Jennifer Sluga
• Women have served in the U.S. Military since 1901, they began
as members of the Army Nurse Corps
• Women veterans older than 35 outnumber non-veteran women
in percentage who have a college degree
• Female veterans who work year-round and full-time earn about
$6,000 more than their non-veteran counterparts
• There are over 2.2 million women veterans in the United States
• 18.9 percent of female veterans have a service connected
disability, that is nearly 3 percent more than male veterans
• What is a TBI?
-Sudden trauma or head injury that disrupts the function of the brain
• Common causes:
• IED explosions
• Falls
• Vehicle accidents
• TBIs can be rated from 0% to 100% (effective October 24, 2008)
• 38 CFR 3.310
Blurred vision/tired eyes/dilation of pupils
Ringing in ears
Bad taste in mouth
Fatigue/change in sleep patterns
Behavioral or mood changes
• Parkinson’s disease that is diagnosed following moderate or
severe TBI
• Seizures for which no cause has been established following
moderate or severe TBI
• Certain dementias if diagnosed within 15 years after moderate
or severe TBI
• Depression that is diagnosed either:
• Within 3 years of moderate or severe TBI
• Within 1 year of mild TBI
• Hormone deficiency diseases that are diagnosed within 12
months of a diagnosis of moderate to severe TBI
• The VA will use the following evidence to rate TBIs as mild, moderate,
or severe:
MRI, PET, or other scans
length of an altered mental state or altered state of consciousness
length of loss of consciousness
length of amnesia
score on the Glasgow Coma Scale (a test used after head injuries)
• The level of TBI severity will be determined as of the time the injury
occurred, not on the basis of current symptoms. If inadequate medical
evidence is available, the veteran may not be entitled to a presumed
• How many U.S. Soldiers have a TBI?
~115,000 to 400,000
• LESBIAN-women attracted to women
• GAY-men attracted to men
• BISEXUAL-people attracted to both sexes
• TRANSGENDER-people who are the opposite sex internally
than the body they are born into—whether male to female or
female to male
• QUEER-people who don’t want to label themselves by their sex
acts, but do want to claim being different, eccentric, and
• QUESTIONING-people still working out who they are attracted
• INTERSEX-people born into bodies that are not clearly male or
female; hermaphrodites
• ASEXUAL-people who just aren’t that into sex with anybody
• ALLY-straight people who support the XXXX community
• PANSEXUAL-people attracted to others by individual
personality, not gender
• Sex-biological/physiological makeup of an individual’s
reproductive anatomy or secondary sex characteristics
• Gender-personal identification of one’s own gender (gender
• Sexual Orientation-an individual’s enduring physical, romantic
and/or emotional attraction to another person
• Gender Expression-external manifestation of one’s gender
identity, usually expressed through “masculine, feminine”,
gender variant behavior, clothing, haircut, voice, or body
• Transgender people may be straight, lesbian, gay or bisexual.
• Always use a transgender person's chosen name. Often transgender people
cannot afford a legal name change or are not yet old enough to change their
name legally. They should be afforded the same respect for their chosen name as
anyone else who lives by a name other than their birth name (e.g., celebrities).
• Whenever possible, ask transgender people which pronoun they would like
you to use. A person who identifies as a certain gender, whether or not that
person has taken hormones or had some form of surgery, should be referred to
using the pronouns appropriate for that gender.
• If it is not possible to ask a transgender person which pronoun he or she
prefers, use the pronoun that is consistent with the person's appearance and
gender expression. For example, if a person wears a dress and uses the name
Susan, feminine pronouns are appropriate.
• It is never appropriate to put quotation marks around either a transgender
person's chosen name or the pronoun that reflects that person's gender
• Estimated 66,000 LGBT*QQIAAP in the military
• Roughly 2% of all military personnel
• ~13,000 active duty (<1%)
• ~53,000 national guard & reserves (3.4 percent)
• VA home loan benefits have been extended to include service
members in same-sex marriages
• Some veterans will want to add their partner as part of their
claim even if the VA doesn’t recognize the relationship—just
advise them that it will not be recognized at this point
• Please see VHA directive 2013-003
• Providing Health Care for Transgender and Intersex Veterans
• http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863
• VA health care now covers hormone therapy to assist in an individual’s
• Identity--whether sexual or gender--for many people is viewed on
more of a continuum than seen as black vs white
• For example: Many women report that when serving they find themselves
identifying as more asexual to take on more “male” characteristics to fit in
• Bottom Line: None of these things are contagious– treat all your
veterans as equals. They all served their country and they all
deserve the same respect and advocacy you can provide
• Are there any other new changes that everyone would benefit from
Please raise your hand and share!
Statements on Rape: 2012 Elections
“So the way [my father] said it was, ‘Just remember, Roger, some girls,
they rape so easy. It may be rape the next morning”
– Wisconsin State Representative Roger Rivard
“In the emergency room they have what’s called rape kits, where a
woman can get cleaned out [and not get pregnant].”
– Texas State Senator Jodie Laubenberg
“[F]rom what I understand from doctors, [pregnancy from rape is] really
rare. If it’s a legitimate rape, the female body has ways to shut the
whole thing down.”
– United States Senate candidate from Missouri Todd Akin
• VHA reports that:
• 1 out of 4 women have reported MST to VHA
• 1 out of 100 men have reported MST to VHA
• Department of Defense (DoD) FY13 Sexual Assault Prevention
and Response Office’s survey reports an increase of reports of
sexual assault by over 50%
• From 3,374 total reports in 2012 to 5,061 to 2013
• Conditions related/caused by/secondary to MST can be rated
from 0% to 100%
• Forms used when filing a claim for MST
• 21-22
• 21-526 OR 21-526EZ
• 21-4142
• 21-4138 OR/AND 21-0781a
• Mental Health to include:
• PTSD, Depression, Anxiety, etc
• Emotionally:
• catastrophic thinking, isolation, strained relationships, sadness, depression,
guilt, sleep disturbances, suicidal thoughts/tendencies
• Vaginal:
• Painful intercourse, Vaginal itching, burning, rawness, sensitivity and
painful to touch, cuts in vagina, clitoral pain
• Urinary:
• Painful Urination, urgency and frequency of urination, slow or hesitant
urination, feelings of incompetent emptying, habit of pushing urine out,
burning urination, leaking with coughing, sneezing, or laughing
• Muscular:
• Pain in the gluteal or back muscles, knees, and/or abdominal area,
soreness, spasms, sharp pains, muscles weakness all can be found in the
pelvic floor muscles
• Rectal:
• Constipation, diarrhea, pain with defecation, burning/itching, pain or
irritation by wearing certain underwear, pain after orgasms
• Skin:
• Raw feeling of vaginal tissues, burning or itching of vagina, feelings of
vaginal swelling
• Conditions I have seen granted due to MST:
• Urinary incontinence
• Fecal incontinence
• (SMC) Erectile dysfunction
• (SMC) Gynecological dysfunction to include:
• FSAD (Female Sexual Arousal Disorder)
• Defined as a lack of, or significantly reduced, sexual interest
or arousal
• There are both psychological and biological causes of FSAD
and often the two overlap
• There is a GYN DBQ that helps allow diagnosis of condition
• Conditions I have seen granted due to MST:
• Gynecological dysfunction to include:
• Dyspareunia
• Vaginismus
• Valvodynia
• Vulvar vestibulitis
• Pelvic floor dysfunction
• Stomach Conditions:
• IBS-irritable bowel syndrome
• Acid Reflux
• 91% of nations veterans are at least 35 years old, majority
didn’t serve in post- 9/11 era
• 72% of veterans are at least 50 years old
• 69% of veteran suicides are of this age group
• People experience emotional and mental health crises in response to a wide
range of situations—from difficulties in their personal relationships to the loss of
a job. For Veterans, these crises can be heightened by their experiences in
military service.
Hopelessness, feeling like there’s no way out
Anxiety, agitation, sleeplessness, or mood swings
Feeling like there is no reason to live
Rage or anger
Engaging in risky activities without thinking
Increasing alcohol or drug abuse
Withdrawing from family and friends
• The presence of the following signs requires immediate attention:
Thinking about hurting or killing yourself
Looking for ways to kill yourself
Talking about death, dying or suicide
Self-destructive behavior such as drug abuse, weapons, etc.
• If you are a Veteran or know a Veteran who is experiencing any of these signs,
call the Veterans Crisis Line at 1-800-273-8255 and Press 1, chat online at
www.VeteransCrisisLine.net*, or text 838255 today.
• If you are a Veteran or know a Veteran who is experiencing any
of these signs, call the Veterans Crisis Line at 1-800-273-8255
and Press 1, chat online at http://www.veteranscrisisline.net/, or
text 838255 today.
• Direct contact numbers for VA mental health professionals in your
• If you don’t have a VA close: Make connections in your community—have a
resource available to you in case you are working with someone who is suicidal
or needs to get connected to a mental health professional
• Contact family members—the more people that know of the plan the safer the
person could be
• Its best to contact someone while the veteran is in your office- better chances of them
getting the help they need
• Society as a whole is changing and so will veteran benefits
• It is our job to stay up to date on benefits for our veterans and their
family members to be the best advocate we can be
• You don’t have to understand everything, you just have to be
willing to accept it
• Future topics of interest/importance?
Contact information:
Jenn Sluga
[email protected] or 608-283-1292

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