On May 20, the House Veterans Affairs Subcommittees on Disability Assistance and Memorial Affairs and Health held a hearing, “Healing the Wounds: Evaluating Military Sexual Trauma Issues.”
Disability Assistance and Memorial Affairs Chair John Hall (D-NY) said, “MST [military sexual trauma] has been a concern among many veterans who have continually expressed frustration with the disability claims process, especially in trying to prove to the VA [Department of Veterans’ Affairs] that the actual assault ever happened. For many women and men, when their disability claims for PTSD [post-traumatic stress disorder] related to MST are denied, they suffer a secondary injury, which results in an exacerbation of PTSD symptoms. Thus, they are less likely to file an appeal. There also has been frustration with the lack of appropriate health care providers to treat veterans who have experience working with MST. We cannot allow this to happen to this nation’s veterans who have served her. VA and DoD need to ensure that the proper treatment is available. Veterans should be able to have access to treatment facilities and qualified staff with care and benefits delivered by employees who are properly trained to be sensitive to MST related issues. These veterans need to be treated with the dignity and respect that they deserve.”
“Last May, the House Committee on Veterans’ Affairs held a roundtable discussion with women veterans representing veteran service organizations and their auxiliary organizations,” said Health Subcommittee Chair Michael Michaud (D-ME). He continued, “During the roundtable discussion, military sexual trauma was a commonly cited concern and the participants expressed their frustration with the shortage of appropriate health care providers to treat veterans with military sexual trauma. I am proud to say that just last month, S. 1963, the Caregivers and Veterans Omnibus Health Services Act, was enacted as Public Law 111-163. This landmark legislation included important provisions from H.R. 1211, the Women Veterans Health Care Improvement Act, which was introduced by [Rep.] Stephanie Herseth Sandlin [(D-SD)]. Among the key provisions, VA would be required to provide training and certification for VA mental health care providers on caring for veterans suffering from sexual trauma and PTSD. As we build a VA for the 21st century, we must ensure that it embraces the growing and unique needs of our women veterans. I am pleased to join my colleagues in the DAMA Subcommittee to explore ways that we can better support veterans with military sexual trauma.”
In a statement submitted for the record, Health Subcommittee Ranking Member Henry Brown (R-SC) said, “Sexual assault and harassment is unacceptable in any sector of American society and is a particularly serious matter in our military and veteran populations. Because it occurs in a hierarchical and highly stressed environment, the negative physical and psychological effects of MST can be intensified and make one more likely to develop a mental health condition. The most common mental health condition observed among those veterans who report MST is post-traumatic stress disorder (PTSD). It is encouraging that VA has come a long way since initially establishing a program to provide MST treatment in the 1990’s. In 2003, VA began screening every patient seeking health care at a VA facility for MST and providing those who disclose it with free, confidential treatment and counseling. To receive such care, a veteran does not need to be service-connected, have reported the incident previously, or have documented that it occurred. Additionally, each VA facility has a designated MST point of contact, coordinated through VA’s national MST Support Team. With the recently enacted Caregivers and Veterans Omnibus Health Services Act, Congress mandated sexual trauma training and certification for VA mental health providers to ensure proper provision of the supportive services veterans with MST experience need and deserve.”
Dr. Kaye Whitley, director of the Sexual Assault Prevention and Response Office in the Office of the Under Secretary of Defense for Personnel and Readiness at the Department of Defense (DoD), explained, “When we created our policy in 2005, we established the framework for a coordinated, multidisciplinary response system modeled after the best practices in the civilian community. Victim care begins immediately upon an initial report of a sexual assault. At the heart of our sexual response system are the Sexual Assault Response Coordinator (SARC) and victim advocates. Service members worldwide have access to a 24/7 response. Every military installation in the world – both in garrison and deployed – has a SARC and victim advocates who provide the human element to our response. Our SARCs and victim advocates will: work with victims to identify and address issues related to their physical safety and needs as well as concerns about their commander and the alleged perpetrator; listen to victims’ needs and then connect them with appropriate and necessary resources, including medical care, mental health care, and legal and spiritual resources; and connect victims to off-base resources when necessary. SARCs and victim advocates also work with victims to help them decide whether to make a restricted or unrestricted report. In order to ensure that victims make an educated decision in which they are fully informed of their choices, we developed a Victim Preference Reporting Form (called DD 2910), which explains their options. This form is completed by the victim with the assistance of the SARC or victim advocate in every case. In each case, the SARC or victim advocate emphasizes that the victim should keep a copy of the DD 2910 in his or her personal files.”
Dr. Whitley also noted DoD’s efforts to collaborate with partners to provide victims with better services: “We have been working with the Department of Veterans Affairs since the inception of the program in 2005. In addition, we have recently begun to meet with a variety of veterans groups to identify what gaps there might be related to our issue as service members transition from active duty to veterans status. Meeting with non-governmental groups, such as Iraq and Afghanistan Veterans of America and the National Organization for Women, has helped us gain a fuller understanding of the challenges that veterans might be experiencing.”
Phyllis Greenberger, president and chief executive officer of the Society for Women’s Health Research, detailed research conducted on the incidence of MST: “Research in the area of MST and sexual assault has revealed some interesting sex-based differences: First, women are more likely than men to contract a sexually transmitted infection, or STI. STIs are often more difficult to treat in women and can have emotional and mental impacts over a woman’s lifespan. Sexual assault can result in an unplanned pregnancy or conversely leave a woman unable to bear children in the future. The impacts of MST are not limited to reproduction. Infection with HPV after a sexual assault can result in cancer decades later in life. Scientists studying HIV in women found the virus enters and infects the cells of the vaginal wall in a way different from how the virus is introduced into male cells. Second, sexual assault is a common trigger for post-traumatic stress disorder, months and even years after the attack. Scientists are finding that women do not respond the same to some of the common medications prescribed for PTSD, often faring worse than men taking the same medication for the same diagnosis. Third, multiple traumas can increase the likelihood of developing PTSD, and the combined impacts of working in a war zone, multiple deployments, MST, and for a disproportionate share of female military members, exposure to early life trauma, all raise the risk for an eventual PTSD diagnosis. Females in the military have twice the levels of PTSD and depression as their male counterparts. Fourth, research suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels, and can vary based on where she is in her menstrual cycle and whether or not she uses medications that alter hormone levels, such as birth control. The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST, and may further help discover more effective PTSD therapies for women – therapies that are responsive to sex-based hormonal differences. More research is critical for moving forward and determining targeted treatments for women and men.”
Helen Benedict, professor of journalism at Columbia University and author of The Lonely Soldier: The Private War of Women Serving in Iraq, testified, in part, about the need for adequate training of VA health professionals to address military sexual trauma. She said, “For my book…I interviewed more than 40 female veterans of our current wars. Too often they told me that when they tried to report an assault, the military and VA treated them as liars and malingerers…It is therefore essential that the counselors used by the military and the VA be trained in civilian rape crisis centers, away from a military culture that habitually blames the victim, and that is too often concerned with protecting the image of a platoon or commander by covering up wrongdoing. These counselors, and indeed anyone within the military charged with investigating sexual assault, should be trained to understand the causes, effects, and costs of sexual abuse to both the victim and to society.”
Ms. Benedict also noted that many service members become victims of sexual violence “long before they enlisted.” She said, “In two studies of army and marine recruits, conducted in 1996 and 2005 respectively, it was found that half the women and about one-sixth of the men reported having been sexually abused as children, while half of both said they were physically abused. The picture may have shifted lately with the recession driving more people into the military. Nonetheless, it looks as if close to half our troops are enlisting to escape violent homes. Thus we need to provide counselors trained not only in military sexual assault but in childhood abuse and trauma. These counselors should be available to active duty troops and veterans. They should [be] embedded with the combat stress counseling teams already deployed. This is necessary not only to help troops cope with trauma, but to help prevent further sexual violence. Psychologists have long known that an abused boy can grow into an abusive man. I emphasize this because too often the focus when addressing military sexual trauma is on women alone, ignoring the fact that men cause the problem, and that they, too, are sexually assaulted in the military.”
Scott Berkowitz, founder and president of the Rape, Abuse, and Incest National Network (RAINN), discussed the importance of confidentiality in increasing support for MST victims: “So how do we get more victims to come forward for help? Former Congresswoman Tillie Fowler [(R-FL)], who chaired the investigation into the Air Force Academy, told me at the time that every victim they interviewed – every single one – told the panel that they would never access help without the guarantee of confidentiality. This response matches RAINN’s own research. In the course of developing the National Sexual Assault Online Hotline, the consistent message from victims was that the service must guarantee confidentiality, even anonymity. This led us to go to great lengths to create a safe technology that victims would trust. DoD has made some progress on this score with the introduction of restricted reporting, which allows the victim to access services without an official report that engages the chain of command. Those we have spoken to within the services believe restricted reporting has been a qualified success. It has encouraged more than 3,000 victims to come forward and get help, about 15 percent of whom later decided to make an unrestricted report and pursue prosecution. Still, the safety of a restricted report is incomplete. Victims’ communications with military victim advocates do not enjoy the rape crisis counselor privilege that is found in most state laws, leaving open the possibility that the victims advocate could later be forced to testify against the victim in court. That possibility is sure to discourage some victims from coming forward, which is the reason most states have passed some kind of rape crisis privilege law. I understand that DoD recently submitted this change to OMS for the president’s approval, and I hope the administration acts swiftly to approve and implement the change. At the same time, DoD has determined that mandatory reporting laws for medical personnel, in California for example, supersede the protections victims enjoy under restricted reporting. The result is that victims in those states are forced to forego the medical care they urgently need – even treatment for major injuries, and testing for STls and HIV – unless they’re willing to sacrifice the confidentiality promised by restricted reporting…We encourage Congress to investigate this issue and determine a whether a federal solution is feasible.
Anuradha K. Bhagwati, executive director of Service Women’s Action Network (SWAN), discussed the experiences of female veterans and the inadequate services for veterans seeking treatment services. She noted, “MST survivors universally describe the horror of using VA medical centers nationwide. The climate at VA hospitals is still largely unwelcoming to women, but for MST survivors, the experience of going to an appointment can be life-threatening—triggers of one’s assault or harassment are everywhere, from the prospect of running into your perpetrator, to being surrounded by male patients who routinely engage in sexual harassment of female patients, to being improperly treated by staff members who have no knowledge about the unique experience of sexual trauma in a military setting. One survivor said to SWAN, ‘I don’t want to be fending off advances when I’m raw from dealing with my issues in therapy,’ while another said, ‘I have no [private] health care. I have to use the VA. Therefore I have to go through all the embarrassment.’ Survivors universally say that if they had health insurance, they would definitely use private health care instead of the VA.” Ms. Bhagwati added, “Many veterans are ignored, isolated, or misunderstood at VA facilities because their PTSD is not combat-related. The veterans’ community still primarily considers PTSD to be a combat-related condition, to the great detriment of MST survivors. Survivors who have used the VA routinely say they are fed up with being given endless prescription medication – one Iraq veteran described the experience of her VA MST treatment as nothing but ‘pills and pep talks.’ Many survivors wish they had access to yoga, massage therapy, acupuncture, and gender-specific MST support groups. Lots of MST patients echo the comments of other veterans generally – that a lack of privacy, child care, and availability of evening or weekend appointments prevents them from accessing care at VA medical centers. I strongly recommend that the committee give MST survivors the option of fee-based care for all treatment. At the same time, VHA [Veterans Health Administration] cannot be let off the hook. VA medical centers ought to have separate facilities for [female] patients and easy, safe, and direct access to MST treatment areas for both male and female MST survivors.”
Joy Ilem, deputy national legislative director for Disabled American Veterans, and Jennifer Hunt, project coordinator for Iraq and Afghanistan Veterans of America, also testified.
