# Department of

# Veterans Affairs

Advisory Committee on

Women Veterans

# 2004 Report

The Department of Veterans Affairs Advisory Committee on

Women Veterans is required to submit a report of activities in

Compliance with the provisions of Public Law 98-160

**TABLE OF CONTENTS**

+--------+---------------------------------------------------------+---+
| # Lett |                                                         | # |
| er fro |                                                         |   |
| m the  |                                                         | i |
| Chair. |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
| ...... |                                                         |   |
+--------+---------------------------------------------------------+---+
| #      | # Executive Summary.....                                | # |
| Part I | ....................................................... |   |
|        |                                                         | 1 |
+--------+---------------------------------------------------------+---+
| # P    | # Summary of Recommendati                               | # |
| art II | ons..............................\...\...\...\...\..... |   |
|        |                                                         | 3 |
+--------+---------------------------------------------------------+---+
| # Pa   | # Recommendations                                       | # |
| rt III | and Rationale.......................................... |   |
|        |                                                         | 9 |
+--------+---------------------------------------------------------+---+
| #      | # A. Strategic Planning.                                | # |
|        | ....................................................... |   |
|        |                                                         | 9 |
+--------+---------------------------------------------------------+---+
| #      | # B. Outreach.............                              | # |
|        | ....................................................... |   |
|        |                                                         | 1 |
|        |                                                         | 0 |
+--------+---------------------------------------------------------+---+
| #      | # C. Research and Studies...                            | # |
|        | .................................\...\...\...\...\..... |   |
|        |                                                         | 1 |
|        |                                                         | 1 |
+--------+---------------------------------------------------------+---+
| #      | > D. Women Veterans Health Program                      | # |
|        | > ..................................                    |   |
|        |                                                         | 1 |
|        |                                                         | 3 |
+--------+---------------------------------------------------------+---+
| #      | > E. Women Veterans Program Managers/Benefits           | # |
|        | > Coordinators.....                                     |   |
|        | ....................................................... |   |
|        |                                                         | 1 |
|        |                                                         | 4 |
+--------+---------------------------------------------------------+---+
| #      | > F. Health Care                                        | # |
|        | > ........                                              |   |
|        | ....................................................... | 1 |
|        |                                                         | 5 |
+--------+---------------------------------------------------------+---+
| #      | > G. Behavioral and Mental Health                       | # |
|        | > Care.................................                 |   |
|        |                                                         | 1 |
|        |                                                         | 6 |
+--------+---------------------------------------------------------+---+
| #      | > H. Women Veterans Who are                             | # |
|        | > Homeless..................\.............              |   |
|        |                                                         | 1 |
|        |                                                         | 7 |
+--------+---------------------------------------------------------+---+
| #      | > I. Sexual Trauma Counseling                           | # |
|        | > ..........................................\...        |   |
|        |                                                         | 1 |
|        |                                                         | 8 |
+--------+---------------------------------------------------------+---+
| #      | > J.                                                    | # |
|        | > Training...............                               |   |
|        | ....................................................... | 1 |
|        |                                                         | 9 |
+--------+---------------------------------------------------------+---+
| #      | > K. Veteran Employment and                             | # |
|        | > Education................................             |   |
|        |                                                         | 2 |
|        |                                                         | 0 |
+--------+---------------------------------------------------------+---+
| #      | > L. National                                           | # |
|        | > Cemeteri                                              |   |
|        | es..................................................... | 2 |
|        |                                                         | 2 |
+--------+---------------------------------------------------------+---+
| #      | # M. Departm                                            | # |
|        | ents of Defense and Veterans Affairs................... |   |
|        |                                                         | 2 |
|        |                                                         | 2 |
+--------+---------------------------------------------------------+---+
| # P    | # VA Response                                           | # |
| art IV | to Recommendations..................................... |   |
|        |                                                         | 2 |
|        |                                                         | 4 |
+--------+---------------------------------------------------------+---+
| #      | # A. Strategic Planning.                                | # |
|        | ....................................................... |   |
|        |                                                         | 2 |
|        |                                                         | 4 |
+--------+---------------------------------------------------------+---+
| #      | # B. Outreach.............                              | # |
|        | ....................................................... |   |
|        |                                                         | 2 |
|        |                                                         | 6 |
+--------+---------------------------------------------------------+---+
| #      | # C. Research and Studies...                            | # |
|        | .................................\...\...\...\...\..... |   |
|        |                                                         | 2 |
|        |                                                         | 7 |
+--------+---------------------------------------------------------+---+
| #      | > D. Women Veterans Health Program                      | # |
|        | > ..................................                    |   |
|        |                                                         | 3 |
|        |                                                         | 1 |
+--------+---------------------------------------------------------+---+
| #      | > E. Women Veterans Program Managers/Benefits           | 3 |
|        | > Coordinators.....                                     | 3 |
|        | ....................................................... |   |
+--------+---------------------------------------------------------+---+
| #      | > F. Health Care                                        | # |
|        | > ........                                              |   |
|        | ....................................................... | 3 |
|        |                                                         | 4 |
+--------+---------------------------------------------------------+---+
| #      | > G. Behavioral and Mental Health                       | # |
|        | > Care.................................                 |   |
|        |                                                         | 3 |
|        |                                                         | 6 |
+--------+---------------------------------------------------------+---+
| #      | > H. Women Veterans Who are                             | # |
|        | > Homeless..................\.............              |   |
|        |                                                         | 3 |
|        |                                                         | 7 |
+--------+---------------------------------------------------------+---+
| #      | > I. Sexual Trauma Counseling                           | # |
|        | > ..........................................\...        |   |
|        |                                                         | 3 |
|        |                                                         | 9 |
+--------+---------------------------------------------------------+---+
| #      | > J.                                                    | # |
|        | > Training...............                               |   |
|        | ....................................................... | 4 |
|        |                                                         | 1 |
+--------+---------------------------------------------------------+---+
| #      | > K. Veteran Employment and                             | # |
|        | > Education................................             |   |
|        |                                                         | 4 |
|        |                                                         | 3 |
+--------+---------------------------------------------------------+---+
| #      | > L. National                                           | # |
|        | > Cemeteri                                              |   |
|        | es..................................................... | 4 |
|        |                                                         | 5 |
+--------+---------------------------------------------------------+---+
| #      | # M. Departm                                            | # |
|        | ents of Defense and Veterans Affairs................... |   |
|        |                                                         | 4 |
|        |                                                         | 5 |
+--------+---------------------------------------------------------+---+

+--------+---------------------------------------------------------+---+
| #      | # Appendices................                            | # |
| Part V | ....................................................... |   |
|        |                                                         | 4 |
|        |                                                         | 7 |
+--------+---------------------------------------------------------+---+
| #      | # A. Historical Perspec                                 | # |
|        | tive................................................... |   |
|        |                                                         | 4 |
|        |                                                         | 8 |
+--------+---------------------------------------------------------+---+
| #      | > B. Past Chairs and Current Chair of the Advisory      | # |
|        | > Committee on Women                                    |   |
|        | > Veterans                                              |   |
|        | ...................................................\... | 5 |
|        |                                                         | 3 |
+--------+---------------------------------------------------------+---+
| #      | # C. VA Advi                                            | # |
|        | sory Committee Membership Profile ..................... |   |
|        |                                                         | 5 |
|        |                                                         | 4 |
+--------+---------------------------------------------------------+---+
| #      | # D. Adviso                                             | # |
|        | ry Committee Site Visits - A Cumulative Record...\..... |   |
|        |                                                         | 6 |
|        |                                                         | 1 |
+--------+---------------------------------------------------------+---+
| #      | # E. Summary of S                                       | # |
|        | ite Visits for 2002-2003............................... |   |
|        |                                                         | 6 |
|        |                                                         | 2 |
+--------+---------------------------------------------------------+---+
| #      | # F. Briefings to the Ad                                | # |
|        | visory Committee on Women Veterans (2002-2004)......... |   |
|        | ..................\................................\... |   |
|        |                                                         | # |
|        |                                                         |   |
|        |                                                         | 6 |
|        |                                                         | 3 |
+--------+---------------------------------------------------------+---+
| #      | # G. Charter Renewal ...                                | # |
|        | ...................................................\... |   |
|        |                                                         | 6 |
|        |                                                         | 7 |
+--------+---------------------------------------------------------+---+
| #      | # H. Cente                                              | # |
|        | r for Women Veterans Mission and Goals................. |   |
|        |                                                         | 6 |
|        |                                                         | 9 |
+--------+---------------------------------------------------------+---+

# 

**Letter from the Chair**

This Report is dedicated to the women veterans of our great Nation

who have stood the test of time,

persevered, marching forward, eyes front,

accepting not, that which was less for their service.

The Advisory Committee on Women Veterans (Committee) celebrated its 20th
anniversary in the fall of 2003, having been established in 1983 by
Public Law 98-160. Its history is one of strong advocacy in fulfilling
its Congressional charge of assessing the needs of women veterans with
respect to compensation, health care, rehabilitation, outreach, and
other benefits and programs administered by the Department of Veterans
Affairs (VA); reviewing the programs and activities of VA that are
designed to meet these needs; developing and providing recommendations
to the Secretary of Veterans Affairs for appropriate actions regarding
the needs and services of women veterans; and following up on these
recommendations.

Since its inception, steady and continued progress has been seen in VA's
approach to addressing the benefits, services, care and treatment of
women veterans. However, the Committee also recognizes that, in a
delivery system as massive as VA, whose largest recipient population is
male, oversight and advocacy remain crucial. For this reporting period
of 2002 - 2004, the Committee reviewed the recommendations of the 2002
Report, gathered information from extensive briefings by VA leadership,
reviewed pertinent VA reports and publications, interfaced with outside
agency ex-officio members of the Committee and veteran service
organizations, participated in two full Committee VA site visits that
included Veterans Health Administration (VHA) and Veterans Benefits
Administration (VBA), National Cemetery Administration (NCA), and Vet
Centers. The site visits incorporated local women veterans town hall
meetings. Several individual Committee members made additional scheduled
VA site visits, and members had personal contact with women veterans in
various forums.

The aforementioned activities brought us to the recommendations
contained herein. This report builds on those of the past to recognize
and define vital issues that impact women veterans and their receipt of
benefits by recommending VA actions to improve the quality of care and
services. Additionally, the report contains numerous appendices as a
documentation of activity and also as a Committee historical record for
future times, so as not to lose over time, what has, in fact, gone
before.

The composition of the Committee membership is vital to the
accomplishment of this charge. The selection of its membership attends
to the integrity of the Committee and the true purpose for which it was
established. It is imperative that the Committee is balanced in regard
to the contributory strength and expertise of its members while ensuring
a comprehensive representation of diversity and experience. Without
this, the efforts of the Committee would be far less than comprehensive
and fall short of its intended mission.

Women are the fastest growing population within VA's health care system.
The numbers indicate that in Fiscal Year (FY) 2003, 333,578 women
enrolled (up 9.4 percent from FY 2002), and for users in FY 2003,
196,134 women used (up 7.5 percent from FY 2002) the services provided
by VA.

The number of women in the military continues to climb, most recently,
in part, due to the challenges facing our country since September 11,
2001. It is also our honor to represent this new era for future women
veterans by contributing to VA's need to stand ready to serve their
needs with dignity and respect.

With all that has been done within VA for women veterans, the Advisory
Committee was saddened to learn of the passing of Dr. Katherine Skinner
of the Health Services Research and Development Service of the VA
Medical Center in Bedford, Massachusetts. The women veterans' community
is indebted to Dr. Skinner for her contribution and pioneering work in
assessing the health status of women veterans. She was the primary
investigator of the "Quality of Life in Women Veterans Using VA
Ambulatory Care." The findings of her research have helped to guide VHA
in enhancing women veterans' health care across the country. In deep
appreciation for her work, we remember Dr. Skinner.

It is difficult to list all those who have assisted the Committee over
the past 2 years. VA senior leadership and staff were available to us
without question. I, on behalf of the entire Committee, thank them all
for providing us with the necessary data, insight, and knowledge that
have become a part of the background of each recommendation. Many of
these individuals are noted in the Appendix on Briefings found in this
Report. I personally thank those who worked closely with the Committee
throughout the reporting period. This includes the Director and staff of
the Women Veterans Health Program office, along with the four Deputy
Field Directors; the Women Veterans Coordinator of VBA; the Directors
and staff of the Medical Centers, Vet Centers, and Regional Offices that
were a part of our site visits; and the Director and Associate Director
of the Center for Women Veterans were all vital contributors. The Center
for Women Veterans coordinated and provided the Committee with full
administrative support and I am deeply appreciative of the Center and
its entire staff for the professional approach and attention it gave to
the Committee.

The Committee serves at the pleasure of the Secretary. I would like to
thank Secretary Principi for his confidence in appointing each of us to
this distinguished Committee. We have worked diligently to fulfill our
duties and responsibilities to not only the Secretary and the Department
of Veterans Affairs, but to all the women veterans of this country. It
has been my great honor to sit as Chair of the Advisory Committee on
Women Veterans for the reporting period 2002-2004. And I am proud to
have served with these selected members of the Committee who are
veterans from a wide sweep of local communities across the U.S. We have
all been given a tremendous opportunity to serve our country, once
again.

The Committee members are all veterans, and as such, we know it is all
about "the mission." The Committee strives to be ever true to its
mission...to our duty...true to our sister veterans of today, and true
to the trust placed in us by those who have gone before on the
committee, in an effort, and with hope, that we too, have added to the
Committee's strong foundation for those who follow.

Respectfully submitted,

![](media/image1.jpeg){width="1.6243055555555554in" height="0.35in"}

Marsha Four, R.N.

Chair

**PART I**

**Executive Summary**

The 2004 Report of the Advisory Committee on Women Veterans provides
recommendations that address the following issues:

-   Strategic Planning

-   Outreach

-   Research and Studies

-   Women Veterans Health Program

-   Women Veterans Program Managers/Benefits Coordinators

-   Health Care

-   Behavioral and Mental Health Care

-   Women Veterans Who are Homeless

-   Sexual Trauma Counseling

-   Training

-   Veteran Employment and Education

-   National Cemeteries

-   Departments of Defense and Veterans Affairs

The report of the Advisory Committee on Women Veterans (Committee) is
submitted biennially by the Committee. The Committee is appointed by the
Secretary of Veterans Affairs (Secretary) for a 2- or 3-year term.
Current Committee membership includes representation by veterans from
the Air Force, Navy, Army and Marine Corps, as well as the Reserve and
National Guard. Members represent a variety of military career fields
and possess extensive military experience, to include service in Vietnam
and the Persian Gulf Wars.

A total of 60 recommendations with supporting rationale are provided in
this report. Recommendations stem from data and information gathered in
exchange with the Department of Veterans Affairs (VA) officials,
Department of Labor (DOL) officials, members of House and Senate
Congressional Committee staff offices, women veterans, researchers,
veterans service organizations, internal VA reports, and site visits to
Veterans Health Administration (VHA) and Veterans Benefits
Administration (VBA) facilities.

###### Highlights 

-   Address recommendations to improve the care for women veterans by
    increasing time commitment for Women Veterans Program Managers
    (WVPM) and Benefits Coordinators positions, permanently removing
    eligibility restrictions for sexual trauma counseling, and ensuring
    a standardized new employee orientation that includes information
    concerning the specific needs of women veterans.

-   Ensure that the WVPMs are included at all Veterans Integrated
    Service Network (VISN) level and local Capital Asset Realignment for
    Enhanced Services (CARES) implementation planning and
    decision-making processes, including privacy standards and
    construction.

-   Develop outreach materials targeting minority women veterans, older
    women veterans, and those living in rural areas and the U.S.
    territories, with attention to their unique ethnic, cultural, and
    geographic influences.

-   Ensure that patient satisfaction assessments and clinical
    performance measures and monitors are aggregated and reported by
    gender to detect differences in the quality of care. This research
    is to include increases of Post Traumatic Stress Disorder (PTSD) in
    certain minority women veterans, specifically African-American.

-   Conduct a national study through the VHA's Health Services Research
    and Development Service on the variation of all VHA care delivery
    models for women, including primary care clinics, and that this
    study additionally includes how these models are linked with
    outcomes of quality of care and patient satisfaction.

-   Utilize the WVPMs on medical center and VISN committees relative to
    strategic planning, staff education and orientation, and facilities
    management. That the VISN leadership incorporates the WVPM
    Integrated Business Plan into the overall VISN Strategic Plan.

-   Recommend that each inpatient/residential psychiatric unit has
    capacity to dedicate a specific area on the unit to segregated
    patient rooms and treatment for women veterans, including PTSD units
    and homeless domiciliaries.

-   Authorize funding to provide for enough additional Military Sexual
    Trauma (MST) counselors to meet the needs of those suffering MST as
    identified by the Vet Center team leaders in conjunction with the
    Office of Readjustment Counseling Services. MST counselors should be
    allocated based on need.

-   That the Secretary requests consideration by the Secretary of
    Defense for an evaluation that gender be added to the Form DD214,
    "Certificate of Release or Discharge from Active Duty," for outreach
    and strategic planning purposes.

-   VISN Directors commit to continue funding the Homeless Women
    Veterans Pilot Projects within the VISN where these programs are
    located, based on positive outcomes as determined by the Director,
    VA Program on Homelessness.

-   Mandate that new staff orientation and sensitivity trainings and
    orientations with annual in-services to the staff of all VHA
    treatment sites, to include contracted Community Based Outpatient
    Clinics; document training on the employee training record; and
    ensure that the training is comprehensive in nature to include the
    history of women in the armed forces and military sexual trauma.

-   Recommend that the Secretary communicates the Committee's request to
    the DOL, that DOL, through its network of state employment directors
    and assistant directors, work with states to the greatest extent
    possible, to ensure Local Veterans Employment Representatives and
    Disabled Veteran Outreach Program receive information that will
    increase their sensitivity to women veterans issues to include
    military sexual trauma.

-   Recommend that the National Cemetery Administration include
    designations of acronyms WAAC, WAVES, SPAR, WAC, WAFS, and WASP, on
    headstones or markers to recognize women veterans who served in
    those specially designated units/corps.

# **PART II**

# **Summary of Recommendations**

# 

1.  Ensure that Women Veterans Program Managers (WVPMs) are active
    participants at all Veterans Integrated Service Network (VISN) level
    and local Capital Asset Realignment for Enhanced Services (CARES)
    implementation planning and decision-making group processes.

2.  Conduct a sub-analysis of CARES data and market penetration to
    determine women veterans' trends. That these data are aggregated at
    the local medical center and reported to the Women Veterans Health
    Program (WVHP) office in order to plan for projections of Veterans
    Health Administration (VHA) impacting the local medical center
    utilization of services and care for women veterans.

3.  Perform a current assessment of compliance with the Privacy
    Standards, as outlined in the revised VHA Handbook 1330.1, "VHA
    Services for Women Veterans," at all VHA treatment delivery sites
    and re-assess this compliance on an annual basis with monitored
    outcomes reported to the local respective VISN leadership and the
    WVHP office.

4.  Ensure that all medical center Space Utilization/Facilities
    Management committees apply the Privacy Standards outlined in
    revised VHA Handbook 1330.1 in the work process and that these
    privacy standards are applied consistently throughout the
    facilities. That this is facilitated by the inclusion of the WVPM on
    all space planning or renovating projects in the medical center
    where services are offered and provided to women veterans to include
    Community Based Outpatient Clinics (CBOC). The VISN Women Veterans'
    Health Council to assess and report on this annually with copies of
    the report forwarded to VISN leadership and the WVHP office.

5.  Translate into Spanish, brochures and outreach materials that are
    currently only available in English.

6.  Develop outreach materials targeting minority women veterans, older
    women veterans, and those living in rural areas and the U.S.
    territories, with attention to their unique ethnic, cultural, and
    geographic influences.

7\. That the Veterans Benefits Administration (VBA) begin an outreach
effort to medical associations, such as the American Medical Association
(AMA) and health care providers, etc., that may have contact with people
born to mothers who served in Vietnam who are eligible for compensation
for certain birth defects.

8\. Aggregate and report, by gender, patient satisfaction assessments
and clinical performance measures in order to facilitate trending and
comparison of differences in the quality of care.

9\. Commission a follow-up study to the study entitled "Survey of Female
Veterans: A Study of the Needs, Attitudes and Experiences of Women
Veterans" published by Louis Harris and Associates in August 1985, to
examine the current status, demographics, needs, and experience of women
veterans of the U.S. Armed Forces.

10\. Identify and solicit earmarked research funds to conduct a study
with sufficient numbers of women veterans by age, race or ethnicity,
period of service, and both VA and non-VA healthcare utilization to
conduct appropriate statistical analyses on the success of VA health and
benefits programs in meeting the needs of women veterans. (This is a
follow-up to Recommendation #17 of this Committee's 2002 Report.)

11\. Conduct a study to investigate the reason for the disproportionate
occurrence of the incidence of Post Traumatic Stress Disorder (PTSD) in
African-American women veterans, in light of the fact that 35 percent of
those seeking treatment for PTSD are African-American women, as cited in
current literature reviews which demonstrates an increase in that
cohort.

12\. Conduct a study to investigate the impact of the Anthrax vaccine
and other military occupational exposures, both intentional (i.e.
immunizations to include Anthrax) and unintentional (i.e. chemical
exposures) on the reproductive system.

13\. Actively proceed with the authorized National Vietnam Veterans
Longitudinal Study and re-address and evaluate the cohorts of the 1988
"The National Vietnam Veterans Readjustment Study" to include a broad
based health inquiry.

14\. Fund and perform qualitative study/studies through Health Services
Research and Development (HSR&D) to attain outcomes to determine
appropriate panel size to maintain competence in the delivery of care to
women veterans; and to determine how many women veterans are necessary
to maintain a primary women's health care clinic.

15\. Fund and conduct a national study through HSR&D on the variation of
all VHA care delivery models for women, including primary care clinics,
and that this study additionally include how these models are linked
with outcomes of quality of care and patient satisfaction.

16\. The WVHP office conduct an assessment of compliance to determine
whether clinicians, who also serve as WVPMs, have appropriate time
allocations to perform and accomplish the duties of both positions.

17\. Perform a study to determine the prevalence of Military Sexual
Trauma (MST) among homeless women veterans, the psychosocial
consequences of MST, and whether a correlation exists between MST and
homelessness.

18\. Incorporate performance standards into the Executive Career Field
Performance Plans that demonstrate individual leadership, and
accountability of care and services provided to women veterans.

19\. The WVHP remains in a position and at a reporting level of high
organizational visibility to ensure and protect its strength, authority,
and autonomy within VHA in order to: guarantee its ability to provide
consultation and program oversight; provide guidance and direction to
all levels within VHA to include the medical centers and VISNs; and
ensure that there be no diminution of the role and authority of the
program.

20\. Local and VISN leadership be held accountable for implementing all
strategies outlined in VHA Handbooks 1330.1 and 1330.2, "Women Veterans
Program Manager Position," and that mechanisms be developed for a
process to monitor compliance. Furthermore, demonstrate evidence of the
level of support and implementation of formal guidance outlined in the
VHA Handbooks.

21\. On an annual basis, the four Deputy Field Directors (DFD), as well
as one Lead VISN Woman Program Manager designated by the Committee, will
provide a briefing on key issues within their respective areas during
one of the Committee's Washington, DC, meetings.

22\. Establish a minimum of 20 hours or .5 full-time equivalent (FTE) as
a threshold for the time allotted to WVPMs in the accomplishment of
their duties.

23\. VHA provide the WVPMs with appropriate space, equipment and
administrative support to accomplish their responsibilities in
accordance with guidance outlined in VHA Handbook 1330.2 and that VBA
provide this same level of support to its Women Veteran Coordinators.

24\. Utilize the WVPMs on medical center and VISN committees relative to
strategic planning, staff education and orientation, and facilities
management.

25\. VISN leadership to demonstrate and show evidence that the
strategies outlined in the Women Veterans Health Program Integrated
Business Plan has been incorporated into its plan. Further, that the
VISN Women Veterans Health Council assesses this process and report its
findings to the WVHP.

26\. All medical center women veterans' advisory committees incorporate
non-VA employee women veterans consumers on their committee who
represent the diverse population within each VA medical center treatment
area and that this local women veterans advisory committee and the WVPM
host an annual town meeting for women veterans of the area.

27\. Modify the Fee Basis package to alert providers of the need to
follow-up on test results (i.e. mammography) of patients referred to
community (outside) providers in order to provide timely continuity of
care and case management.

28\. Medical center clinics monitor the oversight of coordination for
case management between community contract care providers and VHA care
providers for continuity of care. Additionally, develop a process for
oversight to ensure that providers communicate findings to patients in a
timely manner.

29\. Monitor data on services and treatment provided by fee-basis and
contract, in a VHA database for evaluation, in order to project future
needs and utilization of services by women veterans.

30\. Develop a comprehensive educational plan for primary care
providers/clinicians that will enhance current practice and the
utilization of the mental health screenings, to ensure that they more
readily identify those women veterans who are at high risk and in need
of mental health referrals in order to expedite the primary care
referral to a mental health provider.

31\. Team leaders to monitor and evaluate the workload of the counseling
and support staff, along with staff/client ratios at Vet Centers, to
determine if personnel levels are adequate to provide timely treatment
in meeting the current demands along with the expected/projected client
increases as a result of Operation Enduring Freedom/Operation Iraqi
Freedom (OEF/OIF) and the increasing number of women veterans accessing
the VA system, with a report to the Director of Readjustment Counseling
Services.

32\. Vet Center team leaders identify and evaluate barriers that may
lead to a diminished ability to serve women veterans with a report to
the Director of Readjustment Counseling Services.

33\. Ensure that each inpatient/residential psychiatric unit has
capacity to dedicate a specific area on the unit to segregated patient
rooms, bathrooms, social areas, and treatment for women veterans, and
that this arrangement is extended to PTSD units and homeless
domiciliaries.

34\. All VISN homeless coordinators review and monitor the homeless
veteran community outreach plan within their respective VISN medical
centers to ensure that women veterans are a targeted population, and
that an annual report is forwarded to the VA Program on Homelessness.

35\. The VHA, at each of its medical center behavioral/mental health
departments, develop and implement a strategic plan and proactive local
policy to provide coordinated linkages with community-based non-profits,
social service providers, and local governmental agencies. This should
include the identification of resources to provide care and support for
the children of homeless women veterans, in order to bring comprehensive
assistance to homeless veterans.

36\. The Secretary of Veterans Affairs, as current Chair of the
Presidential Interagency Council on Homelessness (ICH), work with the
ICH to initiate a grant that would coordinate a grant-funded Request for
Proposal (RFP) from VA Homeless Grant and Per Diem Program with that of
the Department of Health and Human Services (HHS), to allow non-profit
organizations to respond to a single RFP grant initiative addressing the
residential needs of homeless women veterans with children.

37\. VISN Directors commit to continue funding the Homeless Women
Veterans Pilot Projects within the VISN where these programs are
located, based on positive outcomes as determined by the Director VA
Program on Homelessness.

38\. VA develops guidelines for homeless women veterans' program case
management based on a review of outcomes and lessons learned from the 11
VA homeless women veterans' pilot programs, for utilization in local VA
homeless programs.

39\. The Secretary identify funding for the homeless special needs
grants in the VA Grant and Per Diem Program, as outlined in Public Law
107-95, "Homeless Veterans Comprehensive Assistance Act of 2001," and
that a RFP be released.

40\. VA Grant and Per Diem Program identify homeless women veterans as a
priority in the next capital and per diem only (PDO) grant round RFPs as
offered within the VA Grant and Per Diem Program.

41\. VA seeks legislation to make permanent the authority to provide
counseling, treatment, and care to victims of military sexual trauma.

42\. Make the treatment of PTSD arising from sexual assault a permanent
function of the Vet Center mission.

43\. Extend VA's authority to provide counseling, treatment, and care
for sexual trauma victims to National Guard members and Reservists who
were sexually assaulted while on active duty for training.

44\. Provide funding to support hiring additional MST counselors to meet
the needs of those suffering MST as identified by the Vet Center team
leaders in conjunction with the Office of Readjustment Counseling
Services.

45\. Authorize and fund the contract fee basis program administered by
the Vet Center program to treat MST veterans when and where necessary.

46\. VHA develop enhanced initiatives and devote additional resources to
assist the Behavioral and Mental Health Program with expanding the MST
program and incorporating a more coordinated integrated approach to this
delivery of care. Further, the Committee recommends that this
coordination should include but not be limited to outreach, provider
education, MST research, clinical care services, information technology
systems development, data capture, the development of best practices,
and the reporting of performance outcomes.

47\. Waive the eligibility criteria for prenatal and delivery care to
women veterans who are pregnant due to rape while on active duty.

48\. Mandate that new staff orientation and sensitivity trainings and
orientations with annual in-services to the staff of all VHA treatment
sites, to include contracted CBOCs; document training on the employee
training record; and ensure that the training is comprehensive in nature
to include the history of women in the armed forces and military sexual
trauma.

49\. VHA develops a training program that is mandatory for all affiliate
residents and interns prior to their practice in a VA facility and that
it includes a history of veterans' sacrifice and service and its impact
on current health related conditions of the veterans era of service.

50\. Incorporate and extend MST training (as offered within VA medical
centers or the VISNs) to Vet Center staff as determined appropriate by
the Vet Center team leader and the Director of Readjustment Counseling
Services, in conjunction with the medical center behavioral and mental
health department.

51\. The Secretary communicates the Committee's request to the
Department of Labor (DOL), that DOL, through its network of state
employment directors and assistant directors, work with states to ensure
Local Veterans Employment Representatives (LVERs) and Disabled Veteran
Outreach Programs (DVOPs) receive information that will increase their
sensitivity to women veterans issues to include MST.

52\. VA continue efforts to develop, recruit, and retain women employees
for senior management positions and that the Secretary continue to
aggressively encourage the identification of women veterans, who are
viable candidates, for appointment to all VA advisory committees. The
Committee requests that the Secretary extend this recommendation on
behalf of the Committee to the Secretary of Labor.

53\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor, that DOL (VETS) continue efforts
to work with state representatives to encourage the hiring of more women
veterans as DVOPs and LVERs, and that the DOL identify obstacles and
barriers to this effort.

54\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor; that the contracts developed by
DOL's Veterans\' Employment and Training Service (VETS) for training and
rehabilitation services or employment opportunities for veterans of OEF
and OIF provide ample and equitable opportunity for women veterans of
these operations. The Committee requests that grantees report
participation and job placement rates by gender to DOL VETS.

55\. VA propose legislation to increase the delimiting period for
Montgomery GI Bill usage from 10 to 20 years.

56\. The National Cemetery Administration (NCA) include designations of
acronyms WAAC, WAVES, SPAR, WAC, WAFS, and WASP, on headstones or
markers to recognize women veterans who served in those specially
designated units/corps.

57\. Ensure that veteran benefits advisors' at Transition Assistance
Program briefings specifically address the existence of VA MST programs,
and that information packets are disseminated.

58\. The Secretary establishes a process whereby formal member
appointments are made by both the Department of Defense (DoD) and VA,
for representation on all task forces and working groups dealing with
MST.

59\. The Secretary suggests to DoD that pregnant service members, opting
to be released from active duty prior to delivery, be briefed by the
veterans TAP representative on VA eligibility, services and limits of VA
services regarding pregnancy care within VA. The Committee also
recommends that the women service members receive a briefing from the
Tri-Care customer service representative on benefits related to delivery
and newborn coverage. These two briefing requirements should be
incorporated into the Commander's pregnancy counseling checklist.

# 60. The Secretary of Veterans Affairs request consideration by the Secretary of Defense for an evaluation that gender be added to the Form DD214, "Certificate of Release or Discharge from Active Duty." 

# 

# 

# 

# **Part III**

# **Recommendations and Rationale**

# 

# **A. Strategic Planning**

# **Recommendations:**

1.  Ensure that Women Veterans Program Managers (WVPMs) are active
    participants at all Veterans Integrated Service Network (VISN) level
    and local Capital Asset Realignment for Enhanced Services (CARES)
    implementation planning and decision-making group processes.

2\. Conduct a sub-analysis of CARES data and market penetration to
determine women veterans' trends. That these data are aggregated at the
local medical center and reported to the Women Veterans Health Program
(WVHP) office in order to plan for projections of Veterans Health
Administration (VHA) impacting the local medical center utilization of
services and care for women veterans.

**Rationale:** As the CARES process moves forward, the Committee expects
that the ability of VA medical centers (and other health facilities) to
provide services for women veterans will be preserved and improved. This
will only happen if specific attention is paid to this aspect of VA's
mission throughout CARES implementation to avert the prohibitive costs
of retrofitting new facilities.

Matters of importance to women veterans - including space/facilities,
privacy and safety - must be addressed during the implementation and
integration steps of the CARES process at the national, VISN, and local
levels.

During site visits, the Committee has often observed that the limited
space and poor configuration in women's health examination rooms
resulted in violation of patient privacy. Privacy standards as published
in revised Handbook 1330.1," have been determined within VA. Often these
standards do not translate into specific direction and definition for
site utilization. Standard examination rooms have basic equipment.
However, if it is a gynecology examination room, the foot of the table
is to be placed away from the door with enough space for the doctor to
perform the exam. This may require additional space.

**Recommendations:**

3\. Perform a current assessment of compliance with the Privacy
Standards, as outlined in the revised VHA Handbook 1330.1, "VHA Services
for Women Veterans," at all VHA treatment delivery sites and re-assess
this compliance on an annual basis with monitored outcomes reported to
the local respective VISN leadership and the WVHP office.

4\. Ensure that all medical center Space Utilization/Facilities
Management committees apply the Privacy Standards outlined in revised
VHA Handbook 1330.1 in the work process and that these privacy standards
are applied consistently throughout the facilities. That this is
facilitated by the inclusion of the WVPM on all space planning or
renovating projects in the medical center where services are offered and
provided to women veterans to include Community Based Outpatient Clinics
(CBOC). The VISN Women Veterans' Health Council to assess and report on
this annually with copies of the report forwarded to VISN leadership and
the WVHP office.

**Rationale**: As the result of site visits and feedback from women
veterans, evidence indicates that issues related to facilities
environment privacy standards remain and are a continued concern.

# **B. Outreach**

# **Recommendations**:

5\. Translate into Spanish, brochures and outreach materials that are
currently only available in English.

6\. Develop outreach materials targeting minority women veterans, older
women veterans, and those living in rural areas and the U.S.
territories, with attention to their unique ethnic, cultural, and
geographic influences.

**Rationale:** The Committee commends VA for their extensive efforts and
new initiatives in its outreach to women veterans. With the increasing
number of women veterans and those eligible activated National Guard and
Reserve troops, the Committee believes that outreach will remain a
priority, especially to those segments of the women veteran population
that are hard to reach. The Committee further commends VA and the WVHP
office for the development of the "Women Veterans Health Program" and
"Military Sexual Trauma Counseling and Treatment" pamphlets that have
been printed in English and Spanish, as well as the orientation brochure
entitled "We are Women Veterans."

**Recommendation:**

7\. That the Veterans Benefits Administration (VBA) begin an outreach
effort to medical associations, such as the American Medical Association
(AMA) and health care providers, etc., that may have contact with people
born to mothers who served in Vietnam who are eligible for compensation
for certain birth defects.

**Rationale**: Public Law 106-419, "Veterans Benefits and Health Care
Improvement Act of 2000," authorizes benefits to children born of
mothers who served in Vietnam and who have certain types of birth
defects. It has been noted in briefings from VBA that few have applied
for such benefits to date. Since many of those eligible for this benefit
are no longer minors, it is felt that they are probably receiving care
by community providers who are not aware of the benefits for which they
are eligible.

# **C. Research and Studies**

**Recommendations:**

8\. Aggregate and report, by gender, patient satisfaction assessments
and clinical performance measures in order to facilitate trending and
comparison of differences in the quality of care.

9\. Commission a follow-up study to the study entitled "Survey of Female
Veterans: A Study of the Needs, Attitudes and Experiences of Women
Veterans," published by Louis Harris and Associates in August 1985, to
examine the current status, demographics, needs, and experience of women
veterans of the U.S. Armed Forces.

10\. Identify and solicit earmarked research funds to conduct a study
with sufficient numbers of women veterans by age, race or ethnicity,
period of service, and both VA and non-VA healthcare utilization to
conduct appropriate statistical analyses on the success of VA health and
benefits programs in meeting the needs of women veterans. (This is a
follow-up to Recommendation #17 of this Committee's 2002 Report.)

11\. Conduct a study to investigate the reason for the disproportionate
occurrence of the incidence of Post Traumatic Stress Disorder (PTSD) in
African-American women veterans, in light of the fact that 35 percent of
those seeking treatment for PTSD are African-American women, as cited in
current literature reviews which demonstrates an increase in that
cohort.

12\. Conduct a study to investigate the impact of the Anthrax vaccine
and other military occupational exposures, both intentional (i.e.
immunizations to include Anthrax) and unintentional (i.e. chemical
exposures) on the reproductive system.

13\. Actively proceed with the authorized National Vietnam Veterans
Longitudinal Study and re-address and evaluate the cohorts of the 1988
"National Vietnam Veterans Readjustment Study" to include a broad based
health inquiry.

### Rationale: The Committee commends VA for the attention that has been given to studies and research in regard to women veterans. Further, the Committee commends VA for its approach to the development of a comprehensive VA women's health research agenda, which includes a systematic review of VA's research portfolio related to women's health, a literature review as a foundation for an evidence base, analyses of existing data and data sources on the health and health care of female veterans, and identification of strategic priorities for research based on analysis of the needs of women veterans and the gaps in knowledge. 

###### Based on the briefings over the past 2 years, the Committee has recognized and determined that a number of possible areas of investigation are needed for consideration. A number of studies, performed several decades ago, if re-addressed, would provide VA with current demographics and information on long-term health effects resulting from previous military service. 

Over 51 percent of enlisted women and 24 percent of women officers come
from minority groups. There are some indications that they may be more
susceptible to PTSD from combat or personal trauma. The study entitled
"Survey of Female Veterans: A Study of the Needs, Attitudes and
Experiences of Women Veterans," published by Louis Harris and Associates
in August 1985 was the last study designed to provide broad demographics
trends on the current female, veteran population. "The National Vietnam
Veterans Readjustment Study," was yet another that compared in-country
Vietnam veterans with Vietnam Era veterans and civilian cohorts.

# **Recommendations:**

14\. Fund and perform qualitative study/studies through Health Services
Research and Development (HSR&D) to attain outcomes to determine
appropriate panel size to maintain competence in the delivery of care to
women veterans; and to determine how many women veterans are necessary
to maintain a primary women's health care clinic.

15\. Fund and conduct a national study through HSR&D on the variation of
all VHA care delivery models for women, including primary care clinics,
and that this study additionally include how these models are linked
with outcomes of quality of care and patient satisfaction.

**Rationale**: Women veteran's health clinics and care centers have a
wide and varied approach to the delivery of care to women veterans
across the country. In VHA, care delivery models exist as comprehensive
care centers, as primary care clinics, and others as Ob-Gyn clinics.
Yet, it has not been determined what standard should exist for the
appropriate women veterans' panel size in order to maintain physician
competence in the delivery of primary and gender related care to women,
nor have the components of effective, quality care been determined.

Many years were devoted to the struggle of the establishment of these
specific VHA women's health clinics and comprehensive centers. The
Committee looks to the emphasis that university medical centers place on
women's health care as a specialty, as evidenced by the requirement that
trainees have a proportionate number of women on the longitudinal
panels.

The Committee is extremely concerned about a possible erosion of
specific free-standing comprehensive women's health clinics and the
mainstreaming of women veterans into general primary care.

As a foundation for developing a sound evidence base related to the
organization and delivery of health care services to women veterans and
the continuation and possible expansion of women's health clinics, a
number of studies are being recommended.

**Recommendation:**

16\. The WVHP office conduct an assessment of compliance to determine
whether clinicians, who also serve as WVPMs, have appropriate time
allocations to perform and accomplish the duties of both positions.

**Rationale:** WVPMs are critical in the successful implementation of
the processes and systems to ensure timely access to quality care for
the increasing numbers of women veterans accessing VA health care. In
accordance with guidance published in VHA Handbook 1330.2, WVPMs must be
allocated adequate time to perform the administrative requirements of
their role.

**Recommendation:**

17\. Perform a study to determine the prevalence of Military Sexual
Trauma (MST) among homeless women veterans, the psychosocial
consequences of MST, and whether a correlation exists between MST and
homelessness.

**Rationale**: Data gathered by the Northeast Program Evaluation Center
(NEPEC) in a study of program cohorts, from the 11 VA homeless women
veterans' pilot programs, indicate that 43 percent of the study
participants had reported rape and 38 percent reported sexual harassment
while in the military.

# **D. Women Veterans Health Program** 

**Recommendations:**

18\. Incorporate performance standards into the Executive Career Field
Performance Plans that demonstrate individual leadership, and
accountability of care and services provided to women veterans.

19\. The WVHP remains in a position and at a reporting level of high
organizational visibility to ensure and protect its strength, authority,
and autonomy within VHA in order to: guarantee its ability to provide
consultation and program oversight; provide guidance and direction to
all levels within VHA to include the medical centers and VISNs; and
ensure that there be no diminution of the role and authority of the
program.

20\. Local and VISN leadership be held accountable for implementing all
strategies outlined in VHA Handbooks 1330.1 and 1330.2, and that
mechanisms be developed for a process to monitor compliance.
Furthermore, demonstrate evidence of the level of support and
implementation of formal guidance outlined in the VHA Handbooks.

**Rationale:** For more than 7 years, the WVHP office has been providing
oversight and direction for the delivery model for the care and
treatment of women veterans within VA. The contributions of the WVHP to
advancing the delivery of health care and services to women veterans
throughout VA's health care system are indisputable. The commitment,
expertise, and investment of program officials have resulted in program
enhancements and improved health care and customer satisfaction outcomes
since the office's formal designation within the VHA in 1997.

**Recommendation:**

21\. On an annual basis, the four Deputy Field Directors (DFD), as well
as one Lead VISN Woman Program Manager designated by the Committee, will
provide a briefing on key issues within their respective areas during
one of the Committee's Washington, DC, meetings.

### Rationale: The Committee historically makes one site visit per year. It is recognized that due to the vast VHA system, the Committee is limited to the number of locations that could be visited over time. The Committee appreciates the energy and investment of the DFDs in the delivery of women veterans' health care and as a source of information to the Committee. 

# **E. Women Veterans Program Managers/Benefits Coordinators**

**Recommendations**:

22\. Establish a minimum of 20 hours or .5 FTE as a threshold for the
time allotted to WVPMs in the accomplishment of their duties.

23\. VHA provide the WVPMs with appropriate space, equipment and
administrative support to accomplish their responsibilities in
accordance with guidance outlined in VHA Handbook 1330.2 and that VBA
provide this same level of support to its Women Veteran Coordinators.

**Rationale:** As reported by the WVHP office, the increasing number of
women veterans was noted. Women veterans enrolled in VA in Fiscal Year
(FY) 2003 were 333,578 (up 9.4 percent from FY 2002) and of those
enrolled in FY 2003, 196,134 (up 7.5 percent from FY 2002) actually used
the system. The projected number of women veterans, as estimated by the
CARES data, projects that in 2012 the number of women veterans will be
528,728 and in 2022 it will be 699,314. It is unclear if these numbers
account for the large number of activated women serving in the National
Guard and Reserves.

The Committee views the administrative demands of the WVPM as increasing
especially in terms of outreach and utilization as resource team
members. We also considered the duties and responsibilities they face in
order to adhere to and comply with VHA Handbook 1330.2 in the
accomplishment of their duties.

While we recognize the progress of establishing a minimum threshold of
10 hours (.25 FTE) for WVPMs, the Committee continues to view this as
insufficient for them to accomplish their mission and goals.

**Recommendations:**

24\. Utilize the WVPMs on medical center and VISN committees relative to
strategic planning, staff education and orientation, and facilities
management.

25\. VISN leadership to demonstrate and show evidence that the
strategies outlined in the WVHP Integrated Business Plan have been
incorporated into its plan. Further, that the VISN Women Veterans Health
Council assesses this process and report its findings to the WVHP.

**Rationale:** The WVPMs are deeply vested in their role and position of
providing assessment of needs and implementation of services to women
veterans. The wealth of knowledge and expertise they have to offer not
only to the women veterans but also to the medical center and VISN
cannot be denied. The Committee feels the WVPMs would also provide a
great resource and contribution to the mission in many arenas where they
are not necessarily being fully utilized. This was apparent on the
Committee's last two site visits.

**Recommendation:**

26\. All medical center women veterans' advisory committees incorporate
non-VA employee women veterans consumers on their committee who
represent the diverse population within each VA medical center treatment
area and that this local women veterans advisory committee and the WVPM
host an annual town meeting for women veterans of the area.

**Rationale:** Reflecting on the experiences and diversity of the
Committee, we applaud the efforts of the WVPMs in their contribution to
their local women veterans advisory committees. These local committees
serve not only the medical center but also their community of women
veterans. We believe these local committees should also be a diverse
representative body with the ability to not only be the voice of local
women veterans but also allow for women veterans to have a voice.

# **F. Health Care**

**Recommendations:**

27\. Modify the Fee Basis package to alert providers of the need to
follow-up on test results (i.e. mammography) of patients referred to
community (outside) providers in order to provide timely continuity of
care and case management.

28\. Medical center clinics monitor the oversight of coordination for
case management between community contract care providers and VHA care
providers for continuity of care. Additionally, develop a process for
oversight to ensure that providers communicate findings to patients in a
timely manner.

29\. Monitor data on services and treatment provided by fee-basis and
contract, in a VHA database for evaluation, in order to project future
needs and utilization of services by women veterans

**Rationale:** Providing high-quality, user-friendly health care for
women in a traditionally all male environment such as the Veteran's VHA
is a daunting challenge. Data capture is vital as VA explores new
services to include workload, utilization, and cost. As software is
expanded, it is essential that every facility identify a mechanism to
collect and track data for outcome measures and the evaluation of the
delivery of care.

**Recommendation:**

30\. Develop a comprehensive educational plan for primary care
providers/clinicians that will enhance current practice and the
utilization of the mental health screenings, to ensure that they more
readily identify those women veterans who are at high risk and in need
of mental health referrals in order to expedite the primary care
referral to a mental health provider.

**Rationale:** Literature on abuse and victimization indicates that
female sexual assault victims seek the help of a medical physician twice
as frequently as male victims and that the severity of the victimization
is the most powerful predictor of utilization rates. The patient seldom
identifies trauma or behavioral health as his or her chief complaint.
Frequent physical symptoms seen in trauma survivors are chronic pain,
gastrointestinal problems, obesity, and hypertension. In order to
address the needs of veterans in a holistic approach to the delivery of
sexual trauma care the Committee is concerned about the fragmented and
lack of coordinated approaches utilized in the assessment and treatment
of the emotional and physical after-affects of MST.

# **G. Behavioral and Mental Health Care**

**Recommendations:**

31\. Team leaders to monitor and evaluate the workload of the counseling
and support staff, along with staff/client ratios at Vet Centers, to
determine if personnel levels are adequate to provide timely treatment
in meeting the current demands along with the expected/projected client
increases as a result of OEF/OIF and the increasing number of women
veterans accessing the VA system, with a report to the Director of
Readjustment Counseling Services.

32\. Vet Center team leaders identify and evaluate barriers that may
lead to a diminished ability to serve women veterans with a report to
the Director of Readjustment Counseling Services.

**Rationale:** VA did not focus on treating the emotional traumas
experienced by veterans during military service until the late 1970's.
The impetus for this was congressional action authorizing the Vet Center
Program. Today, as in the past, Vet Centers are often the first stop for
veterans requiring treatment for PTSD, addiction and other mental health
conditions. The Global War on Terrorism is producing a new generation of
veterans who will need such treatment well into the future. To date,
more than 67,000 of these combat zone veterans are women. A VA outreach
effort is underway now to inform these veterans of the services Vet
Centers can provide for them. These outreach efforts must include women
veterans, and PTSD, as well as other programs provided by Vet Centers to
OEF and OIF veterans must identify and eliminate barriers to women's
participation. The Vet Centers have received a temporary increase in
staff to help handle what could become a long-term increased workload
resulting from the newly focused outreach effort. It is the Committee's
sense that with this workload increase future increased funding may be
necessary to provide a permanent increase in full-time equivalent FTE
counseling positions.

**Recommendation**:

33\. Ensure that each inpatient/residential psychiatric unit has
capacity to dedicate a specific area on the unit to segregated patient
rooms, bathrooms, social areas, and treatment for women veterans, and
that this arrangement is extended to PTSD units and homeless
domiciliaries.

**Rationale:** During site visits and through briefings, the Committee
has noted that psychiatric treatment facilities, domiciliaries, and
other spaces used for inpatient/residential treatment of women suffering
from mental health conditions are inadequately configured to ensure the
privacy and safety these women need to achieve successful treatment
outcomes. This is particularly important for those women who suffered
from military sexual trauma, sexual trauma, and domestic violence.

# **H. Women Veterans [W]{.smallcaps}ho are Homeless**

# **Recommendations:**

34\. All VISN homeless coordinators review and monitor the homeless
veteran community outreach plan within their respective VISN medical
centers to ensure that women veterans are a targeted population, and
that an annual report is forwarded to the Director, VA Program on
Homelessness.

35\. The VHA, at each of its medical center behavioral/mental health
departments, develop and implement a strategic plan and proactive local
policy to provide coordinated linkages with community-based non-profits,
social service providers, and local governmental agencies. This should
include the identification of resources to provide care and support for
the children of homeless women veterans, in order to bring comprehensive
assistance to homeless veterans.

36\. The Secretary, as current Chair of the ICH, work with the ICH to
initiate a grant that would coordinate a grant-funded RFP from VA
Homeless Grant and Per Diem Program with that of HHS, to allow
non-profit organizations to respond to a single RFP grant initiative
addressing the residential needs of homeless women veterans with
children.

**Rationale:** The rising number of women in the military has the
potential for an increase in the number of women veterans who are
homeless. Women veterans who are homeless must be recognized as having
unique needs, such as privacy, childcare, prenatal and pregnancy care,
and treatment for physical and sexual trauma.

**Recommendations:**

37\. VISN Directors commit to continue funding the Homeless Women
Veterans Pilot Projects within the VISN where these programs are
located, based on positive outcomes as determined by the Director VA
Program on Homelessness.

38\. VA develops guidelines for homeless women veterans' program case
management based on a review of outcomes and lessons learned from the 11
VA homeless women veterans' pilot programs, for utilization in local VA
homeless programs

**Rationale**: The special attention and investment made recently by VA
in pilot programs for women veterans who are homeless that have resulted
in development of successful approaches to helping these women that
should be shared across the system to increase positive outcomes.

####### Recommendations:

39\. The Secretary identify funding for the homeless special needs
grants in the VA Grant and Per Diem Program, as outlined in Public Law
107-95, "Homeless Veterans Comprehensive Assistance Act of 2001," and
that a RFP be released.

40\. VA Grant and Per Diem Program identify homeless women veterans as a
priority in the next capital and PDO grant round RFPs as offered within
the VA Grant and Per Diem Program.

**Rationale:** Women veterans who are homeless are estimated to be
approximately three to four percent of the homeless veterans'
population. Women veterans who are homeless seeking residential
treatment in VHA may have minor dependents and would have to relinquish
custody or find guardians in order to be admitted to residential
programs, i.e. domiciliaries, substance abuse treatment units, and PTSD
units. Often times, placement in the community or in VA funded Homeless
Grant and Per Diem transitional programs are the only options of choice
for the woman veteran.

# **I. Sexual Trauma Counseling**

# **Recommendations:** 

41\. VA seeks legislation to make permanent the authority to provide
counseling, treatment, and care to victims of military sexual trauma.

42\. Make the treatment of PTSD arising from sexual assault a permanent
function of the Vet Center mission.

43\. Extend VA's authority to provide counseling, treatment, and care
for sexual trauma victims to National Guard members and Reservists who
were sexually assaulted while on active duty for training

**Rationale:** The legal authority, Public Law 103-452, "1994 Veterans
Health Program Extension Act," that permits VA to provide sexual trauma
counseling and treatment to military members of both sexes, even if they
are not otherwise eligible for veterans' benefits, expires on December
31, 2004. The Committee recognizes that a VA legislative proposal has
been put forward and that recent Congressional hearings were held on
this issue. Data indicate that of those screened for MST, 1 in 20 women
(19,463) and 1 in 100 men (22,486) reported this experience. The most
recent screening data indicate that 21 percent of female veterans
screened in FY 2002 and 19.03 percent of those screened in FY 2003
reported MST. Additionally, a recently completed VHA study, "Military
Sexual Trauma Among the Reserve Components of the Armed Forces," shows
that Guard and Reserve component members have been sexually assaulted
while on active duty for training. Under current law, these victims are
not eligible for treatment.

**Recommendations:**

44\. Provide funding to support hiring additional MST counselors to meet
the needs of those suffering MST as identified by the Vet Center team
leaders in conjunction with the Office of Readjustment Counseling
Services.

45\. Authorize and fund the contract fee basis program administered by
the Vet Center program to treat MST veterans when and where necessary.

**Rationale:** Currently, funding levels support 39 FTE positions for
MST counselors within the 206-facility Vet Center system. The Committee
is concerned that this FTE level is inadequate to meet the need for such
treatment, due to the current data reported on VA MST screenings. MST
counselors have overloaded patient panels and there can be long waiting
times for treatment. If current funding does not allow for additional
counseling staff levels, consideration must be given to fee-basis
contracting for the service, where the workload indicates an increased
need.

**Recommendation:**

46\. VHA develop enhanced initiatives and devote additional resources to
assist the Behavioral and Mental Health Program with expanding the MST
program and incorporating a more coordinated integrated approach to this
delivery of care. Further, the Committee recommends that this
coordination should include but not be limited to outreach, provider
education, MST research, clinical care services, information technology
systems development, data capture, the development of best practices,
and the reporting of performance outcomes.

**Rationale:** Services, treatment, and care are provided to MST victims
in an array of VHA facilities and program settings including inpatient
and outpatient wards, medical and mental health arenas, Vet Centers,
women's health centers, and CBOCs. Considering the fragmented system of
service delivery, a more coordinated and comprehensive approach is
needed.

**Recommendation:**

47\. Waive the eligibility criteria for prenatal and delivery care to
women veterans who are pregnant due to rape while on active duty.

**Rationale:** It is unclear, under current legislation that provides
for treatment and care as the result of MST, if women veterans and those
who are otherwise ineligible to receive VA care (those with less than 24
months of active duty, National Guard and Reservists) who as the result
of MST become pregnant, will be eligible for prenatal care and
childbirth benefits. The Committee recognizes that this may be a rare
occurrence; however, the Committee believes it must be defined.

# **J. Training** 

**Recommendations:**

48\. Mandate that new staff orientation and sensitivity trainings and
orientations with annual in-services to the staff of all VHA treatment
sites, to include contracted CBOCs; document training on the employee
training record; and ensure that the training is comprehensive in nature
to include the history of women in the armed forces and military sexual
trauma.

49\. VHA develops a training program that is mandatory for all affiliate
residents and interns prior to their practice in a VA facility and that
it includes a history of veterans' sacrifice and service and its impact
on current health related conditions of the veteran's era of service.

**Rationale:** New staff orientation and sensitivity training is
developed and offered at medical centers, vet centers, CBOCs and to
affiliated staff. However, training does not occur on a consistent or
universal basis. The Committee believes this is an important element
that needs more attention and is an investment in the total care and
services offered by VHA. The Committee finds this especially true in
regard to the affiliates and believes that veterans have the right to
expect that those who deliver their care have an understanding of who
they are as veterans and the sacrifice they have made. This issue is
made difficult by the rotational aspects of residents and interns.

The medical community, university medical schools, and the Nation at
large have benefited greatly from the expenditures made by VA for both
direct healthcare and medical research. These expenditures have come
from VA's budget as yet another investment in our country. However, the
actual veteran does not benefit reciprocally.

**Recommendation:**

50\. Incorporate and extend MST training (as offered within VA medical
centers or the VISNs) to Vet Center staff as determined appropriate by
the Vet Center team leader and the Director of Readjustment Counseling
Services, in conjunction with the medical center behavioral and mental
health department.

**Rationale:** In order to maximize and efficiently utilize the limited
funding available, the Committee believes that the sharing of resources
is an important aspect of fiscal responsibility. For this reason the
Committee believes that certain training sessions and seminars be
extended beyond the walls of the medical center to other VA staff.

**Recommendation:**

51\. The Secretary communicates the Committee's request to the DOL, that
DOL, through its network of state employment directors and assistant
directors, work with states to ensure LVERs and DVOPs receive
information that will increase their sensitivity to women veterans'
issues to include MST.

**Rationale:** As more women move from active duty to veteran status,
seeking employment, training opportunities, and re-entry into the job
market, consideration must be given to the military experience of women
veterans and the impact it has had on their lives as they move to
re-integrate into the community at large.

# **K. Veteran Employment and Education**

**Recommendation**:

52\. VA continue efforts to develop, recruit, and retain women employees
for senior management positions and that the Secretary continue to
aggressively encourage the identification of women veterans, who are
viable candidates, for appointment to all VA advisory committees. The
Committee requests that the Secretary extend this recommendation on
behalf of the Committee to the Secretary of Labor.

**Rationale:** The Committee commends the Secretary for his initiative
to develop, recruit, and retain women employees throughout VA for senior
management positions. The Committee recognizes the progress made by VA
and DOL to ensure qualified women veterans, including minority women,
are identified and appointed to serve on all veterans advisory
committees. Women veterans across the country excel in all arenas and
provide an excellent resource for advisory committees far beyond their
gender. The Committee believes that increased attention is needed in
their appointments.

**Recommendations:**

53\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor, that VETS continue efforts to work
with state representatives to encourage the hiring of more women
veterans as DVOPs and LVERs, and that DOL identify obstacles and
barriers to this effort.

54\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor; that the contracts developed VETS
for training and rehabilitation services or employment opportunities for
veterans of OEF and OIF provide ample and equitable opportunity for
women veterans of these operations. The Committee requests that grantees
report participation and job placement rates by gender to VETS.

**Rationale:** Approximately 67,000 female troops have been deployed in
support of OEF and OIF. Women are being exposed to the hazards of a
combat environment and the physical and mental traumas of combat as
never before. It is important to keep their needs in mind when designing
veterans' employment and employment rehabilitation programs.

The approaching retirement of many state-level DVOP and LVERs affords an
opportunity for DOL VETS to work with state representatives to encourage
the hiring of more women veterans into these positions. The Committee
commends the efforts DOL has made to use the good offices of its network
of state directors and assistant directors to encourage each state to
identify, recruit and hire more women veterans into LVER and DVOP
positions.

The Committee anticipates that the VETS will develop programs and award
new contracts to provide training and rehabilitation services as well as
employment opportunities for veterans of OEF/OIF. It is important that
the needs of women combat zone veterans be made part of this process.

**Recommendation:**

55\. VA propose legislation to increase the delimiting period for
Montgomery GI Bill usage from 10 to 20 years.

### Rationale: With VA support Congress, recently passed legislation to increase the value of Montgomery GI Bill benefits. Among the beneficiaries of this legislation will be veterans of OEF/OIF. Consideration should be given to an extension to allow veterans who chose full-time parenting - most of whom are women - to use their benefits to prepare them for return to the workforce after meeting the demands of child rearing. 

### Additionally, an extension of the delimiting period will permit increased opportunity for older veterans who may need to update skills or change employment fields to remain a part of the labor force. 

# **L. National Cemeteries**

# **Recommendation:** 

56\. The National Cemetery Administration (NCA) include designations of
acronyms WAAC, WAVES, SPAR, WAC, WAFS, and WASP, on headstones or
markers to recognize women veterans who served in those specially
designated units/corps.

**Rationale:** Headstones provided by the NCA are a source of pride to
women veterans in that they are the final, lasting testament to their
veteran status. When large numbers of women were openly encouraged to
assist their country during World War II, Korea and in the initial
phases of the Cold War, they were placed into specially designated
units, such as Women's Auxiliary Army Corps (WAAC), Women Accepted for
Volunteer Emergency Service (WAVES), Semper Paratus-Always Ready (SPAR),
Women's Army Corps (WAC), [Women\'s Auxiliary Ferrying Squadron
(WAFS)](http://www.wpafb.af.mil/museum/history/wasp/wasp2.htm), and
Women Airforce Service Pilots (WASP). Although women today train and
serve alongside their male counterparts in integrated squadrons, it is
important to honor the special status of the women veterans who paved
the way for total integration of generations to follow.

# **M. Departments of Defense and Veterans Affairs**

**Recommendation**:

57\. Ensure that veteran benefits advisors' at Transition Assistance
Program briefings specifically address the existence of VA MST programs,
and that information packets are disseminated.

**Rationale:** The Committee commends VA and the Department of Defense
Manpower Data Center for establishing the lines of communication to
share information on combat injuries (and non-battle casualties) for the
returning veterans of OEF/OIF as they are discharged from active duty.

Data indicate that of those screened for MST, 1 in 20 women (19,463) and
1 in 100 men (22,486) reported this experience. Due to increasing number
of veterans, both men and women, who present with the need for these
services the Committee strongly recommends that VA provides them.

**Recommendations:**

58\. The Secretary establishes a process whereby formal member
appointments are made by both the Department of Defense (DoD) and VA,
for representation on all task forces and working groups dealing with
MST.

59\. The Secretary suggests to DoD that pregnant service members, opting
to be released from active duty prior to delivery, be briefed by the
veterans TAP representative on VA eligibility, services and limits of VA
services regarding pregnancy care within VA. The Committee also
recommends that the women service members receive a briefing from the
Tri-Care customer service representative on benefits related to delivery
and newborn coverage. These two briefing requirements should be
incorporated into the Commander's pregnancy counseling checklist.

**Rationale:** Some women who are pregnant and choose to separate from
active duty are eligible to enroll in VA, however, some find themselves
not adequately informed with regard to VA eligibility priority
enrollment and how this will impact the timeframe for access to VA
maternity benefits. Complete information on all available resources, as
it relates to maternity and delivery care, will allow the woman the
opportunity to make an informed decision on the coverage that best fits
her needs.

**Recommendation:**

# 60. The Secretary requests consideration by the Secretary of Defense for an evaluation that gender be added to the Form DD214.

**Rationale:** The DD214, "Certificate of Release or Discharge From
Active Duty," an important tool for outreach, program development
efforts, and strategic planning purposes. However, it is difficult to
determine the gender based on name alone.

# 

# **Part IV**

# **VA Response to Recommendations** 

# 

# **A. Strategic Planning**

1\. Ensure that Women Veterans Program Managers (WVPMs) are active
participants at all Veterans Integrated Service Network (VISN) level and
local Capital Asset Realignment for Enhanced Services (CARES)
implementation planning and decision-making group processes.

***VA Response:*** Concur. WVPMs are active participants at VISN level
and local CARES implementation planning and decision-making group
processes. Presently, there is a Lead WVPM designated for each VISN who
also serves as a member of the National Women Veterans Health Program
Field Advisory Group. In addition, each VA facility has a designated
Women Veterans Program Manager. VHA will utilize these existing
processes in providing input and consultation to CARES implementation
and planning activities. CARES decisions will also be incorporated into
VHA ongoing strategic planning activities and support the Women Veterans
Health Program's (WVHP) continued involvement to ensure quality,
accessible delivery of services to women veterans. The Director, Women
Veterans Health Program office, is a consultant to the National
Leadership Board (NLB) Strategic Planning Committee, and will be a
consultant to each NLB strategic champion group on issues relevant to
women's health. As CARES issues arise, VISN and local medical center
directors will seek advice and counsel from the WVHP office.

-   Target Date: Ongoing

2\. Conduct a sub-analysis of CARES data and market penetration to
determine women veterans' trends. That these data are aggregated at the
local medical center and reported to the Women Veterans Health Program
(Women Veterans Health Program office) office in order to plan for
projections of Veterans Health Administration (VHA) impacting the local
medical center utilization of services and care for women veterans.

***VA Response*:** Concur. Women veterans are one of the fastest growing
segment of the veteran population based on the Census2000 and VetPop
data. VHA anticipates that women veteran enrollees will increase as well
and has empowered the Women Veterans Health Program to collaborate with
all VHA program offices to actively explore and propose strategies to
ensure that we are prepared to meet the needs of women veterans. Our
ability to project valid women veteran health care utilization trends at
the health care market area level has been restricted by the fact that
women veteran enrollees have consistently comprised only approximately
4.5 percent of the total VHA enrollees. VHA's Policy and Forecasting
Office will consult with actuary contractors to ensure alternative

women veteran health care utilization data is available to support
future strategic planning initiatives.

-   Target Date: FY 05

3\. Perform a current assessment of compliance with the Privacy
Standards, as outlined in the revised VHA Handbook 1330.1, "VHA Services
for Women Veterans," at all VHA treatment delivery sites and re-assess
this compliance on an annual basis with monitored outcomes reported to
the local respective VISN leadership and the WVHP office.

***VA Response:*** Concur. The National Women Veterans Health Program
Integrated Business Plan, Objective 1.1 states: "The Women Veterans
Health Program (WVHP) office will develop and incorporate
structural/environmental and psychosocial patient safety and privacy
standards in the revised VHA Handbook 1330.1, Services for Women."
Appendix B of the Handbook outlines the Standards that were developed
and Appendix C provides a tool to monitor outcomes of compliance with
the Privacy Standards. Also, data obtained from the Survey of Health
Care Experiences of Patients for FY 02 and FY 03, with a focus on women
veterans' satisfaction results, indicate that in both years, 85-86
percent of the women queried were satisfied with privacy. These results
are from inpatients. Appendix C also focuses on inpatient and outpatient
compliance with privacy standards. The revised VHA Handbook 1330.1
published in July 2004 requires every facility to complete a Plan of
Care/Clinical Inventory commencing in FY 05. VHA's Office of the Deputy
Under Secretary for Health for Operations and Management will coordinate
with the WVHP to assess compliance with the established privacy
standards on an annual basis.

-   Target Date: 3^rd^ quarter FY 05 and annually thereafter

4\. Ensure that all medical center Space Utilization/Facilities
Management committees apply the Privacy Standards outlined in revised
VHA Handbook 1330.1 in the work process and that these privacy standards
are applied consistently throughout the facilities. That this is
facilitated by the inclusion of the WVPM on all space planning or
renovating projects in the medical center where services are offered and
provided to women veterans to include Community Based Outpatient Clinics
(CBOC). The VISN Women Veterans' Health Council to assess and report on
this annually with copies of the report forwarded to VISN leadership and
the WVHP office.

***VA Response:*** Concur. VHA Handbook 1330.1, VHA Services for Women
Veterans, Appendix B "Women Veterans Health Structural and/or
Environmental Privacy and Safety Standards," provides guidance to WVPMs,
who are responsible for interpreting and providing education to facility
staff on the safety and privacy needs of women veterans. The Handbook
states that the WVPM should be included in all space planning or
renovation projects at the facility and CBOCs where services are offered
and provided to women veterans. VISN Lead WVPMs and VISN Women Veterans
Health Councils will share the standards with VISN leadership. Appendix
C, "Plan of Care/Clinical Inventory." will be required from each
facility for FY 05 and will assess the level of compliance. This report
will be submitted to facility and VISN leadership prior to sending it in
to the national Women Veterans Health Program Office.

-   Target Date: 1^st^ quarter FY 05

# **B. Outreach**

5\. Translate into Spanish, brochures and outreach materials that are
currently only available in English.

***VA Response:*** Concur. The most widely requested and distributed
brochures, pamphlets, fact sheets, and booklets are available in Spanish
(listed below). The VHA, VBA, and NCA actively monitor materials to
ensure that they meet the needs of veterans. The following is a list of
the most widely distributed materials available in Spanish. Numerous
benefit fact sheets and other informational materials, printed in
Spanish, are available on VA's Internet web site
([http://www.va.gov](http://www.va.gov/)).

-   Women Veterans Health Program Brochure, *A Promise Kept*

-   Military Sexual Trauma Brochure *Counseling and Treatmen*t

-   *A Summary of VA Benefits*

-   *Federal Benefits for Veterans and Dependents*

-   *Gulf War Veteran Information*

-   *Veterans of the Gulf War*

-   *Investigation of Gulf War Veterans*

The following Benefit Fact Sheets are available on the VA Web Page in
both English and Spanish:

-   Disability Compensation Benefits

-   Disability Pension Benefits

-   Dependency and Indemnity Compensation

-   Burial Plot-Interment Allowance

-   Death Pension Benefits

-   Burial Flag

-   Montgomery GI-Bill -- Active Duty -- Chapter 30

-   Vocational Rehabilitation Benefits -- Chapter 31

-   Post-Vietnam Educational Assistance Program (VEAP) -- Chapter 32

-   Montgomery GI Bill -- Selected Reserves -- Chapter 106

-   Assistance for Homeless Veterans

-   Former Prisoners of War POWs

-   Home Loan Guaranty Benefits

-   Incarcerated Veterans Benefits

-   Service-Disabled Veterans Insurance - RH

-   Survivors & Dependents Educational Assistance -- Chapter 35

VA will also have the Fact Sheet on Disability Compensation for Sexual
Trauma translated into Spanish and posted on the VA Web Page.

VA will consider the Committee's request for printing additional
publications in Spanish.

-   Target Date: Ongoing

6\. Develop outreach materials targeting minority women veterans, older
women veterans, and those living in rural areas and the U.S.
territories, with attention to their unique ethnic, cultural, and
geographic influences.

***VA Response:*** Concur. Homeless women veterans are a segment of the
various populations targeted in VA's overall outreach efforts among them
minorities, the elderly, and those residing in outlying areas. We
believe that the reality of "women are veterans too" is deeply engrained
VA-wide. VHA's revised Handbook 1330.1, Health Care for Women Veterans
incorporated cultural standards, which serves as guidance to the field
on the importance of women\'s unique ethnic, cultural, and geographic
influences. The WVHP Orientation brochure entitled \"We are Women
Veterans\" reviews the history of women veterans to help insure cultural
and gender sensitivity. All brochures developed by the WVHP for outreach
are available in Spanish and English. In addition, all WVHP outreach
materials have been designed to represent cultural and ethnic
sensitivity.

Information materials and exhibits used in VBA's outreach programs
depict diversity. VBA will encourage local VA staff involved in outreach
to incorporate, where lacking, inclusion of women in materials. We
believe that VBA outreach coordinators are sensitive to women's issues
and this sensitivity crosses into all age groups, ethnic origin, or
geographic concerns.

-   Target Date: Ongoing

7\. That the Veterans Benefits Administration (VBA) begin an outreach
effort to medical associations, such as the American Medical Association
(AMA) and health care providers, etc., that may have contact with people
born to mothers who served in Vietnam who are eligible for compensation
for certain birth defects.

***VA Response:*** Pending further discussion. VBA has conducted
extensive outreach on Spina Bifida benefits as well as benefits for
women Vietnam veterans' children with birth defects. Several initiatives
were implemented to provide information and assistance to this special
group of veterans and dependents, including:

-   Web Page Information

-   Publications

-   Toll-Free Telephone Service

-   Electronic Inquiry

-   Women Veterans Coordinator (WVC) Training

-   External Contacts and Briefings

-   Women Vietnam Veterans Reproductive Outcomes Health Study Group

-   Meeting with Service Organization Representatives

# **C. Research and Studies**

8\. Aggregate and report, by gender, patient satisfaction assessments
and clinical performance measures in order to facilitate trending and
comparison of differences in the quality of care.

***VA Response:*** Concur. VHA's Office of Quality and Performance
currently has the capability of aggregating customer satisfaction and
clinical performance indices by gender. Ongoing analyses are conducted
by the Office of Quality and Performance; their website updated
regularly and currently contains End of Fiscal Year '03 male/female
comparisons on prevention and clinical practice guideline performance
measures. The Office of Quality and Performance will provide a briefing
to the Committee at their next scheduled meeting.

-   Target Date: October 2004

9\. Commission a follow-up study to the study entitled "Survey of Female
Veterans: A Study of the Needs, Attitudes and Experiences of Women
Veterans" published by Louis Harris and Associates in August 1985, to
examine the current status, demographics, needs, and experience of women
veterans of the U.S. Armed Forces.

***VA Response:*** Concur. The study on the needs, attitudes and
experiences of women veterans published in 1985 is outdated. During the
years subsequent to that study, the number of women serving in the
military has increased and their roles changed dramatically. Today,
approximately 10.5 percent of the OEF/OIF veterans seeking VA health
care are women. Approximately 4.5 percent of our enrollees and patients
are female. A survey of enrolled female veterans will assist us in
identifying the needs of this increasing veteran population. To meet the
increasing and changing health care needs of women veterans, a current
study of women veterans' demographics and experiences merits serious
consideration. We also recognize the need for more global studies on
specific veteran populations. Extensive women veteran demographic data
are currently available in multiple data repositories e.g., VetPop,
Census2000, Defense Management Data Center and VHA actuarial data
repositories. The Under Secretary for Health and VA's Office of Policy,
Planning, and Preparedness will collaborate with the ACWV to determine
committee expectations relative to future studies on women veterans over
and above data that currently exists. Once determined, it is reasonable
to expect that an appropriate survey could be conducted within a year.

-   Target date: Within a calendar year of the identification of
    specific study variables provided by the Advisory Committee on Women
    Veterans.

10\. Identify and solicit earmarked research funds to conduct a study
with sufficient numbers of women veterans by age, race or ethnicity,
period of service, and both VA and non-VA healthcare utilization to
conduct appropriate statistical analyses on the success of VA health and
benefits programs in meeting the needs of women veterans. (This is a
follow-up to Recommendation #17 of this Committee's 2002 Report.)

***VA Response:*** Concur. The Office of Policy, Planning and
Preparedness is currently in the process of reviewing proposals for a
contract to further analyze the findings of the 2001 National Survey of
Veterans. The 2001 survey oversampled women veterans and may provide a
rich source of data in these areas. We will emphasis to the contractor
the need to look closely at the data from the women veteran cohort.

-   Target Date: Expect to have contract awarded by end of FY 04.

11\. Conduct a study to investigate the reason for the disproportionate
occurrence of the incidence of Post Traumatic Stress Disorder (PTSD) in
African-American women veterans, in light of the fact that 35 percent of
those seeking treatment for PTSD are African-American women, as cited in
current literature reviews which demonstrates an increase in that
cohort.

***VA Response:*** Concur. PTSD in women veterans is a priority research
area. VA has existing solicitations for research on both women veterans'
health care and posttraumatic stress disorder (PTSD). These
solicitations also encourage consideration of the needs of special
populations of women veterans. VHA's Office of Research and Development
(ORD) will continue to encourage studies that explore the prevalence and
incidence of PTSD among women veterans, and assess treatment
alternatives, taking into consideration special needs of differing
demographic groups of women veterans (e.g., racial and ethnic groups,
and by era of service such as Iraq vs. Gulf War). ORD will solicit
requests for proposals (RFP) to encourage research related to women's
health care and PTSD and will consider this is a priority area of
investigation.

-   Target Date: Ongoing

12\. Conduct a study to investigate the impact of the Anthrax vaccine
and other military occupational exposures, both intentional (i.e.
immunizations to include Anthrax) and unintentional (i.e. chemical
exposures) on the reproductive system.

***VA Response:*** Concur. Research studies investigating the effects of
chemical and other occupational hazardous exposures on the reproductive
system are important. Even though studies to date have not demonstrated
adverse reproduction outcomes for veterans of Operations Desert
Shield/Desert Storm (1990-1991), studies covering even longer periods
are necessary. This is an area that is highlighted as a priority in the
recent Solicitation of Applications for Deployment Health Services
Research.

-   Target Date: Ongoing

13\. Actively proceed with the authorized National Vietnam Veterans
Longitudinal Study (NVVLS) and re-address and evaluate the cohorts of
the 1988 "The National Vietnam Veterans Readjustment Study" to include a
broad based health inquiry.

***VA Response:*** Concur. Plans for the NVVLS are currently under
review. While the final form of the project is still unclear, it is
reasonable to anticipate that a broad-based health inquiry may be
included. The Director of the WVHP will confer with the study developers
to ensure that women veterans' cohort are included in the broad based
health inquiry.

-   Target Date: 3^rd^ quarter FY 05

14\. Fund and perform qualitative study/studies through Health Services
Research and Development (HSR&D) to attain outcomes to determine
appropriate panel size to maintain competence in the delivery of care to
women veterans; and to determine how many women veterans are necessary
to maintain a primary women's health care clinic.

15\. Fund and conduct a national study through HSR&D on the variation of
all VHA care delivery models for women, including primary care clinics,
and that this study additionally include how these models are linked
with outcomes of quality of care and patient satisfaction.

***VA Response (Recommendations 14 and 15*):** Concur. Research on the
quality and outcomes of the various care delivery models for women
veterans is important. VHA has developed and implemented guidance on
appropriate panel sizes for primary care. Current solicitations
encourage research in this area (both qualitative and quantitative) and
future solicitations will continue to direct attention to examining the
relationship of health care delivery organization, provider expertise
and experience, quality of care, outcomes, and patient satisfaction.
Data from the Survey for Women Veterans should also provide additional
information. It will be necessary to evaluate the outcomes of these
research initiatives relative to the appropriate panel size and care
delivery models for women before assuming a position on these two
recommendations. The competitive, scientific peer review process will
determine the actual funding of any research studies in these areas.

-   Target Date: FY 06

16\. The WVHP office conduct an assessment of compliance to determine
whether clinicians, who also serve as WVPMs, have appropriate time
allocations to perform and accomplish the duties of both positions.

***VA Response:*** Concur. VHA Handbook 1330.2, "Women Veterans Program
Manager Positions" (March 2003) provides guidance on developing the WVPM
position description for Title 5 and Title 38 employees. Six performance
standards were identified to ensure the WVPMs successful performance.

The performance standards and competency statements are focused on
administrative duties. Administrative time allocation is negotiated
between the WVPM and management team based on measurable program
outcomes. Clinical time allocations are calculated separately with the
minimum ten-hour administrative duties clearly defined. A July 16, 2003,
memorandum from the Deputy Under Secretary for Health for Operations and
Management (DUSHOM) to the VISN directors recommended at least ten hours
of administrative time. A second memorandum on June 16, 2004, requesting
an update on the goal of having the WVPM dedicate a minimum of 10 hours
per week (.25 FTEE) for programmatic activities was received on July 6,
2004. Measurement of compliance, program effectiveness, and
administrative WVPM hours will be monitored through site visits by
Deputy Field Directors and Lead WVPMs, VISN Women's Health Advisory
Councils and VHA Handbook 1330.1, Appendix C, "Plan of Care/Clinical
Inventory." Additional assessment of administrative hours will be
reviewed annually through the Plan of Care/Clinical Inventory commencing
in FY 05.

-   Target Date: Ongoing monitoring

17\. Perform a study to determine the prevalence of Military Sexual
Trauma (MST) among homeless women veterans, the psychosocial
consequences of MST, and whether a correlation exists between MST and
homelessness.

***VA Response:*** Concur. The Associate Chief Consultant, Health Care
for Homeless Veterans and the Northeast Program Evaluation Center
(NEPEC) are conducting an evaluation of an 11-site demonstration project
specifically funded to provide targeted outreach and specialized
services to homeless women veterans. Both baseline and follow-up data
obtained on 600 homeless women veterans who participated in the
evaluation of the national homeless women veterans program indicate that
33 percent show evidence of PTSD. Detailed data are also available on
their trauma histories before, during, and after military service and
have demonstrated that almost 90 percent had been exposed to serious
lifetime trauma (67 percent had been raped and 64 percent sexually
assaulted). During their period of military service 31 percent had been
raped, 27 percent assaulted and 36 percent either raped or assaulted. It
is important to note that this sample was not selected because of their
trauma histories, but rather because they were homeless and in need of
services. Data collection is scheduled to end in February 2005. The
NEPEC will issue a report in August 2005. Data are continually fed back
to the office of the Associate Chief Consultant, Health Care for
Homeless Veterans for review and appropriate action. Analysis of the
data will yield information on the prevalence of MST among homeless
women veterans, the psychosocial consequences of MST, and whether a
correlation exists between MST and homelessness and aid in the
identification of additional research and resource opportunities.

Additional programs will be established in the next several years
allowing gathering of additional data. We are keenly aware of this being
a serious problem and our efforts are focused on providing treatment
services to these veterans as well as continuing to evaluate their needs
to improve our services.

-   Target Date: FY 05

# **D. Women Veterans Health Program**

18\. Incorporate performance standards into the Executive Career Field
Performance Plans that demonstrate individual leadership, and
accountability of care and services provided to women veterans.

***VA Response:*** Concur: VHA has mechanisms in place to ensure that
all performance standards are measured and/or analyzed by gender to
ensure accountability for women\'s care and that appropriate time and
resources are available to ensure that women's needs are being met. Each
performance measurement can be aggregated by gender to discern
differences or identify deficiencies along gender lines.

In March 2000, the VBA issued an all-station directive reinforcing its
commitment to outreach to women veterans. It emphasized the importance
of the Women Veteran Coordinator (WVC) position and provided basic
language to be used as an addendum to the assigned coordinator's
position description. The directive provided Core-Operating Standards
for the WVC program that requires regional office management to quantify
the amount of time and resources that can be will be devoted to WVC
functions. Appropriate space, equipment, and clerical support are
important elements in supporting the role of the WVC. These guidelines
will be reviewed and reissued, if appropriate.

-   Target Date: Ongoing

19\. The WVHP remains in a position and at a reporting level of high
organizational visibility to ensure and protect its strength, authority,
and autonomy within VHA in order to: guarantee its ability to provide
consultation and program oversight; provide guidance and direction to
all levels within VHA to include the medical centers and VISNs; and
ensure that there be no diminution of the role and authority of the
program.

***VA Response:*** Concur. The WVHP is appropriately placed and will
continue to receive support from within VHA.

-   Target Date: Ongoing

20\. Local and VISN leadership be held accountable for implementing all
strategies outlined in VHA Handbooks 1330.1 and 1330.2, "Women Veterans
Program Manager Position," and that mechanisms be developed for a
process to monitor compliance. Furthermore, demonstrate evidence of the
level of support and implementation of formal guidance outlined in the
VHA Handbooks.

***VA Response:*** Concur. The WVHP Integrated Business Plan, VHA
Handbook 1330.1, "VHA Services for Women Veterans," and VHA Handbook
1330.2, "Women Veterans Program Manager Positions," have been
distributed to all facilities and VISN offices. The Deputy Field
Directors (DFDs) and WVPMs continue to provide education regarding the
program goals and the published information. The documents are available
on the WVHP intranet website and are available to all VA employees.
National and VISN level education conferences in primary care, mental
health and preventive health also focus on the provision of women's
health care. Implementation of strategies of Handbooks 1330.1 and 1330.2
will be monitored through the Plan of Care/Clinical Inventory annually
commencing in FY 05. The WVHP staff will continue to assess compliance
through ongoing site visits and feedback.

-   Target Date: 3^rd^ quarter FY 05 and annually thereafter

21\. On an annual basis, the four Deputy Field Directors (DFD), as well
as one Lead VISN Woman Program Manager designated by the Committee, will
provide a briefing on key issues within their respective areas during
one of the Committee's Washington, DC, meetings.

***VA Response:*** Concur. The four DFDs and one designated Lead VISN
WVPM will provide a briefing to the Committee at their October 2004
meeting in Washington, DC.

-   Target Date: October 2004

# **E. Women Veterans Program Managers/Benefits Coordinators**

22\. Establish a minimum of 20 hours or .5 full-time equivalent (FTE) as
a threshold for the time allotted to WVPMs in the accomplishment of
their duties.

***VA Response:*** Nonconcur. We believe it is important to provide
adequate time to the WVPM. VISN directors, as well as the Director, WVHP
office continually survey and monitor time allocations. Adjustments will
be made, as appropriate.

-   Target Date: Ongoing

23\. VHA provide the WVPMs with appropriate space, equipment and
administrative support to accomplish their responsibilities in
accordance with guidance outlined in VHA Handbook 1330.2 and that VBA
provide this same level of support to its Women Veterans Coordinators.

***VA Response:*** Concur. VHA believes they are in compliance. Specific
instances of non-compliance should be brought to the attention of the
Deputy Under Secretary for Health for Management and Operations.

In March 2000, VBA issued an all-station directive reinforcing its
commitment to outreach to women veterans. It emphasized the importance
of the WVC position and provided basic language to be used as an
addendum to the assigned coordinator's position description. The
directive provided Core-Operating Standards for the WVC program that
requires regional office management to quantify the amount of time and
resources that can be will be devoted to WVC functions. Appropriate
space, equipment, and clerical support are important elements in
supporting the role of the WVC. These guidelines will be reviewed and
reissued, if appropriate.

24\. Utilize the WVPMs on medical center and VISN committees relative to
strategic planning, staff education and orientation, and facilities
management.

***VA Response:*** Concur. VHA Handbooks 1330.1 and 1330.2 state that
the WVPM will be a member and/or advisor on appropriate committees
(i.e., strategic planning, staff education and orientation, and
facilities management). VHA will review the CBOC handbook and
incorporate into Handbooks 1330.1 and 1330.2 that a Lead WVPM will serve
as a member or consultant on any CBOC and facilities management
committee. The Lead WVPMs are members of the VHA National Advisory
Committee and have been involved in the development and implementation
of the Integrated Business Plan (IBP). All of the Lead WVPMs are
recognized as the women's health contact person in their VISN and
participate on

VISN level committees. The Director, Women Veterans Health Program
office, will monitor as part of an ongoing performance standard.

-   Target Date: Ongoing

25\. VISN leadership to demonstrate and show evidence that the
strategies outlined in the Women Veterans Health Program Integrated
Business Plan has been incorporated into its plan. Further, that the
VISN Women Veterans Health Council assesses this process and report its
findings to the WVHP.

***VA Response:*** Concur. The Lead WVPM will work to incorporate
appropriate performance measures from the WVHP Integrated Business Plan
into the VISN Strategic Plan. The VISN Women Veterans Health Council
will perform an annual systematic review of the VISN Strategic Plan for
the purpose of monitoring relative to outcomes and reported out to the
Committee, VISN Director, as well as the USHOM through the Director,
WVHP.

-   Target Date: Monitored relative to outcomes and report on the status
    of achievement to the committee on request.

26\. All medical center women veterans' advisory committees incorporate
non-VA employee women veterans consumers on their committee who
represent the diverse population within each VA medical center treatment
area and that this local women veterans advisory committee and the WVPM
host an annual town meeting for women veterans of the area.

***VA Response:*** Concur. Guidance published and incorporated in VHA
Handbook 1330.1, "VHA Services For Women Veterans," dated July 16, 2004.
The Director, Women Veterans Health Program office, will follow-up to
ensure compliance and implementation.

-   Target Date: 3rd quarter FY 05 and annually thereafter

# **F. Health Care**

27\. Modify the Fee Basis package to alert providers of the need to
follow-up on test results (i.e. mammography) of patients referred to
community (outside) providers in order to provide timely continuity of
care and case management.

***VA Response:*** Nonconcur. The VistA Fee software package is a
financial system and was not designed to serve as a clinical alert. The
clinical care package that is currently used by VA clinicians is the
more appropriate mode to house the referral of a veteran to community
care and to retrieve an alert. The responsible primary care provider or
team member will annotate in the Computerized Patient Record System
(CPRS) and provide timely and proper follow-up. The alert in CPRS could
then also be used to report VAMC receipt of community health care
reports by VAMC departments outside of Fee operations as well.

28\. Medical center clinics monitor the oversight of coordination for
case management between community contract care providers and VHA care
providers for continuity of care. Additionally, develop a process for
oversight to ensure that providers communicate findings to patients in a
timely manner.

***VA Response:*** Concur. CBOC and inpatient contracting template will
stipulate that contract providers will provide information to the VA
provider and patient within a reasonable period of time. A provision
that requires communication of tests results to patients and VA
providers will be added to the new fee basis template, as well as to all
CBOC contracts as a performance requirement.

-   Target Date: FY 05

29\. Monitor data on services and treatment provided by fee-basis and
contract, in a VHA database for evaluation, in order to project future
needs and utilization of services by women veterans.

***VA Response:*** Concur. A number of national database initiatives
including the Fee Data cube being developed through VSSC can provide or
can be modified to provide paid fee claims data associated with veterans
identified as being female, as the information is transmitted from VistA
Fee to Central Fee and KLF. The first version of the Fee Replacement
Software (anticipate FY 07 national release), will feature a centralized
veteran Fee record that will allow for queries to retrieve various fee
authorization information regardless of having processed paid fee
claims. The new system will allow VHA to monitor data more carefully.

-   Target Date: FY 07

30\. Develop a comprehensive educational plan for primary care
providers/clinicians that will enhance current practice and the
utilization of the mental health screenings, to ensure that they more
readily identify those women veterans who are at high risk and in need
of mental health referrals in order to expedite the primary care
referral to a mental health provider.

***VA Response:*** Concur. VHA's Patient Care Services ensures that all
primary care education programs address women veterans' health issues,
achieving this inclusion through partnering with the VHA Women Veterans
Health Program office on all course development, conference planning,
and training design.

There are a number of recently developed educational products that
address MST assessment and care. They include: The Veterans Health
Initiative, "Military Trauma" published in Jan. 2004 and the "Iraq War
Guide" from VA's National Center for PTSD, revised in May 2004. Also,
screening for mental disorders in primary care and specialty mental
health venues is emphasized in the joint VA/ DoD Clinical Practice
Guidelines on PTSD published in May 2004. These tools and the training
modules will help ensure that all veterans, particularly those returning
OEF/OIF service members, are properly screened and referred for
specialty care, as needed.

-   Target Date: Ongoing

# **G. Behavioral and Mental Health Care**

31\. Team leaders to monitor and evaluate the workload of the counseling
and support staff, along with staff/client ratios at Vet Centers, to
determine if personnel levels are adequate to provide timely treatment
in meeting the current demands along with the expected/projected client
increases as a result of Operation Enduring Freedom/Operation Iraqi
Freedom (OEF/OIF) and the increasing number of women veterans accessing
the VA system, with a report to the Director of Readjustment Counseling
Services.

***VA Response:*** Concur. Program planning and evaluation are integral
aspects of established Vet Center program policy and operations. Vet
Center program workload reports are readily available and are routinely
monitored at all levels of program activity to include workload levels
for individual Vet Center counselors and teams, as well as for regional
and national workload aggregates. Workload activity is continuously
monitored to ensure that the veteran clients served by the Vet Center
are representative as to gender, ethnicity and era of service when
compared to the local veteran population.

-   Target Date: Ongoing

32\. Vet Center team leaders identify and evaluate barriers that may
lead to a diminished ability to serve women veterans with a report to
the Director of Readjustment Counseling Services.

***VA Response:*** Concur. A hallmark of the Vet Center program since
inception is the tailoring of the services specific to the needs of the
local veteran population. This includes systematic attention to
relieving the impact of any potential barriers to care for local
veterans. For this purpose Vet Center Team Leaders and Regional Managers
are responsible for ensuring that the Vet Center is located
strategically within the community for ease of access by veterans and
family members, and that the Vet Center staff composition adequately
reflects the local veteran population. Vet Centers are small
community-based facilities, located outside of the larger medical
centers, in easily accessible, consumer-oriented facilities highly
responsive to the needs of the local veterans. The Vet Center program
service mission is more-than-medical featuring a holistic mix of direct
counseling and multiple community-based service functions. Vet Center
Team Leaders and Regional Managers will continually assess potential
barriers to care for local veterans.

-   Target Date: Ongoing

33\. Ensure that each inpatient/residential psychiatric unit has
capacity to dedicate a specific area on the unit to segregated patient
rooms, bathrooms, social areas, and treatment for women veterans, and
that this arrangement is extended to PTSD units and homeless
domiciliaries.

***VA Response:*** Concur. Space design and accommodation of privacy and
personal needs continue to be a high priority; Patient Care Services
(PCS) will work to ensure that all mental health construction and design
projects include

dedicated space for women veterans. These issues are being considered in
the Mental Health Strategic Plan, which included a Women's Health Sub
Group.

-   Target Date: Ongoing

# **H. Women Veterans Who Are Homeless** 

34\. All VISN homeless coordinators review and monitor the homeless
veteran community outreach plan within their respective VISN medical
centers to ensure that women veterans are a targeted population, and
that an annual report is forwarded to the VA Program on Homelessness.

***VA Response:*** Concur. Homeless women veterans' needs are a high
priority. Information outreach activities and other information
concerning specialized services to homeless women veterans are contained
in VA's Annual Report to Congress. A separate report on the 11-site
demonstration project for homeless women veterans will be issued by the
NEPEC in August 2005.

VISN homeless coordinators continually review programs and services
provided to all homeless veterans including women veterans. This ongoing
review and coordination effort includes periodic conference calls that
identify important issues including enhancements of services to women
veterans. The Associate Chief Consultant, Health Care for Homeless
Veterans will work with the Deputy Under Secretary for Health for
Operations and Management (10N) to survey VISNs to identify outreach
plans to homeless women veterans for each VA medical center in the VISN.
Discussions on outreach to homeless women veterans have been and will
continue to be a topic of high priority on all homeless program calls.
The Director of Homeless Veterans Programs and the Associate Chief
Consultant Health Care for Homeless Veterans will continue to monitor
field actions and site reports compiled to enhance services to this
target population provided to them by the NEPEC.

-   Target Date: Ongoing

35\. The VHA, at each of its medical center behavioral/mental health
departments, develop and implement a strategic plan and proactive local
policy to provide coordinated linkages with community-based non-profits,
social service providers, and local governmental agencies. This should
include the identification of resources to provide care and support for
the children of homeless women veterans, in order to bring comprehensive
assistance to homeless veterans.

***VA Response:*** Concur. VA actively engages community-based service
providers, social service providers and local government agencies
formally in the development of local needs and plans through the
Comprehensive Homeless Assessment Local Education and Networking Group
(CHALENG) for veterans.

Case management of mental health patients, will help ensure a
comprehensive coordination of services. VHA's partnering with community
providers of services to homeless veterans ensures that community
resources beyond the scope of VA's service mandate are identified and
made available to those women in need. In addition, VA issued a Notice
of Funding Availability (NOFA) on July 14, 2004, to solicit applications
from operational, grant and per diem-funded programs in order to enhance
services to homeless women veterans, including women with children. It
is expected that funding will be announced in October 2004.

-   Target Date: Ongoing

36\. The Secretary of Veterans Affairs, as current Chair of the
Presidential Interagency Council on Homelessness (ICH), work with the
ICH to initiate a grant that would coordinate a grant-funded Request for
Proposal (RFP) from VA Homeless Grant and Per Diem Program with that of
the Department of Health and Human Services (HHS), to allow non-profit
organizations to respond to a single RFP grant initiative addressing the
residential needs of homeless women veterans with children.

***VA Response:*** Concur. VA has been in discussion with and hopes to
develop a funding opportunity with the Department of Health and Human
Services to provide services to family members particularly children of
homeless veterans. We will continue to pursue this enhanced coordinated
services plan with HHS. In addition, VA is pleased to report that our
latest NOFA has enhanced targeted funding for transitional housing
programs that serve homeless women veterans with children. We will
gladly share with the Committee the funding made available under this
NOFA later this year after awards are announced.

-   Target Date: Ongoing

37\. VISN Directors commit to continue funding the Homeless Women
Veterans Pilot Projects within the VISN where these programs are
located, based on positive outcomes as determined by the Director VA
Program on Homelessness.

***VA Response:*** Concur. VA continues to make a strong effort to find
and serve homeless women veterans with a full range of health care
benefits, transitional housing and access to other supportive services
at 11 sites identified four years ago. The outcome has been positive and
VA has continued to strongly support those pilots. The Director,
Homeless Veterans Programs, and the Associate Chief Consultant, Health
Care for Homeless Veterans, monitor the progress at these sites
periodically. However, final determination of whether these projects
continue is best determined by facility and VISN leadership since it is
their responsibility to manage the resources needed to manage these
programs. As we monitor the eleven sites in this pilot, we will evaluate
and adjust to improve outreach, services delivery and programmatic
outcomes. We will enhance opportunities for clinical staff to share
experiences and to enhance service delivery.

-   Target Date: Ongoing

38\. VA develops guidelines for homeless women veterans' program case
management based on a review of outcomes and lessons learned from the 11
VA homeless women veterans' pilot programs, for utilization in local VA
homeless programs.

***VA Response:*** Concur. The Associate Chief Consultant, Health Care
for Homeless Veterans will work with the Director, Homeless Veterans
Programs, the Director, Center for Women Veterans, the Director, WVHP,
the Director, NEPEC, and the Deputy Under Secretary for Health for
Operations and Management to ensure that successful programs are
identified and supported. Improvements to homeless women\'s programs are
ongoing and based upon literature and clinical experience. As we monitor
and evaluate, we are learning lessons and adjusting programs
accordingly.

-   Target Date: Ongoing

39\. The Secretary identify funding for the homeless special needs
grants in the VA Grant and Per Diem Program, as outlined in Public Law
107-95, "Homeless Veterans Comprehensive Assistance Act of 2001," and
that a RFP be released.

***VA Response:*** Concur. VA is taking steps to implement its funding
to "special needs" populations under title 38 Section 2061. VA currently
has a Notice of Funding Availability (NOFA) outstanding and is reviewing
applications from existing service providers to enhance services to
homeless women veterans, including those with children. We will share
the results of selections made with the committee when they are made
public.

40\. VA Grant and Per Diem Program identify homeless women veterans as a
priority in the next capital and per diem only (PDO) grant round RFPs as
offered within the VA Grant and Per Diem Program.

***VA Response:*** Concur. VA has been very successful in increasing the
level of services for homeless women veterans. The percentage of women
veterans who participate in programs funded by VA\'s grant and per diem
program is 3.3 percent; however, nearly 20 percent of all programs have
a capacity to serve women veterans. We believe that our efforts to
increase awareness of and funding to support women veterans,
particularly women veterans with children will encourage even greater
levels of participation by women veterans. We appreciate this
Committee\'s recommendation among others to identify \"women veterans\"
as a priority for funding under the homeless providers grant and per
diem program, and have already taken steps to increase funding for women
veterans specific programs.

# **I. Sexual Trauma Counseling**

41\. VA seeks legislation to make permanent the authority to provide
counseling, treatment, and care to victims of military sexual trauma.

***VA Response:*** Concur. This legislation has been approved by both
the Senate and the House and is awaiting final congressional action.

-   Target Date: Pending outcome of legislative proposal

42\. Make the treatment of PTSD arising from sexual assault a permanent
function of the Vet Center mission.

***VA Response:*** Nonconcur. VA is authorized to provide treatment for
military sexual trauma as specified in 38 U.S.C. 1720D. Military sexual
trauma (MST) counseling currently provided in Vet Center programs
resulted from a VHA policy decision. VA has no legislative authority to
make MST counseling permanent within the Readjustment Counseling Service
mission. However, that is not to say that VA leadership could not again
decide as a matter of policy to implement any future MST-related
treatment authority through VA's Vet Center programs.

-   Target Date: Ongoing

43\. Extend VA's authority to provide counseling, treatment, and care
for sexual trauma victims to National Guard members and Reservists who
were sexually assaulted while on active duty for training.

***VA Response:*** Concur. Legislative proposals are under advisement by
VA.

-   Target Date: Pending outcome of legislative proposal

44\. Provide funding to support hiring additional MST counselors to meet
the needs of those suffering MST as identified by the Vet Center team
leaders in conjunction with the Office of Readjustment Counseling
Services.

***VA Response:*** Concur. Readjustment Counseling Service (RCS) is
supportive of increasing the number of dedicated military sexual trauma
counselors in the Vet Center program contingent upon appropriated VHA
medical care appropriations.

-   Target Date: Ongoing

45\. Authorize and fund the contract fee basis program administered by
the Vet Center program to treat MST veterans when and where necessary.

***VA Response:*** Nonconcur. As alluded to above, VA's treatment
authorities to provide readjustment counseling services to combat
veterans and counseling and care for victims of MST are distinct and
separate authorities (39 U.S.C. 1712A and 38 U.S.C. 1720D,
respectively.) Although the Vet Centers do play a key role in providing
(PTSD) counseling for MST victims, the authority to furnish readjustment
counseling services by contract only covers those veterans included
under the terms of section 1712A, i.e., certain combat veterans.
Veterans eligible for MST care and counseling under section 1720D are
not included among those veterans. Hence, that contract authority cannot
extend to them.

46\. VHA develop enhanced initiatives and devote additional resources to
assist the Behavioral and Mental Health Program with expanding the MST
program and incorporating a more coordinated integrated approach to this
delivery of care. Further, the Committee recommends that this
coordination should include but not be limited to outreach, provider
education, MST research, clinical care services, information technology
systems development, data capture, the development of best practices,
and the reporting of performance outcomes.

***VA Response:*** Concur. VA 's orientation toward our patients and
their families is informed by the principles of the President's New
Freedom Commission on Mental Health and the Action Agenda for
Transforming VA Mental Health Care that drives implementation of the
President's Commission recommendations in our Department. This
orientation is based on health promotion and a preventive care approach.
It focuses on patient and family education about good health care
practices and behaviors to avoid. For those who do have mental
disorders, the orientation involves the concepts of rehabilitation that
addresses a patient\'s strengths as well as deficits. It embodies a
belief in recovery of function to the greatest degree possible for each
patient. Survivors of MST will be significant beneficiaries of this
approach.

The Action Agenda and the Mental Health Strategic Plan from which it is
derived, are broad in scope and encompass the areas of clinical care,
research and education. MST is a key element of the Education Employee
Education Service's (EES) FY 05 Critical Focus Areas. Mental Health has
been identified as an area of focus for EES's FY 2005 education and
training support. MST will be a major element of that training.

-   Target Date: Ongoing

47\. Waive the eligibility criteria for prenatal and delivery care to
women veterans who are pregnant due to rape while on active duty.

***VA Response:*** VA is considering whether to seek a legal opinion on
that issue/recommendation.

# **J. Training**

48\. Mandate that new staff orientation and sensitivity trainings and
orientations with annual in-services to the staff of all VHA treatment
sites, to include contracted CBOCs; document training on the employee
training record; and ensure that the training is comprehensive in nature
to include the history of women in the armed forces and military sexual
trauma.

***VA Response:*** Concur. VHA currently has systems in place to capture
orientation and training. New employee orientation provides an
opportunity for the facility\'s WVPM to educate new staff about VA
services available to women veterans. In an effort to expand education
to all staff, the WVHP Integrated Business Plan has a working group
dedicated to developing new products, tools and processes that focus on
the unique needs and contributions of women veterans. An orientation
brochure developed by the WVHP, "We Are Women Veterans" and accompanying
video provides a history of women\'s service in the military, and is
used for contractors, academic trainees and staff orientation. The
Deputy Under Secretary for Health for Operations and Management directed
local and VISN leadership, in a recent memo, to ensure that this
information is provided to all VA health care contractors and academic
trainees who provided care to women veterans. The Military Sexual Trauma
brochure was redesigned to be sensitive to the needs of survivors of MST
and is available in Spanish and English. New Women Veteran Program
Managers in VHA receive 40 hours of training within six months of their
appointment, and documentation of this training is done by the local
facility. VISN directors will re-enforce the need to track such
training. Refer to response #30.

-   Target Date: Ongoing

49\. VHA develops a training program that is mandatory for all affiliate
residents and interns prior to their practice in a VA facility and that
it includes a history of veterans' sacrifice and service and its impact
on current health related conditions of the veterans era of service.

***VA Response:*** Concur. Understanding the military history is an
important component of working with and treating our veteran patients.
The Office of Academic Affiliations has sent out approximately 150,000
VA Military Service History Pocket Cards (June 2004) each year for the
past five years to all trainees in our health care facilities. The Card
is a pocket-sized resource that provides all VA health professions
trainees with a guide to understanding health issues that are unique to
veterans. It also suggests questions that invite the veteran to tell
his/her own story while providing literature references to a specially
developed Internet web site that provides information offering greater
insight into the veteran\'s story. These cards have been
enthusiastically received. This year, the Office of Academic
Affiliations will include distribution of the Military Service Pocket
Card to all new clinical employees as well as trainees.

In addition, the Employee Education System has just produced an
orientation video in May 2004, titled \"The Price of Freedom: The
Military Experience,\" that provides a general outline of military
service. Copies of this video were sent to all VAMCs, Vet Centers and
Chief Social Workers, along with a discussion guide to be used with
employees following their viewing of the film. All facilities are
encouraged to use it as part of their orientation for new and current
clinical staff and trainees.

VHA will ensure that the video offering will be included in the
orientation package for new physician residents, which is currently
under development. VHA anticipates that the package will be completed in
time for the next academic year.

-   Target Date: Ongoing.

50\. Incorporate and extend MST training (as offered within VA medical
centers or the VISNs) to Vet Center staff as determined appropriate by
the Vet Center team leader and the Director of Readjustment Counseling
Services, in conjunction with the medical center behavioral and mental
health department.

***VA Response:*** Concur. This training is currently being provided. A
comprehensive training module on MST has been developed as part of the
Veterans Health Initiative. This on-line course, developed by VA
clinicians, educates on symptoms, conditions, and associated
sensitivities of individuals who have suffered these experiences, to
assist in appropriate care delivery.

Beginning in 1993 with the inception of VA's program to provide sexual
trauma counseling, RCS program officials played a prominent role in
collaborating with other VHA officials to implement this program and
conduct the initial training of VHA staff. RCS was instrumental in
developing the Staff Training and Experience Profiles (STEP) used to
evaluate the credentials of prospective sexual trauma counselors
applying for a position at a Vet Center. RCS annual in-service training
programs regularly feature sexual trauma treatment as curriculum topics.
VA medical center clinicians are frequently used as faculty and VISN
service providers routinely attend targeted clinical presentations at
RCS trainings. The educational cross-fertilization goes in the other
direction as well, as Vet Center sexual trauma counselors are encouraged
to access training via neighboring VISN sponsored programs.

51\. The Secretary communicates the Committee's request to the
Department of Labor (DOL), that DOL, through its network of state
employment directors and assistant directors, work with states to ensure
Local Veterans Employment Representatives (LVERs) and Disabled Veteran
Outreach Programs (DVOPs) receive information that will increase their
sensitivity to women veterans issues to include MST.

***VA Response:*** Concur. VBA's Vocational Rehabilitation and
Employment Service has a longstanding and ongoing working relationship
with DOL's Veterans Employment and Training Services (VETS), and will
develop training materials such as a joint VA/DOL Satellite Broadcast to
used for training LVERs and DVOPS and VR&E field staff working with
women veterans. These materials will feature sensitivity to MST issues.
VR&E officials will meet with DOL to discuss shared training efforts.
The materials will be available by the 2^nd^ quarter of FY 05.

-   Target Date: 2^nd^ quarter of FY 05

# **K. Veteran Employment and Education** 

52\. VA continue efforts to develop, recruit, and retain women employees
for senior management positions and that the Secretary continue to
aggressively encourage the identification of women veterans, who are
viable candidates, for appointment to all VA advisory committees. The
Committee requests that the Secretary extend this recommendation on
behalf of the Committee to the Secretary of Labor.

***VA Response:*** Concur. In the report to the Secretary of Veterans
Affairs on April 2, 2003, the Secretary's Task Force on the Employment
and Advancement of Women in the Department of Veterans Affairs
identified strategies for success that will move VA into a position of
leadership in the employment and advancement of women. A report on the
implementation of all strategies will be completed by December 2004.

VA conducted benchmarking and assessed best practices from internal and
external programs that will improve the recruitment, employment, and
development of women employees. VA's Recruitment and Marketing Plan was
then updated in August 2004. One of the objectives is to expand VA's
outreach efforts and employment of veterans. With that objective in
mind, the strategies are to:

-   prepare the Secretary of VA's memorandum re-emphasizing VA's
    commitment to the hiring of veterans, using veteran's preference and
    veteran hiring flexibilities, and marketing of the National Veteran
    Employment Program (NVEP) initiatives for interagency cooperation;

-   develop a veteran-focused Web site linking veterans to on-line
    resources;

-   participate in military job fairs at the local and or national
    level;

-   create a critical hard-to-fill vacancies database and provide access
    to veteran candidates through the NVEP Web site;

-   update veterans outreach brochures;

-   network with and establish partnering and liaison relationships with
    veterans stakeholders;

-   link the NVEP Web site to military service sites, veterans
    stakeholders' sites, transition centers, and transition Web sites
    nationally;

-   develop a media plan for veterans outreach initiatives;

-   meet with Administration representatives and other VA key officials
    to discuss NVEP strategies and initiatives for the Administrations'
    participation;

-   track and monitor veterans' employment trends in VA;

-   develop a marketing plan to educate human resources specialists on
    veterans' preference laws, statutes, and veteran hiring
    flexibilities;

-   network and identify points of contact in VA's Office of Human
    Resources Management to assist veterans with the application
    processes;

-   assess the effectiveness of the Delegated Examining Units' process
    in addressing veterans employment in VA; and,

-   increase veterans employment in VA to attain the representation goal
    of 33 percent by the year 2008.

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-   Target Date: December 2004

VA actively pursues appointing gender and ethnic diversity to all of its
advisory committees. All VA advisory committees have female members, and
ten committees have members who are women veterans. In reaffirming VA's
commitment to build upon its record of appointing advisory committee
members who are women veterans, VA invites the active participation of
the Advisory Committee on Women Veterans. Recommendations of veteran
candidates should be forwarded to Dr. Irene Trowell-Harris, Director,
Center for Women Veterans, who will then forward them to VA's Advisory
Committee Management Officer. VA deeply appreciates the Committee's
willingness to assist in this endeavor.

53\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor, that DOL (VETS) continue efforts
to work with state representatives to encourage the hiring of more women
veterans as DVOPs and LVERs, and that the DOL identify obstacles and
barriers to this effort.

54\. The Secretary extend this recommendation, on behalf of the
Committee, to the Secretary of Labor; that the contracts developed by
DOL's Veterans\' Employment and Training Service (VETS) for training and
rehabilitation services or employment opportunities for veterans of OEF
and OIF provide ample and equitable opportunity for women veterans of
these operations. The Committee requests that grantees report
participation and job placement rates by gender to DOL VETS.

***VA Response (Recommendations 53 and 54):*** The Center for Women
Veterans will request a DOL briefing at the October 2004 meeting of the
Advisory Committee on Women Veterans to discuss these issues.

-   Target Date: October 2004

55\. VA propose legislation to increase the delimiting period for
Montgomery GI Bill usage from 10 to 20 years.

***VA Response:*** The Administration has no official position on this
legislative proposal.

# **L. National Cemeteries**

56\. The National Cemetery Administration (NCA) include designations of
acronyms WAAC, WAVES, SPAR, WAC, WAFS, and WASP, on headstones or
markers to recognize women veterans who served in those specially
designated units/corps.

***VA Response:*** Concur. The designations for those units, such as
WAAC or WAVES, are already available to be inscribed on headstones and
markers. While they are not mandatory in the inscription as service
designations are (e.g., US ARMY), they are accommodated in the
additional inscription area upon request from the next of kin and there
are some references to what might be added to an inscription in the
form\'s instructions. The next revision of the form will probably take
place in 2005 and we will definitely consider adding more descriptive
options, such as WAAC, etc., in the instructions.

-   Target Date: FY 05

# **M. Departments of Defense and Veterans Affairs**

57\. Ensure that veteran benefits advisors at Transition Assistance
Program briefings specifically address the existence of VA MST programs,
and that information packets are disseminated.

***VA Response:*** Concur. Information about veterans benefits has
already been incorporated in the standard military transition briefings
that VBA representatives conduct for the formal Transition Assistance
Program as well as for other military briefings. MST information has
been incorporated in the slide presentation used by those
representatives.

58\. The Secretary establishes a process whereby formal member
appointments are made by both the Department of Defense (DoD) and VA,
for representation on all task forces and working groups dealing with
MST.

***VA Response:*** Concur. The intent of this recommendation has been
met at various levels throughout both agencies. The Director of the
Center for Women Veterans (CWV) is a formal member on the Defense
Advisory Committee On Women In The Services (DACOWITS) as the VA
representative and advisor on all joint agency initiatives that impact
women service members. Colonel Denise Daley is a formal member of the
Secretary of VA's Advisory Committee on Women Veterans. VA clinical and
policy experts served at witnesses on two Senate Armed Services
Committee hearings on the subject of Military Sexual Trauma. The
Directors of the CWV and WVHP partnered with the DoD Task Force on Care
for Victims of Sexual Assault charged by the Under Secretary of Defense
in the development of a comprehensive program for sexual assault victims
and the development of the United States Army sexual assault program. In
follow-up to the final task force report, five VA clinical and policy
experts have been invited to participate in a Care for Victims of Sexual
Assault Conference to develop strategic courses of action on critical
unresolved issues discussed in the Task Force Report. The conference
will take place from September 20-24, 2004, at the National Conference
Center in Lansdowne, VA.

-   Target Date: Ongoing

59\. The Secretary suggests to DoD that pregnant service members, opting
to be released from active duty prior to delivery, be briefed by the
veterans TAP representative on VA eligibility, services and limits of VA
services regarding pregnancy care within VA. The Committee also
recommends that the women service members receive a briefing from the
Tri-Care customer service representative on benefits related to delivery
and newborn coverage. These two briefing requirements should be
incorporated into the Commander's pregnancy counseling checklist.

***VA Response:*** Concur. VBA will include information in TAP briefings
about limited pregnancy medical services for veterans. Compliance will
be observed during supervisory evaluations of the briefings conducted by
the military service coordinators.

-   Target Date: Ongoing

# 60. The Secretary of Veterans Affairs request consideration by the Secretary of Defense for an evaluation that gender be added to the Form DD214, "Certificate of Release or Discharge from Active Duty." 

# 

***VA Response:*** Concur. DoD will be migrating to a new integrated
personnel system, DIMHRS (Defense Integrated Military Human Resources
System), which will capture gender as a data element. Information will
be contained in DIMHRS that is identical to what is on the DD214 today.
Over 100 of the data elements available through DIMHRS will be shared
with VA.

Revision of the paper DD214 to include gender will be referred by VBA to
the appropriate working group of the Benefits Executive Council which is
comprised of representatives of VA and DoD.

-   Target Date: FY 05

#### PART V

# **Appendices**

##### 

## Appendix A

##### Historical Perspective

Women veterans were the best-kept secret for many years. The 1980 Census
was the first time that American women were asked if they had ever
served in the Armed Forces, and an astonishing 1.2 million said "yes."
Because very few of these newly identified veterans used VA services,
Congress and VA began a concerted effort to recognize and inform them of
their benefits and entitlements. Activities were initiated to increase
public awareness about services for women in the military and women
veterans.

Soon after the 1980 census, Congress granted veteran status to women who
had served in the Women's Army Auxiliary Corps (WAAC) during World War
II.

In 1982, at the request of Senator Daniel Inouye, the General Accounting
Office (GAO), conducted a study and issued a report entitled: "Actions
Needed to Insure that Female Veterans Have Equal Access to VA Benefits."
This study found that:

-   Women did not have equal access to VA benefits.

-   Women treated in VA facilities did not receive complete physical
    examinations.

-   VA was not providing gynecological care.

-   Women veterans were not adequately informed of their benefits under
    the law.

At the same time, VA commissioned Louis Harris and Associates to conduct
a "Survey of Female Veterans: A Study of the Needs, Attitudes and
Experiences of Women Veterans," published in August 1985, to determine
the needs and experiences of this population. This survey found that 57
percent of the women did not know they were eligible for VA services,
benefits, and programs. Another particularly troublesome finding was
that women veterans reported twice the rates of cancer as compared to
the women in the general adult population, with gynecological cancers
being the most common.

The results of the Census and the Harris survey raised many questions
concerning women veterans, but one conclusion was inescapable: the
system was failing them. In April 1983, Harry Walters, Administrator of
the Veterans Administration, began to remedy this situation by
establishing a National Advisory Committee on Women Veterans.

In November 1983, following the first meeting of the VA Advisory
Committee, Congress passed Public Law 98-160, "Veterans' Health Care
Amendments of 1983," mandating VA to establish an Advisory Committee on
Women Veterans. The charge to the Committee was broad. Not only were
they tasked with assessing the needs of women veterans with respect to
adequate access to VA programs and services, but they were also
empowered to make recommendations for change.

Under the leadership of Dr. Susan H. Mather, the Committee was entrusted
with the responsibility to follow-up on these activities and to report
their progress to Congress in a biennial report.

The following events are historical markers since the establishment of
the Advisory Committee on Women Veterans.

1984 First report of the Advisory Committee identified the need for
strong outreach, and the lack of adequate privacy and gender-specific
treatment for women at VA facilities as the most pressing areas of
concern.

> Pamphlets, posters and publications about the service of women
> veterans and their eligibility for VA services were developed.
>
> President Reagan proclaimed the first "Women Veterans Recognition
> Week." The states of New Jersey, California and Washington declared
> 1984 as "Women Veterans Year."

1985 As a result of the Advisory Committee's recommendations, VA
appointed the first Women Veterans Coordinators.

> "The National Vietnam Veterans Readjustment Study," commissioned by
> Congress, was the first national study on veterans that included
> women.

1986 The Advisory Committee report focused on health care needs.
Recommendations were made to expand VA health care to include
osteoporosis, gynecological and hormonal care, research, mammography,
Agent Orange exposure diseases and smoking cessation.

> Women Veterans Coordinators were appointed in VA regional offices.

1987 Congress revisited the issue of women veterans in an oversight
hearing. Women veterans testified to noted progress but expressed
concern about the consistency of the quality of health care provided to
women veterans at VA facilities.

1988 A Veterans Health Administration office to address women's health
issues was first created.

1989 The Advisory Committee on Women Veterans began site visits.

1991 GAO was tasked by Congress to do a follow-up study on VA health
care for women. Their 1992 report was entitled, "VA Health Care for
Women - Despite Progress, Improvement Needed."

1992 The 1991 GAO report, along with Congressional hearings related to
sexual harassment and assault, led to the enactment of Public Law
102-585, "Veterans Health Care Act of 1992." It provided specific
provisions for women's health and broadened the context of
Post-Traumatic Stress Disorder (PTSD) to include care for the aftermath
of sexual trauma associated with military duty.

1993 Dedication of the Vietnam Women's Memorial.

1994 Secretary Jesse Brown established the Women Veterans Program Office
within the Office of the Assistant Secretary for Policy and Planning.
Joan Furey was appointed Executive Director of the Women Veterans
Program Office.

> The Center for Women Veterans was created by Congress under Public Law
> 103-446, "Veterans' Benefits Improvements Act of 1994."
>
> The National Center for Post-Traumatic Stress Disorder created a
> Women's Health Sciences Division at the Boston VA Medical Center.
>
> Three research projects were proposed by VA as an alternative to a
> comprehensive epidemiologic study of the long-term health effects
> experienced by women who served in the Armed Forces in Vietnam, as
> mandated by Public Law 99-272, "Veterans' Health-Care Amendments of
> 1986." The original study was determined not scientifically feasible.
> The three research projects included:

-   a study of post-service mortality (results were published in 1995);

-   the re-analysis of psychological health outcome data collected for
    women in "The National Vietnam Veterans Readjustment Study"
    (completed in 1988); and,

-   a study of reproductive outcomes among women Vietnam veterans.

> VA funds the first national study on the quality of life of women
> veterans who use VA health care services.

1995 Joan Furey was confirmed as the first Director of the Center for
Women Veterans. Committee members increased communication with women
veterans, increased individual site visits to VA facilities, and
provided briefings to Congressional members and staff.

1996 The first "National Summit on Women Veterans Issues" was held in
Washington, DC, marking the first time women veterans from across the
Nation had the opportunity to come together with policy makers and VA
officials.

1997 Kathy Zeiler was appointed as the first full-time Director for the
Women Veterans Health Program.

> The Women in Military Service for America Memorial was dedicated.
>
> The First National Conference of VA Women Veterans Coordinators was
> held in San Antonio, Texas.

1998 VA completed the "Women Vietnam Veterans Reproductive Outcome
Study," and published its findings.

> The 50th Anniversary of the Women's Armed Forces Integration Act.
>
> 1999 Carole Turner was appointed as the second Director for the Women
> Veterans Health Program.
>
> Results of the 1998 VA study indicated that children of women who
> served in Vietnam had a higher rate of birth defects. This prompted a
> Congressional hearing.
>
> For the first time, the Subcommittee on Minority Women Veterans was
> established within the Advisory Committee.
>
> VA's decision to provide prenatal and obstetrical care to eligible
> women veterans signaled a new era in VA gender-specific services.
>
> The Second National Conference of VA Women Veterans Coordinators was
> held in Chicago, Illinois.

2000 VA allocated funds for the first time (\$3 million) to support
programs specifically for women veterans who are homeless. Three-year
demonstration programs were designed at 11 locations across the country.

> The Veterans Benefits and Health Care Improvement Act of 2000, PL
> 106-419, authorized special monthly compensation for women veterans
> with a service-connected mastectomy. Additionally, it provided
> benefits for children with birth defects born to women Vietnam
> veterans.
>
> The Sunset Provision for sexual trauma counseling in VA was extended
> to December 31, 2004.
>
> VA convened two task forces to study the necessity for inpatient
> psychiatric units for women in each VISN, and the need to extend
> sexual trauma counseling to Reservists and National Guard who have
> been victimized while on inactive duty training days.
>
> The second "National Women Veterans - Summit 2000" was held in
> Washington, DC.
>
> VHA Women Veterans Health Program was selected as the Bronze Winner of
> the 2000 Wyth-Ayerst HERA Award. Awards are presented to those
> demonstrating leadership in women and children's health.

2001 Women's Health National Strategic Work Group convened to develop
progressive, state-of-the-art programs to provide high-quality
comprehensive health care for FY 2002 through FY 2007. The Group
commissioned Dr. Katherine M. Skinner to study the role of Women
Veterans Coordinators.

> September 11, 2001, changed the battlefield. Women in the Pentagon are
> now as vulnerable as those directly on the front lines. The likelihood
> of women casualties increases commensurately.
>
> Dr. Irene Trowell-Harris was appointed and confirmed as the second
> Director of the Center for Women Veterans.
>
> The Charter for VA Advisory Committee on Women Veterans was renewed.
>
> Appointments of the first minority women veterans in leadership were
> made on the VA Advisory Committee on Women Veterans, in the positions
> of an African-American as Chair, and an American Indian as Vice-Chair.

2002 The Third National Conference of VA Women Veterans Coordinators was
held in Las Vegas, Nevada.

> The population of women veterans as a percentage of all veterans is
> expected to increase as the number of former military service women
> continues to grow.

2003 According to VA's Office of Policy, Planning & Preparedness VetPro
program (based on the 2000 Census) of the 25.6 million veterans, 1.7
million are women veterans. In 2002, the 1.7 million women veterans
constituted 6.5 percent of all veterans living in the United States,
Puerto Rico, and overseas.

> VA has seen a significant increase in the number of women veterans who
> receive benefits and health care services from the Department. The
> number of women veterans enrolled in VA\'s health care system grew
> from 226,000 in FY 2000 to 420,000 in FY 2002, an increase of 86%.
> Women veterans enrolled in VA in Fiscal Year (FY) 2003 were 333,578
> (up 9.4 percent from FY 2002) and of those enrolled in FY 2003,
> 196,134 (up 7.5 percent from FY 2002) actually used the system.
>
> VA celebrated the 20th Anniversary of the Advisory Committee on Women
> Veterans on 15 September 2003 at the Women in Military Service for
> America Memorial (WIMSA) with Senator Daniel K. Inouye presenting the
> keynote address. Committee past and present chairs, co-chairs and
> members were honored at the ceremony.
>
> The Charter for VA Advisory Committee on Women Veterans was renewed.

2004 The Fourth National Conference of VA Women Veterans Coordinators
was held in Las Vegas, Nevada.

> The third "National Summit on Women Veterans Issues - Summit 2004" was
> held in Washington, DC.
>
> **Appendix B**
>
> **Past Chairs and Current Chair of the**
>
> **Advisory Committee on Women Veterans**
>
> Dr. Susan Mather - Interim Designated Federal Official (1983-86 -
> estimate)
>
> COL Lorraine Rossi, USA, Retired (1986)
>
> MG Jeanne Holm, USAF, Retired (1986-88)
>
> RADM Frances T. Shea-Buckley, USN, Retired (1986-89)
>
> MG Mary Clarke, USA, Retired (1989-92)
>
> Shirley Ann Waltz Menard, Ph.D., R.N. (1992-94)
>
> RADM Mary Nielubowicz, USN, Retired (1996-97)
>
> MAJ Linda Schwartz, USAF, NC, Retired (1998-2000)
>
> COL Karen L. Ray, USA, Retired (2000-02)
>
> Marsha T. Four, R.N. (2002 - Present)

#### Appendix C

#### VA Advisory Committee Membership Profile (2002-2004)

**Marsha Tansey Four, USA**

**Chair 2002-2004**

Ms. Four is a Vietnam veteran who served on active duty with the Army
Nurse Corps from 1967 to 1970. Currently she is the Director of Homeless
Veterans Services for the Philadelphia Veterans Multi-Service and
Education Center. Ms. Four has been actively involved in veterans'
issues on a local, regional and national level for many years. She was
the founder and executive director of the Philadelphia Stand Down from
1993 to 1998, and currently serves as the Ex-Officio Director of this
volunteer project. She is also a member of VA VISN 4 Management
Assistance Council and Homeless Working Group. A life member of the
Vietnam Veterans of America, she serves on their National Board of
Directors and is Chair of the Women Veterans Committee. She was
appointed to the Advisory Committee on Women Veterans in March 2001 and
appointed Chair in August 2002.

**Gwen M. Diehl**

**Sergeant First Class, USA, Retired**

Ms. Diehl retired from the US Army with 20 years of honorable service,
at the rank of Sergeant First Class. She served in Operation Desert
Shield and Operation Desert Storm and was awarded the Bronze Star. In
her 20-year military career, Ms. Diehl held an impressive range of
assignments from a Military Records Clerk and Records Section Supervisor
in Personnel Service Companies, to overseeing the deployment and
redeployment of the 1,000 members of the Support Squadron 3rd Armored
Cavalry Regiment (ACR) to Operations Desert Shield and Desert Storm. In
her current position, Ms. Diehl is the confidential Staff Assistant to
the Director at the Illinois Department of Veterans' Affairs. She is a
public speaker for the Department, and provides explanations of programs
and courses of action to Legislators' offices, veterans' organizations,
and the inquiring public. Ms. Diehl has an Associates Degree in Business
Administration and a Bachelor of Science Degree in Management. Sergeant
Diehl was appointed to the Advisory Committee on Women Veterans in
September 2002.

**Cynthia J. Falzone, USA**

Ms. Falzone served in the US Army during the Vietnam era and was trained
as a medic. She is an accredited Veterans Representative for Vietnam
Veterans of America (VVA); served as a Board Member of VVA Chapter 11
for three terms; and served as Vice-chair of VVA Metro Counsel for two
terms. Ms. Falzone is an accredited Veterans Service Officer at the
American Legion, and presently serves on the Board of Directors for
Self-Initiated Living Option, Inc. (SILO). In her current position at
the NYS Division of Veterans Affairs, she serves as a State Veterans
Counselor. Ms. Falzone is bilingual and assists Spanish-speaking
veterans and dependents with all needed services. She has had experience
as a women veterans coordinator, and was responsible for creating or
coordinating several outreach programs throughout the state. Ms. Falzone
is a member of several veterans service organizations. Ms. Falzone was
appointed to the Advisory Committee on Women Veterans in September 2002.

**Bertha Cruz Hall, USAF**

Mrs. Cruz Hall is a Hispanic veteran, who served in the United States
Air Force for 4 years. She worked in Personal Affairs and assisted
survivors of servicemen with obtaining benefits. Currently, she is
retired from the Texas Veterans Commission, where she provided direct
counseling to veterans in reference to all matters relating to veterans
benefits. She also retired as the State Women Veterans Coordinator for
Texas, where she represented veterans before the discharge review
boards, and assisted with claims appeals. Other affiliations include the
Tarrant County Veterans Council; District Service Officer, American
Legion; executive committee member of the Disabled American Veterans,
and a member of the advisory board for the Fort Worth Homeless Veterans
Program. In addition to her knowledge of women veterans\' issues, Mrs.
Cruz Hall\'s extensive background in veterans' assistance activities is
a valuable asset to this Committee. Mrs. Cruz Hall was appointed to the
Advisory Committee on Women Veterans in February 1998.

###### Edward E. Hartman, USA 

Mr. Edward E. Hartman, a disabled veteran, served in the Persian Gulf
War, and was appointed as National Director of Voluntary Services of the
million-member Disabled American Veterans (DAV) in March 2002. Mr.
Hartman heads a corps of DAV members who, with members of the DAV
Auxiliary, donate more than 2.4 million hours a year to volunteer work
at VA medical facilities; directs the nationwide DAV Transportation
Network; and coordinates activities involving DAV co-sponsorship of the
annual National Disabled Veterans Winter Sports Clinic. He also
coordinates corporate sponsorship of the Program. Mr. Hartman is a life
member of DAV Chapter 23. He has held various positions at DAV as the
National Appeals Officer, Assistant Supervisory NSO in the Washington,
DC, Office, Associate National Director of Voluntary Services, Assistant
National Director of Voluntary Services. Mr. Hartman was appointed to
the Advisory Committee on Women Veterans in January 2002.

## 

**Kathy LaSauce**

**Lieutenant Colonel, USAF, Retired**

Colonel LaSauce retired from the Air Force in 1992 as the senior ranking
woman pilot in the U.S. military. She was among the first women to serve
as Aircraft Maintenance Officer, and one of the first ten women trained
as Air Force pilots. She accumulated almost 4,000 hours of international
flight time as a Lockheed C-141 aircraft commander, instructor, flight
examiner pilot, and Boeing 707 presidential support pilot. Prior to her
retirement, Colonel LaSauce was the Deputy Commander for Air
Transportation, 89th Military Airlift Wing; Commander, 93rd Aerial Port
Squadron; and Assistant Deputy Commander, 89th Operations Group, 89th
Airlift Wing, Andrews Air Force Base, MD. During her career, she
represented the Air Force in a number of public appearances. Colonel
LaSauce received numerous awards, including the California Professional
Woman of the Year for 1978, and the Citation of Honor that is one of the
Air Force Association's highest awards. She earned a masters degree in
Aeronautical Science from Embry-Riddle Aeronautical University. Colonel
LaSauce was appointed to the Advisory Committee on Women Veterans in
January 2002.

**M. Joy Mann**

**Major, USAF, Reserve**

Major Joy Mann is the Commander of the 512th Mission Support Squadron,
United States Air Force Reserve. Her squadron members provide personnel
service, education and training assistance, and computer and network
service to over 1,800 Reserve members located at Dover Air Force Base,
Delaware. Major Mann is an Air Reserve Technician - a Federal civilian
employee who has dual status as a Reservist. She has completed the
following military courses: Squadron Officers School and Air Command and
Staff College. Her education includes a bachelor's degree and a master's
degree in French literature from the University of Delaware. Major Mann
is a lifetime member of the Reserve Officers Association, where she
holds the Department of Delaware Air Force Vice President position. She
is a volunteer member of the Delaware Committee for Employer Support of
the Guard and Reserve, working as the State Ombudsman. Major Mann was
appointed to the Advisory Committee on Women Veterans in October of
2000.

**Lory Manning**

**Captain, USN, Retired**

Captain Manning retired from the U.S. Navy in 1994, after a 25-year
career. A graduate of the Naval War College, Command and Staff College,
she held increasingly responsible positions in the Navy, including tours
of duty on the staff of the Chief of Naval Operations; Chief of Naval
Personnel; and Chief of Legislative Affairs. Captain Manning was
directly involved in the development of naval policy on the utilization
of women. She is the recipient of numerous military awards, including
the Legion of Merit. Currently, she serves as the Director of the Women
in the Military and Hire a Vet Projects at the Women\'s Research and
Education Institute (WREI), located in Washington, DC. Captain Manning
was appointed to the Advisory Committee on Women Veterans in June 1998.

**Michelle (Mitzi) Manning**

**Colonel, USMC, Retired**

Colonel Michele \"Mitzi\" Manning served in the US Marine Corps from
1972-1999, and is currently attending Wesley Theological Seminary. She
is a Certified Candidate for the Order of Deacon in Full Connection in
the United Methodist Church, and hopes to serve as a chaplain to the
elderly. Her assignments in the Marine Corps included command of a
squadron and the Western Sector; US Military Entrance Processing
Command; Assistant Chief of Staff, Marine Forces Pacific; and as the
Secretary of the Joint Staff. Her awards include the Defense Superior
Service Medal with Oak Leaf Cluster, the Legion of Merit, the
Meritorious Service Medal with three stars, the Navy Commendation Medal,
the National Defense Service Medal with Bronze Star, the Sea Service
Deployment Ribbon, and the Drill Instructor Ribbon. She currently serves
as the Chaplain of the Women Marines Association. Colonel Manning was
appointed to the Committee July of 2000 and served as Vice Chair from
2002 through 2003.

**Kathleen A. Morrissey, R.N., B.S.N.**

## Colonel, USA, Retired 

Colonel Morrissey is a Vietnam veteran, having served on active duty
with the U.S. Army Nurse Corps from 1969 - 1971. She retired as the
State's Chief Nurse and Deputy Commander of Detachment 5, Headquarters
STARC, New Jersey Army National Guard. Colonel Morrissey has been
employed by the New Jersey Department of Military and Veterans Affairs
since 1988, holding a variety of positions including Deputy Director for
the Division of Veterans Services and Administrator of the Office of
Cemeteries and Memorials. She recently retired as the Assistant Director
of New Jersey\'s Veterans Health Care Services. Colonel Morrissey is a
member of the Veterans of Foreign Wars, the American Legion, the
National Guard Association of the United States, and the American Nurses
Association. Colonel Morrissey was appointed to the Committee in July
2000 and appointed Vice Chair in March 2004.

**Carlene Narcho, USA**

Ms. Narcho served in the United States Army for 8 years. Since that
time, she has served in many different capacities related to Native
American issues. She has provided outreach to Native American groups,
training in many subjects, including child abuse and neglect. She has
been a member of the Navajo County Advisory Board, the National Council
of Native American Advisory, and the National Council of American
Indians Welfare Reform Task Force. Currently, she is Executive Director,
Department of Social Services, White Mountain Apache Tribe, Whiteriver,
AZ. She was appointed to the Committee in March 2004.

# **Joan E. O'Connor**

**Commander, USN, Retired**

Commander O'Connor retired from the Naval Reserve in 1999. She was a
direct commissioned Public Affairs Officer and served on active duty in
Boston from 1980-1981. As General Counsel for the Massachusetts
Department of Veterans' Services, she drafts legislation and regulations
and writes legal opinions on veterans' laws and benefits. She hears
administrative law appeals from veterans who have been denied public
assistance. She represents the Department on employment issues at
administrative hearings and Departmental appeals. Previously, she was an
Assistant City Solicitor in Somerville, MA, and a lawyer in private
practice. She holds a Master's degree in public relations from Boston
University and a law degree from New England School of Law. Commander
O'Connor was appointed to the Advisory Committee on Women Veterans in
January 2002.

**Lorna Papke-Dupouy, USMC**

Ms. Papke-Dupouy has over 26 years of experience dealing with issues
concerning women in the Department of the Navy. She also served 10 years
on active duty with the United States Marine Corps. Her accomplishments
include generating an "Education and Pre-deployment Fair" onboard an
aircraft carrier for over 5,000 officers, sailors and family members,
preparing them for impending 6-month separation. She also choreographed
USS Abraham Lincoln's Homecoming 2001, "Pennies from Heaven," onboard
Naval Station Everett, hosting family members, local citizens and
friends welcoming home the crew of over 3,000 officers and sailors. She
was appointed to the Committee in March 2004.

**Emily Sanford**

**Captain, USN, Retired**

Captain Sanford served in the United States Navy from 1957 to 1985 in
positions from staff nurse to various Directorships, including Nursing
Service and Hospital Staffing. She also served as a Hospital Corps
School Instructor, Duty Under Instruction at the University of Colorado
and Navy Nurse Officer recruiting. She is a past President, Navy Nurse
Association of Southern California, a member of the Waves National
Golden West Unit, and a member of the Retired Officers Association. She
is also active in many community and charity groups. She was appointed
to the Committee in March 2004.

## Sheryl Schmidt, USAF

Ms. Schmidt is an Air Force veteran who served on active duty from
1974 - 1980 in electronics installation and combat communications. She
currently serves as the Deputy Secretary for Women Veterans Affairs and
Operations with the California Department of Veterans Affairs. She is
responsible for ensuring that issues important to women veterans remain
part of the California public policy process and provides executive
oversight to the Farm and Home Loan Division and the Veterans Services
Division. Her background in California's veteran's programs ensures that
the issues and recommendations suggested by the Committee reach a
broader number of women veterans. Ms. Schmidt received her bachelor's
degree in Management from St. Leo University; her master's in Business
Administration (M.B.A.) from California State University, Sacramento;
and is a licensed CPA. Ms. Schmidt is a lifetime member of the Disabled
American Veterans, American Veterans, and the American Legion. She also
serves on the California Military Museum Advisory Board and the
Sacramento Women Veterans Resource Project (women veterans homeless
transition center). Ms. Schmidt was appointed to the Advisory Committee
on Women Veterans in January 2002.

**Master Sergeant Lewis E. Schulz II**

**USAF Retired**

Lewis E. Schulz II is retired from the US Air Force at the grade of
Master Sergeant. During his military service, he held positions as
Accounting Supervisor, Special Agent - Defense Investigative Service;
B52 Defense Aerial Gunner/Instructor; and Deputy Comptroller. After his
military retirement, Mr. Schulz was the Director of the Department of
Veterans' Services in Collier County, Florida. He conducted specialized
administrative work in counseling, advising and assisting veterans,
widows and dependents in any claims with the Veterans Administration or
other federal, state or County agencies. He has had course work majoring
in psychology, and is currently retired as a civilian. Mr. Schulz
presently serves as President of the National Academy for Veterans'
Service Officers and is a member of several veterans service
organizations. Master Sergeant Schulz was appointed to the Advisory
Committee on Women Veterans September of 2002.

**The Honorable Winsome Earle Sears, USMC**

Ms. Sears enlisted in the United States Marine Corps at the age of 19
and held various leadership positions, receiving the Meritorious Mast
for effective reorganization of the training department, as well as the
Good Conduct Medal. As a Corporal, she fulfilled many duties. She was a
squad leader and Training Non-Commissioned Officer, repaired electrical
equipment and diesel engines, and ensured that equipment was "war
ready." She also scheduled troops for training to ensure proper military
knowledge was maintained. Delegate Sears was elected to the Virginia
House of Delegates in November 2001 after she upset a 20-year incumbent
in her first attempt for elected office. The first Republican elected to
represent a minority district since Reconstruction, she was also the
first elected female veteran. Ms. Sears graduated Cum Laude from Old
Dominion University. In addition to receiving her Master of Arts from
Regent University, she was also accepted by the School of Law at George
Mason University. Ms. Sears was appointed to the Advisory Committee on
Women Veterans in September 2003.

**The Honorable Sara A. Sellers**

**Chief Master Sergeant, USAF, Retired**

Chief Master Sergeant Sellers retired from the United States Air Force
after 30 years of service. She received many awards and commendations
during her service. She is a member of the VFW, The American Legion, the
DAV, Vietnam Veterans of America, and the Air Force Sergeants
Association. She was appointed as a Commissioner on the American Battle
Monuments Commission. She also served on the Defense Advisory Committee
on Women in the Services (DACOWITS) for three years. In addition, she is
also active in many civic and charitable organizations. She was
appointed to the Committee in March 2004.

**Luc M. Shoals**

**Chief Master Sergeant, ANG, Retired**

#### Chief Master Sergeant Luc M. Shoals served as the Recruiting and Retention Superintendent for the HQ Oklahoma Air National Guard, and holds a Bachelors Degree in Business Administration from the University of Central Oklahoma. She entered the Army National Guard in 1979-1981, and served as a Photojournalist. CMSGT Shoals then joined the Air National Guard in 1982 as a Financial Services Specialist. Later she moved to personnel as the Personnel Superintendent and conducted programs to recruit personnel to satisfy the requirements of the Air National guard. She later held the position as a Minority Officer Recruiter, where she recruited minority pilots and navigators nationwide for the Air National Guard. In September 2000, Sergeant Shoals retired. Chief Shoals also holds an Associate degree in Liberal Arts and an Associate degree in Human Resources Management. Her decorations include the Air Force Commendation Medal, Armed Forces Reserve Medal, Air Reserve Forces Meritorious Service Medal, NCO Professional Military Education Ribbon, Army Service Ribbon, Air Force Training ribbon, Air Force Longevity Service Award Ribbon with four Oak Leaf Clusters and the National Defense Service Medal. Chief Master Sergeant Shoals was appointed to the Advisory Committee on Women Veterans in September 2002. 

#### Appendix D

#### Advisory Committee Site Visits

#### A Cumulative Record

  ---------------- ------------------------------------------------------
  1987             St. Petersburg Beach, FL

  1989             Minneapolis, MN

  1993             San Antonio, TX

  1994             Albuquerque, NM

  1997             Los Angeles, CA

  1998             Chicago, IL

  1999             Seattle, WA

  2001             Boston, MA

  2002             Tampa, FL

  2003             Phoenix, AZ
  ---------------- ------------------------------------------------------

**Appendix E**

**Summary of Site Visits for 2002-2003**

The Advisory Committee on Women Veterans conducts a site visit each year
to a VA medical center that has an active program for women veterans.
The site visit provides an opportunity for Committee members to compare
the information that they receive from briefings by VA officials with
actual practices in the field.

**Tampa/Bay Pines, FL:**

The Committee conducted a site visit September 23-27, 2002, to the Tampa
and Bay Pines VA Medical Centers (VISN 8). The Tampa VA Medical Center,
a Women Veterans Comprehensive Health was the recipient of the 2002
Award of Excellence, for its Women\'s Health Center.

Briefings and tours at Tampa and Bay Pines Medical Centers included the
Women's Health Clinics, Sexual Trauma Treatment Unit, Mental Health and
Psychiatric Departments, the Homeless Domiciliary, the Homeless Women
Veterans Demonstration Program, the Spinal Cord Injury Unit, Geriatric
Unit, and Prosthetics. The Committee had particular interest in the
Sexual Trauma Treatment Unit and the Homeless Women Veterans
Demonstration Program, 1 of only 11 in the VA system. Veterans expressed
concerns about issues such as time allotment for WVPMs, additional
examination rooms, homeless program, space, privacy, especially with the
inpatient psychiatric unit and the MST program.

**Phoenix, AZ:**

The Advisory Committee on Women Veterans conducted a site visit during
June 16-21, 2003, to the VA Medical Center in Phoenix, AZ (VISN 18). The
main focus of the visit was the Carl T. Hayden VA Medical Center.
However, the Committee received briefings from WVPMs in VISN 18.
Additionally, presentations and tours were given at the VA Regional
Office, Vet Center, VISN 18 office and adjacent Community Based
Outpatient Clinic, National Memorial Cemetery of Arizona, Arizona State
Veterans Commission office, and Veterans State Home. Veterans expressed
concerns about issues such as time allotment for WVPMs gender-specific
services, participation in CARES, space, privacy, lack of a
formally-structured VISN Women Veterans Advisory Committee, and mental
health and MST treatment.

**Appendix F**

## Briefings to the Advisory Committee on 

## Women Veterans (2002-2004)

The Advisory Committee received the following briefings during the
period covered by this report:

Office of the Secretary and Center for Women Veterans (CWV)

-   Nora Egan, Chief of Staff, priority VA issues such as budget, CARES,
    MST, January and September 2003, January and April 2004.

-   Dr. Irene Trowell-Harris, Director, Center for Women Veterans,
    January and September 2003, issues update, budget, Committee
    website, and National Summit.

-   Dr. Irene Trowell-Harris, Director, Center for Women Veterans,
    January and April 2004, initiatives update, Committee membership,
    media interviews.

-   Harriett Heywood, Esq., Associate Director, Center for Women
    Veterans, update on 2004 National Summit, April 2004.

-   Desiree Long, Program Analyst, Center for Women Veterans, Results of
    the Stakeholders Engagement Survey, April 2004.

-   Luc Shoals, Advisory Committee on Women Veterans, overview of Focus
    Group Site Visits to Miami and Los Angeles, April 2004.

Veterans Benefits Administration (VBA)

-   Lynda Petty, Women Veterans Program Coordinator, Compensation and
    Pension Service, January and April 2004, Special Monthly
    Compensation (SMC-k) for mastectomy, recent regulations and
    legislation, status of claims for the Vietnam Veterans Benefits.

-   Carolyn Hunt, Deputy Director, Compensation and Pension Service,
    January and September 2003 and January 2004, recent regulations and
    legislation, status of claims for the Vietnam Veterans Benefits Act.
    Recent regulations and legislation related to women veterans;
    research on differences in compensation and pensions ratings between
    male and female veterans; and legislative proposals submitted by
    VBA.

    Veterans Health Administration (VHA)

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-   Carole Turner, Director, Women Veterans Health Program, Update
    women's health programs and issues, January and September 2003,
    January and April 2004.

-   The Honorable Robert H. Roswell, M. D., Under Secretary for Health,
    the future of women's health care provided by VA, renewing
    privileges of physicians practicing at VA, limitation on
    time-allotments for clinic appointments, waiting time for
    appointments and emergency treatment, January 2003 and April 2004.

-   Dr. Susan Mather, Chief Public Health and Environmental Hazards
    Officer, update of Women Veterans Health Services Survey, status of
    the eight Comprehensive Women Veterans Health Centers and Centers of
    Excellence, outcome of data collection and type; programs involved
    in collection, January 2003 and September 2003.

-   Susan H. Mather, M.D., M.P.H., Chief Public Health and Environmental
    Hazards Officer, plans for expanding treatment for
    medically-discharged women veterans, plans to expand access to all
    VA programs, especially rehabilitation for women veterans, impact of
    increased enrollment of women veterans in VA health care related to
    long-term treatment and support, plans for treatment of PTSD for
    women veterans, plans to increase access to VA services to activated
    female Reservists, April 2004.

-   Dr. Jonathan Perlin, Deputy Under Secretary for Health, sensitivity
    training for providers (physicians, residents, etc), limitation on
    time-allotments for clinic appointments, status of women veteran
    wellness clinics, appropriateness and cost of mammograms within VA
    versus by fee-basis/contract and follow up on 2002 Committee
    recommendations, September 2003.

-   Laura Miller, Deputy Under Secretary for Health for Operations and
    Management, follow-up on 2002 Report Recommendations, status of
    VISN-wide Strategic Plan incorporating outreach goals, plan for
    inpatient psychiatric beds dedicated for women veterans, ensure that
    a system-wide standardized training module be utilized for all new
    employee orientation, which includes the specific needs of women
    veterans as contributed by the WVPMs, January 2004.

-   Marsha Goodwin, Community-based Outpatient Clinics (CBOCs), Women
    Veterans Domiciliary Programs, January 2003.

-   Paul Kearns, Director, Veterans Equitable Resource Allocations
    (VERA), Resource Allocation and Analysis, current initiatives,
    January 2003.

-   Han K. Kang, Dr.P.H., Director, Environmental Epidemiology Service,
    Data from the Department of Defense Manpower Data Center Database on
    recent combat veterans, April 2004.

    National Cemetery Administration (NCA)

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-   Peggy McGee, January 2003, NCA update and issues, distributed
    videos.

-   Lindee Lenox, Chief of Operations, Office of Memorial Programs,
    presented on grave markers for women, especially from Army/Air
    Force, placement of flags in cemeteries or on headstones, September
    2003.

Services for Women Veterans Who Are Homeless

-   Peter Dougherty, Director, Homeless Program, Initiative for Homeless
    Women Veterans, January and September 2003.

-   Peter Dougherty, Director, VA Homeless Program, eleven homeless
    women veterans demonstration programs, continuance of future funding
    for homeless programs, January 2004.

#### Department of Labor (DOL)

-   Ron Drach, Team Leader, Strategic Planning and Legislative Affairs,
    Veterans' Employment and Training Service (VETS), January 2004,
    update on policies and plans.

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-   Frederico Juarbe, Jr., Assistant Secretary, Veterans Employment and
    Training, January 2003, current initiatives, overview of operation,
    progress report: Special grants to train women veterans for
    non-traditional jobs.

#### Legislative Initiatives and Hill Site Visits

-   Site Visits to the House and Senate Veterans' Affairs Committee
    Members and Staff, January and September 2003, January 2004.

-   The Honorable Gordon H. Mansfield, Assistant Secretary, Legislative
    issues affecting women veterans, the Tyler-Bender Mandatory
    Discharge Relief Act of 2002, Procedure to introduce legislation
    regarding submission of the Advisory Committee's Biennial Report to
    Congress, January and September 2003.

-   Pamela Iovino, Deputy Assistant Secretary for Legislative Affairs,
    Legislative issues affecting women veterans, Cadet Nurse Proposal,
    MST continuation legislation, Status of legislative extension
    request through 2010 for the Advisory Committee's Biennial Report to
    Congress, September 2003 and January 2004.

-   Phil Riggin, Advisory Committee Manager, White House Liaison,
    Charter Renewal for the Advisory Committee, Length of Committee
    membership, September 2003 and January 2004.

-   Bill Buffington, Director, Legislative Affairs, Legislative issues
    affecting women veterans, Cadet Nurse Proposal, MST continuation
    legislation, Status of legislative extension request through 2010
    for the Advisory Committee's Biennial Report to Congress, April
    2004.

#### Capital Asset Realignment for Enhanced Services (CARES) 

-   Dr. Barbara Chang, Consultant for Academic and Clinical Affairs,
    January and September 2003, (CARES), protection of the Women's
    Health Centers, protection of separate and defined space for women,
    special programs for women.

-   Jay Halpern, Director, Office of CARES, impact of health care
    services on women veterans, January 2004.

-   Ethel Sligh, Program Analyst, release of CARES Report, next steps
    and implementation, April 2004.

#### Minority Veterans Issues - Center for Minority Veterans (CMV)

-   Charles Nesby, Director, CMV, January 2003, Overview: Center for
    Minority Veterans, Outreach to Native American women, Benefits
    pamphlets in Spanish language.

#### Research and Surveys

-   Dr. John Demakis, Director, VHA Health Services Research and
    Development , Women Veterans Health Status Survey's initial
    findings, VA Research Studies on Issues related to Womens' Health,
    VA-funded research on women veterans, January 2003 and 2004.

-   Susan Krumhaus, National Survey of Veterans (NSV) Project Manager,
    Office of Policy and Planning, Policy Analysis Service, update on
    the NSV, January and September 2003.

#### Sexual Trauma Counseling Services - Readjustment Counseling Services (RCS) 

-   Dr. Alphonso Batres, Director, and Charles Flora, Deputy Director,
    RCS, update on sexual trauma counseling, budget, staffing and new
    programs, January 2004.

-   Charles Flora, Deputy Director, RCS, services for women veterans,
    April 2004.

Board of Veterans Appeals (BVA)

-   Rick Thrasher, Chief Counsel for Litigation Support, Board of
    Veterans Appeals, use of "markers" for reviewing claims regarding
    sexual trauma, January 2004.

Office of General Counsel

-   Roberto DiBella, Office of General Counsel, ethics issues, January
    2004.

Veteran Service Organizations (VSO)

-   Robert E. Wallace, Executive Director, and William L. Bradshaw,
    Director for National Veterans Service, Veterans of Foreign Wars of
    the United States (VFW), January 2004.

**Appendix G**

**Charter Renewal**

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**Appendix H**

**Center for Women Veterans**

**Mission and Goals**

[MISSION]{.underline}

The mission of the Center for Women Veterans is to assure that women
veterans receive benefits and services on a par with male veterans,
encounter no discrimination in their attempt to access these services,
are treated with respect and dignity by VA service providers, and to act
as the primary advisor to the Secretary for Veterans Affairs on all
matters related to programs, issues, and initiatives for and affecting
women veterans.

[GOALS]{.underline}

Our goals were developed to assess women veterans\' services within and
outside the Department on an ongoing basis, to assure that VA policy and
planning practices address the needs of women veterans, and foster VA
participation in general Federal initiatives focusing on women\'s
issues. Specific goals of the Center include:

-   Identifying policies, practices, programs, and related activities
    > that are unresponsive or sensitive to the needs of women veterans
    > and recommend changes, revisions or new initiatives designed to
    > address these deficiencies.

-   Fostering communication between all elements of VA on these findings
    > and assuring that women veterans' issues are incorporated into
    > their strategic planning.

-   Promoting and providing educational activities on women\'s issues
    > generally, and women veterans specifically for, VA personnel and
    > other appropriate individuals.

-   Encouraging collaborative activities on issues related to women with
    > other Federal agencies.

-   Creating an informal forum for the open discussion of women
    > veterans' issues for interested VA personnel.

-   Developing an open dialog with the women veteran community to assess
    > their perception of VA services for women.

-   Promoting research activities on women veterans\' issues.

-   Fulfilling all other functions of the Center as outlined by Congress
    > in Public Law 103-446.