**Department of Veterans Affairs (VA)**

######## Advisory Committee on Women Veterans

###### January 21 -- 23, 2003

###### VACO, Room 230

Advisory Members Present:

  ---------------------------------------- ------------------------------
  Ms. Marsha Four, Chair                   MAJ M. Joy Mann, USAF Reserve

  COL Michele (Mitzi) Manning, USMC (Ret), CPT Lory Manning, USN (Ret)
  Vice Chair                               

  SFC Gwen M. Diehl, USA (Ret)             COL Kathleen A. Morrissey, NJ
                                           ANG

  Ms. Cynthia J. Falzone                   CDR Joan O'Connor, USNR (Ret)

  Ms. Bertha Cruz Hall                     Ms.Sheryl Schmidt, CA Dept of
                                           Veterans Affairs

  Edward E. Hartman, DAV                   MSgt Lewis E. Schulz, II, USAF
                                           (Ret)

  LTC Kathy LaSauce, USAF (Ret)            CMSgt Luc M. Shoals, OK ANG

  **[Ex-Officio]{.underline}**             

  COL Denise Dailey, DACOWITS              
  ---------------------------------------- ------------------------------

#### VA Staff Present

+-----------------------------------------------------------------------+
| #### I                                                                |
| rene Trowell-Harris, Ed.D., R.N., Director, Center for Women Veterans |
+-----------------------------------------------------------------------+
| Harriett Heywood, Esq., Assoc. Director, Center for Women Veterans    |
+-----------------------------------------------------------------------+
| Desiree Long, Center for Women Veterans                               |
+-----------------------------------------------------------------------+
| Yvonne Johnson, Center for Women Veterans                             |
+-----------------------------------------------------------------------+
| Angelia Sare, Center for Women Veterans                               |
+-----------------------------------------------------------------------+
| Connie Raab, VHA, Public Health Communication Office                  |
+-----------------------------------------------------------------------+
| Vicky Holly, National Cemetery Administration                         |
+-----------------------------------------------------------------------+
| Mary B. Burdick, Ph.D., R.N., VA National Center for Health Promotion |
| and Disease Prevention                                                |
+-----------------------------------------------------------------------+
| Linda Kinsinger, M.D., MPH, VA National Center for Health Promotion   |
| and Disease Prevention                                                |
+-----------------------------------------------------------------------+
| Linda Lipson, VHA, Health Services Research and Development Service   |
+-----------------------------------------------------------------------+

# Guests

  -----------------------------------------------------------------------
  Renaee Allen, Veterans of Foreign War

  Michael Doyle, McClatchy Newspapers

  A. Wendy Lawrence, Veterans of Foreign War

  Ruth Mahnken, MSSW, Staff Member, HVAC, Subcommittee on Oversight and
  Investigations

  Carolyn Tyler, 5^th^ Amendment WACs

  Cathy Wiblemo, The American Legion
  -----------------------------------------------------------------------

## 

## The Advisory Committee on Women Veterans meeting was called to order by Marsha Four, Chair. The agenda was reviewed, and accepted. Minutes from the Tampa VAMC site visit were reviewed and approved, with the following revisions:

## Page 2

## *Advisory Committee Budget* section; first bullet -- change budge to budget.

## *Suggested Meeting Dates* section, last bullet -- add Harriett before Heywood.

The entire site visit package, with attachments, is located in a
three-ring binder in the Center for Women Veterans' (CWV) office.

Members were asked to begin thinking of questions for the presenters,
and to begin thinking about issues for an agenda for their visit to the
Hill.

**Briefing: Congressional and Legislative Affairs -- Tom Ryan, DAS for
Congressional and Legislative Affairs**

Mr. Ryan presented an overview of the legislative process, and answered
inquiries from the committee members on the following subjects:

-   Permanent authority for the Biennial Report -- Linda Lutes will
    assist the Committee with drafting wording for legislative packet.

-   Gulf War -- recognize uniqueness of services for women veterans.

-   Category 8.

-   Veterans Equitable Resource Allocations (VERA).

-   Dual compensation -- DoD working on how to enact bill.

-   Omnibus Reconciliation Act.

-   Mandatory funding for VA Health Care -- legislation in Congress.

-   Prescription benefit -- VA Plus Choice -- would provide another
    source of income to the VA - currently in discussion with HHS.
    Product should be complete in late September 2003.

-   Tyler Bender Mandatory Discharge Relief Act of 2002 -- died in
    previous Congress - VA has not taken a position because it is a DoD
    issue.

-   TriCare collaboration -- law currently prohibits transfer of funds
    from VA to TriCare - will consider reviewing issue because it is
    another income stream for the VA.

-   Medicare subvention -- not a viable option.

-   Will provide listing of House/Senate members who are veterans and a
    listing of Senate Veterans Affairs Committee members.

**Update: Veterans Health Administration, Dr. Susan Mather, Chief,
Public Health & Environmental Hazards Officer**

Dr. Mather presented a brief resume of her VA professional career, her
role in getting women veterans' issues heard, and establishment of Women
Veterans Health Program. She provided updates on the following:

-   [Status of the 8 Comprehensive Women Centers]{.underline} -- Located
    in San Francisco, West LA, Minneapolis, Chicago, Boston,
    Philadelphia, Durham, and Tampa. With minor exceptions, the Centers
    look very much like they did when they were initially set-up.
    However, today, they have moved to the primary care model, and they
    must now generate enough money to justify their existence.

##### [Status of the Clinical Programs for Excellence]{.underline} - Established 10 years ago with 6 facilities around the country: Pittsburgh; Durham; Boston; Alexandria, Louisiana; Bay Pines; and Tampa. The goal is to become the research and teaching model for the Department. Requirements for a designation of Clinical Programs for Excellence are outcomes-based and consist of the following standards:

  -------------------------------- -- -----------------------------------
  95% primary care                    95% between the ages of 52-69 ages
                                      screening for breast cancer
                                      mammography

  90% screened for military sexual    95% between ages of 52-75 receive
  trauma                              screening for cervical cancer

  90% provided private and safe       Development of two additional
  environment                         gender-specific measures

  Women health providers have         
  current skills and they provide     
  90% of care to women at the         
  medical center                      
  -------------------------------- -- -----------------------------------

####### Outcome Data -- Statistics relative to OB/GYN procedures for Fiscal Years 1999-2001 presented. A review of 14 fee-basis contracts from around the country found that all of the facilities were accredited by JCAHO. VA now has the authority to treat maternity cases. Last year, VA paid for 700 deliveries and has asked Congress to legislate brief care for the newborn.

**Remarks: The Honorable Anthony J. Principi, Secretary**

Mr. Principi opened his remarks and articulated his expectations of the
Committee. He addressed issues on the budget and his decision to suspend
care for Category 8 veterans for the remainder of the year. Mr. Principi
concluded his remarks with a request that the Committee continue to
assist him by advising on issues that affect women veterans.

**Update: Domiciliary Care Programs, Jane Tollett, R.N., Ph.D., VHA,
National Coordinator, Pain Management Initiative**

Dr. Tollett provided the background and an update on VA's Domiciliary
Care Programs. *(Attachment 1)*

-   Domiciliary care is VA's oldest healthcare program, and was started
    to serve disabled Civil War veterans.

-   Focus: economically disadvantaged veterans.

-   Distinct component of VHA's continuum of services.

-   Consists of two components:

    -   Biopsychosocial rehabilitation (vocational) -- gets the veteran
        re-connected to the community.

    -   Biosocial rehabilitation -- promotes physical and mental
        agility.

    -   Special populations served by domiciliaries include:

        -   Homeless

        -   PTSD

        -   Elderly

        -   HIV/AIDS

        -   Women

**Briefing: Board of Veterans Appeals (BVA), Rick Thrasher, Chief
Counsel, Litigation Support**

Mr. Thrasher presented an overview of the BVA, the appeals process, and
the use of markers for reviewing claims regarding sexual trauma
*(Attachment 2)*

-   Regulations now allow the Board to develop cases instead of sending
    back to VBA.

-   Decision on whether to remand or develop is discretionary. However,
    an internal commitment was made to develop cases by using paralegals
    and attorney sources to do administrative duties.

-   In March 2002, VA published final rules to address proof problems
    unique to PTSD personal assault claims. The rule gives increased
    sufficiency to the veteran's lay testimony and allows for evidence
    from sources other than a veteran's service record, including
    evidence of behavioral changes.

# Full Committee Discussions

The Committee discussed the following items:

-   VISN 8 site visit.

-   Status of 2004 Summit:

    -   Funding has been set-aside.

    -   Informally requested VSO assistance.

    -   Preliminary planning committee selected.

    -   Entered into contract with VA's EES for conference coordination.

    -   Expect fairly aggressive marketing.

    -   Biggest event for women veterans.

    -   June/September -- possible months.

-   Status of 20^th^ Anniversary Celebration:

    -   MG Jeanne Holm and Dr. Linda Schwartz will co-chair planning
        committee.

    -   No VA funding allocated -- collaborating with VSO for support.

    -   Will be held in conjunction with an Advisory Committee meeting.

    -   WIMSA site selected.

-   2004 Report of the Advisory Committee on Women Veterans

    -   Lory Manning will co-chair Benefits Subcommittee.

    -   Kathy Morrissey will co-chair Health Subcommittee.

    -   Determine title of report - email suggestions to Kathy LaSauce.

    -   Edward Hartman will coordinate choosing the artwork for cover.

    -   Historical section will be a dynamic document.

The Subcommittees met in separate sessions to develop their respective
portions of the 2004 Report.

**Briefing: Resource Allocation and Analysis, Paul Kearns, Associate
CFO, Resource Allocation & Analysis**

Mr. Kearns presented on the Resource Allocation -- VERA 10 model. The
main objective of VERA is to ensure a fair and equitable distribution of
resources. *(Attachment 3)* The presentation consisted of an overview of
the following components of VERA:

-   Composition of the Budget.

-   Classification of Patients.

-   FY 2003 VERA Model Allocation to VISNs.

**Briefing: Advisory Committee Management, Phil Riggin, White House
Liaison and Advisory Committee Manager**

Mr. Riggin provided information on the following items:

-   Advisory Committee Charter Renewal:

    -   Renewals are required every 2 years. The charter for the
        Advisory Committee on Women Veterans expires December 31, 2003
        and is one of six VA advisory committees that must go through
        the charter renewal process.

    -   Mr. Riggin will consult with the Director, CWV, and Committee
        chair to discuss any changes to the charter.

-   Clarification of his role -- serves as advisor to VA's advisory
    committees.

-   Committee will effectively be advocating its viewpoints to Congress
    when they meet with HVAC/SVAC staffers.

-   A listing of VA advisory committees names and objectives was
    distributed.

-   Mr. Riggin also provided the names and phone numbers for his
    staffers:

    -   Vivian Drake -- 273.4838

    -   Shirley Williams -- 273.4842

**Briefing: Veterans Benefits Administration, Carolyn Hunt, Deputy
Director, Compensation and Pension Service**

Ms. Hunt presented statistics and information *(Attachment 4)*
pertaining to:

-   Special Monthly Compensation (SMC-k)

-   Children of Vietnam Veterans

    -   Spina Bifida Claims

    -   Women Veterans

    -   Claims Status

-   Military Sexual Trauma (MST) Regional Office Training

**Briefing: Health Services Research & Development Service (HSR&D), Dr.
Donna Washington, Research Associate, VA Greater Los Angeles Healthcare
System**

Dr. Washington's briefing provided an overview of FY 2001 HSR&D research
projects specific to women veterans. (Attachment 5)

-   Funding for women's health research at VA totaled \$28.7 million for
    317 studies in FY 2001, a 12 percent increase from previous fiscal
    year.

-   VA continues to be a major source of support for women's health
    research, providing just over \$6 million in funding for 57 studies
    in FY 2001.

-   VA researchers garnered significant additional support for women's
    health research-\$22.7 million-from a multitude of agencies and
    organizations.

    -   In FY 2001, a total of 110 new studies were funded, representing
        about \$7.3 million or 25.5 percent of all funding.

-   Of extreme interest is the effectiveness of mental health services
    in designated mental health clinics with separate providers vs.
    integrated clinics.

**Update: Office of Policy and Planning, Policy Analysis Service, Susan
Krumhaus, National Survey of Veterans (NSV) Project Manager**

Ms. Krumhaus provided the following background and update on the NSV:

-   Sample size -- 20,000; 600 females surveyed

-   Information included in survey:

    -   Demographic

    -   Usage of VA vs. non-use

    -   Health status ventures

    -   Race, ethnicity, income, and satisfaction with use of benefits

    -   Broad overview of veteran population

-   VA senior staff was briefed on the preliminary findings

-   Written report, with general findings is being circulated through
    the Department

-   When finalized, report, including methodology, will be posted on the
    Internet

-   Anticipate publication in March

######### Remarks: Robert E. Wallace, Executive Director, Veterans of Foreign War (VFW)

> Mr. Wallace addressed the Committee during lunch and solicited
> feedback on how the VFW can be more responsive to women veterans. He
> asked the Committee members to email any feedback that they, or their
> constituents might have. Mr. Wallace also introduced other VFW staff
> members who were present:

-   William Bradshaw, Director, Veterans Services

-   Wendy Lawrence, Associate Director, National Legislative Service

-   Renaee Allen, Field Representative, National Veterans Service

######### Briefing: Frederico Juarabe, Jr., Assistant Secretary, Department of Labor (DOL), Veterans Employment and Training

Mr. Juarabe provided an update on current initiatives, an overview of
operations, and a progress report on the special grants to train women
veterans for non-traditional jobs.

-   Military Occupational Specialties (MOS) have been expanding for all
    branches of the military.

-   DOL website and program initiated, UMET (use your military
    experience and training).

-   Challenged VA to seek better ways to provide better, more seamless
    services.

-   By 2020, 10 percent of all veterans and 20 percent of those under 45
    will be women.

-   Asked National Veterans Training (VET) Institute to become more
    sensitive to the needs of women veterans especially in non-
    traditional occupations.

    -   VETs funded two programs:

        -   Program in Tennessee trains women veterans as carpenters.

        -   Program in Mississippi trains women veterans as welders and
            ship builders.

-   Attempting to improve services to the homeless by building
    coalitions and providing a cooperative, holistic approach to the
    delivery of services.

-   HR 40-15, Veterans Employment Act of 2002, provides services in a
    much more flexible way and allows the tailoring of services to
    special populations that include veterans.

-   DOL's Transition Assistance Program identifies MOSs that are of
    interest to veterans.

**Update: Colonel Denise Dailey, Ex-Officio, DACOWITS Representative**

COL Dailey gave an update of the DACOWITS Committee. Some of the
highlights include:

-   The Committee's charter was revised October 12, 2002

-   Committee size reduced from 25 to 13

-   Committee will focus on:

    -   Retention of women officers

    -   Improvement of OB/GYN care and treatment for family members

    -   Effect of deployment on families

**Update: Dr. Irene Trowell-Harris, Director, Center for Women
Veterans**

Dr. Trowell-Harris gave an update on the Center's operations.
*(Attachment 7)* Some of the accomplishments include:

-   Published the Advisory Committee on Women Veterans 2000 and 2002
    Reports

-   Published the 2000 Summit Report

-   Developed and posted on the Internet the 25 Most Frequently Asked
    Questions

-   Completed Committee nomination packages and charter renewal

-   Revised Center's performance measures to better address
    effectiveness of outcomes

**Unscheduled Statement: Carolyn Tyler, Founder, 5^th^ Amendment WACs
-** Ms. Tyler provided background information on the issue of
involuntary discharge due to pregnancy.

**Welcoming Remarks: Dr. Leo Mackay, Deputy Secretary**

Dr. Mackay made welcoming remarks and held a roundtable discussion with
Committee members. Discussion topics included:

-   CARES

-   VERA

-   Category 8

-   Protecting women veterans' health clinics and programs.

**Briefing: Dr. Jonathan Perlin, Deputy Under Secretary for Health**

Dr. Perlin provided a briefing on the status of the Veterans Health
Administration.

-   Renewing privileges of physicians practicing at VAMCs

    -   All health care providers in VA are credentialed and privileged

    -   VETPRO, VA's national credentialing database, was instituted in
        2001

-   Limitation on time allotted for patient visits

    -   Placing limitations on the amount of time that a provider can
        spend with a patient is not supported by policy

-   Waiting time for appointments and emergency treatment

    -   Waiting caused by influx of veterans enrolling in system

    -   Fewer employees taking care of double the amount of veterans

    -   Unsustainable workload growth precipitated the Secretary's
        decision to suspend enrollment and treatment of new Category 8
        veterans for the remainder of the year

**Briefing on Capitol Hill: House and Senate Veterans Affairs Committee
Staff Members**

The Advisory Committee met with staff members (Kingston Smith, Susan
Edgerton, Kathleen Greve, and Ruth Mahnken) from the HVAC and SVAC. The
purpose of the meeting was to have a two-way informal discussion, and
question-and-answer session. Discussion topics included:

-   Make permanent the authority for sexual trauma counseling.

-   Make permanent the authority for the Biennial Report.

-   Status of Women Veterans Coordinators (Health/Benefits):

    -   Increase FTEE to at least half-time.

    -   Make official name change to Women Veterans Manager.

-   Privacy Concerns -- inpatient psychiatric, medical records, and
    examinations. VA was asked by Congress to provide a privacy report.
    Is the issue of privacy report updated? Who is responsible for the
    review of report?

-   Concurrent receipt -- effect on women.

-   Women Veterans Health Program Office -- make permanent.

-   Programs for homeless women veterans, and future planning.

-   Increasing numbers of women in recent deployments.

-   Impact of Priority 8 - who is responsible for oversight and
    compliance?

# Employment of veterans.

**Briefing: Dr. Barbara Chang, Consultant for Academic and Clinical
Affairs, Capital Asset Realignment for Enhanced Services (CARES)**

Dr. Chang provided an overview of the CARES program and highlighted the
following items *(Attachment 8)*:

-   CARES is currently in Phase 2 of planning, with an 18-month
    timeframe for 20 VISNs

-   CARES is based on capital assets.

-   Very specific for geographic region.

-   No specific planning initiatives for women veterans in Phase 2.

-   CARES is a macro level of planning and is not ideally suited for
    planning for small program needs.

**Discussion: Nora Egan, Chief of Staff**

Ms. Egan held a general discussion with the Committee. She reiterated
the broad charter of the Committee, which is to advise the Secretary on
the needs of women veterans. She noted the opportunity to provide
services to women veterans won't be so unique in the future.

Committee members expressed concern that the previous briefing on CARES
did not fully answer their concerns of:

-   Why are there no specific planning initiatives actively publicized
    for women veterans in Phase 2 (regionally)?

-   Why is there no specific space allocated at the medical center
    facility level for women veterans?

Ms. Egan agreed to provide follow-up on the issues.

**Update: Peter Dougherty, Director VA Homeless Program**

Mr. Dougherty provided an overview on the status of the 11 demonstration
homeless women's programs. *(Attachment 9)*

-   Sites chosen include: Boston, Brooklyn, Tampa, Cleveland,
    Cincinnati, Atlanta, Seattle, Los Angeles, San Francisco, Dallas,
    and Houston.

-   To date, 1,349 women have been contacted by outreach workers and
    referred to the program.

-   Programs average a current caseload of 30 active patients. There are
    currently 324 women actively receiving services.

-   To date, 514 women have been enrolled in the evaluation potion:

    -   86 percent needed substance abuse treatment

    -   69 percent needed medical treatment

    -   32 percent had non-combat PTSD

    -   5 percent had schizophrenia

    -   60 percent had a mood disorder

    -   23 percent had minor children for whom they were responsible

-   The rate of homelessness decreased as women remained in the program.

**Full Committee Discussions**

The Chair asked Committee members to think about, and to start
developing a comprehensive statement of the following issues discussed
with HVAC and SVAC staffers:

-   What do you think a women's health center should look like and
    offer?

-   What are some of the vocational rehabilitation issues?

-   Child issues?

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-   Future meetings:

    -   Site Visit -- TBD after consultation with Carole Turner

    -   Fall Committee meeting - TBD -- will coincide with the 20^th^
        anniversary celebration in September

-   If Committee members wish to complete local site visits, they must
    contact the Center for Women Veterans for instructions.

**Closing:** The Advisory Committee for Women Veterans adjourned at 3:30
p.m., Friday, January 23, 2003.

  ---------------------- ------------------------------------------------
  Submitted by:          **/s/**

                         Irene Trowell-Harris, R.N., Ed.D.

                         

  Approved by:           **/s/**

                         Marsha T. Four, Chair

                         

  Dated:                 **May 5, 2003**
  ---------------------- ------------------------------------------------