A veteran in Temple, TX, boards a vehicle provided by the Veterans Transportation Service, one of the methods VA is using to improve access for rural beneficiaries. With veterans increasingly concentrated in rural areas away from VAMCs, VA also is trying to reach about 825,000 veterans through telehealth and mobile health by the end of 2013.

Since at least 2003, when it established the Capital Asset Realignment for Enhanced Services (CARES) Commission, the VA has wrestled with finding the best way to respond to changing veteran demographics and needs. Created to recommend the best ways to eliminate underutilized facilities, develop new facilities where demand had increased and redirect resources to better meet veterans’ needs, the commission and its recommendations have encountered significant community and political opposition. In a time of greater fiscal constraint, however, consolidations that reflect the dramatically altered distribution of veterans might be harder to avoid.

For the study, Teachman analyzed population data from 3131 counties from the 1980, 1990, 2000, and 2010 censuses. During the period studied, the number of veterans fell by 22%, from 28 million to 22 million. The decline occurred as the very large cohort of World War II veterans died and their numbers were not replaced by veterans from the much smaller all-volunteer active duty forces, which totaled only 2.0 million in 1980 and 1.4 million in 2010.

At the same time the number of veterans fell, the overall U.S. population grew by 80 million during the 30-year span. As a result of the confluence of these factors, the veteran proportion of the U.S. population dropped from slightly more than 12% in 1980 to about 7% in 2010.

“By itself, the decline in the number of active-duty service members and veterans means that the likelihood of civilian-military interaction has decreased,” Teachman wrote.

The biggest factor in reducing interaction between the two population groups has been the smaller proportion of people serving, Teachman said.

“In World War II, 70% of the birth cohorts served. During Vietnam, it was 25% of the birth cohort. Today, it’s just 7%. It’s a self-selected group. Before, with the draft, it was a more representative cross section of American men,” he said.

Geographic concentration in a relatively small number of counties has further increased separation of veterans from broader civilian society. On a county level, the results of the reduced number of veterans and increased geographic concentration are easy to see. In 1980, veterans accounted for more than 10% of the population of 80% of American counties. In 1990, that was true for 73% of counties and in 2000, for 55%.