As an 18-year-old on her first field assignment as a teletype operator in West Germany for Exercise Reforger in 1974, Marilyn McCloud left her tent one night to use the latrine and was raped by another soldier.

Over a 21-year career, McCloud said she was exposed to lesser forms of sexual abuse and harassment - enough so that by the time she retired as a sergeant first class, it had damaged her mental health, instilled a deep anger, and left her too frightened even to shop near her New Orleans home without her husband.

For a few years before Hurricane Katrina in 2005, which would force her to relocate to St. Petersburg, Fla., McCloud said she tried several times to get the health care she needed from the VA. She said she always got “the runaround” from a skeptical VA staff, both in New Orleans and in Florida, and finally she gave up.

On returning to New Orleans in 2011, McCloud became friends with two national service officers at a local chapter of Disabled American Veterans (DAV). These women suggested she might be suffering from military sexual trauma.

“I went to my computer and started reading,” she said. “I did my own research and all the symptoms, that was me. When I saw there was a name to my situation, I went back [to the service officers]. They explained to me I could be taken care [of] for that. They gave me more and more information, [though] I was still hesitant to go to the VA” because earlier “it was a whole lot of craziness.”

She did access VA care, however, and during three years of group therapy sessions, McCloud said she “opened up” about the trauma and learned coping skills. She still sees a VA staff psychiatrist to renew medication. She rates her care from VA today as off the charts. “On a scale of one to 10, it's a 20,” she said.

Because of an attentive facility director and strong staff, McCloud, who is now 62 and an adjutant of a local DAV chapter, said the Southeast Louisiana Veterans Health Care System in New Orleans is defined by “professionalism, from the moment you park and throughout the whole place. … He cares about everybody.”

The fact that McCloud disparaged VA health care as failing miserably to meet her needs a decade ago and praises the system today reflects a degree of real reform. At the direction of Congress, the VA has made many strides in response to the long-neglected medical needs of a rising population of female veterans, according to a new report on female veterans that DAV released Wednesday.

Women Veterans: The Journey Ahead is a progress report on gains and remaining gaps in VA services and benefits for female veterans since DAV conducted a first comprehensive report four years ago.

Women today make up almost 20 percent of active duty, reserve, and National Guard forces. They are 10 percent of America's veteran population, and that's projected to grow to be more than 16 percent over the next 25 years.

Since 2014, women have gained the right to compete for any assignment across every military occupational specialty and “are the fastest-growing subpopulation of the military and veteran communities,” the report says. But the population of women “is growing more rapidly than the systems we have in place to support them,” including at the VA. “This has created an environment in which - whether intentional or not - women's service to the nation is often less recognized, less respected and less valued than their male counterparts.”

As professional equality has increased for women, Congress and the VA still struggle to ensure parity in health care and other services. DAV's latest report seeks to educate VA leaders and lawmakers on the unmet needs of female veterans to ensure reforms continue.

“Every day, in ways both large and small, women veterans go overlooked because we are attempting to wrap them into an existing, at times ill-fitting, system rather than creating a system that wraps around them,” the report says.

One example of a health care reform recently directed by Congress that has fallen short is in vitro fertilization (IVF) services, said Sonya Nunez, 35, a DAV national service officer in Little Rock, Ark. Nunez was a C-130 cargo plane crew chief in the Air Force when she medically retired in 2013 with multiple sclerosis.

While on active duty, Nunez had difficulty getting pregnant and was diagnosed with endometriosis, which required surgery. Nunez and her husband learned they could only have a child through IVF, a $20,000 procedure their TRICARE health plan didn't cover.

In fall 2016, Congress approved a two-year test program to cover IVF service for female veterans who can't become pregnant due to a service-connected condition. Nunez qualified, but the only IVF clinic in Arkansas, located in Little Rock, rejected Nunez as a patient when VA's contractor for outside medical services, TriWest, set reimbursement rates for IVF services below that of Medicare.

TriWest then directed Nunez and her husband to a clinic six hours away in St. Louis, but learned too late this group also rejected its payment rates. Finally, a clinic in Dallas, five hours away, was found that would accept the VA rates. But the IVF procedure requires patients to reside locally for 10 days to two weeks to receive almost daily testing or treatments, Nunez said.

One unsuccessful procedure exhausted Nunez's sick leave and racked up thousands of dollars in charges to the VA for mileage, meals, and hotel accommodations for her and her husband, despite trying to use some lab testing at the Little Rock VA hospital to support the Dallas IVF clinic and cut down on travel demands. Nunez ultimately abandoned her hope of conceiving a child through IVF services provided by the VA.

“In my experience, in the state of Arkansas, the VA was not prepared for it. On paper, it looks absolutely awesome. 'Your condition is service-connected. You can't have children. Here you go. We're going to pay for it.' Even thinking, 'Dallas is only five hours away,' it's still not feasible,” Nunez said. “You cannot accomplish IVF out of state without having to take ridiculous amounts of time off work.”

Ironically, said Nunez, the VA spent thousands of extra dollars on travel out of state for her and husband, “money that could have been used to pay” the higher fees charged by the local IVF clinic, which the VA and TriWest had declined to cover.

The 72-page DAV report urges a holistic approach to improving transition, recovery, and long-term support of female veterans. It recommends 45 specific actions the VA and partner agencies should take to deliver better health care, including mental health and suicide prevention services, community care, rehabilitation and prosthetic services, shelter, financial counseling, and more.

The report also acknowledges significant gains for female veterans from recent legislation promoting gender-specific VA health care, improved training for clinical providers, more privacy and security in VA facilities, enhanced maternity care services, enhanced peer-support programs, and expanded access to child care.

More improvements are needed, the report concludes. Women “are carving out larger, more prominent places in our military and veteran spaces each day. But we can't just tell them they belong; we have to show them.”

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