09.11.2012 Views

President Obama placing the wreath at the Tomb - Minnesota ...

President Obama placing the wreath at the Tomb - Minnesota ...

President Obama placing the wreath at the Tomb - Minnesota ...

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

December 2009<br />

<strong>President</strong> <strong>Obama</strong> <strong>placing</strong> <strong>the</strong> <strong>wre<strong>at</strong>h</strong> <strong>at</strong> <strong>the</strong> <strong>Tomb</strong><br />

of <strong>the</strong> Unknown Soldier on<br />

Veterans Day – November 11, 2009


Continuing to Serve<br />

<strong>Minnesota</strong> Paralyzed<br />

Veterans of America<br />

One Veterans Drive<br />

SCI-238<br />

Minneapolis, MN 55417<br />

Monday - Thursday:<br />

8:00 AM - 4:00 PM<br />

Friday:<br />

8:00 AM - 1:30 PM<br />

Phone: 612-725-2263<br />

Toll Free: 1-800-663-6782<br />

Fax: 612-726-9472<br />

Email: mnpva@qwestoffice.net<br />

Executive Director<br />

Richard F. Jost<br />

Phone: 612-467-1651<br />

Email: rfjostmnpva@qwestoffice.net<br />

Officers<br />

<strong>President</strong> Charlie Wittwer<br />

Vice-<strong>President</strong> Russ Osborne<br />

Secretary Eric Webster<br />

Treasurer John Christensen<br />

Past <strong>President</strong> Eric Webster<br />

Board of Directors<br />

Leo Dondlinger – Todd Kemery<br />

Tom Fjerstad – Dave Langsdale<br />

Bill Frisby – Dave Hallis<br />

N<strong>at</strong>ional Director<br />

Thomas R. Fjerstad, PRP<br />

N<strong>at</strong>ional Service Offices<br />

Jason Stephenson – 612-629-7022<br />

Senior Benefits Advoc<strong>at</strong>e SCI-141<br />

Jim Arndt – 612-629-7021<br />

Voc<strong>at</strong>ional Rehab. Program SCI-139<br />

One Veterans Drive<br />

Minneapolis, MN 55417<br />

Tami Anderson – NSO II<br />

Federal Building Room 194B<br />

St. Paul, MN 55111<br />

612-970-5988<br />

1-800-795-3609<br />

FTS 612-970-5668<br />

Nor<strong>the</strong>rn Highlights Staff<br />

Editor Richard F. Jost<br />

Circul<strong>at</strong>ion Dianna Way<br />

Nor<strong>the</strong>rn Highlights<br />

Advertising R<strong>at</strong>es<br />

Please call <strong>the</strong> office for r<strong>at</strong>es.<br />

612-725-2263<br />

or<br />

1-800-663-6782<br />

The <strong>Minnesota</strong> Chapter of <strong>the</strong> Paralyzed Veterans of America is a non-profit organiz<strong>at</strong>ion.<br />

Our funding is primarily received from don<strong>at</strong>ions. The Paralyzed Veterans of America is<br />

<strong>the</strong> name of our parent organiz<strong>at</strong>ion, and is chartered by <strong>the</strong> Congress of <strong>the</strong> United St<strong>at</strong>es<br />

of America. All members of <strong>the</strong> Paralyzed Veterans of America, have sustained a spinal<br />

injury or disease. If you have any questions, or you would like to make a don<strong>at</strong>ion to our<br />

organiz<strong>at</strong>ion, please write to <strong>the</strong> address or call <strong>the</strong> numbers listed on this page<br />

Any and all articles th<strong>at</strong> appear in this newsletter, is <strong>the</strong> opinion of <strong>the</strong> author of<br />

said article, and not necessarily those of its members, Board of Directors, or th<strong>at</strong><br />

of this organiz<strong>at</strong>ion. Any advertising th<strong>at</strong> appears in this newsletter, is paid for by <strong>the</strong><br />

business or organiz<strong>at</strong>ion th<strong>at</strong> placed <strong>the</strong> advertisement. The <strong>Minnesota</strong> Paralyzed<br />

Veterans of America, by printing said advertisements, does not endorse and shall not<br />

be held liable for any claims of any kind against said business or organiz<strong>at</strong>ion.<br />

The <strong>Minnesota</strong> Paralyzed Veterans of America’s newsletter will be published<br />

12 times per year. The editor and/or assistant may edit all articles for content,<br />

grammar, clarity and punctu<strong>at</strong>ion.<br />

— Richard F. Jost, Editor.<br />

Wishing<br />

you a<br />

Happy,<br />

Healthy<br />

and Safe<br />

Holiday<br />

Season<br />

Table of Contents<br />

Volume 16, Issue 3<br />

Nor<strong>the</strong>rn Highlights<br />

<strong>President</strong>’s Report 3<br />

Executive Director’s Report 4<br />

Sr. Benefit Advoc<strong>at</strong>e’s Report 5<br />

Membership Report 5<br />

Government Rel<strong>at</strong>ions Dir. Report 6<br />

January Calendar & Schedule 7<br />

January Birthdays 8<br />

For Sale 8<br />

Member Applic<strong>at</strong>ion 9,10<br />

PVA Ad 11<br />

Spiritual Thoughts 11


<strong>President</strong>’s Report – Charlie Wittwer<br />

Hello everyone,<br />

As I look out my window and see snow on <strong>the</strong> ground, <strong>the</strong> bay iced over and a thin co<strong>at</strong> of ice on my van. Now being a<br />

college gradu<strong>at</strong>e and have acutely deduced th<strong>at</strong> winter is indeed here even though <strong>the</strong> calendar says it officially begins<br />

December 21st. So I guess we better put away <strong>the</strong> summer toys and replace <strong>the</strong>m with winter toys, (i.e.: snow blowers,<br />

shovels, snow machines, cross country skis, and anything else we can think of) but most if all we need warm clo<strong>the</strong>s to<br />

shield us from <strong>the</strong> winter woes th<strong>at</strong> are sure to come. I guess I better get down to business and let you know wh<strong>at</strong> has<br />

been going on.<br />

The main thing for me is my trip to Washington D.C. from November 10th-12th for <strong>the</strong> Veteran’s Day ceremony.<br />

Our Advocacy committee was <strong>the</strong>re which includes Tom Fjerstad, Todd Kemery and myself. It was a sobering and<br />

enlightening day with <strong>the</strong> event held <strong>at</strong> <strong>the</strong> <strong>Tomb</strong> of <strong>the</strong> Unknown Soldier. N<strong>at</strong>ional PVA was <strong>the</strong> host for this gre<strong>at</strong><br />

event. We witnessed <strong>President</strong> <strong>Obama</strong> and his very lovely wife, Michelle. We saw many dignitaries on <strong>the</strong> dias among<br />

<strong>the</strong>m, Chaplin Keith Ethridge, Directior, VA Chaplin Service, The Honorable Tammy Duckworth, Assistant Secretary,<br />

of Veteran Affairs, The Honorable Eric K. Shinseski Secretary of Veteran Affairs, and our very own Mr. Gene Crayton,<br />

N<strong>at</strong>ional <strong>President</strong> Paralyzed Veterans of America. The highlight of <strong>the</strong> ceremony was when <strong>President</strong> <strong>Obama</strong> laid <strong>the</strong><br />

<strong>wre<strong>at</strong>h</strong> on <strong>the</strong> <strong>Tomb</strong> of <strong>the</strong> Unknown Soldier. It was an exhilar<strong>at</strong>ing experience for all of us. I have never been to an event<br />

when <strong>the</strong>re were so many secret service people all over <strong>the</strong> place; you knew for sure something very noble was going on.<br />

Twenty-five organiz<strong>at</strong>ions were part of <strong>the</strong> planning committee th<strong>at</strong> organized this ceremony. The only glitch was <strong>the</strong> rain,<br />

but even th<strong>at</strong> did not stop <strong>the</strong> hundreds of veterans and civilians who were in <strong>at</strong>tendance. I was truly honored to be a<br />

part of this and hope to <strong>at</strong>tend in <strong>the</strong> years to come. The reception followed back of <strong>the</strong> Mayflower Hotel, in Washington<br />

D.C.; from1:00 to 4:00 p.m. and of course it was sponsored by N<strong>at</strong>ional PVA. It was a very special day all around and <strong>the</strong><br />

highlight of <strong>the</strong> reception was when we posed for a picture with Mr. Buzz Aldrin, <strong>the</strong> second man to walk on <strong>the</strong> moon<br />

which was taken by my lovely wife Jan who was with us <strong>the</strong> entire trip.<br />

Thank you for your time and remember to have fun and be kind!<br />

3


Executive Director’s Report – Richard Jost<br />

4<br />

By <strong>the</strong> time you read this we will have been visited by N<strong>at</strong>ional PVA<br />

PesidentGene Crayton (story follows) for a Voc<strong>at</strong>ional Rehabilit<strong>at</strong>ion<br />

celebr<strong>at</strong>ion on Tuesday December 1, 2009 th<strong>at</strong> Governor Tim Pawlenty,<br />

Minneapolis Mayor R.T. Rybak, Mike Pugliese Deputy Commissioner<br />

of Veterans Affairs of <strong>Minnesota</strong> along with many o<strong>the</strong>rs <strong>at</strong>tended.<br />

It was gre<strong>at</strong> to host <strong>President</strong> Crayton during his visit to <strong>the</strong><br />

Minneapolis SCI Center. W<strong>at</strong>ching <strong>the</strong> <strong>President</strong> work during<br />

his meetings with <strong>the</strong> SCI Director and Medical Center Director,<br />

I realized th<strong>at</strong> PVA is in very good hands with Gene Crayton as<br />

<strong>President</strong>.<br />

One of <strong>the</strong> reasons I am so very proud of this Minneapolis VA Medical<br />

Center is because of an article in <strong>the</strong> <strong>Minnesota</strong> Department of<br />

Veterans Affairs newsletter th<strong>at</strong> was received in <strong>the</strong> chapter office. The<br />

article I am referring to is as follows:<br />

“The Minneapolis VA Medical Center (VAMC) has joined a select group<br />

of organiz<strong>at</strong>ions th<strong>at</strong> have achieved a sustained level of excellence in<br />

performance as determined by <strong>the</strong> U.S. Department of Veterans Affairs.<br />

The Minneapolis VAMC is one of three recipients of <strong>the</strong> 2009 “Circle<br />

of Excellence” award, which was recently presented by <strong>the</strong> U.S. VA<br />

Deputy Secretary W. Scott Gould during a ceremony in Washington,<br />

D.C. Also honored were <strong>the</strong> Cooper<strong>at</strong>ive Studies Program Clinical<br />

Research Pharmacy <strong>the</strong> White River Junction VA Medical Center in<br />

Vermont.<br />

It was an honor to accept <strong>the</strong> “Circle of Excellence” award as this<br />

medical center continues in journey of continuous improvement,” said<br />

Minneapolis VAMC Director Steven Kleinglass. “This award honors<br />

every member of our staff who strives daily to serve our Veterans with<br />

first-class medical care.”<br />

The “Circle of Excellence” award recognizes organiz<strong>at</strong>ions (medical<br />

centers, benefits offices and cemeteries) within <strong>the</strong> U.S. VA th<strong>at</strong> have<br />

implemented management approaches th<strong>at</strong> result in sustained high<br />

levels of performance and service.<br />

Since 1992, <strong>the</strong> U.S. VA has recognized its departments with <strong>the</strong><br />

Robert W. Carey Quality Award.<br />

Each year <strong>the</strong> VA presents a Carey trophy award to <strong>at</strong> least one<br />

organiz<strong>at</strong>ion. Only recipients of <strong>the</strong> award during <strong>the</strong> previous five<br />

years are eligible for <strong>the</strong> “Circle of Excellence” recognition. The<br />

Minneapolis VAMC was <strong>the</strong> 2008 Carey trophy award winner.”<br />

The above article appeared in <strong>the</strong> Volume 3, Issue 12 of <strong>the</strong> <strong>Minnesota</strong><br />

Department of Veterans Affairs Newsletter d<strong>at</strong>ed December 2009.<br />

In closing I would like to wish everyone a safe, healthy and happy<br />

Holiday Season!!<br />

Live Life Laugh Daily Enjoy <strong>the</strong> Ride


Senior Benefit Advoc<strong>at</strong>e’s Report – Jason Stephenson<br />

ISSUANCE OF A SPORT MODEL WHEELCHAIR<br />

In accordance with VHA Directive 1173.06 Paragraph 4c, A Sports Model wheelchair may be considered for eligible<br />

VA beneficiaries who have a disability resulting in <strong>the</strong> an<strong>at</strong>omical loss, or loss of use, of <strong>at</strong> least one lower extremity<br />

which prohibits <strong>the</strong>ir particip<strong>at</strong>ion in normal sports activities. It must be determined th<strong>at</strong> <strong>the</strong> VA beneficiary is<br />

actively engaged in a sports activity which requires a specially designed sports wheelchair for <strong>at</strong>tainment of maximum<br />

rehabilit<strong>at</strong>ion. One sport model wheelchair may be furnished in addition to <strong>the</strong> veteran’s primary chair as well as<br />

back-up of equal value to a veteran who requires <strong>the</strong> continued use of a wheelchair for mobility. The request for a<br />

Sports Model wheelchair needs to be approved by <strong>the</strong> Major Medical Committee after a Physician who specializes in<br />

Rehabilit<strong>at</strong>ion medicine has entered a consult.<br />

Sports Model wheelchairs may be furnished to eligible veterans in lieu of a conventional type chair, even if <strong>the</strong> veteran is<br />

not actively engaged in a sports activity, provided <strong>the</strong> unique modific<strong>at</strong>ions in height, depth, and width contained in <strong>the</strong><br />

sport chair are appropri<strong>at</strong>e for <strong>the</strong> veteran’s physical condition and <strong>the</strong>re are no contraindic<strong>at</strong>ions for daily use.<br />

Replacement of a Sports Model wheelchair may not be authorized merely because a veteran desires a new model or type,<br />

or solely because a chair has been used for a particular length of time.<br />

If a veteran is interested in obtaining a Hand Cycle wheelchair, a Hand Cycle Wheelchair may be furnished but it will<br />

be furnished under <strong>the</strong> same provisions as st<strong>at</strong>ed above for Sports Model wheelchairs.<br />

If you have any questions regarding <strong>the</strong> issuance of a Hand Cycle wheelchair or a Sports Model wheelchair, please feel<br />

free to contact your Paralyzed Veterans of America N<strong>at</strong>ional Service Officer <strong>at</strong> ei<strong>the</strong>r 612-970-5668/1-800-795-3609 or<br />

<strong>at</strong> 612-629-7022.<br />

Also of note, in compliance with PVA N<strong>at</strong>ional Policy, both <strong>the</strong> PVA Regional Office and<br />

PVA SCI Office to include Voc Rehab office will be closed from December 24th through<br />

January 3rd. Jason, Tami, Elaine, and Jim want to wish everyone Happy Holidays and a<br />

Happy New Year.<br />

Membership Report – Dave Hallis<br />

Our current membership is <strong>at</strong> 340 with <strong>the</strong> breakdown as follows:<br />

Service Connected = 153<br />

Non Service Connected = 187<br />

Please keep in mind to enlist new members when you are out in <strong>the</strong> community because we would really like to see our<br />

membership increase. Veterans with a spinal cord injury or spinal cord disease with an honorable discharge from <strong>the</strong> military are<br />

eligible for membership into our chapter.<br />

The <strong>Minnesota</strong> PVA Chapter welcomes <strong>the</strong> following new members: Wayne McM<strong>at</strong>h and Lawrence Mullaly. We look forward to<br />

seeing both of you <strong>at</strong> our upcoming events. WELCOME!<br />

The MNPVA Chapter office received notific<strong>at</strong>ion th<strong>at</strong> MNPVA member Petro J Kmit has passed away. The chapter extends its<br />

deepest symp<strong>at</strong>hies to his family and friends during <strong>the</strong>ir time of sorrow.<br />

N<strong>at</strong>ional PVA notified <strong>the</strong> chapter office th<strong>at</strong> Walt Cable and Thomas J Shaughnessy have been placed on <strong>the</strong> undeliverable list.<br />

If any one knows how to contact <strong>the</strong>m please call <strong>the</strong> office so we can place <strong>the</strong>m back on our membership rouster again.<br />

5


Government Rel<strong>at</strong>ions Director’s Report – Thomas R. Fjerstad, PRP<br />

I was in Washington, DC for Veterans Day along with Chapter<br />

<strong>President</strong> Charlie Wittwer and Chapter Sports Director Todd<br />

Kemery. This was my ninth time in Washington for Veterans<br />

Day. Charlie, Todd and I <strong>at</strong>tended <strong>the</strong> ceremony <strong>at</strong> <strong>the</strong> <strong>Tomb</strong><br />

of <strong>the</strong> Unknowns in Arlington N<strong>at</strong>ional Cemetery. PVA was<br />

<strong>the</strong> official host for Veterans Day this year and our current<br />

N<strong>at</strong>ional <strong>President</strong> Mr. Gene Crayton delivered <strong>the</strong> speech <strong>at</strong><br />

<strong>the</strong> ceremony while se<strong>at</strong>ed next to <strong>President</strong> <strong>Obama</strong>. <strong>President</strong><br />

Crayton made PVA proud on a cold and rainy day in Arlington.<br />

The list of dignitaries in <strong>at</strong>tendance is too long to cover in its<br />

entirety but it included <strong>the</strong> First Lady, Vice <strong>President</strong> Biden and<br />

VA Secretary Shinseki.<br />

After <strong>the</strong> ceremony it was off to <strong>the</strong> reception <strong>at</strong> <strong>the</strong> Mayflower Hotel<br />

hosted by PVA. Secretary Shinseki spoke <strong>at</strong> <strong>the</strong> reception and a good<br />

time was had by all. <strong>President</strong> Wittwer, Todd, and I had our picture<br />

taken with Buzz Aldrin of Apollo 11 fame, <strong>the</strong> second man to set foot<br />

on <strong>the</strong> moon. I would like to thank <strong>the</strong> PVA N<strong>at</strong>ional staff involved<br />

with organizing a reception th<strong>at</strong> truly made PVA shine.<br />

On November 10th I was up on <strong>the</strong> hill visiting <strong>the</strong> offices of our<br />

elected represent<strong>at</strong>ives. I extended a personal invit<strong>at</strong>ion to <strong>the</strong><br />

reception <strong>at</strong> <strong>the</strong> Mayflower <strong>the</strong> next day and thanked <strong>the</strong>m for<br />

<strong>the</strong>ir support in <strong>the</strong> passage of advanced appropri<strong>at</strong>ions for <strong>the</strong><br />

Department of Veterans Affairs. On Thursday, October 22, 2009,<br />

<strong>President</strong> <strong>Obama</strong> signed H.R. 1016 into law. Public Law 111-81<br />

secures timely funding for veterans health care delivered through<br />

<strong>the</strong> Veterans Health Administr<strong>at</strong>ion. This was a huge victory for<br />

veterans. I received a present<strong>at</strong>ion on this concept in September<br />

of 2008 during a trip to Washington for a Chapter Government<br />

Rel<strong>at</strong>ions Directors meeting. The bill was introduced in<br />

February by Congressman Filner Chairman of <strong>the</strong> House<br />

Committee on Veterans Affairs. This <strong>the</strong>n became <strong>the</strong> number<br />

one initi<strong>at</strong>ive during <strong>the</strong> chapters visit to <strong>the</strong> hill in early March<br />

of this year. We be<strong>at</strong> our heads against <strong>the</strong> wall for many years<br />

over mand<strong>at</strong>ory funding and to have this bill signed into law<br />

eight months after it was introduced is absolutely astounding.<br />

On <strong>the</strong> local front our new office in <strong>the</strong> Veterans Building<br />

is nearly complete and will be fully oper<strong>at</strong>ional prior to <strong>the</strong><br />

start of <strong>the</strong> <strong>Minnesota</strong> Legisl<strong>at</strong>ive session <strong>at</strong> noon on Thursday<br />

February fourth. I was in <strong>at</strong>tendance <strong>at</strong> <strong>the</strong> UVLC meeting on<br />

November 4th. <strong>Minnesota</strong> Department of Veterans Affairs Deputy<br />

Commissioner Mike Pugliese requested organiz<strong>at</strong>ions share<br />

legisl<strong>at</strong>ive ideas for <strong>the</strong> upcoming session. I will be meeting and<br />

discussing ideas with <strong>President</strong> Wittwer and presenting those<br />

ideas to <strong>the</strong> chapter board <strong>at</strong> its December meeting.<br />

6


January 2010<br />

1 2<br />

3 4 5 6 7 8 9<br />

10 11 12 13 14 15 16<br />

17 18 19 20 21 22 23<br />

24 25 26 27 28 29 30<br />

31<br />

Office<br />

Closed<br />

Martin Lu<strong>the</strong>r King Day<br />

Schedule of Events<br />

December 21 Winter Begins<br />

December 24 Christmas Eve Day – Holiday Office Closed<br />

December 25 Christmas Day – Holiday – Office Closed<br />

December 26 Kwanza Begins<br />

December 31 New Year Eve Day – Holiday – Office Closed<br />

Office<br />

Closed<br />

New Years Day<br />

NOVEMBER 2009<br />

S M T W T F S<br />

1 2 3 4 5 6 7<br />

8 9 10 11 12 13 14<br />

15 16 17 18 19 20 21<br />

22 23 24 25 26 27 28<br />

29 30<br />

JANUARY 2010<br />

S M T W T F S<br />

1 2<br />

3 4 5 6 7 8 9<br />

10 11 12 13 14 15 16<br />

17 18 19 20 21 22 23<br />

24 25 26 27 28 29 30<br />

31<br />

January 1 New Year’s Day – Holiday – Office Closed<br />

January 18 Martin Lu<strong>the</strong>r King, Jr. Day – Holiday – Office Closed<br />

January 20 BOD Meeting<br />

Hospital Visit<strong>at</strong>ion: Monday through Friday<br />

Bowling South: Thursday mornings starting <strong>at</strong> 11:00 a.m. <strong>at</strong> <strong>the</strong> Eden Prairie Bowling Lanes in Eden Prairie, <strong>Minnesota</strong><br />

Bowling North: Thursday afternoons starting <strong>at</strong> 2:00 p.m. <strong>at</strong> Bowlers Advantage/Bunkie’s Bar & Grill Bowling Lanes in Chisago, <strong>Minnesota</strong><br />

Please call <strong>the</strong> MNPVA office if you plan on <strong>at</strong>tending any of <strong>the</strong> above activities <strong>at</strong><br />

612-725-2263 or 1-800-663-6782 or via email <strong>at</strong> mnpva@qwestoffice.net<br />

Birthstone: Garnet<br />

Flower: Carn<strong>at</strong>ion<br />

7


8<br />

January<br />

Birthdays<br />

1 Joseph R. Lanctot<br />

2 Harlan H. Ebert<br />

4 Edgar E. Traut<br />

Robert J. Young<br />

5 Lee M. Whitley<br />

7 Curtis L. Jorgenson<br />

Gordon G. VanKleek<br />

8 Michael W. McFarland<br />

Raymond A. Ostlund<br />

Philip N. Schmitz<br />

9 Donald O. Thompson<br />

12 Emmett N. Kuklock<br />

16 Mark G. Rahn<br />

23 Andrew J. Bernstrom<br />

26 Brian K. Olson<br />

Bill Wicklow<br />

27 Gary L. Hieronimus<br />

28 Mark P. Mimnaugh<br />

Roger H. Tottingham<br />

29 Robert L. Hawley<br />

Phillip J. Koehntop<br />

31 P<strong>at</strong>rick A. Donley<br />

Glenn D. Jackola<br />

FOR SALE:<br />

2006 Chrysler Town & Country Touring, Rollx<br />

conversion with infloor ramp, excellent condition,<br />

GPS, DVD lea<strong>the</strong>r, 32K, $26,000.00, for more<br />

inform<strong>at</strong>ion, please call 651-322-1277


PARALYZED VETERANS OF AMERICA<br />

MEMBERSHIP APPLICATION<br />

An individual is eligible for membership by meeting <strong>the</strong> following criteria: (1) is a citizen of <strong>the</strong> United St<strong>at</strong>es;<br />

(2) was regularly enlisted, inducted, or commissioned, and was accepted for or on active duty, in <strong>the</strong> Army, Navy,<br />

Marine Corps, Air Force, or Coast Guard of <strong>the</strong> United St<strong>at</strong>es or an ally of <strong>the</strong> United St<strong>at</strong>es; (3A) was separ<strong>at</strong>edfrom<br />

<strong>the</strong> service in <strong>the</strong> Armed Forces under conditions o<strong>the</strong>r than dishonorable; or (3B) is on active duty or must<br />

continue to serve after <strong>the</strong> cess<strong>at</strong>ion of hostilities; and (4) has suffered a spinal cord injury or disease (such as MS,<br />

ALS), whe<strong>the</strong>r or not service connected in origin. Membership is free. Complete and mail <strong>the</strong> applic<strong>at</strong>ion to:<br />

PVA Membership Department, 801 18th Street, NW, Washington, DC 20006 or to <strong>the</strong> chapter of choice.<br />

800-424-8200 • www.pva.org<br />

Chapter Name: _____________________________________________________________________________________<br />

First Name: ___________________________ Middle Initial: ________ Last Name: ____________________________<br />

D<strong>at</strong>e of Birth: _______ / _______ / _______ Social Security Number: _______________________________________<br />

Male Female Are you a United St<strong>at</strong>es citizen? Yes No<br />

Address: __________________________________________________________________________________________<br />

City: _________________________________ St<strong>at</strong>e: ___________________________ Zip: _______________________<br />

Home Phone: ______________________________________ O<strong>the</strong>r Phone: ______________________________________<br />

Email: _______________________________________________________________________________________________<br />

VETERAN STATUS INFORMATION<br />

DATE(S) OF<br />

MILITARY SERVICE<br />

Start D<strong>at</strong>e<br />

month/d<strong>at</strong>e/year<br />

<strong>Minnesota</strong> PVA Chapter<br />

month d<strong>at</strong>e year<br />

End D<strong>at</strong>e<br />

month/d<strong>at</strong>e/year<br />

TYPE OF<br />

SEPARATION<br />

Discharge (D) or<br />

Retirement (R)<br />

D or R<br />

D or R<br />

BRANCH OF SERVICE<br />

Army Air Force Navy Marine Corps Coast Guard<br />

Army Air Force Navy Marine Corps Coast Guard<br />

Have you ever been discharged under conditions th<strong>at</strong> are less than honorable? Yes No<br />

Is your spinal cord injury or spinal cord disease service connected? Yes No<br />

DISABILITY CLASSIFICATION<br />

SPINAL CORD INJURY<br />

(Complete ONLY if you have a traum<strong>at</strong>ic spinal cord injury)<br />

D<strong>at</strong>e of Injury: _______ / _______ / _______<br />

Injury Level: C1-C08 Cervical T01-T12 Thoracic<br />

Cause of SCI:<br />

L01-L05 Lumbar S01-S05 Sacral<br />

Vehicular (auto, motorcycle, aircraft, bicycle, etc.)<br />

Violence (gunshot, stabbing, explosion, etc.)<br />

Pedestrian (hit by car, etc.)<br />

Sport or recre<strong>at</strong>ion (swimming, diving, etc.)<br />

Flying or falling object<br />

Medical-surgical complic<strong>at</strong>ions<br />

O<strong>the</strong>r traum<strong>at</strong>ic injury ___________________________<br />

Unknown<br />

SPINAL CORD DISEASE<br />

(Complete ONLY if you have non-traum<strong>at</strong>ic spinal cord disease)<br />

D<strong>at</strong>e of diagnosis/onset of condition:<br />

_______ / _______ / _______<br />

Specific disease:<br />

Multiple Sclerosis<br />

Poliomyelitis<br />

Amyotrophic diseases (l<strong>at</strong>eral sclerosis, transverse myeltis)<br />

Syringomyelia<br />

O<strong>the</strong>r (specify) ________________________________<br />

9


LEVEL OF FUNCTION<br />

Indic<strong>at</strong>e your level of function:<br />

10 3/08<br />

Paraplegia Quadriplegia Hemiplegia No paralysis <strong>at</strong> this time<br />

GENERAL INFORMATION<br />

Please check <strong>the</strong> appropri<strong>at</strong>e box or fill in <strong>the</strong> blank of each of <strong>the</strong> c<strong>at</strong>egorical th<strong>at</strong> best describes your present st<strong>at</strong>us.<br />

This important inform<strong>at</strong>ion enables <strong>the</strong> PVA to compile d<strong>at</strong>a for <strong>the</strong> effective implement<strong>at</strong>ion and support of our programs.<br />

EDUCATION (highest level)<br />

Less than high school gradu<strong>at</strong>e<br />

High school gradu<strong>at</strong>e/GED<br />

Some college or trade school<br />

Associ<strong>at</strong>e’s degree<br />

Bachelor’s degree<br />

Attended gradu<strong>at</strong>e school<br />

Gradu<strong>at</strong>e degree<br />

O<strong>the</strong>r<br />

CURRENT EMPLOYMENT STATUS<br />

Employed full time<br />

Employed part time<br />

Self-employed<br />

Unemployed<br />

Unemployed due to disability<br />

Retired<br />

O<strong>the</strong>r ________________________<br />

MARITAL STATUS<br />

Divorced<br />

Married<br />

Never Married<br />

Separ<strong>at</strong>ed<br />

Widowed<br />

RACE/ETHNICITY<br />

Asian or Pacific Islander<br />

Black, not Hispanic/L<strong>at</strong>ino origin<br />

Hispanic/L<strong>at</strong>ino<br />

N<strong>at</strong>ive American or Alaskan N<strong>at</strong>ive<br />

White, not Hispanic/L<strong>at</strong>ino origin<br />

O<strong>the</strong>r ________________________<br />

TYPE OF RESIDENCE<br />

Apartment<br />

Assisted living facility<br />

Single-family home/condominium<br />

St<strong>at</strong>e/veterans retirement home<br />

Nursing home<br />

VA hospital<br />

VA nursing home<br />

O<strong>the</strong>r ________________________<br />

SOURCE(S) OF INCOME<br />

(check all th<strong>at</strong> apply)<br />

Employment<br />

Gifts/O<strong>the</strong>r<br />

Priv<strong>at</strong>e pension<br />

Social Security<br />

VA compens<strong>at</strong>ion<br />

VA pension<br />

Worker’s compens<strong>at</strong>ion<br />

NEXT OF KIN INFORMATION OTHER CONTACT INFORMATION<br />

Rel<strong>at</strong>ionship: ____________________________________<br />

(someone o<strong>the</strong>r than next of kin)<br />

Name: _________________________________________<br />

Rel<strong>at</strong>ionship: ____________________________________<br />

Same as member address on front of form<br />

Name: _________________________________________<br />

Address: _______________________________________<br />

Address: _______________________________________<br />

City: __________________________________________<br />

City: __________________________________________<br />

St<strong>at</strong>e: _______________________ Zip: ______________<br />

St<strong>at</strong>e: _______________________ Zip: ______________<br />

Phone: _________________________________________<br />

Phone: _________________________________________<br />

The Veterans Benefits Department advoc<strong>at</strong>es for quality health care for our members and can assist you to obtain <strong>the</strong> appropri<strong>at</strong>e<br />

benefits available as a result of your military service. Is PVA presently your benefits represent<strong>at</strong>ive? Yes No<br />

If yes, I have no objection and hereby permit PVA Service Officers to provide inform<strong>at</strong>ion to <strong>the</strong> PVA N<strong>at</strong>ional Membership<br />

Department th<strong>at</strong> pertains to my qualific<strong>at</strong>ions for membership.<br />

I declare th<strong>at</strong> I have read and meet <strong>the</strong> qualific<strong>at</strong>ions. I understand th<strong>at</strong> my<br />

membership could be revoked if any inform<strong>at</strong>ion provided is inaccur<strong>at</strong>e.<br />

Office Use Only<br />

D<strong>at</strong>e Received: ____________________________<br />

Applicant’s Sign<strong>at</strong>ure<br />

D<strong>at</strong>e<br />

Member ID#: ______________________________<br />

Processed D<strong>at</strong>e: ___________________________


Spiritual Thoughts<br />

Proverb 17:22<br />

A Cheerful heart is good medicine, but a<br />

crushed spirit dries up <strong>the</strong> bones<br />

11


1 Veterans Dr. SC1-238<br />

Minneapolis, <strong>Minnesota</strong> 55417<br />

First Name: ___________________________________________ MI: ___________________<br />

Last Name: __________________________________________________________________<br />

Address: ____________________________________________________________________<br />

___________________________________________________________________________<br />

City: ___________________________________ St<strong>at</strong>e: _____________ Zip: _____________<br />

Home Phone: ( ______ ) ____________________E-mail: ______________________________<br />

Birth D<strong>at</strong>e: _____/ ____ / ____ Membership ID Number ______________________________

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!