Note: This article is part of a series on VA’s progress implementing the VA MISSION Act of 2018.
Sometimes a quick trip to a local walk-in retail health clinic or urgent care facility is a convenient alternative for minor injuries and illnesses.
As part of implementing the VA MISSION Act of 2018, VA will offer an urgent care benefit that provides eligible Veterans with greater choice and access to timely, high-quality care.
With urgent care, Veterans have a new option for care for the treatment of minor injuries and illnesses, such as colds, sore throats, and minor skin infections. The benefit is offered in addition to the opportunity to receive care from a VA provider, as VA also offers same-day services.
Eligible Veterans will be able to receive urgent care from an urgent care provider that is part of VA’s contracted network of community providers without prior authorization from VA. VA can pay for an urgent care claim only if:
- The Veteran is eligible for the benefit;
- The urgent care provider is part of VA’s contracted network of community providers; and
- The services are not excluded under the benefit (excluded services include preventive services and dental services).
This benefit will be available when final Federal regulations are published and effective, on June 6, 2019.
Eligibility
To check their eligibility once the urgent care benefit has started, Veterans should contact their local VA medical facility.
To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov (https://www.va.gov/find-locations/) or contact their local VA medical facility. VA staff can inform the Veteran of available in-network locations and offer to find the closest locations.
VA can only pay for care under this benefit if the Veteran is eligible, the services are not excluded under the benefit, and the provider is part of VA’s contracted network of community providers and is identified as an urgent care provider. If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.
Covered Services
The urgent care benefit covers treatment of non-emergent symptoms such as flu-like symptoms (coughs and colds), wheezing, sprains, sore throats, painful urination, bumps and bruises, ear pain, and mild skin irritations, which are typically addressed by urgent care facilities and walk-in retail health clinics. Excluded from the benefit are preventive and dental services.
Important: While urgent care is a convenient benefit for the treatment of non-emergent symptoms, Veterans should always consider talking with or seeing their primary care provider if they are concerned that the community provider will not understand the complexities of their medical history or medications.
In addition, if you believe your life or health is in danger, call 911 or go to the nearest emergency department right away.
Urgent care is not a replacement for an eligible Veteran’s preventive health care. Eligible Veterans should work with their primary care provider for this type of care. If an eligible Veteran goes to an urgent care provider and receives services that are not covered by this benefit, they may be required to pay the full cost of care.
Copayments
Eligible Veterans may be charged a VA copayment for urgent care that is different from other VA medical copayments. VA copayments for urgent care depend on the eligible Veteran’s assigned priority group and the number of times they visit an in-network urgent care provider in a calendar year.
- Priority Groups 1-5. There is no copayment for the first three visits during a calendar year. For the fourth visit and all subsequent visits in a calendar year, the copayment is $30.
- Priority Group 6. There is no copayment for the first three visits during a calendar year if the visit is related to special authority* or exposure. For the fourth visit and all subsequent visits in a calendar year, the copayment is $30. If the visit is not related to special authority* or exposure, the copayment is $30 per visit, regardless of which visit it is.
- Priority Groups 7-8. The copayment is $30 per visit.
- Priority Groups 1-8. No copayment for a **flu shot-only visit. Visits consisting only of a flu shot do not count as a visit for the number of visits in a calendar year*.
*Special authorities include those related to combat service and exposures (e.g. agent orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as Military Sexual Trauma, and presumptions applicable to certain Veterans with psychosis and other mental illnesses.
When the benefit starts, Veterans can contact the VA Health Resource Center (HRC) for questions related to urgent care copayments at 1-877-222-VETS (8387). Veterans will also be able to contact their local VA medical facility for more information about urgent care copayments.
Prescription Medication
VA will pay for or fill prescriptions for urgent care. For routine prescription medication, the prescription must be submitted to VA to be filled.
For urgent prescription medication of a 14 day or fewer supply, Veterans can either fill the prescription at a contracted pharmacy in the VA network or the prescription can be filled at a non-contracted pharmacy. If a non-contracted pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.
Some Veterans may be required to make a copayment for medication. Information about copayments can be found at https://www.va.gov/COMMUNITYCARE/revenue_ops/copays.asp.
Going Forward
This benefit will be available when final Federal regulations are published and effective, on June 6, 2019. The new urgent care benefit is consistent with President Trump’s commitment to provide Veterans with more choices and greater access to healthcare they’ve earned through their service to our country.
Resources
- Fact Sheet – Veteran Community Care – Urgent Care (VA MISSION Act of 2018)
- Fact Sheet – Veteran Community Care – Eligibility (VA MISSION Act of 2018)
- Fact Sheet – Veteran Community Care – General Information (VA MISSION Act of 2018)
*Special authorities include those related to combat service and exposures (e.g. agent orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense [SHAD/Project 112], Southwest Asia Conditions) as well as Military Sexual Trauma, and presumptions applicable to certain Veterans with psychosis and other mental illnesses.
**Free flu shots are currently only available through VA’s partnership with Walgreens, but will be available more widely in the future as part of the urgent care benefit.
Written by VHA Office of Community Care
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I was scammed by VA and the clinic although not on purpose, it’s business as usual. The VA gave me the name of the clinic to use for urgent care. The clinic said they knew of this program and could send the bill to the VA. They called me a day after I was seen to say I needed to get pre-authorization or they would send me a bill. They said I should have known this. It takes me 5 calls minimum to get anything done so I don’t use pre-authorization or community care. I just suffer because I so hate healthcare, I thought this program might be for me. I was wrong. No one can improve any US health care including VA, nice try though.
THE NEW VA MISSION Act Urgent Care Supplemental Option SOUNDS WONDERFUL. one problem, while there are many pharmacy’s within minutes from my home THERE ARE NO URGENT CAR facilities nearby. the closest urgent care to my home is 27 miles away. my zip code is 99515. please provide hope this gap will be corrected in the near future. the Health Benefits Center 877-222-8387 was no help. They still think we need a referral to be seen at an urgent care. thank you for your help.
Hi, when will you have repeat meetings? I just tried to attend a meeting this morning on the MISSION act, but it was standing room only, and I can’t stand that long. Could you please schedule a meeting in Lake Havasu City, Arizona In a large room where more people can fit? I am a Choice user, I need the information. There have been many improvements in the VA, but getting the word out hasn’t been one of them. Please schedule more meetings, right away. I don’t want to feel like I’m out on the secret. The article was ok at letting me know that MISSION existed, but no explanation of much of anything.
Please please please work harder on this.
I’m 68 years old and my Coventry Medicare Advantage plan gives me lower co-payments than my VA health benefits. It also provides my blood pressure & cholesterol medication to me at no charge. There hopefully will be a few vets that do benefit from the Mission Act, but I’m guessing they will be few and far between. Finding an in-network provider in your area can be difficult or non-existent, and getting approval from the VA can also be a hassle. Until the time comes that you can use your VA healthcare card at any legitimate hospital or doctors office I’m afraid the Mission Act is just another example of the VA “blowing smoke” to make it look like some improvements are being made in the system.
I have several orthopedic issues. My primary said I needed to see the VA Clinic inhouse ortho doc for referrals outside. He tells me my primary has to submit the consult!!
Priority Group 1:
Veterans with VA-rated service-connected disabilities that are 50% or more disabling
Veterans determined by VA to be unemployable due to service-connected conditions
Priority Group 2:
Veterans with VA-rated service-connected disabilities that are 30% or 40% disabling
Priority Group 3:
Veterans who are Former Prisoners of War (POWs)
Veterans awarded a Purple Heart medal
Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty
Veterans with VA-rated service-connected disabilities 10% or 20% that is disabling
Veterans awarded special eligibility classification under Title 38, U.S.C., Section 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”
Priority Group 4:
Veterans who are receiving Veterans who are receiving aid and attendance or housebound benefits from VA
Veterans who have been determined by VA to be catastrophically disabled
Priority Group 5:
Non-service-connected veterans and non-compensable service-connected veterans rated as 0% disabled by VA and whose annual income and net worth are below the VA pension benefits national income threshold
Veterans receiving VA pension benefits
Veterans eligible for Medicaid programs
Priority Group 6:
World War I veterans
Compensable 0% service-connected veterans
Veterans exposed to Ionizing Radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
Project 112/SHAD participants
Veterans who served in a theater of combat operations after November 11, 1998 as follows:
Veterans discharged from active duty on or after January 28, 2003, who were enrolled as of January 28, 2008 and veterans who apply for enrollment after January 28, 2008, for 5 years post discharge
Veterans discharged from active duty before January 28, 2003, who apply for enrollment after January 28, 2008, until January 27, 2011
Priority Group 7:
Veterans with income and/or net worth above the VA national income threshold and income below the geographic income threshold who agree to pay co-pays
Priority Group 8:
Veterans with income and/or net worth above the VA national income threshold and the geographic income threshold who agree to pay co-pays
Sub-priority a: Non-compensable 0% service-connected veterans enrolled as of January 16, 2003, and who have remained enrolled since that date
Sub-priority c: Non-service-connected veterans enrolled as of January 16, 2003, and who have remained enrolled since that date
Sub-priority e**: Non-compensable 0% service-connected veterans applying for enrollment after January 16, 2003
Sub-priority g**: Non-service-connected veterans applying for enrollment after January 16, 2003
Today is the 1st day of the new VA Mission Act allowing veterans to see outside non-VA healthcare participating clinics for non-emergent care…and I am here to be your gini pig on how it works. I’ve had a nasty cough for 2 weeks.
Below are the steps I took and within 2 hrs I was seen by a participating non-va community clinic and received my prescriptions at a participating CVS. I’ve also provided you the links to make it easy for you to simply put in your address or zip codes.
How it works: https://www.va.gov/COMMUNITYCARE/programs/veterans/Urgent_Care.asp
Find a local Community Care (non-VA health) retailer or urgent care: https://vaurgentcarelocator.triwest.com/Locator
Find a participating non-VA health pharmacy: https://vaurgentcarelocator.triwest.com/Home/LocateRx
1) Call the National Mission Act Call Center at 1-844-698-2311 to check your eligibility, if you require VA referral, and what your co-pay is.
2) Then go to va.gov to find the nearest participating clinic/Urgent Care.
3) Bring your VA ID
4) They have very specific formulary requirements for prescriptions (Urgent Care and National) and you will have to go to a participating pharmacy which can be found going to http://www.express-script.com. Have them write your script so if anything they prescribe is not on the formulary list you can get using your personal health insurance.
That is it folks. Like I said…between making the call to the National Mission Act Call Center to picking up my prescriptions, I was done in TWO hours!!
How does one know what primary group one is in
1) Call the National Mission Act Call Center at 1-844-698-2311 to check your eligibility, if you require VA referral, and what your co-pay is.
2) Then go to https://vaurgentcarelocator.triwest.com/Locatorto find the nearest participating clinic/Urgent Care.
3) Bring your VA ID
4) They have very specific formulary requirements for prescriptions (Urgent Carenand National) and you will have to go to a participating pharmacy which can be found going to http://www.express-script.com. Have them write your script so if anything they prescribe is not on the formulary list you can get using your personal health insurance.
I live in Athens, Georgia, a 2 hour drive from VA hospital in Augusta, Georgia. My body is one that cr4ates polyps on a regular basis, with none being cancerous through the years. Even though we have an outstanding VA outpatient clinic in Athens, I must travel to Augusta for endoscopies and colonoscopies, normally seeing a different provider every trip since the VA Hospital is staffed with resident and fellowship doctors, with minimal permanent staff doctors. How do I find out if I can use a local provider for such procedures under the new VA program starting today, 6 June 2019?
This program does not solve the problem. The VA will make us jump through massive hoops in order to get the bills paid. And several veterans will get stuck with these bills that they cannot pay. Most veterans can’t even pay the $30 co-pay. The problem is not being able to go to urgent care the problem is is the VA is our understaffed and the staff that is there is Under qualified to treat the veterans. We can’t get help. I for one have been really struggling and fighting to get the help I need before it kills me. So somebody please get a grip and help us veterans out.
Another Trump inspired program appearing to help Vets but turns out to be little help for Vets while some persons will just be enriched and provides little if any care for Vets.
So, how do we determine what Priority group we belong to?
It is determined by your disability rating. See below
Priority Group 1
Veterans with service-connected disabilities rated 50% or higher
Veterans determined by VA to be unemployable due to service-connected conditions.
Priority Group 2
Veterans with service-connected disabilities rated 30% – 40%
Priority Group 3
Veterans who are former Prisoners of War (POWs)
Veterans awarded a Purple Heart
Veterans whose were discharged for a disability
Veterans with service-connected disabilities rated 10% – 20%
Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”
Veterans awarded the Medal Of Honor.
Priority Group 4
Veterans who are receiving aid and attendance or housebound benefits Veterans who have been determined by VA to be catastrophically disabled
Priority Group 5
Nonservice-connected veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits.
Veterans receiving VA pension benefits
Veterans eligible for Medicaid programs.
Priority Group 6
Veterans with service-connected disabilities rated 0%
Veterans exposed to Ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
Project 112/SHAD participants
Veterans who served in Vietnam between Jan. 9,1962 and May 7,1975
Veterans of the Persian Gulf War who served between Aug. 2, 1990 and Nov. 11, 1998
Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning Aug. 1, 1953 and ending Dec. 31, 1987
Combat veterans who were discharged on or after Jan. 28, 2003, are eligible for enhanced benefits for 5 years after discharge.
Priority Group 7
Veterans with gross household income below certain limits and who agree to pay copays
Priority Group 8
Veterans with gross household income above certain limits and who agree to pay copays
This is he same question I have. What determines our Priority group?
Check with your local VA eligibility clerk. They can tell you. Also, Google VA Priority Groups and see where you fit. For example: Priority Group 6 are vets with environmental hazards exposure, like Agent Orange. PG 3 are Purple Heart recipients, etc.
I for one appreciate President Trump, and his administrations efforts to improve medical care for veterans. Since taking office I’ve noticed quite a few improvements in the care I receive, courtesy towards myself and other veterans, quick response time to concerns and, or questions I might have about medication, treatment, symptoms. This new VA Mission Act program probably won’t solve every concern disabled veterans have (I’m 100% total and permanent service connected disabled), but I truly have notice improvements in care, and response times, so this new VA Mission Act allowing access to participating Urgent Care providers in our communities should reduce my waiting time I currently suffer going to the VA walk-in clinic for same day treatment.
I hope in time all disabled veterans like myself, will start experiencing positive change to the VA Health system, and like me, appreciate President Trumps efforts to drive positive change for those that served.
God bless
1) Call the National Mission Act Call Center at 1-844-698-2311 to check your eligibility, if you require VA referral, and what your co-pay is.
2) Then go to https://vaurgentcarelocator.triwest.com/Locatorto find the nearest participating clinic/Urgent Care.
3) Bring your VA ID
4) They have very specific formulary requirements for prescriptions (Urgent Carenand National) and you will have to go to a participating pharmacy which can be found going to http://www.express-script.com. Have them write your script so if anything they prescribe is not on the formulary list you can get using your personal health insurance.
Emergency care, urgent care, VA care…How about some dental care? I’m down to about 10 teeth left but they don’t match up for chewing anything without making sores. When will the VA include dental care for all vets?
Why are we only getting 3 visits with no co pay and after that we are being charged 30.00 If we are over 50 percent we are not suppose to being charged period.
Why are we only getting 3 visits with co pay and after that we are being charged 30.00 If we are over 50 percent we are not suppose to being charged period.
I searched for providers in my local area. Zero. So, I guess I have to rely on the VA for urgent care, at night and on weekends. That means the VA must provide that, right? I have not seen anything saying they do. I go to the Long Beach VA, and haven’t seen a doctor in over 2 years, even during walk-in urgent care during the day. I was hoping that if there was community care, that I would be able to see a doctor (versus a pharmacist or nurse) once in a while. I wonder how much money the VA has spent launching the VA MISSION Act, instead of providing care?
Great concept, no providers in network.
I tried to get my choice provider extended for services and was told the new procedure is to get an appointment with your primary provider first, then they will approve or disapprove the appointment. My appointment with my primary care is scheduled for three weeks out. What kind of urgent care is this? The whole reason this was implemented was that VA clinics are overwhelmed.
“To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov (https://www.va.gov/find-locations/) or contact their local VA medical facility. VA staff can inform the Veteran of available in-network locations and offer to find the closest locations.”
What if its after hours and no one picks up the phone?
Where is the link to the VA Network Pharmacies
1) Call the National Mission Act Call Center at 1-844-698-2311 to check your eligibility, if you require VA referral, and what your co-pay is.
2) Then go to https://vaurgentcarelocator.triwest.com/Locatorto find the nearest participating clinic/Urgent Care.
3) Bring your VA ID
4) They have very specific formulary requirements for prescriptions (Urgent Carenand National) and you will have to go to a participating pharmacy which can be found going to http://www.express-script.com. Have them write your script so if anything they prescribe is not on the formulary list you can get using your personal health insurance.
Victory for the veteran. However, does this cover Dermatology?
So far Is this mission act is as clear as Mud in your eye. We loose choice and get some kind of urgent care that is to far for most of us to travel to in less than three hours. sound like a loose loose proposition to me.
You are right! I am in Ohio and my closest urgent care is in Pennsylvania…????
Richard, when I looked online for a zip code within Ohio…I saw many Minute Clinics on the list just for Ohio. Urgent cares are fewer between, but one of the objectives of the Mission Act is to allow folks who need to be seen for more “sick call” related situations to be seen quickly and more conveniently than relying on the VA alone. So I’m not sure where you were looking for your nearest Minute Clinic or Urgent Care (basically the same thing but with a few extra perks), but hopefully this site will make it easier to locate:
https://vaurgentcarelocator.triwest.com/Locatorto find the nearest participating community clinic/Urgent Care.
Participating pharmacies can be found going to http://www.express-script.com. CVS is a participating pharmacy near me.
Same here, I’m in Western NY & nearest urgent care facility listed in their network is Erie PA at 96 miles from here.
What’s the point?!
Yes sir…..the questions on receiving benifits continue. Simplification for those in need is an important step for the administrators of these laws/benifits especially those you mentioned. Thanks for your service and thank you for thinking of our fellow vets in need. Now is they would just contact all war veterans and advise them that they may qualify for wartime veterans pensions, a lot of folks could live out there lives a little more comfortably than they are now is they fall into the catagories of need.
It is a shame that I have found four on my own that qualified and never even knew they had the option.
Thankfully, President Trump has opened SOME of the awareness and is making health clinics available to vets that are not able to do like you and me with the medicare and the supplement.
Cheers to you my fellow vet.
Daniel Grammer, class of Agent Orange US Navy
There needs to be an expansion of Veteran Dental services. Poor Dental health leads to overall poor health and an increase in Heart attacks. Currently, if you’re not Retired Military you need a 100% Service-Connected Disability to receive Dental benefits. This needs to be expanded immediately! I am currently 60% Service-Connected and am desperately in need of Dental Care.
Steve Friedlander (0584)
I agree with you sir the fact that any veteran that receives a 10% Disability Rating receives Primary Health Care and Mental Health Care but if a Veteran is not Retired or receiving 100% Disability Rating then we get left by the wayside. Since when does a disability Rating have anything to do with the type of health care that veterans receive. We’ve all served our country so why are we not provided proper Health Care on all three fronts. As a Veteran that’s receiving 70% disability myself the requirements don’t add up.
I agree…if you qualify for VA healthcare with 60% disability rating, you should be covered for dental care as well…also if you receive dental care while admitted in a VA hospital, especially if your teeth had to be extracted and you are discharged without being finish getting treated, you should be able to continue with that dental clinic until all treatments have been received including receiving dentures and partials to replace teeth extracted. This needs to be addressed now and not buried in bureaucratic red tape..2
VAdip is only about $20 a month if you’re VA eligible. Great program. All preventive included along with some restorative costs partially covered. Delta dental. Call your VA. You’re eligible.
I totally agree with Steve! And delta dental will not help with the costs involved with gum and teeth problems associated with diabetes and heart problems
I’m a peace time vet I served from 1956 to 1960 in USAF afc 18518234 would like to know if i’m eligible for VA health care. How do I find out if I’m eligible?
Eddie,
I commend you on not wanting to add the cost of medical services to the VA healthcare expenses, but please be advised you would have a hard time doing that. You see under Community Services IE: Hospitalization VA covers the expense. Well….they are suppose to cover it, but getting the bills paid is another deal. From my experience (about 8 trips to the ER) private hospitals don’t want to treat veterans covered by VA. The billing process is difficult and they would rather not bother instead of getting their claims rejected by VA for the 1st time. After this the private hospitals send you a bill for thousands of dollars claiming its your responsibility to pay. So with urgent care, the same type of situation would present itself-who is going to pay? VA is supposed to cover it, but its a long process. I have refused to pay the hospital bills and have bill collectors calling me for payment. I keep referring them to VA but after 45 days VA closes the claim and then you are stuck with the bill. So don’t get your hopes up about this new urgent care because although it looks good on paper, it will definitely be a challenge.
In March, via emergency room services, I was hospitalized at a local hospital. I had previously went to the local VA clinic to seek care, but left after realizing, they didn’t really have an effective sickcall program in place. Feeling my condition deteriorating, I phoned the VA hospital that provide authorization to seek emergency care at the local hospital near me. Then upon arriving at the hospital ER, I notified the admission/intake individual of my Veteran status, and the name of the individual who approved me to seek care there. I was admitted to the hospital for 3 days. The individual that submits paperwork to VA came to see me & asked a few questions in a condescending manner, but in the end, VA took care of the bill.
I received a letter in mail about the mission act and stated I was eligible with 0 co-payment. I would like to speak with someone about this.
I HAVE READ THIS A COUPLE OF TIMES AND STILL DON’T UNDERSTAND MUCH OF IT
I HAVE READ THIS A COUPLE OF TIMES AND STILL DON’T UNDERSTAND ALL OF IT.
I live in Olney Ill.My wife doesn’t like to drive all that well.Our closest VA hospital is in Marion Ill. Which is 2hr. awayI also have to go to St. Louis john Cochran for my arthritis which is 2hrs.I go to Effingham which is 45min.How will this help me on thing s like a colonoscopy.Thank You.
If an eligible Veteran for benefits has Medicaid and a supplemental Blue Cross Blue Shield, how will a VA urgent/walk-in facility process a claim to the Veteran’s health insurance company? May I correctly assumed a private insurance company’s payment to the VA will be accepted as a portion of the charge of medical services received?
I am an eligible Veteran for VA healthcare but have used Medicare and my supplement for my medical services because I did not want to add the cost of my medical services to the VA healthcare expenses. However, if a local VA walk – in facility for Veterans’ health care needs, I would enroll for this new Outside Networks Act (Mission Act) of 2018..
How would an eligible Veteran for medical service, not currently enrolled in VA medical care services, receive certification for services provided by the Mission Act of 2018? I believe there are thousands of eligible Veterans like myself who would want to use these walk – in clinics which have never been participating in the VA healthcare system, thus, a brief document with instructions and a short form application for qualifications for this program would bring many new enrollments of Veterans to VA healthcare services.
I encourage you to create such a document to facilitate Veterans now wanting to reenter or for the first time start participating in the program of healthcare by the VA for veterans. You may ask why this request for a new simplified enrollment form for VA healthcare services being expanded to the local communities, is necessary. I am an 85-year-old overseas US Army veteran, but one of the lucky ones who at this time is capable of handling most of my own paperwork and driving my car to places to receive medical services. Others, probably millions, in my age group need help completing the necessary paperwork, transportation to and from VA services, and financial help paying private healthcare facilities. Please, try your best to make this as simple and convenient for many older and often Veterans.
Best regards, Eddie W Varney US 52403125.