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98–635 2016

EXAMINING ACCESS AND QUALITY OF CARE AND 

SERVICES FOR WOMEN VETERANS 

HEARING 

BEFORE THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

THURSDAY, APRIL 30, 2015 

Serial No. 114–18 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

RALPH ABRAHAM, Louisiana 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

AMATA COLEMAN RADEWAGEN, American 

Samoa 

MIKE BOST, Illinois 

CORRINE BROWN, Florida, Ranking 

Minority Member 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

JERRY MCNERNEY, California 

JON TOWERS, Staff Director 

DON PHILLIPS, Democratic Staff Director 

Pursuant to clause 2(e)(4) of rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to prepare 

both printed and electronic versions of the hearing record, the process of converting between 

various electronic formats may introduce unintentional errors or omissions. Such occurrences 

are inherent in the current publication process and should diminish as the process is further 

refined. 


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C O N T E N T S 

Thursday, April 30, 2015 

Page 

Examining Access and Quality of Care and Services for Women Veterans ....... 1 

OPENING STATEMENTS 

Hon. Jeff Miller, Chairman ..................................................................................... 1 

Prepared Statement ......................................................................................... 38 

Hon. Corrine Brown, Ranking Member 

Prepared Statement ......................................................................................... 39 

Hon. Mark Takano .................................................................................................. 2 

WITNESSES 

Dawn Halfaker, Veteran ......................................................................................... 3 

Prepared Statement ......................................................................................... 41 

Joy Ilem, Deputy National Legislative Director, National Service and Legislative Headquarters, DAV ...................................................................................... 6 

Prepared Statement ......................................................................................... 47 

Lauren Augustine, Legislative Associate, Iraq and Afghanistan Veterans of 

America ................................................................................................................. 7 

Prepared Statement ......................................................................................... 61 

Patricia Hayes PhD, Chief Consultant for Women’s Health Services Office 

of Patient Care Services, VHA, U.S. Department of Veterans Affairs ............ 9 

Prepared Statement ......................................................................................... 66 

Accompanied by: 

Susan McCutcheon RN, EdD, National Mental Health Director for 

Family Services, Women’s Mental Health, and Military Sexual 

Trauma, VHA, U.S. Department of Veterans Affairs 

And 

Curtis Coy, Deputy Under Secretary for Economic Opportunity, VBA, 

U.S. Department of Veterans Affairs 

STATEMENT FOR THE RECORD 

Veterans of Foreign Wars of the United States .................................................... 87 

Vietnam Veterans of America ................................................................................. 92 

Statement of the Office of Inspector General ........................................................ 104 

The American Legion .............................................................................................. 114 

Keith Kelly, Assistant Secretary for Veterans’ Employment and Training 

Service U.S. Department of Labor ...................................................................... 118 


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EXAMINING ACCESS AND QUALITY OF CARE 

AND SERVICES FOR WOMEN VETERANS 

Thursday, April 30, 2015 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

Washington, D.C. 

The committee met, pursuant to other business, at 10:42 a.m., in 

Room 334, Cannon House Office Building, Hon. Jeff Miller [chairman of the committee] presiding. 

Present: Representatives Miller, Lamborn, Bilirakis, Roe, 

Benishek, Huelskamp, Coffman, Wenstrup, Walorski, Abraham, 

Zeldin, Costello, Radewagen, Bost, Brown, Takano, Brownley, 

Titus, Ruiz, Kuster, O’Rourke, Rice, McNerney, and Walz. 

OPENING STATEMENT OF CHAIRMAN JEFF MILLER 

The CHAIRMAN. The full committee will come to order. I appreciate again you all being here this morning for this oversight hearing, Examining Access and Quality of Care and Services for Women 

Veterans. 

Women have been serving our Nation in the Armed Forces since 

the Revolutionary War, but today more than ever. They are an important and an increasing population of veterans served by the Department of Veterans Affairs with their numbers expected to grow 

even as the veteran population as a whole in our country is slated 

to shrink. 

Women of the modern military excel in a variety of roles, as medics, pilots, civil affairs specialists, as officers, and enlisted. They follow in the footsteps of the WAVES and the WACs of World War 

II and the Nurse and Medical Specialist Corps of the Korean and 

the Vietnam wars. 

The service they provided was not dependent on their gender and 

the services the VA is charged to provide them while being respectful of their unique prospective needs and concerns should not be either. 

Women veterans are just that. They are veterans and as such, 

they are deserving of the same respect, the same attention, the 

same consideration that is afforded to the male veterans with 

whom they have served alongside. 

However, last year, the Disabled Veterans of America released a 

report that found serious gaps in every aspect of programs that 

serve women veterans. According to the DAV, the vast majority of 

these deficiencies result from a disregard for the differing needs of 

women veterans and are focusing on the 80 percent solution for 


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men who dominate in both numbers and in the public’s consciousness. This is unacceptable. 

Today I will be requesting the Government Accountability Office 

to conduct an assessment of VA’s ability to improve the healthcare 

access and quality of our women veterans. GAO last conducted an 

investigation on healthcare for women veterans in 2010 and found 

that availability of services for women varied significantly across 

the VA healthcare system and that VA faced a number of key challenges in providing healthcare to women veterans. 

In the intervening five years, VA has made some strides in improving healthcare for women veterans, but too many gaps still remain, especially considering that just yesterday, GAO informed me 

that VA had yet to provide documentation to show that VA has, in 

fact, implemented two of the five recommendations that were made 

in that report. 

I am hopeful that through GAO’s effort and this hearing we will 

discover the extent to which VA has improved services for women 

veterans, where challenges to quality care and services still exist, 

and how those gaps can be overcome once and for all both for the 

women who are in VA care today and for the thousands of women 

who will transition into VA care over the next several years. 

I again want to thank everybody for being here today, and I recognize Mr. Takano, for any opening statement he may have. 

[THE PREPARED STATEMENT OF CHAIRMAN JEFF MILLER APPEARS

IN THE APPENDIX] 

OPENING STATEMENT OF HON. MARK TAKANO 

Mr. TAKANO. Thank you, Mr. Chairman, for holding this hearing, 

this important hearing on women veterans’ health issues and the 

access to healthcare within the Veterans Administration. 

I know only too well the consequences of the increasing role that 

our women play in our Nation’s defense. Within my own caucus, 

Tammy Duckworth of Illinois is a living example of women being 

put in the line of fire and the sacrifices they are making for our 

country. 

And there are women on both sides of the aisle who are serving 

our country valiantly and, as you say, their role is only going to 

increase as the nature of our voluntary military is going to need 

the increased participation of women in our Nation’s defense. 

In particular today, I hope to explore issues such as an interoperability of record systems as a way of making a more seamless effort 

to connect healthcare services that women need that may be outside the VA. I see that as a major impediment. If we can make the 

electronic healthcare records more interoperable and more seamless, it will give us, I think, greater options to cooperate, have the 

VA cooperate on a private-public partnership basis. 

I am concerned about the payment delays. I was reading through 

some of the testimony of one of the women who was trying to obtain OB/GYN services and since there is a shortage within the VA, 

something we must address, we have to contract out. But the problem of contracting out is the fact that the VA is not timely in their 

payment. 


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So these are all a bunch of, you know, important issues that we 

need to discuss. I know my colleagues have a lot of questions on 

both sides. I am very, very eager to begin this hearing. 

Thank you. 

The CHAIRMAN. Thank you very much, Mr. Takano. 

And every member on this committee on both sides of the aisle 

wants the best for the veterans that have served this Nation regardless of party affiliation, regardless of gender, and I think it is 

an appropriate time that we take today to hear from some of those 

who have worn the uniform of this Nation. 

So I would call our first panel of witnesses to come forward to 

the dais, if you would, and I will call you, the first and only panel. 

First on the panel is Dawn Halfaker, a veteran, a business 

owner, and a strong voice in the veteran community; Joy Ilem, a 

veteran and the Deputy National Legislative Director for the National Service and Legislative Headquarters of the Disabled American Veterans; Lauren Augustine, a veteran and a Legislative Associate for the Iraq and Afghanistan Veterans of America; Dr. Patricia Hayes, the Chief Consultant for Women’s Health Services for 

the Department of Veterans Affairs’ Office of Patient Care Services. 

Dr. Hayes is accompanied by Dr. Susan McCutcheon, VA’s National Mental Health Director for Family Services, Women’s Mental 

Health and Military Sexual Trauma, and Curtis Coy, VA’s Deputy 

Under Secretary for Economic Opportunity. 

I appreciate you all being here today. Ms. Halfaker, you are recognized for your opening testimony. 

And I have to ask before how is the little one doing that I spent 

time with at the dedication of the Disabled for Life Memorial? 

Ms. HALFAKER. Very good. Thanks for asking. 

The CHAIRMAN. Very good. 

STATEMENT OF DAWN HALFAKER 

Ms. HALFAKER. Mr. Chairman and members of the committee, 

thank you for holding this hearing and for inviting me to testify. 

The issues you are reviewing are of great concern to me as one 

whose military career was cut short after I was severely wounded 

in Iraq while serving there in 2004. 

I am very proud to have served in uniform and to continue to 

serve as an advocate for my fellow wounded warriors, veterans, 

and their families through affiliations with nonprofits like USO, 

Wounded Warrior Project, as well as my own service-disabled, veteran-owned business where I employ a lot of veterans and wounded 

warriors. I am also pleased to be able to advocate for my fellow 

women veterans by testifying today. 

Looking back and while the VA has come a long way since just 

a generation ago where there was no women’s program and VA 

hospital could not provide women patients the most basic privacy, 

they have absolutely come a long way, but the department still has 

much to do and more work to close the gaps that DAV portrayed 

in its report, The Long Journey Home. 

VA care is an entitlement and a promise for those of us who 

served and I use its medical system proudly. I want the system to 

work to help our veterans and to ensure that the promise is kept 

for all veterans. 


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My testimony today reflects what I have learned as a VA patient 

and focuses on my recent experience in getting maternity care 

through the VA. As the chairman alluded to, he had the pleasure 

of meeting my little guy. He is about a year old now and he is 

doing great. So thanks again for asking. 

Understandably the VA outsources maternity care, but its administrative stewardship of this service is so hands off that women 

veterans don’t get enough support during this vulnerable period. 

The problems I have encountered are systemic, largely due to a 

wide gap between VA’s detailed written directives and what the 

veterans actually experience. Consider VA’s policy which among 

other things states that women veterans continue to get care 

through VA facilities during their pregnancies for management of 

any other conditions, coordination of care and information sharing 

between non-VA and VA providers is critical, and each facility 

must ensure seamless coordination of non-VA maternity care with 

VA care. 

While these are very sound policies, the expectations they set are 

largely piled on a single individual at each medical center called 

the maternity care coordinator. That individual actually has more 

than a dozen specific responsibilities. 

My coordinator failed to meet several of these responsibilities at 

critical points. So instead of experiencing seamless coordination of 

care, I felt abandoned at times and had to navigate some difficult 

challenges on my own. 

So where did things go wrong? Well, from the start, my maternity care coordinator handed me a list of DC area maternity care 

providers, but quickly warned that she couldn’t really endorse any 

of these providers and I would need to go find a doctor on my own 

who would accept the VA contract at Medicare rates and would 

sign it. 

I had expected the medical center to have a network of OB/GYN 

providers with whom it contracts. I was surprised to learn that it 

hadn’t established any maternity care contracts which left me on 

my own to find obstetrical care. 

As it turned out, my choosing a George Washington University 

Hospital physician proved lucky because her office had actually 

treated another veteran patient, only one, but at least had learned 

how the VA contract works and was willing to sign it. 

I was also surprised to discover that VA is essentially a maternity care bill payer, but it doesn’t even carry out that role very efficiently. For example, over the course of my pregnancy, my doctor 

routinely had lab work done. But because VA was very slow in paying the bills, the lab company began billing me directly. 

My maternity care coordinator apparently couldn’t fix the problem and I soon got collection notices that nonpayment would jeopardize my credit. 

Things got worse. During the pregnancy, my doctor became concerned by signs suggestive of a fetal heart problem and referred me 

to Children’s Hospital for an echocardiogram. That is the only facility in this area that does those. 

I notified my maternity care coordinator to get the needed approval but was told that it would take several weeks because the 

DC, VA had no established relationship with Children’s. 


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With my child’s well-being potentially at risk, the idea of waiting 

weeks to get an okay just didn’t seem right, but my coordinator 

wouldn’t budge until I said I would record our conversation and 

alert my congressman. That finally sparked action and led to VA’s 

arranging with Children’s for the procedure. So thank you, Congress. 

The good news was that the testing revealed that there was no 

cardiac abnormality, but I was soon stuck in the middle again now 

getting bills from Children’s. It took eight weeks and a conference 

call with the VA officials in two different offices to clarify that VA 

had paid Children’s. But because its payment only covered a fraction of the charges, Children’s demanded that I pay the difference, 

more than $1,700. 

After trying to unsuccessfully get my maternity care coordinator 

to resolve this Catch-22, I eventually learned that she had been out 

for several weeks with her own prenatal issues. Surprisingly nobody had been assigned to serve as a backup, so luckily my VA 

OIF/OEF coordinator and case manager happened to contact me 

and was willing to step in and resolve the problem. 

There is much room for improvement, so let me offer a few recommendations. Women veterans should be afforded access to highquality maternity care. The burden should not be on the veteran 

to go find qualified OB/GYN care. Obstetrical care should not start 

with a pregnancy test as outlined in the VA handbook. It should 

start with preconception counseling to assure a woman is as 

healthy as possible before conception to promote her health and the 

health of her future children. 

If VA is going to outsource maternity care, it should be seamless 

and it must include the full range of maternity-related service that 

a veteran may require. VA medical centers should contract with a 

single high-quality provider such as GWU or a network of providers similar to TRICARE so that the veterans can be assured of 

receiving excellent care where experienced clinicians are sensitive 

to the unique needs of women veterans and that veterans do not 

bear the cost associated with that care. 

Pregnancy is a vulnerable period in which women veterans 

should have reliable ongoing support and there can’t be a single 

point of failure. I applaud VA’s direction that pregnant veterans be 

assigned a maternity care coordinator, but that requires both adequate staffing and appropriate training to assure high-quality, consistent, ongoing, 24/7 service. 

Mr. Chairman, women veterans look to you and this committee 

to help assure that VA meets these challenges. Thank you for the 

opportunity to share my perspective and I am pleased to answer 

your questions. 

[THE PREPARED STATEMENT OF DAWN HALFAKER APPEARS IN THE

APPENDIX] 

The CHAIRMAN. Thank you very much. 

Ms. Ilem, you are recognized for five minutes. 


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STATEMENT OF JOY ILEM 

Ms. ILEM. Thank you, Mr. Chairman, for inviting DAV to testify 

at this important hearing. 

Over the past decade of war, women have been a rapidly increasing and important component of the military services as you have 

noted. Women now routinely serve in occupations that put them in 

harm’s way and combat and resulting in trauma, injury, and environmental exposures associated with modern warfare. 

And as you know and are aware, following military service, 

women are turning to VA in record numbers. In fact, the number 

of women seeking VA care has doubled, more than doubled in the 

past decade and continues to rise. 

As a disabled veteran and user of the system, I know firsthand 

what issues women veterans face when they seek care. The experiences of current wartime deployments have contributed to a number of new challenges and transition reintegration challenges for 

these servicemembers. 

As a result, DAV commissioned a study in 2014 to look at women 

transitioning from the military and the existing federal programs 

and services available to aid them in that transition. Our report, 

Women Veterans, The Long Journey Home, represents a comprehensive assessment of the existing policies and programs serving women across the federal landscape. 

One of DAV’s key legislative priorities has been to ensure that 

women veterans are properly recognized for their military service 

and receive equal benefits and high-quality medical care services in 

the VA healthcare system. 

DAV’s report notes that despite a government that provides a 

generous array of benefits to assist veterans with transition and readjustment following military service, gaps are evident for women 

in existing programs. And these gaps can impede a successful transition and negatively impact their health outcomes. 

The majority of these deficiencies, as you noted, result from a 

disregard from the differing needs of women veterans and historic 

focus on developing programs for men who are prominent in numbers and public consciousness. 

Research demonstrates that when compared to men, women veterans returning home from current wartime deployments are more 

likely to be divorced, a single parent, and unemployed after the 

service. They have higher rates of homelessness, at least twice as 

high as women nonveteran. 

Some have limited access to transitional and safe housing options, especially for homeless women with minor children, high 

rates of military sexual assault, and higher use of VA mental 

health services. Women also continue to report limited access to 

child care services as a barrier to needed healthcare. 

Despite the fact that VA has made tremendous progress to improve services for women, they still lack consistent access to a full 

range of gender-sensitive healthcare benefits and services. 

To correct these deficiencies, DAV makes a number of key recommendations including requiring every VA medical center to hire 

a gynecologist and appropriate staffing levels to meet demand for 

gender-specific services; implementation of gender-specific clinical 

IT tools; improving access to gender-sensitive mental health proVerDate Aug 31 2005 11:32 Jun 28, 2016 Jkt 000000 PO 00000 Frm 00010 Fmt 6633 Sfmt 6633 Y:\98-635.TXT PAT

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grams; tailored transition assistance, education, and career guidance programs; increased access to safe transitional beds and housing for homeless women veterans with children; improved access to 

specialized prosthetic items and treatment for MST; permanent authorization for child care services and women-focused post deployment readjustment retreats; and an effective plan for systemic culture change to ensure women experience a welcoming, safe, and 

private environment of care at all VA facilities. 

Over the history of our country, millions of women have answered the call to duty and put themselves at risk to preserve our 

Nation’s security. They have kept their promise and served this 

country faithfully, many with distinction. Now it is time we keep 

our promise to them and we can do that by acknowledging their 

dedicated military service and serving them with greater respect, 

consideration, and care. 

Given the fact that more than half of the women veterans under 

VA care are service disabled, the department must step up its efforts to address their unique health maintenance needs, reallocate 

resources to do so, and ramp up clinical training for these high-priority VA beneficiaries with age-appropriate, customized care. 

This is a transformative moment for the VA. Secretary McDonald 

is leading an ambitious effort to change the department’s overall 

culture and to direct resources where they will ensure VA 

healthcare services can meet the needs of every veteran who needs 

them. That cannot happen without a strong focus on women veterans and a detailed plan of action. 

For these reasons, we call on Congress to legislate and set a firm 

deadline of Memorial Day 2016 for action by the department to 

complete the steps outlined in DAV’s report. This will ensure that 

women veterans have equal access to comprehensive, high-quality, 

gender-sensitive healthcare and benefits. 

Again, DAV appreciates the opportunity to testify before the committee today and I am happy to answer any questions you may 

have. 

[THE PREPARED STATEMENT OF JOY ILEM APPEARS IN THE APPEN- DIX] 

The CHAIRMAN. Thank you very much. 

Ms. Augustine, you are recognized for five minutes. 

STATEMENT OF LAUREN AUGUSTINE 

Ms. AUGUSTINE. Chairman Miller and distinguished members of 

the committee, on behalf of Iraq and Afghanistan Veterans of 

America, we would like to extend our gratitude for the opportunity 

to share our views and recommendations on improving women veterans’ access to quality healthcare and service. 

As the leading post-9/11 veterans’ empowerment organization 

with the most diverse and rapidly growing membership in America, 

we are proud to have a diverse group of women veteran members 

and leaders as part of our organization. 

This March, we launched our first women veterans’ survey as 

part of an effort to understand more about women’s experiences 

during and after service. Over 1,500 women veterans have responded so far. 


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In addition to the survey, IAVA’s research department traveled 

to seven cities across the country and spoke with dozens of women 

veterans in an ongoing series of focus groups. In speaking with our 

members across the country, we have narrowed our suggestions 

here today to three main points. 

First, VA, DoD, and the Nation at large must recognize women 

for their ongoing service to this country. Second, the VA specifically 

needs to expedite planned improvements to VA facilities to support 

and improve services and care for women at these facilities. And, 

finally, there must be a renewed focus on research to fully understand where gaps in services exist. 

Women have played a vital role in our military throughout history and their impact and contributions are continuing to grow 

and, yet, what IAVA has learned while traveling the country is 

that women veterans continue to encounter barriers to care and 

benefits including an overall culture that does not fully recognize 

or accept them as veterans. 

Last year during IAVA’s advocacy campaign, Storm the Hill, one 

of our own leaders experienced a group of fellow veterans thanking 

her for her support while thanking her male colleagues for their 

service. 

Recent IAVA focus group data illustrate this type of disconnect 

is widely reported with less than 40 percent of women veterans reporting that they felt the U.S. treats their military service with respect. 

These frequent instances of dismissing or ignoring women’s military service must change and nowhere is that more necessary than 

inside the walls of VA facilities. We suggest that as a first step, VA 

medical centers implement staff training programs to counter these 

assumptions. 

Additionally, the role of the women veterans’ program manager 

should be strengthened to ensure this position is given the necessary authority to implement policies. The need for an inclusive 

environment is not restricted to the staff at the VA. Patient advocates must also be prepared to handle complaints related to harassment or individuals creating a hostile environment in order to 

enact actual culture change. 

Second, VA medical centers need specific operational and structural changes that support the needs of all veterans. In our recent 

focus groups, women consistently pointed out that they have had 

to endure long wait times to get care from a provider that they 

trust or who are trained in women-specific medical fields. 

While our women veterans’ survey is still open, our initial analysis shows that about 70 percent of our respondents rate the VA 

as fair, poor, or very poor in their support provided to women veterans. Among those who have used private healthcare, only one in 

four rated private healthcare in the same satisfaction levels. 

And while the VA has made great strides to address these types 

of issues, there is still a need to ensure every VA medical center 

has appropriate facilities that are fully staffed to support the needs 

unique to women. 

From our initial survey results, only about half of those enrolled 

in VA care said the facility they last visited had a gynecologist on 

site and less than half reported a women’s VETS coordination or 


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program manager on site. These statistics and issues are not new, 

but the need to address the disparity in gender-specific care remains. 

Third and finally, there must be renewed emphasis on good data 

and reliable research into the experiences of women veterans. Gaps 

in services and improvements in care cannot be fully achieved unless they are fully defined. 

The VA has already taken steps in the right direction here with 

the establishment of the Center for Women Veterans, the renewal 

of the charter for the Advisory Committee on Women Veterans, and 

the recent Women’s Health Research Conference. 

But the VA, DoD, and Department of Labor among other government agencies should make additional improvements to their research by incorporating gender and minority analysis into all reports to better inform gaps in services and programs. Specifically 

focusing on the VA, VBA must track and analyze all rating decisions by gender to ensure accurate, timely, and equitable rating decisions. 

I think what most sums up this testimony is the observation of 

a Vietnam veteran who attended one of our focus groups. She noted 

that while there may have been some progress, by and large, it has 

not been enough and certainly not fast enough. Many of the challenges that existed when she transitioned to VA care decades ago 

still exist. 

With the women veteran population only projected to increase, 

the time to address these issues is now. IAVA would like to thank 

you for bringing these issues to the forefront and giving us the 

chance to offer our views and the views of our members here today. 

Thank you for your time and attention. 

[THE PREPARED STATEMENT OF LAUREN AUGUSTINE APPEARS IN

THE APPENDIX] 

The CHAIRMAN. Thank you very much. 

Dr. Hayes, you are recognized for five minutes. 

STATEMENT OF PATRICIA HAYES, ACCOMPANIED TODAY BY 

MR. CURTIS COY, VETERAN BENEFITS ADMINISTRATION, 

DEPUTY UNDER SECRETARY FOR ECONOMIC OPPORTUNITY, 

AS WELL AS DR. SUSAN MCCUTCHEON, THE VHA’S NATIONAL MENTAL HEALTH DIRECTOR FOR FAMILY SERVICES, WOMEN’S MENTAL HEALTH, AND MILITARY SEXUAL 

TRAUMA 

STATEMENT OF PATRICIA HAYES 

Ms. HAYES. Good morning, Chairman Miller, Mr. Takano, and 

distinguished members of the House Committee on Veterans’ Affairs. Thank you for the opportunity to discuss the high-quality 

care and support that VA is providing to our women veterans. 

The number of women veterans enrolling in VA healthcare has 

increased rapidly, placing new demands on a VA healthcare system 

that has historically treated mostly men. 

In fiscal year 2014, there were more than two million women veterans in the United States and of those women veterans, over 

635,000 are enrollees to include more than 400,000 users of VA 

healthcare services. 


VACREP0180 with DISTILLER
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To address this growing number of women veterans who are eligible for VA healthcare, VA is strategically enhancing services and 

access for women veterans. 

In 2008, VA first identified the necessary actions for ensuring 

that every woman veteran has access to VA primary care. Since 

then, our plan for delivering care to women veterans has basically 

come to fruition. 

VHA’s Women’s Health Services oversees program and policy development for women’s health and provides strategic support to implement positive changes in the provision of care for all women veterans. 

Women’s Health Services works to ensure that timely, equitable, 

high-quality, comprehensive healthcare services are provided in a 

sensitive and safe environment at VA facilities nationwide. 

VA Women’s Health Services’ programs include comprehensive 

primary care, women’s health education, reproductive health, communication, and partnerships. To provide the highest quality of 

care to women veterans, VA offers women veterans trained and experienced, designated women’s health providers who can provide 

general primary care and gender-specific primary care in the context of a long-term patient and provider relationship. 

Today designated women’s health providers are available at all 

VA medical centers and 90 percent of community-based outpatient 

clinics. With the launch of such a large-scale change in services, 

Women’s Health Services recognized the need to assess the 

progress towards implementation of high-quality programs focused 

on women veterans. 

We evaluate all our women veterans’ health programs through 

several mechanisms and in addition, VHA uses an independent 

contractor to conduct detailed site visits to objectively assess the 

implementation of services for women veterans nationwide. 

Also, recent analysis indicates that VHA outperforms private and 

public sector healthcare in many quality performance measures. As 

a recognized leader in the provision of high-quality healthcare, 

VHA initiated efforts to address gender disparity, a problem that 

actually affects healthcare nationwide. 

Since 2006, VHA’s Office of Informatics and Analytics has analyzed all the external peer-review program data by gender and published a quarterly gender report on the Web site. Over the years, 

we have been working very hard to close the gender disparities 

gap. 

In fiscal year 2008, VHA launched a concerted women’s health 

improvement effort focusing on providers’ attention on gender disparity data. And from 2008 to 2011, VA saw a significant reduction 

in gender disparity for many measures. 

At the close of 2013, small gender gaps existed in only a few 

measures including cholesterol management in high-risk patients, 

diabetes care, and rates of influenza vaccination. VA continues to 

address such key clinical issues and others including cardiac care 

to improve women veterans’ health. 

VA recognizes the importance of providing services to women veterans over their life span. VA provides a full continuum of mental 

health services to women veterans including outpatient, inpatient, 

and residential treatment options. VA also recognizes the signifiVerDate Aug 31 2005 11:32 Jun 28, 2016 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 Y:\98-635.TXT PAT

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cance that support groups and partnerships with our local communities have in the transition and recovery of women veterans. 

A number of programs connect women veterans and veterans 

with families with healthcare, employment, financial counseling, 

and housing. 

In conclusion, our mission at VA is to care for those who shall 

have borne the battle as well as their families and survivors. We 

are providing the highest-quality healthcare for today’s women veterans while actively working to meet the needs of those who will 

come to us in the future. 

We have made significant strides in recent years. However, we 

still have much to do as VA continues to focus on the nationwide 

effort to enhance the language, the practice, and the culture of VA 

to be more inclusive of women veterans. We will continue to improve our efforts to provide high-quality, timely healthcare to our 

women veterans and we appreciate this committee’s ongoing support in doing so. 

Mr. Chairman, this concludes my testimony and my colleagues 

and I are prepared to answer any questions that you or other committee members may have. 

[THE PREPARED STATEMENT OF PATRICIA HAYES APPEARS IN THE

APPENDIX] 

The CHAIRMAN. Thank you very much, Dr. Hayes. 

I will yield myself five minutes for questioning. 

Dr. Hayes, I would go to your written statement where you say 

that VA intends to address the hiring of gynecologists and improve 

access by expanding on-site gynecological services and the support 

as we implement the Choice Act. 

My question is, how many gynecologists does VA anticipate hiring using the funds that were provided in the Choice Act for staffing and how much Choice Act funding totally will be allocated to 

this effort? 

Ms. HAYES. Sir, I would like to first make sure that we understand that gender-specific healthcare for women is available at 

every site both through the primary care gender provider, that is 

the designated women’s health provider is going to do the PAP 

smears, mammograms, birth control, and preconception counseling. 

In addition, we now have access to gynecology at 117 of our facilities on site. Everywhere else, they are referred to community 

providers in order to have the highest-quality care for women in 

that community. 

We are right now in the process of looking at those 35 sites. As 

you know from our work on the Choice staffing, Section 301, we are 

looking at a workforce management model that will tell us exactly 

how many gynecologists we need at each and every site, not just 

the ones that have only one at this time and those that have none 

on site. 

So I am not able to answer your question directly about the number and about the money that we will be using for those sites. 

The CHAIRMAN. If you would as you go through the process provide the committee with the data that you do develop. 

How many of the gynecologists that you intend to hire are going 

to be full time versus part time? 


VACREP0180 with DISTILLER
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Ms. HAYES. I also don’t know the exact answer to that. We are 

recognizing that a gynecologist on site has many roles. One is to 

conduct gynecology clinic and to perform surgeries both inpatient 

and outpatient. But they also have the role of helping to oversee 

the care of women in the emergency department and also to help 

teach primary care providers in the best care of women. 

So it may well be possible that these could be full-time providers 

with part of their time providing on that site, emergency room, and 

one of the things that we would also like to enhance is the use of 

telehealth gynecology so that women in the remote areas can be 

seen in those clinics without having to travel to the main site. 

The CHAIRMAN. In her written statement, Ms. Halfaker paints a 

powerful illustration for how she puts it, VA’s administrative stewardship of maternity care is poor and causes unnecessary trauma. 

Dr. Hayes, I hope that you take her testimony and use it as a 

guide on how to improve maternity care for women veterans which 

will become increasingly important as the committee continues to 

examine how to expand fertility service for service-disabled veterans. 

And at one point in her testimony, and I actually wrote it down, 

she talked about some of the most critical maternity care expectations are piled on a single individual, the medical center’s maternity care coordinator, who in Ms. Halfaker’s case failed at critical 

points to meet her responsibilities at very key times. 

Ms. Halfaker. 

Ms. HALFAKER. Thank you, Mr. Chairman. 

I would say that, and I apologize for going over the time a little 

bit, so I had to cut my oral testimony short, but what I wanted to 

say was include a couple of my fellow combat veterans, women who 

have also had children, one of those members serves in Congress, 

both use the VA at a different location. I was here at the DC, VA. 

And both had the same issues. 

And, in fact, I will just say Melissa Stockwell, one of our other 

combat veterans, she is still kind of in, I guess, financial peril trying to, you know, juggle bill paying, that she has gotten a lot of 

bills from the VA and—or, excuse me, not from the VA, but from 

wherever she got her care, that the VA has not paid and it has 

been several months since she had her child. And so I know that 

that has been very hard on her and her family. 

So, you know, I have a couple data points. I haven’t interviewed, 

you know, a lot of women veterans, but I know that the ones I have 

talked to, they all really focus in on the bill paying issue where, 

you know, women veterans are stuck in the middle between the 

VA’s fee office and the providers that are providing the care and 

somehow end up getting a lot of those bills. 

So I think that is one of the biggest issues and then trying to 

find a provider is the other big issues. There is a lot of great facilities in this area, so I was very lucky to end up at George Washington University Hospital where I got great care, but, unfortunately, for other women veterans, they may not know where to go 

and that can very much be a problem for them. 

The CHAIRMAN. Thank you very much. 

My time has expired, but I was struck by Ms. Halfaker’s comments that not only had VA failed to establish contracts with local 


VACREP0180 with DISTILLER
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providers to provide maternity care to women veterans, but was so 

slow in reimbursing one of the non-VA care providers that she was 

forced to be billed. And the consternation that caused was probably 

not a good thing. And in a second round, I probably will talk about 

that issue. 

Mr. Takano. 

Mr. TAKANO. Mr. Chairman, before I begin, I would like to ask 

unanimous consent that Ranking Member Brown’s full written 

statement be entered into the record. 

The CHAIRMAN. It will be entered into the record in the appropriate place without objection. 

[THE PREPARED STATEMENT OF RANKING MEMBER CORRINE

BROWN APPEARS IN THE APPENDIX] 

Mr. TAKANO. Thank you, Mr. Chairman. 

Ms. Halfaker. 

Can you also tell me, besides the billing issue, was there an issue 

also with your medical records being available to the VA and how 

did that play into your care? 

Ms. HALFAKER. Sure. So as far as the medical records go, I think 

in the VA handbook there is a policy that states that the provider 

will have to send the medical records back to the VA. I don’t really 

have any visibility into that process, whether that did or didn’t 

happen. 

But I know that I have tried to get a follow-up appointment at 

the VA numerous times and there continues to be a lot of delays. 

I think that they are experiencing a large number of women veterans at the DC, VA right now and so it has been hard to get a 

follow-up appointment. Some of that is on me with my schedule, 

but it is also, you know, a several-month wait time right now. 

So they are advising us to use the Veterans Choice Act and get 

purchased care, so I am trying to get signed up for that right now 

which is also another process within itself. So since having my 

child a year and a month ago, 13 months ago, I have not been able 

to get back into the VA to find out whether or not they have my 

medical records and follow-up with kind of a routine OB/GYN appointment. 

Mr. TAKANO. Is the delay in your appointment somehow related 

to the medical records issue or is that not relevant or you don’t 

know? 

Ms. HALFAKER. Sir, I don’t know. 

Mr. TAKANO. Ms. Ilem, you have insight into this? 

Ms. ILEM. I mean, it sounds like from talking with Ms. Halfaker, 

you know, it could be an issue of demand as well. You know, when 

they are telling you it is going to be several months for, you know, 

a basic appointment in a facility, the volume has increased, you 

know, for a number of people. 

But I would add, you know, for a long time, the DC, VA did not 

have mammograms on site and we went right across the street to 

have those done. The unfortunate thing is when you would come 

back for your appointment, the VA clinician would ask you did you 

have your mammogram and what were the results. 

And, you know, we would constantly say, I mean, you have a contract across the street. Why are you not getting those results and 


VACREP0180 with DISTILLER
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why are they not being forwarded and put in my record in a timely 

manner? 

So I think that continues to be a problem at sites where they 

have to go off site for mammograms. 

Mr. TAKANO. Dr. Hayes, can you at all shed some light on to the 

untimeliness of the payments and just what we can do to get this 

unstuck? 

Ms. HAYES. Certainly, Mr. Takano. We have known previously 

because of the fact that about 30 percent of women do have to use 

non-VA care that there have been difficulties in care coordination 

and payment. 

Some of these issues actually have been dealt with very directly 

by the move to the Chief Business Office from all of the remote feebasis personnel now being under the management of VA’s Central 

Office, Chief Business Office in the last couple of months that that 

change has occurred. 

I think the more important thing is that with the advent of the 

PC3 contract, within the contract, there are guidelines for timeliness of getting the person into care within—a consult within seven 

days, making sure that the bill now goes through the PC3 contractor. And so the VA is paying the contractor directly and they 

are resolving the issues locally. 

That hasn’t fixed it. We knew for quite some time that payment 

and slow payment has been a challenge. We also know, though, 

and what is disappointing about this case is that there has not 

been the right kind of case management and care coordination from 

the side where our women veteran program manager and others 

have failed the veteran in this case and it sounds like in others to 

navigate that so that we do have ways that balance billing should 

not happen for veterans. They shouldn’t be getting bills from private sector providers. 

Mr. TAKANO. What do you have to say about Ms. Halfaker’s suggestion that VA contract with, you know, a single source, a big 

source where there may be, you know, a large array of OB/GYN or 

gender-specific services available? 

Ms. HAYES. There is a couple of angles to that. One is in our 

larger sites, there have been contracts in place and they must follow all of the GSA contracting rules which are very complex, of 

course, but they do allow for that. 

The other thing, though, as I said about the PC3 contract, that 

does, in fact, enroll a network of providers. Some of the problems 

with having a central contract in the past have been that it has 

been, say, at University of Philly, but those who live further away 

can’t, therefore, participate in that. The OB/GYN care needs to be 

relatively close to their home so that when they deliver, they are 

nearby. 

So we actually think that the network of a PC3 type contract is 

the better way to enroll outside providers into VA OB/GYN care 

and that has been happening. 

Mr. TAKANO. Mr. Chairman, my time is up. Thank you. 

The CHAIRMAN. Thank you. 

Dr. Roe, you are recognized. 

Dr. ROE. Thank you, Mr. Chairman. 


VACREP0180 with DISTILLER
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Having spent 31 years in this business of delivering babies and 

so forth, this is something I happen to finally know something 

about. So I have a lot of questions and really amazing to hear Ms. 

Halfaker. And for you veterans out there, thank you for your service and I say that as a fellow veteran. Thank you. 

I found it astonishing that you wouldn’t have—at home where I 

am, the VA, we have a VA. We have a group of OB doctors in my 

practice, 11. At the time I was in practice, five of us were veterans 

and so we coordinated with them. I don’t know that I ever got a 

record from the VA. If I had a question, I just called the provider 

out at the VA which was a nurse practitioner and said why did you 

send this patient over here. 

That has been an issue getting the information from the VA to 

me. Why in the world the VA—Medicare actually, they don’t pay 

a lot, but they pay pretty timely. And I can’t imagine why the VA 

can’t write a check. How hard is that to do? And you should have 

a contract like any other insurance plan does that you agree to, the 

physician agrees to, and we take that on. 

And, look, most of us out there, either veteran physicians or nonveterans, are more than happy to take care of veterans. I can tell 

you right now our practice takes care of any veteran that wants to 

show up. 

And what I just heard Dr. Hayes say the GSA contracting rules 

are very complicated. Well, that runs a lot of providers off. You just 

don’t want to fool with it. I mean, it is such a hassle. That should 

be easy as pie to do and it ought to happen yesterday. 

And the fact that you had to have an echo, and thank goodness 

your baby was fine, didn’t have to have any further treatment or 

anything, that should be the least of your worries. The fact is you 

should be worrying about your pregnancy and your outcome of your 

baby, not the Children’s Hospital sending you a bill. And that 

ought to be fixed yesterday so you don’t worry about that anymore. 

And, Dr. Hayes, a question to you. How do you explain when you 

tell me about all these things that the VA—and, by the way, they 

are doing a lot better. I want to thank you for that. But how do 

you explain in the focus group that Ms. Augustine talked about 70 

percent of the support services they describe as fair, poor, or very 

poor? 

I mean, if I had an evaluation of my practice was that, I would 

have been making some changes ASAP. 

Ms. HAYES. Yes. 

Dr. ROE. How when your testimony was very rosy, there is a provider everywhere, but that is not the perception these patients are 

having—— 

Ms. HAYES. I understand your question. 

Dr. ROE [continuing]. How do you explain that? 

Ms. HAYES. I can’t speak to the survey that they have, but I do 

know that we do have sites. As I said, ten percent of our community-based outpatient clinics do not have designated women’s 

health providers yet, so I don’t know to what extent the veterans 

who responded to the survey may be represented of folks attending 

those clinics. We are working to increase that. 

We also know that those who have designated women’s health 

providers are very highly satisfied. So, yes, it is a contrast in data, 


VACREP0180 with DISTILLER
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but I think, you know, we can’t just focus on the data but on fixing 

the problem. 

Dr. ROE. Well, I mean, if you don’t know what the problem is, 

you can’t fix it. I think—— 

Ms. HAYES. Right. 

Dr. ROE [continuing]. You have to know what the data is. And, 

Ms. Augustine, I think you had what, 1,500? Maybe it wasn’t a 

double blind, randomized trial that we would, but still surveying 

1,700 people or 1,500, whatever it was, is pretty accurate. Could 

you comment on that? 

Ms. AUGUSTINE. So the survey is still ongoing and the analysis 

is still being done on that. And I would like to speak to the point 

that was brought up about the 70 percent of respondents. That was 

with the VA as a whole rating the VA as fair, poor, or very poor 

in their support provided to women veterans. 

We also have a data point that—once again, the survey is still 

open, so respondents are still coming in and the analysis is still 

being done, but thus far, about 65 percent feel the VA adequately 

provides female practitioners and access to female-specific care. So 

approximately one in three do not. So that would be in line with 

what Dr. Hayes is mentioning. The 70 percent is the VA overall. 

Dr. ROE. Overall. Thank you for that. 

And I think basically when you see a volume increase, in our 

practice, what we did when we would—I would go to church and 

somebody would say I can’t get an appointment with you for four 

or six months. We would hire a new provider and we knew that 

pretty quickly. And we responded to that because we had to provide those services in the community. 

And I think the VA has been very slow to respond to the demand. Any comments, Dr. Hayes. 

Ms. HAYES. I think it follows with my comments that we are aggressively looking at the workforce issues, exactly where do we 

strategically expect additional increase, where do we have gaps 

right now, and proposing that we make sure we hire up in those 

sites. That really is part of our workforce planning right now. 

Dr. ROE. And I think the physician-patient relationship, back to 

Ms. Halfaker, I was the maternity care coordinator for my patients 

for 30 years and if you came to me, I made sure that you got the 

services you needed to take care of you. And that is what somebody 

needed to do and fell down on that. I think that is exactly what 

you pointed out was this gap that was missing there. 

If you were my patient, you knew exactly who to come to with 

your problems and our office took care of those problems so you 

didn’t have to walk out thinking about that. What was happening 

to you was that was not happening. When this person was removed 

or was gone or for whatever reason, there was no one to step in 

and fill that void for you as I understand that. 

Ms. HALFAKER. Congressman Roe, if I could just add to that. I 

think an important point was made by Ms. Augustine about, you 

know, there is the policies that are written in the Women’s Health 

Program Office which are excellent and they have done an excellent job in trying to push this out. 

But it does take the larger organization at the leadership level, 

at the VISN level to say we are going to hire these people. We are 


VACREP0180 with DISTILLER
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going to be in tune with our women veteran program managers 

that are telling us these are the services that are needed. 

And I think that point is really important that we need throughout the system to make sure they get the support they need for 

what they know. They have put down the policies. They put down 

the programs, but the reality on the ground is what is showing 

here. 

Dr. ROE. I yield back, Mr. Chairman. Thank you. 

The CHAIRMAN. Thank you. 

Ms. Brownley, you are recognized. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

I wanted to talk a little bit about child care for our veterans. And 

last week, I introduced legislation and many of my colleagues here 

who are supporting that legislation to make permanent and expand 

the VA’s successful child care pilot program. 

I want to particularly thank you, Ms. Ilem, and the disabled vets 

for your support on the bill. 

I just wanted to ask maybe all of you if you want to weigh in 

on what we have learned from the pilot program and what we 

know of the role of child care for women in terms of accessing timely health services. 

Ms. HALFAKER. Well, I will start out, but we thank you so much 

for introducing that bill. This has been an ongoing issue over the 

last decade. Any surveys, major surveys that were done identified 

child care, access to child care as a barrier for many veterans in 

general, both men and women. 

And the pilots that were done have been deemed to be very successful and I think Dr. Hayes could talk more about that. But as 

it is an issue, you know, we have seen the new clinic out at DC. 

We were so pleased to see is they renovated and revised that clinic 

to include area for child care there as well. And we are hearing 

from more women, DAV’s Women Veterans’ Advisory Committee, 

that are coming in. Some facilities having even done it not just in 

the women’s clinic but various areas around the facility. 

We see more and more a younger population of women coming 

into the system and older veterans that may be grandparents that 

are now responsible for the children and having that, being able to 

bring them along in an environment that they feel comfortable in, 

you know, has been very helpful, I think, for so many women and 

men. 

Ms. BROWNLEY. Any others? 

Ms. AUGUSTINE. I can also echo similar statements from IAVA’s 

perspective. Our members have consistently said that child care is 

a barrier to care and providing child care helps to remove some 

barriers. And for several years now, it has been a policy agenda 

statement of ours to expand child care services at VA facilities because the pilot program has been so successful and so widely appreciated. 

Ms. BROWNLEY. Thank you. 

Ms. HAYES. VA has recommended that we be given permissive 

authority to provide child care in order to meet the exact kinds of 

needs that we are seeing here and that locally, veterans could have 

a voice in how to set that up, how communities might participate 

in it. 


VACREP0180 with DISTILLER
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Ms. BROWNLEY. Thank you. 

Dr. Hayes, I wanted to ask you. You talked a little bit about the 

closing of the gender disparity gap, as you called it. And I wanted 

to understand sort of the measurement of that and what that kind 

of means. 

And is it sort of an average of overall services for women within 

the VA? Are you able to disaggregate more rural areas where I 

think we might have, you know, bigger issues than we do in the 

urban areas? Could you talk a little bit about that measurement? 

And we are always looking for tools of how we monitor these issues 

to make sure that we are on the right trajectory for improvement 

and is this a measurement that we can be looking at? 

Ms. HAYES. Certainly. When we talk about gender disparity data, 

we are actually looking at clinical prevention measures, so whether 

you get your flu shot or not, whether you get mammograms or not, 

and whether you have your lipids measured. These are health 

measures that are put out by national groups outside the VA and 

VA has always been higher than the private sector or Medicare, 

Medicaid on these measures. 

One of the things that hasn’t been addressed nationally outside 

of the VA or earlier in the VA is that women actually—overall, 

women’s healthcare is poor. We don’t do as good a job on cardiac 

disease in women, on flu shots in women nationally. And so VA 

saw that while we did better across the board, we didn’t do as well 

in these issues regarding prevention measures in men and women. 

We have basically set forth to tackle that measure. 

I do want to address another part of your question which is we 

are looking at implementation of women’s healthcare, what are we 

offering for women at various sites, and the variability in how well 

we provide healthcare for women. 

We have a number of different measures including site assessments and a dashboard, as we call it, for looking at how well are 

we getting these policies in place, how many women are assigned 

to designated women’s health providers. We have these types of 

measures and we are putting those out now on a semi—the dashboard is once every six months. The other measures are annual 

and we have roll-up reports on those. So we are looking at the variability across our system and how well we do those. 

Ms. BROWNLEY. Thank you, Doctor. 

And I yield back. 

The CHAIRMAN. Thank you very much. 

Mr. Coffman, you are recognized. 

Mr. COFFMAN. Thank you, Mr. Chairman, for holding a hearing 

on this important subject. 

And thank you, members of this panel, for sharing your views 

with our committee. 

I believe it is absolutely critical that the VA adopt policies to 

meet the needs of our Nation’s growing number of women veterans. 

The rapidly increasing demographic shift of the American veteran 

population is really quite stunning. The number of women veterans 

using VHA between 2003 and 2012 nearly doubled. Twenty percent 

of new recruits now are women while in 2012, it was only 6.5 percent of VA’s patient population were women. 


VACREP0180 with DISTILLER
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To address this dramatic shift last month, I introduced the 

Women Veterans Access to Quality Care Act. The bill requires VA 

to ensure the availability of OB/GYN healthcare services at all VA 

medical centers to improve its healthcare facilities to meet the 

needs of our women veterans and to hold hospital directors publicly 

accountable for women’s healthcare outcomes at their facilities. 

I am thrilled that the Vietnam Veterans of America signaled its 

full support for my bill in its statement for the record submitted 

to the committee today, and I look forward to working with all of 

you on the panel as well and with my colleagues on the dais to 

make sure that we get the bill right and ensure our women veterans are getting the healthcare that they deserve and invite all 

my committee members to join me in this effort. 

Ms. Augustine, in your testimony today, you noted the survey 

conducted by the Iraq and Afghanistan Veterans of America that 

found 56 percent of respondents felt that the VA provided an adequate number of women practitioners. Only 41 percent believe the 

VA provided an adequate number of doctors specializing in women’s care and only 34 percent said the VA adequately provided specialized facilities for women. 

Do you think that VA’s current policies to place, quote, ‘‘designated women’s health providers,’’ unquote, is adequate to address 

the needs of your membership? 

Ms. AUGUSTINE. Based on what we are hearing from our members like you read in our new survey which is updated data, there 

is still a population that is being under-served in those needs. We 

know that the VA is doing their due diligence to try to meet those 

needs. 

What we are hoping to see is that it is done quickly, that there 

is adequate staffing levels to meet the demands so that there aren’t 

situations like we have heard about this morning, and that moving 

forward, the increasing number of women veterans, particularly 

the younger generation coming in that is that increase, is getting 

the services that they need in a timely manner. 

Mr. COFFMAN. Okay. And thank you for your service as well. 

Ms. AUGUSTINE. Thank you. 

Mr. COFFMAN. Ms. Halfaker, thank you for your service to the 

United States Army as an MP. Was that in Iraq? 

Ms. HALFAKER. Yes, sir. 

Mr. COFFMAN. Do you think that the VA’s designated women’s 

health providers are adequate given these figures? 

Ms. HALFAKER. I would say no. 

Mr. COFFMAN. Okay. In 2010, the GAO found that VHA was not 

complying with its own privacy policies for women veterans. For 

example, check-in areas were in busy, mixed gender areas. Gynecological exam rooms did not have adjacent restrooms and examination tables were facing entryways. 

Anybody in the panel, based on your personal experiences or 

based on the feedback of your membership, if GAO did the same 

review today, what would they find? 

Ms. AUGUSTINE. I can speak to a member I talked with last week 

said that exact same thing. The women’s clinic in her local medical 

facility was located directly next to the pharmacy, right next to the 

front door. It was always busy. In fact, there was people from the 


VACREP0180 with DISTILLER
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pharmacy who then came into the women’s clinic because there 

was no longer seating available in the pharmacy. So there was certainly a lack of privacy that she shared concerns with. 

Mr. COFFMAN. Okay. Yes. 

Ms. ILEM. I would just say some of the infrastructure issues that 

are throughout VA, you know, have especially impacted on women’s health with the safety and privacy issues. Many of the facilities had very small locations for their women’s clinic initially. 

They have been moved around a lot and being able to put in for 

construction and infrastructure changes, you know, is, you know, 

a slow process, as you know, throughout VA. So I think that has 

been a problem, an overarching problem for women’s health clinics. 

Mr. COFFMAN. Yes. 

Ms. HALFAKER. And so I would just say that that was my experience about two years ago at the DC, VA Medical Center which is 

the only place that I have gotten care at the VA, but now they have 

built a new state-of-the-art facility that does not have those issues 

and is adequate. 

Mr. COFFMAN. Thank you, Mr. Chairman. I yield back. 

Ms. WALORSKI [presiding]. Thank you. 

The chair recognizes Ms. Titus for five minutes. 

Ms. TITUS. Thank you. 

I also want to thank the chairman for holding this hearing. He 

may recall that I sent him a letter last October that was signed by 

all the members on this side asking for us to look into the issue 

of women’s health. So I am very glad that we are doing that. 

I am also awaiting the results of an IG’s investigation that we 

requested that looks into some of these very same topics, the issues 

of privacy, gender-specific care, and meeting other kind of 

healthcare needs. 

I would just ask first very quickly, Dr. Hayes, Nevada has about 

22,000 women veterans and that is probably a low estimate. We 

have got a brand new hospital in Las Vegas. Can you tell me how 

many gynecologists we have on staff? 

Ms. HAYES. I know that you have at least one, but I don’t know 

how many full-time positions you have for gynecology, you have 

both in Reno and in Las Vegas. 

The issue sometimes, though, doesn’t look that clear when we 

look at making sure that we have the right healthcare for women 

at all the sites and that we make sure we have enough primary 

care providers. As you have heard here, we still have some gaps 

to fill with regard to that. 

And as we make sure that gynecology is used for the scarce resource that it is in our country which is the abnormal conditions, 

making sure that we can do surgery for women, for hysterectomies, 

so we are still trying to manage that in the way that makes for the 

best sense for our women. 

Ms. TITUS. If you would get me those numbers, I would appreciate it. Thank you. 

Ms. Augustine, you know that far too often women aren’t recognized as veterans by their peers. They don’t even really self-identify as veterans so they don’t receive the respect that they deserve. 

Also, they don’t tend to get the information they need about what 

services are available and then they don’t use those services. So I 


VACREP0180 with DISTILLER
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think this is a cycle that we need to break, especially for our new 

young women veterans, the newest generation post 9/11. 

Do you have any advice to the VA about what we can do to bring 

about some kind of cultural transformation? 

Ms. AUGUSTINE. Sure. So the culture change that I mentioned in 

my testimony is certainly a first step. There are some additional 

things that can always be done. For starters, every time I receive 

mail from the VA, it has the wonderful quote from Abraham Lincoln, but the male pronouns are an initial telling me right away 

this is for he and him and not for me as a her. 

So I think that would be a great step. I have appreciated the 

change in vocabulary from VA personnel. I have heard several 

times over the past month for those instead of using he. But when 

I get mail that says he, that is an initial something telling me right 

off the bat that it is not for me. 

I also think from our members’ perspective that 90 percent of 

them have not participated in the peer support program but would 

like to. And I think that opening up peer support programs for 

women would help bring them together and get them to have a cultural change within themselves and ourselves, I should say, to be 

proud of their service and to be more willing to self-identify. 

Ms. TITUS. Thank you. I think that is a very simple change that 

we should make in our correspondence. 

Ms. Ilem, I would also thank you for all the work that DAV has 

done on this topic and your report, The Long Journey Home, is a 

good play book for us to use as we continue to address this topic. 

One of the challenges that I hear, too, is that when women have 

a bad experience at the VA, then they don’t want to go back. Is 

there some way that we can get the word out that things are 

changing, that things are improving, and that they should give it 

another shot? 

Ms. ILEM. We absolutely want, you know, to make sure that 

women can take advantage of all of the positive things that VA has 

to offer, especially in the very specialized services that they provide 

oftentimes for PTSD, for military sexual trauma treatment, for 

blindness, burns, amputations. 

And we want VA to be that provider and they do need to step 

up their efforts in terms of this cultural change and especially during this big transformative moment. It is a real opportunity for 

them to make sure that throughout the organization that they are 

looking at every program office to say are we meeting the needs of 

our women veterans and they should invite women veterans in to 

talk about their experiences with VA and embrace that to be able 

to improve those services. 

Ms. TITUS. Thank you. 

Just one last thing to anybody on the panel. I would like to go 

back to Ms. Brownley’s comments about child care. I am very supportive of her bill. Another thing I hear from women veterans, 

though, or student veterans that they need child care support so 

they can go back to school and take advantage of the GI Bill to get 

an education to better provide for their family. 

Is this something that you hear about? I am working on a bill 

on that. I would appreciate your help and your advice. Do you hear 


VACREP0180 with DISTILLER
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women talk about the need for child care when they go back to college? 

Ms. ILEM. We are hearing through Student Veterans of America 

and some of the organizations that are working more closely on the 

campuses that that can be an issue. Certainly I think it is something, you know, that we really, you know, need to look at and we 

are certainly happy to work with your staff in looking into that 

more. 

Ms. TITUS. Thank you. 

Ms. AUGUSTINE. The same comment, yes. 

Mr. COY. I am sorry. I would also suggest that—I visit lots of college campuses with our GI Bill students and you are right. It is 

not a woman veteran issue. It is a family issue for many of our student veterans. And we look at many of these campuses. We promote that kind of thing. We look forward to working with you on 

your bill to see if we can do even more. 

Ms. TITUS. Thank you very much. 

Thank you, Madam Chairman. 

Ms. WALORSKI I wanted to add my thanks as well, ladies, for 

being here, for all of you for coming today, and thank you for your 

service. 

I worked a little bit with military sexual assault and I am wondering, I guess to anybody on the panel, but to Dr. Hayes, it seems 

that when we really just a couple of years ago started really working together on solutions for this unbelievable amount of military 

sexual assault, and I also serve on the Armed Services Committee 

which it really came to my attention there and many of us have 

been involved with that nationwide, so do you see long-term—you 

know, it seems like right now we have got a lot of military sexual 

assault women coordinators in a lot of facilities now in the VA and 

especially the larger ones. Some of the CBOCs even in my area 

have service coordinators as well. That seems to have tied up so 

many of these loose ends about coordination of care, about the vulnerability of feeling like nobody is following up. 

When you look at the kind of issues that Ms. Halfaker described, 

when the VA looks at the model for success for being able to treat 

female veterans, is the MST kind of a model of what you are following as you are kind of putting these building blocks together to 

deal with more women coming in and be able to treat them adequately and with first-class healthcare? 

Ms. HAYES. Absolutely. I appreciate the fact that the MST points 

of contacts have really shown a way to coordinate care within our 

system. And I would actually like to turn to Dr. McCutcheon a little bit about some of those points in terms of what we have 

learned. 

Ms. MCCUTCHEON. Thank you, Dr. Hayes. 

And thank you for your recognition of the MST coordinator. 

Yes, we do have an MST coordinator at every facility across the 

country. As you mentioned in some CBOCs, we also have MST coordinators. I think it is a wonderful infrastructure for us and we 

have been taking care of those veterans who have experienced 

MST. More and more veterans are actually seeking treatment who 

have screened positive in our system. 


VACREP0180 with DISTILLER
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So we see that as good news. It is a collateral position and some 

of the positions that Dr. Hayes has spoken about are actually fulltime positions. And so there is more dedication. If you know any 

of our MST coordinators, they are typically psychologists or social 

workers, so they also have responsibilities as clinicians to provide 

mental healthcare. 

So the MST coordinator is an administrative position, but thank 

you for recognizing them. 

Ms. WALORSKI Absolutely. And I don’t know if this question 

would be for you, Dr. McCutcheon, or Dr. Hayes. So as more 

women are coming into the military and more OB/GYN services 

need to be available, more pregnancies identified, more women accessing that kind of help, what happens, for example, for—and I 

was just asking this question to my colleague, Dr. Wenstrup—what 

happens when a woman becomes pregnant in the field somewhere? 

She is active duty. She becomes pregnant. She leaves. And are 

there specialists in the VA as there are for the whole area of prosthetics, Walter Reed, you know, one of the best places in the world 

that has become the prosthetic maker? 

What if these women are coming from areas of harm, toxicities, 

things that could be identified that could be harmful passed on to 

a child? Is there anybody in the country that the VA looks at and 

says, you know, if there is a question about what she was exposed 

to prior to this birth or even after this birth, where does she go? 

And if that is not available in your area or you are in a rural 

area, what do you do? Who do you ask and is that a fee-based service to a specialist somewhere and who would that be? 

Ms. HAYES. Well, you ask excellent questions because we have 

been very attuned to the issues about what are the effects of military service on women. And so there is a number of points in which 

this is critical. 

One is our whole department that does look at exposure issues 

in the Office of Public Health and we work very closely with them 

about whether any of these toxins could have a reproductive health 

effect. And for quite a few years now, we have looked at everything 

from depleted uranium to water to airborne issues. 

Ms. WALORSKI. Yes. 

Ms. HAYES. The other thing is I have an OB/GYN on my staff 

who is director of reproductive health and we have consistently 

looked at how to get information to the field about how to evaluate 

the military experience. Where was this woman? 

The good news is at this point in time, we do not see patterns 

of reproductive health effects from military service. That is a really 

important message, but we are not stopping to look. You know, it 

continues to be an active issue for VA. If someone were to have a 

consideration about that possibility, we certainly would hook them 

up with a high-risk OB if we thought there was something going 

on. 

Ms. WALORSKI. I appreciate it. Thank you very much. 

And the chair yields to Ms. Kuster for five minutes. 

Ms. KUSTER. Thank you very much. 

And I want to thank the chair for her leadership on the military 

sexual assault issue and we continue to work on this as a biparVerDate Aug 31 2005 11:32 Jun 28, 2016 Jkt 000000 PO 00000 Frm 00027 Fmt 6633 Sfmt 6633 Y:\98-635.TXT PAT

VACREP0180 with DISTILLER
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tisan issue and one that men and women on both sides of the aisle 

care a great deal about. 

Thank you all for your service to our country and to those of you 

at the VA for your service to our veterans. 

I want to focus in. We are very fortunate. I am from New Hampshire. We work out of the White River Junction VA Hospital and 

the Manchester, New Hampshire. It is not a full-service hospital, 

but one of the things that we have in both of those locations is 

brand new facilities in very old historic hospitals but brand new facilities for women. 

And I just want to commend to my colleagues the notion that 

when these were being designed, they actually brought in women 

veterans, worked very, very closely particularly around I would say 

sort of mental health and level of comfort issues. 

The design for the White River Junction for the entrance was 

very carefully thought through so that women would feel safe in 

this facility, would feel safe coming and getting care. I believe it 

is an all female staff for the services. So just a lot of thought went 

into asking the women veterans what is it that you need to come 

in and get the care that, you know, we are here to provide. 

And I want to commend that all around the country that approach and to be, as we always talk about on this committee, veteran-centric and in this very case very sensitive. 

I have worked with the chair on her concerns on military sexual 

trauma and I just wanted to follow-up with all of you about the 

availability of care for sexual assault survivors and what more we 

could be doing. Do you see any gaps? We would be more than 

happy to follow-up with legislation, but just if you have any 

thoughts on that topic or more broadly mental health issues generally, PTSD, traumatic brain injury, any of those thoughts that 

you might have. 

Ms. ILEM. I would first say, you know, VA provides some of the 

state-of-the-art best care for survivors of sexual assault, male and 

female population. And in that vein, you know, we want to make 

sure that the providers themselves have the time to provide the 

evidence-based treatments that we know work in treatment and be 

able to spend the time with these veterans that they need. 

They are often very complex cases, you know, suicidal ideation, 

other substance use disorders associated with depression, you 

know, along with PTSD. So we have expressed some concern, you 

know, to really want to look at those staffing levels in terms of, you 

know, VA has said that they have met a minimum standard across 

the country. 

And Dr. McCutcheon could probably talk to that more, but I 

think our concern is, you know, has there really been an independent study done about staffing levels and the number of hours 

that it takes for the prescribed treatments that VA, you know, does 

have available in their arsenal. 

And we have heard from providers in the past that they don’t, 

you know, feel that they have the time to spend with veterans that 

they want and to do PTSD treatment. So that would be my point 

on that. 

Ms. KUSTER. Thank you. 


VACREP0180 with DISTILLER
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Any of the others or, Dr. McCutcheon, if you would like to weigh 

in. 

Ms. MCCUTCHEON. If I may follow-up from some of the comments 

from Ms. Ilem. We report to Congress every year on our capacity 

to provide MST-related mental healthcare. And the report this year 

shows that every facility across the country does have that capacity 

to provide that care. 

And also what Ms. Ilem said is that we are very proud that we 

are able to offer the gold standard of treatment for our veterans 

who have experienced MST. As you know, MST is not a diagnosis, 

but there are many diagnoses associated with MST with 

posttraumatic stress disorder being the most frequently, most prevalent diagnosis. 

And so at the VA, we do train our clinicians on these gold standards of cognitive processing therapy, prolonged exposure. We also 

provide evidence-based therapies for depression. So we have this as 

part of our clinical treatment. 

And you are right also to mention that we have many men in our 

system that have also experienced MST. And up to three years ago, 

there were actually more males in our healthcare system than 

women. And so we also give the same attention to our males who 

have had this experience. 

Ms. KUSTER. Well, I just want you all to know that we have a 

focus on this, that we want to make sure to first of all stop the 

practice completely and protect all of our servicemen and women, 

but that we will continue to follow this very closely. 

And thank you. I yield back. 

Ms. WALORSKI. Thank you. 

The chair recognizes Dr. Wenstrup for five minutes. 

Dr. WENSTRUP. Thank you, Madam Chair. 

If I may for a second go to one of your points you were making 

if someone becomes pregnant while on active duty in the field that 

initially they would be treated. They would go to DoD care rather 

than VA, but the same issues apply whether it is, you know, immediately at that time or down the road once they are out of uniform. 

And I want to thank all of you for your service in uniform and 

what you are doing today. 

And, Mr. Coy, welcome back. It is good to see you. 

Ms. Augustine, you brought up a very good point about the words 

of Lincoln as you enter the building. And, you know, I was pleased 

when the secretary came in. That was one of the first things that 

he did is address that issue and make it ubiquitous for both male 

and female. And I think that is important today. 

Obviously, you know, our highest priority is to get people into 

care and the situation that we are faced with today in the VA is 

understanding that we have, I use this figuratively, we have patients in the ambulance and they need to get to care. So the discussions of the changes we are making and expanding and things like 

that, those are all good, but does it help someone today. 

So my question is, how much demand are you seeing for women 

to go outside the VA and is the demand there because the services 

aren’t there or they prefer to go outside the VA for whatever reason? What are you finding in that regard? 


VACREP0180 with DISTILLER
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Ms. HAYES. Women have had to use outside VA services in the 

VA system now for quite a number of years and, as I said, about 

30 percent of women in a given year do use non-VA care whether 

it is through the contract PC3 fee basis and now we certainly openly use the Choice card for women as well as men. There is a slightly higher number of women proportionately using the Choice card 

than men. We are tracking it. We are just beginning to look into 

it. 

Dr. WENSTRUP. Yes. 

Ms. HAYES. But as part of our ongoing look at what is it that 

women need and how are we going to be able to best get it for 

them. Surprisingly, though, not all of the care has always been for 

gender-related care. When we look at care outside the VA, women 

need the whole gamut of care. 

Dr. WENSTRUP. Yes. 

Ms. HAYES. And I think that kind of reflects things like the high 

musculoskeletal injuries, so we have women using physical therapy 

outside the VA, home health assistance in the elderly veteran. You 

know, our range of veterans is the whole age range. 

And so we continue to study what it is and to increase services 

in-house. I think sometimes there is a question about why we use 

so much non-VA care for women and it really isn’t a budgetary 

issue. It is an issue of making sure we have the highest quality for 

care inside the VA. 

So we don’t set up a mammogram until we have a critical mass 

of women and we can bring the right specialists in-house, for example. And I think sometimes that gets confusing when we look at, 

well, why do we have such high non-VA care use. And it is really 

about making sure that we have the right providers in place to provide the high-quality care. And sometimes that means in the community. 

Dr. WENSTRUP. Yes. And I appreciate that. I mean, what is best 

for the patient—— 

Ms. HAYES Right. 

Dr. WENSTRUP [continuing]. And what do we need right now. 

And to be honest with you, you know, and in other hearings and 

as we probe into where we are going with the VA, we don’t even 

really know what it costs within the VA compared to private sector 

because they can’t really tell how much we are spending on all our 

physical plant and everything else. 

So that is down the road. We need to get to that point and so 

that we can provide not just with women’s care but all care and 

how we are doing it the best, but I appreciate it. 

Mr. Coy, a question for you, if I could. There are steps that the 

Department of Labor Veterans’ Employment and Training Services 

are taking and also Vocational Rehab and Employment Services. 

Are there differences per se in the counseling that a woman gets 

compared to a man? Are there certain things that are different 

there as we look ahead or as we are doing it today? 

Mr. COY. Thank you, Doctor. 

I have got two or three different ways to answer that with respect to transition and then with respect to just sort of everyday 

situations. 


VACREP0180 with DISTILLER
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With respect to transition, we, as you know, have completely revamped the Transition Assistance Program in the last couple 

years. And what we are dedicated to do is making sure that all of 

our departing servicemembers are informed consumers of their VA 

benefits. 

We have over 300 benefits advisors that do these TAP classes. 

Thirty-five percent of them are women, 90 percent are veterans, 

and four percent are spouses of servicemembers as we are out 

there. So each one of those benefits advisors is keeping an eye out 

for some of those things that women, those women, departing 

women servicemembers may need or want. 

With respect to VRE and those services, as you know, VRE services are case management services. They are individualized services for each of those veterans, whether they are a man or a 

woman. So we do that case management on an individual basis 

there. 

Dr. WENSTRUP. Thank you. I yield back. 

Dr. ROE [presiding]. Mr. O’Rourke, you are recognized for five 

minutes. 

Mr. O’ROURKE. Thank you, Mr. Chairman. 

I yield one minute of my time to Mr. Walz. 

Mr. WALZ. I thank the gentleman for the courtesy. 

And thank you all for being here and help us tackle this issue. 

Dr. Hayes, I understand cultural change takes time, but I am 

wondering if you could do one thing for me. I wonder if you could 

capture the name of this warrior that Ms. Halfaker talked about, 

capture that the bills weren’t paid, give it to one of your assistants 

here and pay the bill this week. That is one less thing they should 

worry about and that lets us solve that. 

I thank the gentleman. I give him back his time. 

Ms. HAYES. We will absolutely take care of that. Thank you. 

Mr. O’ROURKE. Thank you, Mr. Walz. Thank you. 

Dr. Hayes, reclaiming my time, I was noting my colleague from 

New Hampshire’s comments about a women’s clinic at the VA 

there and she talked about an all female staff who are helping veterans in her community. 

In El Paso, Texas, the community I serve and represent, I hear 

persistently from veterans about our women’s clinic and its shortcomings, one of which is that there is one OB/GYN provider who 

is part time, who is male, and many of the veterans who speak at 

my town hall meetings, women veterans say that those who have 

experienced military sexual trauma are very uncomfortable with 

that situation. 

When we talked to the VA about that, they say that they cannot 

discriminate based on gender in hiring and they are not going to 

make any changes to that situation. 

In addition, we have the problem that we only have a half-time 

provider and you have wait times to get an OB/GYN appointment 

of up to six months, maybe longer, but six months is a number that 

we know to be true from some of the veterans we work with. 

Dr. Hayes, how do you respond to that? How would you guide me 

in improving that situation and working with VA to make it better? 

Ms. HAYES. I would like to work very closely with you on that 

particular issue and anyone that is having that issue about gender 


VACREP0180 with DISTILLER
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of provider because of a number things. As I think Ms. Ilem pointed out, we already have a policy that says that we will honor a veteran’s request for gender of provider whether it is in-house or 

whether we use non-VA care for that. 

So that only sort of stop gaps the measure, though. The other one 

I would question is the issue about hiring and we already know 

that we have received waivers from the Office of Personnel Management when we know that we have a preponderance of a need 

for a female provider. And so we can go directly to that situation. 

It does show the need that we have to look at each provision of 

gynecological care and we are starting to do that. I have already 

got appointments for a number of places. We are talking to the directors about this. We realize that our policy isn’t making it to the 

ground in terms of the needs. 

And so we will look at the need there, how many GYNs do they 

have. Some women do not have the preference for a female GYN, 

but many do and we are looking at being able to provide that inhouse wherever possible. 

Mr. O’ROURKE. Thank you. 

You know, your answer alone right now is helpful to us. Perhaps 

there is a communication breakdown in El Paso in terms of what 

they believe they can or cannot do—— 

Ms. HAYES. Right. 

Mr. O’ROURKE [continuing]. When it comes to serving the needs 

of women veterans in El Paso. So appreciate your answer. But, yes, 

I want to followup with you and let’s make this situation better. 

Ms. HAYES. Let’s do it. 

Mr. O’ROURKE. So thank you. 

And then for the other panelists in the remaining two minutes 

that we have, I would love to get your thoughts on whether the 

focus should be to continue to build up capacity within the VA or, 

Ms. Halfaker, I thought you made some important comments about 

creating or pushing for excellence in how that care is referred, how 

it is paid for, and how it is coordinated. 

When I read that the secretary is trying to hire 28,000 unfilled 

positions within the VA, I worry about focusing on building something up and not capitalizing on capacity that is within the community. So if you wouldn’t mind addressing that. And if there is time, 

I would love to hear from Ms. Ilem and Ms. Augustine as well. 

Ms. HALFAKER. Sure. Thank you. 

I firmly believe that I think that it is taking too long to staff. I 

mean, we have been hearing about these staffing issues for quite 

some time. There has always been issues at the DC, VA where I 

go. And, you know, they can’t seem to resolve those staffing issues 

and so, you know, we continue to wait six months. You know, five 

to six months is usually the average wait time at least for me. So 

I would say that, you know, we are better served. 

Finally I called just very recently to try to make an appointment 

as I alluded to earlier in my testimony and, you know, they referred me to the Veterans Choice and said that I could call this 1– 

800 number if I wanted to try to get an appointment sooner if I 

was eligible to get enrolled in that. 

And I have not followed up on that yet to call that 1–800 number, but, you know, given all that, I would think that, you know, 


VACREP0180 with DISTILLER
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the VA is best served to have some kind of network where care can 

be provided seamlessly and, you know, information can be efficiently shared between the VA and, you know, the outside provider. 

Mr. O’ROURKE. Thank you. 

And, Ms. Ilem and Ms. Augustine, I am out of time. So if you 

wouldn’t mind, I would love to get your responses for the record or 

we could follow-up after the hearing. 

Thank you. Mr. Chair, I yield back. 

Dr. ROE. Thank you, Mr. O’Rourke. 

Mr. Costello, you are recognized for five minutes. 

Mr. COSTELLO. Thank you, Dr. Roe. 

First let me just say that as a new member of the Veterans’ Affairs Committee that it is very gratifying to be able to work on 

issues like this with Congresswoman Brownley and Titus and 

Ranking Member Brown, Congresswoman Rice, Congresswoman 

Walorski, as well as Congressmen O’Rourke, Coffman, Roe, 

Wenstrup, Walz, and others. 

The bipartisan focus on what is the most nonpartisan of issues 

which is making sure that those unique issues to female veterans 

related to healthcare access and opportunity and our collective desire to improve them is something that I think we should emphasize indicates that we do want to solve problems and make improvements in our country and that this committee is doing that. 

And I applaud Chairman Miller and Ranking Member Brown for 

this hearing. 

I have a broad brush of a question for all of you collectively. As 

we await review and recommendations from the IG on the letter 

that we had transmitted, what are the few areas where we need 

to focus our efforts in the next several years for female veterans? 

And I would open that up both on the employment side and obviously on the access to healthcare side. 

Ms. ILEM. I would just say one major gap that I think VA really 

needs the committee’s support on is making sure about the implementation of the gender-specific clinical IT tools. There are a number of IT tools that are, you know, very gender specific that I know 

some of them have been pending for years in terms of the implementation and if you are able to provide some sort of push forward 

to make sure those go to the front of the line because many of them 

are life safety issues and providing better care for women. 

Ms. AUGUSTINE. I will add to that and say that from our members, we are hearing that mental healthcare is one of the most critical aspects for improvement within the VA in addition to meeting 

the capacity of the need that is continuing to grow. 

Ms. HAYES. I think that you can tell from our focus that we know 

we need to meet the gaps in terms of resources and staffing primary care, boots on the ground to serve our women veterans. That 

is absolutely number one. 

We are implementing some of the changes that Ms. Ilem responded to and this will help us do better care coordination. We 

also have a number of apps and other ways for maternity tracking, 

maternity care coordination, some of these issues that have been 

brought up today. We already have some of the fixes in the pipeline, but the pipeline needs to move fast. I think those are really 

the key points for us and mental health. 


VACREP0180 with DISTILLER
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Mr. COY. I will just add. You mentioned employment. As the 

DAV report pointed out, you know, there is really no good definitive data as to why women veterans seem to have a higher unemployment rate, although we know the demographics of women are 

much different than—of women veterans than they are of male veterans. Women veterans certainly are younger, more diverse, and 

certainly more educated than their male counterparts. 

We have seen, though, employment figures drop somewhat dramatically since 2011 to 2014. In fact, 9.7 to about 5.3 today. But 

I think there is a lot more information that we need to get with 

that respect and we need a bigger push on making sure that 

women veterans are afforded all of those employment opportunities 

that everyone else is. 

Mr. COSTELLO. So following up Congressman Wenstrup’s question related to DoL Veterans’ Employment and Training Service, is 

it just a function of focusing more within the framework of what 

exists to make sure that female veterans receive the attention or 

is even more of a curriculum change or something additive? I 

mean, I know that you said you are still looking into that, so that 

may be an unfair question because you are still looking into that, 

but any illumination on that point I would appreciate. 

Mr. COY. I think it is a vexing question that we have been looking at and trying to understand as well. I think in the TAP curriculum, we have a number of things going for and some things 

going against. 

For example, a lot of times people are six months out or four 

months out. They are thinking about getting out and moving and 

doing all those things and not focused on those kinds of things. 

How do we make sure that those benefits and those things that we 

can help veterans including women veterans are done after they 

transition out as well? 

Mr. COSTELLO. Thank you. 

Dr. ROE. Thank you. 

Ms. Brown, you are recognized for five minutes. 

Ms. BROWN. Thank you. 

First of all, let me just say I want to thank the chairman because 

I have wanted this hearing for over a year and I am very excited 

about having it. 

Thank all of you for your service and for being here today because I think this is very helpful. 

As we develop a comprehensive program for women and as, 

women are the fastest growing group of veterans, how are we going 

to best address the needs as, I understand that there will be some 

challenges? 

I personally used to go through to Bethesda for treatment. Now 

I go to George Washington Hospital. I like going where it is all 

women in the facility. Several years ago, women told the committee 

they didn’t like going into the VA because men—would do catcalls. 

So I say how in the world can we address that? We did in Jacksonville at the clinic because women have a separate entrance 

which works. Some of the other women say they don’t want that. 

So as we develop this program, what is the best to alleviate this? 

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nity, we have the Choice Program, so that a veteran can go outside 

of the system if the system is not working. 

So we can start with Dr. Hayes. 

Ms. HAYES. Certainly. Your point is well taken, Representative 

Brown, because of the issues that women veterans need to have a 

voice in what is happening at their site. And so we heard about 

women being able to talk about how they wanted the women’s center set up. 

But I also would say that there are a number of women who say 

I don’t want—— 

Ms. BROWN. Yes. 

Ms. HAYES [continuing]. A separate women’s clinic. And so what 

has to happen at that site is what we do have at many sites. We 

have a separate women’s clinic and we have women’s providers in 

the more general gender neutral primary care clinics integrated 

with the clinic so a women veteran does have a choice within our 

system as to how to receive her care. 

But listening to the women in that site, in that community, I 

think is the only way we can provide the best care. 

Ms. BROWN. Anyone else? 

Ms. AUGUSTINE. Sure, I can add to that. I will say based on our 

preliminary survey data that 70 percent of women veterans that 

responded feel that VA provides a comfortable and safe environment and 30 percent do not. And I think what that reflects is the 

need to really listen to the women veterans on the ground as has 

been repeated so far. 

And I think another point where that can be gathered is in peer 

support groups. We had a vast majority of respondents who wanted 

that sort of system where they could provide feedback about many 

different things including the care they are receiving at the VA. 

And I think that would be a wonderful opportunity to receive that 

feedback and implement community-based solutions. 

Ms. ILEM. Absolutely. And the culture just at the highest levels 

and throughout the organization is important because women veterans aren’t just going to be exclusively in that women’s clinic. I 

mean, they may be able to provide all those primary care and some 

gender specific. They may have to go to lab, X-ray throughout the 

system to specialty clinics. 

We want to make sure that throughout that system, that VISN 

director, the hospital director, and each department is really looking out for women and making sure that their attention, you know, 

has been paid to them and their needs and that they are not being 

called out or there is something inappropriate happening that 

needs to, you know, be addressed immediately at the, you know, location. 

Ms. BROWN. I am very interested in your comments because you 

indicated that you received a Choice card and you didn’t follow-up, 

You have yet to enroll. 

Ms. HALFAKER. Yes, ma’am. I have not actually enrolled in the 

Choice Program yet. My understanding, there is an enrollment 

process. And so I literally had a conversation with the VA women’s 

clinic a couple days ago and just haven’t had time because they 

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cause they were full and that they were, you know, experiencing 

high volume patients. 

And so they told me to call the 1–800 number for the Veterans 

Choice Program. So I haven’t done that yet, but just to me, that 

is not a very efficient way to refer patients into that program. You 

would think that they would have kind of a more defined protocol 

as to how I would then, you know, go get my care through the Veterans Choice. 

Ms. BROWN. I learned at my workshop in Jacksonville if a veterans calls that number, they get a list of physicians in the area 

and they can make a referral right then. With a wait time less 

than 30 days. 

I would like for you to follow-up and then follow-up with us because I want to know because it is supposed to be seamless. 

Ms. ILEM. And—— 

Ms. BROWN. Yes. 

Ms. ILEM [continuing]. I would just mention, too, because Ms. 

Halfaker had noted earlier that when she was referred out for her 

maternity—— 

Ms. BROWN. Yes. 

Ms. ILEM [continuing]. Care originally that she was asked to go 

find a provider and to negotiate that contract with that provider to 

see if they would accept the VA Medicare rate. And, you know—— 

Ms. BROWN. That was the Choice Program. That is not necessary. 

Ms. ILEM. Right. But it shouldn’t even be for fee basis if they 

wanted to use that method. I mean, the veteran should not be put 

in the middle of trying to negotiate that contract. 

Ms. BROWN. Absolutely. That is right. 

Ms. ILEM. VA should be doing that once they have selected a provider, but I think also the point taken that often women veterans 

want the referral of VA—— 

Ms. BROWN. Yes. 

Ms. ILEM. —to make sure they are going to go to a quality provider that is certified and, you know—— 

Ms. HAYES. I would also like to add, though, that we won’t want 

to lose Ms. Halfaker to VA care. She is a VA patient in our clinic. 

What has failed here is that we didn’t make her a follow-up appointment. We knew when her baby was going to be born. We 

didn’t make her the follow-up appointment she needed nine, ten 

months down the road. 

I think the real issue here is about our care coordination. And 

while she certainly has the choice to find a new primary care provider, I would rather have us bring her back into our fold in an 

appropriate way and not be told that she has to wait months for 

an appointment. She is an established patient with us. 

Ms. BROWN. What are your feelings about that, Dr. Hayes. 

Ms. HAYES. Well, our maternity care coordinator—— 

Ms. BROWN. Yes. 

Ms. HAYES [continuing]. Which we already heard were major 

problems in her case, but that person should be calling her monthly following up on how she is doing, should set up her follow-up appointments with the VA, and know if something goes wrong, know 

how she is doing, see if she needs supports after her pregnancy, 


VACREP0180 with DISTILLER
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talk to her about her mental status and her psychosocial issues and 

her supports all the way along. 

That is our model for maternity care coordination because we 

know they are outside our system. It is a fragmented system. We 

didn’t do what we needed to do for her and that is what I am saying. Clearly she is our patient. We want her to be part of our fold. 

If she wants Choice, that is fine, but I am hearing her say that 

wasn’t the answer to what she wanted. 

And so we can go both ways with her, but I would like to say 

that we need to do a much better job in maternity care coordination, have more people in place, and make sure this happens for 

our veterans. 

Ms. BROWN. Absolutely. Absolutely. 

Dr. ROE. Thank you. 

Dr. Benishek, you are recognized for five minutes. 

Dr. BENISHEK. Thank you, Mr. Chairman. 

Well, I am a father of a female veteran, so I certainly understand 

some of those issues. And, frankly, I am a little chagrined to hear 

the story about, you know, call this 800 number and then see what 

happens. And it seems like she should be able to get an appointment, you know, not have to make another call and then you don’t 

know who is going to be at the end of that call or what is going 

to happen. 

It seems like we need to have a better system of referral when 

we are dealing with providers outside the VA system. And I certainly understand that that would maybe need to be because, I 

mean, you are not going to have a gynecologic or obstetric service 

at a VA hospital because it is going to be sporadic as far as the 

need. 

But I am somewhat concerned about the availability of staff. So 

what has changed? Ms. Hayes, you are sort of a part of it, right? 

Have they improved the number of providers in areas around the 

country so that you don’t have to call an 800 number? Can a patient get a gynecologist referral without, you know, an actual appointment, without having to call around? 

Ms. HAYES. Absolutely. We have increased the number of providers many, many fold. You know, we went from having only 

about 30 sites that had women’s clinics. Now we have 2,500 trained 

providers over the last several years. Our issue is we haven’t been 

going fast enough for the number of women coming in our doors. 

And, you know, we have been aware of that, but it hasn’t gotten 

down to every level, every community-based outpatient clinic, every 

main site. They haven’t—— 

Dr. BENISHEK. Are you talking about physicians that are in your 

clinics or this is physicians in the community that are taking care 

of veteran patients through some contract or through the Choice 

Program? 

Ms. HAYES. There are a number of ways that we can take care 

of veterans in the community. One is what used to be called fee 

basis, the non-VA care. Those are not contract. Those are individual authorizations. 

In addition, we have what is called contract. PC3 is our acronym 

for it. That is a network of providers that are contracted through 

the PC3 provider. What that means is—— 


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Dr. BENISHEK. No. I am familiar. 

Ms. HAYES. Right. 

Dr. BENISHEK. I am familiar. What I want to know is—— 

Ms. HAYES. So the veteran can be sent to a specific provider. And 

then the third option for veterans is the Choice card. And right 

now it is set up so that if the clerk is saying you have—what Ms. 

Halfaker said is accurate. They are provided a phone number because they are called and they are saying I need a Choice option. 

And the 800 number gives them a list of providers that they can 

see in their area for that condition. 

Dr. BENISHEK. It doesn’t sound like the best of techniques because it leaves the onus on the patient to find the provider. I mean, 

it seems to me that a patient is seeing a provider within the VA, 

here, call this number and make an appointment. Why can’t the 

appointment just be made while the patient is in contact with you? 

Ms. HAYES. I think it is in terms of what many of our veterans 

want about an outside provider that they actually want to see. 

That is part of why the system was set up that way. But I appreciate your comment that for a veteran who doesn’t know exactly, 

rather would see VA, we need to do something different in terms 

of care coordination on that end. 

Dr. BENISHEK. All right. Thank you. 

Where are you in your hiring for providing specialty care like 

gynecology? I mean, where are you in your process? Do you have 

enough of those providers or what is the story there? 

Ms. HAYES. We are not clear on whether this issue is really recruitment. We are looking at the 35 sites that do not have gynecology on site. And many of them have fewer than a thousand 

women. So in terms of workload, that is not why we are looking 

at this. We are looking at it in terms of making sure the knowledge 

base is on site. 

And so the issue of our workforce and what we exactly need is 

one that we are doing a close study on right now as part of our 

overall workforce planning model. And I don’t have the answers for 

you right now exactly what we need at those sites. 

Dr. BENISHEK. But do all the CBOCs have a staffing plan or do 

they have a referral plan? I mean, if Ms. Halfaker walks into a 

CBOC in my district, is she going to get an 800 number? Where 

will the gynecologist be? 

Ms. HAYES. She will be referred through the non-VA care or the 

PC3. It would be only if she said I want to use the Choice Act because in a community-based outpatient clinic, we don’t have gynecology on site. 

Dr. BENISHEK. Right. 

Ms. HAYES. Likely either the main facility or they would use telehealth or they would use a non-VA care arrangement in order to 

get the gynecologist that they are working with. 

Dr. BENISHEK. All right. Thank you. I am out of time. 

Dr. ROE. Dr. Benishek, thank you. 

If anyone has any further questions, I will open a second round, 

but only for two minutes because we have a fairly busy agenda this 

afternoon. I guess Ms. Titus should be first, yes. 

Ms. TITUS. Thank you all. I appreciate the information you provided us. 


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One thing that bothers me is when you say you don’t have a gynecologist, but you have a person who will give a PAP smear and 

a mammogram. I would ask every woman in this room how many 

of you go for those annual exams to a general practitioner as opposed to a gynecologist? I do not think you would see very many 

hands go up. 

Ms. HAYES. Well, if I could say, one of the things that VA—— 

Ms. TITUS. No. I just want to make that point. 

The second point I want to make, though, is to give a shout out 

to a young woman whose name is Nadine Noky and she lives in 

Venice, Florida. And she is an Iraq veteran. And it goes to that 

point of culture transformation. 

She said she wanted people to know she was a veteran. She was 

proud of that, but she couldn’t find anything to wear. Everything 

was designed for men. So she started her own T-shirt company 

called Lady Brigade. She prints T-shirts that say this is what a 

veteran looks like that fit women or one that says any girl can 

wear heels, but it takes a woman to wear combat boots or another 

one that says mother, sister, soldier. 

I got to give her credit for that. I mean, what a great way to 

wear your pride on your T-shirt. I just want to tell her I think that 

is great that she is doing it. 

Thank you, Mr. Chairman. 

Dr. ROE. Thank you. 

Mr. O’ROURKE. Thank you, Mr. Chair. 

So I do get a chance to hear from Ms. Ilem and Ms. Augustine 

on how we balance staffing up to an adequate level within the VA, 

but also acknowledging that we are unlikely to get to the idea on 

the near future and that as Ms. Halfaker suggested, we need to 

promote excellence and coordination of care. 

And so, Ms. Ilem, if we could start with you. 

Ms. ILEM. I think the coordination of care point is absolutely essential and I think Dr. Hayes has referred to that. You know, I 

think, you know, keeping women veterans in the VA system to 

make sure that they can have comprehensive care and the benefits 

from the system, everything that it has to offer, especially for service-disabled veterans, and when there is an issue of, you know, 

staffing levels, I mean, we know people leave, we know people— 

they have trouble recruiting in certain locations. 

I think assisting that woman veteran and making sure that there 

is really that care coordination piece which is an overall problem, 

not just for women, but I think for women veterans, it is especially 

important is because a high number or a high percentage have to 

use outside care. 

And that is really what VA researches have indicated. We don’t 

know what happens when you go outside of VA. We don’t have the 

data. And they are working hard now to really look at women, specifically women veterans and the impact of military service on their 

care, so they are going to have better care at VA, a better opportunity, and to keep them in when they can and better coordinate 

that care when they can’t. 

Ms. AUGUSTINE. I would echo what Ms. Ilem said. We think that 

the VA can provide excellent care for veterans that is specific for 

veterans and unique to veterans, but we also want to make sure 


VACREP0180 with DISTILLER
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they are receiving that care in a timely manner. And if that is not 

being met, then outside care is necessary. And above all of that, coordination between that outside care and the VA is critical to maintaining a strong bridge between the two groups. 

Mr. O’ROURKE. Thank you. 

Dr. ROE. I thank the gentleman for yielding. 

Ms. Brown, you are recognized. 

Ms. BROWN. Thank you. 

I have to tell this quick story. When I was first elected in 1992, 

the Orlando Hospital was closing because of BRAC. We contracted 

the Department of Defense and the facility was given to VA. Female veterans need separate facilities where their examination can 

be conducted. There is a lot that goes into the planning and making sure that the facilities is accommodating for women veterans. 

But, Dr. Hayes, my question pertains to research. Very little research has been done on women veterans, whether it is through VA 

or through the National Foundation of Health. 

What are we doing to make sure that certain ailments pertaining 

to women veterans that benefit the entire American fabric once we 

do this research, where are we? 

Ms. HAYES. I would thank you for the question because I think 

actually we have done a significant amount of research. And my office works very closely with VA office research and also with NIH 

and the Office of Women’s Health and HHS in order to put forth 

an agenda for research on women. 

And about half of that research has been on mental health issues 

in women veterans and making sure that our treatments for 

women are as robust as they are, have already been shown as they 

are for men. 

We have published more research on women veterans in the last 

four or five years than in the previous 25 years combined. But 

more than that, we have established a practice-based research network in VA so that now any research, you can’t say, well, I don’t 

have enough women to do research on because we have about 

150,000 women veterans that are subject to that possible pool of research subjects. 

So I would say that we need to continue to look at our research 

agenda, but that we have really done a lot to make sure that the 

issues for women veterans are represented in the research portfolio. 

Ms. BROWN. Good. Would you give us an update as to where we 

are on some of the research that has been done? You say you published it, but we would like to have that information so we could 

share it with other members. 

Ms. HAYES. Certainly. We can certainly provide that to you. And 

we also have a Web site that we have for veterans and for the public that is a synthesis of research in the VA. Be happy to send you 

that as well. 

Ms. BROWN. Thank you. 

And thank you, Mr. Chairman. And thank you—yes, ma’am. 

Ms. ILEM. And if I could just mention one thing on the research. 

They have included the VSOs on that. Some of the premier researchers, Dr. Becky Yano within VA have reached out to the VSO 


VACREP0180 with DISTILLER
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community. And I have made recommendations to IAVA and others 

to make sure that they have us included on their work groups. 

Ms. BROWN. A lot has changed because at one point, women were 

not included in a lot of the research and in the specimens, the trial 

specimens. So that has changed. 

Ms. HAYES. Absolutely it has changed. And I appreciate your reminder that we reached out and we have an oversight or a commentary committee of veterans about the research, about the direction of the research, about the issues that we are looking at in research because that is really critical to us being able to do the right 

research on women veterans. 

Ms. BROWN. Thank you. 

Thank you, Mr. Chairman. 

Dr. ROE. Thank you. 

And I would ask the ranking member if she has any closing remarks? 

Ms. BROWN. I just want to thank you all for your service and 

thank you for your testimony. I am looking forward to the second 

panel. 

Dr. ROE. Thanks very much. This is the only panel. 

In closing, Dr. Hayes, thank you for your work that you are 

doing. Obviously things have improved, I think dramatically to VA 

as far as women’s health issues are concerned. So thank you for 

your perseverance in doing that. 

Always take some bullet points away from the hearings when 

you hear the testimony. And one is pay the bills. That is not very 

hard. Well, bill will do that. That should be fixable today, tomorrow, whatever. 

Number two, just like any other insurance plan, if I have a private insurance plan, I have a group of providers on there that my 

insurance plan has worked out for me to go see. And if I don’t like 

that, next year when I get my insurance plan, I will get a different 

plan. 

So I think the VA ought to be looking at trying to provide a list 

of providers. That was clearly a problem when they had to go out 

and seek these on their own. I think that is something the VA can 

do for the veteran. 

And thirdly, I heard that we need someone to make sure that 

there is a—I mean, in my situation, it is a physician-patient relationship—to make sure that someone coordinates that care. And 

there is care that the VA needs to send out because, as you pointed 

out, maybe in some places, there is just not enough patients to 

keep somebody there. So we need to have someone in those facilities and make sure that you knock all those hurdles away from 

people so it doesn’t get so frustrating that some of them will just 

quit looking. 

So I think those are the few things I would like to see. And then 

on the Veterans Choice card, I was informed that we are going to 

have a hearing in a couple of weeks on that which I think we 

should. There are certainly some hiccups out there that have been 

pointed out to me already. 

But I want to thank all of you all for being here and your great 

testimony has really been helpful to me. The committee will be posVerDate Aug 31 2005 11:32 Jun 28, 2016 Jkt 000000 PO 00000 Frm 00041 Fmt 6633 Sfmt 6633 Y:\98-635.TXT PAT

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sibly submitting further questions to you all. I would appreciate a 

quick response on that. 

Without any further comments, the meeting is adjourned. 

[Whereupon, at 12:33 p.m., the committee was adjourned.] 

APPENDIX 

PREPARED STATEMENT OF CHAIRMAN JEFF MILLER

The Committee will come to order. 

Thank you all for joining us for today’s oversight hearing, ‘‘Examining Access and Quality of Care and Services for Women Veterans.’’ 

Women have been serving our nation in the Armed Forces since 

the Revolutionary War but—today more than ever—they are an 

important and increasing population of veterans served by the Department of Veterans Affairs with their numbers expected to grow 

even as the veteran population as a whole is projected to shrink. 

The women of the modern military excel in a variety of roles— 

as medics, pilots, civil affairs specialists—as officers and enlisted. 

They follow in the footsteps of the WAVES and the WACS of 

World War II and the Nurse and Medical Specialist Corps of the 

Korean and Vietnam wars. 

The service they provided was not dependent on their gender and 

the services the VA is charged to provide to them—while being respectful of their unique perspectives, needs, and concerns—should 

not be either. 

Women veterans are just that—veterans—and, as such, they are 

deserving of the same respect, attention, and consideration that is 

afforded to the male veterans with whom they served alongside. 

However, last year, the Disabled American Veterans (DAV) released a report that found serious gaps in every aspect of programs 

that serve women veterans. 

According to DAV, ‘‘[t]he vast majority of these deficiencies result 

from a disregard for the differing needs of women veterans and a 

focusing on the eighty-percent [80] percent solution for men who 

dominate in both numbers and the public consciousness.’’ 

That is unacceptable. 

Today, I will be requesting the Government Accountability Office 

(GAO) conduct an assessment of VA’s ability to improve the 

healthcare access and quality of women veterans. 

GAO last conducted an investigation on healthcare for women 

veterans in 2010 and found that availability of services for women 

varied significantly across the VA healthcare system and that VA 

faced a number of key challenges in providing healthcare to women 

veterans. 

In the intervening five years, VA has made some strides in improving healthcare for women veterans but too many gaps remain. 

[Especially considering that, just yesterday, GAO informed me 

that VA had yet to provide documentation to show that VA had implemented two of the five recommendations made in that report. 

Awaiting Final GAO Confirmation] 

I am hopeful that, through GAO’s effort and this hearing, we will 

discover the extent to which VA has improved services for women 

veterans, where challenges to quality care and services still persist, 


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and how those gaps can be overcome once and for all—both for the 

women who are in VA care today and for the thousands of women 

who will transition into VA care over the next several years. 

f 

PREPARED STATEMENT OF RANKING MEMBER, CORRINE BROWN

Thank you, Mr. Chairman, for calling this hearing today. 

In the 14 years of war and sacrifice following 9/11, American 

women have stepped up in greater numbers than ever before to defend their country by joining the military. 

Across the services, women have put their lives on the line in 

Iraq and Afghanistan. One hundred sixty one have lost their lives 

in the effort. Another 1,003 have suffered life-altering physical 

wounds. And in all, 280,000 have served and returned home to 

transition back into civilian life. 

Today, women are the fastest growing group of veterans. There 

are currently 2.2 million of them who are eligible for benefits and 

services through the Department of Veterans Affairs. These are 

hard earned benefits designed to assist female veterans through 

the all too often difficult transition process. However, according to 

the Department of Veterans Affairs, more than one-third don’t even 

self-identify as veterans. It is taking time for the country as a 

whole to recognize, understand and acknowledge their contributions because with less than one percent of the population serving, 

so few Americans are in direct contact with any servicemember, 

much less a female servicemember. 

I would like to applaud the VA for their hard work and dedication in this area. I know that Patricia Hayes has been the lightning 

rod for VA focusing on the needs of women veterans. VA has taken 

great strides in the past two decades to ensure facilities and services are available for those who choose to seek services at VA and 

close the gender gap. 

Having said that, Mr. Chairman, we know much more needs to 

be done. I am somewhat amazed that even at the VA, we hear 

women veterans are often sidelined by VA employees and other 

veterans who assume they are the wives or daughters accompanying the male veterans there. The VA has had to retool its signage because until recently, women soldiers were not represented in 

the photographs on the walls or depicted in the pictures in the 

pamphlets veterans receive at VA facilities. 

When asked, women veterans say they want timely, high quality, 

gender-specific care. They want it in an atmosphere of recognition 

and respect where there are opportunities for social interaction, 

and they tend to need help with child care and transportation to 

make appointments. What this means is that if the VA is to fulfill 

its obligation to all veterans, primary care, mental health and specialty care must be gender-specific, comprehensive and integrated 

specifically to meet women veterans’ needs. 

I have three bills I want to mention at this hearing today that 

I believe will help VA in this mission. 

The first is H.R. 1575, a bill I introduced that would expand and 

make permanent a successful pilot program providing mental 


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healthcare in retreat settings for recently returned women warriors 

who have been diagnosed with PTSD. 

The second bill, H.R. 1948, introduced by Health Subcommittee 

Ranking Member Brownley, extends the VA’s authority to provide 

drop off child care at VA medical centers and Community Based 

Outpatient Clinics so veterans caring for children do not have to 

miss appointments. I am pleased to be an original cosponsor of this 

legislation. 

The third bill, H.R. 2054 I have introduced, requires that gender 

specific services be continuously available at every VA medical center and community based outpatient clinic. It also directs that the 

necessary personnel be hired and contracts signed to provide gender specific services based on Departmental standards, demand, 

and the projected growth of the demand. 

Mr. Chairman, I want to thank the witnesses for being here this 

morning. I look forward to the ideas and suggestions and yield 

back. 


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VACREP0180 with DISTILLERInsert offset folio 59 here 98635.059
100 


VACREP0180 with DISTILLERInsert offset folio 60 here 98635.060
101 


VACREP0180 with DISTILLERInsert offset folio 61 here 98635.061
102 


VACREP0180 with DISTILLERInsert offset folio 62 here 98635.062
103 


VACREP0180 with DISTILLERInsert offset folio 63 here 98635.063
104 


VACREP0180 with DISTILLERInsert offset folio 64 here 98635.064
105 


VACREP0180 with DISTILLERInsert offset folio 65 here 98635.065
106 


VACREP0180 with DISTILLERInsert offset folio 66 here 98635.066
107 


VACREP0180 with DISTILLERInsert offset folio 67 here 98635.067
108 


VACREP0180 with DISTILLERInsert offset folio 68 here 98635.068
109 


VACREP0180 with DISTILLERInsert offset folio 69 here 98635.069
110 


VACREP0180 with DISTILLERInsert offset folio 70 here 98635.070
111 


VACREP0180 with DISTILLERInsert offset folio 71 here 98635.071
112 


VACREP0180 with DISTILLERInsert offset folio 72 here 98635.072
113 


VACREP0180 with DISTILLERInsert offset folio 73 here 98635.073
114 


VACREP0180 with DISTILLERInsert offset folio 74 here 98635.074
115 


VACREP0180 with DISTILLERInsert offset folio 75 here 98635.075
116 


VACREP0180 with DISTILLERInsert offset folio 76 here 98635.076
117 


VACREP0180 with DISTILLERInsert offset folio 77 here 98635.077
118 


VACREP0180 with DISTILLERInsert offset folio 78 here 98635.078
119 


VACREP0180 with DISTILLERInsert offset folio 79 here 98635.079
120 


VACREP0180 with DISTILLERInsert offset folio 80 here 98635.080
121 


VACREP0180 with DISTILLERInsert offset folio 81 here 98635.081
122 


VACREP0180 with DISTILLERInsert offset folio 82 here 98635.082
123 

Æ 


VACREP0180 with DISTILLERInsert offset folio 83 here 98635.083