1. Jennifer Sluga

4. 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 today 18.9 percent of female veterans have a service connected disability, that is nearly 3 percent more than male veterans

6. 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

7. Headache Confusion Lightheadedness Dizziness Blurred vision/tired eyes/dilation of pupils Ringing in ears Bad taste in mouth Fatigue/change in sleep patterns Lethargy Behavioral or mood changes Vomiting/nausea Convulsions/seizures

8. 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

9. 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 service-connection How many U.S. Soldiers have a TBI? ~115,000 to 400,000

12. 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 fabulous

13. QUESTIONING-people still working out who they are attracted to 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

14. Sex-biological/physiological makeup of an individual’s reproductive anatomy or secondary sex characteristics Gender-personal identification of one’s own gender (gender identity) 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 characteristics Transgender people may be straight, lesbian, gay or bisexual.

15. She-male He-she It Trannie Tranny Shim Gender-bender 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 identity.

16. 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)

17. 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

18. VA health care now covers hormone therapy to assist in an individual’s transition 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 knowing? Please raise your hand and share!

20. 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

24. 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

26. MST IS NOT A CONDITION Conditions related/caused by/secondary to MST can be rated from 0% to 100%

27. Forms used when filing a claim for MST 21-22 21-526 OR 21-526EZ 21-4142 21-4138 OR/AND 21-0781a

28. 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

29. 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

30. 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

31. 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

34. 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

39. 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. www.VeteransCrisisLine.net*

40. 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.http://www.veteranscrisisline.net/ Direct contact numbers for VA mental health professionals in your area 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

44. 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?

45. Contact information: Jenn Sluga sluga.jennifer@countyofdane.com or 608-283-1292 sluga.jennifer@countyofdane.com