[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
CULTURAL BARRIERS IMPACTING WOMEN VETERANS' ACCESS TO HEALTHCARE
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
FIRST SESSION
__________
THURSDAY, MAY 2, 2019
__________
Serial No. 116-10
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
39-914 WASHINGTON : 2021
COMMITTEE ON VETERANS' AFFAIRS
MARK TAKANO, California, Chairman
JULIA BROWNLEY, California DAVID P. ROE, Tenessee, Ranking
KATHLEEN M. RICE, New York Member
CONOR LAMB, Pennsylvania, Vice- GUS M. BILIRAKIS, Florida
Chairman AUMUA AMATA COLEMAN RADEWAGEN,
MIKE LEVIN, California American Samoa
MAX ROSE, New York MIKE BOST, Illinois
CHRIS PAPPAS, New Hampshire NEAL P. DUNN, Florida
ELAINE G. LURIA, Virginia JACK BERGMAN, Michigan
SUSIE LEE, Nevada JIM BANKS, Indiana
JOE CUNNINGHAM, South Carolina ANDY BARR, Kentucky
GILBERT RAY CISNEROS, JR., DANIEL MEUSER, Pennsylvania
California STEVE WATKINS, Kansas
COLLIN C. PETERSON, Minnesota CHIP ROY, Texas
GREGORIO KILILI CAMACHO SABLAN, W. GREGORY STEUBE, Florida
Northern Mariana Islands
COLIN Z. ALLRED, Texas
LAUREN UNDERWOOD, Illinois
ANTHONY BRINDISI, New York
Ray Kelley, Democratic Staff Director
Jon Towers, Republican Staff Director
SUBCOMMITTEE ON HEALTH
JULIA BROWNLEY, California, Chairwoman
CONOR LAMB, Pennsylvania NEAL P. DUNN, Florida, Ranking
MIKE LEVIN, California Member
ANTHONY BRINDISI, New York AUMUA AMATA COLEMAN RADEWAGEN,
MAX ROSE, New York American Samoa
GILBERT RAY CISNEROS, Jr. ANDY BARR, Kentucky
California DANIEL MEUSER, Pennsylvania
GREGORIO KILILI CAMACHO SABLAN, W. GREGORY STEUBE, Florida
Northern Mariana Islands
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
Thursday, May 2, 2019
Page
Cultural Barriers Impacting Women Veterans' Access To Healthcare. 1
OPENING STATEMENTS
Honorable Julia Brownley, Chairwoman............................. 1
Honorable Neal P. Dunn, Ranking Member........................... 2
WITNESSES
Ms. Joy Ilem, National Legislative Director, Disabled American
Veterans....................................................... 3
Prepared Statement........................................... 31
Ms. Lindsay Church, M.A., Minority Veterans of America........... 5
Prepared Statement........................................... 37
Ms. Ginger Miller, Women Veterans Interactive.................... 7
Prepared Statement........................................... 40
Ms. BriGette McCoy, Women Veteran Social Justice Network......... 8
Prepared Statement........................................... 42
CAPT (Ret.) Lory Manning, Service Women's Action Network......... 10
Prepared Statement........................................... 46
Dr. Patricia M. Hayes, PhD, Veterans Health Administration....... 19
Prepared Statement........................................... 47
STATEMENTS FOR THE RECORD
Women Who Serve.................................................. 53
Iraq and Afghanistan Veterans of America (IAVA).................. 56
Paralyzed Veterans of America (PVA).............................. 59
Vietnam Veterans of America (VVA)................................ 61
Veterans of Foreign Wars (VFW)................................... 63
CULTURAL BARRIERS IMPACTING WOMEN VETERANS' ACCESS TO HEALTHCARE
----------
Thursday, May 2, 2019
Committee on Veterans' Affairs,
U. S. House of Representatives,
Washington, D.C.
The Subcommittee met, pursuant to notice, at 10:04 a.m., in
Room 1300, Longworth House Office Building, Hon. Julia Brownley
[Chairwoman of the Subcommittee] presiding.
Present: Representatives Brownley, Lamb, Levin, Brindisi,
Rose, Cisneros, Peterson, Dunn, Coleman, Barr, and Meuser.
Also Present: Representatives Houlahan and Radewagen.
OPENING STATEMENT OF JULIA BROWNLEY, CHAIRWOMAN
Ms. Brownley. Good morning, everyone, thank you for being
here, and I am calling this oversight hearing to order. And,
before we get started, I would like to ask for unanimous
consent that Ms. Houlahan join us today on the dais.
Without objection, so moved.
I want to welcome everybody to the Subcommittee on Health's
second hearing of the 116th Congress. Today is a historic day
in this Committee, as it marks the first time in recent memory
that this Committee has held a hearing singularly focused on
serving our Nation's 2 million living women veterans.
Women have served in every American conflict since the
Revolutionary War. Deborah Sampson and Margaret Corbin, the
first American women known to have served in combat earned
pensions for their service during the Revolutionary War. Today,
2 million women veterans live in the United States and are the
fastest-growing demographic in both the military and veteran
population. Currently, women comprise nearly 20 percent of
military personnel and 10 percent of the veteran population,
and 35 percent of whom are women of color.
Even though women have served in every American conflict,
the Department of Veterans Affairs is a system created to serve
men and did not serve women veterans until the 1980s. While the
Department of Veterans Affairs has indeed evolved and some say
that the organization is not your grandfather's VA, but there
is still a long way to go. That is why the Women Veterans Task
Force has been created to ensure there is equitable access to
all VA services for our Nation's women veterans. And I will add
that I am encouraged that the VA and the Secretary himself has
committed to working with us to that end.
However, despite centuries of honorable service, the women
who serve our country are still treated as second class
servicemembers and veterans. A visible minority in the
military, women experience everyday indignities that make them
feel like they do not belong. The probable root causes range
from the impacts of the long-standing prohibition on women in
combat jobs, to going into combat-wearing protective equipment
that was made for men.
Most troubling is the widespread incidence of sexual
violence in the ranks, an epidemic that disproportionately
affects women. At least one in four servicewomen experience
military sexual trauma by the very teammates who are supposed
to have their backs. More than half of servicemembers who
report their assaults also report that their commands
retaliated against them.
Therefore, it should not be surprising then when women
leave the military, they are reluctant to enter veteran-serving
spaces. When they do, they often find the same lack of respect
that they endured on active duty. Recent research found that at
least 25 percent of women veterans experience sexual harassment
or questioning of service status by male veterans while at the
VA.
Even the organizations meant to serve veterans are often
hostile to women veterans. In her statement for the record,
Army veteran Melissa Bryant, Chief Policy Officer of Iraq and
Afghanistan Veterans of America explained, ``Now, as a
veterans' advocate, I still hear the misogyny in our community
from the time I am asked who is your sponsor at VA medical
centers to when I am referred to as young lady by my own
veteran colleagues.''
VA's system itself remains rife with barriers to care.
Twenty four percent of women veterans using VA health care
still do not have a specially trained woman's health primary
care provider. Women veterans are 46 percent more likely to use
community care than male veterans, largely to receive basic
preventive services such as Pap smears and mammograms. This has
resulted in billing problems, which again disproportionately
affect women. In addition, women veterans face longer wait
times, staffing shortages, and facilities that fail to meet
basic environment-of-care standards. Even here in Washington,
DC, the Women's Health Center has more limited hours available
for primary care appointments than are available for men.
Women veterans are remarkable Americans and deserve
equitable access to the benefits and resources that they have
earned. Women represent resilient leadership in their
communities and classrooms and their careers, and right here in
Congress.
In short, our goal is to make the invisible woman veteran
visible. So, as chair of this Subcommittee and the Women
Veterans Task Force, I am well aware of the work we need to do
and today is our first step in doing it.
So, with that, I would like to recognize Ranking Member
Dunn for 5 minutes for opening remarks he may wish to make.
OPENING STATEMENT NEAL P. DUNN, RANKING MEMBER
Mr. Dunn. Thank you very much, Chairwoman Brownley, and
thank you for having this hearing.
Today's hearing is just the start of an ongoing
conversation I expect this Subcommittee to have throughout the
116th Congress. So, in the interest of time and given the
constraints we are under this morning, I will keep my comments
brief and to the point.
I appreciate the opportunity to be here to discuss how to
break down the barriers for women veterans in the Department of
Veterans Affairs system, systemwide.
Women are a sizable and growing segment of the VA's
population, as you noted, with the number of women who use the
VA health care system tripling in just the last 18 years. VA
has made a number of strides to address the unique and often
complex needs of women veterans; however, far too many
disparities continue to exist in care, benefits, services, and
treatment.
I am particularly distressed to have learned that,
according to a recent study, one in four women veterans report
being subjected to inappropriate, unwanted comments from male
veterans in the VA system; that is unacceptable. I look forward
to this morning what steps we are going to be taking to
eradicate this type of harassment in the VA enterprise-wide and
to ensure the equitable treatment of women veterans within the
VA's environment.
So, thank you again for calling this important hearing and
I yield back to you, Chairwoman Brownley.
Ms. Brownley. Thank you, Dr. Dunn. And thank you to our
witnesses for being here today. We have two extraordinary
panels joining us today.
For the first panel, we have a formation of all women
veterans. First we have Ms. Joy Ilem, National Legislative
Director of Disabled American Veterans; next we have Ms.
Lindsay Church, Chief Executive Officer of Minority Veterans of
America; next we have Ms. Ginger Miller, Chief Executive
Officer of Women Veterans Interactive; next we have Ms.
BriGette McCoy, Chief Executive Officer of Women Veteran Social
Justice Network; and, finally, we have Captain Lory Manning,
Director of Government Relations for Service Women's Action
Network.
With that, I now recognize Ms. Ilem for 5 minutes. Welcome.
STATEMENT OF JOY ILEM
Ms. Ilem. Chairwoman Brownley, Ranking Member Dunn, and
members of the Subcommittee, thank you for inviting DAV to
testify today.
As a service-disabled veteran who has gotten my care at VA
for more than two decades, I appreciate the opportunity to
discuss cultural barriers impacting women veterans' access to
health care. There is no bigger barrier to care than a culture
that does not embrace women veterans or, at best, makes them
feel marginalized. Ensuring that women veterans are treated
with dignity and respect, have equal access to high-quality
comprehensive care, and readjustment services from VA is a top
legislative priority for DAV.
The number of women coming to VA for care has tripled, as
you have all noted, since 2000, and many have wartime service,
and more than half of the women using the VA health care system
have a service-related injury and will need a lifetime of care.
While VA has made progress and illustrated a commitment to
improving services for women veterans, several long-standing
challenges still remain.
DAV's most recent report issued in 2018, ``Women Veterans:
The Journey Ahead,'' highlighted the need for culture change in
VA. We found that women veterans perceived their military
service was not understood or appreciated like their male
peers. Women veterans told us they want to be treated with
dignity, respect, have equal access to earned benefits, and,
most importantly, they want to be recognized as veterans and
appreciated for their contributions in military service.
Another notable barrier to care is that many women veterans
do not feel welcome or safe at VA facilities. As confirmed by
the recent study just mentioned, that one in four women
reported being harassed by male veteran patients.
Unfortunately, women who experience this harassment were
significantly more likely to report either delaying or missing
care.
We applaud VA's new anti-harassment campaign and training
of employees that is underway to intervene when they see
harassment occurring, and encouraging veterans to immediately
report such conduct.
To meet the goal of a zero tolerance policy for harassment,
we challenge all veterans and Veterans Service Organizations to
do their part as well.
Women veterans who have their military service questioned,
who are routinely disrespected, and will not stay to find out
that VA offers exceptional, evidence-based, and culturally
competent clinical care and integrated services, and women
veterans need that expertise, and they deserve to have a system
that full embraces and supports them.
VA researchers have been specifically looking at barriers
to care for this population, as well as health impacts of
wartime service and the unique transition issues women face
when they return home. These concerns are heightened for women,
who make greater use of community care than their male peers,
and who have experienced a variety of problems under the Choice
program. As VA transitions to its new community care network,
it will be essentially that community providers are properly
trained about women veteran culture, common military exposures
and health conditions for women, and receive training and
evidence-based practices for treating them.
VA health care is the best system of care for women
veterans with complex health care needs. VA's veteran-focused
research, comprehensive health and mental health services, and
specialized programs for trauma make it uniquely suited to care
for this population, but longstanding issues that persist act
as barriers to that care for some women. VA still struggles at
certain locations to ensure privacy, safety, a welcoming
environment--all noted--and sufficient members of staff with
expertise in women's health; and specialty care coordinators,
women peer specialists, and dedicated women's clinics.
To address these persistent challenges, it will require the
Secretary to commit to cultural transformation at all levels of
the organization and to dedicate the necessary resources to
achieve that change. This means keeping the needs of women
veterans central to planning and decision-making in all program
offices.
In closing, we are pleased with the progress VA has made,
but there is so much more to do. We do, however, want to
recognize the exceptional work of the Women's Health Services
Office, the Center for Women Veterans, and the Veterans'
Experience Office, which we are pleased to learn are listening
and collaborating with women veterans to build trust and
improve their health care experience, so they can count on VA
for providing access to quality, timely care at all sites.
Again, Madam Chairwoman, we thank you and the Subcommittee
for your continued interest in improving the health services
for our Nation's women veterans, and I look forward to
responding to any questions you may have.
Thank you.
[The prepared statement of Joy Ilem appears in the
Appendix]
Ms. Brownley. Thank you, Ms. Ilem.
And I now call on Ms. Church for 5 minutes.
STATEMENT OF LINDSAY CHURCH
Ms. Church. Chairwoman Brownley, Ranking Member Dunn, and
distinguished members of the Committee, thank you for the
opportunity to testify today about the cultural barriers
impacting women veterans' access to health care.
I would like to begin by acknowledging that the land on
which we gather is the unceded territory of the Piscataway and
Nacotchtank people.
My name is Lindsay Church and I am the CEO and cofounder of
the Minority Veterans of America. I served in the United States
Navy from 2008 to 2012 as a Persian/Farsi linguist. I am a
queer, gender-nonconforming women veteran that served all but 3
months under ``Don't ask, don't tell.'' I was medically retired
after three surgeries to my sternum and rib cage left me
permanently disabled, and I personally receive my care at the
VA.
As the CEO of MVA, I represent veterans across 46 states,
two territories, and three countries; 47 percent of them are
women and several of whom are in the audience today. Together,
our members account for over 6,000 years of service, some
dating back to conflicts and eras that predate when they were
legally recognized as veterans, my mom being one of them.
In today's military, the role of women is quickly expanding
and, though more jobs and occupations are opening up to women
every day, the culture and institutions meant to support women
veterans after service has not kept up with the rapid growth.
Similar to our male counterparts, we as women veterans are
immensely proud of our service and what we have done, the
service and support we have offered to our nation; however,
many of us experienced instances of harassment, degradation,
and discrimination based on our gender identities and/or sexual
orientations. We withstood and persevered those experiences,
and we did so honorably.
The harassment that happens to women in the service is
magnified by the weight of the entire United States military
that renders each of us powerless until the day that separate.
Even if we want to leave out of fear for our own safety, we are
beholden to a system that demands compliance no matter the
circumstances. Upon discharge, we must decide, based on the
severity of our experiences and the intensity of our needs,
whether or not we will return to a setting where military
affiliation is the common thread among the community. This is
the dilemma that each of us faces when we are deciding whether
or not to enroll in the VA.
For many women, voluntarily reentering military culture to
use our VA benefits is an insurmountable barrier. Moreover, the
VA has a poor reputation among our community. We know them for
perpetuating a toxic culture for women and minorities,
providing sub-par care that lacks a nuanced understanding of
who we are, and seemingly every day there is a new story of a
veteran dying by suicide in the VA parking lots and waiting
rooms.
For those of us that finally overcome these barriers, we
enter VA facilities across the Nation only to be met with
plaques inscribed with the words, ``To care for him who shall
have borne the battle, and for his widow and his orphan.''
Lincoln's words, which are the motto and mission of the
Department of Veterans Affairs, serve as physical
representations of the deep and lasting history of invisibility
for women in the military and veteran community.
Changing the motto won't by itself address the deep
cultural divide that exists between women and the veteran
community, but it is a step in the direction toward inclusion.
Continuing to maintain and uphold the motto, despite that women
veterans have called for change, signals a willful desire to
exclude us.
Chairwoman Brownley, Ranking Member Dunn, and members of
the Committee, if we are to change the outcomes that women
veterans are experiencing today and increase their access to
health care, we must look to the roots of the problems and not
just triage the results.
First and foremost, this starts by opening a dialogue about
the inclusion of all servicemembers in the VA's motto.
Second, accessing the VA needs to be easier. We want an
opt-out rather than opt-in process, not just for women, for all
veterans. If we believe that veterans have earned their
benefits, servicemembers should automatically be enrolled in VA
benefits and rated for their service-connected disabilities
before they are charged without relying on outside agencies to
file their claims. Additionally, women veterans should be
assigned a primary care doctor in the nearest women's clinic.
Third, women veterans need to have greater access to
positions of leadership at the VA. Representation matters and
if we are not represented in the places where decisions are
being made about our health care and our benefits, how can we
ensure that we are heard, considered fully, and that our ideas
are acted upon in the same way as our male counterparts.
Lastly, all VA facilities should have community standards
and expectations of staff and patients. Stories of women
veterans being sexually assaulted, harassed, discriminated at
VA facilities should be anomalies and not commonplace.
Thank you for your time and consideration on this matter. I
look forward to your questions.
[The prepared statement of Lindsay Church appears in the
Appendix]
Ms. Brownley. Thank you, Ms. Church.
And I now recognize Ms. Miller for 5 minutes.
STATEMENT OF GINGER MILLER
Ms. Miller. Chairman Brownley and members of the
Subcommittee, as the President of and CEO of the national
nonprofit organization Women Veterans Interactive, I am
grateful to present my testimony regarding the cultural
barriers impacting women veterans' access to health care.
To understand the cultural barriers impacting women
veterans' access to health care, one must first understand the
climate in which we exist: the women veterans' climate, a
hostile takeover.
Women veterans are trying to stay afloat in a culture that
has been male-dominated for centuries and now we are competing
to stay relevant in a culture that insists we downgrade our
service to run parallel with that of a commitment by a military
spouse or a husband. Women veterans are uniquely different from
military spouses and it is time that this country stops lumping
us together, not to mention being overshadowed by the
caregivers.
Women veterans are existing in a climate where we have
become good for business, but not good enough to do business
with. And, even more unfortunate, women veterans are living in
a culture where our voices are only heard in a celebratory
fashion when we achieve something great or when we hit rock
bottom and become good for press.
I am here to testify this morning in an effort to change
the climate and culture that has become the norm for women
veterans. Our noble service to this country is worth more than
a story. Our sacrifices as women veterans are worth more than a
tick mark on an outdated, one-sided survey conducted by male-
dominated VSOs who may happen to have a few women veterans on
staff.
Women veterans are more than objects and we don't need
another survey, we need action; we don't need another national
portrait campaign, we need a national outreach and engagement
campaign. Women veterans don't need another male-dominated VSO
to represent us at the table, we need to have a seat at the
table, and, if we can't have a seat at the table, we will
continue to build our own.
For women veterans, the environment in which we are
expected to thrive in after serving in the military has become
hostile and at times volatile, to say the least, because our
voices are not being heard appropriately and we do not have
adequate representation at every level of government. Women
veteran nonprofit organizations are grossly overlooked and
underfunded, if funded at all. Our volunteers are overworked
and for some the outlook is bleak, and yet we continue to hold
on and hope against hope, hope for inclusion to have a seat at
the table where our voices will be heard and hope for much-
needed funding to deliver the proper services to the population
we serve.
Women Veterans Interactive is a solutions-driven nonprofit
organization focused on outreach and engagement. WVI delivers
impact in the lives of women veterans through a holistic,
proactive approach that is grassroots in nature.
The mission of Women Veterans Interactive is to meet women
veterans at their points of need through advocacy, empowerment
into action, outreach and unification, all to break down
barriers that lead to homelessness. WVI addresses the unique
needs and unrecognized challenges faced by our Nation's 2
million women veterans. Since inception, Women Veterans
Interactive has supported over 3500 women veterans and our
network has grown past 50,000.
Women Veterans Interactive and the Department of Veterans
Affairs have an intimate understanding of the importance of
women veterans becoming connected to health care. Since 2012,
WVI has invited the Department of Veterans Affairs into our
fold to collaborate with us on all of our outreach efforts.
Most recently, WVI's 2018 and 2017 Annual Women Veterans
Leadership and Diversity Conference, we had a benefits claims
clinic in collaboration with the Department of Veterans
Affairs, in which each clinic had approximately 150 veterans to
attend. The feedback from the benefits claims clinic have been
remarkable, with some women veterans stating that it is the
first time the VA has treated them like their service matters,
and other women veterans said they have a brighter outlook on
going to the VA medical center to receive health care.
Additionally, in 2017, WVI partnered with the Center for
Minority Veterans to conduct a virtual town hall with over 300
attendees. In 2016, we created the State of Women Veterans
social media campaign with a goal to reach 500,000 veterans,
and we surpassed that goal.
Every Women Veterans Interactive and Department of Veterans
Affairs collaboration is positive. So, I pose the question, why
is more not being done by the Department of Veterans Affairs to
collaborate with women veteran nonprofit organizations like
Women Veterans Interactive? And why are more women veterans'
organizations not invited to the Veterans Affairs meetings,
especially when it comes to discussing issues and solutions
around women veterans?
If we are going to change the culture and we are going to
have women veterans to have more access to health care, then,
Madam Chairwoman, we need to be at the table. I am recommending
that we work together to find solutions and have something
where we can allocate funding for collaborative women veterans
direct outreach and engagement with the Department of Veterans
Affairs, and require the Department of Veterans Affairs to
focus on consistent outreach with women veterans, and meet with
the Secretary of the Department of Veterans Affairs on a
biannual basis.
Thank you, Madam Chairwoman.
[The prepared statement of Ginger Miller appears in the
Appendix]
Ms. Brownley. Thank you, Ms. Miller, for your testimony,
and I now recognize Ms. McCoy for 5 minutes.
STATEMENT OF BRIGETTE MCCOY
Ms. McCoy. Thank you to the House Committee and Committee
chair, thank you for inviting my organization and inclusion of
my testimony on issues concerning women veterans, specifically
the cultural issues impacting women veterans. You will see in
the notes, I have sent a document that has all of the
information related to the organization that I founded 10 years
ago, Women Veteran Social Justice Network, as a homeless
veteran in HUD-VASH housing during my process, disability
process in the VA.
So, I am an ally. I am a military sexual trauma MST
survivor and advocate. My service and contributions are as
important as my male veteran counterparts.
Women veterans serve, yet our visibility and opportunities
have unseen barriers to accessing many of the programs that the
civilian sector believes are available to all who served. It is
vitally important to hold in high regard and utilize the
narratives of veteran women like me of all eras and all service
periods and all service backgrounds as primary sources to
inform research, curriculum, and policies concerning women
veterans.
The cultural issues impacting women veterans are vast;
there are too many to fully note in this setting to give the
full historical context, legislative background, and full
unintended consequences and implications of each.
I do believe that the historical context of women not being
formally included in the military structure until the 1940s is
a topic for inclusion in this hearing. Women veterans were not
legislated to use the VA for gender-specific medical care until
the early 1990s. Only in recent years have women's specific
health care spaces been constructed in VA's facilities.
In my work over the past 10 years and my personal
experience interacting with the government and the community
for support, a major factor that repeatedly and consistently
challenged me has been the language which is used to describe
and talk about me as a woman veteran. Within the context of
being a woman veteran I have heard terms like low-hanging
fruit, female, victim, and references by men about how easy it
is for a woman to get disability benefits, and I assure you
that that is categorically untrue.
These othering terms have an unintended consequence for our
country and the communities that serve women veterans. How we
speak about women veterans can be a part of a deeper problem of
what we believe and have been socialized to believe about women
in general. This is a root-cause factor that drives the
cultural divisions and creates a barrier for meaningful, well-
funded support for women.
The language used to speak about research, legislative,
create, and institute programs for our women veteran community
continues to be a major limiting factor toward addressing
issues and needs. Why are organizational leaders calling us
female after the military service? There are no female veteran
organizations. Where is the national female veteran of America
organization? Even in 1948 when President Truman signed the
Armed Services Integration Act, ``female'' was not used in the
title, but the word ``women.''
I know that there will be some that say that doesn't
matter, but I will argue that using biological terms to
dehumanize what you name or call something or the language you
use to speak about a person does have impact, positively or
negatively. We can trace the language in policies and
legislation and funding, and see that funding drives services
and programs.
Second, women veterans currently have narrowly-defined,
language-specific access to some of the most well-funded and
highly-engaged programs. Most are intentionally excluding a
huge proportion of women, and the funding legislated for their
programs is language-specific to eras, combat, and gender. It
is emotionally draining as an advocate to continually send
women to organizations that have veteran programs to have them
told that they don't meet the guidelines.
Further, the brochures are male-centered and the veteran
service community organizations and their organizing documents
do not include women who have served, or they are told to go to
auxiliary membership, are put together with spouses, which is a
completely different population.
Third, VA medical treatment visits pose issues when
organizing documents and place cards have male-centered quotes
and presentations. The space was not created with women in
mind.
There have been upgrades and changes in support of women in
the facilities, but we are still being catcalled and harassed
going into the mental health and medical appointments, when we
can get them. It is never clear what the outcome will be for
women who reports harassment, or for the patient or employee
that harasses. My personal experiences of being harassed within
the VA and the discussions with other women about the need to
change their appearance, come at certain times of day, switch
to other hospitals, or stop going to the VA at all is another
area of discussion.
We are not always treated with the same professional
respect as our male counterparts. Many times our rank and era
in service are used to limit access to programs for
professional advancement.
I have more, but I know that my time is winding down, and
so I want to hand over the time to my colleague here.
Thank you.
[The prepared statement of BriGette McCoy appears in the
Appendix]
Ms. Brownley. Thank you, Ms. McCoy, and I now recognize
Captain Manning.
STATEMENT OF LORY MANNING
Captain Manning. Chairman Brownley, Ranking Member Dunn,
distinguished members of the Subcommittee, on behalf of the
Women's Service Action Network, I thank you for the opportunity
to share our views and recommendations regarding the cultural
barriers to women veterans' access to health care at the
Department of Veterans Affairs.
In the past years, VA has made hard-won improvements to the
quality and comprehensiveness of women's care, but all that
improvement is for naught if women encounter barriers when
trying to use that care. I will discuss two of these barriers
today: sexual harassment and the invisibility of women
veterans.
Over the years, we at SWAN have heard many complaints about
groups of male veterans getting together to harass women
veterans on VA grounds, including at the Washington, DC VA
Hospital.
An academic study and a newspaper article both published
this year elucidate the problem. The study appears in the
Women's Health Issues published by the Jacobs Institute of
Women's Health; the article by reporter Jennifer Steinhauer was
in the March 12th edition of the New York Times and headlined,
quote, ``Treated Like a Piece of Meat: Female Veterans Endure
Harassment at the VA.''
The study sampled women veterans who use 12 different VA
hospitals and found one in four of those sampled reported
receiving catcalls, derogatory comments, propositions, and
denigrations of the women's status as veterans from male
veterans on the grounds.
The New York Times article recounts how, quote, ``An
entrenched sexist culture at many veterans' hospitals is
driving away female veterans,'' unquote. SWAN believes that
what women veterans want, and warrant is for VA leaders at all
levels, with oversight from Congress, to stop that harassment
now and to create a VA culture in which women veterans are
treated with the same respect, appreciation, and dignity as
male veterans.
Women veterans also report to SWAN that they feel invisible
in the office staffs of VA facilities and to the American
public in general, and they are. It begins with the VA motto:
``To care for him who has borne the battle, his widow and his
orphan.'' SWAN, while appreciating Lincoln's historic words, is
among the veteran's organizations which support changing that
motto.
According to the Department of Veterans Affairs February
2017 report, ``The Past, Present, and Future of Woman
Veterans,'' only 22.4 percent of all women veterans use VA
health care, making them a mere 7.5 percent of total VA health
care users.
Women veterans are irked when they are asked for their
husband's Social Security numbers at check-in desks or are
refused free coffee provided at some VA facilities with the
admonition that the coffee is only for veterans. These slights
seem minor, but they accrete over time, leaving women veterans
frustrated and disheartened.
The invisibility becomes more damaging when the gender-
specific needs of women veterans are ignored as happens, for
example, when they are sometimes issued prosthetic devices
designed for men. This should never happen. And major damage
can be done if women veterans are invisible to those at any
level making tough decisions on health care resources if those
decision-makers either don't understand the need for women's
programs or conclude that reallocation from these programs
helps many while hurting only a few. SWAN believes leadership
at all levels must take great care when initially allocating or
later reprogramming resources to or from women's health care
programs that they have a clear understanding of the effects
their actions can have.
SWAN additionally entreats Congress to exercise its
oversight responsibilities to ensure the needs of women
veterans and other special-focus populations are not unduly
sacrificed when such actions are necessary at the national
level.
Madam Chairman, let me say how deeply I appreciate the
opportunity to offer SWAN's views on these critically important
matters. Thank you for your time and attention.
[The prepared statement of Lory Manning appears in the
Appendix]
Ms. Brownley. And I thank you for your testimony, and I
thank all of the witnesses here today for their testimony. To
me, it sounds like we are having a veteran women me-too moment
that I think all of us collectively have to make into a
movement, so I think we are in the beginning steps of that.
So we will now begin the question portion of the hearing
and I will recognize myself for 5 minutes.
And the first question I wanted to Ms. Ilem from DAV is,
you talked about in your testimony with regards to solutions to
some of the issues is to make women's health a stand-alone
program with its own leadership structure at the central
office, et cetera. I know in talking to some of the medical
center directors who get allocated, you know, a large chunk of
money and it is their responsibility then to allocate it as
they see fit in terms of what their needs are, and I believe
that in some situations women's needs are being overlooked
across the country. But if you could just speak a little bit to
how you think things should be restructured?
Ms. Ilem. Well, I think that a task force would help in
terms of internally within VA. I mean, we are hoping that the
Secretary will really take this to heart. I mean, he has
indicated that he wants to ensure women veterans receive the
care and benefits they deserve through VA.
These programs, I think you are exactly right, have been
ignored because of the funding structure. They are often lumped
in, their VERA allocation with, you know, primary care. We have
seen report after report from the IG or GAO about these same
problems. I mean, I could look back at testimony or those
reports over the years and we see the continued same problems;
they don't get resolved.
So I think it is going to take a different tack and I hope
that VA, the Secretary, from the leadership down, will
determine what would be, you know--convene a task force,
determine from the leadership, at the VISN level, at the local
level, how can they best serve to make sure they really get at
these problems.
Ms. Brownley. Thank you.
And, Ms. Church, I thank you for your testimony and I think
you were very clear in saying that women veterans are more
likely to be a member of an ethnic or racial minority, the
LGBTQ community or the like, than are male veterans. I think
the data shows that if you are a minority, if you are a part of
the LGBT community, that actually the services rendered are
even less than women overall.
You also talked about using the traditional VSO for
accessing compensation and benefits, and you described them as
insurmountable barriers for women veterans. You know, what
needs to be done there?
Ms. Church. Honestly, in order to be able to access your
benefits, you should be able to do it automatically through the
VA or through the Department of Defense. We have gone to a
place where we use a third party to file our benefits and our
claims; however, it should be automatic, it should be something
that happens right when you get out of the service.
As a medical retiree, I was part of a pilot program in 2012
of the--I was one of the first to get DOD disability rating, as
well as a VA rating, as soon as I got out. So, as soon as I got
out, I knew exactly what my benefits were going to be, I
already had my service-connected disabilities, and I was able
to carry on with my life. I didn't have to use a traditional
VSO and I didn't have to be re-traumatized, because some of
these places can be the biggest perpetrators of toxic culture.
It has happened for years and years, but at the end of the day
we shouldn't have to go to a third party in order to get access
to our benefits through the government that we work for. So the
recommendation is remove the third party.
Ms. Brownley. Great. And when you exited the military, was
it clear what you needed to do to receive your services?
Ms. Church. Absolutely. I was actually--you are actually
able to, if your unit allows you to, apply for VA benefits 6
months before you are out; however, it is not a mandate. It
should be a mandate that you go 6 months before you are out,
that you go and get your disability rating.
Ms. Brownley. Thank you.
Ms. Miller and Ms. McCoy, you both have served our country
honorably and in both of your testimonies you have talked about
your homelessness and certainly I think all of us here on the
dais believe that no one who wore the cloth of our Nation
should be without a home, and women veterans are the fastest-
growing homeless population in our country.
So if you could just describe a little bit about what the
economic--how the economic stability is a factor in enabling
women veterans to access their own health care?
Ms. Miller. Thank you for that question.
From where I sit, the economic status has something to do
with it, but it is really the outreach to women veterans when
they get out of the military, because they are disconnecting
from service and they are disconnecting from their peers. As
for me, when I became homeless in the early '90s, my husband
was suffering from post-traumatic stress disorder, I got a
medical discharge, we stayed with family for X amount of time,
then when his post-traumatic stress disorder kicked into high
gear, we had to find someplace to go. I was unskilled, my son
was about two years old at the time, I didn't have a college
degree.
So I think for women veterans to get connected and stay
connected to the source, then that will also help to prevent
the homelessness. The economic status has a little bit to do
with it.
One of the things we do at Women Veterans Interactive, if a
woman veteran is homeless or on the brinks of being homeless
and she has a claim in with the Department of Veterans Affairs,
we can get that claim expedited. You know, we stopped at least
two to three evictions in 2018. If a woman veteran was getting
evicted, we would call the Department of Veterans Affairs, they
would expedite the claim.
So I think there is just like a major disconnect when it
comes to the economic status of homeless women veterans.
Ms. Brownley. Thank you.
Ms. McCoy, briefly, because I am way over my time, which
the chair is not supposed to do.
Ms. McCoy. So, yes, it is economic. In my case, I came out
of the military, I didn't understand that the benefits--that I
needed to keep fighting for my benefits. I was considered
service-connected right out of the military at zero percent. I
was a single mom with a very disabled daughter, and I had
medical conditions that were already there and went untreated.
And so in that process, you know, I had had some education
after I got out, I did all of the things I thought were the
right things, and still ended up homeless.
And so it is an economic issue, in my case it was an
economic issue, but it also has to do with what Ms. Ginger
said, you know, it is the disconnect. So, in my case, that is
why I created the WVSJ. We started online as a community peer-
supported network, supporting one another online just with
information resources and through that process grew to over
12,000 followers on Facebook with over 50 networks worldwide.
So it is very important to get information and resources
out to women veterans, but also the challenge with homelessness
is that it keeps changing. Every year, what is homelessness
keeps changing. So when I was experiencing homelessness, couch
surfing was considered, and now it is not. So we have to--you
know, again, language is a big part of it.
Ms. Brownley. My time is up, but thank you, thank you very
much.
I now call on Dr. Dunn for 5 minutes.
Mr. Dunn. Thank you very much, Chairwoman Brownley. And
thank all the members of the panel for your compelling
testimony, I appreciate that.
This is a question, let me just start on the right end of
the panel and sort of work over. Given some of the barriers to
care within the VA health care system and the other portions of
the VA system, which all of you have referenced, and the fact
that it can take a long time to change a culture like the
culture in the VA, would you support granting women veterans
greater authority to use VA health care benefits in the
community to ensure they have access to care?
And I will start with Ms. Ilem, if you will start--Ilem,
I'm sorry.
Ms. Ilem. Thank you for the question.
In my testimony, one of the things that I point out is that
women veterans do use higher rates of community care in VA,
through VA being referred to the community, because of their
lack of ability to provide maternity care and some other
specialty services that they don't always have a provider
available for.
Mr. Dunn. So for specialty services clearly, but I was
thinking more of the routine.
Ms. Ilem. Right. So the issue that I bring up in our
testimony is that VA has done so much research on women
veterans and they are--the women veterans who are coming to VA
are very clinically complex and users of a high number of
services across the board in both primary care, specialty care,
and mental health, and we are just concerned that fragmentation
of care can relate to gaps in care for them and we want to make
sure that providers in the community have the expertise to
treat them.
While we want women to get the care they need and what is
best for them, and that may be the situation they prefer or
want or need, but we need to make sure that the women
providers--or the providers that they are going to, that they
are going to get quality care with expertise in the conditions
and having an understanding of what exposures women have, you
know, experienced and what are the most conditions that they
are being treated for.
Mr. Dunn. And maybe quickly down, the same question about
access to care in the community. I mean, we assume in the
community they have--presumably, they have solved these issues,
or they would be out of business. Go ahead.
Ms. Church. So, I hear your question and I would like to
actually say that I prefer that the VA step up first. I believe
that we have a lot of work to do and that there are a lot of
actionable items for us to continue to build the outreach and
build the reputation up of the VA first. I do believe that we
are going to see--women will experience barriers whether it be
civilian care or VA. In the civilian, they will lack
understanding of what it means to be a servicemember, in the VA
they will lack understanding what it means to be a woman;
however, breaking apart the VA doesn't necessarily accomplish
that.
Mr. Dunn. As a veteran, I certainly agree with you on that.
And just we are working our way across. So, access to care
in the community as a potential stopgap maneuver.
Ms. Miller. Well, I think that would be an awesome option,
because the VA has been researching women veterans for years;
we are not aliens, we are women. There are plenty of doctors
out in the private sector that support and service women every
day. So, you know, while you are trying to figure this thing
out, I would like to have an option to go get my Pap smear and
to get my mammogram with a provider that I am used to when I
had my private care. I mean, why should we have to suffer and
walk through the halls and be catcalled and all these things
while you figure it out. I would love to get a voucher to go
out to a private sector, to a private doctor to get my health
care, especially my women health care, because I know that, if
one thing or another, at least they are certified, they are
real doctors.
Mr. Dunn. Thank you. And--
Ms. McCoy. So in my case, I spend tens of thousands of
dollars outside of the VA on my own care, because there are so
many different areas of gaps in services.
I agree with Ms. Lindsay and Ms. Ginger, because I think
both parts are equally as strong. We don't need to just let the
VA just walk away and say they don't have to do anything, they
need to hold up their part of the bargain, but I also feel
like, while we are waiting on that process, we do need services
in place. I would love to have a voucher to pay for my
chiropractic, I would love to have a voucher to pay for my
acupuncture, because these are things that are coming out of my
pocket. So it is very important to have these types of services
and resources.
Mr. Dunn. Thank you.
Captain?
Captain Manning. I would like to signal a little bit
different notice. I mean, I live in the Washington, DC area and
get most of my health care on the outside, because I am
military retiree and I have no service connection. It is not
that easy to get appointments on the outside, particularly for
some of the specialty things. Do you want to see a
dermatologist? Call me in 3 months.
I also think that it is necessary as a stopgap sometimes,
but I worry about, particularly if you address women as a group
and send them outside, that VA will at some point down the road
think that we don't have to be responsible for them anymore, it
is just the guys we are really taking care of now.
Mr. Dunn. I appreciate your insights on that.
As you can tell, the way everybody evacuated, the votes
have been called across the street. So--
Ms. Brownley. So are you taking over the meeting?
Mr. Dunn. We will be back; we can come back--
Ms. Brownley. I am just teasing you.
I wanted everybody to know that members are getting up
because we need to go and vote on the floor. So we will pause
momentarily. I anticipate it will probably be at least a half
an hour, it could be a little bit longer than that. And--what?
[Pause.]
Ms. Brownley. Excuse me, the terminology is we will recess.
[Laughter.]
Ms. Brownley. But we will reconvene. Is that the
appropriate word? Excellent.
So thank you very much for being here and we will join you
shortly.
Mr. Dunn. Thank you.
[Whereupon, at 10:51 a.m., the Subcommittee recessed, to
reconvene at 12:24 p.m., the same day.]
Ms. Brownley. Thank you, everyone, for waiting. We had
quite a few votes on the floor. So I deeply apologize, and I am
afraid that some members who are needing to get back to their
districts, because we are not going to be voting again today,
might not be returning to the Committee. We will see how it
goes, but we are reconvening, and I am gaveling back in.
And, Mr. Meuser, you have 5 minutes, and thank you for
sitting in as the ranking member.
Mr. Meuser. Well, thank you, Chairwoman, very much. It is
my honor to be here with you all. And thank you all for waiting
as well.
I am in Pennsylvania's 9th Congressional, we have a
Veterans Administration and a VA in Lebanon, which tends to be
ranked very well and we are pretty proud of it actually, always
room for improvements. We also have a VA in Wilkes-Barre that
many of my constituents attend. And we are a very military-
focused or very military-heavy district at Fort Indian Town
Gap, so we have over 50,000 veterans within my district.
Also on my district team I have three veterans, Navy and
Army, and two of which are women. So I find that to be a great
benefit to the type of constituent services that we provide, as
well as the work that we do for veterans, men and women.
Your testimonies earlier were very compelling, very
compelling. This is a very important hearing. This information
is essential for us to be aware of, know better, and to respond
to. That is the whole idea. It certainly sounds as if the HR
departments within the VA facilities and perhaps on a more
macro level need to not just be aware of this information, but
take this in and create new procedures and plans around it. I
think that goes without saying and I think that is a
responsibility of this Committee to assure that does in fact
occur.
You mentioned that there wasn't much collaboration with
your organizations, so we need to be inclusionary by all means,
the Veterans Administration as a whole right up to the
Secretary. The Secretary does need to engage; I am sure he has,
but more so. And you mentioned other things, from homelessness
to various other issues.
So do know that your words are very, very important and are
resonating.
So the question I want to ask is, what is your
recommendation as far as some of the things I just mentioned,
what you talked earlier, what can we do within the human
resources department to recognize these issues, work on them on
a daily basis, on a larger scale, and right down into the VA
facilities themselves?
So I think I will start with Ms. McCoy, if you could
answer?
Ms. McCoy. So I think that the big thing is going to again
go back to language, crafting the appropriate language to make
the changes, the appropriate changes, so that the policies, the
legislation, the funding, all of those are aligned in a way
that they are allied--that you are an ally and not that the
agencies are hostile. They are presenting as supportive, but in
their writing, in their funding, and all of these other things,
they are presenting as hostile.
So I think that that is going to--that is where we have to
like start, but in order to do that you have to bring subject
matter experts, women veterans, to the table, not to just talk
at us, but to actually have the input from us to give the
insight, so that the legislation and the policies are
appropriately placed and the verbiage is correct, so that it
doesn't exclude people like our Reservists and our National
Guard members.
Mr. Meuser. I agree. Excellent.
Ms. Ilem, could you respond as well.
Ms. Ilem. Sure. I would agree that we need to make sure at
the local facility level that facility director is engaged with
their people, making sure they are out there watching that the
training has occurred, making sure that, you know, harassment
is not occurring, that they have a way to deal with it, that
they are working with employees, and that there is a way for--
if it is reported, how they are going to resolve that and what
they are going to do. I mean, it has got to be at the facility
level; while you want to have a national program and you want
them to push that all the way down, I mean, it is at the
facility where you really need to make sure wherever a veteran
might go, you don't want to see that happen.
So it can't just be one program office or, you know,
information coming from just one direction, it has to be across
the system.
Mr. Meuser. Thank you. And we look forward to working with
you and for you.
Madam Chairwoman, I yield back.
Ms. Brownley. Thank you, Mr. Meuser.
Mr. Cisneros, 5 minutes.
Mr. Cisneros. Thank you, Madam Chair.
Thank you to all our witnesses who are here today. I really
do appreciate you coming and speaking on this matter.
Care for our women veterans and the specific obstacles they
face that may impact their pathways and willingness to seek out
VA treatment is of utmost importance to me, being a veteran
myself, especially as it relates to intimate partner violence.
Director Ilem, in your testimony you mentioned some
research, that the VA researchers are becoming increasingly
aware of the rise of woman veteran patients who are survivors
of intimate partner violence, and in fact emerging research has
proved that women veterans are at a greater risk for intimate
partner violence than non-veteran women. Could you elaborate on
this specific research, the data that was found, and why you
think they found that data?
Ms. Ilem. Well, I think one thing that VA research has
really shown--I mean, they have done more research over a short
period of time, like almost in a 7-or-8-year period than they
had done in 25 years, so they are really learning a lot about
this population--and VA has always been forward-thinking in
terms of asking questions when veterans come in, they are
looking to make sure that they have the services available if
someone is homeless, if someone has experienced trauma of some
sort, and their findings are really I think showing that we
need to, you know, pay attention, be looking for these types of
things. What are the specifics within this population that seem
to be--put veterans more at risk, that can help for prevention
and can help moving forward in terms of addressing the issue?
So I think researchers are on the forefront and part of
that whole aspect that really make VA unique and special, and
they need to make sure that they continue that line to really
be working with veterans.
Mr. Cisneros. And do you have any recommendations? And, you
know, it is good that you say the VA is good out there in
asking the questions, but what could they do and what also
could Congress do to kind of help along with that process to
make it better?
Ms. Ilem. Well, I think they need to make sure that those--
once they have asked the question, what are the programs and
services that these women veterans need to address that issue,
to make sure that they have the mental health services, to make
sure they have the support services around that. So turning
that into action is the most critical thing once they have
asked the question, what can we do to make sure we support this
veteran.
Mr. Cisneros. So you raise another issue actually that I
was going to bring up as well. You know, it is also troubling
that women veterans who have experienced intimate partner
violence place them at risk for developing certain mental
health conditions and substance use disorder, increasing the
risk of suicide.
What would you recommend are appropriate outreach programs
and efforts to support women veterans that are impacted by
intimate partner violence?
Ms. Ilem. Well, I think some of the organizations here at
the table really also have some great--an opportunity and for a
really important role to play, I think like BriGette McCoy and
others, who have a support system and have an outreach that is
beyond the VA arm.
I mean, this is one thing that we know is often women
veterans don't have the--they are not connected with the VA or
they are not connected with the VSO community, where they might
not readily know about the resources that are available. So it
is important to engage the organizations that are here. This is
everyone's issue and I think that that will be a critical piece
in moving forward.
Mr. Cisneros. Does any other members have any comments on
this and how we can address this issue?
Ms. McCoy. So I think one of the bigger problems related to
this topic is that there will be a large group of women who
will not perceive themselves as being victims of domestic
violence. Having clear presentation of the awareness, being
able to describe what domestic violence includes, because it is
to me similar to military sexual trauma, there are a lot of
people who say they didn't experience it until you start
describing what it is and what it includes. And so that is one
big part of the outreach.
The other part, because WVSJ has been instrumental in
connecting groups of women within certain demographics, social
media, although some people think it is the devil, actually we
have been able to, you know, extract people from situations
where it was unsafe, because we had an integrated network of
peer support online, crowd-sourced, to intervene on behalf of
woman veteran. So there are ways to implement those things and
keep the person safe, and protect their identity as well.
Mr. Cisneros. All right. Well, thank you for your answers.
My time has expired.
Ms. Brownley. Thank you, Mr. Cisneros, for being here after
a long day on the floor.
I thank the panel again for being here. I think today's
meeting is just a terrific start for all of the issues that we
need to continue to drill down on until we really do determine
solutions, and keep working and making that cultural change and
shift that is so very, very necessary. And as I said earlier in
my comments, I think this is, you know, a veteran women's me-
too moment and I think we have to really make it into a
movement, and I think that movement will help to shift a lot of
the cultural issues that you all are all facing as women
veterans.
So, thank you very much, and we are going to go to our
second panel. And for our second panel we have Dr. Patricia
Hayes. Dr. Hayes is the Chief Consultant for Women's Health
Services at the Veterans Health Administration.
Thank you, Dr. Hayes, again, for having to wait for a long
period of time. We appreciate you being here. And as you take
your chair and get comfortable, I will recognize you for 5
minutes.
STATEMENT OF PATRICIA M. HAYES
Dr. Hayes. Thank you very much. Good afternoon, Chairwoman
Brownley and Congressman Meuser, and distinguished members of
the Subcommittee.
I am going to start my statement, but I have to just
acknowledge the tremendous sense of being moved by the members
of these--of these veterans themselves coming here today and
taking time from their lives to let us know their concerns
about the VA, it is very, very important.
I wanted to talk about the number of women veterans
enrolling in VA health care is increasing, which places new
demands on the VA health care system. More women are choosing
VA for their health care than ever before, with women
accounting for over 30 percent of the increase in veterans over
the last 5 years. To address this influx, VA is strategically
enhancing service and access for women veterans.
Every VHA health care system has a full-time women veterans
program manager who advocates for the needs of women veterans
using that facility. VA has enhanced provision of care to women
veterans by focusing on the goal of developing women's health
primary care providers at every site of VA care. VA now has at
least two women's health providers at all of VA's health care
systems, and at least one at 90 percent of the community-based
outpatient clinics.
VA has implemented models of care that ensure women
veterans receive equitable, timely, high-quality primary health
care from a single primary care provider and team, thereby
decreasing fragmentation and improving quality of care for
women veterans. And we have worked to implement a mobile
training to specifically meet the needs of rural primary care
providers and nurses at 40 CBOCs per year.
VA provides a wide scope of services to women veterans,
including comprehensive primary care, gynecology care,
maternity care, and fertility services other than in vitro
fertilization, specialty care, and mental health services.
Additionally, recent legislation authorizes IVF for married
veterans with service-connected disabilities that result in
infertility.
VA has witnessed 154-percent increase over the past decade
in the number of women veterans accessing VA mental health
care. Over 40 percent of women veterans who use VA have been
diagnosed with at least one mental health condition, and many
also struggle with multiple medical and psycho-social
challenges, including trauma-related difficulties, and
increased risk for suicide is of great concern.
To ensure that VA mental health providers have the skills
and expertise to meet women veterans' unique treatment needs,
VA developed innovative clinical training such as the women's
mental health mini-residency. Unfortunately, some women
veterans experience sexual assault or harassment during their
military service and may struggle even years later with its
aftereffects. VA provides free care, including outpatient,
residential and in-patient care for any mental or physical
health condition related to military sexual trauma, and
eligibility is expansive. Veterans do not need to have reported
their experiences at the time or have any documentation that
they occurred, and may be able to receive free military sexual
trauma-related care even if they are not eligible for other VA
care.
VA is proud of high-quality health care for women veterans.
Ongoing quality measures show that women veterans are more
likely to receive breast cancer and cervical cancer screening
than women in private sector health care. Unlike other health
care systems, VA analyzes quality performance measures by
gender. This has been key in the reduction and elimination of
gender disparities in important aspects of health screenings
and chronic disease management.
Since 2014, VA has tracked access by gender and identified
small, but persistent disparities in access for women veterans,
who overall are waiting longer for appointments than male
veterans. To mitigate this disparity, VA has identified sites
with longest wait times for women veterans and is working with
those sites directly on initiatives to improve access,
including designating more women's health providers through
hiring or training, and improved team efficiency.
VA continues to make significant strides in enhancing the
language, practice, and culture of the Department to be more
inclusive of women veterans. My office sponsored the recently
published research by Drs. Klap and Yano that found that one in
four women veterans reported experiencing harassment by other
veterans when they visited VA health care facilities. VA is
focused on ensuring all veterans are treated with dignity and
respect, and women who served in our country's military deserve
to be treated with honor, just as their male counterparts are.
With input from male and female veterans, VA launched an
End Harassment Program in every VA medical center in the summer
of 2017 and has continued to implement this program nationally.
Through increased awareness, education, reporting, and
accountability, VA is working to address this issue. We have
launched messaging, including, ``It's not a compliment, it's
harassment,'' directed primarily at educating male veterans
that certain conduct is unacceptable.
Employees have been trained on culture-change efforts,
including an awareness of the experience of women veterans, and
ways to intervene and respond. We will be persistent in our
culture-change efforts.
Gains for women veterans would not have been possible
without consistent congressional commitment in the form of both
attention and financial resources. It is critical we continue
to move forward with the current momentum and preserve the
gains made thus far. Your continued support is essential to
providing high-quality care for our veterans and their
families.
Madam Chairwoman, this concludes my testimony. I am
prepared to answer any questions.
[The prepared statement of Patricia M. Hayes appears in the
Appendix]
Ms. Brownley. Thank you, Dr. Hayes, and I appreciate your
testimony, and I will now recognize myself for 5 minutes for
questioning.
The first question that I have--and I think anybody who is
in the audience--I am not sure that you can answer questions
beyond the medical arena around women's health in issues like
homelessness and other kinds of things, so we are not going to
get into those questions, but I had recently had the
opportunity to visit the VA medical center which has really a
very beautiful women's health center. I did mention earlier
that they didn't have extended hours, but the center is
absolutely beautiful, you feel like you are walking into a spa-
like atmosphere. And women there can receive all of their
gender-specific care, including mammograms, they don't have to
leave the clinic to make that happen. But according to a 2017
VA report--I call this the gold standard in some sense and the
standard that we all want to achieve--only 7 percent of the VA
facilities met this standard.
So I am wondering if you could speak to what VA's plans are
in terms of replicating the gold standard across the country.
Dr. Hayes. Certainly. Thank you for the question.
We have been working for a number of years to make sure
that women veterans have the right kind of care wherever they
go for care. So we actually shifted away from building women's
clinics for a number of years, because we wanted to make sure
that women out in the more rural areas, in the distant areas
geographically had access. That is our primary care provider,
we are saying that--we are still concerned that 90 percent of
our CBOCs have it, but 10 percent don't. So we have been
focused very much on making sure that, wherever you come for
care, you have a women's health provider.
In the meantime, as the population has grown exponentially,
many sites have moved towards developing a women's clinic, we
call it a Model 3 Women's Clinic comprehensive care with GYN on
site. We are now at 75 women's clinics.
So we didn't say you have to do it. In fact, what we really
said is that you must talk to the women veterans in your
community; you must hold a town hall, you must have input from
the women as to what do the women at that site want, and add in
the issues about what is the best way to deliver care. And we
have some sites that the women said we do not want a stand-
alone women's clinic. We are women, we are soldiers where a
soldier is a soldier, and we don't want that.
Most sites there is some combination of women's clinics,
comprehensive women's clinics, and integrated primary care for
women.
Ms. Brownley. So women veterans disproportionately use
community care compared to male veterans and we know the
reasons why, but how will the women veterans be uniquely
impacted by the MISSION Act and how is the VA going to ensure
equitable, integrated care for women?
Dr. Hayes. The MISSION Act, of course, does allow for
different kind of choice going out, but for women veterans
about 30 percent of the care every year must be in the
community, and that is because of maternity care, some of the
infertility care, in some places mammograms, and also a lot of
it is actually in-home care. As women age and live longer than
men, they have more of the community care dollar.
I think that what is most critical about community care is
care coordination and care navigation, and we have invested in
mammogram coordinators, maternity care coordinators, and really
our issue is going to be that we have right-sized our resources
to have enough community care navigation and coordination and
that is our challenge right now.
Ms. Brownley. Thank you. And there are only 65 mammogram
sites in the country and that really doesn't necessarily
correspond to where there are large concentrations of women
veterans. For example, Puget Sound VA system in Washington
State is used by thousands of women veterans and there is no
on-site mammogram capability.
So what are the standards that the VA is using to determine
where mammograms should be placed?
Dr. Hayes. We have recently developed a tool to continue to
look at the key issues on where mammograms are and you are
absolutely correct, most places we do not have a significant
population to be able to have the highest quality of mammogram.
That is critical to me, that we make sure that women are not
seen by someone who hasn't seen enough mammograms.
In places like Puget Sound, the other--one of the other big
issues is space and it takes considerable space and lead-lined
walls. And so we are continuing to work with sites like that
about how they can prioritize adding radiology space and
mammogram space. So it is about a population issue and it is
about making sure that we have the highest-quality care.
And the third part is navigation and if we don't have
someone who is tracking to make sure that that mammogram result
gets noted by the primary care provider, gets to the breast
cancer surgeons or whoever they need, we are in trouble. So we
need to make sure that, number one, we are tracking mammograms,
and that is the biggest part of what we are doing.
Ms. Brownley. Thank you very much. My time is up, so I
yield to Mr. Meuser for 5 minutes.
Mr. Meuser. Thank you, Madam Chairwoman.
Dr. Hayes, I thank you for being with us here this
afternoon. I do understand that you do some really positive
work for the Veterans Administration and for women veterans, so
thank you.
Dr. Hayes. Thank you, sir.
Mr. Meuser. I also understand that you were here during the
testimony of the previous panel. Do you have any comments or
response to some of the testimony given?
Dr. Hayes. Certainly, thank you.
I think that the issue of culture change, we really can't
say enough about how that is a problem that we are focused on.
We knew it was happening, we got the data to show that it was
happening, we continued to throughout the country do more work
on a wider spread of research on the topic, but it has been a
challenge. Other systems don't actually have to manage this
challenge of military culture bleeding over into veteran
culture and how to deal with training our employees and our
veterans to end harassment. So we do, we have worked a lot with
research, but it is not good enough to say that women can just
have a separate space or that they should go out to the
community; we have to step up. I really like that comment about
VA, it not only is stepping up, we have to step up. We have to
end the harassment, not just of women, end harassment for race
and ethnicity issues, for LGBT issues, we have got to change
this culture.
And a lot of it is engaging Veterans Service Organization
folks here, because part of VA is what I call right-thinking
men who are appalled by this behavior, and empowering them as
well as they come to VA to say something to the other folks
that are conducting themselves this way. So, VA has this as a
high agenda.
I think the other thing that was really striking in hearing
the panel is kind of the disconnection, whether it is a little
bit of disconnection between them, but also the ongoing issue
of us making sure that we are working with these partners,
these women veteran expert partners in everything that we can
do. And the challenge from the level of the Center for Women
Veterans and the level of every VA to make sure that we are
involving these groups of women veterans and the other groups,
i.e. MVA and others that have provided information, to make
sure that we are hearing them and incorporating the veteran's
word in what it is that we offer to veterans, and I heard that
loud and clear from them today.
Mr. Meuser. Certainly. All right, thanks.
What steps as of late has the VA taken to combat harassment
when it is detected or seen at the VA facilities?
Dr. Hayes. The End Harassment Program--and you notice I
call it End Harassment, because we are not anti-harassment, we
are not against harassment, we want it to stop, we want it to
end--and we have done a number of things. We developed an
education program for veterans, which it talks about this is
not a compliment, this is harassment. We have worked with male
veterans to have them tell us, you know, what were some of
these things, because this behavior disrupts care. It is a
terrible experience for veterans who experience harassment and
it just disrupts the whole system.
So we have to educate male veterans, we do it in some of
the new employee orientation. We are in the process, a
widespread process of educating the employees to understand
these experiences, and also what is widely known in research as
a bystander intervention, teaching them through a role-playing
system how to actually intervene. And if they don't feel
comfortable intervening, they can call their supervisor, they
can call the police, there are a number of options. So we
educate.
The next step is reporting. We have set up reporting
systems locally. Veterans can report, staff can report; you can
report to the police, you can report to the patient advocate,
and you can report to the Women Veterans Program manager. There
will be people that are evidenced as, you know, putting out
there as you can call me, their name is on a poster.
And then there is accountability and we believe very
strongly the accountability has to be at the local level. The
local leadership has to be out and engaged in this, they have
to know what the reports are and they have to be actively
working to change this culture, to engage the employees, to
engage the veterans, to walk around and themselves say this has
to stop, we have to change this.
Mr. Meuser. All right, very good.
The panel also brought up the idea of an outside agency to
conduct a cultural assessment of the VA or specific VAs; what
are your thoughts on that?
Dr. Hayes. I honestly don't know of groups that could do
this for us. I mean, we work closely with some of the other
major think tanks, Mitre and Rand and folks like that, and they
have been involved in some of the research. I actually think
that the best assessment is listening to the veterans
themselves. We have what we call a card study, we have just
done another round that we will be publishing about what do
veterans think about this effort, do they notice that we are
changing the efforts.
So I would be very interested in hearing more specifically
about what someone might think we could get, what would be the
utility of that, but listening to the veterans is the number
one strong message that we have. I encourage facility directors
to call in veterans and ask them specifically about this, what
have you experienced at this VA and where are the hot spots,
where are the trouble spots.
Mr. Meuser. Thank you.
Thank you, Madam Chair. I yield.
Ms. Brownley. Thank you. And, Mr. Cisneros, you have 5
minutes.
Mr. Cisneros. Thank you, Madam Chairwoman.
Thank you, Dr. Hayes for being here today. I want to ask
you about a specific pilot program that is being run between
the Air Force Women's Health Initiative team and the VHA's
Office of Women's Health Services, the program is a Women's
Health Transition Assistance Training Pilot Program. As one of
the previous witnesses testified, veterans aren't always aware
of their services or the benefits that they have, and I will
even kind of testify that was true in my own case when I was
getting out of the military. Some of the data that was
collected in this for those that have gone through the program
indicate 99 percent of the participants surveyed responded they
would recommend this course to others; 80 percent of
participants have agreed to post-course follow-up.
Could you elaborate on some of the data findings and why is
this program being so successful, and why these women have said
they want to continue with this?
Dr. Hayes. Absolutely. As you well know, VBA and the
Department of Defense and the Department of Labor run a TAP
program for servicemembers as they exit the military. We knew
for a long time that women veterans have been telling us that
they didn't know about their benefits. And the other thing that
was brought to our attention is that the time--the year after
transition, that whole transition year, is at higher risk for
suicide. We are very concerned about the high suicide rate and
the rising suicide rate among women veterans.
And so we worked with the great partners in the Department
of Defense to design a TAP program for women, which is in
addition to the regular TAP program. It does walk them through
their benefits. It is a time when women are with women, so they
can talk about issues, about things like reproductive health
issues, gender-specific health issues, and I think that is part
of why they find it a comfortable place, but it also gives them
a lot more technical information about what is VA health care
and how can they access it.
They also--for most sites we get them to a VA hospital, so
that they can kind of blow away the myths about what is a VA
hospital like and see some of these gold standard clinics that
are there, and realize that they may want to enroll and use
that care.
This project is a proof-of-concept project. We are in pilot
phase and we are happy to announce that Navy just this week has
very much agreed to come on board and help with Navy and Marine
sites. So now we have participation in Air Force, Army, Navy,
and we think that we are going to get a wider ability to have
people come into it and have the various services, be able to
speak to what they think what benefit it is for them.
So we are going to continue to collect the data, we are
going to go back to the Joint Executive Committee of DOD and VA
and report our findings. And so far, people actually think it
is wonderful; we are not surprised, we think it is a very
important part of what we are doing. We are also going to
compare it to an online version, so we can see whether is it
really--what is the importance of having it in person, what can
you get from an online version for those that want to take it
virtually.
Mr. Cisneros. All right. So just to be clear, it sounded
like you said Army, Navy, and the Air Force are now going to
implement this program?
Dr. Hayes. Yes, sir.
Mr. Cisneros. Oh, wow, that is wonderful.
Dr. Hayes. It is wonderful, yes.
Mr. Cisneros. So how do we get it out of the pilot program
phase and to really make sure that we implement this through
the entire Department of Defense or all three military
branches, maybe even the Coast Guard at some point there too,
to make sure that we are taking care of our women veterans?
Dr. Hayes. Well, we are going to fund up the next part of
the pilot, carrying us through the end of '19 now and into
2020. We need the data. It really is important, I think, when
you look at something that is going to be costly in some ways
to make sure that it really is a proof of concept that this is
an important addition to the TAP program.
So, as I said, the next thing would be a decision. There is
a well-oiled machine that works between the TAP oversight, as I
said, with the Department of Labor, VBA, and DOD, and it will
go back to that group, in their wisdom, to consider it.
Mr. Cisneros. All right. Well, thank you very much, and I
yield back my time.
Ms. Brownley. Thank you, Mr. Cisneros.
Mrs. Radewagen, you have 5 minutes. Thank you for joining
us.
Mrs. Radewagen. Thank you, Madam Chairman.
Dr. Hayes, according to DAV's written testimony, VA reports
that only 70 percent of women veterans are assigned a
designated women's health primary care provider. That is
concerning considering the improved satisfaction and quality
that data indicates are correlated with such an assignment.
What steps are you taking to ensure that every woman enrolled
in the VA health care system is assigned to a designated
women's health primary care provider?
Dr. Hayes. Thank you for that question. We, as you have
heard, are really committed to having designated women's health
primary care providers. There is a national shortage of primary
care providers, so we have worked a lot on training up our own
providers who may have been rusty about women's health, 5800 of
them have been provided, but we found that we are still having
difficulty recruiting in the remote and rural areas. And so we
have established a training program that takes the training to
that remote site.
Our community-based outpatient clinics frequently have very
few staff and can't send their staff away for a week to
training. So in the last year and a half we have actually
trained up over 70 providers.
And you may be relieved to hear that the first week of May
and the last week in April we trained in Hawaii, and we had
several folks from the islands come, so they can now be
designated women's health providers. We wanted to make sure
that we reached groups that have had great difficulty in
accessing this training, and you may want to interview them. I
think that they were very excited to be included and we were
very happy to be able to make sure that they could get their--
lots of travel, as you well know, and it is a group that we
wanted to make sure.
And I am glad you asked the question, because it happened
to be that we reached--as I said, we are looking at those sites
that are geographically dispersed that can't easily access,
can't hire up. There may not be a primary care provider in that
area, and we can't steal them from another--you know, we can't
steal them from Indian Health Service or another federally-
qualified health center. We have to make sure that we are
working in partnership with all of those groups and provide the
best training that we can for our women's health providers.
So we still have a long way to go. We actually have such a
wave of women coming in that even with all of the training we
are doing, this year we are going to hit over 700 trained and
we are still going to probably have a gap of five to 700
providers. So I am continuing to look. Workforce management is
working with me in terms of enhancing the recruitment under the
Secretary's recruitment provisions and our goals for
recruitment, but we have an uphill battle here.
Mrs. Radewagen. Also, you note that provider turnout is an
issue with respect to the initiatives VA is pursuing to improve
training on women's health across the VA health care system.
What, if any, incentives exist to encourage providers to seek
out those training opportunities? And, if none exist, what
incentives do you think would be helpful?
Dr. Hayes. There are not specific incentives to be a
women's health provider and that is problematic. If anything,
there is a bit of disincentive, because we are getting so busy
that they frequently get over-paneled quickly, they have
difficulty kind of keeping everything going. We do have
retention--we have a turnover in retention in this group that
is higher than the other primary care groups. And it is really
a technical issue about there is not a separate medical
certification for this group of providers, so we are not able
within the laws and rules about provider groups. We would need
to have some specific way to identify the work they are doing
and to be able to provide additional financial incentives in
this group.
Mrs. Radewagen. I see. So what outcome improvements do you
see for women veterans following the mini-residencies in
women's health that your statement references?
Dr. Hayes. The training itself, I think that there are both
kind of subtle and really obvious things. The obvious things
are resolved when you can have someone not have to go somewhere
else for Pap smear, because someone has been trained up on live
models and feels comfortable handling a Pap smear, handling a
vaginal infection.
The more subtle things or not so direct things are about
understanding the experience of veterans in the military,
trying on, you know, what we call the battle rattle, and then
going back and realizing that this complaint about
musculoskeletal pain, about a headache or a neck problem, or a
joint problem, is because of what that woman had to do with her
heavy equipment on. And then we also have them trained up a lot
on military sexual trauma, interpersonal violence, depression,
management of basic mental health conditions in the primary
care setting. So we have taken someone who is a good VA
provider and helped them expand their role to really, truly be
a good provider for women veterans.
Mrs. Radewagen. Thank you, Madam Chair. I yield back.
Ms. Brownley. Thank you, Mrs. Radewagen.
I thank you, Dr. Hayes, for being here. And I had--before
we conclude, I just had one very quick follow-up question on
the End Harassment Program you were speaking of.
So the last thing you said about the program is
accountability and I just--I was curious to know when you are
teaching employees around harassment, is that a required
program that each and every employee must undergo, like we do
here in Congress, and, you know, they must go through this
training and must go through it on an annual basis?
Dr. Hayes. Every employee must go through the employee OPM
harassment program. What we are doing in VA is we are adding to
that program and to several other training programs that
employees are taking. There is a new program the Secretary has
been rolling out called Own the Moment, and it is about
customer service, it is about direct interaction with veterans,
and we are enhancing that program to add this together.
So, to answer your question directly, that is not a
mandatory program. We are still in development of how to roll
this out additionally. In fact, I have a meeting with the
Secretary in about a week with various groups within the VA. So
it is a little bit preliminary to say how much more we are
going to be making sure happens, but we can get back to you on
what the plans are. And not just for VHA where we have the
medical centers and the accountability, but we also want to
extend the program across all of VA, the cemeteries and the
benefits agencies, in terms of being able to address the
culture everywhere.
Ms. Brownley. So it is very possible that we have employees
across the VA who have been untouched by any of these programs?
Dr. Hayes. Quite--yes, sir--yes, ma'am. I believe that
right now there are employees who have been untouched by the
program.
Ms. Brownley. And then you talked about the reporting
system. So, once an incident reported, is every incident then
investigated and pursued?
Dr. Hayes. The reporting is done locally, and it is done to
the patient advocate and/or what is called the Disruptive
Behavior Committee for mental health disruption; it is
accounted to the local director, and they are tracking and
accounting for what is done.
So because this range of behaviors can be everything from
catcalling, where there might be something like looking at the
design and trying to make sure that you can't congregate there
and have women walk the gauntlet, that might be the action.
There are many other much--I don't want to sort of qualify
them, but egregious things that absolutely have to have police
intervention, maybe the veteran has to be accompanied every
time he comes into the setting. So there are various ranges of
action that are possible.
Ms. Brownley. But a supervisor or a medical director or a
VISN director or anybody at central office may not hear about
any of these instances?
Dr. Hayes. We actually decided not to roll them up to the
central office level.
Ms. Brownley. So medical director level, VISN level--
Dr. Hayes. Yes. I want the action to be accountable
locally.
Ms. Brownley. I agree, I agree, but sometimes one has to
make sure that it is happening locally.
Dr. Hayes. I defer to your judgment. And in this area, you
know, we have been going back and forth on it. I just didn't
want us to create a meaningless report that people were just
sending up somewhere.
Ms. Brownley. Understood, yeah.
Dr. Hayes. That was the issue for me is that what is the
utility in a report that just has a lot of numbers, which
hopefully will go up initially, you know. We see this challenge
with these kind of reports.
Ms. Brownley. Yeah. I just feel like this is really, you
know, we are sort of--in terms of culture, it is sort of in a
crisis situation. I think everybody, including yourself and
others in the VA, acknowledge that, but it just seems to me
that we need to have more tools that replicate that urgency,
and so that is why I am sort of following up on those
questions.
But I think our time has come to a close and I really
appreciate you being here. And I think just before we close the
hearing, I just would like to say, I think what we have learned
today has been extensive, and I think the conclusion is that
women continue to face sexism and discrimination and inequities
in the system, in a system that was originally built for men.
And I think everyone on the Committee believes that no woman
should endure sexual harassment of any kind when she is seeking
her health care and no veteran should ever have her service
considered less valuable because of her gender or minority
status.
So I think we have got a lot of work and the work is cut
out for us, and I intend on following up and having more
hearings like this one, so that we can drill down further.
So I appreciate everybody's participation, and, with that,
I will ask Mr. Meuser if he has any closing comments.
Mr. Meuser. Thank you, Madam Chairwoman. No, I do not. I do
too thank you very much, Dr. Hayes, and our previous panelists
and their testimony. So, thank you very much.
Ms. Brownley. So, thank you again.
And, with that, all members will have 5 legislative days to
revise and extend their remarks, and include extraneous
material.
So, without objection, the Subcommittee stands adjourned.
Thank you.
[Whereupon, at 1:08 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Joy J. Ilem
Chairwoman Brownley, Ranking Member Dunn and Members of the
Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify
today at this oversight hearing on Cultural Barriers Impacting Women
Veterans' Access to Health Care. DAV is a non-profit veterans service
organization comprised of more than one million wartime service-
disabled veterans that is dedicated to a single purpose: empowering
veterans to lead high-quality lives with respect and dignity. Ensuring
that women veterans are treated with respect and dignity and have equal
access to high quality comprehensive primary care, gender-specific
health care services, disability benefits and the broad range of
specialized care and readjustment services from the Department of
Veterans Affairs (VA) is a top legislative priority for DAV.
Women are serving in the military in record numbers and represent
10 percent of the veteran population. There are more than two million
women veterans in the U.S. today and according to VA it expects women
will make up 18 percent of the veteran population by 2040. \1\ Women
are also turning to VA for care in record numbers and more than half of
the women using VA services have a service-connected condition and are
eligible for VA benefits and a lifetime of care. \2\
---------------------------------------------------------------------------
\1\ Department of Veterans Affairs. Women Veterans' Health Care.
Women Veterans Today.
\2\ Women's Health Services. Office of Patient Care Services.
Veterans Health Administration. Department of Veterans Affairs.
Sourcebook: Women Veterans in the Veterans Health Administration Vol.
4: Longitudinal Trends in Sociodemographics, Utilization, Health
Profile, and Geographic Distribution. February 2018. P. 3
---------------------------------------------------------------------------
These sociodemographic changes led DAV to release two special
reports on women veterans. Women Veterans: The Long Journey Home was
released in 2014, with a follow-on report in 2018, Women Veterans: The
Journey Ahead. These reports highlight the changes in this population
over time, critical policy implications for VA, what was needed to
ensure women veterans have access to high quality health services in
all VA sites of care, and most importantly how we could better serve
this population of veterans. Our 2014 report looked at barriers women
veterans returning from recent deployments faced in readjusting to
civilian life after military service. Our new study looks at progress
made and more generally, at the needs of a diverse women veterans'
population using VA health care today. We very much appreciate this
opportunity to discuss the recommendations in our most recent report in
relation to the barriers identified in women veterans' pursuit of
veteran-centric health care.
The unprecedented growth in the number of younger women veterans
coming to VA for care over the past two decades has placed specific
demands on the system and relates to a number of policy changes that
have taken place related to delivery of care for this population.
Specifically, a national focus on oversight, starting in 2008, by the
Women's Health Services Program Office and the advent of training and
deployment of designated women's health primary care providers (WH-
PCPs) and the provision of comprehensive primary care, including
gender-specific services for women patients.
Understanding VA's specific challenges requires a look back at the
changing dynamic of women veterans seeking VA health care services. The
number of women seeking VA care has tripled since 2000, growing from
about 160,000 to 500,000 today. \3\ VA has had to ensure younger women
in their childbearing years have access to reproductive health services
and that older women veterans, another growing population in VA, have
access to age appropriate services for chronic health conditions and
sex-specific care. Additionally, the increasing proportion of women
veterans with a service-connected condition who use VA care (48 percent
in fiscal year (FY) 2000 compared to 63 percent in FY 2015) \4\ also
required program adjustments and policy changes to ensure quality of
care and effectiveness of services for this group. Higher utilization
of outpatient services among women veterans, as well as increased rates
of purchased care and specialized services all resulted in the need for
increased capacity, research, resources and oversight of the Women's
Health Program.
---------------------------------------------------------------------------
\3\ Department of Veterans Affairs. News Release. New Text Feature
Available Through VA's Women Veterans Call Center. April 23, 2019.
\4\ Sourcebook, p. 3
---------------------------------------------------------------------------
Women's care needs and preferences for health care in VA are often
quite different than those of the male veterans the VA health care
system was originally created to serve and long-standing cultural
barriers that have impacted women veterans' access to VA care are often
a result of failing to understand the different needs, preferences, and
perspectives of women veteran patients.
While there has been significant progress in many aspects of VA
health care for women, there are some longstanding issues that still
exist. VA's environment of care surveys, which identify deficiencies in
privacy, safety and dignity in patient care settings seem to routinely
get shortchanged or ignored. In recent reports the GAO (Government
Accounting Office) has highlighted these deficiencies and made
recommendations about how to correct them. \5\ However, little has
changed in the way VA collects or submits these surveys or holds its
leadership accountable for implementing necessary changes. While Women
Veterans Program Managers (WVPMs) are responsible for managing
environment of care surveys, they have no authority to hold facility
leadership accountable for accuracy and completion of responses to
surveys or to ensure changes are made to correct identified
deficiencies.
---------------------------------------------------------------------------
\5\ Government Accountability Office. VA MEDICAL CENTERS: VA Should
Establish Goals and Measures to Enable Improved Oversight of
Facilities' Conditions. GAO-19-21: Published: Nov 13, 2018. Publicly
Released: Nov 13, 2018.
---------------------------------------------------------------------------
Women have been found to value privacy, safety and appearance of
patient care environments. In the VA, where women are still a minority
of the patient population, these aspects of health care may be even
more important to ensure women are made to feel welcome and comfortable
in seeking care. DAV feels strongly that women veterans should be able
to take advantage of VA's comprehensive system of care and specialized
programs and services. Women should be able to rely upon a system that-
at its best-understands the unique needs of this population through its
dedicated Women's Health Research program and commitment to evidence-
based care.
We are pleased to learn that VA researchers are looking at how gaps
in the delivery of gender-sensitive comprehensive care can result in
disparities in quality and patient experience among women veterans
using VA health care and more importantly that VA's Women's Health
Program, in collaboration with researchers, has adopted VA's model of
using evidence-based quality improvement-or EBQI to see if it can be
used to help facilities with gaps in delivering comprehensive services
to women. These sorts of initiatives are essential for breaking down
barriers to care and achieving delivery of comprehensive care in gender
sensitive care environments throughout the system that ensure safety,
dignity and privacy for women patients.
Research has also shown that women veterans prefer women clinical
providers, particularly when it comes to ``sensitive'' sex-specific
care such as gynecology \6\ and express a preference for women's
comprehensive health clinics. Veterans who use these clinics express
high satisfaction with communication and care coordination. \7\ Yet
despite the efforts of many policy leaders within VA, there are still
many women who lack access to women's clinics and ensuring adequate
staffing for such clinics has remained an organizational challenge.
---------------------------------------------------------------------------
\6\ J Obstetrics Gynecology Apr 2005, Vol 105, #4, p 747-750.
\7\ Brunner, J. et al, Women Veterans: Patient-Rated Access to
Needed Care: Patient-Centered Medical Home Principles Intertwined.
Women's Health Issues 28-2 (2018) 165-171.
---------------------------------------------------------------------------
VA reports that a majority of women veterans (approximately 70
percent) are assigned to a designated women's health primary care
provider. Only a small percentage receive care in designated women's
health clinics-in FY 2005 and FY 2010, VA reported that only 12 percent
of women used women's health clinics and 22 percent used both women's
health clinics and general primary care clinics (34 percent of the
total population). In FY 2015, 16 percent used women's health clinics
and 17 percent used both women's health clinics and general primary
care clinics (32 percent of the total population). \8\ Women's health
clinics must be staffed with specialized primary care providers in
addition to adequate clinical and non-clinical support staff. Ideally
these clinics should also have integrated mental health care services
available. Because these clinics require appropriate staffing levels
and space, VA medical center directors must support their growth and
maintenance as a high priority.
---------------------------------------------------------------------------
\8\ Sourcebook. P. 58
---------------------------------------------------------------------------
With these longstanding issues still not fully addressed it may be
time for Congress and VA to consider a new hierarchy for women's
health, specifically making it a program with its own leadership
structure at the Veterans Health Administration (VHA), VISN and
facility level. In this type of hierarchy, leadership within the
program would be able to control resources within the program's budget
and hold staff accountable for adhering to policies that affect women
patients. Elevating the Women's Health Program in this manner would
also send the message from the top down that women veterans are
important to VA, perhaps leading to the important cultural change
embracing women veterans as an important part of the community-a change
that women veterans and their advocates have long sought.
Women Veterans under the New Veterans Community Care Program (VCCP)
Congress enacted major reforms in Public Law 115-182, the VA
MISSION Act of 2018, which will soon affect health care for all
veterans. While DAV supported the enactment of this bill and believes
it has the potential to better serve veterans using VA services through
an integrated care network of well trained and knowledgeable VHA and
private-sector providers that will provide improved access to services
veterans need-our confidence has waned given VA's proposed rule on
access standards which is likely to cause more disruption and confusion
among veterans. We sent comments reflecting our concerns about using
the new ``drive time'' standard for primary care; about the VA's lack
of requirements for comparable quality and access data for network
providers; and about the dangers of using access measures for VA's
specialized care models (for polytrauma care, blindness, spinal cord
injury or dysfunction or homelessness among others) as inclusionary
criteria for contract care. We believe implementing the access
standards as proposed may have the effect of fragmenting care and
unraveling some of the best systems of care available for veterans with
complex care needs such as our women veterans.
The transition to the Veterans Choice Program (VCP) under Veterans
Access, Choice and Accountability Act of 2014 (VACAA, P.L. 113-146)
proved difficult for VA, its contractors, and most of all, veterans.
Women veterans use more contract care then male counterparts because
frequently, the sex-specific care they require such as mammography,
maternity care, and gynecological care is not available at VA (in FY
2015, 37 percent of women veterans compared to 23 percent of male
veterans used community care.) \9\ Contracting, once seen as the answer
to veterans' wait times and access, was not proven to be the panacea
some policy makers had hoped. A recent study found that women veterans
experienced confusion about eligibility, frustration when scheduling
appointments, difficulty obtaining lab and test results from contract
providers and problems with being held personally liable for VA's late
payments for contract care. \10\ Notably, a GAO study also showed that
appointment waiting times for VCP providers were, on average,
significantly longer than 30 days as required under VACAA. \11\
---------------------------------------------------------------------------
\9\ Women's Health Services. Office of Patient Care Services.
Veterans Health Administration. Department of Veterans Affairs.
Sourcebook: Women Veterans in the Veterans Health Administration Vol.
4: Longitudinal Trends in Sociodemographics, Utilization, Health
Profile, and Geographic Distribution. February 2018. P. 49.
\10\ Mattocks, KM, et al. Examining Women Veteran's Experiences,
Perceptions, and Challenges With the Veterans Choice Program, Med Care
2018;56: 557-560.
\11\ Veterans Choice Program: Improvements Needed to Address
Access-Related Challenges as VA Plans Consolidation of its Community
Care Programs GAO-18-281: Published: Jun 4, 2018. Publicly Released:
Jun 4, 2018.
---------------------------------------------------------------------------
During the implementation phase of the MISSION Act, DAV believes
veteran populations who often have complex health histories and require
specialized care with supportive wraparound services, such as our women
veterans, should receive special attention to ensure their needs are
served. Women veterans' health care must be a highly reliable service
with knowledgeable women's health care providers whether at VA sites of
care or in the community.
For example, VA knows that many women have experienced sexual and
physical trauma that puts them at risk for a number of adverse life
outcomes and health consequences. An integrated system of care allows
VA to closely follow these veterans and coordinate their care and
provide access to necessary supportive services-which is particularly
important to women veterans dealing with intimate partner violence,
homelessness or child care issues. Without special coordinated
wraparound systems of care, these women could easily fall between the
cracks (as was demonstrated in their experiences with VCP). In our 2014
report, Women Veterans: The Long Journey Home, DAV discovered this was
the case with too many women returning from deployments to Iraq,
Afghanistan and other combat zones. The Department of Defense and VA
missed critical opportunities for communication and warm handoffs
during transitions between systems. While many federal programs and
services exist to serve women veterans' readjustment needs, without
appropriate support and coordination too many women have been unaware
of them or unsure how to access them, as evidenced by lower market
penetration rates between male and female veterans-according to VA,
only 22 percent of female veterans used VA in fiscal year 2015 compared
to 28 percent of male veterans. \12\
---------------------------------------------------------------------------
\12\ Sourcebook. Vol. 4. P. 18.
---------------------------------------------------------------------------
Access to community health care services has been necessary and
will continue to be so in a system that caters to a small, dispersed
population of women. For these reasons VA must ensure the preparedness
of network participants within its community care program. According to
a RAND study only about two percent of New York providers surveyed were
adequately prepared to address veterans' health care needs. \13\ For
these reasons VA must also ensure that contractors are properly trained
about military and veterans' culture, special conditions within the
veterans' population and evidenced-based treatments for service-related
mental health conditions. VA must provide community partners guidance
on how to properly screen and treat certain conditions for which it has
expertise such as PTSD and ensure referrals are made back to VA for
specialized services when necessary.
---------------------------------------------------------------------------
\13\ Tanielian, Terri, Carrie M. Farmer, Rachel M. Burns, Erin L.
Duffy, and Claude Messan Setodji, Ready or Not? Assessing the Capacity
of New York State Health Care Providers to Meet the Needs of Veterans.
Santa Monica, CA: RAND Corporation, 2018. https://www.rand.org/pubs/
research--reports/RR2298.html.
---------------------------------------------------------------------------
To ensure quality of care integrity VA has created robust systems
to coordinate the care veterans receive in the private sector. However,
more contracting will require more VA coordination and case management
for veterans with complex medical conditions. If their coordinator
roles are collateral with other assignments, VA must ensure that each
coordinator has sufficient time allotted to fulfill all their
responsibilities.
Deficiencies in VA Programs and Staffing to Meet the Needs of Women
Veterans
In an effort to ensure all sites of care are capable of providing
high quality gender-specific care, VA has developed a program to train
women's health primary care providers (WH-PCPs) yet VA's IG found that
many of these designated providers do not meet VA's own proficiency
standards and have too few women assigned to their panels to gain or
maintain proficiency. Training and support for VHA staff and its
contract providers is essential to ensure that women using VHA have
knowledgeable providers wherever they seek care. DAV is pleased with
VA's women's health mini-residency program which provides specialized,
hands-on training to many providers, yet it appears that VA lacks the
resources needed to be able to train a sufficient number of providers
to meet steadily growing demands for care and replacements for staff
attrition. Retention can also be difficult if providers do not believe
they have adequate clinical and administrative support. Hiring and
contracting knowledgeable providers is essential for filling these
gaps-therefore, for FY 2020, the Independent Budget coauthors
recommended adding additional funding for VA to hire 1000 new staff to
include women's health providers, specialty care coordinators, peer
counselors and administrative support staff to address increased demand
for care.
DAV also believes Congress must make women veterans' maternity care
a more robust benefit. Because women veterans have several conditions
(often service-connected) including combat injuries and mental health
conditions that put them at risk for adverse birth outcomes, VA should
be authorized to provide at least 14 days of post-maternity care to the
woman veteran and her newborn infant. Congress must also authorize
emergency transportation for the newborn (without the mother) if needed
care is unavailable at the facility in which the mother is receiving
care.
Continued leadership at the local and national level is important
to ensuring that women's programs remain a priority. Making women's
health a distinct program may also ensure programs have the funding and
authority necessary to implement important changes. Having a designated
funding stream better ensures that women's issues remain at the
forefront of VA's agenda. Strategic plans must also specifically
address VA's programs for women.
Culture Changes Needed-VA's End Harassment Campaign
As VA transforms its health care system, it must ensure that its
facilities offer the safety and privacy in welcoming therapeutic
environments that all veterans deserve. Unfortunately, recent research
indicates that women veterans still do not always feel safe or welcome
at VA health facilities. While this may partially relate to a negative
experience with VA staff or the less than optimal aspects of facility
design at some facilities or lack of gender-specific supplies for women
patients at certain locations, a recent study found that it often stems
from male veteran patients who make inappropriate or unwanted comments
or sexually suggestive remarks to women veterans or question their
right to use VA care. Unfortunately, the percentage of women veterans
who claim to have been subjected to sexual harassment in the military
approximately 25 percent or 1 in 4, \14\ is similar to the proportion
of women who report harassment (1 in 4) from other veterans while
seeking care at VHA. \15\ More importantly, the study found that those
that reported harassment were significantly more likely to report
either delaying or missing care.
---------------------------------------------------------------------------
\14\ https://www.mentalhealth.va.gov/msthome/saam.asp accessed 4/
29/19.
\15\ Women's Health Issues 29-2 (2019) 107-115.
---------------------------------------------------------------------------
This type of harassment is most likely to impact younger women
veterans who have a history of trauma exposure, or screen positive for
anxiety or depression. \16\ We are pleased to see that VA is working to
address this issue, to make needed cultural changes and to eliminate
harassment or disrespectful behavior from fellow patients, visitors or
staff. The Veterans Experience Office reported it convened women
veterans panels who recommended that management reward and hold staff
accountable for creating an empathetic and responsive culture using the
VA as a way of implementing the End Harassment Campaign. \17\
---------------------------------------------------------------------------
\16\ Women's Health Issues 29-2 (2019) 107-115.
\17\ https://www.va.gov/ve/docs/storybookWomenVeterans.pdf
---------------------------------------------------------------------------
According to VA, its End Harassment Campaign trains employees
through simulations aimed at identifying and intervening in situations
where women are being harassed. It creates messaging for potential
harassers and urges women to report harassing incidents to VA security.
We concur that it is every VA employee's responsibility to ensure that
all veterans feel safe when seeking care at VA. We suggest that the
facility director has the ultimate responsibility for oversight and
should be accountable for ensuring that any type of harassment at the
facility is immediately addressed and resolved. VA may consider
offering new women patient's volunteer escorts from the main entrance
to their appointments for those that want them, or any other veterans
as requested. This could also serve as an opportunity to provide women
veterans with a welcome package including a facility map and contact
information for the women's clinic, the women veterans' program
manager, military sexual trauma coordinator and the patient advocate.
Escorts would perhaps allow women to feel both welcome and safe as they
become oriented to the facility and access care.
VA's programs rely upon research and data to ensure effective
programming. Women's research in VA has accelerated significantly over
the last several years with the creation of the Women's Health Research
Network and other collaborative efforts. Over a five-year period 2011-
2015, VA published more studies on women veterans' health than in the
previous 25 years combined. \18\ This research directly benefits
veterans at the bedside and is part of what makes VA, in our opinion,
the best place for women veterans to seek care. For example, in recent
years VA clinician/researchers became aware that many of their women
veteran patients were survivors of intimate partner violence (IPV).
Emerging research proved that women veterans are at greater risk for
IPV than non-veteran women.
---------------------------------------------------------------------------
\18\ Yano, E.M. Advances in VA Women Veterans' Research. Center for
the Study of Healthcare Innovation, Implementation and Policy. Briefing
to the Advisory Committee on Women Veterans. VA Central Office. May 9,
2018.
---------------------------------------------------------------------------
This prompted VA to hire coordinators at each medical center to
serve women veterans reporting IPV. We commend VA appropriators for
understanding this need and providing the funding to assure all VA
medical centers had these coordinators. Another issue identified within
the women veterans' population is a heavy reliance on VA mental health
services.
Mental Health Care
Women veterans often have a variety of exposures including combat,
military sexual trauma (MST), childhood trauma, and intimate partner
violence that place them at risk for developing certain mental health
conditions. Eating disorders are also common among survivors of MST.
\19\ While rates of suicide for women veterans are lower than their
male peers, women veterans are twice as likely to commit suicide as
women who have no military service. The rate of suicide among women
veterans is also accelerating much more quickly than that of male
peers. More must be done to understand risk and protective factors for
women veterans and to assure there are more gender tailored
interventions to prevent suicides among this subpopulation.
Specifically, VA health care facilities must ensure that women's mental
health champions and MST coordinators, whose positions are collateral
duties, have the ability to independently dedicate at least 30 percent
of their time to carry out required administrative responsibilities
associated with these positions. Suicide prevention remains a top
clinical priority for VHA and the Department has developed a number of
innovative practices to assure veterans are able to have the level and
type of support and services they need to recover from mental health
conditions common among veterans.
---------------------------------------------------------------------------
\19\ DAV Women Veterans Report. 2018 p. 32.
---------------------------------------------------------------------------
Substance use disorder (SUD), is also common among women veterans
who use VHA, and often co-occurs with other mental health conditions
complicating diagnosis and treatment. SUD increases the risk of
suicides and can make women vulnerable to intimate partner violence.
SUD puts veterans at risk for a spiral of decline: job loss, adverse
health effects, homelessness, criminal activity, and family
dissolution. To prevent a downward trajectory, VA must ensure women
veterans have timely access to services offered by VHA including the
full spectrum of mental health and substance abuse treatment services
from detoxification to rehabilitation. The underlying causes of women's
SUDs are often different than men's, and, accordingly, VA should make
women-only programs and/or topic-specific programming (based primarily
on women's interests such as parenting and safe relationships) more
widely available.
VA is one of the largest employers of peer specialists using them
in mental health care and primary care settings. Peer counselors are
generally in recovery from a mental health condition including
substance use, an eating disorder, or PTSD from combat or military
sexual trauma. Because they've ``been there,'' peer specialists often
serve as role models for veterans offering encouragement, helping to
answer questions about options for care, supporting goals for recovery,
and help veterans remain engaged in their care plan. VHA has hired a
disproportionately high number of women peer specialists (relative to
women's use of VA) but we understand they are not equitably distributed
throughout the system. DAV urges Congress to provide dedicated
resources to hire and train women peer counselors for placement within
patient aligned care teams with a focus on supporting care for women
veterans with mental health conditions, particularly for women dealing
with MST-related health issues and those at higher risk for suicide.VA
should also be provided dedicated resources to increase the number of
full-time clinical staff focused on providing mental health counseling
to women patients dealing with reproductive mental health issues, such
as postpartum depression, perinatal loss, and menopausal transition.
Unfortunately, even with commitment from DoD leadership, improved
preventive and survivor assistance programs, rates of military sexual
assault continue to soar. A 2016 report indicated that officer
candidates in service academies were often unaware of which behaviors
might constitute sexual harassment or assault. \20\ As the military
continues to rely upon women service members to carry out its mission
and women are integrated into all military occupations, DoD must
redouble its efforts and focus on training troops about what
constitutes inappropriate behavior and to ensure, at all levels of the
command structure, there is zero tolerance for sexual harassment or
assault and adherence to ethical and professional conduct toward women
service members as colleagues.
---------------------------------------------------------------------------
\20\ Davis, L. et al., eds. (2017) Office of People Analytics.
Defense Research, Survey, and Statistics Center. 2016 Workplace and
Gender Relations Survey of Active Duty Members. XVI.
---------------------------------------------------------------------------
Many veterans turn to VA for specialized MST-related treatment and
value Vet Centers which strive to staff according to the demographics
and needs of veterans they serve in the communities in which they are
located. These centers offer programs for combat and military sexual
trauma and other highly sought mental health services that at times
involve family members in a veteran's care. Because of the knowledge of
local veterans' needs and the market they are serving, local Vet Center
leadership must be included in any local planning to establish
community care networks. Vet Centers also offer women-only retreats for
post-deployment readjustment and more than 300 women have participated
in these retreats which have produced consistent and positive results.
VA should conduct research to confirm long-term effectiveness of these
programs and Congress should consider expansion and permanent
reauthorization of retreats if warranted.
Madam Chairwoman, in closing, I want to thank you and the
Subcommittee for your continued interest in improving health care
programs and services for our nation's women veterans. With major
reforms underway at VA, now is the time to address longstanding
cultural barriers impacting women veterans' access to the high quality
comprehensive gender-sensitive health care they need and deserve. As an
organization, DAV also wants to ensure that the role of women in the
military and the sacrifices they have made are understood, acknowledged
and fully appreciated. Please know that DAV is ready to assist you in
your efforts. This completes my statement. I will be happy to respond
to any questions you may have.
Prepared Statement of Lindsay Church
Chairwoman Brownley, Ranking Member Dunn, and members of the
Subcommittee, on behalf of the Minority Veterans of America (MVA),
thank you for the opportunity to testify about the cultural barriers
impacting women veterans' access to healthcare.
My name is Lindsay Church and I am the Chief Executive Officer and
Co-Founder of MVA. I served in the United States Navy from 2008-2012 as
a Persian linguist, all but three months of which were under Don't Ask,
Don't Tell. I am a medical retiree and I, personally, receive my care
through the VA.
Since starting MVA in 2017, we have grown to over 800 veterans
across 46 states, 2 territories, and 3 countries, 47% of them are
women. Together, our members account for 6,000 years of service, some,
dating back to conflicts and eras that pre-dated when they were legally
recognized as women veterans.
I am here today to testify from both my own personal experience and
on behalf of the countless women veterans who will never have the
opportunity to be heard or accounted for.
In the military and veteran community, the role of women is quickly
expanding and their stake of the community is constantly growing. With
more ranks and rates opening to women all the time, the portion of the
community that women make up is only anticipated to continue to grow.
This rapid growth has left a lag in the the culture meant to support
women after service.The culture that we have created, or neglected to
advance, in our military and veteran communities has left many women
veterans without a community to call home.
The cultural barriers that women veterans face are complex in
nature and require a unique understanding of the lived experiences of
women in the military community. At the heart of the cultural barriers
that we face are two primary areas of concern: 1) The toxic culture for
women and minorities in the military and veteran community that have
caused a loss of faith in services designed to support them; and 2) The
perpetuation of systems that render our service and voices, as women
veterans of all kinds, invisible.
Toxic Culture for Women and Minorities:
The military and veteran community have histories of harassment
culture that have long been acceptable when directed at women and
minorities. There have been instances of institutionalized
discrimination that have been held in place for years, sometimes even
decades, before being struck down through acts of Congress or decisions
made at the highest levels. These policies create a space where
harassment and discrimination of the individuals who are impacted by
them is seen as acceptable and tolerated. The harassment that we face
as a result of the culture that is created inflicts lasting damage on
those of us who endure the behavior without an ability to change our
circumstances.
The discrimination that happens in the military to women-identified
individuals is compounded by the force of the entire United States
military that renders each service member powerless until their date of
discharge. Even if you want to leave the military because you are being
harassed, assaulted, or fear for your safety in any way, you are
beholden to a system that demands compliance no matter the
circumstances.
Women identified individuals experience instances of gender-related
discrimination, sexual harassment, and assault at rates that are
exponentially higher than that of our male peers. \1\ In many cases the
offending individual is a supervisor or unit leader who committed the
violation(s), leading to a mistrust for those in positions of
authority.
---------------------------------------------------------------------------
\1\ Complete Results from Major Survey of U.S. Military Sexual
Assault, Harassment Released, RAND Corporation. May 1, 2015. https://
www.rand.org/news/press/2015/05/01.html.
---------------------------------------------------------------------------
In addition to harassment and discrimination based on our gender,
we are often made to feel as though reporting our wounds and injuries
will make us seem inferior to our male counter parts. We unnecessarily
push ourselves beyond human physical capacity and often to the point of
injury or permanent disability. The military perpetuates a 'culture of
fitness' that unduly impacts women who serve. Compared to our civilian
counterparts, women veterans experience higher rates of arthritis,
cancer, cardiovascular disease, and functional impairment. \2\
---------------------------------------------------------------------------
\2\ Data from the Centers for Disease Control and Prevention's
Behavioral Risk Factor Surveillance System (BRFSS), and the Substance
Abuse and Mental Health Services Administration's National Survey on
Drug Use and Health (NSDUH).
---------------------------------------------------------------------------
Anecdotal evidence of this can be found in cases such as that in
Naval Training Station Great Lakes where the second woman in eight
weeks died after a physical fitness test in basic training on Saturday,
April 27, 2019. \3\ I can personally attest to this culture of fitness
and pushing beyond my personal limits as I treated my body as though I
was invincible during service and now I live with the permanent
disabilities as a result.
---------------------------------------------------------------------------
\3\ ``Navy recruit is second woman to die at Illinois boot camp in
2 months''. CBS News, Apr. 27, 2019. https://www.cbsnews.com/news/
kelsey-nobles-navy-recruit-alabama-collapses-dies-boot-camp-navy-recr
uit-training-center-great-lakes-illinois/
---------------------------------------------------------------------------
We carry these memories from our time in service of when we were
harassed or made to feel less than worthy forward with us like battle
scars into our civilian lives. When we separate from the military, we
must decide, based on the severity of our treatment and the intensity
of our needs after service, whether or not we will return, in any
capacity , to a setting where affiliation with the military is the
common thread among the community.
Like our male counterparts, we are proud of our service and what we
have accomplished and, our stories are complicated. For many women,
overcoming this barrier of re-entering military culture voluntarily in
their life after service to use their VA care is too great, so they
choose not to engage their care or benefits.
Despite the barriers, some women decide to engage and attempt to
join the veteran community, either to find others with similar lived
experiences or to gain access to their benefits through a Veteran
Service Officer only to find themselves further harassed and
discriminated against by other veterans . Traditional Veteran Service
Organizations, those that were long seen as the leading experts on
veteran advocacy, have held together some of the most toxic culture for
women.
The Minority Veterans of America itself is an organizations whose
roots are in the harassment I experienced at the American Legion. \4\
When I first shared my story publicly of the discrimination I endured
and witnessed while serving as a Post Commander was met with hundreds
of others who had similar stories to my own from their times trying to
be a part of the American Legion of VFW. These spaces are often the
places that veterans are expected to go to gain access to their
compensation and benefits. This in itself can be an insurmountable
barrier.
---------------------------------------------------------------------------
\4\ Commander quits Seattle veterans group over harassment, racism.
NPR. Mar. 9, 2018.
---------------------------------------------------------------------------
In addition to the hurdle of being forced to re-enter military
culture in order to use the VA, the organization itself has a
reputation in the community for being sub-par care that lacks a nuanced
understanding of who we are. Whether that is true or not, perception to
the user is reality if they have yet to walk through the door. If re-
entering military culture alone does not prove to be a stopping point,
the larger emergent narrative is that the VA does not care as it should
for veterans. The stories that shake the public to the core of veterans
who die by suicide in the parking lots and waiting rooms are too common
for us to be assured that we will be treated with care.
Of the MVA members who are women identified individuals, 54%
disclosed a story of harassment, discrimination, or feeling outside the
military or veteran community on their application for membership. 14%
indicated that they had been raped or sexually assaulted while serving
in the military. These numbers may seem small in comparison to
expectation but, these responses came solely from the prompt, ``Tell us
your story.''
Systems that Perpetuate Invisib ilit y and a Toxic Culture:
In addition to the issues of toxic culture, from the highest levels
of the Department of Veterans Affairs, systems have been built that
hold together and perpetuate the problem. In some cases, these systems
are constructed through mere happenstance. In others these are
constructed through willfully declination to change or adapt to the
changing needs and demographics of the community.
On plaques at VA facilities across the country are the words of
Abraham Lincoln, ``To care for him who shall have borne the battle and
for his widow, and his orphan. ``These words serve as the motto and
mission of the organization. At the time that President Lincoln
delivered this address, women were serving as nurses, spies, and some,
even, as soldiers in the field . When these words were adopted as the
VA's motto, in 1959, thousands of women were on their way to Vietnam as
part of the Army's Nurse Corps.
Despite the fact that they would not be given legal recognition as
veterans until 1980, women have always been among the ranks of those
who have served . The plaques inscribed with Lincoln's words are
physical representations of the deep and lasting history of
invisibility for women in the military and veteran community.
This invisibility is interwoven into the memories of our service
and becomes the narrative of our experiences as veterans. Where our
male counterparts are thanked for their service, women have to fight
for adequate representation, especially for those of us with multiple
minority identities. Women have to fight to be seen. Women have to
fight against the conflicting and confusing memories we have of their
service.
The outcomes that women veterans are experiencing today - rise in
suicide rates and mental health crises, homelessness, health
disparities - are challenges that show the results of our inequitable
access to care. To change these outcomes, we must look to the root of
the problem and not just triage the results. The roots in this instance
are the systems that exist that continue to render our service and
voices, as women veterans of all types, invisible.
Looking at one of these systems as an example is the advisory
committees to the Department of Veterans Affairs. Of the 26 Advisory
Committees to the VA \5\ with committee chair information available
online, only six were chaired exclusively by women identified
individuals . Of those six, only three had served in the U.S. military.
Of those three women, one was a Woman of Color, and none were gender-
diverse.
---------------------------------------------------------------------------
\5\ There are currently 27 standing advisory committees to the
Department of Veterans Affairs. 26 had current information about their
members available online.
---------------------------------------------------------------------------
The lack of ability for women veterans to form any type of majority
without the assistance of our male counterparts, reinforces the belief
and understanding that we do not have the opportunity to make decisions
about our own healthcare.
No matter the composition of these advisory committees, the power
structures in place still ensure that an overwhelming majority of the
decision-makers and advisors to those who lead the Department itself,
are men.
When structures are built in a way that men must give us the
ability to self-govern our own health outcomes, the power dynamic
begins with an imbalance.
Without the voices of women veterans in these positions of
authority, there is no assurance that that we are heard, considered
fully, and that our ideas are acted upon in the same ways as our male
counterparts. Instead, this structure assures women veterans are
beholden to a system that lacks the insight of our lived experiences as
those that are currently being underserved.
Chairwoman Brownley, Ranking Member Dunn, distinguish ed members of
the Committee, as a representative of Minority Veterans of America, I
provide the following recommendations to address the growing and
complex needs of the woman veteran community:
1.Contract with an ou tside ag ency with experience working with
and including women veterans to conduct a cultural assessment of the
Department of Veterans Affairs and its facilities as it relates to
gender identity.
Assess internal staff culture, core values of the
organization, strategic plan and initiatives, and leadership st
ructures.
Assess external culture and what the experience of women
veterans is while navigating the VA system. Examine behaviors and
mannerisms that are considered acceptable within the VA for patrons and
staff.
2.Create community standards for conduct at Department of Veterans
Affairs' facilities for patrons and staff.
Eliminate harassment culture and implement and publicize
department-wide anti -harassm ent campaign.
Make reporting easier and accountability more transparent
in instances where harassment has occured.
3.Create a streamlined process between the Department of Defense
and Department of Veterans Affairs so that VA coverage is op t-out
rather than opt-in.
Assign each woman veteran a primary care doctor in their
nearest Women's Clinic.
Invest furthe r in the tele-mental health system and
prioritize finding providers who specialize in women military and
veteran communities.
This increases access for fill yeterans to ensure they do
not feel bad for seeking care and treatment.
The time a veteran is likely to use their VA healthcare
is a point of crisis. That's too late if the veteran is going to
navigate getting benefits.
4.Invest in expanded research around intersectionality as it
pertains to women veterans and systemic barriers impacting minority
women veterans from accessing healthcare.
Minority women such as women veterans of color, lesbian
and bisexual women (especially those that served during and prior to
Don't Ask, Don't Tell), transgender women veterans, and (non)religious
minority women veterans.
5.Open the VA's motto to public comment to consider change.
Either maintain gender neutrality or revisit the motto
and mission with representation from all communities to ensure input.
Chairwoman Brownley, Ranking Member Dunn, and distinguished members
of the Committee, thank you for the opportunity to testify today on
behalf of Minority Veterans of America about the cultural barriers
impacting women veterans' access to healthcare. For additional
information regarding this testimony, please contact Lindsay Church,
Chief Executive O fficer of Minority Veterans of America at
[email protected].
Prepared Statement of Ginger Miller
Chairwoman Brownley and members of the Subcommittee, as the
President and CEO of the national nonprofit organization, Women
Veterans Interactive, I am grateful to present my testimony regarding
the Culture Barriers Impacting Women Veterans Access to Healthcare.
To understand the cultural barriers impacting women veterans'
access to healthcare, one must first understand the climate in which we
exist.
THE WOMAN VETERAN COMMUNITY CLIMATE (A HOSTILE TAKEOVER)
Women veterans are trying to stay afloat in a culture that has been
male-dominated for centuries, and now we are competing to stay relevant
in a culture that insists we downgrade our service to run parallel with
that of a commitment made by a military spouse to her husband. Women
veterans are uniquely different from military spouses, and it's time
that this country stops lumping us together, not to mention being
overshadowed by the caregivers.
Women veterans are existing in a climate where we have become good
for business but not good enough to do business with and even more
unfortunate, women veterans are living in a culture where our voices
are only heard in a celebratory fashion when we achieve something great
or when we hit rock bottom and become good for press.
I'm here to testify this morning in an effort to change to the
climate and culture that has become the norm for women veterans. Our
noble service to this country is worth more than a story, our sacrifice
as women veterans are worth much more than a tick mark on outdated,
one-sided surveys conducted by male-dominated VSO's who may happen to
have a few women veterans on staff.
Women veterans are more than objects, and we don't need another
survey; we need action. We don't need another national portrait
campaign; we need a national outreach and engagement. Women veterans
don't need another male-dominated VSO to represent us at the table, we
need to have a seat at the table, and if we can't have a seat at the
table, we will continue to build our own.
For women veterans, the environment in which we are expected to
thrive in after serving in the military has become hostile and at times
volatile to say the least because our voices are not being
appropriately heard and we do not have accurate representation at every
level of government.
Women veteran nonprofit organizations are grossly overlooked and
underfunded if funded at all, our volunteers are overworked, and for
some, the outlook is bleak, and yet we continue to hold out and hope
against hope. Hope for inclusion to have a seat at the table where our
voices will be heard and hope for much-needed funding to deliver proper
services to the population we serve.
WHY WOMEN VETERANS INTERACTIVE EXISTS
I started Women Veterans Interactive because I became homeless
after faithfully serving in the United States Navy. During my time as a
homeless woman veteran in the early '90s, I was also the caregiver to
my husband who suffered from severe Post Traumatic Stress Disorder and
mother to our son who was a toddler at the time. Instead of being a
victim, I became a victor by working three jobs and going to school
full time to pull my family and me out of the deadly jaws of
homelessness.
After that horrific experience, I dedicated my life worked to
support veterans, and in 2009 I formed the nonprofit organization John
14:2, Inc. In 2011, I formed Women Veterans Interactive as a division
of John 14:2, Inc. Due to the growth of WVI, in 2018 we applied to IRS
to become a standalone 501 c3 nonprofit organization and was approved
in 15 days.
Women Veterans Interactive (WVI) is a solutions-driven nonprofit
organization focused on outreach and engagement. WVI delivers a
positive impact in the lives of women veterans through a holistic,
proactive approach that is grassroots in nature.
Mission Statement
The mission of WVI is to meet women veterans at their points of
need through Advocacy, Empowerment, Interaction, Outreach, and
Unification to break down the barriers that lead to homelessness. WVI
addresses the unique, and often unrecognized, challenges facing our
nation's 2.3 million women veterans as they return to civilian life.
With members nationwide, WVI provides outreach & support services to
thousands of women veterans through the three pillars of transition,
empowerment, leadership, and diversity. WVI offers tailored programs,
training and resources to equip women veterans at all stages of their
military transition
Since its inception, WVI has supported over 3,500 women veterans
through strategic outreach, signature events, and programs. The WVI
network has grown to more than 50,000 women veterans and continues to
grow every day.
The growth of Women Veterans Interactive is directly related to the
need of women veterans to be connected to and supported by an
organization that is ``For Women Veterans by Women Veterans.'' We do
not have a magic solution, a secret sauce, or a long drawn out
dissertation but we do have a proven method that is directly related to
our grassroots effort approach in engaging and empowering women
veterans.
WOMEN VETERANS INTERACTIVE AND THE U.S. DEPARTMENT OF VETERANS AFFAIRS
Having an intermate understanding of the importance of women
veterans being connecting to healthcare, since 2012, WVI has invited
the U.S. Department of Veterans Affairs Center into our fold to
collaborate with us on all our outreach efforts.
The Department of Veterans Affairs has attended and participated in
every Women Veterans Interactive annual conference since 2012.
Participation included keynote speeches, leadership panels and
facilitation of workshops.
Most recently during WVI's 2018 and 2017 annual Women Veterans
Leadership and Diversity Conference both of which had over 200
attendees, we held a veteran's benefits claims clinics in collaboration
with the Veterans Benefits Administration (VBA). Each year
approximately 125 to 150 veterans were able to receive onsite benefits
claims assistance.
The feedback from the benefits claims clinics have been remarkable
with some women veterans stating that this is the first time the VA has
treated them like their service matters and other women veterans said
they have a brighter outlook on going to the VA Medical Center to
receiving health care from the VA Medical Center.
Additionally, in 2017, WVI partnered with the Center for Minority
Veterans to conduct a virtual town hall that had 300 veteran attendees.
In 2106, WVI created the State of Women Veterans Campaign social
media campaign and reached out to the Department of Veterans Affairs
and formed a collaboration that to reach over 500,000 veterans. The
goal of the campaign was to raise awareness of women Veterans' military
and societal contributions and provide an avenue for informing women
Veterans about the VA benefits they have earned. The campaign was
successful and surpassed the goal of reaching 500,000 veterans.
Every Women Veterans Interactive, Department of Veterans Affairs
collaboration a woman veteran encounters help to change the image of
the VA in a positive matter.
So, I pose the questions, why is more not being done by the
Department of Veterans to collaborate with women veteran nonprofit
organizations like Women Veterans Interactive and why are women
veteran's organization not invited to Department of Veterans Affairs
VSO meetings, especially when it comes to discussing issues and
solutions surrounding women veterans.
CHANGE THE CLIMATE TO CHANGE THE ACCESS
A significant barrier impacting women veterans' access to health
care lies within a system at the Department of Veterans Affairs
dominated by a climate that is neither inviting nor inclusive for women
veterans. It's time to build a culture that is inclusive for women
veterans rather than a culture that treats women veterans as an object
of affection because it's the right thing to do.
One cannot expect a population to engage in healthcare services
they are not aware of, cannot access due to personal hardships, or do
not feel safe accessing because most of the services are located within
a male-dominated environment.
I humbly ask this Subcommittee to work with Women Veterans
Interactive to change the climate that has been set before the women
who have so bravely served and sacrificed for our country.
We can change the climate by establishing legislation that will
Allocate funding for collaborative women veteran direct
outreach and engagement
Require the Department of Veterans Affairs to focus on
consistent strategic outreach and engagement strategies in
collaboration with qualified women veteran nonprofit organizations
Require the Secretary of Veterans Affairs to have semi-
annual meetings with women veteran nonprofit organization.
On behalf of Women Veterans Interactive, our members and the
population we serve, I am appreciative for the opportunity to share our
views on the Culture Barriers Impacting Women Veterans Access to Health
Care.
Prepared Statement of BriGette McCoy
The Organization
Thank you for inviting our voices and insight For over a decade,
Women Veteran Social Justice network (WVSJ), has been heralded as a
safe space to land for women seeking information resources and wanting
to stay informed about military sexual trauma, PTSD, domestic violence,
suicide prevention, housing, peer support and events in their local and
national neighborhood. We also have become known for training other non
profit leaders, supporting the launch of critical programs and services
and bringing communities of women veteran and military women of diverse
backgrounds together online and in person through our integrated
network.
WVSJ Network's digital media component manages an interconnected
network of over 12,500 community connections online with a
collaborative network of 50 other networks of support for the veteran
population at large. Since 2008, WVSJ has been a primary source and
stakeholder to national women military and veteran; outreach, research,
educational and institutional programs, political policy and community-
based program support. This work includes partnering with educational
institutions to bring veteran and civilian communities to network,
published articles within the clinical professional community, national
non-profits for Art and Music organizations, been a stakeholder in Emmy
Award-winning documentaries and non-profit narrative digital
storytelling to bring the military and war times experiences to the
public.
WVSJ advocates collection of the first person narrative for
military service members working with the organizations Unsung Heroes,
Warrior Songs and the National Association of Black Military Women to
collect the narratives. WVSJ is instrumental in leading discussions in
the community to allow a holistic compassionate and honorable way for
the service members to tell their story.
Our collaborations with other community organizations allow
instructional and creative work to include musical and digital art to
help strengthen veteran community connections.
WVSJ community participated in musical and creative art events;
2010- 2012 Creative art in Kentucky, 2014-2015- JDTR Conference Plenary
Workshop Presentations on women veteran and military sexual trauma
research and government policies, Bowling Green University Fall 2013
Bowling Green, facilitate the collection of the narrative of members to
educate community leaders on nuance of best practices to support. WVSJ
Ambassadors have participated in the education journal writing and
publishing articles in Combat Stress E-magazine in Spring 2014, Fall
2018 and Warrior Songs award-winning songwriting and music CD
production of the narratives of women of all eras who have served.
For the past three years, WVSJ has participated in the Women
Veterans Health Fair at Emory University, allowing the first person
narratives to bring awareness and sensitivity to the medical and mental
health needs of women veteran to future clinical staff.
Our founder has consulted with and been in support of graduate and
doctoral student researchers across the country by insight and
expertise contributions to advancing peer-reviewed research since 2012.
Through our programs, national partnerships and collaborative projects,
we have reached tens of thousands of women veterans, their family
members and community leaders.
The Founder
BriGette McCoy is a nationally recognized keynote speaker, veteran
advocate, conference facilitator, and veteran community leader. Her
veteran experience has been requested by multiple media networks
including CNN, MSNBC, NPR and the Today Show.
In 2011 Ms. McCoy and five other women veterans, were interviewed
for the Emmy Award Winning Documentary Service: When Women Come
Marching Home, about women veterans and their civilian transition.
Disabled Veterans of America supported the National Distribution.
In 2013, McCoy provided Congressional testimony on her personal and
professional experiences with military sexual assault, and on suicide
prevention and awareness as a member of the on the Surgeon General's
2012 Suicide Prevention Taskforce.
A Gulf War era veteran who served in the US Army from 1987-1991,
McCoy held a Top Secret Clearance as a data telecommunications computer
operator. She is service-connected and compensated for Post-Traumatic
Stress Disorder (PTSD) from Military Sexual Trauma (MST) and
Neurological injuries. McCoy is one of many women veterans who have
experienced difficulties reintegrating to civilian infrastructures, to
include chronic homelessness with dependent children, challenges
maintaining a career with multiple disabilities, and the impact of
multiple sexual traumas in the military. Despite these barriers, she
leads and volunteers in multiple areas collaborating with various
community organizations who are engaged with veteran outreach.
Ms. McCoy embraces building community relationships inter-
generationally amongst veterans while encouraging participation in
quality life activities, some of which include: retreats for art and
recreation within local and national communities, seeking medical care
utilizing the VA as part of holistic modality for medical and
psychological care, and training or education to increase availability
for socioeconomic growth and development.
McCoy's educational background includes a Bachelors of Science in
Psychology, Masters of Theology and course completion in Education
Technology and Media Design.
Her work is about connecting of communities, organizations and
multidisciplinary fields of study and resources influencing
technological changes of resource delivery to veterans.
Personal Testimony
To the House Committee and Committee Chair: thank you for inviting
my organization and the inclusion of my testimony on issues concerning
women veterans, specifically the cultural issues impacting women
veterans.
I am an ally, a Military Sexual Trauma (MST) survivor and advocate.
My service and contributions are as important as my male veteran
counterparts. Women Veteran serve, yet our visibility and opportunities
have unseen barriers to accessing many of the programs that the
civilian sector believes are available to all who have served.
It is vitally important to hold in high regard and utilize the
narratives of veteran women like me, of all eras, service periods and
service backgrounds as primary sources to inform research, curriculum
and policies concerning women veterans. The cultural issues impacting
women veterans are vast. There are too many to note fully in this
setting and give the full historical context, legislative background
and the full unintended consequences and implications of each. I do
believe that the historical context of women not being formally
included in the military structure until the 1940's is a topic for
inclusion in this hearing.
Women veterans were not legislated to use the VA for gender
specific medical care until the early 1990's. Only in recent years have
Women specific health care spaces been constructed in VA facilities.
In my work over the past 10 years and my personal experience
interacting within the government and community for support a major
factor that repeatedly and consistently challenged me, has been the
language which is used to describe and talk about me as a woman
veteran.
Within the context of being a woman veteran, I have heard terms
like, ``low hanging fruit'', ``female'', ``victim'', and references by
men about how easy it is for women to get disability benefits. I assure
you - THAT is categorically untrue. These ``othering'' terms have an
unintended consequence for our country and the communities that serve
women veterans.
How we speak about women veterans can be part of a deeper problem
of what we believe and have been socialized to believe about women in
general. This is a root cause factor that drives the cultural divisions
and creates a barrier for meaningful, well funded support for the women
veteran community at large.
The language used to speak about, research, legislate, create and
institute programs for our women veteran community, continues to be a
major limiting factor toward addressing issues and needs.
Why are organizational leaders calling us female after military
service? There are no Female veteran organizations. Where is the
national female veterans of america organization? Even in 1948 when
then President Truman signed the Armed Services Integration Act, Female
was not used in the title, but the word Women. I know there will be
some that say that doesn't matter.
I will argue that using biological terms is dehumanizing; that what
you name or call something, or the language you use to speak about a
person does have impact positively or negatively. We can trace the
language in the policies and legislation and funding and see that
funding drives programs and service. Second, women veterans currently
have very narrowly defined, language specific access to some of the
most well funded and highly engaged programs. Most are intentionally
excluding a huge proportion of women, and the funding legislated for
their programs is language specific to eras, combat and to gender. It
is emotionally draining as an advocate to send women to organizations
that have veteran programs to have them told they don't meet the
guidelines for the program. Further, the brochures are male centered
and the veteran service and community organizations and their
organizing documents do not include women who have served or they are
told to go to auxiliary membership or put together with spouses, which
is a completely different population.
Third, VA medical treatment visits poses issues when the organizing
documents and placards have male centered quotes and presentations. The
space was not created with women in mind.
There have been upgrades and changes in support of women using the
facilities yet women are still being catcalled and harrassed going to a
mental health or medical appointments - and when they can get them.(see
the illustration below re:harassment).
It is never clear what the outcome will be for a woman who reports
harassment, or for the patient or employee that harasses. My personal
experiences of being harassed within the VA and the discussions with
other women about the need to change their appearance, come at certain
times of day, switch to other hospitals (where the harassment is less
pronounced) or stop going to the VA at all is another area for
discussion.
Next, women veteran professionals are not always treated with the
same professional respect as our male counterparts. Many times rank,
era and service time are used to limit access to programs for
professional advancement. When Program managers ask me to send them
people to fill their programs but won't make exception for a woman
veteran of any era because their funding stipulates a specific era.
I recognize brands and businesses have certain markets. However, if
your market is veterans - that is who I am. We are the only segment
that is singled out.
Women Veterans are being leveraged and discarded based on the
visibility and funding gained by our presence. There are quite a few
veteran women who have needed to remove themselves from the non profit
community because the environment is extremely toxic and their self
care became more important than the presented image of working for the
organization.
Last, we are veterans first and foremost. When we served the only
time we were called ``female'' was when we were being seperated from
our teams by our gender. Needless to say, it was not in many cases, a
positive reason it was being used.
I also wish to focus on our women Reservists, and National Guard
members.
The language of their service has been a factor that excludes them
from much needed programs and services. With the most recent changes to
service availability for these uniformed personnel it is vitally
important that language includes our women serving in these capacities.
I have many other areas of concern but time is a limiting factor so I
chose to highlight these areas specifically.
Recommendations for us to move forward toward positive changes are
as follows:
My recommendations
Create equity with women veteran subject matter experts
as the co-leads and leads in future events including queries,
discussions, panels part of best practices policy and procedures.
Create space where veteran women thought leaders and
innovators have a primary voice in their care and treatment.
Research of impact of including narrative works, and
veteran and survivor subject matter experts in the planning of programs
and services for veteran women and survivors.
Increase access to funding for women veteran led programs
with cultural competence and history of serving women veterans with 3
or more years.
Include leaders and organizations with proven results and
outcomes directly benefiting women veterans of all eras and service
times for legislative and policy input.
Create Veteran Affairs medical and claims spaces no
tolerance no access for veteran who harass other veterans during times
veterans who are seeking medical treatment or utilizing the VA any VA
programs
Use Ally centered* language, program descriptions, and
educate leaders to present and legislate from that position. *This
includes disability, gender identification, race etc.
(photos upon request)
J.Payton, B.McCoy 2018 ``Current Challenges and Future Directions
Supporting Veteran After Military Sexual Trauma.''
Ambassador Contributions
(Board Member Sr Ambassador Connie Baptiste)
National Guard And Reserve
Women Veterans Access to VA facilities - National Guard
and Reserve Units in rural areas have to travel sometime over an hour
to access a VA
Women Veterans are younger they are only doing one term
and getting out with disabilities.
Child care and access to it during appointments
Mental health support in rural areas
VA education being provided to the location
State vs VA health care for veterans who don't meet the
VA's definition to receive support.
Spousal programs of support for the caregivers
Access to care and support for children born to women
veterans with disabilities
The new policy, Deploy or Get out, military members non-
deployable for more than 12 months will be administratively discharged,
more disabled veterans
Statistics show that veterans move back to their home
area, many from rural areas
Underemployment/unemployment high for deployed Guard and
Reservist.
Current Guard Posture Statement
Army 343,000 Soldiers,
8 division headquarters,
27 brigade comba teams,
96 multifunctional brigades, 8 combat aviation brigades and 2
Special Forces groups Provides the Army 39% of its operational forces
Operates and manages nearly 42% of the Army's manned and unmanned
aircraft. Air Guard 105,700 Airmen, 90 wings,
1,111 aircraft Flies 44% of Air Force's KC-135 air refueling
missions Flies nearly 30% of the Air Force's strategic and tactical
airlift (C-130s / C-17s) missions Flies 30%of the fighter / attack (A-
10s, F-15s, F-16s, F-22s) missions Provides 42% of the Air Force's
Prime BEEF and 53% of the deployable RED HORSE civil engineer units.
Deployments
Since 9/11, the National Guard has supported more than 850,000
overseas deployments.
More than 2,800 Guard Airmen from 48 units served in nine different
locations while filling 46% of the total force's civil engineer needs
overseas last year.
The Air Guard is providing 23% of the total force's Remotely
Piloted Aircraft capability and 25% of the total force's Distributed
Common Ground System (a system that produces military intelligence for
multiple military branches) capacity in direct support of combatant
commanders' intelligence, surveillance and reconnaissance requirements.
Guard Soldiers and Airmen have served on every continent and in
every Combatant Command in more than 70 countries around the world
Army Reserves
Since Sept. 11, 2001, more than 300,000 Army Reserve soldiers have
mobilized, some serving multiple tours, seamlessly integrating into the
active Army and the Joint Force.
Suicide Rate among Guard and Reserve
In 2013, the suicide rate among reservists was 23.4 per 100,000, In
2013, the suicide rate among National Guardsmen, 28.9 per 100,000.
History Makers
The New Hampshire Army Guard's 2nd Lt. Katrina Simpson made history
when she became the first woman officer in the National Guard to
graduate from the U.S. Army infantry officer basic course. (The Army
National Guard Warrior)
https://www.nationalguard.mil/Portals/31/Documents/
PostureStatements/2018-National-Guard-Bureau-Posture-Statement.pdf
https://giveanhour.org/wp-content/uploads/RCP-Fact-Sheet-March-201
7.pdf
https://www.militarytimes.com/news/your-military/2018/02/14/dod-
releases-new-deploy-or-get-o ut-policy/
Prepared Statement of Lory Manning
Chairwoman Brownley, Ranking Member Dunn and Distinguished Members
of the Subcommittee:
On behalf of the Servicewomen's Action Network (SWAN), I thank you
for the opportunity to share our views and recommendations regarding
the cultural barriers to women veterans' access to healthcare at the
Department of Veterans Affairs.
In the past years, VA has made hard-won improvements in the quality
and comprehensiveness of women's care, but all that improvement is for
naught if women encounter barriers when trying to use this healthcare.
I'll discuss two of these barriers today: 1.) sexual harassment and 2.)
the invisibility of women veterans.
Sexual Harassment at VA Facilities. Over the years, we at SWAN have
heard many complaints about groups of male veterans getting together to
harass women veterans on VA grounds including at the Washington, DC VA
hospital. An academic study and a newspaper article both published this
year elucidate the problem. The first, done by Ruth Klap, Ph.D. and
others, called ``Prevalence of Stranger Harassment of Women Veterans at
Veterans Affairs Medical Centers and Impacts of Delayed and Missed
Care,'' appears in Women's Health Issues, published by the Jacobs
Institute of Women's Health. (http://whijournal.com/article/S1049-
3867(18)30194-4/fulltext.) The second, by reporter Jennifer Steinhauer,
was in the March 12th edition of the New York Times and headlined
``Treated Like a `Piece of Meat': Female Veterans Endure Harassment at
the VA''.
The Klap study sampled women veterans who used 12 different VA
hospitals and found one in four of those sampled reported receiving
catcalls, derogatory comments, propositions, and denigrations of the
women's veteran status from male veterans on the hospital grounds. The
New York Times article recounts how an ``entrenched, sexist culture at
many veterans' hospitals is driving away female veterans.''
SWAN believes that what women veterans want, and warrant, is for VA
leaders at all levels, with oversight from Congress, to stop the
harassment now and to foster a VA culture in which women veterans are
treated with the same respect, appreciation and dignity as male
veterans.
Invisibility: Women veterans report to SWAN that they feel
invisible to the office staffs of VA facilities and to the American
public. And they are; it begins with the VA motto ``To care for him who
has borne the battle, his widow and his orphan''. SWAN, while
appreciating Lincoln's historic words, is among those veterans'
organizations which support changing that motto.
According to DVA's February 2017 Report ``The Past, Present and
Future of Women Veterans,'' only 22.4% of all women veterans use VA
healthcare making them a mere 7.5% of total VA healthcare users. Women
veterans are irked when they are asked for their husbands' social
security numbers at the check-in desk or are refused free coffee
provided at some VA facilities with the admonition that the coffee is
only for veterans. These slights seem minor, but they can accrete over
time leaving women veterans frustrated and disheartened.
Their invisibility becomes more damaging when the gender-specific
needs of women veterans are ignored, as happens, for example, when they
are sometimes issued prosthetic devices designed for men; this should
never happen.
And major damage can be done, if women veterans are invisible to
those, at any level, making tough decisions on healthcare resources if
the decision makers either don't understand the need for women's
programs or conclude that reallocation from these programs helps many
while hurting only a few.
SWAN believes leadership at all levels must take great care when
initially allocating-or later reprogramming-resources to or from
women's healthcare programs that they have a clear understanding of the
effects their actions can have on these programs. SWAN, additionally,
entreats Congress to exercise its oversight responsibilities to ensure
the needs of women veterans and other special focus populations are not
unduly sacrificed when such actions are necessary at the national
level.
Madam Chairwoman let me say how deeply I appreciate the opportunity
to offer SWAN's views on these critically important matters. Thank you
for your time and attention.
Prepared Statement of Dr. Patricia Hayes
Good Morning Madam Chair, Ranking Member Dunn, and distinguished
Members of the Committee. I appreciate the opportunity to discuss the
high-quality care and support VA is providing to our women Veterans and
the cultural barriers impacting women Veterans' access to VA health
care.
Overview
The number of women Veterans enrolling in VA health care is
increasing, placing new demands on VA's health care system. Women make
up 16.2 percent of today's Active Duty military forces and 19 percent
of National Guard and Reserves. Based on the upward trend of women in
all service branches, the expected number of women Veterans using VA
health care will rise rapidly, and the complexity of injuries of
returning troops is also likely to increase. More women are choosing VA
for their health care than ever before, with women accounting for over
30 percent of the increase in Veterans served over the past 5 years.
The number of women Veterans using VHA services has tripled since 2001,
growing from 159,810 to 500,000 today. To address the growing number of
women Veterans who are eligible for health care, VA is strategically
enhancing services and access for women Veterans.
Access to Care
Every VHA health care system across the United States now has a
full-time Women Veteran's Program Manager tasked with advocating for
the health care needs of women Veterans using that facility. Mini-
residencies in women's health with didactic and practicum components
have been disseminated system-wide to enhance clinician proficiency;
since 2008, over 5,800 health care providers have been trained in this
national program. Under a new collaboration with the Office of Rural
Health, a pathway for accelerating access to women's health training
for rural primary care providers has been established. Meanwhile, VHA
is actively recruiting additional providers with experience in women's
health care. Numerous initiatives have been launched to improve access
to state-of-the-art reproductive health services, mental health
services, and emergency services for women Veterans, and others have
focused on enhancing care coordination through technological
innovations such as registries and mobile applications.
VA has enhanced the provision of care to women Veterans by focusing
on the goal of developing Women's Health Primary Care Providers (WH-
PCP) at every site of VA care. VA has at least two WH-PCP's at each VA
Medical Center and 90 percent of community-based outpatient clinics
(CBOC) have a WH-PCP in place. We are in the process of training
additional providers to ensure that every woman Veteran has an
opportunity to receive her primary care from a WH-PCP. VA has
implemented women's health care delivery models of care that ensure
women receive equitable, timely, high-quality primary health care from
a single primary care provider and team, thereby decreasing
fragmentation and improving quality of care for women Veterans.
VA is proud of high-quality health care for women Veterans. We are
on the forefront of information technology (IT) for women's health.
Because quality measures show that women Veterans using VA health care
are more likely to receive breast cancer and cervical cancer screening
than women in private sector health care, VA is redesigning the
electronic medical record to track breast and reproductive health care.
Unlike other health care \1\systems \2\, VA analyzes quality
performance measures by gender. This has been key in the reduction and
elimination of gender disparities in important aspects of health
screening, prevention, and chronic disease management. \3\
---------------------------------------------------------------------------
\1\ Centers for Disease Control and Prevention (CDC). 2018.
``Breast Cancer Statistics.'' http://www.cdc.gov/cancer/breast/
statistics/index.htm
\2\ 2017 VHA Support Service Center National Performance Measure
Report
\3\ https://www.womenshealth.va.gov/WOMENSHEALTH/docs/WVHC--
GenderDisparities--Rpt--061212--FINAL.pdf#
---------------------------------------------------------------------------
Scope of Services
VA provides full services to women Veterans, including
comprehensive primary care, gynecology care, maternity care, specialty
care, and mental health services.
Comprehensive Primary Care
To provide the highest quality of care to women Veterans, VA offers
women Veterans assignments to trained and experienced designated WH-
PCPs. The providers can furnish general primary care and gender-
specific primary care in the context of a longitudinal patient/provider
relationship. National VA satisfaction and quality data indicate that
women who are assigned to WH-PCPs have higher satisfaction and higher
quality of gender-specific care than those assigned to other providers.
Importantly, we also find that women assigned to WH-PCP's are twice as
likely to choose to stay in VA care over time. \4\
---------------------------------------------------------------------------
\4\ Bastian L, Trentalange M, Murphy TE, et al. Association between
women Veterans' experiences with VA outpatient health care and
designation as a women's health provider in primary care clinics.
Womens Health Issues. 2014;24:605-612.
---------------------------------------------------------------------------
Gynecology Care
VA offers many gynecologic services, including complex gynecology
care such as gynecologic surgery and treatment of gynecologic cancers.
Women Veterans have access to gynecology care as a basic component of
high-quality care. One hundred and thirty-three sites have a
gynecologist on site. For those facilities where VA does not have a
gynecologist on site, Veterans receive services through care in the
community. VA is unable to recruit gynecologists at some sites because
there is no Surgery Service at those facilities and gynecology is a
surgical specialty. In 2017, VA held its first-ever national VA
gynecology conference: VA Gynecology Health System - Optimizing Access
and Facilitating Best Practices Training. The mission of this
conference was to optimize access to gynecologic services for women
Veterans. A second gynecology conference is planned for June 2019,
focusing on specific gynecologic surgery skills.
Maternity Care
Maternity benefits for enrolled women have been included in the VA
medical benefits package since 1996. In general, these benefits begin
with the confirmation of pregnancy. VA medical facilities do not
provide on-site obstetric care to pregnant Veterans. However, female
Veterans receiving their care through VA have their pregnancies
confirmed at a VA medical facility and receive further maternity care
through community (non-VA) health care providers. Some Veterans will
continue to receive other health care services, such as mental health
services, during their pregnancies through the VA health care system.
Once a pregnancy is confirmed, the VA Maternity Care Coordinator
(MCC) educates the Veteran on maternity benefits and the process for
maternity care throughout the pregnancy. MCCs help Veterans navigate
and coordinate care between VA and maternity care providers in the
community and are available to answer questions and remain in
communication throughout the pregnancy. Because of high rates of mental
health conditions in women Veterans using VA health care \5\, it is
essential that they are supported by MCCs during pregnancy, and women
Veterans are encouraged to return to VA primary care women's health
after their delivery.
---------------------------------------------------------------------------
\5\ Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari
L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe
JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW.
Reproductive Health of Women Veterans: Systematic Review of the
Literature from 2008 to 2017. Semin Reprod Med. 2018 Nov;36(6):315-322.
doi: 10.1055/s-0039-1678750. Epub 2019 Apr 19.
---------------------------------------------------------------------------
VA offers newborn care for up to 7 days after the birth of a child.
Newborn care includes, but is not limited to, inpatient care,
outpatient care, medications, immunizations, circumcision, well-baby
office visits, neonatal intensive care, and other appropriate post-
delivery services.
Infertility and Adoption Reimbursement Services
VA provides infertility services, other than in vitro fertilization
(IVF), to all enrolled Veterans. Veterans receiving care through VA are
offered infertility evaluation and treatment, regardless of service
connection, sexual orientation, gender identity, gender expression, or
relationship or marital status. This includes diagnostic testing and
many infertility treatments, with the exception of IVF.
Congress has authorized VA to furnish fertility counseling and
treatment, including IVF, for married Veterans with a service-connected
disability that results in infertility and their spouses. The Veteran
must be legally married and meet the eligibility requirements of a
service-connected condition that results in infertility. Eligible
Veteran couples can receive a total of three IVF cycles and
cryopreservation storage of their own gametes and embryos without time
limits. Donor eggs, sperm, embryos and surrogacy are not covered
benefits. Treatment with IVF is provided by specialists in the
community, with care coordinated among relevant VA providers and the VA
facility's Women Veterans' Program Manager.
VA has implemented regulations to provide reimbursement of
qualifying adoption expenses incurred by Veterans with a service-
connected disability that results in the inability to procreate without
the use of fertility treatment. Covered Veterans may request this
$2,000 reimbursement for qualifying adoption expenses incurred for
adoptions finalized after September 29, 2016.
Mental Health Services
VA has witnessed a 154 percent increase over the past decade in the
number of women Veterans accessing VA mental health care. Over 40
percent of women Veterans who use VA have been diagnosed with at least
one mental illness, and many struggle with multiple, clinically complex
conditions, such as trauma, mood, and eating disorders \6\. VA's mental
health programming for women Veterans is guided by the principles of
gender-sensitive care and recognizes the importance of offering choice,
flexibility, and options for care. To ensure that VA mental health
providers have the skills and expertise to meet women Veterans' unique
and diverse treatment needs and preferences, VA's Office of Mental
Health and Suicide Prevention (OMHSP) has developed innovative clinical
trainings and initiatives to strengthen mental health services for the
growing population of women Veterans. These initiatives expand the
portfolio of treatment options available to women Veterans and
complement the strong cadre of evidence-based practices available to
all Veterans.
---------------------------------------------------------------------------
\6\ Greenberg, Greg; and Hoff, Rani. FY2018 Mental Health Data
Sheet: National, VISN, and VAMC Tables - All Veterans. West Haven, CT:
Northeast Program Evaluation Center. Annual (2010-Present).
---------------------------------------------------------------------------
Here are some examples:
In 2016, OMHSP conducted the first VA Women's Mental
Health Mini-Residency. During this intensive 3-day training, national
experts led sessions on gender-tailored psychotherapies and psychiatric
medication management, with a focus on the influence of hormonal
changes and the reproductive cycle. Participants serve as local Women's
Mental Health Champions and, as part of the training, developed Action
Plans to disseminate women's mental health practices at their
facilities. The facility Women's Mental Health Champions are now an
important component of the Women's Mental Health infrastructure. In
2018, VA partnered with the Department of Defense (DoD) to conduct a
joint Women's Mental Health Mini-Residency. VA now conducts a yearly
Women's Mental Health Mini-Residency and partners with DoD every even
year.
OMHSP developed clinical training programs in STAIR
(Skills Training in Affective and Interpersonal Regulation) and
Parenting STAIR. STAIR and Parenting STAIR are cognitive-behavioral
trauma treatments that focus on strengthening emotional regulation and
building healthy relationships, including parenting relationships.
These are important areas of functioning that can be highly disrupted
in women with histories of serious interpersonal traumas, such as
sexual assault. Research suggests that emotion dysregulation is
associated with suicidal ideation. Parenting STAIR training teaches
therapists to deliver a component of the STAIR treatment that is
designed to help Veterans who have persistent trauma-related reactions
that negatively impact their parenting and parent-child relationships.
To address an identified need for eating disorder
treatment options, OMHSP partnered with Women's Health Services (WHS)
to develop a cutting-edge multidisciplinary eating disorder treatment
team training, aligned with the Joint Commission's rigorous standards
for outpatient eating disorder care. Coordinated, specialized clinical
care is needed to effectively treat serious eating disorders, which are
associated with increased risk for suicide attempts and death by
suicide.
OMHSP developed a monthly training series to enhance
knowledge of gender-tailored prescribing practices. Effective treatment
of reproductive-linked mental health conditions (e.g., premenstrual
dysphoric disorder [PMDD], perinatal depression and anxiety disorders,
and perimenopausal depression) could reduce suicide risk for affected
women Veterans. Treatment of mental health conditions during specific
reproductive cycle stages differs in some respects from treating those
conditions during non-reproductive parts of the life-cycle. For
example, some, but not all antidepressants have efficacy for PMDD.
Taking antidepressants during only the luteal phase of the menstrual
cycle can be effective for PMDD.
Military Sexual Trauma
Unfortunately, some women experience sexual assault or harassment
during their military service and may struggle even years later with
its after-effects. VA's services for military sexual trauma (MST) can
be critical resources to help them in their recovery journey. Services
for any mental and physical health conditions related to MST are
available for free at every VA medical center (VAMC) and eligibility is
expansive: Veterans do not need to have reported their experiences at
the time or have any documentation that they occurred and may be able
to receive free MST-related care even if they are not eligible for
other VA care. VHA has a number of initiatives to help ensure that
targeted, specialized services are available, and that Veterans are
aware of these services. Since Fiscal Year (FY) 2007, these efforts
have resulted in a 297 percent increase in the number of women Veterans
receiving MST-related outpatient care, indicating the positive impact
of these efforts. Some key initiatives include maintaining a full
continuum of outpatient, inpatient, and residential mental health
services.
As part of the universal screening program, all Veterans seen for
VA health care are asked whether they experienced MST, so that they can
be connected with MST-related services as appropriate, and every VA
health care system has a designated MST Coordinator who can help
Veterans access MST-related services and programs.
VHA also has a range of initiatives to promote continued expansion
of its MST-related programming and promote provider expertise. These
include bimonthly training calls for staff, an annual conference on
treatment program development, online courses, a community of practice
Intranet Web site, and a national MST Consultation Program available to
any VA staff member with a question related to assisting Veterans who
experienced MST. These are important efforts; however, outreach and
engagement efforts must remain an ongoing area of emphasis to ensure
Veterans have access to the care they need.
Child Care
VA is aware of the challenges faced by Veterans with children in
terms of accessing medical appointments and other medical care,
counseling, and caregiving services. Women Veterans currently are and
will continue to be an important part of the Veteran community and an
important part of VA. The total number of women Veteran patients age
18-44 increased from 81,832 in FY 2000 to 187,137 in FY 2015, a 2.3-
fold increase. From the 2015 Study of Barriers to Care for Women
Veterans, when queried about the possibility of on-site child care,
three out of five women (62 percent overall) indicated that they would
find on-site child care very helpful, but in general this was not a
significant factor in whether they choose to use VA care.
Section 205 of Public Law 111-163, Caregivers and Veterans Omnibus
Health Services Act of 2010, as amended (38 United States Code Sec.
1710 note), authorizes VA to provide child-care services through a
pilot program. VA is authorized to continue this pilot program through
FY 2020. Since 2011, VA has been providing child care services through
the pilot program offered at Buffalo, New York, Veterans Integrated
Service Network (VISN) 2; Northport, New York, VISN 3; American Lake-
Puget Sound (American Lake), Washington, VISN 20; and Dallas, Texas,
VISN 17.
While mothers were the largest users of drop-in child care services
at 47 percent; fathers used the service nearly as much at 44 percent;
and grandparents used the service at 9 percent. Utilization and costs
vary at each of the sites, but Veteran satisfaction with the service
remains consistent at all locations. VA has sought permanent but
discretionary authority to provide child care assistance for the
children of eligible Veterans while those Veterans are accessing health
care services at facilities.
Women Veterans Call Center
In 2014, VA established a hotline specific for women Veterans. The
Women Veterans Call Center (WVCC) makes outgoing calls to women
Veterans to provide information about VA services and resources and
responds to incoming calls from women Veterans, their families, and
caregivers. WVCC implemented a chat feature in May 2016, to increase
access for women Veterans and has responded to 1,979 chats. As of
January 31, 2019, the WVCC has received 83,984 calls and has made
1,328,256 outgoing calls, with 672,815 of these calls being successful
(spoke with the Veteran or left a voice message). We are very excited
to announce that VA instituted text interaction for WVCC (1-855-829-
6636) on April 23, 2019.
Expanding Mammograms
Mammograms for women Veterans are available on-site at 64 VHA
health care sites where digital mammography is available. Because we
want to ensure that Veterans are receiving the highest quality
mammograms, when there are insufficient numbers of women to support
such a program in-house, VA uses its community care authorities to
provide mammograms in the community. VHA has also convened a task force
of subject matter experts from women's health, oncology, radiology,
surgery, and radiation oncology to develop guidance to standardize and
enhance breast cancer care in VA facilities nationally. Despite these
accomplishments, VHA agrees with a recent VA Office of Inspector
General report that tracking the results of mammograms performed
outside VA has been a challenge. In response, VA has established
national guidelines for mammography and cervical cancer tracking. VA is
funding positions for cervical cancer and breast cancer screening
coordinators at 27 rural sites and has established education materials,
toolkits, and a national community of practice for Mammogram
Coordinators.
VA has been working to ensure that test results from studies done
outside of VA are documented in the Computerized Patient Record System
and that patients are notified of normal and abnormal mammography
results within an appropriate timeframe. VA completed two IT projects
that will revolutionize tracking and results reporting for breast
cancer screening and follow-up care: The Breast Care Registry and the
System for Mammography Results Reporting. These systems are designed to
work together to identify, document, and track all breast cancer
screening and diagnostic imaging (normal or abnormal), order results,
notify patients, and follow-up to ensure that all women Veterans
receive high-quality, timely breast care, whether treatment is provided
within or outside of VA.
Quality Care
VA is proud of its high-quality health care for women Veterans.
Beginning in FY 2008, VHA launched a concerted Women's Health
improvement effort focusing providers' attention on gender-disparity
data. From 2008 to 2011, VA saw a significant reduction in gender
disparity for many measures, including hypertension, diabetes,
pneumococcal vaccine, and influenza prevention \7\. Improvements were
also made in screening measures for colorectal cancer, depression,
posttraumatic stress disorder, and alcohol misuse. In FY 2011, VA
included Gender Disparity Improvement as a performance measure in the
VISN Director Performance Plans, which concentrated management
attention on systems to continuously reduce gender disparity. WHS has
continued to publish reports on these efforts; the FY 2017 report \8\
illustrates that VA has made continued progress in closing the gap in
gender disparities. At the close of FY 2017, small gender gaps existed
in only a few measures including cholesterol management in high-risk
patients, diabetes care, and rates of influenza vaccination.
---------------------------------------------------------------------------
\7\ https://www.womenshealth.va.gov/WOMENSHEALTH/docs/WVHC--
GenderDisparities--Rpt--061212--FINAL.pdf#
\8\ Improving trends in gender disparities in the Department of
Veterans Affairs: 2008-2013. Whitehead AM, Czarnogorski M, Wright SM,
Hayes PM, Haskell SG. Am J Public Health. 2014 Sep;104 Suppl 4:S529-31.
doi: 10.2105/AJPH.2014.302141.
---------------------------------------------------------------------------
Since 2014, VA has tracked access by gender and identified small
but persistent disparities in access for women Veterans, who overall
are waiting longer for appointments than male Veterans. To mitigate
this disparity VA has identified sites with the longest wait times for
women Veterans and is working with those sites directly on initiatives
to improve access, including designating more women's health providers
through hiring or training and improved provider and team efficiency.
VA has conducted site visits at all health care systems to assess
the quality of the women's health program. After completing a national
review in 2017, VA developed an Evidence-Based Quality Improvement
(EBQI) Process to assist sites with women's health quality improvement
projects. VA has completed EBQI initiatives at 14 sites and will
complete 7 additional site projects in 2019.
Barriers to Care
Although VA continues to successfully expand its female-centric
health care coverage, it has encountered several challenges in meeting
the demand of the increasing women Veteran population. Although VA has
made it a priority to provide top-notch training to providers and other
clinical staff, VA is unable to keep up with the demand to have trained
providers to care for women Veterans. Provider turnover continues to be
an issue, and a national shortage of primary care providers results in
recruitment challenges.
In 2018, VHA Leadership directed that Privacy and Dignity Standards
for Women Veterans be extended to all Veterans. A Workgroup on Privacy
and Environment of Care worked to define all terms and standards for
privacy and environment of care. The definitions were incorporated in
the Appendix C (Veterans Health Environmental Privacy and Security) of
VHA Directive 1330.01(2), Health Care Services for Women Veterans, and
was published on July 24, 2018. In addition, VA's Office of
Construction and Facility Management (CFM) identified appropriate
updates for Design Standards and released a Design Alert to the field
in October 2018, which effectively updated the 2010 CFM design
standards to extend to all Veterans.
New Initiatives/Outreach
Office of Rural Health (ORH) Training Initiative
WHS has partnered with ORH to develop and implement a training
program to specifically meet the needs of rural primary care providers
and nurses at rural CBOCs and VAMCs. This mini-residency for rural
providers and nurses launched in June 2018 and is on track to visit up
to 35 rural clinical sites during its first program year and up to 40
sites per year thereafter, supporting the highest level of care for
women Veterans in rural areas.
Telehealth Services for Women
WHS understands it may be difficult to always make an appointment
in person and is collaborating with the Office of Connected Care and
ORH to ensure that primary and specialty care is delivered via
telehealth to women Veterans both in rural areas of the country and in
other geographical areas where there is a shortage of providers. The
nationwide initiative, Virtual Integrated Multisite Patient Aligned
Care Team (V-IMPACT), implements virtual women's health PACT teams in
their primary care hub sites for the provision of gap coverage in VA
facilities with a shortage of women's health providers. In addition,
WHS has worked with ORH to ensure the inclusion of Women's Health
Clinical Pharmacy Specialists (CPS) in their recent initiative to
expand the availability of CPS via telehealth to rural VA facilities.
Finally, WHS is actively working to promote the use of VA Video Connect
among women's health providers to improve access to primary care.
Transition Assistance Pilot Program
The Women's Health Transition Assistance Training Pilot Program (WH
TAP Pilot) is a collaboration between the Air Force Women's Health
Initiative Team (AFWHIT) and the VHA's Office of Women's Health
Services conducted under the auspices of the VA/DoD Health Executive
Committee, Clinical Care and Operations Business Line, Women's Health
Workgroup (HEC CCO BL WHWG). The aim of this initiative is to increase
transitioning Servicewomen's knowledge about the VHA health care
system, the VHA enrollment process, and eligibility and specific
services and resources available for separating Servicewomen. The
ultimate goal of the WH TAP Pilot Program is to increase timely
enrollment and utilization of VA health care services among eligible
women after they separate from the military, and to ``provide a female
perspective'' and connect Servicewomen to relevant care services
available through VHA.
Musculoskeletal Training
VA tracks the prevalence of medical conditions among women Veterans
and has noted that musculoskeletal conditions such as back pain and
joint pain are the most common conditions in women Veterans, often
resulting in poor quality-of-life and chronic pain. To address this
problem, VA has developed a Musculoskeletal Training Program to train
providers in the physical examination and diagnosis of musculoskeletal
conditions common in women Veterans. This training has been conducted
at seven VA sites and will be conducted at the national simulation
center in 2019. An additional collaborative provider musculoskeletal
training with DoD was piloted in 2018 and will be repeated in Dayton,
Ohio in 2019.
Conclusion
VA continues to make significant strides in enhancing the language,
practice, and culture of the Department to be more inclusive of women
Veterans. These gains would not have been possible without consistent
Congressional commitment in the form of both attention and financial
resources. It is critical that we continue to move forward with the
current momentum and preserve the gains made thus far. Your continued
support is essential to providing high-quality care for our Veterans
and their families. Madam Chair, this concludes my testimony. My
colleague and I are prepared to respond to any questions you may have.
STATEMENTS FOR THE RECORD
Women Who Serve
Diana D. Danis, Lead Administrator Service
Bio: Diana D. Danis is a lifelong advocate and activist on behalf
of women and veterans. Her world-view focuses on changing cultural
paradigms that relegate women to a second-class status and affect their
full and equal participation in society.
She deeply understands that use of language, definitions, access,
communication and inclusion in research determines how effectively
women receive treatment in health care systems. Danis currently serves
as a Senior Advisor to Women Veterans Social Justice and is a lead
administrator for the social media platform of Service: Women Who Serve
as well as the women Military and Veteran advisor to People Demanding
Action and ERA Action.
For 16 years, she and her husband were Caregivers for six family
members, gaining unique insight into insurance, medication, hospital,
rehabilitation, nursing home and hospice systems. Her body of work
includes contributions to the first comprehensive women veterans'
health programs legislation for the Department of Veterans Affairs
while Executive Director of the National Women Veterans Conference
(NWVC), the first social justice women veteran organization in the
country. She contributed to development of the first McKinney-Vinto
Homeless Veterans Act as well as the Reasonable Accommodations in the
workforce section of the Americans with Disabilities Act (ADA).
Danis was the first military woman radio network news broadcaster
on the American Forces Network (AFNE) while serving in the Army. During
her service in Europe, she was one of a handful of women in the
International Women's Coalition for Change that created the first Women
and Families Support Centers for the US Army in Europe to address
domestic violence.
She formerly served on the President's Committee for Employment of
People with Disabilities, was a member of the Colorado Coalition for
the Homeless Board of Directors and the Veterans Program Director for
the International Association for Personnel in Employment Security
while serving as a training development instructor and Course Manager
at the National Veterans Training Institute (NVTI). Danis developed and
presented the first Diversity Training Certificate Course at the
University of Colorado at Denver and is a co-developing specialized
segments of Crisis Intervention Training (CIT) emphasizing Unique
Populations.
Danis serves on the Advisory Committee for the Military Women's
Coalition founded in 2018 and consulted to Diloitte on the anticipated
needs and issues of women who serve for the next decade.
She regularly speaks on grassroots organizing for individuals and
small organizations, addressing sexual assault in the military and VA,
disability concerns, women's status in society and diversity issues.
Thank you Chairwoman Brownley and Ranking member Dunn a for the
opportunity to submit this statement to the House committee on Veterans
Affairs regarding Cultural Issues Confronting Women Veterans.
In the 1980's when I first came to the House and Senate Veterans
Affairs Committees about the status of women veterans, I truly believed
Congress was going to do what was necessary to right a plethora of
wrongs.
Senator Inoye launched a GAO inquiry in 1981 to find out what is
was going to take to insure women veterans had equal access to medical
care and benefits. An earnest effort ensued, 13 facilities visited,
calls to 32 others, interviews with VA Central Office and Veteran
Service organizations. They decided the VA had made progress but
because we were only 2.5% (742,000) they really hadn't focused on our
needs. Mind you that's half of the number we are today, but the vet
population was massive back then and even though Congress was packed
with veterans, there were no women veterans and we were not even an
afterthought.
Here's what they decided:
- we should have access to treatment programs and facilities.
- we should be able to get complete physical exams
- that gyn and other gender specific care should be provided
- that plans should be made for inevitable increases in our
population
- And that every effort should be made to identify us and inform us
of our benefits.
That 29 page report came out in 1982.
I went to the Denver VA ER in 1985 and was told they didn't treat
women. After that I met a bunch of people in Congress and spent years
working on changing the system, working on legislation, creating a
national organization - trying to make all those changes happen.
In 1991, another GAO report requested to see what had happened
since 1982 because now there were women and men in Congress asking a
lot of questions and furiously working on legislation and of course the
testimony around Tailhook was hammering Armed Services and Veterans
Affairs in both the House and Senate and none of it was pleasant.
The gist of the 1992 publication was as expected:
- The VA had made significant progress toward providing health care
to women vets. They said equal to men. I was there, not so much, though
better - at least they were treating us.
- The VA Advisory Committee on Women Veterans was created and Women
Veteran Coordinators were assigned in each medical center. It was an
additional duty, not a regular job, but it was progress.
- They found out that doing in house Mammography required following
American College of Radiology Standards and they weren't doing enough
of them to be on target or proficient. Sometimes wanting a a service
in-house has good intentions that aren't viable and still aren't in
most locations today.
- Privacy issues continued to be a huge problem and weren't being
corrected with renovations to add things like women's bathrooms - true
story, few VA's had women bathrooms other than for staff and outside
the cafeteria.
- And finally, the report said they couldn't find any programs that
were unable to accommodate female patients. Had they talked to any of
us using VA services, they just would have heard peals of laughter
waving across the country.
- They would have heard the laughter immediately turn to anger as
they revealed sexual harassment and sexual assault IN VA facilities.
- They would have heard about safety and security and the need to
never go to appointments unaccompanied
- They would have heard about providers ignoring health complaints
and being shined on as malingerers
- They would have heard about not knowing about programs being
offered in the VA medical centers that women could also participate in
After years of work, the Women Veterans Health Programs Act of 1992
first authorized the VA to provide gender specific care to women
veterans and established mental health care, regardless of disability
status for those traumatized by sexual harassment, sexual assault and
rape in the military. That public law 102-585 has been amended a lot in
the last two and a half decades.
I testified next to the bill's sponsor Congresswoman Patricia
Schroeder, (D) (CO) and have a signed copy of the bill in a box
somewhere.
So here we are, 26 years later, walking the same path.
What are the Cultural Barriers Confronting Women Veterans?
Natural progression should have brought us further than continued
sexual harassment in the VA and discomfort attending appointments for
many, many women veterans along with being referred to as men - when
being called back to see a provider. At this point it is not just
education but an ingrained sense of disdain for those women who serve.
That requires a big rethink in how the VA educates and punishes
personnel.
-I recommend legislation to deal with harassment and assault on VA
campuses. Clearly expecting people to be respectful and not assault
others is too big of an ask, so more severe implications are in order.
For example, a staff member calls a woman veteran back who has
close-cropped hair and is dressed in sweats. The individual refers to
her as ``Mister'' or makes some other snarky remark. It is
unprofessional, unnecessary and harmful.
There continue to be deep concerns about the treatment of older
women veterans and the in patient status of women veterans, especially
those with mental health issues and dementia problems is growing.
My husband has been going with me to VA appointments for 23 years.
He has been regularly asked which doctor he is waiting for, if he would
like some coffee and thanked for his service hundreds of times. He is a
civilian. They don't ask me.
We have seen the Women Veteran Coordinator positions morph into
Women Veteran Program manager capacities in recent years.
Unfortunately, in spite of many highly qualified women veterans
applying for these positions, they tend to be used as internal
promotional opportunities for civilian nursing staff rather than for
external hiring of competent, highly trained women veterans seeking
positions where they can best used their skill, knowledge and abilities
to serve their sister veterans.
The Center for Women Veterans should be a fertile information,
training and education ground for feeding the best and brightest
nationally to the VA facilities across the country. A full scale Train
the Trainer staff preparing Women Veteran Coordinators to review
problematic Claims issues - like Sexual assault claims, development of
complicated records construction for those who served in Iraq and
Afghanistan whose field records are lost or incomplete, aiding in the
training of Women Veteran Program Managers to do the best possible
outreach and assistance for women veterans, especially for those in
rural areas would bridge many of the the gaps we continue to see in
addressing the needs of women veterans.
Cultural issues in this day and age include ethnic, religious and
regional differences. The rules and regulations that come with
implementation of the Mission Act June 6th are going to have an instant
impact on those already jaundiced by years of constant upheaval
experienced by those impacted by Choice. Rumors are already flying and
the stress level of the third of veterans who reside in rural America -
many of them women - are already over the top. Rural veterans tend to
be isolated and deeply suspicious of the ``next great idea'' being
sprung on them by government.
Many have had a lot of issues with getting providers paid that they
were referred to by Choice - either TriWest or HealthNet. Now, they are
going to have four new entities to deal with and the rumblings,
especially for women who have to get their mammograms and a lot of
specialty gender specific care in the community, are growing.
Every day those of us who deal with women veterans in crisis are
faced with those afraid to go to an exam alone. Many do not have anyone
to take them to appointments or go with them and be there to help them
just be calm. Some are unsafe driving by themselves because they are
stressed beyond measure by an upcoming Compensation & Pension exam (C &
P).
A couple of examples of how outlandish some of these contracted
situations have become:
One of our women vets was instructed to have her C & P for Military
Sexual Trauma (MST) in a Chiropractic Office, another in a Nail Salon.
I repeat, A NAIL SALON!
Service: Women Who Serve, the MST Committee of the Military Women's
Coalition (MWC), the 2019 VA Trailblazers, and Women Veteran Social
Justice (WVSJ) are all recommending hands-on peer support and
assistance for women veterans who are attending VA appointments or C &
P exams by themselves and would like someone to attend with them
through the process.
Another issue is the manner in which women veteran claims for PTSD
or other mental health issues derived from sexual assaults are
adjudicated in favor of women veterans far less often than PTSD for
combat veterans. Following GAO reports highlighting additional
discrepancies due to poor Claims Adjudicator training, those denied
were suppose to be informed and their claims revisited. To our
knowledge, that has yet to occur.
At this point I am not even going to go into legal issues, veterans
family court, transportation, bad VSOs, homelessness, childcare or
decent paying jobs for women who already get paid far less than their
male counterparts - especially women of color. I do thank your
contemporaries in the House Judiciary Committee for the hearing
yesterday on extending the deadline for the Equal Rights Amendment - We
would appreciate Constitutional equality.
The big last issue I will address is women veteran suicide. When
you look at the myriad of barriers women veterans face and how
overwhelming these issues can become, it is no wonder that the thing
someone may see as not so big a deal, is the deal breaker for
continuing to ride this rock around the sun. Over the years, I have
brought only the most serious cases of bad treatment at the hands of
the VA to members of this committee and the members have always come
through and made a difference. Please know that in doing so, you save
lives.
As disabled veteran I have used VA services for many years. The
majority of the time accessing benefits is reasonable and getting
health care is as well. I've had some poor treatment upon occasion, and
make sure the appropriate parties are informed. As an advocate, it's
easier for me, I know the system. We need to make access, continuity
and consistency of care reality for ALL veterans. Thank you for your
time.
Iraq and Afghanistan Veterans of America (IAVA)
Statement of Melissa Bryant
Chief Policy Officer
Chairwoman Brownley, Ranking Member Dunn, and Members of the
Subcommittee, on behalf of Iraq and Afghanistan Veterans of America
(IAVA) and our more than 425,000 members worldwide, thank you for the
opportunity to share our views, data, and experiences on the matter of
cultural barriers impacting women veterans' access to health care.
Support and Recognition of Women Veterans is an incredibly
important part of our work; it is why it is included in our Big Six
Priorities for 2019 which are the Campaign to Combat Suicide, Defend
Veterans Education Benefits, Support and Recognition of Women Veterans,
Advocate for Government Reform, Support for Injuries from Burn Pits and
Toxic Exposures, and Support for Veteran Medicinal Cannabis Use.
I am here today not only as IAVA's Chief Policy Officer, but also
as a former Army Captain and a combat veteran of Operation Iraqi
Freedom. I was a military intelligence officer who led women and men in
combat; but some my most salient memories are from my times leading
troops in garrison, when far too often the true colors of soldiers you
would normally trust in battle would surface. As one of the few, if not
only, women (and especially women of color) officers in my units, I can
point to many an occasion where I helped women soldiers who came to me
for advice and counsel in dealing with harassment in the ranks.
Sadly, I can also point to my own dealings with harassment from my
peers, superior officers, and even soldiers. It was a double burden I
faced when the intersectionality of being a black woman officer would
creep into misogynistic and prejudiced comments made toward me--perhaps
simply because I was a confident leader with a no-nonsense approach to
my work. Now as a veterans advocate, I still hear the misogyny in our
community, from the time I'm asked, ``who is your sponsor?'' at
Department of Veterans Affairs (VA) medical centers to when I'm
referred to as, ``young lady'' by my own veteran colleagues. At best,
it's a casual dismissal of my credentials and expertise to have earned
a seat at the table; at worst, it means just what it sounds like--
flagrant disregard for my service and ultimately an emotional barrier
to care at VA.
Over the past few years, there has been a groundswell of support
for women veterans' issues. From health care access to reproductive
health services to a seismic culture change within the veteran
community, women veterans have rightly been focused on and elevated on
Capitol Hill, inside VA, and nationally. In 2017, IAVA launched our
groundbreaking campaign, #SheWhoBorneTheBattle, focused on recognizing
the service of women veterans, closing gaps in care provided to us by
VA, and finally changing the outdated VA motto to represent ALL
veterans.
IAVA made the bold choice to lead on an issue that was important to
not just the 20% of our members who are women, but to our entire
membership, the future of America's health care and national security.
We continue to fight hard for top-down culture change in VA for the
more than 345,000 women who have fought in our current wars.
The number of women in both the military and veteran communities
has been growing steadily since the 1970s. While more women are joining
the military and are finally given unprecedented roles in combat and
greater responsibilities in leadership, veteran services and benefits
often lag behind. Since 2001, the number of women veterans seeking care
at VA has tripled, but women veterans are also more likely to fall out
of VA health care due to longer wait times and opportunity costs, a
sign that a lack of gender specific services and ease of access is
impacting care for women veterans at the VA.
Despite the ever-growing contribution of women to our national
defense, the American public still does not understand the extent of
our involvement and sacrifice. This lack of understanding not only
impacts our reception when seeking health care from the VA, as I
outlined in my own experience, but throughout our transition home.
Often having faced an unwelcoming culture in the military, the VA can
seem like an equally unwelcoming place to women who are transitioning.
The VA motto does not help. It explicitly excludes women and our
survivors from its mandate, and it reads as outdated: ``To care for him
who shall have borne the battle and for his widow, and his orphan.''
Women veterans are becoming more prominent in American culture
overall, and are stepping up and leading: From the growing number of
women veterans serving in Congress, to the highest leadership positions
among the service branches, veteran and military service organizations,
and other leading groups. Also, as more women veterans step into the
public sphere, our contributions and sacrifices are becoming known and
recognized.
However, every day women veterans enter into VAs nationwide and are
not recognized for our service. Every day, women veterans are looked
past in favor of the familiar image of a man serving in uniform. Until
women veterans are as known and understood as our male counterparts,
IAVA's work will not be done.
For women veterans who choose to seek care at the VA, finding
quality providers who understand the needs of women veterans can be
difficult. While VA has made progress improving women-specific care for
women veterans, including expanding the services and care available
within the VA, there is still much progress needed. Women veterans are
more likely than our male counterparts to seek care in the community,
meaning we are often seen by private care providers that may or may not
understand military service and its health impacts. IAVA's recent
member survey underscores this, as we found that while 70% of
respondents felt that VA clinicians understand the medical needs of
veterans, only 44% felt that non-VA clinicians understood them.
Among IAVA's women veterans, those that self-reported their health
as terrible were more likely to report negative VA experiences and
those with self-reported excellent health were more likely to report
positive experiences with VA health care. These results indicate that
women with more health concerns have worse experiences at the VA, even
though logically they would have larger health concerns than those who
feel their health is excellent. Furthermore, IAVA women veterans aged
31 to 45 were less likely to report a positive experience with the VA
than older women veterans aged 46 to 65. This indicates that the
younger veterans of the post-9/11 generation are the ones struggling
with VA care most - an ominous sign for the future of women's health
care at the VA.
Additionally, women who do seek care at the VA report the quality
and standard of care are not at all uniform. According to the most
recent GAO report on the standards of care of VA medical centers, VA
``does not have accurate and complete data on the extent to which its
medical centers comply with environment of care standards for women
veterans.'' The same report noted a deficiency of 675 women's health
primary care providers as of 2016. This means that these facilities may
not meet basic privacy standards like locked doors, privacy curtains,
and other adjustments to make them feel welcome.
Changing this will require establishing clear standards, training
VA staff to meet these standards, and investing in appropriate
facilities, including women practitioners and doctors who specialize in
women's health. Facilities and providers must regularly be evaluated to
ensure they meet the standards our veterans deserve. The VA, with its
partners, must do a better job of reaching out to women and telling
them about the resources VA has to offer.
This is why in 2017, IAVA worked with Congressional allies on both
sides of the aisle and in both chambers to introduce the Deborah
Sampson Act. This bill called on the VA to modernize facilities to fit
the needs of a changing veteran population, increasing newborn care,
establishing new legal services for women veterans, and eliminating
barriers faced by women who seek care at VA. This bill would also
increase data tracking and reporting to ensure that women veterans are
getting care on par with their male counterparts.
Although the Deborah Sampson Act, the centerpiece of IAVA's She Who
Borne The Battle campaign, was not passed in the 115th Congress, IAVA
is pleased with progress made overall, with key provisions of the
legislation passed or funded in the last two years. These hard-fought
victories included funding to improve services for women veterans, such
research on and acquisition of prosthetics for female veterans,
increased funds for gender-specific health care, women veterans'
expanded access and use of VA benefits and services, improved access
for mental health services, and for supportive services for low income
veterans and families to address homelessness.
Similar to another Deborah Sampson Act provision, the MISSION Act
created a peer counseling program that provided for at least two peer
specialists in patient aligned care teams at VA medical centers to
promote the use and integration of services for mental health,
substance use disorder, and behavioral health in a primary care
setting. The law mandated that the needs of female veterans are
specifically considered and addressed; and that female peer specialists
are made available to female veterans who are treated at each location.
Further, we are pleased that the SUPPORT for Patients and Communities
Act included language that encouraged the hiring of female peer support
counselors, directed VA to facilitate peer counseling for women
veterans and to conduct outreach to inform female veterans about the
program. We urge your Committee to ensure these provisions are carried
out appropriately.
IAVA is also pleased that the Administration recently implemented
another Deborah Sampson Act provision to expand the capabilities of the
VA Women Veterans Call Center to include a text messaging capability.
VA provided testimony in support of this provision during a 2017
hearing on the bill before the Senate Committee on Veterans Affairs,
and we are encouraged that the Department heard our calls for reform.
Women veterans can now text 855-829-6636 to receive answers and
guidance about VA services.
Finally, IAVA is also particularly interested in seeing the results
of the report sought under the FY 2019 Energy and Water, Legislative
Branch, and Military Construction and Veterans Affairs Appropriations
Act that requires the VA to submit a report to Congress on retrofitting
its facilities to eliminate barriers to care for women veterans. That
report was due in March 2019.
While we have seen greater awareness of and progress toward
improving services for women veterans, there is much more we can do.
Toward this goal, IAVA strongly supports passage of the updated Deborah
Sampson Act (S. 514) recently reintroduced by Sens. Jon Tester and John
Boozman. Provisions of the new bill include expanded peer to peer
services, such as the ability for women to receive reintegration
counseling services with family members in group retreat settings,
increased newborn care services, and an increase in spending in order
to retrofit VA facilities to enhance the privacy and environment women
are being treated in, such as privacy curtains and door locks. It also
provides for legal and support services to focus on unmet needs among
women veterans, like prevention of eviction and foreclosure and child
support issues. This must be the year that Congress passes the Deborah
Sampson Act into law.
Beyond care, ensuring women veterans have proper access at the VA
requires addressing the culture problem and harassment at its
facilities. While not only impacting women veterans, harassment at the
VA is a systemic issue that oftentimes happens between patients, in
waiting rooms, and while veterans are checking in or leaving care--just
as it remains a systemic problem in the military, as I have detailed in
my own experiences. It is hard to quantify just how many women veterans
face harassment in or around VA facilities, but according to the VA's
most recent reporting, 25 percent of women veterans faced harassment
from strangers in a VA facility such as lewd comments or catcalling.
And for those women that do experience harassment at VA facilities,
these women are more likely to delay or miss their health care
appointments. Harassment has a very real effect on the physical and
mental health of women veterans and VA must do more to address it.
The VA has implemented some programs to combat sexual harassment in
its facilities but ensuring patients are aware of these programs before
entering the Department's doors and empowering VA staff to intervene in
harassment situations and understand reporting requirements must be a
top priority. This can begin by ensuring that the VA's End Harassment
Campaign is fully implemented and understood across every VA facility
nationwide, a move that will set the overall tone for VA culture. This
public outreach campaign is a starting point for what must be a
continued and robust conversation around harassment at VA facilities.
Thank you for allowing IAVA to share our views. I look forward to
working with the House Veterans' Affairs Subcommittee on Health and its
dedicated Women's Task Force to better remedy the problems discussed in
this testimony.
Biography of Melissa Bryant:
Melissa Bryant is the Chief Policy Officer for IAVA. She leads
IAVA's policy division, overseeing the legislative, research, and
intergovernmental affairs departments. Melissa spearheads the
development of our annual policy agenda and advocacy campaigns in
collaboration with IAVA leadership, and leads IAVA's engagement with
the White House, government departments and agencies, particularly the
Departments of Defense and Veterans Affairs, Veteran and Military
Service Organizations, and advocacy organizations.
A former Army Captain and Operation Iraqi Freedom combat veteran,
Melissa has an extensive record of public service, having served on
both active duty and in the civil service as an intelligence officer
prior to joining IAVA. A plans, policy, and operations expert with 15
combined years of experience in the federal government, she has served
in key leadership positions with the Defense Intelligence Agency, the
Joint Staff, the United States Military Academy, and Army Intelligence.
She was successful in building ``coalitions of the willing'' to advance
operational and strategic objectives while developing and implementing
plans and policy for the defense and intelligence communities.
Melissa is an ROTC Distinguished Military Graduate and holds a
Bachelor of Arts degree in Political Science cum laude from Hampton
University, is an alumna of Howard University School of Law, and also
holds a Master of Arts in Policy Management from Georgetown University.
Melissa is a spokesperson for IAVA, and has been featured several
times on MSNBC with Andrea Mitchell, Katy Tur and others, HLN, in The
Washington DC 100, and more.
PARALYZED VETERANS OF AMERICA (PVA)
Chairwoman Brownley, Ranking Member Dunn, and members of the
Subcommittee, Paralyzed Veterans of America (PVA) would like to thank
you for this opportunity to draw attention to barriers women veterans,
particularly those with catastrophic disabilities, encounter in
accessing health care. VA has made tremendous progress in improving
health care programs and services for all women veterans. But there is
still work to be done, and VA must continue to evolve its facilities,
programs, and services to ensure they can meet the health care needs of
women veterans and keep up with the increasing demand for women
veterans' health care services.
Ingress/Egress
It may come as a surprise to some, but the first hurdle that women
veterans with catastrophic disabilities may encounter could be the
entrance to the VA women's health clinic. Because many of these
locations were established in haste, they did not receive the careful
level of planning necessary to ensure wheelchair users could enter the
facility. For example, the outside entrance to a women's health care
clinic our staff recently visited did not have an automatic door for
patients to use. To complicate matters further, the entrance was not
visible to VA staff so they could not see if a patient outside needed
assistance, nor was there an external bell for the patient to alert
them if they needed assistance. Thus, any patient needing help entering
the clinic would be exposed to the elements until someone came along to
help her. VA must ensure that all women's health clinics are easily
accessible for disabled women veterans.
Accessible Exam Rooms
Accessibility to doctors' offices is essential in providing medical
care to people with severe or catastrophic disabilities, but this is
often the next hurdle a woman veteran may encounter at VA. Some of VA's
exam rooms are too small to accommodate a woman veteran in a wheelchair
and a portable lift. Other rooms may not be big enough for a larger
wheelchair to enter at all. A portable lift would be unnecessary if the
examination rooms had built-in ceiling lifts to hoist a woman veteran
from her wheelchair to the examination table, but many women's health
clinics do not have an installed ceiling lift.
Barriers like these tend to make individuals with severe
disabilities less likely to get their routine preventative medical
care. It's a major concern because wheelchair users face the insidious
health threat of remaining seated at all times. Loss of muscle tone and
diminished circulation cause pressure sores to develop and it is very
important that seemingly minor problems like these be detected and
treated early before turning into major and possibly life-threatening
problems. However, if the patient cannot enter the exam room or be
placed upon the exam table, the physician may be forced to examine the
patient in her wheelchair leaving her at risk of further injury and
diminishing the quality of the exam and any care provided.
Mammography Exams
Some VA medical centers do not have diagnostic equipment to provide
mammograms. For the facilities that do, wait times are excessively long
(two months or longer), or the equipment is inaccessible for women
veterans in wheelchairs, particularly quadriplegics. While there are
mammography machines that allow women with physical disabilities to lay
on an exam table, not every VA health care facility has this type of
equipment. We urge VA to ensure that women veterans have timely access
to mammograms regardless of their disabilities.
Internal Communication Barriers
Some women PVA members have expressed the need for better lines of
communication between their main VA health care providers and those
from other service lines. For example, certain oral contraceptives can
be dangerous to women with spinal cord injuries or disorders (SCI/D)
because they can cause deep vein thrombosis (blood clots) in the legs.
Without specialized training, the prescribing doctor may not understand
that this side-effect poses a significantly greater risk to women with
impaired mobility. Therefore, PVA recommends VA establish clinical
guidelines for the treating physician to follow when prescribing
contraceptives for women with limited mobility issues.
In Vitro Fertilization (IVF)
Last year, Congress passed legislation extending for two more years
VA's ability to offer IVF services to veterans with service-connected
disabilities that result in infertility. Although VA covers certain
therapies for those with service-connected disabilities that result in
infertility, there are gaps in this care that primarily affect female
veterans. For instance, VA does not cover surrogacy or outside donors
for IVF and offers virtually nothing for women who cannot conceive or
carry a child due to their service. Likewise, there has been little
research and attention given to female infertility and the impact of
service on reproductive health from other military-related sources like
toxic exposures from chemicals and burn pits. Permanently providing
procreative services through VA would help ensure that greater numbers
of women veterans are able to have a full quality of life that would
otherwise be denied to them as a result of their military service. We
strongly support H.R. 915, which would make IVF services a permanent
part of the medical benefits package at VA and help female veterans
with SCI/D overcome some of the unique challenges they face in
establishing or growing their families.
Importance of Prosthetics for Women Veterans
Despite the increase in the number of women veterans, the
availability of prosthetic devices that meet their needs versus those
of their male counterparts has been lagging far behind. VA must ensure
that prosthetists and administrators at every level understand women's
prosthetic needs. This understanding is necessary to ensure the
outcomes and satisfaction of women veterans is equal to men in using
their prosthetic aids.
All VA facility leaders must be accountable for meeting women
veterans' standard of care for quality, privacy, safety, and dignity.
To advance the understanding and application of prostheses for women,
VA must include academic affiliates, other federal agencies, and for-
profit industry in their research. Meeting the prosthetic needs of
women veterans can be an opportunity for VA to excel.
Peer-to-Peer Counselors for Women Veterans
PVA supported legislation in the 115th Congress directing the VA
Secretary to employ a sufficient number of peer counselors to meet the
needs of women veterans, particularly to address military sexual
trauma, post-traumatic stress, and those at risk of homelessness. Women
veterans who have been able to access peer-to-peer counseling or
retreats provided through VA reported having a better understanding of
how to develop support systems and access VA and community resources.
Peer counseling programs have been a marked success for participants
who show consistent reductions in stress symptoms and increased coping
skills. Congress should actively work to promote peer-to-peer programs
which time and time again have demonstrable success in helping veterans
during their time of need.
PVA will be hosting a new peer-to-peer event this fall that
celebrates the service of women veterans. Our ``WE Served'' event will
be an all-expenses-paid retreat focusing on the holistic wellbeing of
women veterans with disabilities. This immersive and outcomes-driven
experience will empower 50 disabled women veterans to navigate the
unique challenges of their daily lives and help them flourish.
Attendees will receive education and advice from a host of experts on
whole health practices, independent living, financial security,
nutrition, finding meaningful employment, accessing veterans benefits,
and women's health issues. We hope that this event will be the first of
many similar outreach efforts.
PVA appreciates this opportunity to express our views on the
barriers our women veterans face in accessing health care. It is
important to note that many of the barriers that catastrophically
disabled women veterans face in the VA health care system are just a
prevalent if not worse in the community. Thus, we look forward to
working with the Subcommittee to eliminate these barriers and ensure
full access to VA health care and services for all women veterans.
VETERANS OF FOREIGN WARS OF THE UNITED STATES (VFW)
KRISTINA KEENAN, PAST-COMMANDER
POST 605 BENJAMIN FRANKLIN POST
Chairwoman Brownley, Ranking Member Dunn, and members of the
Subcommittee, on behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and its Auxiliary, thank you for the
opportunity to provide recommendations on how to improve Department of
Veterans Affairs (VA) health care services for women veterans.
VA reports that nearly 492,000 women veterans used the VA health
care system in fiscal year 2017, which was a nearly 150 percent
increase since fiscal year 2003, and these numbers will continue to
increase in years to come. VA has worked to improve the gender-specific
care for this population of veterans, but more work needs to be done.
Women veterans using VA often have complex health care needs that
require specialty care for service-connected conditions such as post-
deployment readjustment challenges, post-traumatic stress disorder due
to war-related trauma and sexual trauma, mental health care, and
substance use disorders - services which, on average, they use at
higher rates and more often than male veterans. The VFW is disappointed
not a single piece of legislation became law in the 115th Congress to
address the needs of women veterans. This must change in the 116th
Congress.
Peer-to-peer support has proven time and again to be invaluable to
veterans and VA. This is why the VFW advocates so strongly for the
constant expansion of peer-to-peer support programs. The VFW urges
Congress to pass legislation to expand these programs for women
veterans, providing them more peer and gender-based one-on-one
assistance from those to whom they can relate and connect. This is
extremely crucial in instances when a woman suffers from a mental
health condition, but especially in instances when she is on the verge
of homelessness. In a VFW survey of women veterans, 38 percent of women
who reported experiencing homelessness also have children. These women
face unique barriers to overcoming homelessness, and frequently
commented on the lack of support from anyone who could understand those
barriers. By providing peer-to-peer support for women with those who
have gone through the same hardships, VA would provide a level of
understanding and trust they desperately need. This is why the VFW
urges Congress to pass H.R. 840, the Veterans Access to Child Care Act,
which would provide access to child care for veterans seeking
employment training who have an income at or below their states'
poverty lines. This would serve as a way to reduce homelessness among
women veterans.
According to VA, the majority of women veterans are assigned to
Designated Women's Health Primary Care Providers (DWHP). VA and its
Center for Women Veterans have worked to increase those numbers, and
the VFW asks Congress to provide VA with the resources they need to
continue expanding outreach for knowledge of and access to providers
with necessary gender-specific specializations. Surveys conducted by
the VFW have found women veterans overwhelmingly prefer to receive
their health care from female primary care providers, and are more
likely to be satisfied with their VA health care experience when they
receive care from these providers. That is why the VFW has urged VA to
allow women veterans to choose the gender of their providers when
enrolling in health care.
While the DWHP program continues expanding and providing above-
satisfactory care to patients, the VFW understands there is still a
need for trained gynecologists within VA. Gynecology is a specialty
that has traditionally been understaffed at VA medical facilities
across the country. While some providers are able to perform certain
gynecological procedures, it is important to increase the number of
doctors trained in the specialization of gynecology.
For women veterans who rely on VA for postnatal care, the VFW urges
Congress to extend the number of days newborn care is covered by VA.
Currently, VA only covers newborn care for seven days. One week is not
enough to provide coverage for critical care that may be necessary in
the first weeks of a child's life--especially in the relatively common
instance of false-positive newborn disease testing--nor is it enough to
ease the new mother of unnecessary stress.
The VFW urges Congress to pass S. 514, the Deborah Sampson Act,
which would expand newborn coverage for veterans who use VA while
receiving maternity care. In addition to expanding this care, the
legislation would provide many other improvements to women veterans'
needs within VA. Some of these improvements include analysis of
staffing needs, the establishment of a women veteran training module
for non-VA health care providers, expansion of legal services for women
veterans, and information to be added to the VA website relating to
women veteran programs.
The VFW applauds VA and Congress for their work to provide more
access to gender-specific health care providers for women veterans.
While overall progress has been made, gender-specific mental health
care is still lacking. In VFW surveys, women veterans have voiced
concerns over what they view as a lack of gender-specific training for
mental health care providers. Congress and VA must work to ensure every
VA medical center has mental health care providers who are well trained
in conditions such as postpartum depression and conditions that stem
from menopause or sexual trauma.
Women service members and veterans have also been found to have an
increased risk for eating disorders, which have serious consequences
for both physical and psychological health as well as high mortality
rates. Some of the risk factors which contribute to women veterans
struggling with eating disorders include military sexual trauma and
combat exposure. As VA continues to meet the needs of women veterans,
it is important that VA establishes a comprehensive program for the
treatment of eating disorders.
The VFW has noticed a much lower utilization and awareness of
benefits among older women veterans compared to their younger
counterparts. In one of the VFW's surveys, we found older women
veterans were less likely to report receiving disability compensation,
but equally as likely to have been injured or made ill as a result of
their military service. Similarly, older veterans were less likely to
report that they use VA health care, but equally as likely to report
being eligible for VA health care. We are also concerned that several
respondents who reported being 55 years old or older believed that they
did not rate the same benefits as their male counterparts, which is an
egregious misperception that must be addressed.
No veteran should be left to wonder what, if any, benefits she is
eligible to receive. Furthermore, it must be clear that women veterans
have earned the exact same benefits as their male counterparts. That is
why the VFW urges Congress and VA to continue improving outreach to
women veterans and conduct targeted outreach to older women veterans to
ensure they are aware of all the benefits and services VA provides.
The VA formulary currently carries all categories of
pharmaceuticals deemed preventive by the U.S. Preventive Services Task
Force. However, VA is not required to comply with the Affordable Care
Act requirement for all private sector insurance providers to cover
preventive care and services without cost-shares.
Cost is a significant barrier for lower income veterans who use VA
health care. There are currently 11 categories of preventive
medications found to be effective by the U.S. Preventive Services Task
Force, such as prescribing aspirin to lower the risk of cardiovascular
disease. Cardiovascular disease is the number one cause of death in the
United States and is highly prevalent among the veteran population.
Additionally, folic acid is recommended for pregnant women to prevent
neural tube defects. It is unjust to require women veterans to pay for
preventive medication to prevent such birth defects. Vitamin D is
another preventive medicine which is often prescribed to prevent bone
fractures, which benefits traumatic brain injury patients with
hindbrain injuries. There is also breast cancer prevention medication
which is useful not just for individuals with a family medical history
of breast cancer, but for Camp Lejeune toxic water survivors who have
been found to suffer from increased rates of breast cancer.
These pharmaceuticals have been found to prevent possible disease
and have shown to be cost-saving. The VFW calls on Congress to swiftly
pass legislation which would eliminate this inequity and ensure
veterans have access to lifesaving preventive medicine.
VIETNAM VETERANS OF AMERICA (VVA)
Kate O'Hare Palmer
Chair, Women Veterans Committee
Good morning, Madam Chairwoman Brownley, Ranking Member Dunn and
distinguished members of the Subcommittee on Health. Thank you for
giving Vietnam Veterans of America (VVA) the opportunity to submit our
statement for the record regarding ``Cultural Barriers Impacting Women
Veterans' Access to Healthcare.''
``By March 1973 and the withdrawal of US troops and the remaining
WACs, an estimated four million people had died in the Vietnam War. For
most returning veterans there was no welcome home. Being heckled and
spat on at the airport was the beginning of their private aftermath.
Women, especially, learned to keep silent about being in 'Nam. Many
just tried to get on with life, careers and families, burying their
inward and outwards scars, shame or pride, horror or honor, all mixed
up with memories of friendships forged and loves found. Many have died
without daring to reveal they served in Vietnam. All believe it changed
their lives, for better or worse, but certainly forever.''--The Women
Who Served in Vietnam BBC 2016
Since 1982, Vietnam Veterans of America has been a leader in
advocacy and championing appropriate and quality health care for all
women veterans. The Department of Veterans Affairs (VA) has made many
innovations, improvements and advancements over the past thirty years.
However, some concerns remain respective of its policies, care,
treatment, delivery mode, and monitoring of services to women veterans.
MEDICAL TREATMENT OF WOMEN VETERANS
VA-eligible women veterans are entitled to complete health care
including care for gender-specific illnesses, injuries and diseases.
The VA has become increasingly more sensitive and responsive to the
needs of women veterans and many improvements have been made.
Unfortunately, these changes and improvements have not been completely
implemented throughout the entire system. In some locations, women
veterans experience barriers to adequate health care, and oversight
with accountability is lacking. Primary care is fragmented. What would
be routine primary care in the community is referred out to specialty
clinics in the VA. Over the last five years the percent of women
veterans using the VA has grown from 11% to 17%, with 56% of OEF/OIF
women Veterans having enrolled in the VA. Their average age of women
veterans using the VA is 48; the age of a Vietnam woman veteran is 72.
VVA will continue its advocacy to secure appropriate facilities and
resources for the diagnosis, care and treatment of women veterans at
all VA hospitals, clinics, and Vet Centers. We ask the VA Secretary
ensure senior leadership at all facilities and all regional directors
be held accountable for ensuring women veterans receive appropriate
care in an appropriate environment. Further, we seek that the Secretary
ensure:
The competency of staff who work with women in providing
gender-specific health care;
That VA provides reproductive health care;
That appropriate training regarding issues pertinent to
women veterans is provided;
That an environment is created in which staff are
sensitive to the needs of women veterans; that this environment meets
the women`s needs for privacy, safety, and emotional and physical
comfort in all venues;
Those privacy policy standards are met for all patients
at all VHA locations and the security of all veterans is ensured;
That the anticipated growth of the number of women
veterans should be considered in all strategic plans, facility
construction/utilization and human capital needs;
That patient satisfaction assessments and all clinical
performance measures and monitors that are not gender-specific be
examined and reported by gender to detect differences in the quality of
care;
That general mental health care providers are located
within the women`s and primary care clinics to facilitate the delivery
of mental health services;
Ensure that sexual trauma care is readily available to
all veterans;
Provide support services for women veterans seeking legal
assistance;
Require VA to report on availability of prosthetics for
women;
That an evaluation of all gender-specific sexual trauma
intensive treatment residential programs be made to determine if this
level is adequate as related to level of need for each gender;
That a plan is developed for the identification,
development and dissemination of evidence-based treatments for PTSD and
other co- occurring conditions attributed to combat exposure or sexual
trauma;
That women veterans, upon their request, have access to
female mental health professionals, and if necessary, use VA outsource
to meet their needs;
That all Community-Based Outpatient Clinics (CBOCs) which
do not provide gender-specific care arrange for such care through VA
outsourcing or contract in compliance with established access
standards;
That evidence-based holistic programs for women's health,
mental health, and rehabilitation are available to ensure the full
continuum of care;
That the Women's Health Service aggressively seek to
determine root causes for any differences in quality measures and
report these to the Under Secretary for Health, Assistant Secretary for
Operations and Management, the VISN directors, regional directors,
facility directors, and providers;
That legislation be enacted to ensure neonatal care is
provided for up to 30 days as needed for the newborns of women veterans
receiving maternity/delivery care through the VA;
That H.R. 840, the Veterans Access to Child Care Act,
introduced by Congresswoman Brownley, is enacted into law.
HOMELESS WOMEN VETERANS
Over the past several decades, we have become increasingly more
vested in the recognition of the situation of homelessness among
veterans. VVA well remembers the time when the VA acknowledged that as
many as 275,000 veterans were homeless on any given night. Currently
the VA cites that the number of homeless veterans has been reduced to
37,878 as reported by the most recent Point in Time count. VVA
recognizes this as a useful tool but doubts that this number is
necessarily a solid number. It is a snapshot: it is impossible to have
on record all veterans who are homeless. Nonetheless, it is a true
indicator that all the energy surrounding the above-mentioned programs
has made a difference. It is undeniable that the number of homeless
women veterans has been climbing; however, collection data on homeless
women veterans is not reliable as indicated in the Government
Accountability Office's (GAO) 2011 report, ``Homeless Women Veterans:
Actions Needed to Ensure Safe and Appropriate Housing.'' The report
also cited some significant barriers to access of housing for homeless
women vets:
They are not aware of the opportunities available to
them;
They don't know how or where to obtain housing services;
They are not easily found/identified in the community;
They often ``couch surf'';
They have children and avoid shelters because of the
safety factor;
They avoid social service agencies for fear of losing
their children to the system;
Some 24 percent of VA Medical Center homeless
coordinators indicated they have no referral plans or processes in
place for temporarily housing homeless women while they await placement
in HUD-VASH and GPD programs;
Nearly two-thirds of VA HGPD programs are not capable of
housing women with children;
The expense of housing women with children is a
disincentive for providers.
VVA believes that the VA's ``plan'' to end homelessness among
veterans is quite ambiguous, and that it needs to address several key
questions: Are women veterans and their needs truly being met by the
programs that exist for them today? What will be done to reach them, to
know them, to meet their needs and provide them a safe environment in
which to address these needs? VVA believes that a coordinated plan
needs to be developed at the local level by the leadership of the
respective VA medical center within its homeless veterans program. The
influx of women in the military - one of every ten soldiers serving in
Iraq is a woman - the female homeless population will only grow, making
the need for additional facilities dedicated to women.
WOMEN VETERANS RESEARCH
Because women veterans have historically been a small percentage of
the veteran population, many issues specific to them have not been
researched. General studies of veterans often had insufficient numbers
of women veterans to detect differences between male and female
veterans and/or results were not reported by gender. Today, however,
women are projected to be more than 12% of the veteran population by
2020 and 15% by 2025.
Vietnam Veterans of America asks the Secretary to conduct several
studies specific to women and that Congress pass legislation to mandate
such studies if the Secretary does not act:
A comprehensive assessment of the barriers to and root
causes of disparities in the provision of comprehensive medical and
mental health care by VA for women;
A comprehensive assessment of the capacity and ability of
women veterans' health programs in VA, including Compensation and
Pension examinations, to meet the needs of women;
A comprehensive study of the relationship of toxic
exposures during military training and service, and the infertility
rates of veterans;
A comprehensive evaluation of suicide among women
veterans, including rates of both attempted and completed suicides, and
risk factors, including co-morbid diagnoses, history of sexual trauma,
unemployment, deployments, and homelessness;
VA evaluation of the integration of services to support
veterans.
CARE FOR NEWBORN CHILDREN OF WOMEN VETERANS
VVA requests that any proposed legislation should include language
to increase the time for neonatal care to 30 days, as needed for the
newborn children of women veterans receiving maternity/delivery care
through the VA. Certainly, only newborns with extreme medical
conditions would require this time extension. VVA believes that there
may be extraordinary circumstances wherein it would be detrimental to
the proper care and treatment of the newborn if this provision of
service was limited to less than 30 days. If the infant must have
extended hospitalization, it would allow time for the case manager to
make the necessary arrangements for necessary medical and social
services assistance for the woman and her child. This has important
implications for our rural women in particular. And there needs to be
consideration given for a veteran's service-connected disabilities,
including toxic exposures and mental health issues, especially during
the pre-natal period, or in cases of multiple births or pre-mature
births. Prenatal and neonatal birthrate demographics (including
miscarriage and stillborn data) would seem to be an important element
herein.
WOMEN VETERANS AND VETERANS BENEFITS
The Veterans Benefits Administration (VBA), and to a lesser extent,
the National Cemetery Administration (NCA), have been less proactive
than the Veterans Health Administration in targeting outreach to women
veterans and in ensuring competency in managing claims filed by women
veterans.
VVA asks the Secretary to ensure:
That leadership in all VA Regional Offices is cognizant
of and kept current on women veterans' issues; that they provide and
conduct aggressive and pro-active outreach activities to women vets;
and that VBA leadership ensures oversight of these activities;
That a national structure be developed within VBA for the
Women Veteran Coordinator (WVC) positions at each VARO;
That VBA establish consistent standards for the time
allocated to the position of WVC based on the number of women veterans
in the VARO's catchment area;
That VBA develop a clear definition to the job
description of the WVC and implement it as a full-time position with
defined performance measures;
That VBA identify a subject matter expert on gender-
specific claims as a resource person in each regional office location;
That the WVC is utilized to identify training needs and
coordinate workshops;
That the WVC have a presence in the local VHA system;
That VBA ensure that all Regional Offices display
information on the services and assistance provided by the Women
Veteran Coordinator with clear designation of her contact information
and office location;
That VBA establish a method to identify and track
outcomes for all claims involving personal assault trauma, regardless
of the resulting disability, such as PTSD, depression, or anxiety
disorder;
That VBA perform an analysis and publish the data on
Military Sexual Trauma (MST) claims volume, the disparity in the claim
ratings by gender, assess the consistency of how these claims are
adjudicated, and determine if increased training and testing are
needed;
That all claims adjudicators who process claims for
gender-specific conditions and claims involving personal assault trauma
receive mandatory initial and regular on-going training necessary to be
competent to evaluate such claims;
That the VARO create an environment in which staff are
sensitive to the needs of women veterans, and the environment meets
women`s needs for privacy, safety, and emotional and physical comfort;
That the National Cemetery Administration enhances its
targeted outreach efforts in those areas where burial benefits usage by
women veterans does not reflect the women veterans' population. This
may include collaboration with VBA and VHA in seeking means to
proactively provide burial benefits information to women veterans,
their spouses and children, and to funeral directors.
WOMEN VETERAN PROGRAM MANAGERS
Women Veteran advocates call for congressional oversight and
accountability during this Congress. We are weary of hearing that the
position of facility Women Veteran Program Managers would be full-time
positions, while in reality, after all this time, this isn't
necessarily true. As a system-wide directive, the VA 2017 Handbook
1330.01, Health Care Services for Women Veterans, defines the
responsibilities of both the VISN and VAMC directors. Additionally,
both WVPM positions are further defined in the VA 2018, Handbook
1330.02 Women Veteran Program Managers.
MILITARY SEXUAL TRAUMA (MST)
Currently, instances of sexual assault in the military must be
reported through the chain of command. The creation of a separate and
independent office to address such crimes would remove barriers to
reporting and provide additional protection and safety for victims.
According to the DoD Sexual Assault Prevention and Response Office
(SAPRO), 71% of survivors of MST are under 24 years old and of lower
rank; whereas just under 60% of assailants are between 20 and 34 years
old and of a higher rank. Military groups are extremely small
communities and when reports of assault must proceed through the chain
of command, it is impossible to guarantee that confidential information
will stay with those who have a `need-to-know'. Additionally, survivors
may fear that their own actions may be cause for punishment. The threat
of retaliation or fear of being reprimanded is enough to silence many
survivors or have them recant their stories. A defined system of checks
and balances is needed to level the playing field.
VVA is aware that this issue is outside the purview of the House
Veterans' Affairs Committee. However, VVA would urge members who sit on
the House Armed Services Committee to join your colleagues in pursing
legislation that reassigns MST complaints by service members and all
alleged perpetrators outside of their immediate chain of command.
Suicide Risk
Suicide has become a major issue for the military over the last
decade. Most research by the Pentagon and the Veterans Affairs
Department has focused on men, who number more than 90% of the nation's
22 million former troops. Little has been known about female veteran
suicide until recently. According to an LA Times article in July 2016,
the suicide rates are highest among young female veterans--for women
ages 18 to 29, veterans kill themselves at nearly 12 times the rate of
non-veteran women. And, according to the Times, among the cohort of
nearly 174,000 veteran suicides in 21 states between 2000 and 2010, the
suicide rate of female vets closely approximates that of their male
counterparts--women vets 28.7 per 100,000 vs 32.1 per 100, 000 male
vets.
VVA would like to thank Congresswoman Brownley for her hard work
and dedication to women veterans, and we thank this Subcommittee for
the opportunity to submit our views for the record.
IN CLOSING
More than 250,000 women served during the Vietnam era worldwide;
eight women are listed on the Vietnam Veterans Memorial here in our
nation's Capitol. The Angels on the Wall listed below served with honor
and made the ultimate sacrifice. Please remember them and all the women
who served during the Vietnam War.
1st Lt. Sharon Ann Lane
2nd Lt. Pamela Dorothy Donovan
Col. Annie Ruth Graham
Mary Therese Klinker
2nd Lt. Carol Ann Elizabeth Drazba
2nd Lt. Elizabeth Ann Jones
Eleanor Grace Alexander
1st Lt. Hedwig Diane Orlowski