**The Department of Veterans Affairs**

**Advisory Committee on Women Veterans**

**1998 Report**

The Department of Veterans Affairs (VA) Advisory Committee on Women
Veterans is required to submit a report of activities in compliance with
the provisions of

Public Law 98-160.

**Part I**

**[Executive Summary]{.smallcaps}**

The Advisory Committee on Women Veterans was established in 1983 by

Public Law 98 - 160. The law authorizes the Advisory Committee on Women
Veterans to:

-   Assess the needs of women veterans with respect to compensation,
    health care, rehabilitation, outreach and other benefits and health
    care programs administered by the Department of Veterans Affairs,

-   Review VA programs and activities designed to meet these needs,

-   Make recommendations for appropriate action, and

-   Follow-up on the recommendations made by the Committee.

Since that time, the Committee has made recommendations to the
Department of Veterans Affairs\' that have contributed to the
improvement of VA health care services, benefit programs, and the lives
of America\'s 1.2 million women veterans.

The Veterans' Health Care Eligibility Reform Act of 1996, Public law
104-262, and the Department of Defense's Manpower Data Center reports
that women constitute the fastest growing population of VA eligible
veterans in America. For this reason, outreach and increasing public
awareness about the contributions and military service of women veterans
remain a priority for this Committee.

The Committee convenes three times per year. Two meetings are held at VA
Headquarters in Washington, DC, and at least one field-based site visit
is scheduled to assist Committee members in directly assessing VA
program operations. During this reporting period, the Committee visited
VA facilities in the vicinity of Los Angeles, California. This visit
provided the Committee an opportunity to tour local VA medical
facilities, regional offices and vet centers. Committee members had the
opportunity to talk with clinicians and veterans accessing care and
conducted an open forum for women veterans.

Individual Committee members also conducted site visits at VA Medical
Centers at Walla Walla, Washington, and Richmond, Virginia, VA Medical
Centers. The Committee developed a "Site Visit Protocol" to facilitate
effective site visits for individual members and to provide continuity
in their approach to reviewing programs and services.

The Advisory Committee provided a comprehensive briefing to
Congressional Staff addressing Committee's goals, objectives, issues and
concerns as they relate to the needs of women veterans in today\'s
society.

All Advisory Committee members are military veterans, representing
various branches of the Armed Forces, eras of service, and have
demonstrated experience or expertise with veteran related issues.

The Committee's membership is representative of the diversity in the
women veteran population. This year, in an attempt to better address the
special issues of women of color, the Committee incorporated a special
focus on minority issues in its deliberations. Recognizing the changing
demographics of both the military and veteran population, with 44% of
active duty women now women of color, the Committee hopes to identify
barriers to access of services, specific health care problems and other
concerns of the minority women veteran population and make
recommendations to address them. Findings will be incorporated into the
Committee's biennial report to Congress and will ensure that the issues
affecting women veterans of color are included in all future assessments
of women veterans' issues and recommendations of the Committee.

**Part II**

**[Summary - Recommendations]{.smallcaps}**

A summary of the Committee\'s primary recommendations for 1998 is as
follows:

**Members of Congress:**

-   Enact legislation for Medicare subvention as it relates to VA health
    care.

-   Require, by legislation, all federally funded research studies
    solicit specific information about the military background of the
    subject and his or her exposure to combat conditions to compare and
    contrast the impact of these experiences in the veteran population
    versus the civilian population. Publish outcomes and analytical
    findings by gender.

-   Enact legislation authorizing Selected Reservists and National Guard
    personnel, who experience sexual assault, trauma or harassment while
    on active duty for training, have access to VA counseling and
    treatment programs.

-   Enact legislation to remove all time constraints and limitations on
    VA's services and counseling programs for victims of sexual assault
    and trauma. The Sexual Trauma Counseling program must become a
    permanent part of VA's health care and service agenda for veterans.

-   Require by legislation, all federally funded social service
    agencies, community programs and organizations, identify, within
    their served population, veteran clients and annually report these
    statistics to the Department of Veterans Affairs.

**Department of Veterans Affairs:**

-   Develop programs specifically designed to address the needs of women
    veterans who are homeless and provide gender-specific counseling and
    health care treatment.

-   Establish and maintain a consistent level of staff training focusing
    on treatment protocols, sensitivity concerns, and other issues
    instrumental to providing effective sexual trauma counseling.
    Continuing education of both VA clinical staff and regional office
    staff will ensure quality of care for all veterans.

-   Appoint an individual with expertise in women's health as a
    representative on the VISN clinical executive board (or its
    equivalent).

-   Create a Women Veterans' Advisory Committee within each Veterans
    Integrated Service Network (VISN). Membership should include women
    veterans who routinely utilize VA health care and regional office
    facilities.

-   Include women veterans in all VA sponsored or VA supported research
    programs and surveys and publish findings and results identified by
    gender.

-   Continue to monitor and improve outreach programs and initiatives
    for women veterans with special emphasis on minority populations.

-   Ensure women veterans are equitably represented in appointed, and
    managerial positions within the Department of Veterans Affairs

-   Establish at least one site within each VISN for In-Patient
    Psychiatry care for women veterans.

**Department of Defense:**

-   Incorporate an orientation to VA programs and services as part of
    basic military training.

-   Provide military health care clinicians a thorough orientation to
    the VA Compensation and Pension benefit programs and examination
    requirements.

**Departments of Defense, Labor and Veterans Affairs:**

-   Develop a strong, collaborative relationship between the Departments
    of Veterans Affairs, Labor, and Defense to better serve active duty
    service members, transitioning service members and veterans.
    Department of Defense should enforce mandatory attendance of all
    separating service members at Transitional Assistance Program (TAP)
    briefings. All three Departments should reemphasize the Disabled
    Transitional Assistance Program goals developed for special
    consideration of service members unable to attend regular TAP
    briefings because of physical impairment, disability or
    hospitalization. Include spouses and other family members as
    audience participants for TAP and Conservators, if the service
    member is incompetent, incapacitated or cannot comprehend the
    content of the briefing.

**Part III**

**[Recommendations and Rationale]{.smallcaps}**

A.  **OUTREACH**

**Recommendations**

1.  **VA Continue to monitor and improve outreach programs and
    initiatives for women veterans with special emphasis on minority
    populations. *(VA)***

2.  **Increase outreach efforts to assist community-based agencies. Site
    visits and providing information about the availability of VA health
    care and benefits coupled with the maintenance of viable referral
    networks between VA and the community will enhance services to women
    veterans. *(VA)***

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3.  **Require by legislation, all federally funded social service
    agencies, community programs and organizations, identify, within
    their served population, veterans clients and annually report these
    statistics to the Department of Veterans Affairs*.(VA)***

**Rationale:** The number of women in the military has rapidly increased
with the advent of the all-volunteer military force. Today women
comprise 15 percent of the active duty force and make-up approximately
20% of new military recruits. It is anticipated that this number will
increase in the coming years. Efforts to identify service women and
women veterans to provide information about, and assistance in,
accessing VA benefits and health care services is crucial.

Effective outreach is a significant component in VA's overall strategy
to ensure a successful transition from military to civilian life and
paramount in providing VA benefits to women veterans in accordance with
Congressional mandates.

**Comment:** The difficulty experienced by VA in achieving a successful
outreach program, that informs women veterans of their VA eligibility
and entitlements, has been a major issue for this Committee since its
inception in 1983. In each of the Committee's previous reports, it was
noted that there is continued concern about the design, approach and
consistency of VA's outreach efforts and activities, the effectiveness
of VA outreach programs for women veterans and the quality of
information being disseminated at the local levels.

Additionally, information obtained from the 1996 National Summit on
Women Veterans Issues, and during site visits to VA facilities
throughout the Nation, indicates that in order to facilitate utilization
of VA services by women veterans, outreach must remain a priority.

Therefore, there remains a continued need to emphasize the importance of
developing and maintaining a viable outreach program for women veterans.

**Recommendation**

4.  **Develop and produce a video to address issues affecting women
    veterans, such as VA eligibility criteria, benefit and health care
    services and the contributions of women to the United States
    Military. Distribute this video for use in Transition Assistance
    Program Briefings, local media presentations and Pubic Service
    Announcements. *(VA)***

**Rationale:** The recommendations requesting VA to produce a "women
veterans' " video and the need for continuity of VA dissemination of
information to women veterans have been included in Advisory Committee
Reports since 1994. While various reasons have been offered for not
acting on these recommendations, the need has not diminished. VA has
made significant improvements in health care practices and reducing
access barriers for women veterans. A video will provide an avenue to
showcase these efforts, open ways for new media outreach and ensure
continuity of information and content relative to eligibly criteria.

**Recommendation**

5.  **Incorporate an orientation to VA programs and services as part of
    basic military training*.(DOD*)**

**Rationale:** Congress, in the name of the American people, has
authorized an array of entitlements and benefits for those who serve in
our Nation's Armed Forces. No one can foresee when a military member
will be voluntarily or involuntarily separated. A service member can
experience early termination of their obligatory period of service or
their service career for a number of reasons. If a service member is
injured in the line-of-duty or incurs a disability they generally are
eligible to access VA health care services and apply for VA benefits.
The present Transitional Assistance Program (TAP) is designed to provide
service members an opportunity to attend briefings and receive
information about VA programs within 181 days from separation.
Generally, service members who are involuntarily separated do not have
access to TAP. Introducing information about veterans benefits early in
a recruits enlistment, increases the likelihood they will have some
knowledge about the existence of VA programs at the time of separation.

**Recommendation**

6.  **Place VA benefit and health care information in professional
    medical, nursing, social work and psychiatric publications to alert
    community caregivers to the existence and availability of VA
    benefits and programs. Articles should routinely solicit assistance
    of the community and address the difficulties experienced by VA in
    identifying women veterans**. ***(VA)***

**Rationale**: The increasing number of women entering the military,
curtailment of medical disability benefits and the recent restructuring
of the American welfare system have the potential to increase the number
of VA eligible women in need of medical care and assistance. Educating
health care professionals about VA and the reluctance of some women who
served in the military reluctance to consider themselves as veterans is
a strong component of viable outreach at the service level.

**Recommendation**

7.  **Provide VA orientation training about VA\'s Compensation and
    Pension benefit programs and examination requirements to Department
    of Defense military health care staff**. ***(VA)***

**Rationale:** Informed military health care professionals can assist
eligible military personnel to access VA services and programs when they
are discharged from the service. Additionally, if properly educated,
these informed clinicians should recognize the importance of
documentation of events and medical records needed to support VA
disability claims.

**Recommendations**

8.  **Develop a strong, collaborative relationship between the
    Departments of Veterans Affairs, Labor, and Defense to better serve
    active duty service members, transitioning service members and
    veterans. Department of Defense should enforce mandatory attendance
    of all separating service members at Transitional Assistance Program
    (TAP) briefings. All three Departments should reemphasize the
    Disabled Transitional Assistance Program goals developed for special
    consideration of service members unable to attend regular TAP
    briefings because of physical impairment, disability or
    hospitalization. Include spouses and other family members as
    audience participants for TAP and Conservators, if the service
    member is incompetent, incapacitated or cannot comprehend the
    content of the briefing*.(VA,DOD,DOL*)**

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9.  **Advise the Department of Defense's Advisory Committee on Women in
    the Services (DACOWITS) of the importance and the need to increase
    training opportunities for women service members about programs and
    health care services administered by the Department of Veterans
    Affairs. This Committee can support and increase the availability of
    participation in TAP for women service members and provide technical
    assistance to facilitate a successful transition of military women
    into the civilian communities. Special emphasis must be placed on
    addressing the needs of Selected Reserve and National Guard women
    serving on Active Duty who are disabled in line-of-duty. These women
    are often overlooked because they are not stationed or attached to
    an Active Duty military unit and are not invited or assigned to
    attend routine Transition Assistance Program briefings. *(DOD*)**

**Rationale:** According to Department of Defense\'s Office of
Transition, only 59 percent of eligible service members actually attend
Transition Assistance Program (TAP) briefings prior to discharge**.**
Frequently, service members attending TAP are \"pulled\" out of program
briefings for mission related duties and not afforded an opportunity to
re-enter the briefing schedule. Separating service members too ill or
impaired to ask or receive information about VA programs and services
may not be properly informed about how to access such programs.
Similarly, Selected Reservists and National Guard members injured or
disabled in line-of-duty are often released from their active duty
assignment and rapidly discharged from their parent military
reserve/guard component.

**Comment:** The Committee recognizes that there are logistical problems
in deploying service members and that some situations may be
unavoidable. However, it is important to note that failure to provide
accurate information about VA entitlements deprives separating service
members of the right to valuable programs and services that can assist
them achieve a successful transition from military to civilian life**.**

B.  **Health Care**

**Recommendations**

10. **Develop VA outreach initiatives to inform Selected Reserves and
    National Guard Commanders of the current exclusion, for reservists
    and guard members, to VA sexual trauma health care treatment and
    counseling. Ensure that alternative services can be provided to
    assist their troops should they experience a sexual assault, trauma
    or harassment during their military assignments. *(VA, DOD*)**

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11. **Seek legislative authorization to allow members of the military,
    including Selected Reservists and National Guard members, who
    experience sexual assault, trauma and harassment while in
    performance of their military duty, to be eligible for VA sexual
    trauma counseling and health care. *(VA, DOD, Congress*)**

12. **Eliminate any and all restrictions and time limits on VA's
    (including Readjustment Counseling Service) ability to provide
    sexual trauma counseling and health care. *(VA, Congress*)**

13. **Establish and maintain a consistent level of staff training
    focusing on treatment protocols, sensitivity concerns, and other
    issues instrumental to providing effective sexual trauma counseling.
    Continuing education of VA clinical staff, Readjustment Counseling
    Service staff, and Veterans Benefits Administration\'s regional
    office staff will ensure quality of care for all veterans*.
    (VA[)]{.underline}***

**Rationale:** The Center for Women Veterans reports that survey data
from individual Veterans Health Administration (VHA) facilities
indicates that 20 percent of all women veterans accessing VA care have
reported instances of sexual assault, trauma and harassment during their
military service. As more is learned about the problems of sexual trauma
suffered by men and women in the Armed Forces, it is clear there is an
abiding need for a continuation of appropriate counseling and medical
care services to assist these victims.

**Comment:** It is important to note incidents of sexual misconduct and
victimization are not limited to the Active Duty Force. Members of the
Selected Reserve and the National Guard have also experienced episodes
of assault while performing military duties. VA General Counsel (July,
1997), however, indicated that under present law, members of the
Selective Reserve and National Guard Components who experience sexual
trauma while they are on active duty for training do not meet
eligibility criteria for VA sexual trauma counseling treatment or
assistance.

**Recommendation**

14. **Authorize eligible women veterans to obtain prosthetic appliance
    i.e. shoes, cane, hose etc, designed to fit her specific body
    proportions and height specifications. If feminine apparel is not
    available; a program should be established to permit the issuance of
    a voucher to authorize the purchase from a private vendor. *(VA)***

**Rationale:** The Proceedings for The National Summit on Women Veterans
Issues indicate that VA's prosthetic appliances/equipment are not of
gender-specific design and are generally made to be used by an "average"
man. Women veterans, because of their variance in size and body
proportions, experience problems in trying to adapt to these "standard"
styles.

The process of acknowledging the need for prosthetic support is often
traumatic for a patient. Women veterans should be provided a prosthesis
that compliments their feminine appearance.

**Comment:** To avoid maintenance of a large inventory of these
appliances, VA could establish a voucher/private vendor program as a
cost effective method of adequately providing women veterans feminine
prosthetic equipment.

**Recommendation**

15. **Authorize legislation to permit Medicare-subvention for VA health
    care programs and services and mandate that funds recovered under
    this reimbursement program be retained by the Department of Veterans
    Affairs as a resource to use to enhance medical care** **for
    veterans. *(VA, Congress*)**

**Rationale:** Allowing veterans to access and use VA health care
programs and services with Medicare as the source of payment will
provide veterans, who may not have other private health insurance, with
an additional provider choice for health care services.

Recent changes in the VA health care delivery process indicate that the
cost effectiveness of the present VA system could equate to more buying
power for Medicare dollars. In light of the cost of health care and the
need to ensure continuity of VA health care program resources, Medicare
could provide another viable source of funds for VA.

**Comment:** Veterans, veteran support groups and veterans' service
organizations have requested the right to Medicare subvention. This
issue has been a particular concern for the aging World War II and
Korean veteran population. These veterans, who do not generally meet the
priority definition for VA health care, have been prevented from
applying their Medicare benefits as payment for VA health care.

C.  **Benefit Entitlement**

**Recommendation**

16. **Submit a formal legislative request to amend Title 38 United
    States Code, section 1114 (k) and the 38 Code of Federal Regulation,
    section 3.350 (a) to include a Special Monthly Compensation k-award
    for women veterans who have a simple or a radical mastectomy.**

**Rationale:** Title 38 United States Code, section 1114 (k) and the 38
Code of Federal Regulations, section 3.350 grants a Special Monthly
Compensation k-award for loss of use of one hand, one foot, both
buttocks, one or more creative organs, blindness in one eye, having
light perception only, deafness both ears, having the absence of air and
bone conduction and complete organic aphonia with constant inability to
communicate by speech. The law does not authorize the payment of a
Special Monthly Compensation k-award for simple or radical mastectomy of
a female breast. The Committee believes that a mastectomy involves a
loss comparable to those covered in the law and should qualify for
Special Monthly Compensation k-award.

**Comment:** The outcome of mastectomy (surgical removal of the breast)
frequently results in severe physical disfigurement and necessitates
major reconstructive surgery or the use of prosthesis to replace the
missing breast tissue. In cases of simple or radical mastectomies of the
female breast, no effective function remains. As the female mammary
gland can be deemed a necessary post partum accessory organ, the
addition of simple or radical mastectomy of a female breast in the
eligibility criteria under the conditions of Title 38 United States
Code, section 1114 (k) and the 38 Code of Federal Regulations, section
3.350 (a) to authorize the compensatory payment of a Special Monthly
Compensation k-award is justified.

D.  **Women Veterans Who Are Homeless**

**Recommendations**

17. **Develop VA pilot programs to adequately assess and address the
    issues, concerns, needs and problems of women veterans who are
    homeless. Developing protocols or guidelines to assist VA health
    care providers in accommodating the needs of women veterans that are
    homeless in various shelter and housing situations. *(VA)***

18. **Increase the annual fund level allocated by the Department of
    Veterans Affairs and Congress for the VA Homeless Provider Grant and
    Per Diem Program**. ***(VA, Congress)***

**Rationale:** Homelessness is only a symptom of larger social ills such
as lack of affordable housing, decay of the Inner Cities, decline of the
American Family and jobs which do not pay a fair living wage. There can
be no \"cure\" for homelessness until these problems are addressed and
resolved. The rise in the number of women in the military, the realities
of downsizing of America\'s Armed Forces and recent changes in the
Welfare System have the potential to increase the number of women
veterans who are homeless. Women veterans who are homeless must be
recognized as having different needs than men who are homeless. These
different needs include addressing the issues related to: privacy,
childcare, prenatal and pregnancy care, treatment for physical and
sexual trauma, mental illness and substance abuse.

**Comment:** VA\'s Mental Health Strategic Healthcare Group has achieved
significant inroads in meeting the needs of homeless veterans through
their Health Care for Homeless Veterans\' Programs and the Homeless
Provider Grant and Per Diem Program. The flexibility of the program to
adapt to the emerging needs of the homeless in a variety of locations,
emphasis on creative partnerships with community based organizations and
the matching funds requisites of this Program have proven to be an
effective VA response to assisting veterans who are homeless. This
program is a valuable asset to the Department of Veterans Affairs
because it requires community involvement and financial support to
ensure quality services for veterans. However, women veterans represent
a very small part of the veteran population treated or assisted by VA
homeless programs. There is a critical need for accommodating women
veterans who are homeless and their children. The Committee believes it
essential that VA develop guidelines for providing services to women
veterans who are homeless and their children and spouses, to encourage
providers to make adjustments in their programs to assist these
veterans, and increase the availability of shelter and housing resources
for women veterans. Additionally, an increase in the funding level and
support for VA\'s Homeless Provider Grant and Per Diem Program
ultimately will increase the availability of community services, shelter
and housing for all veterans.

E.  **Minority Women Veterans**

**Recommendation**

19. **Expand VA outreach activities to minority women veterans,
    including Native American women veterans living on and off the
    reservations to include:**

-   **ethnic media (print/radio/TV), churches and community based**

-   **organizations, minority women organizations and health fairs.
    *(VA)***

**Rationale:** A significant number of women serving in the military are
African American, Hispanic, Native American and Asian American. Veteran
women of color are less likely to be reached through VA's routine
outreach program and initiatives of National veterans' service
organizations.

**Comment**: Native American women living on reservations or isolated in
our cities may have even less access to information about VA and/or VA
facilities than other minority women and require special initiatives
that address issues relevant to their culture.

**Recommendations**

20. **Ensure that women veterans of color are included in all areas of
    VA health research and demographic studies that impact women\'s
    health. *(VA, DOD, DOL)***

21. **Conduct demographic reviews of patient outcomes to identify health
    care disparities among women veteran sub-groups in diagnosis,
    treatment, rehabilitation and end of life care. Determine if
    minority women veterans are more frequently institutionalized for
    physical disability and mental illness rather than being treated in
    the more cost effective, efficient and sensitive community based
    care.** ***(VA)***

**Rationale:** National health statistics indicate that certain minority
populations suffer disproportionate morbidity and/or mortality for a
range of health conditions such as breast and cervical cancer, HIV/AIDS,
kidney diseases and diabetes. Recent reports from the Harvard School of
Public Health have indicated that areas of the country with the lowest
life expectancy for women are those with high minority populations.

For example, the top three locations for lowest life expectancy are
areas significantly populated by Native Americans (#1 Bennett County,
South Dakota, including the Pine Ridge Reservation of the Oglala Sioux)
and African Americans (# 2 & 3 Baltimore and Washington, DC.)

VA data however, does not adequately reflect the number of minority
women veterans seeking and receiving the VA health care and other
entitlements due them.

**Comment:** The Committee believes women of color bear a
disproportionate burden of unemployment, poverty, and ill health and may
encounter more barriers in accessing healthcare than their counterparts
in the Caucasian community. There is no indication that military service
diminishes this burden. In order to effectively define needs and
formulate appropriate recommendations for all women veterans, the
Advisory Committee on Women Veterans must be provided reports and data
on health service delivery research and health care outcomes that
reflect responses by the racial/ethnic groups.

Additionally, although Native American women veterans experience some of
the same issues as other minorities including abuse, homelessness,
incarceration and mental illness, the problems these women veterans face
are compounded by the uniqueness of their culture. Many of these women
live on reservations miles from the nearest VA facilities or they live
in urban areas where they feel isolated and insecure.

**Recommendation**

22. **Work with local tribal program officials to ensure Native American
    women veterans are afforded access to and receive VA benefits
    including assistance from VA's Vocational Rehabilitation Specialists
    and are afforded access to programs administered through the
    Department of Labor Veterans Employment and Training Service (VETS)
    programs. *(VA, DOL)***

**Rationale:** The issue of job training is very important for veteran
women of color because the minority populations experience unemployment
rate higher than the National average. There are no data regarding job
opportunities or participation in VA\'s Vocational Rehabilitation
Programs for minority women.

**Comment:** There continues to be a lack of statistical data to
document the participation of eligible Native American women veterans in
VA services and programs. Because of the uniqueness of the Native
American cultures and their special bond with the land, it is not
feasible to expect these veterans to leave their homes to migrate to the
cities in search of work. VA must develop outreach programs that meet
Native American veterans in their life arena.

**F. Women Veterans' Coordinators**

The Women Veterans\' Deputy Field Directors' positions are an important
and valuable resource for coordinating local and VISN outreach,
marketing and public relations activities targeted for women veterans.
The Committee believes that continuing education and training
opportunities are essential to maintain the expertise and high caliber
of the Woman Veterans' Coordinators.

**Recommendations**

23. **Monitor and appropriately allocate the amount of time Women
    Veterans' Coordinators are authorized and provided to perform the
    duties related to this position. *(VA)***

24. **Post and disseminate flyers, brochures, etc providing access
    information for contacting the Women Veterans Coordinator. Ensure
    that staff in public areas such as the telephone operator,
    admission's office, triage units and ward nurses are aware of these
    procedures to ensure effective referrals. *(VA)***

**Rationale:** The Women Veterans' Coordinators' Program has proven to
be one of the most valuable resources for conducting outreach, assuring
quality of health care and educating the public and veteran community
about the special contributions and needs of America\'s 1.2 million
women veterans. Currently, not every VA facility has a full-time Women
Veterans' Coordinator's position. In VA medical facilities with no
full-time Coordinator, an individual is assigned the Coordinator's
duties as a "collateral position", in addition to other job assignments.
This is also the case in all but one VA regional office. Women
Veterans\' Coordinators in collateral positions indicate they frequently
are not given a specific number of hours to work on women veterans\'
issues and are unable to obtain release time from other duties.

**Comment:** Authorization and allocation of time for Women Veterans'
Coordinators must be based on both current and future projections of
women veterans with potential eligibility for care in the VA facilities.
VISN directors and managers should make adjustments in numbers and time
allocation for the Coordinators\' positions only after a thorough study
of local demographic data. This data should includes the proximity and
age of eligible women veterans, availability of TRICARE programs and
services and trends in the utilization of health care services by women
in America.

**Recommendations**

25. **Continue the Veterans Health Administration's Women Veterans'
    Deputy Field Director positions to assure continuity in approach and
    implementation of coordinated health care initiatives to improve
    outreach, program development and public relations, the utilization
    and quality of care for women veterans. (*VA)***

26. **Support and fund educational programs on issues related to women
    veterans including satellite conferences and biennial educational
    meetings for all Veterans Health Administration's and Veterans
    Benefits Administration's Women Veterans' Coordinators*.(VA)***

**Rationale:** Education and training opportunities are the foundation
for the proficiency of the Women Veterans' Coordinator Program. As the
demand for their assistance increases, it is essential that their
knowledge and competence be exemplary. There is a clear need for formal
on-going training that assures VA clinicians and regional office
personnel understand the unique needs of the women veteran population.
Funding for continuing education and training programs for Women
Veterans\' Coordinators must be recognized and supported an integral
part of maintaining the quality of the program.

**Recommendation**

27. **Appoint an individual with expertise in women's health as a
    representative on the VISN clinical executive board (or its
    equivalent). *(VA)***

**Rationale:** Representation will assure that issues related to women's
health programs will be appropriately represented during network
discussions and deliberations on matters that impact clinical
programming and resource allocation.

**Recommendation**

28. **Establish a Women Veterans' Advisory Committees in every VISN and
    VA Health Care facility. The membership of this Committee should
    include VA personnel from the medical facility, vet center and
    regional office as well as minority women and disabled women
    veterans from the local cachement area who are current consumers of
    VA health care services and benefit programs**. ***(VA)***

**Rationale:** Women Veterans\' Advisory Committees on the local level
can assist with outreach efforts, provide feedback about the strength
and weakness of VA and community programs and identify deficiencies in
VA health care practices.

G.  **Research**

**Recommendation**

29. **All studies and surveys sponsored, funded or conducted by VA must
    include gender specific information. VA analysis should routinely
    report the results of these studies and the gender specific
    responses through circulation of the information within the veteran
    community service providers\' networks**. ***(VA)***

**Rationale:** As women in the veteran population increase in number and
the roles of women in the military evolve, there is a growing need for
current information on the demographic characteristics, health profile
and socioeconomic status of these veterans. Although VA has attempted to
collect gender specific data, there is no uniformity in the
Department\'s approach to collection, reporting or publications of
information. For example, the 1992 \"National Survey of Veterans\"
interview schedule reflects a question to discern the gender of the
veteran. However, the report did not include findings by gender
consistently throughout the publication of the results of the survey.

**Recommendation**

30. **Require, by formal legislation, all federally funded research
    programs and studies include a schedule of questions to solicit
    information related to the military background and combat exposure
    for every study subject. *(VA, DOD, DOL, Congress)***

**Rationale:** The allocation and support of fund levels for women
veteran specific research could be augmented by veteran specific data
collected through all federally funded research projects and surveys.

This increase in the availability of information resources and the
process of its collection would provide a method of documenting the
quantity of veterans in a community, the number accessing public and
federal programs and a comparison of demographic veteran data to
civilian counterparts.

H.  **The Future of Women Veterans**

**Recommendations**

31. **Monitor and analyze data on utilization of gender specific VA
    programs by women veterans. *(VA)***

32. **Identify and eliminate barriers experienced by women veterans in
    accessing VA benefits and programs. Develop corrective action to
    ensure quality and timeliness in the delivery of VA health care
    services and benefit programs for women veterans*.(VA)***

33. **Require all VA health care facilities to maintain and advertise
    internal policies established for privacy and security issues as
    they relate to women veterans*.(VA*)**

34. **Establish at least one site within each VISN for In-Patient
    Psychiatry care for women veterans*.(VA)***

35. **Include information about issues affecting women veterans in all
    VA employee training and orientation. Address concerns protocols for
    treatment, trauma intervention, etc., with residents and visiting
    faculty at VA health care facilities and regional office
    staff.(*VA)***

**Rationale:** To ensure efficient and effective health care practices,
VA must evaluate, on an ongoing basis, programs and services to identify
discrepant areas and to assure adequate venues for women veterans in the
future. (Unrestricted access to primary and gender-specific health care,
and the guarantee of a safe and secure environment must be in place if
women veterans are to be counted as part of the future of VA health care
and expected to use VA medical centers, regional offices and vet
centers.)

**Comment**: As changes are being made to VA\'s health care delivery
systems, the Committee is concerned that program and resource allocation
decisions made today will jeopardize women veterans\' access to care in
the future. The number of eligible women veterans is growing each year
and utilization of VA programs and services is likely to increase.
Funding of gender specific services for women veterans is an investment
in the future which needs to be protected regardless of the current cost
cutting climate.

**I. Selected Reserve and National Guard BENEFITS:**

**Recommendations**

36. **Modify all regulations, guidelines and federal statutes that
    provide definitions of active duty, veteran and qualifying active
    duty to include, in part, service in the Selected Reserves or
    National Guard. This will ensure that appropriate health care and
    compensation benefits are provided for members who experience sexual
    assault or trauma during military training or drill period, are
    eligible for VA benefits. *(VA, DOD, Congress*)**

37. **Increase the availability of information exchanges and network
    opportunities between the Departments of Veterans Affairs and
    Defense to ensure that all service persons, including the Selected
    Reservists and members of the National Guard who are injured in the
    line-of-duty are identified and are referred to VA in a timely
    manner. *(VA, DOD)***

38. **Assess Department of Defense's increased reliance on the Selected
    Reserve and members of the National Guard as primary support
    personnel for military action. The results of this assessment should
    support the need for significant** **legislative changes that affect
    the administration of VA benefit's and entitlements to
    reservists/guard members. (VA, DOD, Congress)**

**Rationale:** Today's active military is more reliant on the Selected
Reserves and National Guard components of the Armed Forces for mission
readiness than at any other time in the Nation's history. The demands on
the members of these reserve/guard units are not likely to decline in
the near future. The issues, needs and concerns, of the Selected
Reserves and National Guard members encounter after incurring an injury
or illness in the line-of-duty or while mobilized and/or deployed, are
difficult to address. Primarily this is because of the precarious
situation of these troops in relationship to the military in general and
their VA entitlements and eligibility specifically. Protocols must be
established that ensure a Selected Reservist and/or a member of the
National Guard is afforded quality VA health care for service related
injuries and illnesses and are appropriately provided comparable VA
benefit entitlements. Congress, realizing the important contribution of
the reserve and guard components, has set precedent by providing special
entitlements related to the VA Home Loan Guaranty Program and the
Montgomery GI Bill Education Program.

**Comment:** Lack of adequate support to Reserve and National Guard
troops could have an adverse impact on the future military strength
levels and mission readiness. Reserve component personnel incapacitated
while serving in an official capacity and incurring a service related
disability or injury must be afforded all of the VA benefits and
considerations provided to other veterans.

J.  **National Cemetery System**

**Recommendations**

39. **Provide appropriate legislative resources to permit VA to expand
    and acquire land adjacent to or near established cemeteries and
    facilities to accommodate the burial of eligible veterans. *(VA,
    Congress*)**

40. **Construct Columbarium for cremated remains at all National
    Cemeteries. *(VA)***

41. **Ensure that all existing and proposed State owned cemeteries
    follow VA's internment goals to preserve the obligation to provide
    an honorable resting-place for those exceptional individuals who
    served their country. *(VA)***

**Rationale:** All veterans want the assurance that there is adequate
funding to support the National Cemetery System in its efforts to meet
the obligation of providing a final resting place for all eligible
veterans. There is growing concern, within the veteran population, that
the present system is not prepared to provide for the burial of all
eligible veterans.

K.  **Employment of Women Veterans within VA**

**Recommendation**

42. **Ensure that women veterans are equitably represented in appointed
    positions at all levels of authority within the Department of
    Veterans Affairs. VA should actively recruit qualified women
    veterans that reflect the changing face of the veteran population,
    in positions within the Office of the Secretary and Under
    Secretaries, Assistant Secretaries, as well as VA working groups,
    task forces, advisory Committees and research consultants. *(VA)***

**Rationale**: VA has categorized women veterans' issues as priority
projects throughout the past 15 years. Outreach and education to the
public have increased awareness about the contributions and sacrifices
that women made in service to the Nation. As the visibility of VA
programs for women veterans continues to emerge, the number of women
veterans in leadership positions within the Department of Veterans
Affairs are disappointing.

**Comment:** Increasing the number of women in positions of authority
within the Department conveys the message that women veterans are valued
and recognized for their skills and talents. An important part of
outreach to women veterans involves having representation at the highest
echelons of authority and influence. By including women veterans in
these appointed positions, Congress and the Secretary will demonstrate
their dedication, commitment and recognition to these veterans in real
terms