Sheila Procella joined the Air Force in 1974 to "see the Earth," she said. She enlisted at the tail end of the Vietnam War, shortly after graduating from high school. Although she never left her home state of Texas during eight years of service, her office job proved to be its own battlefield.
"Some of us actually went to war, some of us had war right here in the States, going to work every day knowing we are going to be harassed," said Procella, now 62 and living in Plano, Texas.
At the time, fewer than 3 percent of service members were women. Procella recalled the daily barrage of sexual comments, gestures and men grabbing her inappropriately. And one of her superiors made it clear that her hopes of moving up the career ladder were dependent on having sex with him.
“He was kind of discreet about the way he put it, but his one advance and my one acceptance of his advance led to my promotion," Procella said.
At the time, Procella, who served in the Air Force until 1979 and then went on to the Texas Air National Guard until 1982, accepted the common belief that reporting the incidents would be bad for her career. "It definitely wasn't talked about, you definitely did not report your superiors for any kind of harassment," she explained. "At the time that it happens you sweep it away like you're going to be OK."
But it wasn't OK, and after her military career, Procella found herself dependent on alcohol and drugs to cope.
Eventually, she came to associate her deep depression, anxiety and panic attacks with the harassment and assaults during her military service. Procella, who had also experienced childhood sexual abuse, was diagnosed with military sexual trauma and post-traumatic stress disorder (PTSD) in 2014, nearly three decades after her service. Today she has a 70 percent disability rating from the Department of Veterans Affairs.
There are many others like Procella, who served decades ago, but are just coming to terms with their experience.
A 2015 study published by the American Psychological Association asked 327 female veterans in Southern California about their experiences with sexual trauma. They divided the respondents into two groups — those who served before the terrorist attack on Sept. 11, 2001, and those in uniform afterward. Nearly half of those in the earlier group reported sexual contact against their will during their military service. In the later group, reports of unwanted sexual contact dropped to 30 percent.
A majority of those who reported sexual abuse met the criteria for a PTSD diagnosis, the researchers said.
And a study published last year in the journal Women's Health Issues found that women ages 45-54 reported more sexual harassment and assault while in the military than other age groups.
"I was struck by the idea that it wasn't just younger women," said Carolyn Gibson, a women's health research fellow at the San Francisco VA Medical Center and co-author of that study.
The research also found that the association between sexual trauma and its negative effects on health — such as cardiovascular disease, substance abuse and other physical and mental illnesses — was most pronounced among female veterans ages 45-64.
Gibson said these effects may be exacerbated among women in midlife because there was less awareness around the issue when they were in uniform and they felt compelled to bear the stress alone.
Midlife is also a time of great change for women, Gibson explained, both physically and emotionally, which could lead them to come forward about sexual trauma after their service ended.
"As people go through periods of transition, then those symptoms tend to pick up a lot more," she said. More of the veterans who are younger now, she added, may go public about their struggles with sexual trauma when they enter this phase of life 10 to 15 years down the road.
Battle For Recognition
The Veterans Health Administration coined the term "military sexual trauma" in 2004, and today about 25 percent of women and 1.5 percent of men who use VA health services have the diagnosis, according to the VA. The symptoms are closely associated with PTSD and put individuals at an increased risk for other mental health conditions, including anxiety, depression and eating disorders.
But getting a disability claim based on military sexual trauma can be a long and complicated battle. A 2014 Government Accountability Office report found that disability claims related to sexual trauma during military service used to be far less likely to be approved than PTSD claims from other sources. In 2010, 46 percent of all claims related to non-sexual trauma were approved by the Veterans Benefits Administration, while 28 percent of those related to military sexual trauma were, GAO said. By 2013, half of the sexual abuse claims and 55 percent of PTSD claims were approved.
Some of us actually went to war, some of us had war right here in the States.
The GAO and veterans groups say the increase came after the VA mandated training on military sexual trauma for employees processing claims at regional centers and for health professionals providing the veterans' evaluations.
The VA has added resources specifically for women in recent years, even separate entrances for women at some counseling facilities. Still, it's a challenge to get women through the door to receive help. According to a 2015 VA report on barriers to women's health care, only 19 percent of female veterans used VA services.
"During the Vietnam era, a lot of veterans who came back had a hard time getting into the VA, especially women — they were put off by the VA for several years," said Pam Maercklein, who coordinates women's health care for the Texas Veterans Commission and is an Air Force veteran. "Now the VA, especially here in Texas, is doing a fairly good job of gender-specific treatment."
Anna Baker, the manager of the commission's women's program, said women who are now middle-aged were forgotten when it came to treatment for sexual trauma at the time of their service and afterward.
"We've had several nurses who served in Vietnam who are just now coming out, who are saying that for so many years they just suppressed it," Baker said, "and they're just now starting to have those conversations and deal with those issues that are causing them anguish."
While there's a tendency to associate PTSD with military combat, a 2015 study published in JAMA Psychiatry found that women who served in Vietnam had increased odds of PTSD. The effect, the report found, "appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures."
Delia Esparza, a psychiatric mental health nurse with the Vet Center in Austin, Texas, has been helping veterans — women and men — deal with sexual trauma for more than 22 years.
The Austin Vet Center is one of 300 community facilities across the country that provide veterans (and family members) with free individual and group counseling, in addition to other readjustment services.
Esparza said that even with increased attention to military sexual trauma, many of the problems that Procella and other veterans experienced persist. Among them: Women especially feel stigmatized for speaking out.
She recalled that when she first started practicing she had a female client who was a veteran from World War II.
"She was very troubled by this whole thing," Esparza said of the veteran, who was then in her 70s, "and when she talked about it she became very tearful.
"It stays with you."
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.