Testimony Presented by Linda Spoonster Schwartz RN, MSN, DrPH Associate Research Scientist Yale University School of Nursing Chair VA Advisory Committee on Women Veterans before House Veterans Affairs Committee Subcommittee on Veterans Benefits April 13, 2000
Mr. Chairman I am Linda Spoonster Schwartz RN, MSN, DrPH, an Associate Research Scientist at the Yale University School of Nursing. I am medically retired from the United States Air Force and have the honor to Chair the VA Advisory Committee on Women Veterans. I would like to thank you for holding this hearing on HR 3998 and for asking me to testify this morning. I would also like to thank Congressman Lane Evans and Congresswoman Shelley Berkley for taking the initiative to introduce this legislation to amend Title 38 of the US Code Section (USC) 114 (k) and 38 Code of Federal Regulations (CFR) Section 3.350 (a) to include a Special Monthly Compensation K-award for veterans who have survived radical or modified radical mastectomy of one or more breasts. As you know, the VA Advisory Committee on Women Veterans in our 1998 Report to Congress first recommended this change. The Advisory Committee was authorized by Congress in 1983 to assess the needs of women veterans with respect to compensation, health care, rehabilitation, outreach and other benefits and health care programs administered by the Department of Veterans Affairs. Additionally, the Committee was empowered to make recommendations for change and entrusted with the responsibility to evaluate these activities and report progress to the Congress in a biennial report. From that time to this, Committee members and advisors from all walks of life and all parts of this Nation have collaborated to improve the status of services and programs and assure that women veterans receive quality and gender specific care in a safe and secure environment. The members of the Committee were unanimous in this recommendation because we felt the outcome of radical or modified radical mastectomy results in the loss equal to those enumerated under the "Special Monthly K award. Further the Committee felt this recommendation was in keeping with the spirit and intent of the existing law which also authorizes an additional compensation for, among other things, the loss of both buttocks, loss of sense of smell as well as the loss of loss of use of one or more extremities. The tenor of the present language to the law is one of compassion and concern for a veteran who has sustained an anatomical loss or loss of one of the vital senses. Our discussion today raises a new challenge to the way in which the VA does business. Let me be clear, this is not confrontational, it is in fact another juncture for VA to rethink its policies from the standpoint of America’s 1.2 million women veterans. This is not the first nor will it be the last time advocates for women veterans will encounter policies, regulations, or legal barriers, which constrain VA ability to respond to women veterans. We can appreciate the interpretation of these laws and regulations for compensation some that were codified long before women were an integral part of our Armed Forces. However DOD and VA sources now confirm that women constitute the fastest growing population of VA eligible veterans in America. There is no question that changes to the VA system will continue to evolve as the needs of veterans – man and women emerge in this new age of military technology and the toxic environments of today’s warfare. In this case, the Veterans Benefits Administration of the VA did not concur with the recommendation on mastectomies. Congress now has the opportunity to rectify a small but important aspect of existing law. It is the Committee’s position that radical and modified radical mastectomies involve a loss comparable to those presently covered by Title 38 and should qualify for the "Special Monthly Compensation K Award". For women, the outcome of these procedures frequently results in sever physical disfigurement which necessitates major reconstructive surgery and/or the use of prosthetics. In the case of a modified radical mastectomy, the entire breast and some of the underarm lymph nodes are removed. With a radical mastectomy, there is an extensive removal of the entire breast, axillary lymph nodes and the chest wall muscles under the breast. The surgery was once very common but because of disfigurement and side effects it is now rarely performed. Post-operatively, women may have temporary or permanent limitation of the use of the arm and shoulder. Numbness of the upper inner arm may also occur because the nerve controlling the sensation in that area travels through lymph nodes which may have been removed. Removal of lymph nodes carries a risk of lymphedema a swelling and inflammation of tissue which may extend to the entire upper extremity. In addition to the loss of physical integrity, the loss of a breast to a woman is the loss of an identifying feature, a secondary sex characteristic and a part of her persona as a female. Mastectomy and the post-operative treatment for cancer can also precipitate premature menopause and infertility. Because women have more breast cells than men do, breast cancer is more common in women. The American Cancer Society estimates that women have 100 times more breast cancer than men do. Especially striking is the ACS report that one out of 3,000 American women who are pregnant report a diagnosis of breast cancer. Breasts are also an important part of the maternal – child relationship. VA Reports note that there are an increased number of eligible women veterans of childbearing age using health care services. Thus, we see that these dynamics pose real questions about the role breasts have in the reproductive/creative process. In addition to the question of breast-feeding and the ability to nurture a newborn, several factors may place a woman at higher risk for sexual problems following a mastectomy. There is the question of the loss of body image that comes with the loss of a breast and how that affects the ways in which a woman views herself and her body- her self-esteem, her hopes and fears and her place in society. There is the question of sexuality and how she will relate to her partner and express love physically and emotionally. There can be no question the losses sustained by women who have radical and modified radical mastectomies is immense and has far reaching consequences for the veteran and her family. The proposed legislation signals a new challenge to the VA Women Veterans Advisory Committee and the Congress. In the past we have had to come to the Congress to assure privacy, adequate physical examinations and sexual trauma counseling for women veterans. Today, we deliberate on the question of mastectomies and challenge the status quo. We, which says the aftermath of radical and modified radical mastectomies is as devastating as the loss of an extremity, that the loss of a breast constitutes the loss of a vital part of the creative process and the loss of a breast is a major destruction of the physical integrity of the body of a veteran. I have attempted to clarify the reasoning that went into the Advisory Committee’s deliberations in making this recommendation. I, like several members of the Committee, am a Registered Nurse and have had the experience of caring for women who have had radical and modified radical mastectomies. The pain, sense of loss and great struggle that confronts a woman recovering from these surgeries does not have to be explained to us. I hope that I have been able to adequately convey the physical and emotional consequences experienced by women who survived these surgeries and that this information is sufficient for the Committee to act favorably on the proposed legislation. As more women look to the military for careers, issues like the question of mastectomies will continue to arise. In this particular case, the VA did not concur with the thinking of the Advisory Committee. However through the process of our Report to Congress, we were able to bring the problem to another forum for consideration. This is indeed democracy in action. I believe it is the context in which the Congress meant the Advisory Committee to function. Nevertheless, I would be remiss if I did not say that the 1998 VA Advisory Committee Report to Congress is our last. The authorizing legislation, which required the Secretary of Veterans Affairs to forward our reports to Congress, has been superceded by legislation, which requires us to report only to the Secretary. The Federal Reports Elimination and Sunset Act of 1995 (PL 104-66) summarily eliminated the VA Women Veterans Advisory Committee, to send a report of our activities to the congress. The law takes effect this year. As you can see if that law had been in effect in 1998, there would not have been an official mechanism for us to forward this recommendation for your consideration. The importance of an open channel to convey our concerns and recommendations can not be underestimated. It is my hope that in the coming year, this Committee will restore the requirement for our committee to report to Congress. To whom it may concern:During the last 2 Fiscal Years I have received Consultant Fees for work with the VA Advisory Committee on Women Veterans totaling approximately $ 2,500. I have also received an Honorarium for my work with the Department of Veterans Affairs Consumer Counsel on Serious Mentally Ill Advisory Committee which covered the cost of my expenses in attending the meetings and totaled $ 4,000 for two years. Linda Spoonster Schwartz RN, MSN, DrPH Back to Witness List |