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Submission For The Record of Dennis Cullinan, National Legislative Service, Director, Veterans of Foreign Wars of the United States

MESSRS. CHAIRMEN AND MEMBERS OF THE SUBCOMMITTEES:

On behalf of the 2.4 million members of the Veterans of Foreign Wars of the U.S. (VFW) and our Auxiliaries, I would like to thank you for allowing us to express our views on this very important and timely subject. 

According to recent Department of Veterans Affairs and Military Services data 10% of all veterans are women and 15% of today’s active duty military are women. VA has made vast improvements in care and services provided to female veterans in the last ten years, but with increasing numbers of females deployed to Iraq and Afghanistan a system-wide change may be in order.  VA must be prepared to meet the needs of the increasing number of women veterans who will be seeking health-care services, including mental health care and ensure that its special disability programs are tailored to meet their unique health concerns, especially those who have served in combat.

VFW is concerned that although VA has markedly improved the way health care is provided to women veterans, deficiencies still arise in the area of privacy and delivery of services across the Veterans Integrated Service Networks (VISN). The Independent Budget, of which VFW is a co-author, found that the model used for delivery of primary health care to women veterans using VA health care services is variable. The trend has been to move away from full-service women’s health clinics dedicated to both primary and gender-specific health care to providing mixed gender primary care teams and contracting out other more specific gender care.

VA’s 2000 conference report “The Health Status of Women Veterans Using Department of Veterans Affairs Ambulatory Care Services” noted that with the advent of primary care in VA, many women’s clinics were dismantled and female veterans were assigned to primary care providers on a rotating basis.  The report also found that this further reduced the ratio of women to men using VA, making it more unlikely that a clinician will gain clinical knowledge to develop and maintain expertise in women’s health.

VFW believes that VA needs to increase the priority given to women veterans and take the necessary steps to focus on research and programs that enhance their understanding of women veterans’ health issues.  This will enable them to evaluate which health-care delivery model demonstrates the best clinical outcomes for women. VA must ensure that clinicians caring for women veterans are knowledgeable about women’s health and that they participate in ongoing education about the health care needs of women and be competent to provide gender-specific care to women. They must also ensure that its specialized programs for post-traumatic stress disorder, spinal cord injury, prosthetics and homelessness are equally available to women veterans as to male veterans. Most importantly VA needs to increase its outreach efforts toward this population as women veterans tend to be less aware of their veteran status and eligibility for benefits than their male counterparts. 

VFW believes that the future needs of women veterans can only be met through continued research and studies specifically tailored toward women veterans. VA should collaborate with DOD to collect critical information about the health care needs of women veterans to identify current priorities of returning female servicemembers. An improved environment of sharing data and health information between Departments is essential to ensuring a truly seamless transition from military service to veteran status.

We are pleased to hear that a national survey currently being conducted by the Women Veterans Health Strategic Healthcare Group (WVSHCG) will survey 2,500 to 3,200 women veterans across the nation, including VA users and non-users. The objectives of the survey include identifying the current demographics, health care needs and VA experiences of women veterans. It will also address how health care needs and barriers to VA health care differ among periods of service including OEF/OIF veterans and earlier periods and lastly assess women veterans’ preference for and perceived value of types of VA services and how to improve access to care.  We look forward to reading the findings of the report due out in December 2008.

The challenges facing minority veterans are both similar and different to those facing women veterans. Barriers to service and health care access among minority veterans remain prevalent within the VA system.  VA’s Health Services Research and Development Service released a report in June 2007 entitled Racial and Ethnic Disparities in the VA Healthcare System: a Systematic Review. The findings of the study concluded that disparities appear to exist in all clinical areas of VA. Most troubling was the fact that researchers commented in nearly each case that the underlying cause of these disparities were not explored or remained unclear.

The study did offer a number of future research ideas to help reduce racial disparities within VA – the VFW acknowledges that increased outreach and marketing geared toward literacy, language and cultural issues is a start.  Studies centered on diseases and illness that disproportionately affect minorities, along with creating an environment where patients are more active participants in their health care decisions are also keys to change.  Materials (federal benefit handbooks, brochures and other materials) printed and made available in Spanish are also critical.

We would also like to recognize recommendations made in the July 1, 2006 report of the (VA) Advisory Committee on Minority Veterans (ACMV). 

The ACMV conducts site visits and meets with VA officials in preparation for their annual report of recommendations to better service minority veterans. Their input as to what improvements need to be made is invaluable. Some of the current recommendations include:

  • Coordination with local, federal and state veterans services organizations
  •  in VA outreach activities.
  • Periodic Town Hall meetings to discuss minority veteran issues/concerns.
  • Expanding and improving internet-based access to VA benefits/healthcare with particular attention given to cultural and linguistic diversity.
  • Full-time Minority Outreach Coordinators.
  • More staff diversity in VA facilities.
  • Research that focuses on minority veterans issues to help understand potential barriers to access and find ways to eliminate the barriers.
  • More funding for minority veterans programs.

We applaud the efforts VA has made to reach out to identify and care for the current generation of returning veterans but much remains to be done to improve care and services provided all veterans, in particular women and minority veterans. VA must continue to work to provide an appropriate environment so that all veterans can access the healthcare, benefits and services they have so deservedly earned.

Mr. Chairman and members of the Subcommittees, this concludes the VFW testimony.  We again thank you for including us in this important discussion.