Army veteran Kate Weber is a survivor of military sexual trauma who now spends most of her time doing MST advocacy. (Preston Gannaway/For The Washington Post)

Thousands of female veterans are struggling to get health-care treatment and compensation from the Department of Veterans Affairs on the grounds that they suffer from post-traumatic stress disorder caused by sexual trauma in the military. The veterans and their advocates call it “the second battle” — with a bureaucracy they say is stuck in the past.

Judy Atwood-Bell was just a 19-year-old Army private when she says she was locked inside a barracks room at Fort Devens in Massachusetts, forced to the cold floor and raped by a fellow solider.

For more than two decades, Atwood-Bell fought for an apology and financial compensation from VA for PTSD, with panic attacks, insomnia and severe depression that she recalls started soon after that winter day in 1981. She filled out stacks of forms in triplicate and then filled them out again, pressing over and over for recognition of the harm that was done.

The department labels it “military sexual trauma” (MST), covering any unwanted contact, including sexual innuendo, groping and rape.

A recent VA survey found that 1 in 4 women said they experienced sexual harassment or assault. And the problem is growing more pressing because female veterans represent the military’s fastest-growing population, with an estimated 2.2 million, or 10 percent, of the country’s veterans. More than 280,000 female veterans have returned home from deployments in Iraq and Afghanistan.

View Graphic Sexual assault in the military

About two weeks ago, when Atwood-Bell checked the department’s Web site, as she does every day, she was stunned to discover that the agency had accepted her claim for compensation.

“It’s taken over 20 years, and that should’ve never happened,” said Atwood-Bell, who retired as a sergeant first class and lives in New Hampshire, her voice cracking with emotion. “My fight is not over. It’s not done for so many other women out there. I want to help them to get what we are entitled to.”

The Pentagon has been conducting a high-profile campaign to prevent sexual attacks and punish offenders amid concerns that defense officials neglected these assaults for years.

But advocacy groups say VA has been slow to adjust to the rising number of women in the military.

Some health centers, for instance, only recently opened female restrooms. Women who go to VA centers for treatment say they are routinely asked whether they are waiting for their husbands or are lost. And while there are a few showcase centers for female veterans, a third of VA medical centers lack a gynecologist on staff, according to a report by Disabled American Veterans, or DAV. Thirty-one percent of VA clinics lack staff to provide adequate treatment for sexual assault, according to a recent report by the Institute of Medicine.

Female veterans, in part, are pressing for more VA centers that specifically treat military sexual trauma, with separate waiting rooms for women and child care.

VA Secretary Robert McDonald says the department is taking steps to improve health services to address sexual trauma, such as asking all veterans during intake whether they suffered such an assault or trauma and hiring more doctors, therapists and social workers with experience in issues of sexual assault in the military. The agency also says it is increasing the staff responsible for promoting VA benefits to women veterans and helping them with claims, especially those involving sexual abuse.

This month, the department announced it would expand mental health services to reservists and National Guard members who were sexually assaulted while on inactive duty.

“VA simply must be an organization that provides comprehensive care for all veterans dealing with the effects of military sexual trauma,” McDonald said. “Our range of services for MST-related experiences are constantly being reexamined to best meet the needs of our veterans.”

This year, it became easier for survivors of sexual trauma to get treatment because the government ended the requirement that military members produce proof that they were assaulted or harassed before they get health care.

But advocates say thousands of female veterans confront an even larger problem: They are unable to get disability compensation benefits for sexual trauma because they do not have enough paperwork to support their claims. Advocacy groups and VA officials blame a culture of secrecy and denial inside the military that heavily discourages women from reporting sexual assault.

VA officials said that they are encouraging female veterans to reapply for benefits for PTSD caused by sexual abuse and that they are re-reviewing cases.

Elena M. Giordano says she was raped about 10 years ago by two men on separate occasions while serving aboard a Navy aircraft carrier in the Pacific Ocean as an airman apprentice. When she reported the attacks, she says, Giordano was discharged with “pre-existing personality disorder,” a label that advocates say is often applied by military officers to women who report rape.

Giordano, now 29, said she had never wanted to go public with her complaint. She had originally asked to be assigned to the carrier and didn’t want to leave it. But after the second attack, she said, “I just had to leave. I couldn’t be around men without having a panic attack.”

When she returned home to Arizona, VA agreed to provide counseling and medical treatment. But the department denied her disability benefits, citing the “totality of the evidence.”

Veterans with service-connected disabilities — whether it’s a back injury or PTSD, and including sexual trauma and assault — are entitled to compensation if they are causing lasting pain or make the individuals unable to work. The benefits can run from a few hundred dollars to a few thousand a month, depending on the injuries and their impact, according to federal law.

But in cases of sexual trauma, veterans often lack medical records and other documentation required for compensation through VA because the women do not report the incidents. Also, until recently, the Defense Department allowed the destruction of rape kits after one year and of sexual harassment and sexual assault reports after as little as two years.

Atwood-Bell, for instance, said sexual assault was something female troops did not dare talk about for fear that they would face retaliation and be discharged with a “mental health diagnosis.” She said her application for benefits was rejected twice due to lack of evidence.

The Pentagon released new data on Dec. 4 that showed that 62 percent of those who reported being sexually assaulted had experienced retaliation or ostracism afterward, whether from superiors or peers in the service.

Since many survivors of sexual trauma lack a traditional paper trail, VA officials who evaluate claims have to search for what they call “markers,” such as a change in a performance review, e-mails or letters with friends or clergy about an attack, reports of depression and anxiety, weight loss or gain, requests for a pregnancy test or a test for a sexually transmitted disease.

“These are not easy claims. But I am very passionate about this issue,” said Diana Williard, the quality assurance officer with the Veterans Benefits Administration.“And you do almost have to be like a little detective putting it together. But if there is even one bit of circumstantial evidence, we send them to a mental health counselor to see if they have PTSD.”

Anu Bhagwati, executive director of Service Women’s Action Network (SWAN), calls the marker system “unfair and absurd.”

Her organization, along with the Vietnam Veterans of America, filed a federal lawsuit against VA in July, alleging that the department’s policies are discriminatory and that claims experts consistently impose a higher burden of proof on military-rape survivors than on other veterans when it comes to verifying reports of PTSD.

The plaintiffs argue that veterans seeking disability benefits for combat-related PTSD do not have to provide evidence other than their own statements and a mental health professional’s review linking their illness to military service.

“It’s just a broken policy. So veterans experience betrayal from the sexual assault, from the way they are treated by their units after the assault, and then by the VA when they file claims,” said Bhagwati, a former captain in the Marine Corps. “The VA became the last place, after a long line of places, where any hope they had left of getting help just dies.”

VA officials would not comment on the pending ligation.

Former Army private first class Katie Weber said she was raped by another soldier when she was 18 while posted in Nuremberg, Germany. She tried to report the attack but was told, “in the same breath,” that it didn’t really happen and that she was not to tell anyone about it, Weber said. “When I told another official,” she recalled, “they said I was ‘jumping the chain of command’ and that I was probably ‘just really confused and a little slut.’ ”

When she went home, she discovered that there was a severe lack of suitable medical and mental health services at the department and little understanding of how sexual trauma can cause PTSD. So Weber started a Facebook group called “Women Veterans for Equality in our VA System” to advocate for the interests of those who suffered sexual trauma in the military.

“We were really isolated,” said Weber, now 40 and living in California. “So enter Facebook.”

It was her encouragement and the Facebook group that ultimately persuaded a weary Giordano to resume her fight for benefits.

Giordano said she got “the letter” in late November, saying she would, indeed, be getting compensation benefits.

“I may never understand why they changed their mind and finally believed me,” she said. “But I am glad they did. That’s my hope for justice and dignity for all of the other women who have suffered this. ”