A proposed $15 billion increase in next year's Department of Veterans Affairs $112.8 billion budget is coming as demand for several services is up among veterans in New Hampshire and Maine.

Service areas seeing increased demand include mental health counseling, post-traumatic stress disorder screenings, home-based care for aging vets, rural access to care, veteran homelessness and women's health services.

Dr. Marc Levenson, director of the Manchester Veterans Administration Medical Center, said the center is seeing 300 new applications for care each month, up from 200 monthly two years ago.

Overall, he said, the center's staff has increased by 100 people to 600 full-time employees, and he expects those numbers will continue to climb as demand for services rises.

He said 21,000 of New Hampshire's estimated 125,000 veterans are using some service associated with the facility, 28,000 of the state's veterans are enrolled with the VA "... and the number is going up at an accelerated pace."

Dr. Agu Suvari, a primary care physician at the Somersworth VA Community-based Outpatient Clinic, said demand for VA care is growing because more veterans are losing jobs and the health coverage provided by their former employers.

He said he's seen more veterans enroll for benefits because of the economy, with Vietnam War veterans being one of the largest groups doing so, he said.

John Barrett, the New Hampshire Veterans of Foreign Wars service officer in Manchester, said he, too, is seeing more Vietnam War vets seek out VA services. In some cases, he added, veterans are nearing retirement age after working for 20 to 30 years and the recession has left them either without a job or health insurance, if an employer chose to cut the benefit.

He also is seeing many widows of World War II and Korean War veterans who need VA benefits or other services.

As Vietnam War veterans enter retirement age, they have a high demand for home-based care and for VA medical and dental benefits, Levenson said.

A steady stream of veterans from the nation's current conflicts in the Middle East need treatment for post-traumatic stress disorder and various readjustment issues, he said.

According to Department of Veterans Affairs projections, Levenson said, enrollment for such veterans could rise by 2 to 3 percent per year through 2013.

"So we're adding staff to keep ahead of that workload," he said.

He said they just added another outpatient care clinic at the Manchester VA and want to add a mental health primary care clinic in Manchester.

The Manchester facility has four full-time employees devoted to helping veterans avoid homelessness and plans to hire a fifth, Levenson said.

Child care during appointments is another issue that has arisen, he said.

There also has been a 10 percent increase in women veterans enrolled in the state's VA system, bringing their number to 1,000. The Manchester VA has hired a full-time nurse practitioner to serve as the women veteran's coordinator, he said. The proposed VA budget would devote $183 million for women veteran services, such as mammograms.

The proposed spending package, the largest one-year percentage increase requested by a president in 30 years, would expand health care eligibility to more than 500,000 nondisabled veterans by 2013. The proposed budget would devote $4.6 billion for enhanced outreach services related to mental health care, such as post-traumatic stress disorder screenings and depression and suicide prevention efforts.

There would also be $26 million to combat veterans homelessness. Another $5.9 billion would be devoted to expanding in-house and outside long-term care services.

The budget also calls for $360 million for the development of the HealthVet electronic medical records system, which would allow the departments of Defense and Veterans Affairs to share the records of each veteran seamlessly when a veteran leaves the military and enters the VA system.

Dana Hussey of Rochester, the state's Veterans of Foreign Wars adjutant and a Vietnam veteran, greeted the proposed budget with guarded optimism.

"The increase is always good, but the question is where are they going to use the money," he said.

He said he hopes the increases are not solely directed at the veterans of current wars and added that New Hampshire still would like to see a full-service VA hospital return to Manchester so older vets don't have to travel to Boston for some types of care.

"It's a step in the right direction, but the steps need to be bigger," Hussey said.

Cook/Staff photo Dr. Agu Suvari, a primary care physician, checks Ernest Proper's blood pressure Friday morning at the Somersworth Veterans Affairs Community-based Outpatient Clinic.

Levenson said there are no plans for a full-service VA hospital in Manchester and the VA Medical Center continues to access an additional six- to eight beds when needed from Concord Hospital.

Somersworth's Suvari said veterans would benefit if they could get in-patient care at hospitals closer to home.

The agreement with Concord Hospital is limited, and adding similar agreements with other hospitals would cost more money, he said.

Ernest Proper of Portsmouth, an Army vet who served as a military policeman from 1978 to 1983, said if he had an emergency and went to Portsmouth Regional Hospital, "they would stabilize me and send me to Concord."

Proper, 50, is an unemployed social services worker who said he appreciates having VA benefits.

He said he goes to the Somersworth clinic four times a year for checkups and lab work and preferred his VA coverage over the health insurance his former employer offered.

The proposed VA budget also calls for $440 million to improve access to care in rural areas.

Jim Doherty, a spokesman with the Togus Veterans Affairs Center in Augusta, Maine, said they have been working on that goal for the last few years.

He said they obtained federal funding for a mobile medical unit to serve Maine veterans who live in the northwestern part of the state. The 53-foot trailer was custom-built and provides primary care, mental health counseling and a clinical lab. It also has satellite connectivity.

Doherty said the van is staffed with a social worker, nurse practitioner, a registered nurse and a clerk and the van's territory includes Jackman, Dover-Foxcroft, Bingham and Greenville, Maine.

"We saw the first veterans up there on Sept. 30," Doherty said.

Togus officials also rolled out two 38-foot mobile centers that look like Winnebago campers and provide mental health counseling in rural areas. Doherty said the mobile centers supplement the work done by staff at the Maine VA's five veterans centers. One is in Lewiston-Auburn and the other is in Caribou.

Like New Hampshire, Doherty said Togus officials are anticipating demand for mental health counseling and post-traumatic stress disorder treatment will continue to rise.

"We have pretty much doubled the mental health staffing," he said.

Overall, he said, the Togus center serves 38,000 Maine veterans.

Mary Ann Church, director of the Manchester VA Medical Center's four community-based outpatient clinics in Somersworth, Portsmouth, Conway and Tilton, said her staff is keeping up with the demand for services so far.

They see 6,000 of the state's veterans per year at the four clinics. She said there are two doctors in Somersworth for primary care, and Portsmouth is staffed with a nurse practitioner and a doctor. Tilton has a part-time nurse practitioner.

"We're seeing more and more Iraq and Afghanistan veterans," Church said.

She said they come in spurts after returning home to civilian life with their families. Sometimes they don't seek mental health counseling or treatment for post-traumatic stress disorder for three to five years after they come home, she said.

"We've been able to handle the numbers of the people that have been coming in," Church said.

She said the community-based outpatient clinics also added a homeless veterans component last year because VA officials recognize that as more veterans return home, they will encounter the difficult economy and may have a hard time finding a job.

Amy Marcotte, the team leader at the Veterans Center in Sanford, Maine, said the staff of four clinicians are seeing 200 or more clients and their families each year. She said the ratio between the center's clinicians and clients is 1 to 45 or 50 veterans.

Maine also has veterans centers in Bangor, Caribou, Lewiston and Portland.

She said they specialize in readjustment counseling for combat veterans dating back to World War II. They also counsel men and women who experienced sexual trauma on active duty and they offer bereavement counseling for people who lost loved ones.

"We're well staffed and we can take on new veterans," she said. "The thing that I wish we had most was more awareness in the community that we are here to provide services for veterans."