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Mr. Chairman and Members of the Subcommittee:

On behalf of the more than one million members of the Disabled American Veterans (DAV) and its Women’s Auxiliary, I appreciate the opportunity to discuss Department of Veterans Affairs (VA) programs and services for women veterans.

Throughout history, women have served their country with pride, patriotism, and honor equal to their male counterparts. It was not until the beginning of the 20th century, however, that women were finally permitted to officially serve in the Armed Forces, making them veterans after military service.

According to the VA, there are currently 1.2 million women veterans, representing 4.8% of the total veteran population. In contrast to the overall declining veteran population, the female veterans population of the United States and Puerto Rico is projected to increase by 6% between 2000 and 2020, from 1.24 million to 1.3 million. The number of women serving in the military has continued to increase over time and so has their range of opportunities. Today, 90 percent of military occupations are open to women¾ all non-combatant fields and most combat-support positions. During the Persian Gulf War, some 33,000 women served honorably in Southwest Asia performing combat and combat support functions.

Unfortunately, women veterans use their earned benefits at lower rates than their male counterparts. We acknowledge that the VA has made an effort over the last seven seven years to address the unique needs of this population; however, some women veterans still experience obstacles when trying to obtain health care services and other benefits they need from the VA. The VA must work aggressively toward further effective and positive change through advocacy, outreach, and direct service to women veterans. In doing so, VA will reflect that we truly honor the contributions and sacrifices made by women veterans in service to this nation.

In this vein, our discussion will encompass the following issues: VA health care services for women veterans, including access to counseling and treatment for sexual trauma and inpatient mental health care services; privacy and safety concerns of women veterans utilizing VA facilities; initiatives for women veterans who are homeless; the effectiveness of the VA Advisory Committee for Women Veterans, the VA 2000 National Summit on Women Veterans Issues, and Women Veterans Coordinators; and outreach and benefit awareness among women veterans.

In the past, it was difficult, if not impossible, for women to get gender-specific care at VA medical facilities. For many years, VA focused on the numerically dominant male veterans. With the Congressional mandate for VA to establish a Women Veterans Advisory Committee the beginning of a national effort to identify women veterans and improve VA services to them started in November 1983. In 1993, then Secretary of Veterans Affairs Jesse Brown took the initiative and made a serious attempt to improve and expand services for women veterans by creating a Women Veterans Program Office. He was determined to sensitize the VA to the contributions women have made in the military and address their unique problems as they returned to civilian life as veterans. In 1995, Congress passed Public Law 104-446, establishing the Center for Women Veterans (CWV) and the Center for Minority Veterans.

Over the past seven years, VA has made significant progress in its effort to address the unique physical, mental, and social needs of women veterans. The Women Veterans Program Office and the VA Center for Women Veterans (CWV), both under the direction of Ms. Joan Furey, have been instrumental in helping develop proper programs and services to meet these needs. The DAV commends Ms. Furey for her efforts and dedication to women veterans and advocacy in helping to assure VA policies, practices, and programs are responsive to the needs of women veterans.

Many VA medical facilities have developed special programs and services to meet the specific health care needs of women veterans, including eight women’s comprehensive health centers located in, Boston, Massachusetts; Philadelphia, Pennsylvania; Durham, North Carolina; Tampa, Florida; Chicago, Illinois; Minneapolis, Minnesota; San Francisco, California; and West Los Angeles, California. However, since the restructuring of the Veterans Health Administration (VHA) and implementation of a primary care model throughout the system, we have seen the discontinuation of several dedicated women’s health clinics. The number of women veterans’ clinics and primary care teams has decreased significantly, from 121 in 1994 to 96 in 1998. The DAV is seriously concerned about the incidental impact of the primary care model on the quality of health care delivered by VHA to some women veterans.

The following excerpt is from the January 19, 2000, VA conference report on The Health Status of Women Veterans Using Department of Veterans Affairs Ambulatory Care Services. The report stated:

VA women’s clinics were established because, unlike the private sector, where women make up 50 to 60 percent of a primary care practitioner’s clientele, women veterans comprise less than 5 percent of VA’s total population. As a result, VA clinicians are generally less familiar with women’s health issues, less skilled in routine gender specific care, and often hesitant to perform exams essential to assessing a woman’s complete health status. With the advent of primary care in VA, many women’s clinics are being dismantled and women veterans are assigned to the remaining primary care teams on a rotating basis. This practice further reduces the ratio of women to men in any one practioner’s caseload, making it even more unlikely that the clinician will gain the clinical exposure necessary to develop and maintain expertise in women’s health.

The VA is obligated to provide health care services to women veterans equal to those provided to male veterans. Services must be available to eligible women veterans regardless of the relatively low number of women in comparison to their male veteran counterparts. Additionally, VA must ensure women veterans are not subjected to lower standards of clinical expertise in their health care because of restructuring of VHA and the advent of the primary care model. VA needs to increase the priority given to women veterans’ programs to ensure that quality health care is provided and that services are maintained.

While the VA has been working hard to improve health care services for women veterans, Congress and the Administration may be eroding programs with restrictive fiscal policies. The VA Women Veterans Health Programs must be adequately funded to avoid a decline in services. Initially, funding was earmarked by Congress specifically for women veteran’s health initiatives. Regrettably, Congress has not continued to dedicate funding for these programs. Insufficient funding threatens the progress that has been made in improving and enhancing services and jeopardizes women veterans’ access to quality care in the future. We emphatically agree with comments provided in the 1998 Report of the VA Advisory Committee on Women Veterans, "Funding of gender specific services for women veterans is an investment in the future which needs to be protected regardless of the current cost cutting climate [in Congress]."

Another topic for discussion at the January 2000, VA conference was the outcome of the VA Women’s Health Project, a study designed to assess the health status of women veterans who use VA ambulatory services. Findings from that study revealed there is a high prevalence of sexual assault and harassment experiences reported among women veterans accessing VA services and that active duty military personnel report rates of sexual assault higher than comparable civilian samples. "The data also suggested it is essential that VA staff recognize the importance of the environment in which care is delivered to women veterans, and that VA clinicians possess the knowledge, skill and sensitivity that allows them to assess the spectrum of physical and mental conditions that can be seen even years after assault."

Findings from the VA study revealed that: 1) women who reported experiencing sexual assault while in the military scored lower on all scales measuring physical and mental health status and social functioning in comparison to women veterans who reported no experience of sexual assault during active military service; 2) the consequences of sexual assault include decreased physical and psychological functioning which may persist for an extended period and that women who have experienced sexual trauma are more likely to be high utilizers of healthcare; 3) chronic conditions such as arthritis, obesity and diabetes, and higher rates of numerous medical problems such as irritable bowel syndrome, back and headache pain, eating disorders, poor reproductive outcomes, and digestive problems were reported more frequently by women who experienced sexual trauma in comparison to women reporting no such history; and 4) the psychological effects of sexual trauma may be more severe than those of other traumatic events, including exposure to combat.

Findings from the study also suggest that resources needed to care for women veterans who experienced sexual trauma may be different from those used to care for men. Additionally, the study indicated that women veterans would benefit from a specialized comprehensive health care approach and possibly more intensive mental health care.

VA must not fail to meet these identified needs of women veterans who have experienced sexual trauma during military service. It must seriously consider and address the barriers to care women veterans face and issues that negatively impact on a woman veteran’s decision to seek health care from VA.

Public Law 102-585, the Veterans Health Care Act of 1992, authorized VA to provide counseling services for women veterans who experienced sexual trauma during active military service. This law was amended by Public Law 103-452, the Veterans Health Programs Extension Act of 1994, to authorize VA to provide counseling to both men and women. Currently, the law mandates VA shall operate a program which provides outreach, counseling, and appropriate care and services to veterans who VA determines require such counseling care and services to overcome the effects of sexual trauma. The law extends counseling and treatment services through December 31, 2004. Given the significantly increased rates of sexual trauma reported by women who served or are serving in the military, we urge the Subcommittee to consider legislation to make the VA Sexual Trauma Counseling Program permanent.

Public Law 106-117, section 115 includes provisions that require: 1) VA to conduct a study and submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives reports on its study of expanding eligibility for counseling and treatment to members of the reserve components of the Armed Forces who experienced sexual assault while serving on active duty for training. (Emphasis added.) 2) VA to enter into a collaborative effort with the Department of Defense (DoD) to ensure that members of the Armed Forces, upon separation from active service, are provided appropriate and current information about the VA counseling and treatment program for sexual trauma, including information about eligibility requirements and procedures for applying for these services.

In recent years, DoD has relied more frequently on our military reserve components to meet the National Security missions of our country. The DAV believes it is wholly unfair to exclude certain National Guard and Reserve members who experienced sexual trauma from receiving VA sexual trauma counseling and treatment because they were on "active or inactive duty for training" status vs. "active duty" at the time of the sexual assault. General Counsel Opinion (VAOPGCADV 17-97) dated July 1, 1997, held in part that reservists and members of the National Guard serving on active duty for training when disabled as a result of sexual trauma are not eligible for sexual trauma counseling and care because Section 1720D of title 38, United States Code, requires that the covered trauma occurred while the veteran was on active duty; and the law excludes active duty for training from the definition of "active duty." (Emphasis added.) Counseling and treatment should be available to reservists and members of the National Guard who experience a sexual assault while performing active or inactive duty for training or any other period of official military service.

We request that the Subcommittee consider a legislative amendment to Section 1720D of title 38, United States Code, to make reservists and members of the National Guard who experience sexual trauma during any official military duty period eligible for VA sexual trauma counseling and care. This legislative remedy would make moot the necessity for the VA to carry out provisions in Public Law 106-117, requiring the Secretary to indicate the additional resources that would be required to meet the projected needs of reservists and members of the National Guard needing sexual trauma counseling and treatment. Reservists and members of the National Guard should be entitled to quality health care services for the after effects of sexual assault that occur while serving in an official military capacity that are equal to those entitlements provided to other veterans.

Three areas of specific concern to DAV are the effectiveness of VA programs for women veterans who are homeless, the availability of quality inpatient mental health services for women veterans, and the issue of privacy and safety at VA medical facilities. The VA has been deficient in providing outreach and services to women veterans who are homeless, and some VA facilities’ inpatient mental health services for women are inadequate. Additionally, although VA has made notable progress in levels of privacy and safety afforded to women veterans, improvement is necessary at some VA health care facilities.

The VA has a comprehensive program to help male veterans who experience homelessness, but, until recently, it has not focused on providing the same level of services to homeless women veterans. Women veterans often have different concerns and needs than male veterans who are homeless. They are routinely concerned about issues such as privacy, personal safety, childcare, and treatment programs for the after effects of sexual abuse and assault. VA must address these unique issues in order to develop effective treatment programs and services for homeless women veterans.

The VA Health Care for Homeless Veterans Program (HCHV) is successful largely because of outreach with a focus on reducing homelessness through necessary treatment and rehabilitative services. Outreach workers target areas where homeless persons congregate; however, women generally frequent different areas than their male counterparts. Therefore, many women veterans who may benefit from these services are missed. Transitional housing is a key component in helping the homeless to successfully reintegrate into communities. Program workers often face obstacles in providing transitional housing to women veterans because of childcare issues and or safety concerns. For example, transitional housing is often shared among 3-4 persons. Placing a woman in a house with 3 men may compromise her physical safety. Additionally, housing contracts are generally authorized for the veteran but not her children. If a women veteran is the sole custodian of her children, it is unlikely she will choose a housing situation where her children are unable to remain with her.

We are pleased that Congress last year earmarked approximately $3 million to support demonstration projects for women veterans who are homeless. With continued resources, we are confident VA will develop and maintain programs and services to meet the needs of women veterans who are homeless, including access to transitional housing on par with male veterans.

Many women veterans seek VA counseling and treatment for post traumatic stress disorder (PTSD) and need inpatient mental health services for psychiatric conditions that developed as a result of sexual assault that occurred during military service. The special needs of women utilizing an inpatient mental health program must be carefully considered to avoid having women drop out of inpatient programs or suffer even further set backs in treatment of their service-related conditions. Some VA facilities have closed their women veterans’ inpatient psychiatric units, complaining that low utilization rates do not make them cost effective. Currently, there are only a few VA facilities with inpatient psychiatric units specifically designed to meet the special needs of women veterans.

Women veterans admitted to inpatient psychiatric treatment programs for PTSD frequently report they are the only female in the group and often feel too intimidated to discuss gender-specific issues. Male and female veterans suffering from PTSD may have very different core issues surrounding their traumatic event, i.e., combat-related vs. sexual abuse or trauma. This could potentially lead to complications for the clinician trying to provide group therapy. Women veterans may be disadvantaged in terms of care if a clinician is unfamiliar with the unique manifestation of PTSD symptoms in women who have experienced sexual trauma and the added impact of an assault that occurred during military service.

As the number of women veterans eligible for VA benefits increases, their utilization of VA mental health programs and services is also likely to increase. Women veterans must be provided quality inpatient mental health care services. They should not be disadvantaged in terms of the quality of care they receive and are entitled to because they are seen in lower numbers in comparison to their male counterparts. We suggest that, in VA facilities where numbers of women are too low to be cost effective to maintain an inpatient psychiatric unit or provide appropriate care, contracted care at a nearby facility should be secured.

Women veterans continue to express concern about privacy and safety issues at some VA facilities. It is the VA’s responsibility to ensure and maintain a woman veteran’s right to privacy at all times. It is not uncommon during an inpatient hospitalization or domiciliary stay, for a single woman veteran to be placed in a ward with 30 men. It is understandable in this situation that a woman might feel threatened or that her safety might be endangered. Privacy and safety protocols for women veterans should be consistent and strictly adhered to at every VA facility. Patient treatment rooms should be well marked with "please knock before entering" and hospital curtains installed to ensure privacy. If possible, women veterans should be placed near the nurses station during inpatient hospital stays. Special locks can be installed on doors allowing the patient to easily exit the room, but requiring authorized staff to use a key to enter the room. Women Veterans Coordinators (WVC) should be contacted immediately and informed when a women veteran is admitted as an inpatient. These are just a few precautions that can be taken to ensure a safe and private environment at VA facilities for women veterans.

Additionally, some women veterans indicate they feel uncomfortable sitting in a waiting room mainly comprised of men. All VA facilities should provide a safe, private and comfortable environment for women veterans. Ideally, women veterans should be provided a private waiting area when possible.

Every VA medical center and regional office should have a designated WVC to assist women veterans in accessing VA services and benefits. VA WVCs are a valuable resource for providing outreach, assuring quality health care, and keeping VA informed about the unique needs of women veterans. Many WVCs have been able to successfully guide women veterans through the VA system and raise awareness among VA staff and within communities about the contributions of women veterans. However, we are concerned that there is a lack of continuity of services provided by WVCs throughout the system.

Nurses, doctors, social workers, and benefits and administrative personnel work as WVCs throughout VHA and the Veterans Benefits Administration. We recognize that these women have many responsibilities, including advocacy for women veterans in their communities. The amount of time WVCs have to spend on women veterans’ issues depends on a number of factors, including job description, case load, the number of women veterans in the area, and management priorities at their facilities. Coordinators who have the support of the hospital or regional director and or management are likely to be more able to successfully manage their case load and have adequate time to perform duties related to their WVC position. Their duties as WVCs should not be "secondary" to their overall responsibilities, but approached with appropriately approved managed time to complete necessary tasks and projects. For medical centers in areas where there are statistically sufficient numbers of women utilizing the system, and where it is proven to be cost effective, the WVC position should be mandated as full time. Sufficient resources should be designated to support WVCs and the Center for Women Veterans, including an adequate number of staff to accomplish their mission.

The VA Advisory Committee for Women Veterans, established in 1983 by Public Law 98-60, authorizes committee members 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 VA. Since its inception, the committee has worked hard to address the needs of women veterans and improve VA services to them. In 1989, the committee began conducting site visits at VA medical facilities, regional offices, and vet centers throughout the nation. It has also conducted open forums for women veterans to express concerns and talk about the status of VA programs for women veterans in their location.

The advisory committee submits a report biennially to the Secretary on the activities of the VA pertaining to women, together with assessments of needs and recommendations for future action and, until recently, VA was required to convey the report to Congress. However, Public Law 104-66 removed this requirement. The DAV shares the concerns of the committee and believes the submission of the report to Congress plays an important role in maintaining services and programs for women veterans and helps to bring to the forefront important issues and concerns that need to be addressed. We observe that H.R. 4268, recently passed by the House, would reinstate the requirements for the biennial report to Congress. We appreciate the House action.

Oversight of women veterans’ programs is key to their ultimate success. Our representation on the VA Advisory Committee for Women Veterans affords DAV an excellent opportunity to gain perspective about the concerns of women in the veterans’ community and to make recommendations to fully address the needs of women veterans.

The DAV appreciates the efforts of the advisory committee and fully supports its continuation. We believe recommendations made by the committee provide an honest look at the accomplishments and deficiencies in the VA system concerning women veterans and will help to ensure consistency of quality services to women veterans throughout the country.

The DAV fully supports the upcoming VA 2000 National Summit on Women Veterans Issues. Recognizing that more needs to be done to address the needs of the women veteran community, DAV agreed to cosponsor this event. It provides an excellent opportunity for women veterans, veterans’ advocates, and government policymakers to come together to openly discuss problems and seek solutions. Summit 2000 is an ideal forum in the continuing efforts to effect policy changes within the VA to ensure appropriate medical services and accommodation for hospitalized women veterans, to provide necessary outreach programs and services to women veterans who are homeless, and to assure the availability of treatment for gender-specific conditions, appropriate gynecological care and treatment and counseling for PTSD and other conditions related to their military service.

It is possible that women veterans utilize their benefit entitlements less than their male counterparts in part because of the strong cultural perception associated with the word veteran. Women veterans will often check "no" on a questionnaire when asked if they are veterans, but then indicate that they have served in the military. Many women believe they do not meet the basic definition of a "veteran"¾ perceived to be a male who served in combat. A VA commissioned survey published in 1985 found that 57% of women did not know they were eligible for VA services and programs.

Outreach is key to help identify women veterans throughout the country. The VA Center for Women Veterans reported they hold approximately 30 outreach events each year and that the Veterans Health Administration and Veterans Benefits Administration WVCs conduct on average at least two outreach events each year in their local communities. We appreciate the VA’s efforts to maintain an effective outreach program for women veterans; however, more needs to be done.

Women veterans often "disappear" back into their local communities following active service; therefore, we believe it is necessary to ensure they are clear about their status as "veterans" and are properly informed about benefits and services prior to leaving active military service. The Transition Assistance Program (TAP) provides crucial information to separating servicemembers about programs and benefits available to assist them during their transition and to help them to search for post-service employment. The DAV participates in TAP, providing information about veterans’ benefits and services, as well as comprehensive reviews of service medical records. But we cannot stop here.

Separating servicemembers are often anxious to return to civilian life, new careers, or educational opportunities, and they are not focused on these important issues at the time of separation. Often, it is only when a veteran is in need of help or a particular service or benefit that he or she is open to receiving information. For this reason, it is imperative that VA as well as veterans service organizations make it a priority to increase outreach to women veterans.

The DAV recognizes the lack of benefit awareness among women veterans; therefore, we are redoubling our efforts to reach women who have served in the Armed Forces. Our National Service Officers (NSOs) provide outreach to the veterans’ community by conducting Veteran Information Seminars designed to educate disabled veterans and their families about veterans’ benefits and programs. Our most recent outreach initiative involves the implementation of the DAV Mobile Service Office Program for the purpose of providing free assistance to veterans, with special attention to those residing in rural areas and localities throughout America, which are not in proximity to VA facilities. Although these outreach initiatives do not directly target women veterans, we are hopeful that these efforts will help them to receive the benefits and services they are entitled to.

The DAV also has its own Women’s Veteran Advisory Committee, made up of women veterans from DAV’s membership, who meet annually at DAV National Conventions. The Committee works to increase awareness among women veterans about available benefits, services, and programs, and advises the DAV National Headquarters about the concerns of women veterans. The committee encourages women veterans to play an active role in our organization.

The DAV also recognizes the unique problems disabled women veterans face, including job discrimination, both as women and disabled women veterans; therefore, we have made a concerted effort to build employment and enhance our NSO corps with eligible and qualified disabled women veterans.

We owe a debt of gratitude to women veterans who have proudly and honorably served our nation. More women are serving in the Armed Forces, and this means more women veterans will likely be seeking VA benefits and health care services in the future. The VA must increase outreach to women veterans to ensure they are informed about their benefits and entitlements. VA must also work hard to identify and eliminate barriers experienced by women when accessing VA benefits and programs. We can demonstrate our appreciation, dedication, and commitment to women veterans by ensuring they receive benefits and health care services on par with male veterans.

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