WOMEN VETERANS: THE JOURNEY AHEAD HONORING THE SERVICE OF WOMEN VETERANS Foreword The U.S. military, as studies have shown, is a fairly accurate cross-section of America. It is a diverse blend of race, region, education, creed and—increasingly—gender. Women, now eligible to compete for assignment in all military occupational specialties and positions, are the fastest-growing subpopulation of the military and veteran communities. They comprise almost 20 percent of the active-duty armed forces, Reserve and National Guard and 10 percent of the total veteran population. But the population of women in these communities is growing more rapidly than the systems we have in place to support them. This has created an environment in which—whether intentional or not—women’s service to the nation is often less recognized, less respected and less valued than their male counterparts. It has led to a culture that, in many ways, continues to tell women they don’t quite belong. In the last decade alone, we’ve borne witness to some of the most significant milestones for women in military service, and it is understandable that with such rapid evolution there will be growing pains as the nation’s infrastructure adapts to accommodate gender-specific needs. But the cultural lag has hindered the progress necessary to effectively serve this population, and that must change. DAV’s Women Veterans: The Journey Ahead follows our 2014 report Women Veterans: The Long Journey Home, giving credit for the work done and successes achieved while also spotlighting remaining needs and making recommendations for a road map forward. The journey ahead is not just for women veterans. The Department of Veterans Affairs, among other institutions, has a responsibility to provide and administer effective programs, services and benefits these women have earned. Specifically, VA has an opportunity to utilize what we’ve learned about this population to transform the department with women veterans central to planning and decision- making during this period of significant reform. Mahatma Gandhi said, “No culture can live if it attempts to be exclusive.” Yet every day, in ways both large and small, women veterans go overlooked because we are attempting to wrap them into an existing, at times ill-fitting, system rather than creating a system that wraps around them. We challenge VA to take the findings of this report to adapt their culture into one of inclusivity and to further refine their “whole veteran” care model, which evidence shows women veterans in particular benefit from. We believe the department can recognize the trends among women veterans—in a way that no other health care system is poised to do—and use that information to best support this population’s unique and interconnected needs. Women do belong. They are carving out larger, more prominent places in our military and veteran spaces each day. But we can’t just tell them they belong; we have to show them. And DAV resolves to ensure that the federal programs in place to serve women veterans are effective to meet their needs and fully honor their military service and sacrifice. Table of Contents Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 VA Health Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Comprehensive Primary Care for Women Veterans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Community Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Rehabilitation and Prosthetic Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 VA Mental Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Peer Support Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Veterans Suicide and VA Suicide Prevention Efforts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Military Sexual Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Readjustment Counseling Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Retreats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 VA Women Veterans’ Health Research Initiative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Shelter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Preventing Homelessness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Home Loans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Financial Security . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Legal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Civil Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Criminal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Transition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Transition Assistance Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 VA Disability Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Vocational Rehabilitation and Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Appendix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 davwomenveterans.org 1 Executive Summary Women have a larger presence in the military today than ever before. With more than 200,000 women serving in the active-duty military, VA predicts that by 2020 women veterans will comprise nearly 11 percent of the total veteran population. (Photo by Cpl. Garrett White/U.S. Marine Corps) Women have served in the United States and ensure women can take full advantage of the military with distinction for generations— unique, holistic benefits and services offered by the from Women’s Army Corps, Women Accepted for Department of Veterans Affairs and other federal Volunteer Services and Women Airforce Service agencies. Pilots (better known as the WACs, WAVEs and In September 2014, DAV published Women WASPs) of World War II to combat nurses in Korea Veterans: The Long Journey Home. In that report, and Vietnam to Female Engagement Teams in we focused on the unique challenges experienced Afghanistan. Women’s equitable capabilities were by women veterans transitioning from military recognized in 2013 with the lifting of the ban on service in the post-9/11 era and making a successful women in combat and fully realized in December adjustment to civilian life. We reviewed reports and 2015 when all combat positions were opened to interviewed experts across the government to examine women. Since then, two women have graduated from the adequacy and effectiveness of services and U.S. Army Ranger School, the U.S. Army Infantry programs for women transitioning from the military. Basic Officers Leader Course, and the U.S. Marine In that first report, we found many opportunities Corps Infantry Officer Course. As of 2015, women to strengthen government efforts and made 27 key make up 15.5 percent of active-duty military and 19 recommendations to catalyze improvements in such percent of the Guard and Reserve.1 Currently, women programs as transition assistance, employment, justice are 10 percent of all veterans,2 a number expected to initiatives, family services, housing and health care. increase to 16.3 percent within the next 25 years.3 As We shared the results of our findings in more than recruits, both men and women were promised that a 50 interviews with radio, TV and print media, and grateful nation would care for those “who shall have testified before Congress in three separate hearings borne the battle,” providing them with benefits and focused on the needs of women veterans and women health care services for a lifetime to address both service members transitioning from the military the visible and invisible wounds of military service. and wartime service to civilian life. Finally, we met Today, as we continue our efforts to support women with government leaders and program managers and veterans, we ask the nation to uphold this promise participated in panel discussions and on committees 2 Women Veterans Report | 2018 where we recommended ideas for improving express significantly lower perceived health, physical government services for women veterans. function, life satisfaction, social support, quality of life We are pleased to report that significant progress and purpose in life compared to nonveteran women has been made on many of the issues we raised in over 80 years of age.6 Although currently, only 13.6 our 2014 report. Congress enacted comprehensive percent of women who use VA benefits and services legislation that focused exclusively on women veterans are 65 or older (compared to 50.2 percent of men), and subsequently passed six other laws that included this is a lifelong journey; VA will need to anticipate provisions specific to issues and recommendations and plan for an aging female population just as they for changes DAV suggested. Additional legislation have for men. introduced during the 114th and 115th Congresses The report findings and recommendations focused on key priorities discussed in the report: cover the broad range of women veterans’ needs promoting gender-specific health care for women across a lifespan, including health care, mental veterans; improved training for clinical providers; health, community care, shelter, legal concerns, ensuring the privacy, dignity and security of women education, disability benefits and financial security. by improving the environment of care in VA medical In this executive summary, we provide 45 key facilities; enhancing and coordinating maternity recommendations to drive immediate action that care services; developing a women’s peer support ensures women veterans benefit from a holistic program; expanding access to child care; and approach to transition, recovery and long-term increasing outreach to women veterans to ensure support offered by VA and its partner agencies. awareness of the services and benefits they have earned. Further progress has been made on a majority HEALTH CARE of recommendations by the agencies themselves. For Comprehensive Primary Care for Women Veterans example, VA has expanded access to information VA has developed and deployed a successful for women veterans through the Women Veterans model of comprehensive primary care for women Call Center, 1-855-VA-Women (1-855-829-6636); veterans. However, administrative, organizational promoted culture change and awareness campaigns; and leadership shortcomings that impact all care instituted strong maternity care coordination policies at VA have also undermined the Veterans Health and directives; initiated transition assistance sessions Administration’s ability to consistently meet the exclusively for women; enhanced veterans’ access to needs of women veterans. At the local level, women child care; and focused on expanding eligibility and veterans program managers play a critical role by services in the programs for homeless and unstably ensuring the needs and preferences of women veterans housed women veterans. In all, Congress and the are understood and addressed. Similarly, the VA agencies have addressed in whole or in part all but Office of Women’s Health Services plays the same six of the recommendations made in the last report. role nationally and establishes the forward-looking (A full summary of progress is in Appendix A.) research, training and planning agenda for women This progress is a testament to the combined effort veterans health care in VHA. of the veterans service community and military ́ Recommendation: The VA undersecretary for support groups, Congress and federal agencies health must hold VA facility leaders and directors working collaboratively to ensure the needs of women accountable for meeting women veterans’ standards veterans are understood and being met. However, of care for quality, privacy, safety and dignity, which there is more work to be done. For the current report, includes ensuring these standards are applied in Women Veterans: The Journey Ahead, we reviewed all primary care and specialty care clinics (for progress made since 2014, analyzed new reports, example, prosthetic clinics where women fit and interviewed experts, and identified where additional adjust their prostheses). Leaders who do not meet efforts need to be made and where new efforts are these standards must not be eligible to receive an warranted to meet the unique needs of women outstanding performance rating. veterans. We also wished to expand the focus of this ́ Recommendation: Specific-purpose funding for report to encompass those needs across a lifespan, the Office of Women’s Health Services must be in recognition that our commitment to women maintained to ensure that women’s health training, veterans is lifelong and ongoing. However, we found culture change, leadership coordination, standard that research and studies examining the needs of setting, information technology development, older women veterans are sparse, despite findings and identification and prioritization of research that older women veterans experience a higher needs related to women veterans continues all-cause mortality than nonveteran women4, 5 and without interruption. davwomenveterans.org 3 Community Care ́ Recommendation: VA should ensure that all To meet growing demand and expand geographic VA and community care clinicians who provide access, VA must continue to incorporate community services for women veterans adhere to VA’s providers into its health care system, including evidence-based clinical practice guidelines services for women veterans. However, the unique recommendations. needs of women veterans are best met within ́ Recommendation: Congress should extend the a strong system of comprehensive and gender- number of days it authorizes VA to reimburse care sensitive primary care that helps ensure that all of for women veterans’ newborns. the physical, mental and social needs of women ́ Recommendation: Performance measures should veterans are identified and appropriate referrals are be developed to support delivery of high-quality, made. At present, the private sector is not prepared safe and coordinated maternity care. to take on this role. As VA expands community care, ́ Recommendation: VA needs to continuously it will need to take actions to build competencies monitor the demand for maternity care services in community providers, ensure coordination and and ensure that the need for quality maternity care intensive case management (when needed), and services, maternity care coordinator staffing and structure contracts to support network adequacy maternity care prosthetic needs are met. for women’s health services. ́ Recommendation: Women veterans program ́ Recommendation: Women veterans primary managers at each facility must play an integral role care services and gender-sensitive mental health in leadership assessments and decision-making care must be designated as essential, foundational about community care and services for veterans to services that VA maintains at every facility. ensure the needs and preferences of women veterans ́ Recommendation: Clarify roles and are addressed. This includes Veterans Integrated responsibilities for verifying that all designated Service Networks and facility leadership utilizing women’s health providers who treat small numbers women veterans program managers’ expertise when of women have documented proficiencies in working with Community Veterans Engagement women’s health as required by VHA. Boards, academic affiliates, Vet Centers, community ́ Recommendation: VA must ensure that care, and other community health and social service community care contractors meet VA-established providers to establish local networks. standards for adequacy of women’s health services by both number and geographic location. They Rehabilitation and Prosthetic Services must also meet reasonable timeliness standards VA Rehabilitation and Prosthetic Services provides for wait times that are comparable with those of a lifetime of valuable support including gender- VA for routine and urgent care. Contractors who specific items for pregnancy, postpartum and do not maintain adequate service access could following breast removal. The needs of women potentially incur penalties. veterans have been included in recent clinical ́ Recommendation: In drafting regulations to practice guidelines, and the service has focused implement the VA MISSION Act of 2018, VA attention on women veterans in training materials, must ensure that challenges identified by women publications and speaking engagements. But research regarding their experience with the Veterans Choice advances for women with limb loss have been Program are addressed. Regulations must include hampered by a limited number of women veterans clear explanations of eligibility and identify requisite who require these prostheses who could participate activities to develop veterans’ awareness of the in research studies. new community care program in addition to steps ́ Recommendation: VA Rehabilitation and they must take to receive a referral and ultimately Prosthetic Services should continue to highlight schedule appointments for community care. VA the needs of women amputees in research, must establish a reasonable time line for results presentations and training activities. of diagnostic work or care to be communicated ́ Recommendation: VA Rehabilitation and with VA and the veteran, and safeguards must be Prosthetic Services should continue to explore established to ensure veterans’ credit is not harmed advances in 3D printing technology to provide when VA is the responsible payer for care and fails better fitting prostheses and a wider range of to pay bills in a timely manner. customizable options for women veterans, and ́ Recommendation: Training offered to community promote 3D printing as a treatment choice to care providers must include modules specific to the meet the specialized prosthetic needs of women needs and experiences of women veterans. veterans. 4 Women Veterans Report | 2018 ́ Recommendation: Congress should clarify VA successfully connect with mental health services, research authority to ensure that VA researchers whether those services include evidence-based can lead and fund cooperative research studies. therapies, and whether participants had greater Partners may include academic affiliates, other adherence to treatment and were more satisfied federal agencies and for-profit industry in order with their care. VA should continue to evaluate to advance understanding and application of a variety of models to meet needs expressed by prostheses for women. Civilian, military and women veterans, including the integration of peer veteran women should be used as research counselors in women veterans comprehensive participants to provide an adequate research primary care teams. base to advance innovations. Veterans Suicide and VA Suicide Prevention Efforts VA MENTAL HEALTH CARE Women veterans are twice as likely to commit suicide From 2003 through 2012, women’s use of VA health as civilian women, and younger women veterans’ care services increased 80 percent, with women relative risk is even higher. Access to and familiarity veterans proportionately using mental health services with firearms is one prominent risk factor that more intensively than men. Forty percent of younger younger men and women veterans share. The best women veterans seen in VHA facilities used mental protections against suicide are prompt identification health services, as did 31 percent of older women of mental health concerns, the development of a veterans, a fivefold increase in women’s use of safety plan for access to lethal methods of suicide these services. VA provides comprehensive mental and engagement in an evidence-based treatment health and post-traumatic stress disorder treatment program. Specific analysis of gender differences for programs, such as integrated care models that colocate risk, protective factors, harm reduction strategies primary care and mental health providers, or the and treatments are yet to be done. Behavioral Health Interdisciplinary Program that ́ Recommendation: As VA develops its update of provides an integrated treatment plan and services to the Clinical Practice Guidelines for Assessment individual veterans. VA has consistently been shown and Management of Patients at Risk for Suicide, to provide superior mental health services when the guidelines work group should assess the compared to the private sector. Yet men and women scientific basis and publish recommendations on still experience barriers to seeking mental health care, gender-based differences in risk, protective factors and variability in the quality of services continues to and treatment efficacy for suicide prevention. exist across VA. ́ Recommendation: As part of a comprehensive ́ Recommendation: VA should develop a suicide prevention strategy, VA should aggressively comprehensive five-year strategic plan for mental promote routine screening for mental health health services, as suggested by the National conditions and suicide risk; improve access for Academy of Sciences Committee. The plan should women veterans to evidence-based treatments; address becoming a high-reliability organization and promote harm reduction strategies, including that provides accessible, high-quality, integrated education of providers and family on how to talk mental health care services. The unique needs of to a veteran in crisis or at risk for suicide about safe women veterans should receive explicit attention storage of firearms. in the Mental Health Strategic Plan. Eating Disorders Peer Support Counseling VA has just begun training teams in recognition VA has a robust peer support program of more than and treatment of eating disorders among veterans. 1,000 specialists nationwide, 18 percent of whom are Women veterans with trauma in their backgrounds, women. Peer support is an important component including military sexual trauma, intimate partner of care for women veterans and an important need violence or post-traumatic stress disorder, are at risk expressed by women. VA is testing various models for developing eating disorders, which have significant to provide this service to women veterans; however, clinical implications. little rigorous model development and testing has ́ Recommendation: Ensure that women veterans been done. and their clinicians are aware of available VA ́ Recommendation: VA should define specific resources for eating disorders, and continue outcome measures for the Women Veterans training clinicians about the clinical implications Peer Specialist program, including if veterans of eating disorders. davwomenveterans.org 5 Substance Use Disorders explicitly create outreach and access plans each year Rates of substance use disorders are significant that take into account the local population of veterans, among women veterans who use VHA services. including minority populations such as women, Such disorders contribute to suicides, can make and create specific strategies to reach them. women vulnerable to intimate partner violence, and ́ Recommendation: Local Vet Center leadership co-occur with other mental health conditions that must be included in any local planning to establish can complicate diagnosis and treatment. And they high-performing community care networks to make women veterans vulnerable to a spiral of decline: ensure their knowledge and understanding of job loss, homelessness, criminal activity and family veterans’ needs and existing community resources dissolution. To combat this downward trajectory, are included in plans. VA should also establish women veterans require full access to the wraparound clear protocols for transferring veterans to and services offered by VHA. from Vet Center care and community care ́ Recommendation: VA should ensure women providers when needed. veterans have timely access to a full spectrum of ́ Recommendation: Permanently extend integrated substance abuse treatment services, beneficiary travel, with appropriate oversight from detoxification to rehabilitation. mechanisms, for eligible veterans using Vet ́ Recommendation: VA should increase the Center programs. availability of gender-exclusive substance use disorder programming and ensure all Retreats programming venues comply with environment Nature-assisted therapies, including retreats, have of care standards for women’s privacy and safety. been shown to have a clear and consistent positive impact on readjustment for women veterans. The Vet Military Sexual Trauma Center pilot retreat program has had great success The impact of military sexual trauma, or MST, has with the more than 300 women veterans who have both immediate and lifetime impacts. It has an attended. economic cost—$3.6 billion a year by one estimate— ́ Recommendation: The Vet Center women’s as well as high personal costs. Sexual misconduct retreats have shown consistent positive outcomes and assault don’t occur in a vacuum. These crimes and should be permanently authorized and flourish in an environment where sexual innuendo, expanded by Congress and available to women gender-based bullying, unfair treatment, low veterans who need them. expectations and fundamental disrespect for women are allowed to flourish. Fixing this culture problem at VA Women Veterans Health Research the Department of Defense is the job of its leaders at The VA Office of Research and Development continues all levels. to play an important role in identifying factors that ́ Recommendation: DOD should work with other affect veterans’ care and improving the treatment and federal agencies and outside experts to evaluate programs that serve them. Women must be included and disseminate effective approaches to creating in all research to ensure that results of projects are gender equity within a male-dominated workplace. representative of the entire veteran population. Additionally, DOD should take an aggressive ́ Recommendation: VA must redouble efforts to stand against sexual harassment and assault in the ensure significant representation of women in military by holding commanders accountable for the Million Veteran Program and all broad-based creating a positive culture of inclusion and respect research endeavors—not just those projects that and sponsoring women’s empowerment. specifically address them. ́ Recommendation: All service branches should ́ Recommendation: To the extent possible, aim to prosecute 100 percent of nonrestricted ensure adequate representation of women in all claims of sexual assault, as the Air Force does. biomedical research. All VA clinical trials must report differences in sex and gender, as National Readjustment Counseling Services Institutes of Health studies do. Readjustment counseling in VA continues to be an ́ Recommendation: VA should continue important resource for women veterans, with 12 prioritizing research areas for women veterans percent of current visits made by women. Vet Centers by mapping knowledge gaps. 6 Women Veterans Report | 2018 SHELTER LEGAL ISSUES VA and its partners at the departments of Housing Some women veterans have unmet civil legal needs and Urban Development and Labor have made that impede their ability to obtain and maintain stable tremendous progress in addressing the needs of housing and employment. VA’s promotion of access to homeless veterans, including the needs of homeless free and low-cost legal services is a tremendous help and precariously housed women veterans. Women to this group of women veterans. Women veterans also veterans are less likely to be literally homeless than benefit, as do men, from the ability to access Veterans men, remaining in dangerous relationships or living Treatment Courts and gain treatment and services transiently with friends and family rather than instead of being incarcerated. But access to these sleeping on the street. VA has made adjustments to programs is highly variable across the country and its services to try to capture these veterans into their outcomes for program participants are unclear. programs. However, gaps still exist between what ́ Recommendation: VA should set clear program these women need and what VA provides to ensure goals and metrics for the Veterans Justice Outreach they successfully transition to stable housing. Program that can be applied in differing local ́ Recommendation: To address unmet needs, conditions across the country to particularly ensure Congress should hold hearings to examine the that minority populations of veterans, such as needs of women veterans who are precariously women, are being effectively served. housed or homeless, identifying any gaps in ́ Recommendation: VA should continue to research eligibility that could be addressed to prevent and report on the legal and health care needs of chronic homelessness. Congress should also justice-involved women veterans and on outcomes consider expanding authority under VA’s existing of programs like Medical Legal Partnerships, grant programs that serve homeless veterans to Veterans Justice Outreach and Veterans Treatment allow funds to address some of the remaining Courts. VA could ask the National Academy of priorities held by women veterans, such as short- Sciences to study these programs or bring together term vouchers for child care expenses, to remove an interdisciplinary group from VA, the Bureau of short-term impediments to long-term employment Prisons and the Department of Justice to examine and housing stability. best practices and establish clear national program metrics, goals and outcome measures. Financial Security ́ Recommendation: As in other VA programs, Overall, women veterans are adequately employed women in linked services for Veterans Justice and have higher incomes than comparable civilian Outreach and the Health Care for Re-entry women at all ages. However, they continue to make Veterans Program should be assigned to women less than their male peers, a gap which generally peer mentors and specialists. VA should study the increases over time. Some subpopulations of women need for and effectiveness of peer mentors and veterans struggle with employment. Younger women specialists to support women veterans who have still lag behind their older peers, although they are cases in family court. Women veterans program doing much better now than during the financial managers should be tapped to help coordinate crisis, and disabled women veterans and those in these and other services these women require. school still struggle with employment. State efforts ́ Recommendation: VA and DOJ should work to help military service members transfer experience, cooperatively to establish uniform program training and certificates to the private sector have guidelines for Veterans Treatment Courts that helped all veterans find meaningful employment favor the broadest inclusion criteria to allow after service. veterans to avoid incarceration, enter into ́ Recommendation: DOL should partner with VA treatment and work toward recovery. Congress and veterans service organizations to understand should require the departments to report on barriers to full employment for women veterans, their progress in this endeavor. particularly those in school and those with disabilities, and adjust their employment programs based on these findings. ́ Recommendation: Veterans service organizations should continue to work with VA and their state and community partners to expand best practices for certification and education credits for military experience and training. davwomenveterans.org 7 TRANSITION ́ Recommendation: We concur with VA and DOD have both invested in transition recommendations made by OIG and urge VBA to assistance and outreach to veterans once they have reinstitute training and refresher training for VBA left active duty. While some studies of reintegration employees handling MST-related claims; update and the needs of military families have been done, the the checklist for such claims, to include detailed studies have not included explicit methods to assess steps claims processors must take in evaluating the needs of women military members or determine these special claims in accordance with applicable how well current programs support their transitions. regulations; require claims processors to certify VA and DOD are implementing a new pilot program that they completed all required development to include a women-specific day in the existing action for each claim; and establish routine Transition Assistance Program. quality review measures to ensure consistency and ́ Recommendation: The VA and DOD Joint accuracy of these claims. Incentive Fund should be applied to needed research into women’s experiences with Vocational Rehabilitation and Employment reintegration and family and community Vocational Rehabilitation and Employment is re-engagement. an important program for women veterans, who ́ Recommendation: As part of ongoing assessment currently make up a little more than 20 percent of efforts, DOD must ensure that it collects data and users. While the program studies and publishes study the effects of deployment on the families, outcomes and participant satisfaction, it has not and in particular the spouses, of women service published this data analyzed for female participants. members and on dual military families. Special ́ Recommendation: VA should analyze race attention should be given to any differences in and gender outcomes in longitudinal studies support and services these families may need. of Vocational Rehabilitation and Employment ́ Recommendation: The Transition Assistance participants and make the data and analysis Program should collect and publicize outcome and publicly available. satisfaction data broken down by gender and race. ́ Recommendation: DOD should study women’s Education experience with post-deployment combat stress, VBA educational benefits are being used by women reintegration, and family post-deployment and veterans in large numbers, comparable to those of community re-engagement. DOD should also men, and women are successfully obtaining college develop materials and programs that address the degrees. Like their male counterparts, women veterans special post-deployment challenges of women in can benefit from clear, complete information on the the military. services and culture offered by educational institutions as they decide where to pursue their degree and VA Disability Compensation spend their government-funded educational benefits. The Veterans Benefits Administration has successfully Although the VA GI Bill Comparison Tool is a step conducted outreach to women veterans transitioning forward in collecting and organizing information from the military, resulting in women’s utilization of that veterans may wish to know about a school, it benefits and services that is approaching comparability suffers from both too much information and too with men. VBA created equitable reviews for claims little. While many military-friendly best practices are related to military sexual trauma through a series of included in the tool, many schools do not consistently interventions that corrected past inequities. However, report the information that would allow outcomes the OIG identified processing failures again in August or demographic information about utilization to be 2018 that led to denial of these claims. Recent data analyzed. publications have included data specific to women ́ Recommendation: VA and veterans service veterans, but not all VBA programs reported data this organizations that evaluate and publish way. Some of the information may indicate ongoing information about veterans’ use of educational inequities that require VBA follow-up. benefits or their outcomes should include ́ Recommendation: VBA should continue to consistent breakdowns by gender, race and age. conduct and publish analysis of women veterans’ use, experience and success in pursuing veterans benefits and should ensure all VBA programs are examining their data to identify any gender inequities in the services provided. 8 Women Veterans Report | 2018