In the military, sex assault victims labeled as mentally ill, forced out

Anna Moore talks about the sexual assault she endured in the Army. Anna Moore talks about the sexual assault she endured in the Army. Photo: Lisa Krantz Photo: Lisa Krantz Image 1 of / 96 Caption Close In the military, sex assault victims labeled as mentally ill, forced out 1 / 96 Back to Gallery

Army Pvt. Anna Moore spotted the man approaching as she knelt on the hallway floor, scraping off a dingy layer of wax. He was a sergeant from another battery with no apparent reason for entering the empty third floor of her barracks. Why was he there, she wondered.

“Look at you, all sexy covered in paint,” he said.

Moore worried about her isolated spot that morning. She was a Patriot missile operator, on light duty and recovering from kidney stones, while the rest of her unit in Hanau, Germany, worked in the field.

The sergeant edged closer. He tried to make small talk as he watched her work. Suddenly, he grabbed her between the legs. She jumped and pulled away from him.

“Knock it off,” she told him, then turned and headed for her nearby room. The sergeant followed.

He rushed at Moore and pulled her close, groping and fondling her. She fought back and screamed for help as he repeatedly tried to force her onto the bed. Her battle buddy, who had just returned from the field, heard her screams and called back. The sergeant fled.

She reported the October 2002 assault to her first sergeant, but he instructed her to drop the complaint.

He said the sergeant who attacked her was preparing to transfer back home to his family, that it was better for everyone's career — hers included — to just move on. Then he tore up her sworn statement.

“I said, 'I don't think that's the answer,'” Moore recalled. “He told me to get out of his office. He yelled at me.”

Less than a month later, she began to receive bad job reviews and went to a mental health counselor for support.

What followed is familiar to many sexual-assault victims in the military, according to active and former troops, families, victim advocates and veterans groups.

Less than eight months after she reported the assault, Moore was diagnosed with a pre-existing psychiatric illness that she had never heard of: personality disorder. The Army kicked her out.

Similar accounts from members in every branch of the military show that those who disclose a sexual assault face commanders who often disregard their reports and send them to uniformed counselors, who subsequently find them to be mentally unfit for duty, a seven-month San Antonio Express-News investigation shows.

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Through dozens of interviews with experts and victims, and a review of thousands of pages of military and medical documents, the newspaper found the problem to be pervasive and long-standing, with cases spanning three decades.

The pattern of expulsions continues, defying policies to limit the psychiatric discharges and to ensure qualified doctors evaluate sexual-assault victims.

The mental health diagnoses can come with little or no psychological evaluation, and many are disputed by doctors outside the military.

Victims often had no history of mental health problems. Among them were soldiers who had established promising careers, passed the rigors of boot camp and attained top security clearances.

Yet, military mental health officials diagnosed victims with disorders they claimed existed before their service, making them ineligible for medical benefits or re-enlistment.

No one tracks how often it happens. But women are disproportionately diagnosed with psychiatric disorders and discharged at higher rates than men, according to records obtained by veterans aid groups and reports from the Defense Department.

A survey of 1,200 service members who sought help since 2003 at the nonprofit Military Rape Crisis Center found 90 percent of victims who reported sex assaults were involuntarily discharged from the military.

Most commonly, victims are told they have personality disorder, while others are labeled with adjustment disorder and bipolar disorder, said Panayiota Bertzikis, executive director of the Boston-based center.

“It's a constant problem. They're saying the victims are not credible because they're crazy. They just want them to go away,” said Bertzikis, who was diagnosed with adjustment disorder and pushed out of the Coast Guard in 2007 after reporting a shipmate threw her to the ground, punched her in the face and raped her. “My medical records say I had problems adjusting to being raped.”

The pattern ties to larger failings with how the military handles sex crimes within its ranks.

The Express-News found victims encounter an insular justice system in which superiors often interfere with sex-assault reports. Many face harassment and retaliation, or become targets of investigations into their own conduct. Others who seek transfers away from their bases are held in place for months, despite a policy to let them relocate quickly after an assault.

Commanders who supervise the accused and may hold them in high professional esteem have broad discretion over how to handle the cases and often choose not to prosecute. Instead, they routinely handle accusations as administrative matters that never reach a courtroom.

A series of lawsuits against the Pentagon and an ongoing sex-abuse scandal at Joint Base San Antonio-Lackland, where 33 instructors have been investigated for illicit conduct with 63 trainees, have turned a spotlight on the epidemic of rape in the military.

The Defense Department numbers are staggering. Last year, an estimated 26,000 troops were victims of sexual assault, an increase of 35 percent over 2011.

Military women are far more likely than civilians to be victimized. One in four female soldiers has been sexually assaulted, compared with one in six women in the civilian world.

The prevalence of the problem is aggravated by a lack of faith in the justice system. By the Pentagon's estimate, the vast majority of victims — 89 percent — do not report sex crimes. By comparison, in the civilian justice system, about 65 percent of sexual assaults go unreported, the Justice Department says.

The numbers are rooted in complex cultural dynamics. In a world where good soldiers must sacrifice for the sake of the survival and cohesion of the unit, victims who break the silence say they are ignored, discredited or even punished.

“After reporting it, I became the problem,” said Lola Miles, an Air Force helicopter mechanic who was discharged in 2005 with borderline personality disorder after she told her superiors that a fellow airman had pinned her to a car seat, grabbing and kissing her.

Commanders told her she had invited the abuse by acting like “one of the guys,” said Miles, now a family therapist with a master's degree in mental health counseling. “They told me I needed to repair my reputation.”

To distance her from the perpetrator, she was moved to the overnight work shift. She was told that if she pushed her complaint higher up the chain of command, she would receive a written reprimand.

After Anna Moore reported the sexual assault in her room, she faced mounting harassment from fellow soldiers in her unit of about 100 men and five women. She was groped and subjected to degrading remarks.

VIDEO: Anna Moore tells her story

“Usually, a comment that went with it was that I have a black chick's butt,” she said.

The worst of it came from a higher-ranking specialist in her unit while deployed in Israel.

“He would say I was worthless because I'm a woman and women shouldn't be in the military,” she said.

She reported the harassment — to the same superior who destroyed her sexual-assault report — and was told nothing could be done. When she objected, saying she would be forced to protect herself, her superiors interpreted the remark as a threat.

“So they took my weapon after that,” she said.

The Pentagon has implemented a flurry of reforms aimed at improving care for victims, developing better criminal prosecution and changing military culture. Last year, former Defense Secretary Leon Panetta required a higher level of commanders to decide how sex-assault cases are handled.

Growing awareness of the problem has prompted legislative proposals to remove or limit the power of commanders in the military justice system. New provisions in the 2013 National Defense Authorization Act require the creation of specially trained victims' units for each service branch.

Col. Alan Metzler, the Deputy Director of the DoD Sexual Assault Prevention and Response Office, said the services are broadening new protections for victims.

One key provision would give victims who file an open sexual-assault report the right to appeal an administrative discharge, regardless of whether they feel they were targeted for speaking out, he said. Accounts of retaliation against victims, including complaints of being pushed out for mental disorders, resonate with top military officials, he said.

“They've told us this is something they want us to focus on, and we are,” he said. “We're listening to victims and we're here to fight their fight.”

Read a transcript of Karisa King's interview with Col. Alan Metzler, deputy director of the Sexual Assault Prevention and Response Office at the Pentagon.

Tracking the problem

It's unclear how many sexual-assault victims have been cast out of the military for specious mental health problems. But about 31,000 service members were discharged for personality disorder from 2001 to 2010, according to a study released last year by the Vietnam Veterans Association of America.

The report was spurred by longtime complaints that the military's medical bureaucracy washes out combat soldiers suffering from post-traumatic stress and brain injuries on the basis of alleged personality disorders. Thomas Berger, executive health council director for the veterans' group, contends sexual-assault victims are subjected to the same practice.

“It's a lot easier to get rid of folks under those types of diagnoses than to evaluate them properly and treat them properly, because that takes time and money,” Berger said

Numbers compiled by the Veterans Legal Services Clinic at Yale Law School show women in every branch of the armed services are discharged with personality disorder at disproportionate rates. The widest disparity appeared in the Air Force, where women make up about 20 percent of the population, but account for 35 percent of personality discharges, according to data released by the Yale law clinic.

A Defense Department report released in June shows servicewomen are far more likely to be diagnosed with mental disorders. The study, published in the Medical Surveillance Monthly Report, tracked active-duty service members from 2000 to 2011 and found women were diagnosed with personality and adjustment disorders at more than twice the rate for men.

None of the studies identified the number of troops who reported assaults.

Personality disorder refers to a family of 10 disorders that includes paranoid, borderline and obsessive-compulsive personality disorders. It is a severe mental illness marked by long-term problematic behavior like impulsiveness and anxiety that make it difficult to keep stable personal relationships and hold jobs. By definition, symptoms appear during adolescence.

The consequences for victims extend beyond the loss of their careers.

The Pentagon considers personality disorder to be a condition that existed prior to service and thus does not qualify as the basis for a medical discharge.

The diagnosis can prevent veterans from obtaining lifetime disability benefits and health care. It also may be a red flag for future employers, who can see the diagnosis listed in military paperwork. In some cases, sexual-assault victims have been forced to repay their enlistment bonuses.

Moore, 33, is raising three young children in Colorado, and she and her husband are struggling to pay a $6,000 bill that includes her enlistment bonus plus fees. For nearly 10 years, she has fought the Army to remove the finding of personality disorder from her record.

“It was a completely false diagnosis,” she said. “I was never screened for personality disorder.”

By dismissing troops with personality disorder, the Defense Department saved about $4.5 billion in medical care and $8 billion in disability compensation from 2001 to 2007, according to estimates by the Yale and veterans groups, which contend thousands have been misdiagnosed.

At the behest of Congress in 2008, the Government Accountability Office reviewed a sample of personality disorder discharges. Investigators found hundreds of troops were illegally kicked out.

U.S. Rep. Tim Walz, D-Minn., introduced a bill in March that would require the Defense Department to review and correct the records of veterans improperly discharged for mental disorders, allowing them to receive VA benefits.

In response to congressional pressure in 2008, the Pentagon tightened rules to require a psychiatrist or a psychologist with a Ph.D. to diagnose a personality disorder. A discharge is warranted only when a service member's ability to function is “significantly impaired.”

For troops who served in dangerous areas, the reforms call for military doctors to confirm the original diagnosis. The surgeon general of each branch also must approve the cases, and doctors are required to take into account other possible war-related mental illnesses, such as post-traumatic stress.

But the additional layers of review for combat troops do not apply to sexual-assault victims.

As an apparent result of the changes, personality disorder discharges dropped sharply, from 4,054 in 2007 to 564 in 2010.

But as those numbers tapered, dismissals in some service branches spiked for another mental illness: adjustment disorder.

The veterans group study showed that from 2008 to 2010, annual discharges for adjustment disorder more than doubled in the Air Force, from 303 to 668.

Even after the reforms, Defense Department reviews found hundreds of illegal personality disorder discharges, according to documents obtained under a Freedom of Information Act request by the veterans group. A Navy document showed only 8.9 percent of personality disorder discharges in 2008 and 2009 were legal.

A GAO report in 2010 found problems persist, with as many as 60 percent of troops receiving the diagnosis from a mental health provider who was not sufficiently qualified.

Rebecca Johnson-Stone was among the combat troops whose case was supposed to benefit from the reforms.

According to her account, she was working as an Army intelligence specialist in Iraq in 2009 when a fellow soldier attempted to rape her, slammed her head into a concrete barrier and threw her into a dumpster.

“I remember exactly what he told me before I got dumped: 'You don't deserve to be in combat because you're a woman,'” said Johnson-Stone, 31, who now is married and on active duty in Maryland, where she is studying psychology and plans to pursue a career in neuroscience. “The most dangerous thing I've ever faced since my time in a combat zone was my own brothers in arms.”

As a result of the attack, she suffered a traumatic brain injury that caused severe chronic headaches and destroyed her sense of smell. Despite the injuries, she returned to her team and finished the deployment. But after her return to the U.S., ongoing health problems, including nosebleeds and blackout spells, prompted doctors to recommend her for medical retirement. She agreed to the separation and is waiting to be discharged.

In October, the medical evaluation board rejected the findings of her physician and a neurologist, and switched the underlying reason for her discharge to personality disorder and later changed it again to depressive disorder.

“I don't have a psychiatric illness. I'm hurt,” she said.

'Zero tolerance' is the vow

Despite promises of zero tolerance from Pentagon officials, victims of sexual assault continue to face a hidden battlefield.

Victims taught to believe in loyalty and trust suffer a profound sense of betrayal — first, at the hands of a fellow soldier turned sexual assailant and then by a chain of command that fails to support them.

The experience can be shattering. For victims already struggling to cope, the mistreatment from their command worsens the trauma. Anxiety, nightmares, anger and depression are part of the narrative told by victims.

Terri Odom reported a rape to her superiors in 1986 while working as a Seabee at Naval Air Station Sigonella in Italy.

Still cut and bleeding from the attack, she covered herself with a long-sleeved shirt before seeking help at her duty office, she said. When she told her shift supervisor about the rape and asked for medical treatment, he threatened to write her up for being out of uniform and instructed her to take two aspirins and lay down on an office cot, she said.

VIDEO: Terri Odom tells her story

After the shift ended, she reported the rape to the second ranking commander on the base, who ordered her to rest for three days at home, where she had been attacked.

“He said you don't want to tarnish a good man's career,” she said. “So I had to go back to my apartment, which was the scene of the crime. When you talk about the definition of alone, that is alone.”

Her descent into depression began. When she returned to the naval base, she confided in a chaplain that she had attempted suicide. She was medically evacuated to the U.S. and discharged in 1989 for borderline personality disorder.

“You don't just wake up one day from a severe trauma and suddenly come down with personality disorder,” Odom said. “They re-victimize you.”

Like Odom and other survivors, Moore did not receive proper mental health counseling for sexual assault and became suicidal.

After she went to therapy, her superiors disapproved. She was reprimanded for faking an illness to avoid work. She did not return for help until months later, after her command's dismissal of the assault and harassment reports left her feeling defeated.

“If I had the appropriate treatment, I would have been able to recuperate completely, but because of everything I was put through afterwards, it turned into severe PTSD,” she said.

Data from the Veterans Affairs Department show post-traumatic stress is closely tied to military sexual trauma, which ranges from sexual harassment to rape. Of those veterans who said they experienced sexual trauma, 55 percent also had been diagnosed with post-traumatic stress disorder, said Margret Bell, acting director of the Military Sexual Trauma Support Team at the VA's Office of Mental Health Services.

Post-traumatic stress and personality disorders share symptoms, and distinguishing between the two can be difficult, VA experts said.

“Sometimes, clinicians mistake the behavior of a person with PTSD for that of personality disorder, and it's hard to diagnose that with any validity until the PTSD has been sufficiently treated,” said psychologist Dianne Dunn, the Military Sexual Trauma coordinator for South Texas Veterans Health Care System.

Among the shared symptoms is a difficulty regulating emotions like anger, fear and anxiety, and extreme avoidance of situations that might trigger disturbing memories, she said.

“It's those behaviors that draw attention and get people diagnosed with personality disorder,” she said. “If a clinician doesn't ask the right questions and determine that there is a trauma history, that then would explain why they might very well get the diagnoses of a personality disorder.”

The military setting aggravates post-traumatic stress for victims who must remain in close proximity to perpetrators and continue to live in fear. For service members deployed to dangerous areas, the stigma of reporting mental-health problems is particularly harsh. Fellow soldiers often shun victims who speak out.

“A unit usually pulls away from a woman who reports” sexual assault, said Gail Heather-Greener, a VA Military Sexual Trauma specialist in San Antonio. “In a war zone, I have a mission to stay alive. If you have a problem, you no longer can help us in that mission. So the person reporting the problem is the problem. It reinforces that it was their fault.”

Command influence

The extent to which commanders pressure doctors to dismiss victims with psychiatric disorders is murky. In the case of Myah Bilton-Smith, who was discharged from the Air Force on March 15, records obtained by the Express-News show her superiors attempted to influence the process.

Bilton-Smith was a technical school trainee at Goodfellow AFB in San Angelo, preparing for a career as an intelligence analyst last year when she reported two rapes. An Air Force medical evaluation board subsequently found she had a pre-existing bipolar disorder, a diagnosis that she and her family disputed.

VIDEO: Myah Bilton-Smith tells her story

In May, about a month after she disclosed the first assault, her staff psychologist received an email from Bilton-Smith's superiors that derided her as “a basket case” and cast doubt on her credibility. The message said Bilton-Smith had been spotted “making out” with a Marine on the base.

“This all sounds like a bunch of smoke and mirrors,” Air Force Tech. Sgt. Randal Brooks wrote. “I plan to hold her accountable for her actions just not sure how yet. Bad part is this may send her into an “episode” again.”

The staff psychologist, Capt. Ericka Jenifer, then sent the email to a psychiatrist on the medical board that was to decide Bilton-Smith's fate.

“This is the second incident that the unit reported of Myah having inappropriate sexual interactions with a Marine. This may also be diagnostically relevant,” Jenifer wrote.

A top Goodfellow commander, Lt. Col. Scott Nahrgang also urged Bilton-Smith be discharged for what he portrayed as longstanding mental problems.

In a memo, he described her as a “troublesome airman” who had received mental-health treatment since her arrival at the base in December 2011 — a false statement given that she was not posted to Goodfellow until February 2012 and did not seek therapy until after the assault in April 2012.

A spokesman for Goodfellow said military officials could not comment on the case due to privacy rules.

In September, the board sought to dismiss Bilton-Smith for bipolar disorder. The decision came despite testimony at the board hearing from retired Air Force psychiatrist John Ford, who treated Bilton-Smith at a private facility for seven weeks after the first assault and adamantly disputed the bipolar diagnosis.

“I don't believe that a rational, informed psychiatrist could come to that diagnosis based on the information available,” Ford said in an interview. “She was not exhibiting those symptoms at that time, nor was she exhibiting those symptoms before she enlisted.”

The Air Force ultimately set aside the bipolar diagnosis in November, but only after Bilton-Smith appealed the case and obtained opinions from two VA doctors who concluded she was suffering from stress disorder, stemming from the assaults.

The doctors wrote that they did not find “any credible, objective evidence on examination for other mental or medical health disorders, including bipolar disorder, schizophrenia, substance abuse, etc.”

Bilton-Smith, 21, said the treatment she received from her superiors exacerbated the anxiety and depression caused by the assaults.

“They would treat me as if I was the criminal, as if I was the one who had done wrong,” she said.

kking@express-news.net