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 and been condemned by President Barack Obama as ""shameful and disgraceful."
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."
However, the hurdles are steeper for those who seek disability compensation -- too steep for some veterans groups and lawmakers who support legislation designed to make it easier for veterans to get a monthly disability payment.
"Right now, the burden of proof is stacked against sexual trauma survivors," said Anu Bhagwati, executive director of the Service Women's Action Network. "Ninety percent of 26,000 cases last year weren't even reported. So where is that evidence supposed to come from?"
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.
"We will not stop until we've seen this scourge, from what is the greatest military in the world, eliminated," Obama said after summoning top Pentagon officials to the White House last week to talk about the problem. "Not only is it a crime, not only is it shameful and disgraceful, but it also is going to make and has made the military less effective than it can be."
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.
But not all those veterans seek health care or disability benefits related to the attacks. The 85,000 who sought outpatient care linked to military sexual trauma during the latest fiscal year are among nearly 22 million veterans around the country.
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.
The VA does not break out the cost of treating and compensating individual veterans for sexual abuse or trauma. A veterans combination of disabilities are unique to each individual, so it's not able to attribute specific spending levels for individual disabilities.
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.
It wasn't until June 2011 that the VA began recording monthly disability claims related specifically to military sexual trauma. Veterans file claims for conditions that are a result of the trauma, not for MST itself, which made it particularly difficult to track. The VA came up with a special process for doing so in 2010.
There's no time limit to filing a claim. "We have veterans who call our help line who have been assaulted way back in time. They're still suffering from the effects of World War II or Vietnam. I wish I were exaggerating," said Bhagwati, whose organization advocates for female veterans.
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.
Even though the VA's statistics indicate that a greater percentage of military sexual trauma are getting benefits, lawmakers believe more action is required.
"If half of them are being denied their claims, that's still a lot of people, said Rep. Chellie Pingree, D-Maine.
Pingree and Sen. Jon Tester, D-Mont., are the lead sponsors of the legislation that would allow the veteran's word to serve as sufficient proof that an assault occurred. The legislation is named after Moore, who spent years fighting for disability benefits.
The VA originally opposed Pingree's bill, saying the legislation didn't allow for the minimal evidence "needed to maintain the integrity of the claims process." But VA spokesman Josh Taylor said Thursday that there's been a change of heart and that the VA no longer opposes the legislation.
"VA supports the goals of the legislation, and will continue to work with Congress on the best approach to accomplish it," Taylor said.
An amended version of Pingree's bill passed the House Committee on Veterans' Affairs two weeks ago and could go to the full House as early as this week. The bill no longer requires the department to alter its regulations for military sexual trauma claims. Instead, the bill says that it's Congress' sense that the VA should update and improve its regulations regarding military sexual trauma. And until it does, it must meet extensive reporting requirements, which include a monthly report to all veterans who have submitted a claim that would, among other things, detail the number of claims relating to MST that were granted or denied, the three most common reasons for a denial and the average time it took to process a claim.
Supporters are hoping that the reporting requirements prove so cumbersome that the VA agrees to ease the evidentiary burden for the veterans.