Tuesday, May 20, 2008

VA Struggles to Gear Up to Care for Female Veterans

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By Les Blumenthal

Washington - Two nightmares haunt Robin Milonas.

While serving in Afghanistan in 2004 as an Army Reserve civil affairs officer, the former lieutenant colonel got lost in a minefield while leading a small convoy delivering school supplies to civilians. Even more troubling is the memory of a man who arrived at the main gate of Bagram Air Base carrying a young boy whose leg had been blown off by a land mine.

"I was an outgoing, energetic, determined good soldier who wanted to make the Army a career," said Milonas, of Puyallup, Wash., who just turned 50. "Now I am broken."

Milonas is one of roughly 180,000 women who've been deployed to Afghanistan and Iraq. While they don't officially serve in combat, they have experienced life in a war zone where there are no front lines.

And as they return home, they're increasingly turning to an already overtaxed Department of Veterans Affairs for help. Last year, the VA treated more than 255,000 female veterans. The number is expected to double within five years.

VA officials say they're better prepared to handle female patients than they were several years ago. But they acknowledge "continual challenges" as they move to open the door to a man's world, where pap smears and mammograms could become as common as prostate exams.

And where "military sexual trauma" would be treated as a serious and growing mental health problem, rather than as a subject to be avoided.

"It's not your father's VA - it really isn't," said Patricia Hayes, the VA's national director of women's health care issues. "We have geared up and are gearing up. But there are places that may have gaps."

Others say the agency is far from prepared. And given the VA's chronic budget shortfalls and increasing demands from the rapidly growing number of male veterans, the task could be even harder than expected.

"They aren't ready," said Sen. Patty Murray, D-Wash., said of VA officials. "Absent a proactive, concerted effort and knowing their limited resources, they (VA officials) are struggling with so much this might get lost."

Murray, perhaps the leading VA critic on Capitol Hill, has introduced legislation that requires studying how serving in Iraq and Afghanistan has affected the physical, mental and reproductive health of women, and how the VA is dealing with their problems.

The legislation also would require the VA to start caring for newborn children of female veterans who are receiving maternity care. Currently the VA doesn't cover newborn costs. In addition, it would require increased training for VA personnel dealing with military sexual trauma and post-traumatic stress disorder, or PTSD, in women.

The Senate Veterans Affairs Committee will hold a hearing on Murray's bill on Wednesday.

"It's a hard issue, and pouring a huge light on this is a risk, as some will say women just shouldn't be in the military," Murray said. "But as more women transition home from the physical and mental wounds of war and step back into lives as mothers, wives and citizens, the VA must be there for them."

Robin Milonas says she's been stopped three times by police for erratic driving. When she sees a dark spot in the road, she thinks it's a landmine and swerves. Except for her job teaching special education, she stays home. She constantly checks to see whether the doors and windows are locked.

Milonas has been diagnosed with PTSD and receives therapy at the veterans center in Tacoma, Wash. But three times she's been denied a disability rating from the VA, which says Milonas hasn't proved her problems are related to her service in Afghanistan.

Milonas believes that the VA has yet to recognize that even though women are barred from combat, it's hard for them to avoid the trauma associated with serving in a war zone like Afghanistan.

"The battle is everywhere," she said. She thinks the government's attitude is that "because women aren't allowed in combat, they can't have PTSD. It must be depression or women's issues like PMS."

VA officials say there's no double standard when it comes to disability ratings for PTSD.

"This is the first group of women's vets we have seen with this intensity of experience," Hayes said. "We are not sure what the long-term effects will be."

The VA has begun a long-term study of 12,000 female veterans.

Female veterans have faced a number of problems, ranging from clinics that don't have full-time obstetrician/gynecologists to uncomfortable group therapy sessions where men outnumber women and topics can include sexual assault and harassment.

Concern is mounting over the number of female veterans suffering from military sexual trauma, which can include rape, assault and harassment. According to the VA, nearly one in five female veterans seeking care has been diagnosed as a victim of military sexual trauma, though some believe the figure could be nearer to one in three. The character Melissa in the comic strip Doonesbury was a victim.

The VA now offers women-only group therapy sessions. In addition, female vets can request female counselors, and women-only entrances to clinics are being provided.

"A lot of women are reluctant to come into a hospital," said Jan Buchanan, a women's veterans program manager for the VA's Puget Sound Region. "It seems too military to them. They fear they might see their perpetrator."

But they are coming, and it's the younger veterans in particular.

So far, 41 percent of the women who've served in Iraq and Afghanistan have sought medical help at least once at the VA. That compares with 14 percent of older women and 22 percent of male veterans.

They want birth control, infertility and family planning advice, child care for when they're being treated and coverage for their newborns, VA officials say. There's also increasing concern about homeless female veterans.

"The old saying was, 'If the Army wanted you to have a baby, it would have issued you one,'" said Lourdes Alvarado-Ramos, who rose to the rank of sergeant major in the Army Medical Corps and now is deputy director of the Washington state Department of Veterans Affairs. "But that has changed. The system has been geared to males. Bricks and mortar, clinics and hospitals, they were all thought of as a male place. We need to make women veterans more comfortable with the system."

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