Female vets suffering post-traumatic stress overlooked

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Female veterans suffering from post-traumatic stress disorder aren't getting proper medical help, even though they suffer at about the same rate as their male counterparts, experts say.

The average female patient in the Veterans Administration medical system is 48 years old -- but a rapidly increasing number are younger than 30. Male patients, meanwhile, average 61 years old and, with tens of millions of veterans from World War II, Korea and Vietnam in or approaching their twilight, their ranks are getting older.

The needs of the two groups are vastly different. "It's a complete paradigm shift," said Gina Painter, manager of the women's clinic at the Veterans Affairs Medical Center in Salt Lake City. "We have staff members who don't even know that we have a women's clinic."

The number of female patients at the VA has doubled in the past six years nationally and is expected to double again in the next six. Painter attributes the lack of awareness to the glacial way large bureaucracies accept change.

Studies show that women suffer from PTSD at least as much as men. Although they make up about 14 percent of the fighting force in Iraq and Afghanistan, they comprise only 6 percent of the patients from those wars who have been processed through a mental health intake clinic at the Salt Lake VA.

Nearly a quarter of a million women have served in Iraq and Afghanistan.

Department of Defense officials say about 80 percent of sexual assaults in the military go unreported.

"Victims are concerned about losing their privacy, fearful about being judged, fearful of retaliation and afraid that people will view them differently," Kaye Whitley, the director of the military's Sexual Assault Prevention and Response Office, told a House committee.

Nearly 60 percent of women screened for PTSD at the VA in Salt Lake City since 2008 have been identified as victims of sexual harassment, sexual abuse or rape during their time in the military.

Those who have suffered from harassment alone are likely in the minority. "Among the women I'm doing individual therapy with, I would say that at least 85 percent have had a sexual assault," said VA psychologist Tanya Miller.

"It's unacceptable," said Andrew Wittwer, a combat-veterans case manager at the Salt Lake VA hospital. "There are a lot of injuries that come out of serving in the military. Clearly, sexual trauma shouldn't be one of them."

Although hundreds of thousands of women served in uniform in World War II, Korea, Vietnam and intervening times of peace, it wasn't until 1988 that the VA began offering medical and mental health services to female veterans -- due mainly to a policy favoring vets who served in combat. Today, nearly all veterans are eligible for some level of VA services, but women still underutilize their entitlements.

The VA has a long way to go before it reaches its goal of being a one-stop location for women's primary care. Only about a third of VA medical facilities have a gynecologist on staff.

According to a report from the Government Accountability Office this year, the VA has done a poor job of protecting women's comfort and privacy. Among its observations: Only a small number of gynecological examination spaces have adjacent restrooms, as required by the VA's own rules. And in some clinics, the exam tables were oriented so women's feet faced the door. In at least one such instance, the door opened into the view of a mixed-gender waiting room.

"It's nothing nefarious," said Dan Murchie, a patient advocate at a clinic for veterans of the wars in Iraq and Afghanistan at the Salt Lake VA. "It's just that what has been set up for women is something like an afterthought."

But Murchie lamented the message that that sends to female veterans, especially those who might need mental health care.

"When I get a woman coming into my office, I already know that, more likely than not, I'm going to have to really earn her trust," he said. "Any little thing that makes her feel uncomfortable could make her bolt -- and if she does that, then I can't get her the help she might need."

At war in Iraq and Afghanistan, women carry guns, drive on bomb-laden roads, stand watch on guard towers, take fire and return it. But because women are technically barred from serving in U.S. military units in which direct ground combat is the primary mission, they have a higher burden of proof when it comes to establishing that they've suffered from war-related psychological trauma.

Murchie ruefully recalled one of the first women he tried to help with a benefits claim. "They shot her down like a duck on opening day," he said. "Not surprisingly, she walked out of here pretty disgruntled."

A new policy intended to give all veterans the benefit of the doubt when they file claims for disability benefits related to PTSD is expected to result in a higher approval rate for female vets, who generally don't have the word "combat" in their service records and must establish, through other evidence, that they suffered through traumatic experiences while at war.

Veterans seeking compensation for mental- or physical-health issues must provide proof that those issues are related to their military service. Victims who report the abuse when it happens create a record that can be relied upon later to support a claim.

PTSD expert Janice Krupnick complained to a House committee that what little study has been done "suggests that female veterans are less likely to receive service-related compensation for PTSD and this is, at least in part, a consequence of the relative difficulty of substantiating exposure to non-combat stressors," most notably, sexual assault, she said.

(Distributed by Scripps Howard News Service, www.scrippsnews.com.)

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