More than 85,000 veterans were treated last year for injuries or illness stemming from sexual abuse in the military, and 4,000 sought disability benefits, underscoring the staggering long-term impact of a crisis that has roiled the Pentagon.
A Department of Veterans Affairs accounting released in response to inquiries from The Associated Press shows a heavy financial and emotional cost involving vets from Iraq, Afghanistan and even back to Vietnam, and lasting long after a victim leaves the service.
Sexual assault or repeated sexual harassment can trigger a variety of health problems, primarily post-traumatic stress disorder and depression. While women are more likely to be victims, men made up nearly 40 percent of the patients the VA treated last year for conditions connected to what it calls "military sexual trauma."
It took years for Ruth Moore of Milbridge, Maine, to begin getting treatment from a VA counseling center in 2003 - 16 years after she was raped twice while she was stationed in Europe with the Navy. She continues to get counseling at least monthly for PTSD linked to the attacks and is also considered fully disabled.
"We can't cure me, but we can work on stability in my life and work on issues as they arrive," Moore said.
VA officials stress that any veteran who claims to have suffered military sexual trauma has access to free health care.
"It really is the case that a veteran can simply walk through the door, say they've had this experience, and we will get them hooked up with care. There's no documentation required. They don't need to have reported it at the time," said Dr. Margret Bell, a member of the VA's military sexual trauma team. "The emphasis is really on helping people get the treatment that they need."
Defense Secretary Chuck Hagel has said reducing the incidence of sexual assaults in the military is a top priority. But it's a decades-old problem with no easy fix, as made even more apparent when an Air Force officer who headed a sexual assault prevention office was arrested on sexual battery charges.
The VA says 1 in 5 women and 1 in 100 men screen positive for military sexual trauma, which the VA defines as "any sexual activity where you are involved against your will." Some report that they were victims of rape, while others say they were groped or subjected to verbal abuse or other forms of sexual harassment.
The VA statistics underscore that the problems for victims of sexual abuse do not end when someone leaves the service.
Psychological issues, including PTSD, depression and anxiety, are most common, according to the agency. Victims also can develop substance abuse problems.
Some victims like Moore are so disabled that they are unable to work. Others need ongoing care at VA outpatient clinics and hospitals.
In the final six months of 2011, an average of 248 veterans per month filed for disability benefits related to sexual trauma. That rose by about a third, to 334 veterans per month in 2012, an increase the VA attributed in part to better screening for the ongoing trauma associated with sexual assault. Of those who filed in 2012, about two-thirds were women and nearly a third were men.
"We do a lot more awareness, and as we educate everyone on the potential benefits and that it's OK to come forward, I think you see an increase in reporting," said Edna MacDonald, director of the VA's regional office in Nashville.
To get disability benefits related to sexual trauma, veterans must be diagnosed with a health problem such as PTSD, submit proof that they were assaulted or sexually harassed in a threatening manner and have a VA examiner confirm a link to their health condition.
Many lawmakers and veterans groups support allowing a veteran's statement alone to serve as the proof that an assault or harassment occurred. An examiner would still have to find there's a link to the health condition diagnosed.
The VA's records indicate that veterans seeking compensation related to military sexual trauma had about a 1 in 2 chance of getting their claim approved last year, up from about 34 percent in June 2011.
Benefits depend on the severity of the disability. For example, a veteran with a 50 percent rating and no dependents would get $810 a month. A veteran with a 100 percent rating and a spouse and child to support would get nearly $3,088 a month.
Moore estimates the government's cost for her disability benefits and treatment could well exceed $500,000 over the course of her lifetime.
The VA's undersecretary for benefits, Allison Hickey, a 27-year veteran and former Air Force general, has required all workers handling disability claims to undergo sensitivity training in dealing with military sexual trauma.
Hickey also assembled a task force to review the claims process for veterans claiming sexual assault or harassment while serving in the military. The group looked at 400 claims and determined that nearly a quarter were denied before all the evidence was presented. That led to another training program on the evidence needed or establishing a PTSD claim connected to military sexual trauma. The approval rate is now much closer, though still slightly behind that for other PTSD claims.
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