Combat Stress In Women Veterans Receiving VA Healthcare and Disability

Source: US Department of Veterans Affairs, Office of Inspector General

As directed by the Conference Report to Accompany the Consolidated Appropriations Act of 2010, we conducted a review to assess the Department of Veterans Affairs’ (VA) capacity to address combat stress in women veterans. We assessed women veterans use of VA health care for traumatic brain injury (TBI), post-traumatic stress disorder (PTSD), and other mental health conditions, and whether the Veterans Benefits Administration (VBA) properly adjudicated women veterans’ disability claims for these conditions. We also assessed whether VBA developed and disseminated military sexual trauma (MST) training and reference materials and policies to claims processors and the feasibility of requiring MST training and testing as part of VBA’s claims processor certification.

Based on the integrated data from VA and Department of Defense, we characterized the population of nearly 500,000 veterans discharged from active military duty between July 1, 2005 and September 30, 2006, and we described their experience transitioning to VA and using VA health care and compensation benefits through March 31, 2010. We observed that, with variations in degree, female veterans generally were more likely to use VA health care. They were also more likely to continue using VA health care services — even years after separating from active military service — and to use it more frequently. We noticed that VA generally diagnosed higher proportions of female veterans with mental health conditions after separation, but lower proportions were diagnosed with the specific mental health condition of PTSD and with TBI. These patterns corroborated our findings from our data analyses and from our review of claims files that higher proportions of female veterans generally were awarded disability for mental health conditions other than PTSD, and a higher proportion of men were generally awarded disability for PTSD and TBI.

Our data analyses of the study population indicated that VBA denied females more often for PTSD, and denied male veterans more often for a mental health condition other than PTSD, although the denial rates for male and female veterans for all mental health conditions were almost the same. From our review of veterans’ claims files, we did not find any evidence that claims processors applied VBA’s current policies and procedures differently when evaluating male and female veterans’ disability claims.

Our review identified several issues pertaining to MST that require VBA leadership’s attention. Because VBA does not retain historical data on its denial decisions, we were unable to fully assess how often VBA denied male and female veterans’ disability claims and if VBA reversed its denials on appeal more frequently for male or female veterans. We also found that most regional offices do not post signs informing veterans about the services available through the Women Veterans Coordinators. Furthermore, many of the Women Veterans Coordinators and claims processors we spoke with stated that they often felt unprepared to communicate effectively with veterans who may be distressed or emotional during discussions regarding their MST-related disability claims. These regional office employees stated that additional training would be beneficial.

Lastly, we found that although VBA does provide some training on processing MST-related claims as part of its training on PTSD, it has not assessed the feasibility of requiring additional MST-related training and testing. We recommended the Acting Under Secretary for Benefits, in on-going efforts to modernize the Rating Board Automation data system, develop reporting capabilities to capture longitudinal data on veterans’ claims activity. We also recommended regional offices post signs making veterans aware of services and assistance provided by Women Veterans Coordinators, as well as military sexual trauma sensitivity training be provided to claims processors and Women Veterans Coordinators. Finally, we recommended an analysis be performed of military sexual trauma claims volume, and VBA assess the consistency of how these claims are adjudicated, which would then determine whether additional training and testing on processing these claims is needed.

Review of Combat Stress in Women Veterans Receiving VA Health Care and Disability Benefits (PDF)

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Combat Stress In Women Veterans Receiving VA Healthcare and Disability

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