Friday, July 17, 2009






"Good morning, ladies and gentlemen," declared US House Rep John Hall today, "the Veterans Affairs Disability and Memorial Affairs Subcommittee and the Subcommittee On Health joint-hearing on Eliminating the Gaps: Examining Women Veterans' Issues will now come to order." Hall is the Chair of the Subcommittee on Disability Assistance Memorial Affairs and he chaired the joint-committee hearing this morning. This hearing follows Tuesday's Senate Committee on Veterans Affairs hearing on women veterans' issues (here for Tuesday snapshot, here for Kat Tuesday, here for Wednesday's snapshot, here for Kat Wednesday). The hearing was divided into three panels with a length break (over an hour) between the second and the third panel. The first panel was composed of women veterans: Grace After Fire's Kayla Williams, Disabled American Veterans' Joy J. Ilem, Service Women's Action Network's Anuradha Bhagwati, Wounded Warrior Project's Dawn Halfaker and National Association of State Women Veterans Coordinators, Inc and the Texas Veterans Commission's Delilah Washburn. The second panel was composed of GAO's Randall Williamson, Society's for Women's Health Research and Georgetown University Medical Center's Janice L. Krupnick. Panel three was made up of VA's Bradley Mayes, Patrica Hayes, Lawrence Deyton and Irene Trowell-Harris. We'll focus on the first panel.

In his opening remarks, Subcommittee Chair Hall addressed some of the recent Congressional hearings:

I am particularly eager to recognize the women veterans in this room today and to be enlightened by their experiences with the Dept of Veterans Affairs. VA owes them the proper benefits and care -- just like their male counterparts. However, they are a unique population, since they comprise only 1.8 million of the 23.4 million veterans nationwide and deserve special attention. So VA's mission to care for them must not only be achieved but monitored and supported as well. Sadly, that is not always the case. In response to reports of disparities, during the 110th Congress the Disability Assitance and Memorial Affairs and Health Subcommittees held a joint hearing on women and minority veterans. This Congress too has been very active in its oversight activities to assist women veterans and a record number of them have testified at various hearings. Additionally, on May 20th, Chairman [Bob] Filner of the full [House] VA Committee hosted a special roundtable discussion with women veterans from all eras who were able to paint a picture of military life as a female in uniform and then as a disabled veteran entering the VA system. In many cases, they have served alongside their male counterparts but have not had the same recognition or treatment. Chairman Filner also hosted a viewing and discussion session with Team Lioness members who were on search operations and engaged in firefights but, since there is no citation or medal for this combat service, their claims are not always recognized by VA as valid, so they are denied compensation.

Hall would also note, after the first panel's opening statements, that HR 3155, the Caregiver Assistance and Resource Enhancement Act, had been voted out of committee and referred to the House. Michael Michaud is the Chair of the Subcommittee On Health and we'll note this from his opening remarks:

Another example of this Committee's commitment to women veterans is our work on HR 1211, the Women Veterans Health Care Improvement Act, which was introduced by Ms. Stephanie Herseth Sandlin. My Subcommittee favorably reported this bill to the full Committee in early June and this important legislation passed the House recently on June 23, 2009. Specifically, HR 1211 requires key studies assessing the VA health care services provided to women veterans -- including an assessment of barriers. The bill also provides seven days of medical care for newborn children of women veterans receiving maternity care, authorizes a child care pilot program, requires mental health professionals to receive training on caring for veterans to serve on the VA's Advisory Committee On Wommen Veterans and the Advisory Committee On Minority Veterans. While we have made some progress on the issues facing women veterans, it is clear that more needs to be done. Just earlier this week, there was an article in MSNBC about the VA inadequately serving women veterans. This article described the key findings of a GAO report which reveald that no VA hospital or outpatient clinic is complying fully with federal privacy requirements. In other words, many VA facilities had gynecological tables that faced the door, including one door that opened to a waiting room. Beyond these privacy concers, VA facilities were built to serve male veterans and, therefore, do not accomodate the presence of children. This means that some women veterans have had to resort to changing babies' diapers on the floors of VA hospitals due to the absence of changing tables in the women's bathrooms. In light of these challenges which continue to face women veterans, it is important that we do more to address these issues.

US House Rep Harry Teague noted briefly, "I think that everybody has had enough of us talking about this issue and we need to hear from the experts and let them tell us what the problems are and what we need to do to ensure that all female veterans get a chance to get the help that they deserve and the benefits that they have earned." Which is a good lead in to the following exchanges.

Chair John Hall: I would start with Ms. Ilem and ask when the VA trains it's service officers does it provide special sensitivity training on issues pertinent to female veterans, for instance MST [Military Sexual Trauma}?

Joy Ilem: Yes, as far as I'm aware within our service program -- I mean, there's definitely discussion of MST claims. We have a number of women NSOs but it's provided to all our NSOs -- information about VA's, you know, manuals and regulations, looking for different evidence to help them support their claims and different ways that they can help.

Chair John Hall: How many of your service officers are female? Can they assist in developing claims even if a veteran is from another state?
Joy Ilem: Yes, our NSOs can provide services to anyone. I think in our NSO corps of about 260, I would have to look at the exact number, but I think there's a range of about 30 now. There's been a number of recent new hires of women veterans especially from OEF-OIF populations.

Chair John Hall: And the time that DAV has been working with these issues relating to women veterans, what is your observation on how well VA has responded to the concerns you've raised and how successfuly are they addressing those issues?

Joy Ilem: I think I mentioned in my testimony, one of the concerns I've had, I've been reaching out to the VA for some time and we would appreciate the subcommittee's assistance just to verify especially on the SAPRO, the DoD Sexual Assault Prevention & Response Office -- looking at their confidentiality policy issues, it appears that there's some problem they may have in being able to release those records even with the -- for restricted reports of military sexual assault -- even with the consent of the veteran and so trying to work with VA staff just to try and see if they're collaborating with them to work through some of these barriers and to make sure that their claim developers are aware of the SAPRO policies and where in each of the military services these records are kept and for how long? And can VA, with the consent of the veteran, get access to those reports which can include a physical examination as well as mental health and counseling treatment. So we think those records are critical and we would ask that the Subcommittee try to work to see if VA does in fact collaborate with SAPRO on those policies.

Chair John Hall: Thank you. And Ms. Bhagwati, is the lack of legal representation more determental to women when their claims are the result of a crime?

Anuradha Bhagwati: I'm sorry, sir, the lack of legal work?

Chair John Hall: Legal represenation.

Anuradha Bhagwati: Absolutely, sir. I'm finding that, without the assistance of an attorney, many of those legal claims would be left behind. It takes a lot of courage, stamina, finacial assistance for a veteran -- either male or female -- to pursue an appeal or reconsideration of a claim. A lot of pride and a lot of issues wrapped around a veteran's identity go into the claim process and when a claim is rejected by the VA -- even when the claim is deemed to be sort of sufficient to get an awarding of compensation -- when that denial happens, it can be life shattering. And many veterans, both male and female, just fall off the map.

Chair John Hall: I understand more all the time as we have these hearings about the issues surrounding reproting problems with MST, but what about domestic violence that takes place while the wife is on active duty? How are those instances of PTSD or other disabilities resulting from those injuries adjucated by the VA?

Anuradha Bhagwati: Sir, that remains to be seen. I think a lot of data as both the congressman and Ms. Halfaker pointed out has not been collected on domestic violence in particular. Right now, I can tell you anecdotally, we're working on a case in the marine corps with a -- an NCO who's going through through a commissioning program whose partner spent five days in jail for attempting to kill her and that partner who spent five days in jail is now at Officer Candidate School. So that shock factor -- it's almost unbelieveable that that can happen but there are ways around the system. And DoD needs to explore that.

Chair John Hall: Unfortunately, there are ways around the system not just for men who assault women but also for men who assault men. I know one case particulary that I'm familiar with in my district but it's more egregious and harder to rectify when it's an attack on a female soldier. Ms. Halfaker, for the more seriously injured female veteran is there an outreach effort made directly too them? Are there OEF-OIF coordinators trained to specifically interact with them regarding their needs?

Dawn Halfaker: Sir, I think there is much needed outreach programs. I don't think there is anything specifically targeted for women veterans and I think that's where you get a lot of women initially slipping through the cracks -- especially with the Guard Reserve component. I-I also believe that, you know, peer support is probably a good way to start advocating. It's been Wounded Warriors Project's experience that women -- and particularly this generation of veterans -- are much more responsive and receptive to kind of learning about programs and things like that through their peer network. So I think that the VA needs to explore ways to promote outreach using peer neatworks and things like that. As far as the OEF - OIF coordinators at the hospitals? I mean, it was my experience that there's a lot of inconsisitency and variablity. The VA facility that I go to, the model just to have any kind of coordinatior was stood up incredibly late and its my sense that the coordinators could use a lot more education on the specific programs and -and clinical care that women need and how women can best access thtat care.

Chair John Hall: Thank you. And Ms. Washburn, your suggestion to track MST data has been made by the Center for Women Veterans and its advisory committee but has not yet been implemetned by the VBA. How effective do you think the Center and the committee are in promoting these issue and acting as change agents on behalf of the women they represent?

Delilah Washburn: I believe those things that are imposed by Congress get done, I believe those recommendations sometimes do not.

Chair John Hall: Can you provide us with any more information on the training protocol that the state women veterans coordinator receive in order to assist veterans in filing claims? And secondly what outreach activites to your women's veterans coordinators or do your women's veterans coordinators already perform?

Delilah Washburn: Most of our women's veterans coordinators are also state service officers and are also acredited with other service organizations such as the American Legion, Veterans of Foreign Wars, Military Order of the Purple Heart. So we hold more than just one military organization credential. So whenever we have the opportunity to counsel with our veterans, whether it's male or female, we have to maintain the accreditation that the Dept of Veterans Affairs mandates for service officers. So we have annual training, we have testing and we are proficient at doing those jobs as service officers. And in most cases with the new training force that we see in the regional offices with all the new employees that have bene hired, most of our service organizations and veteran coordinators are more knowledgable than the new VA employees. So we are doing the very best job that we can do to help train some of the new VA employees by pointing out things that they have missed in the letter of the law that says that they can grant benefits. So we're doing our very best job as service officers to continue to not only help them through the maze -- the bureacratic maze -- of getting their claims processed.

Chair John Hall: Thank you. And Ms. Williams, I'm going to ask you this question and then ask each of the other panelists so quickly, because my time is long expired here, quickly give me an answer if VA and the DoD could do one thing to better assist women veterans what would that be?

Kayla Williams: I believe that electronic medical records are absolutely imperative to prevent problems with lost paperwork and missing files and missing records. And that that would really help smooth the transition from the DoD to the VA.

Chair John Hall: Ms. Washburn?

Delilah Washburn: Yes, sir.

Chair John Hall: Ms. Halfaker? I'm just asking for an answer to that same question, just quick if you could.

Delilah Washburn: The one thing that I think that they could do immediately that will make a difference, and not just for gender specific issues, we're talking about we no longer have to worry about providing the stressor for Post Traumatic Stress Disorder. If you're in combat its conceeded. And let's press on with getting a diagnosis and write those claims and get them off the table because the near million claims that are pending is just something that we cannot continue to live with. It's a barrier to veterans getting their benefits.

Chair John Hall: Thank you for the wonderful endorsement of my bill HR 952.

Dawn Halfaker: Outreach.

Chair John Hall: Outreach. Ms. Bhagwati? Microphone please.

Anaradha Bhagwati: Sorry, sir. One thing on the DoD side would be enforcement of VO policy and sexual assault policy. On the VA side, it would be education and training of claims officers about what it's like to be a woman in uniform.

Joy Ilem: I think just true collaboration on all levels within VA, VHA and VVA would be really extremely important. There's just so many areas where they can benefit working together to really solve the problem. It just can't be done piece meal. It helps to work on the preventative side with DoD and during that transition period for women coming to VA.

Chair John Hall: Thank you. And if our members from the Disability Assistance Committe would not object, I would go to our only member of the Health Committee who's here, Ms. Brown.

US House Rep Corrine Brown: Thank you, Mr. Chairmen. And thank you for holding this hearing. I'm going to be real brief. You know, in the early 90s, I called for the first women veterans hearings and then we had a roundtable discsuon a couple of months ago and it seems as if things have not improved. And part of it is the culture. What, if you were making recommendations to the VA or to the Congress, what would you recommend that we do to change the culture and that's for all the panelists? We can start with Ms. Williams?

Kayla Williams: That's a great question and I think one that both the Dept of Defense and the VA are struggling with every day.I truly believe that this conflict is going to change the way that women are treated within the military and the VA because young leaders, young soldiers and service members, they serve alongside women in combat. As they grow in their leadership positions through time, they're used to serving alongside women they're beginning to recognize that women are service members too -- that they aren't just females that happened to show up sometimes. And that change in attitude will slowly trickle through the rest of the system but that's going to take a very long time. I do think that cultural change can also come from systemic changes. When I first got out of the military I went to the VA facility in Washington, DC, which I must admit was an atrocious experience for me. The facility was not clean, I was not given coordinated care and I had a truly unpleaseant experience that scared me away from the VA for many years. Just last month, I went to the VA facility in Martinsburg, West Virgingia and had a profoundly different experience at their OEF - OIF integrated care clinic. I saw several providers, I was led from one appointment to the other to make sure that I knew where I was going. I was sensitively asked about MST, about my combat experiences. And this model is one that I think is worthy of emulation though it may not be perfect in every facility. They also have a women's care clinic. So I know that by putting these facilites in place, staffing them with the right people, that proper care can be given.

US House Rep Corrine Brown: When you first went to the facilities that was in when? When you first?

Kayla Williams: I went to the DC VA in 2006 and then I went to the Martinsburg VA just last month.

US House Rep Corrine Brown: Yes, ma'am?

Delilah Washburn: That's an excellent question. There are several points that I would like to share with you. In today's culture, I could see just from the veterans that talk with us that some of the problems that they face is that now we have appointments that come in the mail to us and we're notified of five or six different appointments. They're not on the same day and these are people that are trying to hold a job down. And they just cannot go to all of these appointments. So -- and then we have child care on top of that. So we have we can't take off from work, so the hours that they're being seen is an issue. We have children that we have to provide care for and -- because we can't take them to the VA, we already know that -- and those are concerns. And why can't we do a better job at scheduling? Why can't we provide it during hours that they're available? If its once a month on a Saturday, why can't we do a women's clinic once a month on a Saturday? If we're doing women's health on Wednesday, why can't we do that from noon to six p.m. to give them an opprotunity to go after work? And where that there would be someone else to help with children? So those are some things that we need to look at that I think culturally we have to change. When we're talking about Military Sexual Trauma, there are so many of the cases that are identified by DoD and where DoD is taking action under the Uniform Military Code of Justice and we already see that these women are having medial problems -- physical as well as mental health issues -- and why don't we get them through the medical evaluation process because that is a disability. And it would help us if DoD would step up and if they have an opportunity to be awarded a military evaluation board or a PEB board, lets get it done because we are finding all too often, after we do finally get them through the VA syste, we're going back to do correction on military record. So DoD could do a better job. If it's an opportunity where they can meet the requirements of medical evaluation, lets get it done.

US House Rep Corrine Brown: Those are some very good suggestions and I don't know why we can't do that Saturday or Sunday afternoon and have someone there to take care of the kids. I mean, I don't see why we can't. Because you were talking about the waiting list and what did you say was the waiting list for women?

Delilah Washburn: We do have appointments that come out through the VA computer system that will often times not consolildate to get you there on one day and often times we have folks that are coming in from a rural area, that's traveling 100 or 200 miles to the large VA medical center. So that's a hardship, transportation is a hardship.

US House Rep Corrine Brown: Right, transportation is a hardship. Question do we have any, and I've been thinking about it, do we give any kind of a gas voucher or anything like that?

Delilah Washburn: There are some organizations, whether it's Disabled American Veterans where they have a transportation program, there are some organizations, Veterans of Foreign Wars they give vouchers, and often times the VA medical centers have monies for that as well but it's not the norm and not everyone knows that they can get help. We're just not advertising it.

US House Rep Corrine Brown: Okay. Thank you. Next. I don't have much time. Next? Yes, ma'am?

Dawn Halfaker: Yeah, I think that, you know, perception and culture can change through action and I think, you know, some of the recommendations that Wounded Warriors Project is prepared to make are actions such as outreach, peer support, consistency in the way VA delivers care and services to women veterans. And it's interesting, I've had the exact same experiences as Ms. Williams. First went to Walter Reed Army Medical Center to the VA facility in Washington, DC. and just had horrible experience after experience there. And again, they are -- they've made some strides in trying to coordinate a OEF - OIF care model where they have, you know, the case managers and things lik that but again it's not -- I don't think that the women veterans who are continuing to recevie care have actually felt any of the changes and certainly there's been no change in culture at that particulra VA.

US House Rep Corrine Brown: And this is the one in DC?

Dawn Halfaker: Yes, ma'am.

US House Rep Corrine Brown: Is it just bad for women or is it bad for everybody?

Dawn Halfaker: I think that would be a good question. I mean, I think that it was initially bad for me just because, you know, when you do just walk through the doors to the VA, it's very -- it's not a pleasant environment. And it's not a safe environment. You know, often times you may encounter somebody yelling, cat calling at you, making a crude remark and it's just, I think, a true culture shock going from the military where that would never be tolerated to a VA facility where you're trying to get care and, you know, you're uncomfortable.

US House Rep Corrine Brown: You know this is the second or third time I've heard about the cat calls and I just don't know how you deal with it because they're not in the military any longer, they're civilains. And you know we face this probelm if we're walking down the street and we see a work crew or something.

Dawn Halfaker: Yes, ma'am, I think that-that it's a leadership issue and, you know, if I was the director of that hospital, I would do whatever I had to do to ensure that that environment couldn't happen so I think it's a leaderhsip issue.

Kayla Williams: And, if I may, ma'am, I do believe that that facility inadequately serves both male and female veterans. My husband's care at that VA was so bad. He was sent back and forth between multiple clinics, told he was in the wrong place, his paper work was lost, he felt that the doctors didn't care about him. His experience there was so bad that he has since refused to go back to the VA at all and relies exclusively on civilian providers even though they are less familiar with blast injuries and post-traumatic stress that results form combat.

US House Rep Corrine Brown: Just quickly.

Anuradha Bhagwati: Ma'am, my personal exprinces with the VA hospital in New York City have been personally devestating and I pay out of pocket for as much care as I need. I use the VA right now for emergency care. You know, I've experienced MST and I had a very bad expereince with a claim. It doesn't take much to disappoint me right now with VA care. I-I every time I walk in there I go with open arms, a generous spirit, I hope to be received well. And there are some fantastic health care providers there, but there are, by and large, both male and female staff members and medical staff do not understand what its like to be a woman in uniform.

US House Rep Corrine Brown: You know and I've had, when I've said part of the problem is the VA and the number and when I've suggested that perhaps we may need to do vouchers so people can go outside, I got real push back from the women. So I mean, if the service is not there, what can we do to change the system? And when I talk to women veterans well they want to go to the VA but the service isn't what they want.

Anuradha Bhagwati: Well ma'am, I think we need to push the VA to provide equal services for women. That needs to be done comprehenslivly. We can't give up on the VA but I need to stress that, especially for women who have been traumatized, now that can be through sexual trauma, post-traumatic stress from combat, whatever the case may be, if they're expereinceing negative epsidoses at the Va hosptials they may just turn away and never come back and so fee-based care needs to be an option. If you talk to women who've been working around MST for awhile, they will -- I would say by and large they agree that fee-based care needs to be accesible for surivors of MST whether that's --

US House Rep Corrine Brown: It should be an option?

Anuradha Bhagwati: Aboslutely.

US House Rep Corrine Brown: Okay, that's what I'm thinking. Yes, ma'am?

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