WASHINGTON — Thousands of female veterans are struggling to get health-care treatment and compensation from the Department of Veterans Affairs on the grounds they suffer from post-traumatic stress disorder caused by sexual trauma in the military. The veterans and their advocates call it “the second battle” – with a bureaucracy they say is stuck in the past.

Judy Atwood-Bell was a 19-year-old Army private when she says she was locked inside a barracks room at Fort Devens in Massachusetts, forced to the cold floor and raped by a fellow solider.

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Army veteran Katie Weber, a survivor of military sexual trauma who now spends most of her time doing MST advocacy, prepares dinner at home in Santa Rosa, California on Dec. 4. Photo for The Washington Post by Preston Gannaway

For more than two decades, Atwood-Bell fought for an apology and financial compensation from VA for PTSD, with panic attacks, insomnia and severe depression that she recalls started soon after that winter day in 1981. She filled out stacks of forms in triplicate and then filled them out again, pressing over and over for recognition of the harm that was done.

VA labels it “military sexual trauma” (MST), covering any unwanted contact, including sexual innuendo, groping and rape.

A recent VA survey found that 1 in 4 women in the military said they experienced sexual harassment or assault. And the problem is growing more pressing because female veterans represent the military’s fastest-growing population, with an estimated 2.2 million, or 10 percent, of the country’s veterans. More than 280,000 female veterans have returned home from deployments in Iraq and Afghanistan.

About two weeks ago, when Atwood-Bell checked the VA website, as she does every day, she was stunned to discover that the agency had accepted her claim for compensation.

“It’s taken over 20 years, and that should’ve never happened,” said Atwood-Bell, who retired as a sergeant first class and lives in New Hampshire, her voice cracking with emotion. “My fight is not over. It’s not done for so many other women out there. I want to help them to get what we are entitled to.”

PENTAGON CAMPAIGN

The Pentagon has been conducting a high-profile campaign to prevent sexual attacks and punish offenders amid concerns that defense officials neglected these assaults for years.

But advocacy groups say VA has been slow to adjust to the rising number of women in the military.

Some health centers, for instance, only recently opened female restrooms. Women who come in for treatment at VA centers say they are routinely asked if they are waiting for their husbands or are lost. And while there are a few showcase centers for female veterans, a third of VA medical centers lack a gynecologist on staff, according to a report by Disabled American Veterans, or DAV. Thirty-one percent of VA clinics lack staff to provide adequate treatment for sexual assault, according to a recent report by the Institute of Medicine.

Female veterans, in part, are pressing for more VA centers that specifically treat military sexual trauma, with separate waiting rooms for women and child care.

Veteran Affairs Secretary Robert McDonald says the department is taking steps to improve health services to address sexual trauma, such as asking every veteran during intake if they suffered such assault or trauma, as well as hiring more doctors, therapists and social workers with experience in issues of sexual assault in the military. The agency also says it is increasing the staff responsible for promoting VA benefits to women veterans and helping them with claims, especially those involving sexual abuse.

This month, VA announced it would expand mental health services to reservists and National Guard members who were sexually assaulted while on inactive duty.

“VA simply must be an organization that provides comprehensive care for all veterans dealing with the effects of military sexual trauma,” McDonald said. “Our range of services for MST-related experiences are constantly being reexamined to best meet the needs of our veterans.”

This year, it became easier for survivors of this sexual trauma to get treatment because the government ended the requirement that military members produce proof that they were assaulted or harassed before they can get health care.

CULTURE OF SECRECY

But advocates say thousands of female veterans confront an even larger problem: They are unable to get disability compensation benefits for sexual trauma because they do not have enough paperwork to support their claims. Advocacy groups and VA officials blame a culture of secrecy and denial inside the military that heavily discourages women from reporting sexual assault.

VA officials said they are encouraging female veterans to reapply for benefits for PTSD caused by the sexual abuse and that they are re-examining cases.

Elena Giordano says she was raped about 10 years ago by two men on separate occasions while serving aboard a Navy aircraft carrier in the Pacific Ocean as an airman recruit. When she reported the attacks, she says, Giordano was discharged with “mental health issues,” a label that advocates say is often applied by military officers to women who report rape.

Giordano, now 29, said she had never wanted to go public with her complaint. She had originally asked to be assigned to the carrier and didn’t want to leave it. But after the second attack, she said, “I just had to leave. I couldn’t be around men without having a panic attack.”

When she returned home to Arizona, VA agreed to provide counseling and medical treatment. But VA denied her disability benefits, citing the “totality of the evidence.”

Veterans with service-connected disabilities – whether it’s a back injury or PTSD, and including sexual trauma and assault – are entitled to compensation if the issues are causing lasting pain or make the individuals unable to work. The benefits can run from a few hundred dollars to a few thousand a month, depending on the injuries and their impact, according to federal law.

FEAR OF RETALIATION

But in cases of sexual trauma, veterans often lack medical records and other documentation required for compensation through VA because the women do not report the incidents.

Atwood-Bell, for instance, said sexual assault was something female troops did not dare talk about for fear that they would face retaliation and be discharged with a “mental health diagnosis.” She said her application for benefits was rejected twice due to lack of evidence.

The Pentagon released new data on Dec. 4 that showed that 62 percent of those who reported being sexually assaulted had experienced retaliation or ostracism afterward.

Former Army private first class Katie Weber says she was raped by another soldier when she was 18 while posted in Nuremberg, Germany. She tried to report it but was told that it didn’t really happen and to “not tell anyone in the same breath,” recounted Weber. “When I told another official, they said I was ‘jumping the chain of command.’ And that I was probably ‘just really confused and a little slut.’ ”

When she went home, she discovered that there was a severe lack of suitable medical and mental health services at VA and little understanding of how sexual trauma can cause PTSD. So Weber started a Facebook group called “Women Veterans for Equality in our VA System” to advocate for the interests of those who suffered sexual trauma in the military.

“We were really isolated,” said Weber, now 40 and living in California. “So enter Facebook.”

It was her encouragement and the Facebook group that ultimately persuaded a weary Giordano to resume her fight for benefits.

Giordano said she got “the letter” in late November, saying she would indeed be getting compensation benefits.

“I may never understand why they changed their mind and finally believed me,” she said. “But I am glad they did. That’s my hope for justice and dignity for all of the other women who have suffered this. “

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