May212013
Hearing Transcript on Healing the Wounds: Evaluating Military Sexual Trauma Issues.
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HEALING THE WOUNDS: EVALUATING MILITARY SEXUAL TRAUMA ISSUES
JOINT HEARING BEFORE THE SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS AND THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON VETERANS' AFFAIRS U.S. HOUSE OF REPRESENTATIVES ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION MAY 20, 2010 SERIAL No. 111-79 Printed for the use of the Committee on Veterans' Affairs
U.S. GOVERNMENT PRINTING OFFICE For sale by the Superintendent of Documents, U.S. Government Printing Office
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CORRINE BROWN, Florida |
STEVE BUYER, Indiana, Ranking |
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Malcom A. Shorter, Staff Director SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
SUBCOMMITTEE ON HEALTH
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. |
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C O N T E N T S
May 20, 2010
Healing the Wounds: Evaluating Military Sexual Trauma Issues
OPENING STATEMENTS
Chairman John J. Hall, Chairman, Subcommittee on Disability Assistance and Memorial Affairs
Prepared statement of Chairman Hall
Hon. Doug Lamborn, Ranking Republican Member, Subcommittee on Disability Assistance and Memorial Affairs
Prepared statement of Congressman Lamborn
Hon. Michael H. Michaud, Chairman, Subcommittee on Health, prepared statement of
WITNESSES
U.S. Department of Defense, Kaye Whitley, Ed.D., Director, Sexual Assault Prevention and Response Office, Office of the Under Secretary of Defense for Personnel and Readiness
Prepared statement of Dr. Whitley
U.S. Department of Veterans Affairs:
Bradley G. Mayes, Director, Compensation and Pension Service, Veterans Benefits Administration
Susan McCutcheon, R.N., Ed.D., Director, Family Services, Women's Mental
Health and Military Sexual Trauma, Office of Mental Health Services, Veterans Health
Administration
Prepared statement of Mr. Mayes and Dr. McCutcheon
Benedict, Helen, Professor of Journalism, Columbia University, New York, NY, and Author, The Lonely Soldier: The Private War of Women Serving in Iraq
Prepared statement of Ms. Benedict
Disabled American Veterans, Joy J. Ilem, Deputy National Legislative Director
Prepared statement of Ms. Ilem
Iraq and Afghanistan Veterans of America, Sergeant Jennifer Hunt, USAR, Project Coordinator
Prepared statement of Sergeant Hunt
RAINN—Rape, Abuse, and Incest National Network, Scott Berkowitz, President and Founder
Prepared statement of Mr. Berkowitz
Service Women's Action Network, Anuradha K. Bhagwati, Executive Director
Prepared statement of Ms. Bhagwati
Society for Women's Health Research, Phyllis Greenberger, President and Chief Executive Officer
Prepared statement of Ms. Greenberger
SUBMISSIONS FOR THE RECORD
American Legion, Denise A. Williams, Assistant Director for Health Policy, Veterans Affairs and Rehabilitation Commission, statement
American Urological Association, Beth K. Kosiak, Ph.D., Associate Executive Director, Health Policy, statement
American Veterans (AMVETS), Christina M. Roof, National Deputy Legislative Director, statement
Brown, Hon. Henry E. Brown, Jr., Ranking Republican Member, Subcommittee on Health, statement
MATERIAL SUBMITTED FOR THE RECORD
Post-Hearing Questions and Responses for the Record:
HEALING THE WOUNDS: EVALUATING MILITARY SEXUAL TRAUMA ISSUES
Thursday, May 20, 2010
U. S. House of Representatives,
Subcommittee on Disability Assistance and Memorial Affairs,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.
The Subcommittees met, pursuant to notice, at 10:05 a.m., in Room 334, Cannon House Office Building, Hon. John Hall [Chairman of the Subcommittee on Disability Assistance and Memorial Affairs] presiding.
Present from Subcommittee on Disability Assistance and Memorial Affairs: Representatives Hall, Donnelly, Rodriguez, Lamborn, and Miller.
Present from Subcommittee on Health: Representatives Michaud, Snyder, and Perriello.
OPENING STATEMENT OF CHAIRMAN HALL
Mr. HALL. Good morning, ladies and gentlemen. Welcome to the House Committee on Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs in a joint session with the Subcommittee on Health for a joint hearing on Healing the Wounds: Evaluating Military Sexual Trauma (MST) Issues.
Would you all please rise and join me in the Pledge of Allegiance.
[Pledge was taken.]
Mr. HALL. Thank you.
We will try to expedite this hearing because there is, at 11:00 a.m., a mandatory break for the address to the Joint Session of Congress by the President of Mexico, President Calderon.
I am grateful today to have the opportunity to conduct this hearing, Healing the Wounds: Evaluating Military Sexual Trauma Issues, with my colleagues, Ranking Member Lamborn; the Health Subcommittee Chair, Mr. Michaud; and Mr. Brown, the Ranking Member of the Health Subcommittee, and am especially enthusiastic to recognize the men and women veterans who are in this room today, and am looking forward to hearing about their experiences with MST.
The purpose of this hearing today is to evaluate ways in which the Veterans Benefits Administration (VBA), the Veterans Health Administration (VHA), and the U.S. Department of Defense (DoD) can better address veterans who are impacted by military sexual trauma or MST and to identify and better prevent, treat, and properly compensate them.
MST refers to sexual harassment and sexual assault that occurs in military settings, often in a setting where the victim lives and works, which means that the victims must continue to live and work closely with the perpetrators.
MST can also disrupt the career goals of many victims as perpetrators are frequently peers or supervisors responsible for the decisions on work-related evaluations and promotions. This means the victims must choose between continuing their careers at the expense of frequent contact with their perpetrators or ending their careers in order to protect themselves.
Many victims shared that when they do report an incident, they are not believed or they are encouraged to keep silent because of the need to preserve organizational cohesion.
The National Center for Posttraumatic Stress Disorder (PTSD) of the U.S. Department of Veterans Affairs (VA) reports that in 1995, DoD conducted a large-scale study of sexual victimization among its active-duty population. This DoD study found that the rates of attempted or completed sexual assault were six percent for women and one percent for men.
Another study found that rates of sexual assault and verbal sexual harassment were higher during wartime than peacetime in their sample study population. This suggests that the stress of war may be associated with increases in rates of sexual harassment and assault.
The National Center for PTSD also reports that the rate of MST among the veteran population who use the VA health care system appears to be higher than that of the general military population.
One study found that 23 percent of female users of the VA health care system report having experienced sexual assault while in the military.
MST has been a concern among many veterans who have continually expressed frustration with the disability claims process, especially in trying to prove to the VA that the assault ever happened.
For many women and men, when their disability claims for PTSD are related to MST and are denied, they suffer a secondary injury, resulting in an exacerbation of PTSD symptoms and, thus, they are less likely to file an appeal.
We cannot allow these things to continue to happen to our Nation's veterans who have served so bravely and both VA and DoD need to ensure that the proper treatment is available.
Veterans should be able to access treatment facilities and qualified staff with care and benefits delivered by employees who are properly trained to be sensitive to MST-related issues. These veterans need to be treated with the dignity and respect that they deserve.
I look forward to hearing from our esteemed panels of witnesses today and now yield to Ranking Member Lamborn for his opening statement.
[The prepared statement of Chairman Hall appears in the Appendix.]
OPENING STATEMENT OF HON. DOUG LAMBORN
Mr. LAMBORN. Thank you, Mr. Chairman.
And I, too, welcome our witnesses to this important hearing to discuss matters concerning military sexual trauma. Occurrences of sexual assault with the ranks of our military are totally and completely unacceptable. It distresses me to think that anyone who volunteers to protect our Nation through service in the Armed Forces would ever have to contemplate much less experience being harmed by a fellow servicemember.
But our military is a microcosm of society and crimes that occur in society unfortunately also occur in the military. So we must face reality and address the problems that arise.
First, it should be made clear through training at every level and to every servicemember that sexual offenses will not be tolerated and that perpetrators will be punished to the fullest extent under the Uniform Code of Military Justice.
Second, the military services should follow through and ensure that justice is rendered in cases involving sexual assault.
I would also add that the military must thoroughly investigate and prosecute false accusers of sexual assault who unfortunately detract from the plight of those who really are victims of sexual assault.
While it is important that we deliberate on the very serious topic of military sexual trauma, I want to also make very clear that this is not an indictment of our military as a whole. The vast majority of the men and women who volunteer for military service are honorable and patriotic individuals who courageously stand to defend our country and other countries from tyranny. They are some of our bravest citizens who abhor the type of individuals who would commit such a repugnant crime as sexual assault.
As far as this topic pertains to VA benefits, I believe the Department has appropriate rules in place for adjudicating and rating sexual trauma cases, but I will be listening for ways that we can possibly improve on the existing system.
I want to thank all of our witnesses for their participation and their testimony and I look forward to our discussion today.
Mr. Chairman, I yield back. Thank you.
[The prepared statement of Mr. Lamborn appears in the Appendix.]
Mr. HALL. Thank you, Mr. Lamborn.
Mr. Michaud?
Mr. MICHAUD. Thank you, Mr. Chairman.
Due to the President of Mexico addressing the joint session, I would ask unanimous consent that my opening remarks be submitted for the record so that we can begin hearing from the panels.
Mr. HALL. Without objection, so ordered.
Mr. MICHAUD. Thank you.
[The prepared statement of Chairman Michaud appears in the Appendix.]
Mr. HALL. Other Members, would you agree to submit written opening statements so we can go to the witnesses? Thank you so much. So ordered.
I would also like to recognize Megan Williams from the Disability Assistance and Memorial Affairs staff who is leaving to go to graduate school in Switzerland and to thank her for her work for the Subcommittee.
The first panel who I will now invite to join us at the witness table is Phyllis Greenberger, Chief Executive Officer (CEO) and President of the Society for Women's Health Research, and Helen Benedict, Professor of Journalism at Columbia University, and Author of the book, The Lonely Soldier: The Private War of Women Serving in Iraq.
Welcome, both of you, and your full written statements are entered in the record. You will have 5 minutes each to give oral testimony starting with Ms. Greenberger.
You are now recognized.
STATEMENTS OF PHYLLIS GREENBERGER, PRESIDENT AND CHIEF EXECUTIVE OFFICER, SOCIETY FOR WOMEN'S HEALTH RESEARCH; AND HELEN BENEDICT, PROFESSOR OF JOURNALISM, COLUMBIA UNIVERSITY, NEW YORK, NY, AND AUTHOR, THE LONELY SOLDIER: THE PRIVATE WAR OF WOMEN SERVING IN IRAQ
STATEMENT OF PHYLLIS GREENBERGER
Ms. GREENBERGER. Thank you.
Mr. Chairman and Members of the Subcommittees, I want to thank you for calling this joint hearing on such an important and timely topic.
As said, I am Phyllis Greenberger, CEO of the Society for Women's Health Research, and we are a nonprofit patient advocacy organization dedicated to improving women's health through advocacy, education, and research of sex and gender differences.
The Society focus is on sex and gender differences and research needs to be done to explore conditions that affect women differently, disproportionately, or exclusively and to identify those differences and understand the implications for diagnosis and treatment.
The pressing issues that bring us here today are the risks and ramifications of military sexual trauma or MST. MST victims are disproportionately, as you know, and almost exclusively women.
A 2008 VA study reported that 15 percent of military women in Iraq and Afghanistan experience sexual assault or harassment and 59 percent of those were at higher risk for mental health problems. This is just among those cases reported. Many more, possibly more than half of all MST cases go undocumented each year.
The ramifications of MST for women persist long after the initial assault. While sexual assault in any setting is horrific, the combined insult of MST occurring while serving in a foreign setting, often in an active war zone, only exacerbates the effects.
By VA estimates, over 70 percent of women in the military have been exposed to combat. Further, with most MST assaults being orchestrated by military personnel against military personnel, the environment of trust among those serving is broken and a chain of command that fails to protect from and respond to MST further degrades unit cohesion.
Research in the area of MST and sexual assault has revealed some interesting sex-based differences. First, women are more likely than men to contract a sexually transmitted infection or STI. STIs are more difficult to treat in women and can have emotional and mental impacts over a woman's life span. Sexual assault can result in an unplanned pregnancy or, conversely, leave a woman unable to bear children in the future.
The impacts of MST are not limited to reproduction. Infection with the human papillomavirus after a sexual assault can result in cancer decades later.
Second, sexual assault is a common trigger for post-traumatic stress disorders months and even years after the attack. Scientists are finding that women do not respond the same to some of the common medications prescribed for PTSD, often faring worse than men taking the same medication for the same diagnosis.
Third, multiple traumas can increase the likelihood of developing PTSD and the combined impacts of working in a war zone, multiple deployments, MST, and for a disproportionate share of female military members exposure to early life trauma all raise the risk for an eventual PTSD diagnosis.
Females in the military have twice the level of PTSD and depression as their male counterparts.
Fourth, research suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels and can vary based on where she is in her menstrual cycle and whether or not she uses medications that alter hormone levels such as birth control.
The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST and may further help discover more effective PTSD therapies for women, therapies that are responsive to sex-based hormonal differences.
More research is critical for moving forward and determining targeted treatments for women and men.
The VA in 2010 is in a unique position to better serve its female veterans at the same time becoming a leader in women's health and sex-based research. Changes in care can only come from sound research and investments in VA research often translate into new knowledge, methods, screenings, and treatment for women and men, military and civilian.
The VA system faces staffing, organizational, and infrastructure challenges when updating to meet the needs of the growing female veteran population. Reports as recent as March 2010 still found deficiencies in the availability of resources for female veterans.
From providing gender-specific care at all VA medical centers to including female subjects in the VA's health services research and development, the VA system with proper support and resources hopefully can transform what is needed today and what is needed for the future.
The VA needs to optimize its interactions with female veterans by offering women the option to participate in research projects. The health information technology capabilities that link all VA medical centers and each veteran's medical and personnel charts offers unmatched capabilities for research.
Further, increasing collaboration between the DoD and the VA would additionally offer an improved continuum of care as women transition from active duty to veteran issues. Clearly there is a need for more investments in the VA and sex-based research and we hope that these recommendations will be acted upon quickly.
I encourage the VA and these Committees to consider the potential impact of appropriate research into women's health and the wide-reaching results that can improve sex-based research as well as mental and sexual health for all.
I want to thank you again for this opportunity to present to the Subcommittees and I would be pleased to answer any questions.
[The prepared statement of Ms. Greenberger appears in the Appendix.]
Mr. HALL. Thank you, Ms. Greenberger.
And I would now recognize Professor Benedict.
Ms. BENEDICT. Hello, Mr. Chairman. Thank you very much, Members of the Subcommittees, for honoring me with the chance to testify.
For 30 years, I have been writing about sexual assault culminating in my book, The Lonely Soldier, about military sexual assault.
First, I would like to commend the Caregivers and Veterans Act signed by President Obama just last month. It was an essential step toward helping female veterans. This Act addresses the horrendous problem of military sexual assault by requiring the VA to train mental health professionals to care for women with sexual trauma. This is progress. Yet, I am concerned that the training be done properly.
For my book, I interviewed more than 40 female veterans of our current wars and studied many other surveys. Too often they told me that when they tried to report an assault, the military and the VA treated them as liars and malingerers. A woman who reports a sexual assault should never be treated as a criminal.
They also told me that their sexual assault response coordinators assigned to help them by the military often treated them with such suspicion that they felt retraumatized and intimidated out of pursuing justice.
Indeed, the usual approach to a report of sexual assault within the military is to investigate the victim, not the perpetrator, and to dismiss the case altogether if alcohol is involved.
It is, therefore, essential that the counselors used by the military and the VA be trained in civilian rape crisis centers away from the military culture that habitually blames the victim and that is too often concerned with protecting the imagine of a platoon or commander by covering up wrongdoing.
These counselors and, indeed, anyone within the military charged with investigating sexual assault should be trained to understand the causes, effects, and costs of sexual abuse to both the victim and society.
Within the VA, reform is also needed. The process for evaluating disability caused by military sexual assault needs to be automatically upgraded and victims who were too intimidated to report an assault while on active duty should never be denied treatment once they come home as they so often are now.
The VA needs to recognize the fact that some 90 percent of victims, according to the DoD, never report assaults within the military because its culture is so hostile to them.
The VA must also recognize and address the fact that it can take years to recover from sexual assault.
In light of the new Caregivers Act, I also want to alert this Committee to the finding that many of our troops were sexually or physically abused long before they enlisted.
In two studies of Army and Marine recruits conducted in 1996 and 2005 respectively, it was found that half the women and about one-sixth of the men reported having been sexually abused as children, while half of both said they were physically abused.
This means that close to half our troops may be enlisting to escape violent homes. Thus, we need to provide counselors trained not only in military sexual assault but in childhood abuse and trauma. These counselors should be available to active-duty troops and veterans. They should be imbedded with the combat stress counseling teams already deployed.
This is necessary not only to help troops cope with multiple traumas of childhood and military sexual assault, as well as combat trauma, but to help prevent further sexual violence. Psychologists have long known that an abused boy can grow into an abusive man.
Finally, let us recognize that more effective than any rules or laws is the attitude of the commander on the ground. Studies have shown that commanders who treat their female soldiers with respect and insist that other soldiers do likewise reduce sexual persecution. Thus, we must reform the culture within officer academies which at the moment is rife with brutal hazing, abuse, and rape as the scandals at Tailhook, Aberdeen, and the Air Force Academy have too long demonstrated.
This violence drums women out of the service and trains men to enact and condone rape and torture.
All officer training schools for all military branches should teach their candidates to understand that rape is an act of anger, hatred, and power, not desire, and that sexual persecution destroys camaraderie and cohesion.
Officers should learn to take pride in ensuring their troops are safe from disrespect and violence from their comrades just as they take pride in bringing them home safely from war.
Thank you.
[The prepared statement of Ms. Benedict appears in the Appendix.]
Mr. HALL. Thank you, Professor.
And to both of our witnesses, thank you. Your complete written statements are a part of the record.
Chairman Michaud and I spoke about the time situation before and if there is no objection from Members of the Subcommittees, we would like to submit our questions in writing and for the record and move on to the second panel so that we can try to hear as many witnesses as possible.
Is there objection to that? Without hearing any, thank you to our witnesses on the first panel. And we will submit questions to you in writing and you are now excused.
And we will move to our second panel, Scott Berkowitz, President and Founder of the RAINN, Rape, Abuse, Incest National Network; Joy J. Ilem, Deputy National Legislative Director of the Disabled American Veterans (DAV); Jennifer Hunt, Project Coordinator, Iraq and Afghanistan Veterans of America (IAVA); and Anuradha K. Bhagwati, Executive Director, the Service Women’s Action Network (SWAN).
Welcome, all of you, again. As you know, your full written statements are made a part of the record, so you each have 5 minutes starting with Mr. Berkowitz.
STATEMENTS OF SCOTT BERKOWITZ, PRESIDENT AND FOUNDER, RAINN—RAPE, ABUSE, AND INCEST NATIONAL NETWORK; JOY J. ILEM, DEPUTY NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; SERGEANT JENNIFER HUNT, USAR, PROJECT COORDINATOR, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; AND ANURADHA K. BHAGWATI, EXECUTIVE DIRECTOR, SERVICE WOMEN'S ACTION NETWORK
Mr. BERKOWITZ. Mr. Chairman, thank you for inviting me today.
My name is Scott Berkowitz. I am the President of RAINN which is the Nation’s largest anti-sexual violence organization. We run the National Sexual Assault Hotline, which is a partnership of about 1,100 local rape crisis centers across the country. We also run an online hotline and do public education.
When I first testified to Congress on this issue about 6 years ago, a DoD task force had just published an exhaustive study. Unfortunately, at the time, that was a fairly common occurrence and about a dozen commission reports that preceded it had had very little impact.
But this report had a different ending. It helped lead DoD to step up its efforts and I think it has resulted in some tangible progress. That is certainly not to say that the problem has been solved—in fact, we are a long way from that, as reporting and prosecution rates remain too low and too few victims reach out for help. But, at last, we are headed in the right direction.
To put the problem in some context: in one sense, the military is not at all unique. About 80 percent of all rape victims are under age 30 and so the problems faced by the military are very similar to those faced by large universities, as both have disproportionately young populations.
Rape is the most violent and traumatic crime that a victim lives to remember. The long-term mental health effects can be devastating, leaving victims at higher risk for PTSD, depression, substance abuse, and many other issues. Embarrassment and shame are almost universal among victims.
In the civilian world, these reactions help explain why victims are so reluctant to report their attack to police, or even to their own friends and family. While the civilian reporting rate is going up, still about six out of every ten victims do not report to police.
Now, add to this mix that in the military, filing an unrestricted report, the kind that can actually lead to a prosecution, will mean that everyone on base knows. Add in the fear of being ostracized, and the impact it might have on your career, and it is clear why so many victims remain reluctant to report.
Of course, there is no single, simple solution. But there are a few lessons from the civilian world. One is that much research has shown that victims who receive prompt care and crisis intervention return to full strength much more quickly and, very importantly, they are ultimately much more likely to report their attack to law enforcement and to follow through with prosecution.
Of course, more reports to law enforcement means many more prosecutions and more prosecutions leads directly to fewer assaults. Rapists are serial criminals. We are talking about a relatively small group who are committing a large number of crimes. And so every time we can convince just one more victim to come forward, leading to just one more successful prosecution, we are potentially preventing dozens of rapes.
So how do we get more victims to come forward? The guarantee of confidentiality is one big piece. I think DoD has made some good progress on this score, with the introduction of restricted reporting, which has already encouraged more than 3,000 victims to come forward, about 15 percent of whom later decided to pursue prosecution.
Still, the safety of a restricted report is incomplete. For example, DoD has determined that some State mandatory reporting laws for medical personnel in California, for example, supersede the protections victims enjoy under restricted reporting. And I think that is an issue that needs some Congressional study.
Also, victims to date have not had the guarantee of privileged communications with military victim advocates, as is the case in most States, though I understand that DoD is in the process of implementing that change.
Another vital part of the solution is to make use of the extensive civilian services available, such as the National Sexual Assault Hotline and local rape crisis centers. These services offer the confidentiality that victims desire and deserve while still advancing the military’s goal of encouraging more victims to report their attack to law enforcement. They are by no means a replacement for military-based services, but they are, I think, a bridge to such services.
While time constraints limit the recommendations I can share today, I do want to touch on issues of leadership and prevention.
Without sincere buy-in from leadership, evidence that zero tolerance means zero tolerance, any prevention efforts will absolutely fail. And so DoD leadership needs to continue to find ways to ensure that the commanders who take this seriously are recognized and rewarded, and that recalcitrant commanders are identified and reformed by training when possible, by the threat of poor performance ratings when necessary.
In this process, we need to ensure that commanders do not fear that an increase in rape reports on their base will be held against them. In fact, such an increase will most likely be a sign that what they are doing is working, that a higher percentage of victims are coming forward and reporting, which is good news. And so that should be reflected in their evaluations.
I would like to add just one quick point about internal DoD management. I have heard reports that DoD is considering moving its sexual assault programs to be under its domestic violence programs. While that might seem efficient on paper, I think doing so has the potential to de-emphasize sexual violence and seriously hamper prevention and victim service efforts.
Now that we have started to make real progress fighting sexual violence in the military, I think it would really be the wrong time to backtrack by conflating two very different issues.
Thank you.
[The prepared statement of Mr. Berkowitz appears in the Appendix.]
Mr. HALL. Thank you, Mr. Berkowitz.
Ms. Ilem, you are now recognized.
Ms. ILEM. Thank you.
Chairman Hall, Chairman Michaud, and Members of the Subcommittees, thank you for inviting DAV to testify at this joint hearing focused on improving treatment and disability compensation policies for veterans with conditions related to military sexual trauma or MST.
This hearing takes on a topic that is very personal and sensitive to many servicemembers, veterans, and the respective departments that are responsible for the safety and well-being of their members.
In most cases, MST profoundly changes the lives of those affected. For these reasons, all VHA patients are screened for history of sexual trauma and treatment is available for MST-related conditions at VA medical facilities.
We acknowledge VHA for providing clear and concise information about MST on its Web site and in its written materials and, most importantly, information on how and where veterans can get help.
It is clearly noted in these materials that service-connection is not required for eligibility for this treatment. However, if a sexual assault is not officially reported during military service, establishing service-connection for a related condition can be extremely difficult.
An area of special concern for DAV relates to collaboration between DoD’s Sexual Assault Prevention and Response Office or SAPRO and VHA. Current DoD policy allows servicemembers to file restricted or unrestricted reports of sexual assault.
In the case of a restricted report, the servicemember opts to forego an investigation but does have the right to have an official record of the incident created, receive a forensic medical examination, and access to medical and mental health treatment as necessary.
Obviously these records are critical to substantiating a disability compensation claim through VBA. For this reason, DAV is concerned that VBA policy manuals appear to lack any reference to SAPRO in obtaining documentation from restricted DoD MST reports.
In reviewing VA’s testimony from this morning, it appears that their collaboration with SAPRO has been focused more on the VHA side of the house and related more to health care providers and treatment issues.
It is my understanding that VBA and SAPRO officials have spoken about the issue, but we are not aware that an official policy, process, or Memorandum of Understanding is currently in place or being developed to secure restricted MST reports.
Once a claim is filed, VBA has a number of standard sources that it examines for records to support these types of claims. It does not appear, however, that these reports are archived in the individual’s military personnel or medical records for purposes of confidentiality. And we have been unable to confirm if VBA unofficially searches for restricted reports as an alternative evidence source for information to substantiate a veteran’s claim.
We also have questions with respect to where the forensic sexual assault examination form and subsequent mental health treatment records related to a restricted MST report are archived by each military branch and for how long.
We ask that VBA provide the Subcommittees with any information it has in reference to materials for claims developers and raters that reflect collaboration with SAPRO and guidance on how to obtain supporting MST documentation from each military service branch including any differences in records retention, security, or disposal policies.
Establishing service-connection for related MST is important including financial stability, increased access to VA health care, but most meaningful for most MST survivors, being rated service-connected for disabilities attributed to the trauma represents validation that the event occurred, expresses gratitude for their service to their country, and recognizes the tribulations they endured while serving.
One of DAV’s central purposes is to aid veterans in obtaining fair and equitable compensation for their service-related disability. In this particular area, however, many of our national service officers report they are deeply frustrated at the routine occurrence of MST claims being denied for lack of evidentiary documentation.
It seems to DAV that the agencies responsible for preventing, monitoring, and reporting on MST and providing related benefits and health care services should work in concert to lower the burden associated with the claims process for these veterans and ensure that both servicemembers and veterans are fully assisted by the government in securing the benefits they deserve and have earned.
If VBA does not have a policy in place to secure restricted MST reports and related medical records, we believe this issue can be resolved internally by the respective agencies through an MOU or some other mechanism if they simply agree to work together to address the issue.
Again, we appreciate the Subcommittees’ interest in this area and efforts to identify ways to improve access to benefits and health services related to military sexual trauma. And we thank you for the opportunity to testify.
[The prepared statement of Ms. Ilem appears in the Appendix.]
Mr. HALL. Thank you, Ms. Ilem.
Ms. Hunt, you are recognized now for 5 minutes.
STATEMENT OF SERGEANT JENNIFER HUNT, USAR
Sergeant HUNT. Good morning.
Chairmen, Ranking Members, and Members of the Subcommittees, on behalf of IAVA’s 180,000 members and supporters, I would like to thank you for giving us the opportunity to testify.
Healing the Wounds: Evaluating Military Sexual Trauma is a critically important topic. The issue of sexual assault has deeply affected IAVA membership, the military and veterans community as a whole, and me personally.
I would like to point out that my testimony today is on behalf of IAVA and does not reflect the views and opinions of the United States Army.
My name is Jennifer Hunt and I am a Sergeant in the Army Reserves. I have served two tours in Iraq and Afghanistan. In Iraq, I earned a Purple Heart when my Humvee was struck by a roadside bomb causing shrapnel injuries to my face, arms, and back.
I also serve as my unit’s designated victim advocate as part of the Army’s Sexual Assault Prevention and Response Program. While I am proud to serve in this position, I sincerely hope that my duties as a victim advocate are ones I will never have to perform, but I am ready should the need arise to provide any support necessary to the victim. I know firsthand how frustrating that the healing process can be having experienced sexual assault as a civilian myself.
Unfortunately, the reality is that servicemembers have been coping with significant and under-reported sexual assault and harassment in the military for years. Even in a war zone, troops cannot escape the threat of sexual assault. While sexual assault disproportionately affects female troops, large numbers of male servicemembers have been victimized as well.
While the number of reported assaults are alarming, they grossly underestimate the severity of the issue. According to the military, only 20 percent of all unwanted sexual contact is reported to a military authority. We must find ways to encourage more victims to report sexual assault and harassment. More importantly, we must make it so that there are no more victims of military sexual trauma.
Despite the urgency of this issue, it has taken decades for the military and the VA to finally respond. In recent years, both Departments have taken commendable steps. The military has introduced a restricted reporting option that can encourage more victims to seek care. It also completed its long-awaited review of the issue by the Defense Department Task Force on Sexual Assault in the Military Services.
For its part, the VA began universally screening all veterans seeking care at the VA for MST in 1999 and every VA facility has a designated MST coordinator who serves as a point person for these issues. The VA provides free treatment to any veteran experiencing health conditions related to MST. However, as is the case with other VA health care, not all veterans have access to the care that they deserve.
These steps are an improvement over the years of inaction, but more must be done. Victims deserve the very best treatment and support that we can provide.
In the interest of time, I would like to concentrate on our top recommendations for how the Subcommittees can best address this important issue. You can also find our recommendations in our written testimony that was submitted to the Subcommittees and our IAVA issue report on women warriors available at our Web site.
First, the VA must do a better job of advertising its MST programs. According to one IAVA member, she did not know until 3 years after returning from a deployment that the VA provided sexual trauma counseling. In her words, it is well hid and not talked about at the VA.
Even the U.S. Government Accountability Office (GAO) had problems locating information about the VA’s MST program. According to the GAO, the VA’s Web site did not provide a complete list of facilities that have MST-related treatment programs.
IAVA believes that no victim should have to chase after their own care.
Second, the VA must expand availability of its specialized sexual trauma treatment in inpatient settings. Less than ten percent of all VA medical centers offer inpatient mental health treatment for veterans that have experienced MST or other traumas. This is simply unacceptable.
IAVA recommends that every Veterans Integrated Service Network (VISN) should offer at least one inpatient setting specializing in care for MST victims.
Finally, the VA must ensure that these victims have access to preferred treatment settings and providers. Victims should not have to settle for mixed-gender treatment options because there are no facilities with separate programs for males and females in their area.
According to the GAO, only nine of 153 medical centers nationally have residential treatment programs specifically for women suffering from mental health injuries.
This problem is also evident in outpatient treatment programs. According to another IAVA member being treated for MST-related conditions, it is difficult to go to appointments when you have a full-time job and there are not enough VA counselors to care for all of us returning veterans on consistent basis.
These recommendations are urgent and IAVA encourages you to work with the rest of your colleagues in Congress to help make them happen. Sexual assault is a violation of military values, values that I hold dear. It undermines the professionalism, the morale, the unit cohesion, and the effectiveness of our men and women in uniform.
Sexual assault is also a crime, a crime that has gone on for far too long with too little done to stop it. These victims need justice. They need our support and they need the proper care for their trauma.
I am here today on behalf of them all to issue you a call to service in their support. Again, I thank you for the time that you have given me to testify in front of this Committee today and I look forward to any questions that you might have.
[The prepared statement of Sergeant Hunt appears in the Appendix.]
Mr. HALL. Thank you, Ms. Hunt, and thank you for your service to our country and to our veterans.
Ms. Bhagwati, you are now recognized.
STATEMENT OF ANURADHA K. BHAGWATI
Ms. BHAGWATI. Good morning, Mr. Chairman and Members of the Subcommittees. My name is Anuradha Bhagwati and I am a former Marine Corps Captain and Executive Director of Service Women’s Action Network or SWAN.
SWAN’s policy work this year focuses largely on reforming DoD and VA’s sexual assault and harassment policies and educating the public about the epidemic known as MST.
SWAN’s testimony is based on the collective input of over 120 MST survivors, MST crisis intervention works and VA health providers. My own experience filing an equal opportunity investigation for sexual harassment and discrimination in the Marine Corps, and experiences with both VHA and VBA corroborate the input of my colleagues and fellow veterans below.
Unlike the civilian world, MST survivors do not have the option of quitting their jobs. They are often stuck working with, nearby, or under the supervision of their perpetrators. There is simply no guarantee that the chain of command will support survivors if they come forward.
Commanders have consistently ignored equal opportunity and sexual assault policies in order to maintain their personnel at full capacity. Additionally, commanders have very little incentive to prosecute perpetrators as documented incidents in their units reflect poorly on their leadership performance and reputations.
MST survivors who report an incident are likely to face isolation, retribution, or accusations of lying, irresponsibility, or impropriety. There is no guarantee of anonymity from the chain of commander or victims’ advocates and survivors are likely to face the horror of retribution from perpetrators and the anguish of being a target of public ridicule, scorn, and further harassment in their respective units.
We cannot honestly expect people to come forward to report and it is irresponsible for us or for DoD to suggest that survivors do so without guaranteeing their protection first. DoD’s failure to protect our servicemembers ought to be the subject for a separate set of hearings as there is far too much to say here.
Suffice it to say that without third-party civilian oversight of sexual assault and harassment cases, survivors will continue to be punished, taunted, isolated, or intimidated by their commands for speaking out and perpetrators will in most cases go unpunished.
MST survivors universally describe the horrors of using VA medical centers nationwide. Triggers of one’s assault or harassment are everywhere from the prospect of running into your perpetrator, to being surrounded by male patients who routinely engage in sexual harassment of female patients, to being improperly treated by staff members who have no knowledge about the unique experience of sexual trauma in a military setting.
One survivor said to SWAN, I do not want to be fending off advances when I am raw from dealing with my issues in therapy.
Survivors universally say that if they had health insurance, they would definitely use private health care instead of the VA.
Many veterans are ignored, isolated, or misunderstood at VA facilities because their PTSD is not combat related. The veterans community still primarily considers PTSD to be a combat-related condition to the great detriment of MST survivors.
Survivors who have used the VA routinely say they are fed up with being given endless prescription medication. One Iraq veteran described the experience of her MST treatment as nothing but pills and pep talks. Many survivors wish they had access to yoga, massage therapy, acupuncture, and gender-specific MST support groups.
I strongly recommend that the Committee give MST survivors the option of fee-based care for all treatment, not just MST treatment. At the same time, VHA cannot be let off the hook. VA medical centers ought to have separate facilities for women patients generally and easy, safe, and direct access to MST treatment areas for both male and female MST survivors.
With respect to MST residential treatment programs, it appears that most MST patients and even many VA providers do not know that these programs even exist. Among patients who have attended, several have experienced sexual harassment by staff or fellow patients.
Also, several programs are collocated with mixed-gender veterans’ programs in which MST patients are not guaranteed privacy or safety from other patients of the opposite sex. VA needs to invest in separate facilities for MST programs and guarantee the safety and welfare of all participants.
Filing for disability compensation for MST is universally considered a traumatic, agonizing, and cruel experience. Many survivors describe the process of rewriting one’s personal narrative for a VA claim and being rejected by VBA as just as traumatic as the original rape or harassment.
VA claims officers nationwide have proven themselves entirely inept when dealing with MST claims. Claims are routinely rejected even with sufficient evidence of a stressor and a corroborating diagnosis from a VA health provider. Many survivors’ claims are rejected outright because of VBA’s lack of knowledge about sexual violence in general.
This Committee needs to understand that until it is safe to report sexual assault or harassment in the military, the majority of incidents will not be reported. This bears directly on the unrealistic and biased nature of VA claims against veterans living with MST. VA must make up for DoD’s failure to protect its own by awarding just compensation to survivors.
Another equal protection issue features prominently in MST issues. The do not ask, do not tell policy has allowed perpetrators to routinely abuse gays and lesbians who would otherwise report harassment or assault. Society has yet to measure the mental health impact of this insidious policy on our Nation’s lesbian, gay, bisexual, and transgender veterans. We must guarantee access to quality health care for all veterans regardless of sexual orientation or gender identity.
I must add a special note for our older MST survivors, our mothers, fathers, and grandparents who suffered at the hands of fellow servicemen decades ago. Much of their trauma continues to be unrecognized by VA or society.
One Vietnam era veteran who described MST to us told us please help me feel validated before I die. Please honor and validate her service and her life by fixing this broken system now.
Thank you.
[The prepared statement of Ms. Bhagwati appears in the Appendix.]
Mr. HALL. Thank you, Captain, for your testimony and for your service to our country and to our veterans.
We will, as with the prior panel, submit questions to you. If you would be so kind as to answer them in writing, and you are excused with our heartfelt thanks for your testimony, which we will be working seriously to address. So this panel is excused.
And we would like to call our third panel including Kaye Whitley, the Director for Sexual Assault Prevention and Response Office (SAPRO), the Office of the Under Secretary for Personnel and Readiness, U.S. Department of Defense, accompanied by Clarence Johnson, Acting Deputy Under Secretary for Plans, Office of the Under Secretary for Personnel and Readiness, DoD; Bradley G. Mayes, Director of Compensation and Pension Service, Veterans Benefits; Susan McCutcheon, R.N. and Ed.D., Director of Family Health and Women’s Mental Health and Military Sexual Trauma Services, Veterans Health Administration, U.S. Department of VA, accompanied by Rachel Kimerling, Ph.D., Director, Monitoring Division of the National Military Sexual Trauma Support Team of the Veterans Health Administration at the VA; Patty Hayes, Ph.D., Chief Consultant, Women Veterans Health Strategic Health Care Group of the Veterans Health Administration, U.S. Department of Veterans Affairs.
Welcome, all of you, and your complete statements are made a part of the record.
Dr.. Whitley, you are now recognized for 5 minutes.
STATEMENTS OF KAYE WHITLEY, ED.D., DIRECTOR, SEXUAL ASSAULT PREVENTION AND RESPONSE OFFICE, OFFICE OF THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE; ACCOMPANIED BY CLARENCE JOHNSON, ACTING DEPUTY UNDER SECRETARY OF DEFENSE FOR PLANS, OFFICE OF THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, U.S. DEPARTMENT OF DEFENSE; BRADLEY G. MAYES, DIRECTOR, COMPENSATION AND PENSION SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND SUSAN MCCUTCHEON, R.N., ED.D., DIRECTOR, FAMILY SERVICES, WOMEN'S MENTAL HEALTH AND MILITARY SEXUAL TRAUMA, OFFICE OF MENTAL HEALTH SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY RACHEL KIMERLING, PH.D., DIRECTOR, MONITORING DIVISION, NATIONAL MILITARY SEXUAL TRAUMA SUPPORT TEAM, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND PATTY HAYES, PH.D., CHIEF CONSULTANT, WOMEN VETERANS HEALTH STRATEGIC HEALTH CARE GROUP, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS
STATEMENT OF KAYE WHITLEY, ED.D.
Ms. WHITLEY. Thank you.
Chairman Michaud and Chairman Hall, Ranking Members Brown and Lamborn, and Members of the Subcommittees, thank you for inviting me today to discuss the progress the Department of Defense has made in recent years on caring for victims of sexual assault.
The reason for our commitment is clear. Sexual assault levies a tremendous human toll, disrupts lives, and destroys the human spirit. In the military, it destroys unit cohesion and affects military readiness.
And as I say at eac
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