-foot enclosed pedestrian sky bridge. Built over a 150-foot-deep ravine, the enclosed sky bridge immediately enhanced efficiency and collaboration. Partners since 1948, the enclosed sky bridge stands as a tangible symbol of the long-term partnership between PVAMC and OHSU. At the time of dedication, it was the longest enclosed sky bridge in the United States. 

National Homes were extended to women, National Guard, and militia Veterans in the 1920's. VA's first research program was established in 1925 and the Veteran’s Bureau began conducting the first hospital-based medical studies. In October 1927, after World War I, General Charles Summerall proposed that Congress revive the "Badge of Military Merit." In January 1928, the Army’s Office of The Adjutant General was instructed to file the materials concerning the proposed medal. Among those materials was a rough drawing of a circular medal disc with a concave center on which a raised heart was visible. Engraved on the back of the medal was "For Military Merit." Also in the early 1930s, General Douglas MacArthur, Summerall’s successor as Army Chief of Staff, resurrected the idea for the Purple Heart medal. On February 22, 1932 -- the 200th anniversary of George Washington’s birth -- the War Department (predecessor to the Department of Defense) announced the establishment of the Purple Heart award in General Order No. 3. In 1929, U.S. Army General Frank T. Hines, VA’s longest-tenured leader, suggested consolidation and coordination of all Veterans activities into one agency. By 1929, the National Homes had grown to 11 institutions that spanned the country.

The establishment of the Veterans Administration (VA) came in 1930 when Congress authorized the president to “consolidate and coordinate Government activities affecting war Veterans.” The second consolidation of federal Veterans programs took place on July 21, 1930, when President Herbert Hoover consolidated the Veterans Bureau with the National Home for Disabled Volunteer Soldiers and Pension Bureau and re-designated it as the Veterans Administration. After the VA was established in 1932, the National Homes were converted to domiciliary care to provide services to economically disadvantaged Veterans. 

The Oregon Soldiers' Home itself opened in 1893 to "provide a home for honorably discharged soldiers, sailors and marines who had served in any wars in which the United States was engaged, or who served in the Indian Wars of Oregon, Washington or Idaho, provided they were or might become citizens of Oregon." Oregon State Soldiers Home was replaced by Roseburg VA Medical Center in 1933. Later in 1937, Roseburg VA Medical Center was designated a Neuropsychiatric Veterans hospital. The 114-acre VA Roseburg VA Medical Center campus provides Veterans of Oregon and Northern California with Primary Care and hospital services. VA Southern Oregon Healthcare System serves Veterans in Oregon, as well as Siskiyou and Del Notre counties in northern California. White City VA Medical Center is a teaching hospital that provides a full range of services, with state-of-the-art technology as well as education and research.

In 1942, a major War Department construction project built over 1,000 buildings in the Agate Desert, near Medford, Oregon. Dedicated on September 15, 1942, U.S. Army Camp White became a World War II military training installation. Camp White was named for Major General George A. White, the longest-serving adjutant general of the Oregon National Guard (ONG), having served nearly 27 years. In 1945 there were 29 locations announced for Veterans hospitals built in the United States. In the Northwest, those were Klamath Falls, Oregon, and Spokane, Washington. Later in 1949, White City VA Medical Center Domiciliary Residential Rehabilitation Treatment Programs (DRRTP) opened in White City, Oregon. DRRTP, established through legislation passed in the late 1860s, is the VA's oldest healthcare program. White City (VA Southern Oregon Rehabilitation Center) provides 255 residential rehabilitation beds and an outpatient department for primary and mental health care. Major General White was one of the founding members of the American Legion. In 2018, ONG dedicated the new Maj. Gen. George A. White Headquarters.

World War II was the most widespread war in history with more than 100 million people serving in military units. About 16 million Americans served during WWII, and many of those Veterans are now receiving VA benefits including Pension and Health Care. On December 5th, 1942, the U.S. Navy, Marine Corps, and Coast Guard were authorized to issue Purple Hearts, retroactively to the attack on Pearl Harbor, which killed thousands of Navy personnel and pulled the United States into World War II. The Presidential Executive Order of 1942 also stated that the Purple Heart was to be awarded to persons who "are wounded in action against an enemy of the United States, or as a result of an act of such enemy, provided such would necessitate treatment by a medical officer." Over 1 million Purple Hearts were awarded during World War II. The only U.S. President to be awarded the Purple Heart is John F. Kennedy. He received the Purple Heart after being seriously injured when the patrol torpedo boat (PT109) he was commanding was sliced in half and sunk by a Japanese warship near the Solomon Islands in August 1944. Kennedy was badly hurt in the collision, as were two other sailors; two more were lost. As the boat sank, Kennedy spent hours rescuing injured members of the crew. He also received the Navy and Marine Corps Medal for his actions.

The World War II Servicemen’s Readjustment Act – the "GI Bill of Rights", provided new education benefits, unemployment compensation, and home loans. The home loan guaranty program was originally conceived in 1944 as a part of an attack on the harsh aftermath associated with wars. The overall objectives of this attack were to diminish to the greatest possible extent the economic and sociological problems of post war readjustments of millions of men and women then serving in the Armed Forces. The American Legion is credited with designing the Serviceman’s Readjustment Act of 1944 — popularly called the “GI Bill” — and pushing the legislation through Congress for President Franklin D. Roosevelt’s signature. The program was one of the major innovations and a most important part of the original Servicemen's Readjustment Act of 1944, Public Law 78-346. The first legal framework was set forth in Title III of that Act. The first legislation of its kind, the GI Bill provided Veterans with education and training; home, farm, and business loans; unemployment pay for up to 1 year; and assistance finding jobs. The original GI Bill provided education and training, rehabilitation and job placement, home loans that required no money down, and more than doubled the number of VA healthcare facilities for Veterans. Since 1944, the GI Bill has helped qualifying Veterans and their family members get money to cover all or some of the costs for school or training.

On August 14, 1945, Japan surrendered and brought to a close the war in the Pacific. Americans everywhere rejoiced that “V-J Day” had finally come. Americans were especially grateful that the surrender eliminated the need for an invasion of Japan, with its enormous cost of human life and property. From New York to San Francisco, people rushed into the streets to give thanks and to hail the end of “the duration” and the victory of liberty. In 1946, General Bradley announced that the VA would build 183 new hospitals -105 General, 49 Neuropsychiatric, and 29 TB, providing an additional 151,500 beds--in 39 states. During the postwar economic boom, Veterans started families and bought homes using their VA Home Loan benefit. The first women doctors were hired, and VA Memorandum No. 2 of 1946, established affiliations with medical schools to help train physicians and other medical personnel needed to work in VA hospitals. When Bradley left in 1947, there were 125 VA hospitals. Although the U.S. Air Force was not established as an independent agency of the Department of Defense until September 18, 1947, the Air Force’s lineage dates back to the early 1900s, when the Army Signal Corps established an Aeronautic Division in 1907. On July 26, 1948, President Truman signed Executive Order 9981: Desegregation of the Armed Forces. The Joseph Maxwell Cleland and Robert Joseph Dole Memorial Veterans Benefits and Health Care Improvement Act of 2022 expanded eligibility at the VA for World War II Veterans. Unless eligible for a higher priority group, World War II Veterans will be enrolled in Priority Group 6 and be copayment exempt for any care and medications related to their service. Surviving spouses, dependent children, and dependent parents of Veterans who died as the result of diseases related to radiation exposure during military service may be eligible for survivors' benefits.

Seattle City Council donated the 44-acre nine-hole golf course for a Veterans Hospital and construction began in the late 1940's. The Seattle VA Medical Center was built on the grounds of Jefferson Park. During World War II, Jefferson Park was used by the U.S. Army as one of the largest Recreation Centers in the nation. Seattle VA Medical Center was dedicated on May 15, 1951. VA Puget Sound Health Care System (VAPSHCS) began partnering with the University of Washington (UW) School of Medicine in 1951. Segregation at VA Hospitals ended in September 1953 when Mr. Harvey V. Higley became Administrator of VA. The designation of color was eliminated from all future VA hospitals and outpatient application forms on February 4, 1954. Major expansion of research and medical care was completed in 1967 and 1985.

During World War II, the city of Spokane and the county donated over 200 acres of land for a hospital. In less than a year, a 1,500-bed hospital was built to care for the wounded returning from war. New construction of a Veterans hospital in Spokane Washington began in 1950. In 2013, Spokane VA Medical Center was renamed Mann-Grandstaff VA Medical Center in honor of Medal of Honor recipients; Private First-Class Joe Eugene Mann and Platoon Sergeant Bruce Alan Grandstaff. PFC Mann of Reardon died in combat during WWII. Platoon SGT Grandstaff of Spokane died in combat during Vietnam. The main campus has 36 hospital beds and 34 rehabilitation-oriented nursing home beds. In addition to the main VA Medical Center in Spokane, the VA Spokane Healthcare System serves Veterans with clinics in eastern Washington, northern Idaho, and northwestern Montana. The Spokane Veterans Home is operated and maintained by Washington State. Also in the 1940s, the Department of Medicine and Surgery was established within the VA along with Veterans Administration Voluntary Services (VAVS) and Veterans' Canteen Service (VCS).

VCS is proud to be a part of the VA. As a self-sustaining entity, VCS provides merchandise and services to Veterans enrolled in VA's Health Care System, their families, caregivers, VA employees, volunteers, and visitors. We are honored to "give back" to the VA through many programs established for the health and well-being of our nation’s heroes. Revenues generated from VCS are used to support a variety of Veteran programs; VA’s National Rehabilitation Events, Fisher House, Suicide Prevention, disaster relief efforts, Substance Abuse Cessation, Women Veterans initiatives, Homeless Veterans programs, community stand downs, Welcome Home Celebrations, and much more. VCS supports VA Fisher Houses across the country by providing coupons to first-time visiting families and being their purchasing source for supplies and necessities. VCS is proud to offer Veterans enrolled in VA healthcare, their families, and VA employees exclusive online shopping benefits.

Nestled between the epic cataclysm that was World War II and the roiling controversy that was Vietnam, Korea is too often referred to as the forgotten war. The 5.7 million American men and women who served in that war each have their memories, whether they were on the battle lines, in the air, or in support of those whose lives were at risk. The war lasted just over three years, but nearly 60 years after the guns fell silent, Americans in uniform still maintained the peace along the 38th Parallel, the border between North and South. Many Korean War Veterans have considered themselves overlooked and underappreciated, their place in history sandwiched between the sheer magnitude of World War II and the fierce controversies of the Vietnam War. The sacrifices made by the more than 2 million American men and women who served in Vietnam will never be forgotten. Their dedication to duty and selfless service paved the way for future Americans to enjoy the freedoms and liberties they fought so hard to protect.

The American Lake Veterans Golf Course, situated on 377 acres, was added after World War II in the 1950s. The mission is to provide much-needed rehabilitation and recreational outlets for the growing population of Veterans, many of whom are severely disabled. American Lake Veterans Golf Course is the 400th Jack Nicklaus Signature Course. In 2014, Jack Nicklaus designed the new back nine holes. At that time, Nicklaus also redesigned the old front nine holes. The golf course opened the renovated front nine in 2022 and is now an 18-hole Jack Nicklaus-designed golf course. Jack Nicklaus is the first sportsman and only the fourth person in history to be awarded the Presidential Medal of Freedom, the Congressional Gold Medal, and the Lincoln Medal.

VA began offering special access to medical care, including physical exams, to Vietnam Veterans with Agent Orange health concerns in 1978. The next year Congress passed the Veterans Health Care Amendments Act of 1979. Upon passage, the VA set up a network of Vet Centers across the country, separate from other VA facilities providing various counseling services and treating post-traumatic stress disorder (PTSD). Vet Centers are community-based counseling centers serving eligible Veterans, U.S. Armed Forces active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. Veterans and current service members, including members of the National Guard and Reserve components, are eligible for Vet Center services through active military duty in any combat theater or area of hostility to include but not limited to: World War II (including American Merchant Marines); Korean War; Vietnam War; Lebanon; Grenada; Desert Storm; Desert Shield; Bosnia; Kosovo; Operations in the former Yugoslavia area; Global War on Terrorism; Operation Enduring Freedom; Operation Freedom's Sentinel; Operation Iraqi Freedom; and Operation New Dawn. Family members of families of service members who died while serving on active-duty are offered bereavement services through Vet Centers. 1-877-WAR-VETS is the around-the-clock Vet Center Call Center where Veterans, service members, and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center. Vet Center counselors and outreach staff, many of whom are Veterans themselves, are experienced and prepared to provide confidential counseling, outreach, and referral services, including professional readjustment counseling. In FY 2023, 115,404 individuals received readjustment counseling at VA's Vet Centers, totaling nearly 1.3 million service encounters. Additionally, teams engaged with 162,291 people through outreach activities.

On February 23, 1984, President Ronald Reagan extended the Purple Heart to victims of international terrorist attacks. VA was established as a cabinet-level position on March 15, 1989. President Ronald Reagan elevated the VA to a cabinet-level executive department and renamed the Department of Veterans Affairs in October 1988. President Ronald Reagan said, "This bill gives those who have borne America’s battles, who have defended the borders of freedom, who have protected our nation’s security in war and peace—it gives them what they have deserved for so long, a seat at the table in our national affairs. ... I like to think that this bill gives Cabinet rank not just to an agency within the government, but to every single Veteran. And so, in signing this bill, I’m saying to all our Veterans what I say to new Cabinet members, 'Welcome aboard.'"

The switch took effect on March 15, 1989, and administrative changes occurred at all levels. President George H. W. Bush hailed the creation of the new Department, saying, "There is only one place for the Veterans of America, in the Cabinet Room, at the table with the President of the United States of America." VA’s Department of Medicine and Surgery, established in 1946, was renamed the Veterans Health Services and Research Administration at that time. On May 7, 1991, it was changed to the Veterans Health Administration (VHA). In August 1990 Iraq invaded Kuwait and seized control of that country. The United Nations Security Council condemned Iraq's invasion and called for the immediate and unconditional withdrawal of Iraqi forces. The invasion triggered a United States response to build a coalition of allies to deter an invasion of Saudi Arabia, free Kuwait from Iraqi occupation, and restore Kuwait's legitimate government. In January 1991, Operation Desert Storm began in response to Iraq's invasion of Kuwait. Before Operation Desert Storm, the U.S. led a nearly six-month build-up of weapon systems in Southwest Asia that began immediately following the invasion of Kuwait on August 2, 1991. During the Persian Gulf War, members of the U.S. Armed Forces were exposed to numerous potentially toxic substances, including fumes and smoke from military operations. In 1992, Congress authorized medical care for Gulf War Veterans for conditions possibly related to exposure to toxic substances or environmental hazards. Threats of enemy use of chemical and biological warfare heightened the psychological stress associated with the military operation.

Medically unexplained illnesses (also commonly referred to as Gulf War illness or Chronic Multi-symptom illness) are a significant concern for some Veterans who served during the Gulf War. VA offers eligible Veterans a free Gulf War Registry health exam to find possible long-term health problems related to Gulf War service. The Gulf War stands as a testament to the dedication and spirit of America’s military members and their willingness to fight for liberty and justice — anywhere and for anyone. More than 650,000 Service members served in Operation Desert Shield and Desert Storm from August 2, 1990, to July 31, 1991. For VA benefits eligibility purposes, the Gulf War period is still in effect. This means that anyone who served on active-duty from August 2, 1990, to present is considered a Gulf War Veteran. Wartime compensation for Persian Gulf War Veterans was passed into law in 1994 for service-connected disability or death.

Anchorage Alaska VA Healthcare System was opened in 1992 and the VA-Indian Health Service partnership was established. In the last decade of the 20th century, VA Medical Centers were grouped into 22 Veterans Integrated Service Networks (VISNs). Currently, there are 18 VISNs operating as regional systems of care to better meet local health care needs and provides greater access to care. In the Pacific Northwest, VISN 20 serves Veterans in 135 counties of Alaska, Idaho, Oregon, and Washington. Operating across three time zones over 817,417 square miles, VISN 20 is home to 273 federally recognized American Indian and Alaskan Native tribes. Spanning 23% of the US land mass, VISN 20 is the largest geographic region of VA. VISN 20 also serves Veterans in Del Norte and Siskiyou counties of California and Lincoln County Montana. The history of the NW MIRECC begins with VISN 20 clinicians and researchers working late into a cool March night, drafting the NW MIRECC charter, and dreaming of a collaborative approach to research, education, and clinical care that might better serve Veterans. In the fall of 1997, VISN 20 leaders from VAPSHCS and the VAPORHCS were commissioned by Congress and VA to establish one of the first three Mental Illness Research, Education, and Clinical Centers (MIRECCs) in the United States. 

VA MIRECC's provide for the improvement of the provision of health-care services and related counseling services to eligible Veterans suffering from mental illness (especially mental illness related to service-related conditions) through—

• the conduct of research (including research on improving mental health service facilities of the Department and on improving the delivery of mental health services by the Department);
• the education and training of health care personnel of the Department; and
• the development of improved models and systems for the furnishing of mental health services by the Department.

The mission of NW MIRECC is to improve the health, well-being, quality of life, and function of Veterans by developing, evaluating, and promoting the implementation of effective treatments for PTSD and its complex comorbidities. The most prominent of these comorbidities are repetitive blast mild Traumatic Brain Injury (mTBI); others are substance use disorder (SUD), Alcohol Use Disorder (AUD), chronic musculoskeletal pain, post-concussive headaches, cognitive impairment, and increased risk for neurodegenerative disorders (chronic traumatic encephalopathy [CTE] and Alzheimer's disease [AD]). UW and OHSU are academic affiliates of NW MIRECC. Also in the early 1990s, VHA designated enhancement funds establishing VA Centers of Excellence in Substance Addiction Treatment and Education (CESATE), including the Seattle CESATE located within the VAPSHCS, Seattle Division.

VA ranks as one of the nation's leaders in health research. Every year, thousands of research studies are conducted at VA medical centers, CBOCs, and nursing homes. Roughly 60 percent of all medical residents obtain a portion of their training at VA hospitals, and VA medical research programs benefit society at large. Postdoctoral fellows have the opportunity to provide individual and group psychotherapy, supervise doctoral-level trainees, and actively participate in weekly team meetings and PTSD consultations as junior colleagues. In 1999, a Joint Venture was developed as a sharing agreement between the Anchorage VA clinic and the Joint-Base Elmendorf-Richardson (JBER) base. Also in 1999, VHA launched the first treatment trials for Gulf War Veterans' Illnesses, focusing on antibiotics and exercise.

On September 11, 2001, terrorists flew commercial airliners into the World Trade Center's Twin Towers in New York City, the Pentagon in Arlington, Virginia, and downed Flight 93 in a field near Shanksville, Pennsylvania. There were 2,996 American lives lost, almost 600 more than Pearl Harbor on December 7, 1941. Forty-one Veterans and six family members of Veterans were laid to rest in national cemeteries. Those we lost on September 11, 2001, will forever hold a cherished place in our hearts and the history of our nation. Hundreds of thousands of people in the New York City (NYC) Disaster Area, at the Pentagon, and the crash site in Shanksville, PA were exposed to dust, debris, traumatic events, and physically and emotionally stressful conditions on and after September 11, 2001. Workers and volunteers performed rescue, recovery, clean-up, and other related support services in the disaster areas. By a joint resolution approved December 18, 2001, (Public Law 107-89), Congress authorized the President to designate September 11 of each year as "Patriot Day" to perpetuate the memory of those who perished in the attack on America, and to pursue peace and justice in the world and security at home. Military hospitals and clinics are found at military bases and posts around the world.

After the 9/11 attacks, the Defense Department created a new civilian medal for DOD personnel. The Defense of Freedom Medal is the civilian equivalent of the Purple Heart, awarded to DOD civilian employees who are killed or wounded by hostile action while serving in support of the department. Since 2003, the VA has collaborated with the Department of Defense (DoD) and military treatment facilities (MTFs) to transition the health care of injured or ill service members of the Global War On Terrorism (GWOT) to VA medical facilities. VA launched My HealtheVet nationwide in 2003. My HealtheVet is the VA’s online Personal Health Record for Veterans, active-duty service members, their dependents, and caregivers. The resources and tools offer Veterans greater control and understanding over health care and wellness. Post-9/11 Transition and Case Management (TCM) ensures that transitioning service members and Veterans receive the care and support they need as they transition from military to civilian life. Every VA medical center has a specialized Post-9/11 Military2VA (M2VA) team ready to welcome you as you transition from service member to Veteran. Often when service members leave the military, they find difficulty with a sense of identity, financial strain, employment/education barriers, relationship changes, mental/emotional wellness, and physical limitations as a result of their time in the military. 

VA continues to innovate and modernize to serve millions of America’s patriots and their families and beneficiaries. VA, DoD, Military Services, and collaborating organizations mark Warrior Care Month in November of each year. Warrior Care Month highlights the strength and resilience – physically, mentally, and spiritually – of our wounded, ill, and injured service members and their families and caregivers. Post-9/11 M2VA teams are trained to address the unique needs of reintegrating service members and Post-9/11 era Veterans. Post-9/11 M2VA team members stand ready to assist with what matters most to Veterans—from accessing care and resources to developing personalized goals for care and navigating benefits. 

• Alaska M2VA Team
• Idaho M2VA Team
• Oregon M2VA Team
• Washington M2VA Team

VA's NW MIRECC serves to improve the mental health and well-being of Veterans through research and dissemination of information to providers both within the VA and the general public. From its early days, NW MIRECC has conducted research to understand PTSD, TBI, schizophrenia, and other mental health challenges facing Veterans, including Alzheimer’s disease. That emphasis led to genetic discoveries in schizophrenia and the identification of cerebrospinal fluid biomarkers for disruptive agitation in Alzheimer's disease. These findings were then passed on to clinicians and other VA personnel via MIRECC Presents, an accredited Continuing Education series on mental health topics provided by NW MIRECC. NW MIRECC's diligent search for answers to mental health problems afflicting our Veterans continues today. In this way, MIRECC Presents empowers mental health providers nationwide to integrate cutting-edge treatments and timely research into their daily clinical practices, thereby raising the quality of care for Veterans who experience mental health challenges. NW MIRECC Research studies have significantly contributed to advancements in our understanding of medical problems and that have led to health improvements for Veterans and civilians alike. NW MIRECC has adapted its mission to more readily address the most critical needs of Veterans in this region: PTSD and its associated conditions; mTBI, SUD, AUD, chronic musculoskeletal pain, post-concussive headaches, and dementia. The following three factors compelled us to make this shift:

1. The return home of Veterans from Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) has substantially increased the already large number of Veterans who struggle with the distress and functional impairments of PTSD and its associated conditions.
2. The close geographic proximity (40 miles) of Department of Defense (DoD) Joint Base Lewis-McChord/Madigan Army Medical Center to the Seattle Washington VAPSHCS campus has provided an exciting opportunity to develop innovative and productive research, education, and clinical care collaborations with DoD personnel that address PTSD and its associated conditions in their early stages in active-duty Servicemembers.
3. It has become clear to NW MIRECC clinicians that PTSD is usually complicated by at least one--and often multiple--associated conditions. The typical OEF, OIF, and OND combat Veteran with PTSD -- as well as Veterans from the Vietnam War and other conflicts--also experiences persistent post concussive symptoms (such as chronic headache) from one or multiple mTBI's; struggles with chronic musculoskeletal pain; is excessively using alcohol to relieve symptoms; and is increasingly concerned that his or her subjective cognitive symptoms will develop into dementia. These other conditions associated with PTSD demand the concentrated focus of multidisciplinary centers like the NW MIRECC.

As part of the NW MIRECC mission to enhance access to mental health expertise, NW MIRECC collaborates and consults with other MIRECCs and Centers of Excellence, as well as with other VA, DoD, Federal, State departments of Veterans Affairs, community agencies, and experts. VA is the world's leading research and educational center of excellence on PTSD and traumatic stress. NW MIRECC approaches research in two ways: clinical and translational. NW MIRECC studies are conducted through clinical research and through translational research wherein teams of clinicians and scientists work side-by-side to characterize and model key features of clinical problems and then translate the findings from scientific theory or animal models into practical applications for Veterans.

NW MIRECC applies a modern genetic, neurologic, and clinical trial methodology to the discovery and development of new and more effective treatments for major and often treatment-resistant mental disorders. NW MIRECC partners with Veteran and non-veteran volunteers as clinical research subjects to develop and evaluate effective treatments for PTSD and its associated conditions, including mTBI, SUD, chronic musculoskeletal pain, post-concussive headaches, and dementia. One example of this renewed emphasis on PTSD and its associated conditions has been our work with the blood pressure medication prazosin. Staff at the NW MIRECC pioneered the use of this medication to treat trauma-related nightmares, one of the most common symptoms of PTSD. Due in part to NW MIRECC's web-based and face-to-face educational outreach efforts, prazosin is now prescribed to over 100,000 Veterans and active-duty Servicemembers, and we continue to investigate its usefulness for other Veteran-related illnesses, including, for example, the post-concussive headaches that Veterans report as one of the most disabling symptoms of mTBI.

Occasionally Veterans face challenges that perplex their mental health providers at the VA. To assist providers with these more difficult cases, experts at the NW MIRECC developed the Mental Illness Consultation Program (MICON). In this program, VA clinicians may contact the NW MIRECC consultants with academic questions concerning a mental health topic or with clinical questions concerning unusual, complex, or difficult patient issues. NW MIRECC clinicians are essential for the diagnosis and management of mental health conditions. They serve in mental health clinics as well as specialty clinics that provide a key space for the development and evaluation of new treatments for PTSD, mTBI, SUD, chronic musculoskeletal pain, post-concussive headaches, and dementia. NW MIRECC specialty clinics also offer clinicians in-depth training in the diagnosis and management of mental health conditions.

VHA medical centers throughout the country offer advanced services such as organ transplants and plastic surgery through the VA National Transplant Program. In 2005 VA announced major funding initiatives for research on neurotrauma, chronic pain, and other health problems prevalent in combat-wounded Veterans returning from Iraq and Afghanistan. NW MIRECC and VAPORHCS played a significant role in co-leading Oregon's post-deployment effort. PVAMC added additional Neuro-Psychologist staff to clinically identify and manage Veterans suffering from TBI. Working with ODVA and ONG; NW MIRECC, VAPORHCS, and PVAMC compiled a comprehensive resource directory website for services and materials. Post Deployment Summits were held with various federal and state agencies, along with Veterans organizations. The Post Deployment Summits helped all aspects of Veterans return to civilian life. 

DOD and VA launched a Pilot program at three MTFs of the Integrated Disability Evaluation System (IDES) in 2007. IDES is a joint disability evaluation process. Based on the success of the IDES pilot program, the integrated process expanded to all remaining worldwide locations and is available to all Service members. Service members determined to be unfit for duty receive a single set of disability ratings to determine the appropriate level of DOD and VA disability benefits. Integration with the VA provides medically separated or retired Veterans with timely access to their VA benefits. Outreach efforts for returning Servicemembers included the development of Unseen Injuries - Medical Information for Combat Veterans led by ODVA. The post-deployment efforts received national recognition in both VA and ONG. VHA continually evolves and cultivates ongoing cutting-edge medical research and innovation to improve the lives of America’s patriots. New programs provide treatment for TBI, PTSD, suicide prevention, women Veterans, and more. In operation since 2007, VA’s National Suicide Prevention Hotline is a free, confidential resource for all service members, including members of the National Guard and Reserve, and Veterans, even if they’re not enrolled in VA benefits or health care. Signed into law in 2020, the National Suicide Hotline Designation Act authorized 988 as the new three-digit phone number for the national suicide prevention and mental health crisis hotline.

The Defense Health Agency's Recovery Coordination Program launched the National Resource Directory (NRD) in 2008 as a resource website that connects wounded warriors, Service Members, Veterans, their families, and caregivers to programs and services that support them. That same year, each branch of military service stood up Wounded Warrior Commands under the DoD Warrior Care Program (WCP) to proactively support wounded, ill, and injured Service members in their recovery and reintegration or transition to civilian life.

• Army Recovery Care Program
• Navy Wounded Warrior
• Marines Wounded Warrior Regiment
• Air Force Wounded Warrior Program
• USSOCOM Care Coalition

Navy Wounded Warrior is open to service members and Veterans in the U.S. Navy and U.S. Coast Guard with serious, non-combat, or combat-related injuries and physical or psychological illnesses. The U.S. Space Force was established in December 2019 creating the first new branch of the armed services in 73 years. The Air Force Wounded Warrior Program (Air Force and Space Force) works together. The establishment of the USSF resulted from widespread recognition that Space was a national security imperative. Guardians of the USSF protect and defend American interests and ensure our forces, our allies, and the world never experience a day without space.

VHA's Community Living Centers (CLC) (VA Nursing Homes) are for Veterans who do not need hospital or nursing home care but cannot live alone because of medical or psychiatric conditions. This distinct level of mental health residential care began in 1995. Serving Veterans with mental illnesses or addictive disorders who require additional structure and support to address multiple and severe psychosocial deficits, including homelessness and unemployment. In 2010, the VA's Domiciliary Care programs and RRTPs were merged into a single system of residential care to become a Mental Health Residential Rehabilitation Treatment Program (MH RRTP). The primary goal of the MH RRTP is to provide treatment and rehabilitation services to Veterans who have mental health and substance use disorders that are often complex and co-occur with medical concerns and psychosocial needs, such as employment and housing. Veterans may stay for a short time or, in rare instances, for the rest of their lives. MH RRTPs include the Compensated Work Therapy-Transitional Residence (CWT-TR) which is designed for Veterans participating in Compensated Work Therapy and who are in the process of transitioning to successful independent community living. VHA also provides RRTP for Veterans to overcome SUD problems from AUD to life-threatening addiction.

VISN 20 CLC's (VA Nursing Homes) are located in Boise ID, Roseburg OR, Seattle WA, Spokane WA, Tacoma WA, and Vancouver WA. Veterans receive nursing home level of care at VA CLCs, which includes help with activities of daily living and skilled nursing and medical care. There are 21 State Veterans Home in the six states served by VISN 20:

• ALASKA STATE Veterans AND PIONEERS HOME – Palmer, Alaska
• IDAHO STATE Veterans HOME – Post Falls, Idaho
• IDAHO STATE Veterans HOME – Pocatello, Idaho
• IDAHO STATE Veterans HOME – Lewiston, Idaho
• IDAHO STATE Veterans HOME – Boise, Idaho
• OREGON Veterans HOME – The Dalles, Oregon
• EDWARD C. ALLWORTH OREGON Veterans’ HOME – Lebanon, Oregon
• WASHINGTON Veterans HOME – Port Orchard, Washington
• WASHINGTON SOLDIERS’ HOME – Orting, Washington
• WALLA WALLA Veterans HOME – Walla Walla, Washington
• SPOKANE Veterans HOME – Spokane, Washington 

VHA operates one of the largest healthcare systems in the world and provides training for a majority of America’s medical, nursing, and allied health professionals. The VA Advanced Psychology Postdoctoral Fellowship in Mental Illness Research and Treatment (MIRT) is a two-year postdoctoral training program at VAPORHCS. The primary goal of the NW MIRECC Advanced Psychology Postdoctoral Fellowship program is to train and equip physicians, psychologists, and other allied health professionals with the knowledge and expertise to lead clinical research efforts that make lasting contributions to the lives of Veterans experiencing mental health challenges. In collaboration with their mentors, NW MIRECC Advanced Psychology Postdoctoral Fellows develop and implement research projects, publish, present findings, write grants, and utilize the latest technology for educational activities and clinical service delivery. Psychology Postdoctoral Fellows devote 75% of their time to research and education activities and 25% to clinical training. Throughout the two-year program, NW MIRECC fellows are trained in clinical and health systems research, advanced clinical care service delivery, and program administration in an interdisciplinary setting.

First launched in 2009, Mobile Vet Centers (MVCs) are large vehicles used to provide outreach to eligible individuals in communities that are distant from existing services. Throughout the country, there are 83 MVCs with space for confidential counseling. VISN 20 MVCs are currently deployed in Idaho, Oregon, and Washington. MVCs can access records through an encrypted connection. With this capability, MVCs are often called upon to support the VA in its important mission of providing emergency services in response to national emergencies and disasters. VISN 20 Mobile services include primary care, laboratory services, social work, nutrition, clinical pharmacist consultations, mental health, telehealth specialty services, prosthetics, and orthotics. Today’s VHA has roots spanning over 150 years and continues to meet Veterans’ changing medical, surgical, and quality of life needs. In recent years VHA has opened more CBOCs, established telemedicine, Vet Centers, and suicide prevention hotlines, and developed other services to accommodate a diverse and ever-changing Veteran population.

In 2011, DoD expanded Purple Heart eligibility for Servicemembers who suffered certain mTBI or concussions. Since 1999, Purple Heart recipients have been placed in the VA’s enrollment Priority Group 3, unless eligible for the higher Priority groups (1 or 2) based on service-connected disabilities. VA reimburses verified Purple Heart recipients for any medical care copays that were made to VA on or after November 30, 1999, the date the Purple Heart Benefit was enacted, or the date the Purple Heart was awarded, whichever is later. In 2023, VA announced the deployment of 25 Mobile Medical Units (MMUs) comprised of Ford F-550 Super Duty Trucks and Mercedes-Benz Sprinter Vans. As a result, VISN 20 deployed two MMUs in Washington. MMUs will provide health care and support to homeless and at-risk Veterans to meet with medical providers, including mental health clinicians, social workers, and staff. Ford Motor Company has been a loyal friend to Disabled American Veterans (DAV) for over 100 years. Henry Ford provided 50 Model T Fords to help disabled World War I Veterans attend the organization’s second national convention. DAV operates a fleet of vehicles around the country to provide free medical transportation for ill and injured Veterans. To find out whether there is a van near you use the DAV Hospital Service Coordinator Directory to contact your nearest HSC for information or assistance. Navigating the resources available to Veterans can be confusing, but DAV believes no Veteran should have to go it alone. 

In 2018 VA launched a telehealth program to serve Veterans living in rural areas who have PTSD. Veterans may be eligible for care through a provider in their local community depending on their healthcare needs or circumstances, and if they meet specific eligibility criteria. In 2019, VAPSHCS opened a new 220,000-square-foot Mental Health and Research Building on the Seattle Washington campus. The Seattle expansion provides outpatient mental health care services, from medication management and psychosocial case management to Dialectical Behavior Therapy and evidence-based individual, family, and group psychotherapy for all major mental health diagnoses.

VA launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ended the Veterans Choice Program and established a new Veterans Community Care Program (VCCP). The VA Community Care Network (CCN) is the VA’s direct link with community providers to ensure Veterans receive timely, high-quality care. Types of care under VA VCCP include General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots. Under VA VCCP, Veterans work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Community care must be first authorized by VA before a Veteran can receive care from a community provider.

Today's VHA - the largest of the three administrations that comprise the VA - continues to meet Veterans' changing medical, surgical, and quality-of-life needs. VA's mission is to serve America’s Veterans and their families with dignity and compassion and be their principal advocate in ensuring that they receive medical care, benefits, social support, and lasting memorials. VA promotes the health, welfare, and dignity of all Veterans in recognition of their service to our nation. The following four categories of Veterans are not required to enroll but are urged to do so to permit better planning of health resources: 1) Veterans with a service-connected (SC) disability rated at 50% or more. 2) Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which the VA has not yet rated, within 12 months of discharge. 3) Veterans seeking care for an SC disability only or under a special treatment authority. 4) Veterans seeking registry examinations (ionizing radiation, Agent Orange, Gulf War/Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) depleted uranium, airborne hazards, and Open Burn Pit Registry).

In 2021, the Defense Health Agency (DHA) certified and set up Puget Sound Military Health System (MHS) as a new market by the 2017 National Defense Authorization Act. Puget Sound MHS includes the U.S. Army Madigan Medical Center, Naval Hospital Bremerton, Naval Health Clinic Oak Harbor, Naval Station Everett clinic, and the 62nd Medical Squadron of the U.S. Air Force. A market is a group of MTFs in one geographic area working together with VA hospitals, medical universities, private sector teaching hospitals, federal healthcare organizations, healthcare partners, and TRICARE partners. TRICARE serves Uniformed Service members and their families, Army National Guard, Army Reserve, Navy Reserve, Marine Corps Reserve, Air National Guard, Air Force Reserve, U.S. Coast Guard Reserve and their families, Survivors, Former spouses, Medal of Honor recipients and their families, and others registered in the Defense Enrollment Eligibility Reporting System (DEERS).

VHA Medical Centers provide a wide range of services including traditional hospital-based services such as pharmacy, critical care, radiology, orthopedics, physical therapy, surgery, and mental health. In addition, most VA medical centers offer additional medical and surgical specialty services including audiology and speech pathology, dermatology, dental, geriatrics, neurology, oncology, podiatry, prosthetics, urology, and vision care. VISN 20 has installed the new electronic health record (EHR) at the Roseburg VA Health Care System in Oregon, the VA Southern Oregon Health Care System, the VA Walla Walla Health Care System in Washington, and the Spokane VA Health Care System in Washington. The new EHR system complements the VA’s longstanding health record system, Veterans Health Information Systems and Technology Architecture, also known as VistA, and Computerized Patient Record System. The new system puts the VA and DOD on a single electronic health record, which improves Veterans’ healthcare experiences by eliminating their need to keep or carry paper records detailing care received from either department. Care providers from both departments will be able to view, update, and securely exchange patient data in the new system, which also enables increased information sharing with providers in the communities where Veterans live and receive care.

The Plymouth colony first cared for Veterans beginning in 1636. Three hundred and eighty-eight years later, the United States continues to provide the best possible care for our greatest assets. NW MIRECC reaffirms its commitment that there is no higher priority than caring for the wounded, ill, and injured service members who have sacrificed so much. NW MIRECC continues to be at the tip of the sword in response to Warrior Care and continues to strive to improve the health and well-being of our Veterans. There is no greater calling than to care for those who ensured our freedom; Warrior Care is America's duty.

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Use of these Materials and Finding VA Health Care

Please note that the health care information provided in these materials is for educational purposes only. It does not replace the role of a medical practitioner for advice on care and treatment. If you are looking for professional medical care, find your local VA healthcare center by using the VA Facilities Locator & Directory. This page may contain links that will take you outside of the Department of Veterans Affairs website. VA does not endorse and is not responsible for the content of the linked websites.

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The Veterans Health Administration (VHA) is the largest integrated health care network in the United States, with 1,255 health care facilities serving 9 million enrolled Veterans each year. There are 18 Veterans Integrated Service Networks (VISNs) in VHA operating as regional systems of care to better meet local health care needs and provides greater access to care. Spanning 23% of the US land mass, VISN 20 is the largest geographic region of VA. In the Pacific Northwest, VISN 20 serves Veterans in 135 counties in Alaska, Idaho, Oregon, and Washington. Operating across three time zones over 817,417 square miles, VISN 20 is home to 273 federally recognized American Indian and Alaskan Native tribes. VISN 20 also serves Veterans in Del Norte and Siskiyou counties of California and Lincoln County Montana. Veterans may be eligible to receive care from a community provider when VA cannot provide the care needed. Veterans Community Care Program (VCCP) provides health care for Veterans from providers in the local community. VCCP includes General Community Care, Urgent Care, Emergency Care, Foreign Medical Care, Home Health and Hospice Care, Indian and Tribal Health Services, In Vitro Fertilization, State Veterans Home, and Flu Shots.

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VA Regional Offices

The Veterans Benefits Administration (VBA) helps service members transition out of military service, and assists with Veterans with education, home loans, life insurance and much more. Service members, Veterans, their families, and Survivors are invited to request information on VA Benefits including disability compensation, pension, fiduciary, education, Veteran Readiness and Employment (VR&E), Home Loans, and Insurance. In addition to information on VA Benefits Veterans may initiate an intent to file and request assistance with filing compensation and pension claims. Visit regional office websites to learn about the services the regional office provides, directions to the facility, hours of operation, and the leadership team that serves the regional office.

Vet Centers in VISN 20

Vet Centers in the VISN 20 Health Care Network are community-based counseling centers that provide a wide range of social and psychological services, including professional readjustment counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and their families. 1-877-WAR-VETS is an around the clock confidential call center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma and get connected to their nearest Vet Center.

Vet Centers provide counseling to make a successful transition from military to civilian life or after a traumatic event experienced in the military. Individual, group, marriage and family counseling is offered in addition to referral and connection to other VA or community benefits and services. If you can’t make it to a nearby Vet Center, VA offers satellite Vet Center locations and Mobile Vet Centers that may be closer to you.

Find out if you can get VA health care as a Veteran

The following four categories of Veterans are not required to enroll but are urged to do so to permit better planning of health resources:

1. Veterans with a service-connected (SC) disability rated at 50% or more.
2. Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.
3. Veterans seeking care for a SC disability only or under a special treatment authority.
4. Veterans seeking registry examinations (ionizing radiation, Agent Orange, Gulf War/Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) depleted uranium, airborne hazards, and Open Burn Pit Registry).

Find out how to apply for VA health care benefits as a Veteran or service member. For other mental health services, contact a VA medical center for information on eligibility and treatment options.

Plan your trip to VA

In 1946, Veterans Canteen Service (VCS) was established by law to provide comfort and well-being to America’s Veterans. With our many retail stores, cafés and coffee shops across the country, we serve those who have served our country. Our Canteens are whole health spaces for Veterans to connect, relax, share and care for themselves in an environment that is their benefit. We are proud to Serve America’s Veterans and those who provide for their care.

Hospital Service Directory

To find out whether there is a van near you use the Disabled American Veterans (DAV) Hospital Service Coordinator Directory to contact your nearest HSC for information or assistance. Please remember that the DAV Transportation Network is staffed by volunteers; therefore, it is unable to cover every community.