One in five servicewomen is raped, sometimes multiple times, during her military career. One in 100 men also experiences rape during military service. Rape may occur in boot camp, basic training, on board ships, on bases, or in military facilities all over the world. It may involve superior officers, subordinates, or people of the same rank. And, for some survivors, it results in a constellation of mental health symptoms including depression, anxiety, and stress, characterizing what the Veterans Administration refers to as Military Sexual Trauma (MST).

Related to post-traumatic stress disorder, MST can be a debilitating condition that may result in involuntary discharge on the basis of health concerns or a decision not to reenlist after serving. Once veterans return to civilian life, though, those with MST often struggle to get the service-connected disability benefits they need to help them access treatment. In this way, rape survivors are being victimized again—this time, by the very agency tasked with helping them.

Several factors are combining to create this benefits crisis for women who need mental health services and other resources to help them process their traumatic experiences. One is the very ubiquity and nature of military sexual assault, the incidence of which continues to rise. As in the civilian world, members of the military are often reluctant to report because of feelings of shame, fear of being disbelieved, and worry about how they’ll be treated. But for those in the military, reporting can also be a career-ending choice. Reported rapists are not necessarily investigated or prosecuted, although rape is a criminal act under the Uniform Code of Military Justice. Bizarrely, in some cases rape investigators are themselves accused rapists, or the officers designated to address reports are known sexual assailants. In one notable case, an officer pardoned a rapist, effectively vacating his punishment. And regardless of whether their attacker is penalized, reporters may still find themselves demoted, discharged, or placed in positions where they have limited opportunities for career advancement; some are driven out of the military while their rapists remain in their previous roles.

Even after events like the Tailhook scandal of 1991, the military cannot come to grips with its relationship to sexual assault. Instead of investigating and punishing the perpetrators, it punishes the survivors, effectively creating a culture where assaults are ignored and women, along with men, are actively encouraged not to report. Then, when those servicemembers leave the military and seek assistance, they face further obstacles. Determinations on disability benefits for those with MST are highly subjective, and they’re approved at much lower rates than those for other service-connected disabilities—including PTSD for factors other than sexual assault. Military women must first be able to process what happened to them as sexual assault, then be able to prove to a doubting administration that they were raped; in a world of rape culture, that can be a challenge. Military women face the same problems their civilian sisters do, with added pressure to show that the aftereffects of their sexual assaults were significant enough to merit benefits to help them recover.

For a veteran with MST to receive VA benefits, she must be able to demonstrate that she was raped by a colleague while serving. If she wasn’t, it doesn’t count as a service-connected disability. Proving this may theoretically be possible through information in her file, but only if she reported the crime—which, again, she may not do, knowing how survivors are often treated. When supporting evidence like this is not available, the VA looks for what are known as “markers,” or signs that the applicant was raped; these can include medical records, testimony from friends and other servicemembers, STI or pregnancy test results, or rape counseling records, released with the servicewoman’s consent. In addition, she must undergo a grueling interview about the specifics of the crime—reminiscent of those victims must endure on the stand in military sexual assault trials—in an environment where a VA adjudicator has an arguably vested interest in disproving her rape, or at least proving that it took place outside a military context.

If the benefits adjudicator appointed by the VA determines that a rape did occur, the VA still needs to determine if she has MST, which the agency defines as “psychological trauma … resulting from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training.” This requires a comprehensive mental health evaluation.

Unlike a hard-and-fast service-connected disability, like the loss of a limb or hearing damage, MST is more elusive, requiring an official to make a decision in each individual case. There are no quick definitions for MST cases, which makes them extremely easy to deny. Should a victim’s case be assigned to an unsympathetic staffer, she might be refused benefits. If she wants to pursue the matter, she could be dragged into an appeals process that could last for months, or even years. As with veterans who have other mental health conditions related to their experience in the service, she may struggle with even basic tasks of daily living, which can make the bureaucratic process bewildering and frustrating.

Overall, around 50 percent of MST claims are approved for benefits, which leaves half of claimants without assistance—and, since many never claim in the first place (it’s estimated that some 26,000 unreported military rapes took place in 2013), it’s difficult to determine how many female veterans overall are struggling with MST and no resources, like mental health services, group counseling, anti-anxiety medications, job placements, housing assistance, and other services offered to disabled veterans. Such tools help veterans manage their MST and rebuild their lives after military rape—and they can make the difference between survival and poverty-level struggle, homelessness, or even suicide.

The inequality in approvals for MST benefits is not just a matter of differing adjudicators and case specifics. It also depends on where the veteran files the request, highlighting a larger problem within the VA, as seemingly standardized processes are actually applied with wildly differing results. A veteran in Los Angeles, for example, is more likely to receive benefits than one in St. Paul, or Detroit. This is a clear miscarriage of justice. The military must apply benefits equally to all wounded veterans, whether their wounds are physical or psychological in nature.

The ACLU and the Service Women’s Action Network released a comprehensive and troubling analysis of the situation for women in the military in 2013, discussing the issue of benefits eligibility for veterans with MST. Furthermore, in a scathing report on the subject issued last summer, the Government Accountability Office identified a very low and inconsistent-by-region benefits approval rate, unprepared adjudicators, and poor quality control. It also made a series of recommendations for the VA, arguing that the agency needs to improve training and outreach as well as conduct more detailed quality reviews and analysis to ensure that veterans are being well-served when they apply for benefits. The VA has pledged to implement those recommendations in coming months and years. Still, both reports, from civilian and government organizations working independently, showed that the Pentagon and VA have been slow to move on military sexual assault and the psychological fallout, despite the fact that sexual assault scandals and calls to action have dogged the military for decades.

Congress hasn’t, though. Last year, Sen. Kirsten Gillibrand (D-NY) pushed for a significant overhaul to the way rape cases in the military are handled, though her bill ultimately lost out to that of Sen. Claire McCaskill (D-MO), who presented less substantial measures for addressing military rape. While arguments between the two senators on the specifics of their plans were sometimes quite barbed, they later collaborated on a campus safety bill aimed at addressing another rape epidemic in the United States: that of the rising number of college students who experience sexual assault on campus. The teamwork suggests that the two women may meet again on the matter of military sexual assault, bringing their experiences with college settings back to the table to do what’s best for survivors.

Meanwhile, the next move belongs to the VA, which must decide how it plans to develop and implement strategies to prevent rape, streamline the reporting process for victims, and promptly act on MST claims. Women who compromise their mental health for their country shouldn’t be left fighting for benefits after they leave the service.