House Committee on Veterans' Affairs

TESTIMONY BY

JOAN FUREY

DIRECTOR

CENTER FOR WOMEN VETERANS

DEPARTMENT OF VETERANS AFFAIRS

BEFORE THE SUBCOMMITTEE ON OVERSIGHT

AND INVESTIGATIONS

COMMITTEE ON VETERANS’ AFFAIRS

U.S. HOUSE OF REPRESENTATIVES

June 8, 2000

Mr. Chairman and Members of the Subcommittee, I am pleased to testify today on behalf of the Department of Veterans Affairs on services in the VA for women veterans. I am accompanied by Carole Turner, RN, MN, CNAA, Director, Women Veterans Health Program, Veterans Health Administration (VHA) , and Mr. Robert Epley, Director, Compensation and Pension Service, Veterans Benefits Administration (VBA).

Women have officially served in the United States military forces since 1901 when the Army Nurse Corps was established. As early as 1938, an article in the American Journal of Nursing stated that the Veterans Administration had 287 hospital beds and 45 domiciliary beds for women beneficiaries. At that time, there were 3,511 women receiving disability compensation as a result of their military service.

Many women have served during the wars of the 20^th Century: 34,000 women served during World War I; 400,000 during World War II; approximately 3,000 served in country in Korea, over 7,000 served in Vietnam; and 49,950 were deployed in the Gulf War. In reviewing the history of women in the military, it is important to remember that, until 1973, the number of women serving on active duty was limited by law to 2% of the active duty force, and the roles in which they served were limited. However, following the dissolution of the draft, that cap was removed and more military occupational specialties were opened to women. As a result, women today comprise 15% of the active-duty force and, with the exception of the Marine Corps, 20% of new recruits. Additionally, all military occupational specialties, with the exception of the combat arms and submarine service, are open to women.

Despite this long history of military service, the 1980 census was the first ever to ask American women if they had served in the military, and it was something of a surprise to find that there were over 1.1 million living women veterans at that time. According to the 1990 Census, women veterans comprise 4% of the total veteran population, and statistical projections indicate that, by the year 2010, that number will increase to 10%. This will be a dramatic change in the demographics of the veteran population and will have significant implications for VA.

In 1982, the General Accounting Office (GAO) reviewed VA’s efforts to serve this growing number of women veterans and found that action was needed to assure equitable services for men and women. Subsequently, a number of dramatic actions occurred to improve services to women veterans. One of the most important was Congress’ establishment of the Advisory Committee on Women Veterans, in 1983. That Committee has been an invaluable asset to the Department and the women who served our country. The Committee’s most recent report will be discussed later in my testimony.

In February 1984, following the establishment of the Advisory Committee, VA implemented an outreach program for women veterans and assigned Women Veterans Coordinators at each of VBA’s regional offices. These positions continue today. Locally developed outreach programs have been very effective in identifying individual women veterans, as well as service organizations, with predominately women membership. A recent example of this outreach includes a special VBA Fact Sheet entitled "Disability Compensation for Sexual Trauma," which is distributed nationally during Transitional Assistance Program (TAP) briefings for active duty personnel within 180 days of separation from the military. During FY 1999, VBA military services coordinators briefed over 217,000 active duty personnel and their families on VA benefits and services.

The Compensation and Pension Service Women Veterans Advisory Group was created in the early 1990’s to review policy and procedures regarding benefits delivery to women veterans. The advisory group has conducted several case reviews of issues generally considered to be associated with women veterans’ claims, such as gynecological diseases - - including disorders of the breast and PTSD secondary to sexual/personal trauma. As a result, field-training tools have been developed. These include satellite broadcasts and a "Guide to Developing Personal Trauma Claims." The Women Veteran Coordinator Intranet Site provides materials to assist VBA coordinators in outreach and claims-processing activities. VBA and VHA also worked collaboratively to develop and present, via satellite broadcast, a three-part training series on "Women’s Health Issues."

A number of other steps have also been taken by VHA to improve services. In 1986, Women Veterans Coordinators were appointed at all VA Medical Centers to be advocates for women seeking care and to promote the provision of high-quality care in an appropriate setting. The availability of gynecology and other gender-specific services was also markedly improved. In 1992, Congress enacted the "Veterans Health Care Act of 1992" (Pub. L. No. 102-585), which authorized counseling for sexual trauma. The Act also authorized certain women veterans’ health services. Since then, thousands of women have received counseling and related services. During that same year, VA established the first four Comprehensive Women Veterans Health Centers (expanded to eight the following year) and established Women Veterans Stress Treatment Teams at four VA medical centers. The VA National Center for Post Traumatic Stress Disorder established a Women’s Division in 1993. Under the reorganization of health care in VHA, known as "The Vision for Change," the Women Veterans Health Program was designated as a special program and a full-time director was appointed in Central Office in 1997.

In December 1993, the Department established the Women Veterans Program Office to assure all VA programs, policies and practices were responsive to the needs of women veterans. In 1994, at the urging of the Advisory Committee, Congress enacted the "Persian Gulf War Veterans’ Benefits Act" (Pub. L. No. 103-446), which established the Center for Women Veterans in VA. At that time, the Women Veterans Program Office was reorganized to meet the requirements of that law. The Director of the Center serves as chief consultant to the Secretary of Veterans Affairs on all issues related to women veterans and also as the Executive Secretary of the Advisory Committee.

As women make up a larger proportion of the Armed Forces, they will make up an increasingly larger proportion of the veteran population. VA is committed to meeting the needs of women veterans in all its programs. The Advisory Committee continues as a valuable partner in these efforts, and I am pleased to appear before you to discuss their latest report.

The 1998 report of the Advisory Committee on Women Veterans, including VA's response to recommendations contained therein, was submitted to Congress in May 1999. The report included 42 recommendations covering 11 areas:

Outreach
Health Care
Benefits Entitlement
Women Veteran who are Homeless
Minority Women Veterans
Women Veteran Coordinators
Research
The Future of Women Veterans
Selected Reserve and National Guard Benefits
National Cemetery System
Employment of Veterans within VA

VA concurred with, or supported, the intent of 36 of the recommendations but did not concur with 6, including the following:

Recommendation 3: Require by legislation, all federally-funded social service agencies, community programs and organizations to identify, within their served population, veteran clients and annually report these statistics to VA.

Recommendation 4: Develop and produce a video to address issues affecting women veterans, such as VA eligibility criteria, benefit and health care services, and the contributions of women to the United States Military. Distribute this video for use in TAP briefings, local media presentations and Public Service Announcements (PSAs).

Recommendation 6: Place VA benefit and health care information in professional medical, nursing, social work and psychiatric publications to alert community caregivers to the existence and availability of VA benefits and programs. Articles should routinely solicit assistance of the community and address the difficulties experienced by VA in identifying women veterans.

Recommendation 10: Develop VA outreach initiatives to inform Selected Reserves and National Guard commanders of the current exclusion of reservists and guard members for VA sexual trauma health care treatment and counseling. Ensure that alternative services can be provided to assist these troops should they experience a sexual assault, trauma or harassment during their military assignments.

Recommendation 16: Submit a formal legislative request to amend 38 U.S.C. § 1114(k) to include a Special Monthly Compensation ("k" award) for women veterans who have undergone a simple or a radical mastectomy.

Recommendation 30: Require, through legislation, that all federally funded research programs and studies include a schedule of questions to solicit information related to military background and combat exposure for every study subject.

Rationales for VA’s non-concurrence in these recommendations were included in the Department’s formal response to the Advisory Committee. A copy of that response was provided to Members of this Committee in May 1999 and is included as an attachment for the Record. I will be glad to answer specific questions regarding these recommendations.

The primary concerns of the Advisory Committee, as reflected in the 1998 report were:

The future of VA programs for women, particularly women’s clinics and other gender-specific services. Although there has been a significant increase in the number of women using VA since 1992 (+64%), they remain a small percentage of the population of veterans accessing VA services. According to VHA, current enrollment figures indicate that approximately 5% of enrolled veterans are women. While it is true that the disparate ratio of men to women in VA facilities presents specific problems for the women veteran population in VA, the development of specialized, in-house women’s services is not seen as an optimal method to provide cost-effective quality health care in every facility.

VHA currently operates approximately 500 community-based outpatient clinics (CBOC’s) to provide access to health care services closer to veterans’ homes, to reduce congestion and travel times and to improve patient satisfaction with VA health care. Coupled with the emphasis on primary care, in some locations specialty clinics are being streamlined as a result of expanding CBOC capabilities. Some VA medical centers originally designed Women’s Health Clinics to provide gender-specific specialty care; e.g., gynecology exams, Pap, general reproductive and breast care, and sexual trauma screening for women veterans, as well as comprehensive primary care. Others established Women’s Clinics, which were, in fact, gynecology clinics, or infrequently scheduled clinics providing only preventive services. With VHA’s shift from disease-oriented specialty care to holistically-oriented primary care, the trend has been to mainstream women’s health, as well as all other specialties, into primary care clinics/teams. There is a difference of opinion between providers and consumers about the impact of mainstreaming women’s health into primary care. Advocates of this approach believe that the individual needs of these women are being met in clinics of another name/type. Others believe that this practice does not address the concern that VA primary care providers may be less attuned to women’s health issues and less skilled in gender-specific care because of the small number of women patients seen in VA. An effective compromise between these two positions has evolved in some facilities where one primary care team has been designated as the women’s team. These teams are designed to provide comprehensive primary care to women, including gender-specific health care, and are consistent with the direction the VA health care delivery system is moving. In all VHA facilities, referral to gynecologists or other specialists is available to all enrolled women veterans, as clinically indicated.

Recognizing that women’s health care delivery in VA is evolving and requires further evaluation, VHA, in collaboration with the Center for Women Veterans, has established a task force to assess the current status of women’s services in VA and provide recommendations to assist management in developing innovative, creative and cost-effective programs that are responsive to the needs of the women veteran population. The task force is comprised of representatives from the National Leadership Board, Women Veterans Comprehensive Centers and the Women Veterans Coordinators. The Director, Center for Women Veterans, is a consultant to this group.

The elimination of the sunset provision from VA’s Sexual Trauma Counseling Program (STC). At the time the Advisory Committee report was completed, the authority to provide sexual trauma counseling under Pub. L. No. 102-585, was due to expire on December 31, 1998. The "Veterans Program Enhancement Act of 1998" (Pub. L. No. 105-368), signed into law November 11, 1998, extended VA’s authority to provide sexual trauma counseling through December 31, 2001, and the "Millennium Health Care and Benefits Act" (Pub. L. No. 106-117), further extended this authority through December 31, 2004.

The enactment of legislation authorizing VA to provide sexual trauma counseling services to National Guard personnel and Reservists who encountered such experiences while on active duty for training. Pub. L. No. 106-117 mandates that the Secretary of Veterans Affairs, in consultation with the Secretary of Defense, conduct a study to determine the extent to which former members of the Reserve components of the Armed Forces experienced sexual trauma while serving on active duty for training, and to determine the extent to which sexual trauma counseling services are utilized. This task force has been established under the direction of Ms. Carole Turner, Director, VHA’s Women Veterans Health Program, and the final study will be reported to the Committees on Veterans’ Affairs of the Senate and House of Representatives in March 2001.

The amendment of 38 U.S.C. § 1114(k) to include the authorization of special monthly compensation for women veterans who have undergone a simple or radical mastectomy. The Administration has stated its support for legislation to effect this change.

Services for women veterans who are homeless. Since 1990, the number of women veterans provided residential treatment through VA’s Domiciliary Care for Homeless Veterans Program (DCHV) increased from 2.7% to 3.5%, and although these programs have worked very hard to develop interventions responsive to the needs of women veterans, their ability to be effective with this population is hindered by the disparate ratio of men to women that exists in the veteran population. In response to this, VA has developed a special initiative for homeless women veterans with and without children. During this fiscal year, $3 million dollars has been allocated to support the development of demonstration programs designed to meet the treatment and support service needs of women veterans who are homeless. I am pleased to announce that, following a competitive RFP process, 11 VA facilities have been selected to receive funds in support of their proposed program. These facilities are located in Atlanta, GA; Brooklyn, NY; Tampa, FL; Cleveland, OH; Cincinnati, OH; Dallas, TX; Houston, TX; Los Angeles, CA; San Francisco, CA; and Seattle, WA.

As I have indicated, most of the issues identified by the Advisory Committee in the 1998 report have been addressed, and in some cases, resulted in subsequent programmatic or statutory amendments.

The Center for Women Veterans will continue to monitor the status of their 1998 recommendations and will work closely with VA staff to assure that those recommendations with which VA concurred are implemented.

Finally, the Center for Women Veterans is hosting "Summit 2000: A National Summit on Women Veterans Issues," June 23 - 25, 2000, at the Omni Shoreham Hotel, Washington D.C. The summit is being co-sponsored by the Disabled American Veterans and the White House Office on Women’s Initiatives and Outreach. The summit is designed to provide representatives from the women veterans' community, veterans’ service organizations, veterans’ service providers, Federal agency representatives and other interested individuals with a forum in which to:

discuss current initiatives for women veterans,

identify issues of concern to the women veterans’ community, and
share ideas on how to improve services to women veterans through programmatic, outreach or other initiatives that address the identified concerns.

I am pleased that staff members from both the House and Senate Veterans’ Affairs Committees have agreed to participate in a panel presentation at the summit. We appreciate their support.

The Center for Women Veterans will publish proceedings of the summit, which will include the issues and initiatives suggested by the summit working groups. This document will be distributed to Federal and State agencies, Congress, veterans’ service organizations, and veterans’ service providers for consideration in organizational strategic planning activities.

VA is grateful for the work of the Advisory Committee on Women Veterans. Its activities and reports play a vital role in helping the Department assess and address the needs of women veterans.

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

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