Delivering equity through VA

For VA, equity means intentionally committing to consistent and systematic fair, just and impartial treatment of all individuals and a just distribution of tools and resources to give Veterans, including Veterans who are members of underserved communities, what is required to enjoy a full, healthy life.

In the 73 years since President Truman desegregated the military in 1948 – making discrimination on the basis of race illegal in the armed forces – many forms of inequity persist in American society. VA is not excluded from the systemic injustices and inequities that pervade American society. For example, G.I. Bill and loan guaranty programs were instrumental in economic prosperity and access to homeownership for Veterans in the postwar years, but many Black Veterans lacked the same level of access. Additionally, exclusionary policies such as Don’t Ask, Don’t Tell affected LGBTQI+ service members and led to the involuntary separation and denial of benefits for many LGBTQI+ Veterans. Other instances of inequities faced by underserved Veterans include disparities in claim rejection rates, unequal post-traumatic stress disorder (PTSD) compensation rates, and address discipline and discharge disparities faced by underserved Veterans.

VA is reducing internal and external barriers that have impeded access to benefits, services and healthcare. VA recognizes that internal barriers will require changes to policies, processes and procedures to enable access for underserved Veterans. VA seeks to advance an inclusive environment that values and supports the diverse communities we serve – Veterans, their families, caregivers and survivors – and cultivate equitable access to care, benefits and services for all. VA is centering equity in the benefits, care and services provided to underserved Veterans through tailored benefits delivery, customized whole health care, services at each phase of their life journey, eliminating disparities and barriers to health, and creating opportunities to enhance access, outcomes and experiences. VA’s current efforts focus on addressing institutional barriers that may inhibit Veterans of color, women, LGBTQ+ Veterans, Veterans with disabilities, rural Veterans who face barriers to service access in remote areas, Veterans at-risk for food insecurity, and others who face persistent inequities, from receiving equitable access to the service and benefits they have earned.

New strategies to advance equity

• Build the data foundation needed to rigorously monitor whether outcomes are equitable for underserved Veterans. VA has identified the lack of complete and consistent collection of demographic data impedes VA’s ability to assess where potential disparities or barriers exist in the benefits and services we provide to Veterans, their families, caregivers and survivors. To address this barrier, VA is launching a Data for Equity strategy, a Veteran-centered model that will synchronize VA’s data on health care, disability benefits, other Veteran-facing services, and address data gaps in demographic information. This data will help VA identify and eliminate disparities for women, Veterans of color, LGBTQI+ Veterans, and other Veterans who are members of underserved communities.
• Improve access and outcomes for underserved Veterans across key programs and services. VA will complete three in-depth equity assessments to identify and address institutional barriers impacting underserved Veterans. The objective is to embed an equity assessment framework into all VA services to improve access for underserved Veterans. First, VA will evaluate disparities in mental health disability compensation rates, particularly for Black Veterans who are more likely to apply for compensation for PTSD than other Veterans but less likely to be granted compensation. Second, VA will evaluate whether Veterans of color or other underserved Veterans and their families face disparities in accessing VA pension program benefits. VA is matching pension data with available demographic data to understand more about Veterans who may be eligible and have not engaged, as well as identify disparities for Veterans who have applied. Third, VA is conducting an equity assessment to assess the unmet needs of minority and women Veterans in the Pacific Islands because Veterans in these locations face systemic barriers and lack equitable access to health care, benefits and opportunities. In particular, these Veterans and many Veterans in rural communities may face higher costs to travel from remote areas to access care.
• Increasing contracting opportunities for women-owned small businesses and small disadvantaged businesses. VA procures well over $30 billion in goods and services annually to support its programs. Providing small businesses with the opportunity to compete for those contracts enables VA to leverage its substantial purchasing power to enhance economic opportunity and equity for Veterans from underserved communities. To meet the goal of increased contract opportunities for women-owned small businesses and small disadvantaged businesses, VA needs to strengthen purchasing and supplier diversity and train VA contracting officers on requirements to improve equitable contracting opportunities. VA will launch an outreach and engagement plan to increase the pool of eligible minority-owned firms to compete for VA contracts.
• Address health equity for underserved Veterans. VA serves a patient population that is increasingly racially, ethnically and gender diverse. While VA is a national leader in achieving equity in health care and health outcomes, VA is not stopping there. VA is committed to improving health equity and reducing disparities in care to ensure access to high-quality care for underserved Veterans. VA is addressing the social and economic determinants of equity for underserved Veterans across socioeconomic factors, including race, ethnicity, gender, income, education and life experience, which impact access and quality care. While VA reports higher quality and better experience for many underserved patient populations than does the private sector, VA has also identified Veterans who are women, racial or ethnic minorities, or of low socioeconomic status as being at higher risk for receiving lower quality care and reporting worse experiences with care. These disparities may be one consequence of insufficient attention to equity in VA quality improvement and performance monitoring processes. To address this barrier, the Veterans Health Administration Office of Health Equity will support the inclusion of equity in VA quality improvement and performance monitoring processes by tracking disparities in health care and health outcomes among Veterans receiving care through VA at the national and local levels.
• Build and maintain trust with underserved Veterans. Trust is VA’s ultimate measure of success; however, VA data shows that Veterans from underserved communities generally show lower trust in VA than other populations. To improve the experiences of underserved Veterans to measurably improve their trust in VA, VA will conduct human-centered design research to better understand the experiences of underserved Veterans. Deeply researching the experiences of underserved Veteran populations is important to understanding and designing policies and programs around what matters most to these Veterans. As VA continues to embed equity into benefits and service delivery, these efforts will be informed by in-depth and real-time customer feedback from underserved Veterans.

Building on VA’s progress

This equity action plan builds on VA’s progress delivering on equity and racial justice in the first year of the Biden-Harris Administration.

• Supporting LGBTQI+ Veterans through policy and program changes. VA is expanding the types of gender-affirming care included in its medical benefits package to support transgender and gender diverse Veterans, and it began a rulemaking process to change the policy, which currently bans VA from providing gender-affirming surgical care. VA is also supporting LGBTQI+ Veterans impacted by the Don’t Ask, Don’t Tell policy and issued guidance instructing VA adjudicators to determine that all discharged service members whose separation was due to sexual orientation, gender identity, or HIV status should be classified as eligible Veterans for VA benefits. VA has also added gender identity information to Veteran health records so that providers understand their patients’ self-identified gender identity, sexual orientation and pronouns.
• Advancing equity through grantmaking, research and training. VA granted a first-of-its-kind equity research award, which provided $1 million for Diversity, Equity, and Inclusion research focused on minority health, health disparities and promoting equity in scientific activities.
• Improving access for Native American and Alaska Native Veterans. VA developed a journey map that explores where program improvements and improved outreach are needed to meet the specific needs of Native American, American Indian and Alaska Native Veterans. VA also conducted four virtual claims clinics in three Tribal communities that enhance access to services and benefits. The clinics have provided a sounding board about the inequities experienced by Native Veterans who reside in rural communities.
• Strengthening services for women Veterans. VA developed a women Veterans experience journey map to better understand the experiences and inequitable barriers that women Veterans face as they transition from service members to Veterans, and in interacting with VA benefits and services. VA also launched the Women’s Health Transition Training that provides gender specific information to transitioning service women in health care enrollment and services. The Center for Women Veterans initiated an ongoing survey for women Veterans who do not use VA services and benefits to understand the root causes of any inequities that prevent these women Veterans from using VA services.
• Using Veterans’ voices as VA’s north star for equitable service delivery. VA has revised the VSignals survey, a platform that gathers feedback from Veterans and caregivers about their experiences using VA services, to include new questions about equity. VA also hosted 55 virtual listening sessions for Veterans and spoke with more than 550 participants to gather feedback on Veterans’ experiences and perceptions related to inequity in services and care at VA health care facilities for underserved Veterans.
• Addressing inequitable barriers faced by Veterans with an other than honorable discharge status. VA engaged Veterans with other than honorable discharges during VA’s Summit on Other than Honorable Discharges. VA has conducted strategic outreach to LGBTQI+ Veterans, PTSD and Traumatic Brain Injury survivors, survivors of military sexual trauma and underserved Veterans who disproportionately received stricter sentencing in the military justice system.
• Supporting Veterans experiencing homelessness. VA is planning through the Homeless Program Office to develop a technical assistance initiative aimed at increasing the rate of universal screening of suicide risk in homeless services settings.