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Hearing Transcript on Issues Facing Women and Minorities.

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ISSUES FACING WOMEN AND MINORITY VETERANS

 



JOINT HEARING

BEFORE  THE

SUBCOMMITTEE ON HEALTH

AND THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

OF THE

COMMITTEE ON VETERANS' AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED TENTH CONGRESS

FIRST SESSION


JULY 12, 2007


SERIAL No. 110-33


Printed for the use of the Committee on Veterans' Affairs

 

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COMMITTEE ON VETERANS' AFFAIRS

BOB FILNER, California, Chairman

 

CORRINE BROWN, Florida
VIC SNYDER, Arkansas
MICHAEL H. MICHAUD, Maine
STEPHANIE HERSETH SANDLIN, South Dakota
HARRY E. MITCHELL, Arizona
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
SHELLEY BERKLEY, Nevada
JOHN T. SALAZAR, Colorado
CIRO D. RODRIGUEZ, Texas
JOE DONNELLY, Indiana
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
CLIFF STEARNS, Florida
JERRY MORAN, Kansas
RICHARD H. BAKER, Louisiana
HENRY E. BROWN, JR., South Carolina
JEFF MILLER, Florida
JOHN BOOZMAN, Arkansas
GINNY BROWN-WAITE, Florida
MICHAEL R. TURNER, Ohio
BRIAN P. BILBRAY, California
DOUG LAMBORN, Colorado
GUS M. BILIRAKIS, Florida
VERN BUCHANAN, Florida

 

 

 

Malcom A. Shorter, Staff Director


SUBCOMMITTEE ON HEALTH
MICHAEL H. MICHAUD, Maine, Chairman

CORRINE BROWN, Florida
VIC SNYDER, Arkansas
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
SHELLEY BERKLEY, Nevada
JOHN T. SALAZAR, Colorado
JEFF MILLER, Florida, Ranking
CLIFF STEARNS, Florida
JERRY MORAN, Kansas
RICHARD H. BAKER, Louisiana
HENRY E. BROWN, JR., South Carolina

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JOHN J. HALL, New York, Chairman

CIRO D. RODRIGUEZ, Texas
PHIL HARE, Illinois
SHELLEY BERKLEY, Nevada
DOUG LAMBORN, Colorado, Ranking
MICHAEL R. TURNER, Ohio
GUS M. BILIRAKIS, Florida

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
July 12, 2007


Issues Facing Women and Minority Veterans

OPENING STATEMENTS

Hon. Michael Michaud, Chairman, Subcommittee on Health
    Prepared statement of Chairman Michaud
Hon. 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 R. Turner
Hon. Gus M. Bilirakis, prepared statement of


WITNESSES

U.S. Department of Veterans Affairs:
    Shirley A. Quarles, R.N., Ed.D., Chair, Advisory Committee on Women Veterans
        Prepared statement of Dr. Quarles
    Colonel Reginald Malebranche, USA (Ret.), Member, Advisory Committee on Minority Veterans
        Prepared statement of Col. Malebranche
    Betty Moseley Brown, Ed.D., Associate Director, Center for Women Veterans
        Prepared statement of Dr. Brown
    Lucretia M. McClenney, Director, Center for Minority Veterans
        Prepared statement of Ms. McClenney


Disabled American Veterans, Joy J. Ilem, Assistant National Legislative Director
    Prepared statement of Ms. Ilem
Murdoch, Maureen, M.D., MPH, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, Veterans Health Administration, U.S. Department of Veterans Affairs
    Prepared statement of Dr. Murdoch
Rosenberg, Saul, Ph.D., Associate Clinical Professor of Medical Psychology, University of California, San Francisco, CA
    Prepared statement of Dr. Rosenberg
Wilson, Hon. Heather, a Representative in Congress from the State of New Mexico


SUBMISSIONS FOR THE RECORD

American Legion, Shannon L. Middleton, Deputy Director for Health, Veterans Affairs and Rehabilitation Commission, statement
Brown, Hon. Corrine, a Representative in Congress from the State of Florida, statement
Miller, Hon. Jeff, Ranking Republican Member, Subcommittee on Health, and a Representative in Congress from the State of Florida, statement
Veterans of Foreign Wars of the United States, Dennis Cullinan, Director, National Legislative Service, statement
Vietnam Veterans of America, Marsha Four, Chair, Women Veterans Committee, and John J. Rowan, National President, joint statement
Women’s Research and Education Institute, Susan Scanlan, President, statement


MATERIAL SUBMITTED FOR THE RECORD

Post Hearing Questions and Responses for the Record:

Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance and Memorial Affairs, Committee on Veterans' Affairs, to Hon. R. James Nicholson, Secretary, U.S. Department of Veterans Affairs, letter dated July 26, 2007

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Shirley A. Quarles, R.N., Ed.D., Chair, Advisory Committee on Women Veterans, U.S. Department of Veterans Affairs, letter dated August 2, 2007

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Colonel Reginald Malebranche, USA (Ret.), Member, Advisory Committee on Minority Veterans, U.S. Department of Veterans Affairs, letter dated August 2, 2007

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Saul Rosenberg, Ph.D., Associate Clinical Professor of Medical Psychology, University of California, San Francisco, CA, letter dated August 2, 2007 [NO RESPONSES WERE RECEIVED FROM DR. ROSENBERG]

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Joy J. Ilem, Assistant National Legislative Director, Disabled American Veterans, letter dated August 2, 2007

Hon. Michael H. Michaud, Chairman Subcommittee on Health, Committee on Veterans' Affairs, to Betty Moseley Brown, Ed.D., Associate Director, Center for Women Veterans, U.S. Department of Veterans Affairs, letter dated August 2, 2007

Hon. Michael H. Michaud, Chairman Subcommittee on Health, Committee on Veterans' Affairs, to Lucretia M. McClenney, Director, Center for Minority Veterans, U.S. Department of Veterans Affairs, letter dated August 2, 2007

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, Committee on Veterans' Affairs, to Shannon L. Middleton, Deputy Director for Health, Veterans Affairs and Rehabilitation Commission, American Legion, letter dated August, 2, 2007


ISSUES FACING WOMEN AND MINORITY VETERANS


Thursday, July 12, 2007
U. S. House of Representatives,
Subcommittee on Health,
Subcommittee on Disability Assistance and Memorial Affairs
Committee on Veterans' Affairs,
Washington, DC.

The Subcommittees met, pursuant to notice, at 10:00 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee on Health] presiding.

Present from the Subcommittee on Health: Representatives Michaud and Hare.

Present from the Subcommittee on Disability Assistance and Memorial Affairs: Representatives Hall, Hare, Lamborn, Turner, and Bilirakis.

OPENING STATEMENT OF CHAIRMAN MICHAUD, SUBCOMMITTEE ON HEALTH

Mr. MICHAUD. The Subcommittee on Health will come to order.  I’d like to thank everyone for coming today.  This is a joint hearing with the Subcommittee on Disability Assistance and Memorial Affairs as well.

Today we will examine the U.S. Department of Veterans Affairs (VA) programs regarding women and minority veterans.  The face of the military is changing and so is the face of the veterans' population.  According to the 2000 census, minorities make up over 14 percent of the existing veterans' population.  The population of women veterans is projected to continue to rise from six percent in 2000 to eight percent in 2010 and to ten percent in 2020.

VA needs to consistently evaluate existing programs to address the needs of special groups and make changes when needed.  I further believe that VA should implement new and innovative programs to help close the many gaps that exist today in delivering high-quality, safe healthcare and other benefits and services VA provides.

Service in Operating Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has created growing challenges for the VA in meeting the needs of women and minority veterans as they separate from service.  We know that an unprecedented number of female servicemembers have been routinely exposed to combat or combat-like conditions.  VA reports that the prevalence of potential post traumatic stress disorder (PTSD) among new OEF/OIF women veterans treated at VA has grown from one percent in 2002 to nearly 19 percent in 2006.  Issues such as cultural differences, effective outreach, education, research and delivery of care should be carefully examined in an effort to provide the best possible service to these veterans.

I hope that we will learn how the VA is meeting the needs of these populations, what challenges are on the horizon, and what we can do to provide veterans the best possible care available.

At this time, I would yield to Mr. Lamborn who is the ranking member of the Disability Assistance and Memorial Affairs Subcommittee for an opening statement.

[The statement of Chairman Michaud appears in the Appendix.]

OPENING STATEMENT OF  HON. DOUG LAMBORN, RANKING REPUBLICAN MEMBER, SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

Mr. LAMBORN. Thank you, Mr. Chairman, for recognizing me and I look forward to this hearing with you, with Mr. Hall from New York, with Mr. Turner and everyone else who can join us as we go through this hearing.

I’m glad that we are having this hearing on the challenges facing minority and women veterans.  I welcome our witnesses including my colleague from New Mexico Representative Heather Wilson.  And I thank you all for your contributions to the Veterans’ Affairs system.

America’s minorities and women of our great Nation are integral to the quality of our national security.  Women make up nearly ten percent of our Nation’s 24 million living veterans.  Women on active duty represent more than 15 percent of our armed forces.  According to a 2005 Heritage Foundation study, about 25 percent of military recruits identify themselves as other than Caucasian.  Further, military women are more likely to identify themselves as members of a racial or ethnic group than men.

Our military has a higher percentage of some minorities such as African Americans, American Indians, Native Alaskans and Hawaiians and Pacific Islanders than the percentage of these minorities in the general population.  These men and women are patriots.  In more than two centuries of service to our country, women and minority servicemembers have created a rich legacy.  This legacy has only been enriched by the intrepid and resolute accomplishments of their decedents in the global war on terror.

Our challenge is to ensure that women and minority veterans indeed all veterans receive equal treatment for their qualifying service to our Nation.  The VA Centers for Women and Minority Veterans and the Department's associated Advisory Committees are charged with increasing awareness of VA programs, with identifying barriers and inadequacies in VA programs, and with influencing improvement.

We do not look to these VA programs to merely identify and report, we want them to influence policy and accept a measure of accountability for departmental results.  In that regard, I will, of course, be very interested in hearing today about challenges facing women and minority veterans such as gender specific healthcare.

I want to learn about disabilities more likely to effect minority veterans.  I want to hear about the challenges facing veterans who wish to take advantage of economic opportunities in the public and private sectors.  I will, however, especially want to learn today how the VA and it’s component organizations are effectively rising to meet these challenges.

Mr. Chairman, I yield back.

[The statement of Congressman Lamborn appears in the Appendix.]

Mr. MICHAUD. Thank you very much, Mr. Lamborn.  And now I would like to yield to a gentleman who feels strongly about veterans' issues as well, Mr. Hall who is the Chairman for the Subcommittee on Disability Assistance and Memorial Affairs for an opening statement.

Mr. Hall.

OPENING STATEMENT OF  CHAIRMAN HALL, SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

Mr. HALL. Thank you, Chairman Michaud and Mr. Lamborn.  I always enjoy serving with you on our Disability Assistance Subcommittee.  Good morning, all. 

I would first like to say that I am honored to join Mr. Michaud in co-chairing this hearing and I applaud the leadership he exercises on behalf of our veterans, especially on veterans healthcare issues.  I would also like to thank the witnesses for joining the two Subcommittees this morning for a hearing to examine issues facing women and minority veterans.

This rare joint hearing speaks volumes about how important these issues are to the Committee as a whole.  I look forward to hearing from all of today’s witnesses.  I also want to apologize in advance for the fact that I am double booked in another committee meeting and will have to leave and then come back in a little while so that I can hear as much testimony as possible.  I will read the written testimony that I may miss in person.

Women veterans are the fastest growing segment of the veteran population comprising seven percent of the total veteran population and five percent of those using VA services.  Over 14 percent of veterans are from a racial or ethnic minority group with African Americans comprising the bulk at 9.7 percent according to 2000 U.S. Census figures.  I am certain that the VA does its best to ensure that all veterans encounter no barriers to access and the receipt of veterans' benefits, treatment and services.  However, the fact remains that the barriers in society at large that women and minorities often face might very likely translate into barriers in the smaller VA system.

As such, Congress, in its wisdom, developed both the Center for Minority Veterans and the Center for Women Veterans in 1994 to ensure that these veterans are fully integrated into the VA system.  I look forward to hearing from both Centers as well as their separate Advisory Committees, which developed detailed reports to help inform the policies of the VA for women and minority veterans.  I especially would like to learn the VA’s and the Advisory Committee on Minority Veterans' views on the sunsetting provisions that would end the Advisory Committee in 2009 and what, if any, plans it has to replace this vital organization.

I know that Representative Gutierrez has introduced a bill, H.R. 674, that would prevent this from occurring.  Getting rid of the Minority Veterans Advisory Committee would be a seriously troubling result in light of the recent findings by VA researchers that health disparities appear to exist in all clinical arenas and have a direct impact on the health outcomes for minority veterans.

And lastly, but certainly not least, I welcome my colleague Congresswoman Heather Wilson, the only woman veteran in Congress.  I am sure that all of our witnesses, including our experts and the veterans service organizations will provide critical insight on issues facing women and minority veterans, especially in light of returning OIF and OEF veterans.

Thank you very much and I yield back, Mr. Chairman.

[The statement of Chairman Hall appears in the Appendix.]

Mr. MICHAUD. Thank you very much, Chairman Hall.  Mr. Turner, do you have an opening statement?

OPENING STATEMENT OF HON. MICHAEL F. TURNER

Mr. TURNER. Mr. Chairman, I want to thank both of the Chairmen for our proceeding with this hearing.  This is very important and I want to congratulate and thank Heather Wilson for all of her efforts in Congress, not only to be a strong advocate for veterans in our military, but also to bring her experience to assist us so that we can also better serve.  Thank you.

Mr. MICHAUD. Thank you.  Mr. Bilirakis, do you have an opening statement?

Mr. BILIRAKIS. I’ll submit my opening statement for the record, but I wanted to thank you for having this hearing.  I also want to thank Congresswoman Heather Wilson for her great insight.  And it is just a great subject and we need to concentrate more on minority veterans and women veterans.  Thank you very much.  I appreciate it.

[The statement of Congressman Bilirakis appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  It is my pleasure now to introduce our first panelist, Congresswoman Heather Wilson of New Mexico.  I want to thank you very much for your willingness to come here and give us your expertise and your insight on these very important issues.  Thank you for your leadership as well on these issues.

So without further ado, Congresswoman Wilson.

STATEMENT OF HON. HEATHER WILSON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW MEXICO

Ms. WILSON. Mr. Chairman, thank you.  And thank you very much for having this hearing today and bringing some focus on an issue very important to me. 

Now all of us are concerned about whether the VA healthcare system is meeting the needs of our current generation of veterans, but there is a special subcategory that sometimes I think gets overlooked.  And the fact that you are having this hearing today says that the Congress and this Committee in particular cares about women veterans and whether they are getting the services that they need.

In 1978, I got a one way ticket to Colorado Springs, Colorado, to attend the United States Air Force Academy in the third class with women.  They opened the Air Force Academy to women when I was a junior in high school.  And I got on the bus and went to the base of that big ramp at the front edge of the ramp part range in Colorado and walked up a ramp with huge letters over the top of it that said, “Bring me men.”

It took over 25 years to get that sign taken down.  It is gone now, but some of us as women veterans think that maybe the VA healthcare system is now only experiencing the kind of integration that the military saw 20 years ago because my classmates and the women who went into the military in the 1970s are now starting to retire.  And, we also have women returning from combat zones with healthcare needs that we haven’t seen in previous generations.  So it creates a new challenge for the VA and I appreciate your willingness to look at this.

Currently deployed in Iraq, one in seven Americans deployed in Iraq and Afghanistan are women.  They are doing jobs that in previous generations no women undertook in the military.  And we need to orient our healthcare system towards the needs of both women and men.  Women, frankly, face different obstacles when trying to get care from the VA, their needs are often different.  Whether it is long term, whether the VA is going to be able to deal with the problems, whether it is osteoporosis or obstetrics/gynecology (OB/GYN) care or cancer screening and treatment or mental health issues and how they manifest themselves, they are often different needs.  And we need to make sure that the VA is responsive to those needs.

For example, if you are a veteran and you go to one of the clinics for a problem with PTSD at the VA hospital and they have a support group that is a bunch of guys, is that really where a woman feels particularly comfortable talking about her experiences?  I am not sure I would.  And I am not sure I would turn to the VA for the kind of care.  Likewise, many women veterans do not even call themselves veterans.  It is an interesting phenomena.  But it is only now that women who have served in the military even use that term to describe themselves.  And it is very different from men who have served.  Someone, a fellow woman veteran gave me a tee shirt which I still have and wear from time to time around the house that says on the back of it, “I am a veteran too.”

Getting women to that point where they feel like they are veterans and they feel comfortable calling on the VA healthcare system, that the door is open to them, is a hurdle that we have to get over and the VA has to reach out to women veterans, I believe.  In addition to those kinds of social or psycho-social issues, there is a question of appropriate care.  And while I haven’t seen too many specifics incidences of problems in the VA healthcare system, I certainly had my share of them going through the U.S. Department of Defense (DoD) healthcare system and I can’t imagine that the VA has magically addressed all of these problems without having to kind of go through their own learning curve.

You know, for example, when I was on active duty and they had opened up flight school to women, you had to have a flight physical.  Well a flight physical for women included an OB/GYN exam.  The rules said that a flight physical had to be done by a flight surgeon, but the flight surgeons often times had only done their, you know, their last OB/GYN exam was in medical school and they didn’t like it much when they did it the first time.  So there were rules about how healthcare was to be provided for active duty women that weren’t—there wasn’t a most appropriate way to provide care.  And I believe that those kinds of things probably exist in the VA healthcare system, but were only on the upward curve now with respect to the women that are getting care from the VA because their numbers have been so small, particularly the numbers of women veterans who are also combat veterans.

In the 110th Congress, I have introduced a piece of legislation.  It is a bipartisan commission on wounded women warriors.  We focused a lot in the last year about the VA healthcare system and it’s responsiveness to veterans overall.  And all of us are keenly aware of the problems at Walter Reed and elsewhere on the care of our returning soldiers and veterans, but I think there is a subgroup we also need to look at.  And I introduced this legislation to establish a 12 member bipartisan commission to bring some focus and expertise on this issue, to identify major problems and surface them at senior levels.  The military did this in the 1970s and 1980s and it was very effective at identifying policies that needed to be changed, capabilities and services that needed to be expanded and provided and to better support our women in the military.  And now I need to—I think we need to do a similar kind of thing for women veterans.

Last month during debate on the military construction and VA Appropriations bill for fiscal year 2008, I offered an amendment that was accepted by voice that would devote $2 million from the Administration’s general operations expenses account to the Advisory Committee on Women Veterans.  The intent of that amendment was to provide the funding for a bipartisan commission on wounded women warriors to look at these issues and identify problems and plans to make sure healthcare for women veterans is what it needs to be so that we can adequately meet their needs.

We can’t address the needs of women veterans unless we fully understand the problems.  And I don’t think we are yet fully at the point of fully understanding the problems within the VA healthcare system.  And I think this Congress needs to make sure that we put ourselves on a path to do so.

I thank you very much for holding this hearing today.  And to the extent I can, I would be very happy to answer any questions you may have of me.

Mr. MICHAUD. Thank you very much, Congresswoman Wilson.  Just a quick question, do you get a lot of communication between women veterans that might not go to a male member of Congress that know your experience?  And what has been some of their concerns, if there is anything different than what you have already given in your testimony?

Ms. WILSON. Sure.  I think women sometimes feel more comfortable coming to me and it is I am sure it is—all of us come here with our own stories.  And sometimes people will come where they feel more comfortable or feel somebody will get it.  And so, yes, women veterans do come to me, both New Mexicans and some of the groups nationally or leaders nationally both veterans and active-duty servicemembers.

Some of the kinds of issues is women’s healthcare clinics at VA hospitals.  We have had a problem in some VA hospitals including our hospital in New Mexico where several years ago they wanted to close the women’s healthcare clinic.  For some women being able to walk in and they are, you know, that they have a women’s clinic is kind of important.  Now there are a lot of ways and different models to provide that, but that was an issue.  And it wasn’t just an issue on the appropriateness of healthcare, it was the VA sending a message as to whether we are welcome here, or not, or do they want us to go somewhere else?

And so that is an issue.  I dealt with academy issues with respect to sexual assault, discrimination, those kinds of things come up.  I was very active with Mr. Langevin of Rhode Island when women in Saudi Arabia were being asked to wear the abaya with the Muslim cloak while they were fighting to free the Afghan women from having to wear the burka.  And they were required to wear by DoD policy, and we were able to change that by law.  So, yes, women do come to me.

Mr. MICHAUD. My last question, since there is not a large number of women veterans using VA facilities, trying to look on the fiscal side of the issue, do you think that VA should hire more women staff, or would it be more fiscally responsible to contract out the type of services a woman might need to help women veterans?

Ms. WILSON. I think it is going to depend on the population served and, you know, we have clinics in all over New Mexico that are really quite small.  And it so that a veteran can get primary care and in Truth or Consequences, New Mexico, without having to come all the way to Albuquerque.  At the same time, the availability of services, particularly OB/GYN services in our major VA hospitals, I think is probably an issue.  And the appropriateness of that care, whether it is by a contract doctor or an agreement with one of the universities or direct on-staff hire, and as you all know, the VA has had difficulty filling positions for a variety of reasons over time, but it is an issue of the appropriateness of care.  And frankly, some women prefer to have a women doctor as an OB/GYN.  And even the policy that says for most hospitals now you are a primary provider.  If your healthcare is from a health maintenance organization, I can go to my primary care doctor.  I can also get direct access to my OB/GYN.  I believe that is currently VA policy, but making clear that you can go.  You don’t have to go through another gatekeeper.  You can go directly.  Those kinds of things I think are important to women.

Mr. MICHAUD. Great.  Thank you very much.  Mr. Lamborn?

Mr. LAMBORN. I thank you, Mr. Chairman.  In counting back the years, I think you were leaving Colorado Springs just as I was arriving there, because I moved there in 1987.

Ms. WILSON. I graduated in 1982.

Mr. LAMBORN. Okay.  How prevalent is the problem of women veterans being unaware that their military service qualifies them for VA healthcare?  We are finding that male veterans are many times unaware of the benefits that they are entitled to.

Ms. WILSON. I think you were right, Mr. Lamborn, that there is a problem of awareness of what benefits you are eligible for across the board.  When I left the service, I didn’t retire from the service, I left after seven years as an officer.  I had no clue, you know, that I left without any disability or any problems or anything.  But I think most folks are pretty clueless.  They, you know, we sign off on the forms and go on with our lives and things. 

So I think there does need to be outreach, but there really is a difference and it is starting to change, but women do not think of themselves.  In my generation of women, we don’t call ourselves veterans.  I mean it doesn’t, it didn’t feel comfortable.  It is starting to more, but if you don’t even think of yourself as a veteran, it is unlikely that you are going to walk into the VA and say, “I am a veteran and I want to see if I can get help.”

Mr. LAMBORN. Representative Wilson, you have made reference to that a couple of times now.  Why do you think that is the case?

Ms. WILSON. Because guys are veterans.  You know, it is.  And I don’t, I think, probably for younger women, that is not the case.  I think for our generation of women there is also an association that you are only a veteran if you were in combat.  It is the veterans of foreign wars kind of standard.  I even remember I had an uncle, a World War II veteran, and I was serving in the military.  He is a loveable person and I thought the world of him.  And he arranged for me to be a member of the American Legion Auxiliary, because I thought I should.

Mr. LAMBORN. Okay.

Ms. WILSON. And I was on active duty in the military.  And I thanked him so much and I was a member.  But we didn’t think of ourselves as being necessarily part of the group.

Mr. LAMBORN. Okay.  Thank you.  Now, the VA has brought authority to contract for care of women’s veterans to contract out these services for care.  Do you think non-VA professionals understand the unique needs of women who have served in the military, or are they subject to the same possible issues that the VA is?

Ms. WILSON. The difficulty in the VA is that you are still dealing with a fairly small percentage of the clientele who are women.  So they are not dealing with these issues in large numbers.  I think that one of the areas we do need to look at is combat disabled veterans, and particularly some of the mental health issues that can manifest themselves differently among men and women.  How do women approach mental health issues?  How do they present themselves?  What kinds of therapies are effective?  And I having worked with children, mentally ill children, there are some differences among teens and young adults, men and women and what is affective?  And I think we’re going to need to take a look at that issue.

And we know that there are large numbers of veterans returning with PTSD, acute PTSD as opposed to chronic PTSD, which we saw in the Vietnam cohort or we had been used to dealing with it in the Vietnam cohort.  Do these two populations of women and men respond different, present differently, and what does that mean for the best kind of treatment, whether that is contract or whether that is within the actual VA system.

Mr. LAMBORN. Thank you.  And my last question, to accomplish these goals that we are talking about today, should the VA have women’s clinics?  Should it better integrate women’s healthcare into existing VA clinics or should it enhance the contracting out of care in community settings?

Ms. WILSON. I like the idea of at least some point of presence.  A women’s clinic is a way of reaching out to women in a place particularly for OB/GYN care, cancer screenings, those kind of things, preventative healthcare.  But this was one of the reasons why I think we need a high level commission to focus on things for a while to identify major issues and give us advice as legislators as opposed to all of us taking a wag based on personal experience or what we are seeing in our communities.  Lets get some smart people together to really focus on this.  Call in a lot of women veterans.  It is amazing what they will tell when you turn off the microphones and close the doors and say, “What is really happening?  What works?  What doesn’t work?  What regulations are you facing that are barriers to you?” 

And when we did that with women in the Defense Department, it was amazing.  Some of the stupid rules and regulations that were barriers to women getting care.

Mr. LAMBORN. Well thank you for your answers.  Thank you for your testimony today.  And thank you for all the work that you are doing in this area.  And most of all, thank you for your service to our country.

Ms. WILSON. Thank you very much.

Mr. MICHAUD. Mr. Hare?

Mr. HARE. Thank you, Mr. Chairman.  And thank you so much for coming this morning, Representative Wilson.  I just had a comment, maybe a question.  Well, actually, I was just thinking about what you said about a new generation of women veterans and perhaps that is because we see currently in Iraq, when causalities come, we are seeing a lot of women who are injured and who are losing their lives.  I think it is very unfair to your generation, to our generation of veterans that preceded them that they are somehow forgotten.  In other words, if they haven’t served recently are they really veterans?  I think that is sad.

I guess what I would like to know from your perspective is what can we, and the VA do, to really bring the attention back to the people like yourself who have served honorably?  We have a responsibility, I think, to and I have said this many times to this Committee to all of our veterans irregardless of what branch, irregardless of what their gender is.  What can we do, do you think, to get the VA and to promote the type of benefits for veterans so that they—you know you just said you get women behind a door and you shut off the microphones and they will talk a lot.  What could we do to enhance that and to be able to get more women to be able to understand that there are benefits available, and how to get them?  Because I think it is terribly important that we do this.

Ms. WILSON. A couple of things.  First of all, I think it is important for the Congress as a Congress to establish a commission and say, “Let’s get some smart people and get some recommendations on what legislation and programs we need to support.  I think that is important and it allows us to provide some leadership.

One of the things that is important, and I heard someone slip recently in a position of public prominence, I don’t want to identify them in a speech talking about our men in military.  Our men overseas.

Mr. HARE. Uh huh.

Ms. WILSON. It was the first Persian Gulf War when the lexicon of American public life changed for the first time.  When you heard at that time, General Colin Powell, Brent Scowcroft, the first President Bush, the Members of Congress, for the first time they talked about our men and women in the Persian Gulf.  The military had gone co-ed.  And that was the first Cable News Network (CNN) war really where, you know, America was surprised that we had women helicopter pilots flying into harms way in front of the infantry forces.  It was a major social change.  But we can’t go back, as I and that was just a slip, but I heard it.  And when someone said, “Our men in the military.  Our men in Iraq and Afghanistan.”  Language matters, and people like me will hear that if you say it.

I would also encourage, you there are now, there is at least in New Mexico and I think it is growing national movement.  I look at all the flags behind you and all of us have the Jewish War veterans and the Purple Heart veterans and the American Legion and the VFW that all come to see us and see all of you annually.  There is now a group starting and I think it is nationwide, but a chapter has started in New Mexico of a National Association of Women Veterans.  We have to stand up first for ourselves.  And I would encourage you to reach out to women veterans and ask them to come in and talk to you about what is going on with the VA in your community.

And I am a member of some of those organizations of women veterans and there is an Association of Women Aviators that I am an honorary—well I am an associate member of I guess.  I am not an aviator by profession.  But those kinds of things I think help women to bring our issues to the floor just like the Reserve Officers Association does and make people aware of problems.

So a commission, meet with people, and as leaders be careful to include us.

Mr. HARE. Absolutely.  I am sorry I came in late and I don’t know if you mentioned this in your testimony or not, but do you have any idea of how many women veterans we are talking about think are being underserved or not being served?

Ms. WILSON. In Afghanistan and Iraq, one in seven Americans serving there is a woman.  There have been over two million American women who have served this country in uniform in our history.  Over two million and every single one of them was a volunteer.

Mr. HARE. That is amazing.  Thank you very much.

Mr. MICHAUD. Thank you, Mr. Hare.  Mr. Bilirakis?

Mr. BILIRAKIS. Thank you, Mr. Chairman.  I have one question.  First of all, thank you for your testimony and enlightening us on this issue.  Do you think it would be helpful if we had a program within the VA where women veterans can talk to women veterans and identify with them whether it is outreach, any kind of an issue.  Would you think that would be helpful?

Ms. WILSON. The VA does have an office for women’s veterans that does outreach and so forth, but I actually think it is helpful to facilitate women coming together.  At one time in my deep dark past, I served on the Defense Advisory Committee on Women in the Service after I had left the military but came back.  And one of the great things about those conferences and meetings that we had was women in the military got together and there was cross talk. 

If you are in any group and you were talking about there is what six percent now?  Between six and eight percent of our veterans are women.  That means in any room with 100 people there are only six women.  You are feeling a little isolated in any group.  If you make the effort to pull women together so that you can get cross talk about what is going on in my State, in your State, and the healthcare system and so on, you get good ideas that come out of that and you help to identify problems.

The VA does have an office for women veterans.  I am not sure how much they really bring together in a working group kind of way, those kinds of colloquy to pull together women veterans in a circumstance where they are not out numbered.  And to be able to take our shoes off and say, “So what is going on in your State, because this one is a mess,” or whatever it is.  I think it would be helpful.

Mr. BILIRAKIS. And maybe making sure that we mandate that there is one, at least one person at an out-patient clinic or the VA where the veteran can go to that individual, making sure that that is a women so they feel comfortable talking to them.

Ms. WILSON. There are up sides and down sides to that, which is why I get back to lets pull some people together and make sure the system of care is responsible.  If you created it at one VA hospital the women’s office or the women’s advocate in some ways that says to the rest of the system, “Well, I don’t have to deal with that.  Go down to the women’s office.  Now that is not my job,” as opposed to if you are a cancer specialist or the oncology department has to be taking into account possible screenings for breast cancer and cervical cancer, so integrating into the way the VA does it’s business. 

But I do think that there is advantage, particularly in OB/GYN, care to having systems set up so that women feel as though they are welcome here.  There is a place for —

Mr. BILIRAKIS. Sure.

Ms. WILSON. —and they are not separate but equal or pushed out somewhere else.

Mr. BILIRAKIS. Make sure that there is a women’s counselor there available for them.  Would you agree with that?

Ms. WILSON. Yeah, I would.  But I don’t want to say, “All right, we are going to create a space within the VA for women and this is the women’s office and that is where we deal with that problem because we are the VA, and you know just stay over there.  We have got a little office for you in the closet.”

Mr. BILIRAKIS. Okay.  Thank you very much.  I appreciate it Mr. Chairman.  Thank you.

Mr. MICHAUD. Thank you very much.  And once again, thank you very much, Congresswoman Wilson.  We really appreciate you enlightening us on this particular area.  And thank you for your service not only to your constituents back in your district, but also to your country.  So thank you very much.

Ms. WILSON. Thank you, Mr. Chairman.  I appreciate it.

Mr. MICHAUD. We will now move to our second panel.  And I would ask that the members of the second panel to please come forward.

I would like to thank the second panel.  We have for the second panel Shirley Ann Quarles who is Chairwomen of the Advisory Committee on Women Veterans; Colonel Reginald Malebranche who is a member of the Advisory Committee on Minority Veterans; Saul Rosenberg, who is Clinical Psychologist at the University of California, San Francisco; and Maureen Murdoch who is a VA Medical Center doctor in Minneapolis.

So I want to thank the panelists for coming today.  I look forward to hearing your testimony.  Why don’t we start with Dr. Quarles and work our way down?

Thank you once again for coming here this morning.  Dr. Quarles?

STATEMENT OF SHIRLEY A. QUARLES, R.N., ED.D., CHAIR, ADVISORY COMMITTEE ON WOMEN VETERANS, U.S. DEPARTMENT OF VETERANS; COLONEL REGINALD MALEBRANCHE, USA (RET.), MEMBER, ADVISORY COMMITTEE ON MINORITY VETERANS, U.S. DEPARTMENT OF VETERANS AFFAIRS; SAUL ROSENBERG, PH.D., ASSOCIATE CLINICAL PROFESSOR OF MEDICAL PSYCHOLOGY, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, CA; AND MAUREEN MURDOCH, M.D., MPH, CENTER FOR CHRONIC DISEASE OUTCOMES RESEARCH, MINNEAPOLIS VETERANS AFFAIRS MEDICAL CENTER, MINNEAPOLIS, MN, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS (ON BEHALF OF HERSELF AND NOT VA)

 STATEMENT OF SHIRLEY A. QUARLES, R.N., ED.D.

Dr. QUARLES. Thank you.  Chairman Michaud, Chairman Hall and Members of the Subcommittees.  I am Chair of the Department of Veterans Affairs Advisory Committee on Women Veterans and also a Colonel in the United States Army Reserve.  I am pleased to testify today on behalf of the Department of Veterans Affairs Advisory Committee on Women Veterans regarding our views on:  The Department of Veterans Affairs and how they serve women veterans through it’s current programs; the present and future needs of women veterans, which is a growing population; VA strategies to meet those needs; and outreach efforts that are being conducted on women veterans.

The Advisory Committee was established in 1983 by Public Law 98-160 and charged with advising the Secretary of Veterans Affairs on VA benefits and services for women veterans.  The Committee submits a biennial report to the Secretary about findings and recommendations. 

The Advisory Committee on Women Veterans consists of 14 members, men and women who are mostly veterans.  As a means to obtain information regarding women veterans' services, and programs provided by the VA, the Committee conducts site visits to VA facilities throughout the US.  During the site visits, the Committee tours the facilities, meets with senior leaders, and hosts an open forum for the local women veterans community.  The forum provides an opportunity for open dialog to learn more about women veterans' experiences within the VA, to discuss issues, and for women veterans to raise questions regarding gender specific VA benefits and services.

Another means for the Advisory Committee on Women Veterans to obtain information regarding services provided by the VA is by meeting twice a year at VA Central Office in Washington, D.C.  During these meetings the Committee has briefs from various program leaders.  The Committee also submitted recommendations to the Secretary in their 2006 Report.  The Committee made 23 recommendations that addressed mental health, outreach, research, strategic planning, training, women veterans health program, and women veterans health program managers and coordinators and homeless women veterans.

One recommendation that has already been implemented is the organizational realignment of the Women Veterans Health Program Office to Strategic Healthcare Group.  This recent realignment elevated the Women’s Health Program Office and provided it an opportunity to gain more expertise in the area of women’s health.

To address a strategy as it relates to VA meeting the present and future needs of women veterans, the Committee was able to witness first hand the need to provide mental healthcare during a site visit at Palo Alto VA Women's Center for Mental Health.  Another strategy that the Committee recommends for future needs is through research studies.  Research studies were recommended in both the 2004 and 2006 Advisory Committee on Women Veterans Reports.

Also there is a current national survey that is being conducted to address the knowledge gap we have regarding women veterans.  The final findings for this national survey will be submitted December of 2008.  As it relates to outreach, the Advisory Committee on Women Veterans 2004 Report recommended that materials such as brochures, pamphlets, booklets, and fact sheets be published in both English and Spanish languages. 

The Committee also encourages increased partnership with the Federal, State, county agencies, and national veterans service organizations.  Additionally, the Committee plans to participate in the upcoming 2008 National Summit for Women Veterans.

The Advisory Committee on Women Veterans is grateful to the VA and to the Center for Women Veterans for taking care of our women veterans of yesterday, today, and the future. 

This concludes my formal testimony.  I will be pleased to answer any questions.

[The statement of Dr. Quarles appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  Colonel?

Dr. QUARLES. Thank you.

STATEMENT OF COLONEL REGINALD MALEBRANCHE, USA (RET.)

Colonel MALEBRANCHE. Chairman Michaud, Chairman Hall, and Members of the Subcommittee, I am indeed honored to represent the Chairman of the Advisory Committee on Minority Veterans and give you our views on the services provided by the Department of Veteran Affairs.

Pursuant to Public Law 103-146, the Committee is tasked with assessing the needs of the minority veteran population and reporting back to the Secretary on the effectiveness of the programs and services at meeting those needs.  The Committee works in close coordination and collaboration with the Center for Minority Veterans and relies on the expertise of the Center for current information about VA programs, policies, and services.

In it’s 2006 report on the Greater Los Angeles Healthcare System, the Committee made 11 recommendations with the key issues being outreach, research, staff diversity, and seamless transition.  During its visit to the Los Angeles Ambulatory Care Center, the Committee was dismayed by the staggering number of homeless veterans.  Twenty-three percent of the 90,000 homeless population in Los Angeles were reported to be veterans.  The Committee was encouraged though by the range of programs identified by VA for homeless veterans, yet the Committee was concerned that these programs may not reach the targeted audience.

Outreach is a major challenge for the VA.  At the town hall meeting, the Committee learned that the major issue was that minority veterans were unaware of their VA benefits and other VA services available.  Transportation to VA Centers in major metropolitan, rural and isolated areas is an impediment for minority veterans.  Accessibility, affordability, and distances to VA Centers are major problems affecting minority veterans.

Much remained to be accomplished in the area of outreach.  The Committee recognize that is not simply a VA issue.  Several of its members have taken the mantle to assist the VA in its quest to reach out to minority veterans.

Access to care is another challenge for VA.  The plight of Alaskan natives and other minority veterans living in rural and isolated areas cannot be ignored.  The challenge for VA is to develop and implement innovative programs which target those minority veteran populations.  Rural and remote areas in Alaska and the Navajo Nation may be good targets to test rural health initiatives.  VA could enter into a reimbursable agreement with Alaska natives organizations, Health and Human Services, and the Indian Health Service to reach out to minority veterans and provide all the services which fall within the realm of VA.

The Committee applauds the strides made by VA in expanding its telehealth and telemedicine programs and its ability to reach a significant number of the minority veteran population.

Mental health is and will become a major challenge.  The Committee recognizes the efforts and the programs put forth by VA to support, identify, and care for service personnel who serve and are serving in OEF and OIF.  The early identification of post traumatic stress disorder will certainly help in the observation and treatment of veterans who served in those areas.  Yet, the  Committee is concerned that the same level of services might not be readily available to minority veterans who have served in prior conflicts.

Electronic health records are another part that we need to develop and embrace all services personnel with VA.  The processing and adjudication of benefits seem to affect all veterans and to make them aware of their entitlements.  The Veterans Claim Assistant Act of 2000 puts the onus on VA to maximize its assistance to all veterans. 

Senior staff diversity remains an issue at VA.  The absence of minorities at the senior staff level has been, and continues to be, noticeable during site visits.  Data presented and subscribed by VA suggest that VA’s problems is limited to recruiting white females and Hispanic females, yet all the data maintained at VA suggested that minorities were not well represented at senior staff levels.

The professionalism, the expertise shown by VA personnel was striking.  There was a perception that most staff would endeavor to do anything or everything for a veteran.  The challenge is to include minority veterans in that equation and that philosophy.

Sir, I thank you for this opportunity to address the Subcommittee.  And I would be happy to answer any questions.  Thank you very much.

[The statement of Colonel Malebranche appears in the Appendix.]

Mr. MICHAUD. Thank you very much, Colonel.  Dr. Rosenberg?

STATEMENT OF SAUL ROSENBERG, PH.D.

Dr. ROSENBERG. Thank you both Chairmen and the Committee for inviting me this morning.  I am Dr. Saul Rosenberg.  I am a clinical psychologist.  I did my very first clinical training at the Ann Arbor VA and it has stuck with me ever since.  I currently teach and supervise interns in residence at the San Francisco VA, which is associated with University of California, San Francisco (UCSF) where I am on the faculty.  I am not currently on the faculty or receive salary from the VA.  So I am, I would say, independent of the VA and a friend of the VA.

My interest is in mental health and what the needs are for screening returning troops, when troops screen positive what kind of diagnostic assessments are conducted, and what kinds of treatment recommendations are made, and how can we follow up treatments to make sure that the veterans are getting the most affective treatments.

So we can start with screening.  The DoD, and with the VA and the Deployment Center, have started the use of pre- and post-deployment questionnaires, which is a wonderful innovation.  Soldiers coming back are filling out brief questionnaires regarding exposure to combat, regarding symptoms of PTSD, regarding possible exposure to roadside bombs and improvised explosive devices (IEDs).  The returning soldier then has an interview with a primary care physician who goes over the form, and from that interview a determination is made whether they need to go on to more intensive evaluation and treatment.

My colleagues at  UCSF and the San Francisco VA recently completed a nationwide epidemiological study of veterans returning from Iraq.  They studied over 100,000 veterans in VA healthcare facilities all across the country.  They found a high prevalence of mental disorders.  Mental disorders that fit the criteria of the diagnostic and statistical manual of the American Psychiatric Association were about 25 percent and about five percent had psycho-social and social relational problems.

So almost a third of this sample had diagnosed mental disorders.  Now these disorders were not based on just the screening form, they were based on the actual diagnosis.  There have been reports about the prevalence of PTSD based on the screening form and so it is important to note the difference.  This was an actual diagnosis.

The sample, I think, was pretty representative of women and racial groups.  And one of the positive things about the study is that they did break their results down by racial groups.  A simple recommendation that I would make that would help us understand better the needs and the treatment outcomes of women and minorities is to ask researchers to include gender and a description of race, education, and marital status, all of those variables, when they are doing research so that we have an opportunity to look and see if in fact there are differences.  Oftentimes you will see reports in the literature in which there is no comment at all about race or gender as if everyone is the same.  Researchers should be aware of that.

A related point is that the assessment of mental disorders requires a clinician to do an interview and often benefits from psychological test, which is my area of expertise.  Now psychological tests have often been developed on a white middle-class population.  And so psychologist know, and the American Psychological Association has put out papers on this topic, that there needs to be more what is called culturally sensitive and culturally competent assessment.  Having an individual of this same race interview and test a veteran is a proxy in a way for that cultural sensitivity.  What we care about is does the interviewer or the doctor, the evaluator is that person capable of empathizing with the experience of the person that they are evaluating?  And more particularly, do they know anything about the values and preferences of that person?  Particularly if that person comes from another culture.  So there has been a move within