Editor's Note: This is an opinion column. The thoughts expressed are those of the author.
Imagine going to your doctor’s office for care. You walk in and go to the front desk to check in. But the front desk staff tells you that you can’t get care there. You’re not eligible. Imagine that you know that you are eligible for care, but that this is uniquely due to your being a survivor of sexual violence. Imagine needing to tell the receptionist, in a crowded waiting room, that you are a rape survivor, just to be allowed to see your doctor.
Too often, this is the reality for survivors of military sexual trauma when they seek care and assistance at the Department of Veterans Affairs. Military sexual trauma (MST) is the umbrella term the VA uses for harassment or assault experienced during service. It encompasses both “psychological trauma resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the veteran was serving on active duty, active duty for training or inactive duty training.” Sexual harassment is further defined as “repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”
Military sexual trauma is unique in the ways it can consume a person’s life. It is an intimate and personal invasion that occurs both where you live and where you work, that may have been committed by someone who is a superior, commander, or colleague upon whom you must rely. It often occurs in a place where your life may already have been in danger, and in a situation that you have no way to escape for a substantial period thereafter.
MST — like combat — is an experience, not a condition or diagnosis. Those who survive it may react in different ways, and not all survivors will struggle with challenges in the long term. However, it is strongly correlated with higher rates of post-traumatic stress disorder and other mental health conditions, and may also have associated physical health difficulties. As a result, survivors often must navigate both halves of the VA — the Veterans Health Administration (VHA) and the Veterans Benefits Administration (VBA). Both of these entities have systems in place that unwittingly serve to re-traumatize survivors, time and time again.
VHA offers an impressive array of mental health services to veterans who experienced MST, including universal screening and evidence-based care that ranges from telehealth to outpatient individual or group psychotherapy to inpatient programs. Importantly, all MST-related care is available free of charge. Veterans may also be able to receive MST care even if they are not otherwise eligible for VA care — for example, if they do not meet length-of-service requirements or exceed the income threshold. Even veterans with other-than-honorable discharges may be able to get MST-related care, though this requires approval from a VBA Regional Office. Veterans do not need to have reported their experience when it occurred or have other documentation to prove the event happened to receive this care.
However, it can be difficult for some veterans to access the care they’re entitled to. One barrier comes when they first enter a VA clinic or hospital. Some MST survivors have reported that they cannot make it past the first “gatekeeper” when seeking an appointment with a VA provider. Oftentimes, this individual works in the eligibility office. Veterans who come for healthcare through the exceptional policy regarding survivors are often turned away at the door, as this first individual fails to realize they fall under an exception to the regular eligibility requirements.
Each VA medical center (VAMC) has an MST Coordinator who serves as a contact person for MST-related issues and who can assist Veterans in accessing care. However, many veterans do not know they exist, front-line staff in the eligibility office do not always know to refer survivors to them for assistance and support, and in many locations, the role is a collateral duty rather than a full-time position. Ensuring MST coordinators have enough dedicated time to both conduct outreach, and to support veterans is an important step VA can take to overcome these challenges.
Another barrier relates to the VA environment. Some women veterans are reluctant to seek services at VAMCs, which are male-dominated spaces that can feel unwelcoming to some survivors. VA is well aware of this concern, which is why the department developed and launched the End Harassment campaign.
Unfortunately, recent events have undermined perceptions of how seriously senior VA leaders take the severity of the problem and their willingness to tackle it head-on. The department should redouble its commitment to the campaign while concurrently taking other steps to increase comfort levels of women seeking care, such as increasing availability of the “Sister Assister” peer escort program, particularly at VAMCs with higher rates of harassment.
Regardless of where they choose to get care, survivors who continue to suffer from mental health conditions long after their assault are often eligible to apply for service-connected benefits through the VA — a monthly compensation paid to veterans who were injured in the service and still suffer from those injuries today. Too often however, survivors report being re-traumatized by this very system due to the rigorous requirements of the process and a system that does not consider the realities of trauma’s impact on the individual.
To apply for these benefits, survivors must recount their experience of assault and tell the story over and over — typically a minimum of three times for an initial claim. The first occurs when the veteran submits the application. They must detail their assault, how it occurred, how it changed them, and how it still impacts them today. Soon after they submit their claim, they are then contacted out of the blue by a complete stranger at the VA, who will ask them more questions about the assault. Weeks or months later, they will then be scheduled for a medical exam, where they will meet with a mental health provider, another stranger, who will ask them further questions, many of which have already been answered several times over. The veteran will have no control over whether these conversations occur with a man or a woman.
Each re-telling forces the survivor to relive their trauma. Many don’t sleep for days before and after. Some become suicidal or struggle to fight relapsing into addiction. The VA must do better to conduct its evidence gathering in a trauma-informed manner and avoid forcing veterans to repeat details of their assault they have already disclosed.
Survivors must also provide evidence to the VA of their assault. While the VA has loosened its definition of evidence to include “markers” — signs or events that provide clues that the traumatic event occurred. Yet this loosened standard can still serve as an insurmountable burden. Survivors often do not report their assault due to fear of retaliation and often, a sense that nothing will be done to help them. Additionally, survivors rarely seek mental health treatment during the service, as to do so could risk their security clearance or raise questions as to their “fitness” to serve. As a result, these markers often do not exist.
The VA has loosened the standards of evidence further for claims that result from a combat injury, because combat is a unique environment where strict record keeping and evidence gathering does not exist. Military sexual trauma is no different — when an assault occurs in the military, rarely does strict record keeping or evidence gathering occur. Bills such as H.R. 1092 — the Servicemembers and Veterans Empowerment and Support Act of 2019 —would treat military sexual trauma similarly to combat, ensuring survivors are able to access their benefits.
Oftentimes, veterans appoint representatives to assist them in these claims. The process is overwhelming and confusing, and having an advocate who can help navigate the chaos is often crucial to success in these claims. Yet the VA fails to recognize these individuals, choosing instead to contact the veteran directly, even when the veteran specifically requests for the VA to speak with their representative instead. This is an anomaly in the legal field — it is unheard of in most legal proceedings for the administrative body to ignore a duly appointed representative. The VA should not treat representatives differently than other administrative agencies and should respect veteran-appointed representatives. Additionally, far too few veterans are able to access legal assistance for these claims. The Homeless Veterans Legal Services Act, introduced in 2019, would enable the VA to fund free legal services for veterans and ensure that all survivors have access to representation in these claims.
Our country owes its greatest debt to our veterans, who risk their life to defend our country. The scourge of sexual assault in our military has yet to be addressed in a meaningful way by our military. The VA must become the place that fixes the wrongs the military has failed to fix. It must address the ways in which the very system intended to help our veterans is often causing additional stress and harm. We must do all we can to ensure that survivors view the VA as a place where they are safe, supported, and believed.