From: "\"Doc\" Bruce K. Melson" <>



Today, women constitute almost 15% of active-duty forces. There are more than
1.4 million women who have served, comprising some 5% of all veterans.

And as the number of women veterans has grown, so has the VA health care
system in meeting their needs.
Based on the surprisingly large number of female veterans, Congress and VA
initiated activities to increase public awareness of women veterans and the
benefits they were entitled to.

Back in 1982, the General Accounting Office (GAO) conducted a study that
found serious flaws in VAs health care for women. Congress reacted the
following year by creating VAs Advisory Committee on Women Veterans.
The committee's first report in 1984 found a need for strong outreach and
recognition programs to educate women veterans about benefits. Also, it
indicated a lack of adequate privacy and gender-specific treatment in VA
In response to this and subsequent reports, Congress passed laws to include
specific provisions for women veterans. Furthermore, it broadened the context
of Post Traumatic Stress Disorder (PTSD) to include the aftermath of sexual
trauma associated with military duty. Since then, eight comprehensive
women-veterans health centers have been established.

Congress authorized VAs Center for Women Veterans in 1994, and in November
2000, laws were passed to give female vets benefits for certain
gender-specific conditions.

Room for Improvement

A 1999 GAO follow-up report found that VA had made progress in helping women
veterans get the health care they needed. Efforts to inform female vets of
their eligibility, improve the VA facility environment and help women
navigate the VA system had proved effective. There was still room for
improvement, however.

The report found that more work was needed on the issues of outreach
programs, privacy in hospital facilities and inpatient psychiatric care.
Problems with sexual trauma also continue to arise.
The GAO report indicated complications in VAs outreach programs. Many women
who have served in the military do not know they are eligible for VA
benefits. Some believe only those who served in a war zone or specific
campaigns are considered veterans.

"Women can't come [to VA facilities] if they don't know," says Carolyn L.
Amos, VFW field representative. "Our focus is to get the information to

Outreach programs must be established or expanded so all veterans know their
status and the benefits that status brings, VFW believes. Currently, the
organization is using VFW claims representatives at pre-discharge points to
inform exiting military members of benefits they are entitled to. These
representatives are located at Fort Hood, Texas, and Camp Lejeune, N.C. Two
more will eventually work at San Diego and Fort Bragg, N.C.

A second issue VA has yet to adequately address is privacy and inpatient care
in hospitals. In FY1997, according to the report, women were most often
hospitalized for mental illness. And while many VA facilities offer the
appropriate inpatient treatment for these illnesses, most hospital residents
are men.

So a female vet hospitalized for PTSD or other emotional issues could find
herself the only woman in a large group of men. In addition to personal
fears, these women face other roadblocks to obtaining quality recovery, such
as difficulties with open discussion, group therapy and privacy.

"A lot of women don't go to VA facilities because privacy issues restrain
them," said Bob Gardner, VFW field representative.
VA established special inpatient psychiatric units for women to counter these
problems, but low usage led to closures. Some remain open, but women must
travel from other states and are often far from friends and family.

Precilla L. Wilkewitz, national inspector general and Department of Louisiana
adjutant, strives to meet the needs of women veterans. While on VAs Advisory
Committee (1987-90), she toured VA hospitals looking for security in
psychiatric wards and appropriate female facilities, including bathrooms.

"My main concern is that the needs of women veterans in the VA program be met
with respect and dignity," she said.
The third concern in VA is sexual trauma. A VA study showed 13%-20% of women
vets reported incidents of sexual assault or rape while on active duty. A
Department of Defense study conducted in 1996 found 64% of women experienced
some form of sexual harassment while on active duty. VA studies have shown
that percentage to be anywhere from 55% to 90%.

Congress made strides in this area in 1992, legislating outreach and
counseling services to victims of sexual trauma while on active duty.

But these beneficial programs are not part of the permanent budget. VA is
only authorized to provide the counseling and treatment through Dec. 31,
2004, at which point Congress must renew the programs.
The Advisory Committee favors a permanent program, as GAO's report shows the
number of women vets being treated for sexual trauma continuing to rise.

Efforts and Results Continue

The efforts of the Advisory Committee on Women Veterans and Congress have
made a difference, and can continue to do so if more work is done.

According to a Dec. 9, 2000, article in the National Journal, veterans groups
have identified ways VA could more effectively help women. These methods
include developing better programs for homeless women vets, paying attention
to women's specific health care needs and giving the often multi-tasked women
veterans coordinators more time to do their job.

Homelessness is a common concern among veterans groups, but until now little
attention has been paid to homeless women vets. These women can be at risk
for homelessness because they lack support when transitioning to civilian
life, frequently serve as primary care provider to children and often need to
seek shelter from abusive relationships.
According to Alice Raatjes, associate director of the Center for Women
Veterans, VA has dedicated $3 million to support programs, staffing and
transitional housing for homeless women veterans. By the end of the year, 11
sites around the country should be functional. These facilities will work
with community programs, which can provide services VA cannot.

"The program adds another component to VA in finding and assisting homeless
women veterans," Raatjes said.
VA is beginning to improve its gender-specific treatment options. Women's VA
benefits now entail complete physical exams, including breast and pelvic
exams, gynecology services and referrals for necessary services unavailable
at the facility.

But more changes are needed. Prosthetics and other medical devices at VA
facilities are typically designed for men only, for example.

The Advisory Committee hopes to eliminate this problem, and recommended in
its 1998 report that women be able to obtain prostheses to fit their body
proportions. If female appliances are not available, a voucher program should
be established to authorize purchase from a private vendor, the committee

Another way VA can be improved is by giving women veteran coordinators more
time to do their jobs. Currently, facilities that do not have a full-time
coordinator assign an individual the coordinator's duties in addition to her
own. As a result, the coordinator's responsibilities often are not given the
full time and effort they deserve.

The committee's report suggested allocating and monitoring the time women
veterans coordinators are given to perform their duties. It also is
encouraged that information for contacting the coordinator is distributed
throughout the hospital to provide effective referrals.

Disparities a Thing of the Past?

Many strides have been made to improve women's VA health care, and changes
continue to be implemented.
"We've made enough noise," Wilkewitz said, noting, "We've come a long way
since 1985."

The first National Summit on Women Veterans Issues, held in 1996, brought
together all those involved with women vets. It developed recommendations to
be passed on to Congress and other interested parties. A second summit
followed in 2000.

The 2000 Advisory Committee report is expected to include the following
recommendations: educating women about benefits; ensuring privacy and safety
in VA hospitals; making sexual trauma counseling a permanent program; and
paying more attention to the specific health care needs of women.

The report should be available on the Center for Women Veterans Web site,
. J



"When the way comes to an end, then change - having changed, you pass through."

      I. Ching


 Bruce "Doc". Melson