Soldiers Raped by Other Men 24 08 2009 Men

Gentlemen with MST, we know you are there. We work with some of you, and we know the isolation and shame that you have been feeling for so long. We also know that now is the time to give up that shame and regain the peace and joy that is just on the other side of all the pain.
You are not alone. 4% of male soldiers experience MST¹, which equates to almost 1 in 20 of you. The VA says that more than 50% of the veterans who have screened positive for MST are men.² Thanks to your sheer numbers, more men have experienced MST than women (there are almost 22 million male veterans, compared to less than 2 million female veterans³). You are not alone.
Call us if you need someone to talk to who will listen with understanding and patience. If you want to talk privately and securely to other men with MST, please go here to request an invite to a confidential, all-male, online message board. They are waiting, because it is time to come home.
A male survivor who is also an MST advocate has this to say to you:
“The Silent Wounded. That is what I call us: the MST survivor . . . It is difficult to explain what it is like to enlist in the military service for our country – male or female – to be motivated to serve as an honorable duty. Our discharge papers may say under “honorable conditions,” but we feel no honor . . .
“The pain in one’s soul from being a rape survivor is no different from man to woman – the shame and guilt we feel are equally the same. Because of the way society places a stigma on male sexual assault that is compounded by the military comradeship and brotherhood instilled in us from our first day, we remain the “silent wounded.” Because of the way we were brought up to be men – the male image – these things are not supposed to happen. That is why we remain silent.
“The silence continues to victimize us . . . [but] once I found a voice through the use of the internet, I found myself with a freedom that had not been mine since the attacks on my body in 1969. I was able to speak out where once I felt I would never say a word. To understand the pain inside of you – the silence – it is like a poison and continues to eat at your soul . . . the written word of your voice gives you strength. I believe that is what the author of this web-site is offering you . . . the male survivor, to have a way to speak – to purge ourselves from the poison.
“Find that freedom. The more each of us speak up and say “that happened to me too!” the more our voice is heard further and further from the walls of our silence.
“We need to open up the eyes of everyone. The silence needs to change – awareness of how sexual trauma affects males needs to advance. We are hurting; we should quit doing it alone.”


¹Source: “Sexual Assault Among Male Veterans.” Psychiatric Times. 1 April 2005. <http://www.psychiatrictimes.com/display/article/10168/55225?pageNumber=3>
²Source: “Military Sexual Trauma.” National Center for PTSD. <http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/military_sexual_trauma_general.html?opm=1&rr=rr1758&srt=d&echorr=true>

³Source: “Veterans Numbers from the Census Bureau.” The Tacoma News Tribune. 16 October 2008. <http://blogs.thenewstribune.com/military/2008/10/16/veterans_numbers_from_the_census_bureau>

UCMJ Definitions of Military Harassment, Sexual Assault and Rape.

Men with military sexual trauma often resist disclosure

Clinical Psychiatry News, March, 2008 by Jeff Evans

BALTIMORE -- Male veterans who have a history of military sexual trauma often fail to disclose their condition until well into treatment for posttraumatic stress disorder and have many motivations for covering up their problem, according to speakers at the annual meeting of the International Society for Traumatic Stress Studies.
Another complication is that few clinicians know of community resources to whom to refer male military sexual trauma (MST) patients, said Ilona L. Pivar, Ph.D., of the National Center for Posttraumatic Stress Disorder in the Veterans Affairs Palo Alto (Calif.) Health Care System.
"I speak from experience because of the difficulty getting referrals [and] the difficulty educating providers that this is a problem and that I am there as a resource for referrals," Dr. Pivar said.
Other contributing factors to the low awareness of MST among men include shame and stigma, and resistance to being labeled or targeted as a victim of MST. These are perpetuated by myths about male sexual assault, such as the notion that males cannot be raped, sexual assaults against men happen only in prison, male adult victims must be homosexual, heterosexual males do not rape men, and males are less affected by sexual assault than are females.
"I have veterans who I've treated who do not want to have that box in the VA system checked 'MST,' and they don't have it [checked]; however, they have MST and they have PTSD," she said. "Their initial treatment in the military may have been a precursor for this kind of sensitivity. Certainly, my veterans who are older experienced this as 'something that doesn't happen'" and are told to keep it quiet or are moved away to another unit or even punished."
She said this kind of shifting drastically disrupted and ruined the military careers of some veterans. "Once you've been targeted, I think the feeling is that you lose control of how people behave toward you," Dr. Pivar said.
Many of these veterans experienced MST in the Vietnam or post-Vietnam War era and have kept their trauma a secret for 30 or more years.
The types of sexual trauma include unexpected sexual overtures that are disruptive to self-identity, assault during or after combat (such as an assault by a medic), assault while in military prison, and being targeted by a person higher in command or being assaulted for being weak or small.
Possible clues to identifying MST in men include substance abuse (often severe), problems with sexual intimacy, difficulties with male relationships, marital relationship problems, problems with authority, fear of being labeled homosexual or sexually impotent, history of child sexual abuse or exposure to abuse, anger and aggression, and a history of violence.
The VA does have an effective screening program ("VA Data Reinforce Need for Treatment of Sexual Trauma," CLINICAL PSYCHIATRY NEWS, January 2008, p. 1), but Dr. Pivar suspects that some patients are missed because of stigma and shame. When patients are suspected of having MST, the best approach is to ask directly and empathically," Dr. Pivar said. After veterans begin to learn about their problem, they are "extremely amazed that other men have had this experience and also extremely surprised to know that the numbers of male and female MST survivors are about the same."
Dr. Pivar's presented a small pilot study of 10 male veterans from all military service branches who had experienced MST at a mean age of 20 years. Men were the perpetrators, except for one veteran who had been assaulted by two women. All patients were heterosexual; one man was bisexual.
When the men received treatment at a mean age of nearly 53 years, seven had had some combat exposure, six had been exposed to life-threatening disasters or accidents, four had experienced childhood loss of parental figures, six had observed domestic violence as a child, eight had experienced serious physical or verbal abuse as children, eight had sexual experiences as children with someone who was at least 5 years older, five had experienced a life-threatening illness since their MST, six have tried to commit suicide or self-harm as teenagers or adults, and all had severe substance abuse problems following their MST.
Only one patient had experienced a second sexual assault as an adult outside of MST.
Of the 10 patients, 7 have completed treatment in cognitive processing therapy (CPT) outpatient groups with 12-15 sessions (once per week) and significantly reduced PTSD symptoms (improved severity of depression, guilt cognitions, and self-esteem). Although the patients initially were resistant to joining a support group, after crossing that hurdle, they were motivated to continue treatment, she said.
The three dropouts faced medical problems, financial and housing problems, or they had the highest Clinician-Administered PTSD Scale (CAPS) symptom severity scores.
In conversations with veterans in the Cincinnati area about 3 years ago, Kathleen M. Chard, Ph.D., who directs the PTSD and anxiety disorders division at the Cincinnati Veterans Affairs Medical Center, said she continued to hear that the VA did not provide a suitable treatment setting for their problems.
These men said they had MST and would not feel comfortable in the center's 12-bed, 7-week residential treatment program for victims of all types of traumas, including MST and child sexual abuse. A separate resident program exists for females. A PTSD and anxiety disorders outpatient clinic also is located in the center.
"When you're sexually traumatized in the military by other veterans, combat veterans sometimes don't believe you and may in fact mock you," Dr. Chard said. Some residential trauma programs across the country also have been accused of saying things like:" 'We'll only take you through combat trauma, and if you have other types of trauma, we may allow you to talk about that privately--if there's time and therapist availability.'
"When I heard that, I immediately made a decision that we're going to change our modality," she said.
Now any veteran with PTSD from any event (such as child abuse, MST, or combat trauma) is welcome in the residential treatment programs.
Dr. Chard and her associates began offering CPT in 13 individual and/or group sessions. During group sessions, patients discussed their feelings associated with doing a homework assignment, sharing details of their life, participating in individual therapy, and sharing skills they've developed with others. In addition to CPT, the program added skills training in anger management, affect tolerance from dialectical behavioral therapy, relapse prevention, safety-seeking behaviors, mindfulness, relaxation, sleep, and medications. Patients who discussed the program in or outside of the groups faced immediate discharge.
This was a drastic culture change when it was possible to talk about trauma with anyone at any time. "I'm not saying that we're the best model, but we're the model that fit the needs of Cincinnati veterans at the time and with this response: Referrals have gone up about 25% since we created this change," she said at the meeting, which was also sponsored by Boston University.
In a sample of 30 male veterans with MST who were treated at the Cincinnati VA residential treatment program over a 1.5-year period, only 3 divulged their MST at the outset. None of the assessments that the clinicians ran (CPT, CAPS, Lang's information processing theory, Beck's cognitive-behavioral therapy) provided information to predict MST. Their MST had not been identified in any pretreatment notes at their home VA before coming to the Cincinnati VA. All met criteria for MST at some point in treatment. The veterans served in the Vietnam War (18), the post-Vietnam War era (9), and in the first Gulf War (3).
These 30 veterans "did very well" in treatment, Dr. Chard said, but even though they had similar pretreatment CAPS scores, they had less improvement in those scores after treatment than did non-MST veterans in the residential treatment program. The veterans with MST also entered treatment with poorer Beck's Depression Inventory scores than did non-MST veterans.
The veterans may be hindering their own treatment by not disclosing MST until trauma processing already has begun or even until after it has been completed. It seems to take 5-6 sessions for such veterans to build up enough trust with the therapist to mention their MST, Dr. Chard explained.
To avoid burnout, health care professionals at the center rotate between two residential and single outpatient clinics. Staffing averages at least half a psychiatrist, half a registered nurse, half a nurse practitioner, one psychologist, and one social worker per residential program, she estimated.
BY JEFF EVANS
Senior Writer

COPYRIGHT 2008 International Medical News Group

COPYRIGHT 2008 Gale, Cengage Learning

Lack of Research and Treatment Programs Burdens Survivors of Military Sexual Trauma

• Categorized in: 2010 Issues, July 2010

WASHINGTON, DC—For a civilian victim of sexual assault, the after-effects are devastating. There’s the physical, emotional, and psychological trauma to contend with, as well as having to navigate a world that seems more dangerous than it did before.
For a military servicemember dealing with sexual trauma, these after-effects are compounded by the fact that the perpetrators are almost always their peers—the people they live with and work with—and are sometimes their supervisors. For a victim of military sexual trauma (MST), it can be seemingly impossible to find a place to feel safe, and even seeking treatment can unintentionally force them to relive the initial trauma.
“Perpetrators are frequently peers or supervisors responsible for the decisions on work-related evaluations and promotions,” explained Rep John Hall, D-NY, chair of the VA subcommittee on disability assistance, at a hearing on benefits and treatment options for MST last month. “This means that victims must choose between continuing their military careers at the expense of frequent contact with their perpetrators, or ending their careers in order to protect themselves.  Many victims share that when they do report the incident, they are not believed or are encouraged to keep silent because of the need to preserve organizational cohesion.
“There also has been frustration with the lack of appropriate healthcare providers to treat veterans who have experience working with MST. VA and DoD need to ensure that proper treatment is available.”
Both VA and DoD have made significant progress in recent years in training healthcare providers in recognizing and treating the effects of MST. However, as legislators learned last month, there is still a long way to go before victims of MST can get proper care in a nonthreatening environment.
VA Screening, Treatment
“It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself,” declared Susan McCutcheon, RN, EdD, VA’s director of military sexual trauma, at last month’s hearing. “There is no one way that everyone will respond. For some veterans, MST will continue to affect their mental and physical health many years later. Fortunately, people can recover, and VA has services to do that.”
Since 1992, VA has been developing programs to monitor MST screening and treatment, providing staff with training on most MST issues. Most recently, VA established a national-level MST Support Team to help further all MST-related objectives.
All veterans seeking care at VA are asked two questions: one to assess sexual harassment, and one to assess sexual assault. “Any that answer yes to either question are asked if they are interested in treatment,” McCutcheon said. “VA data indicates that approximately 1 in 5 women and 1 in 100 men seen at VA respond yes when asked about MST.”
McCutcheon noted that, because of the high proportion of men to women in the military, there are actually only slightly fewer men than women seen in VA who have experienced MST.
Every VA facility has a designated MST coordinator who serves as a contact point for patients, helping them find and access VA services. Many facilities have outpatient mental health services focusing on sexual trauma, and some have inpatient programs. There are also single-gender programs to accommodate veterans who do not feel comfortable in mixed-gender treatment.
VA Programs—Few and Hidden
While these initiatives by VA show the agency has the right idea, they are few and far between, veterans’ advocates say. According to GAO, only 9 of 153 medical centers nationally have residential treatment programs for women suffering from mental health injuries. When GAO investigators began researching VA programs, they had trouble discovering which VA facilities had what programs.
“VA’s website did not provide a complete list of facilities that provided MST programs,” according to Jennifer Hunt, project coordinator for the Iraq and Afghanistan Veterans of America (IAVA).
One of IAVA’s top recommendations is for VA to do a better job of advertising its MST programs. “According to one IAVA member, she did not know until three years after returning from a deployment that VA provided sexual trauma counseling,” Hunt said. “In her words, ‘It’s well-hidden and not talked about at VA.’”
Another concern is that inpatient mental health services and gender-specific programs are just too sparse. “VA must expand availability of its specialized sexual trauma treatment in the inpatient setting. Less than 10% of VA medical centers offer inpatient treatment for MST. IAVA recommends that every VISN offer at least one inpatient setting specializing in care for MST victims,” Hunt said. “And victims should not have to settle for mixed-gender options because there are no [VA] treatment programs in their area.”
Mixed-gender treatment programs can be an unacceptable solution for an MST patient, who does not want to discuss or relive the trauma among members of the opposite gender.
“VA medical centers ought to have separate facilities for women patients, and easy, safe, and direct access to MST treatment areas for both male and female MST survivors,” said Anuradha Bhagwati, executive director of the Service Women’s Action Network (SWAN). “Another disturbing trend is VA’s integration of residential programs with other mixed-gender veterans’ programs, in which MST patients are not guaranteed privacy or safety from other patients of the opposite sex. VA needs to invest in separate facilities for MST programs, and guarantee the safety and welfare of all participants.”
Gender-Specific Research
Not enough is known about the physical and mental health consequences of MST, or how those consequences differ between men and women. According to Phyllis Greenberger, president of the Society for Women’s Health Research, studies in the area of MST and sexual assault have revealed interesting sex-based differences that need to be explored further to help improve treatment methods.
“First, women are more likely than men to contract a sexually transmitted infection, or STI. STIs are often more difficult to treat in women and can have emotional and mental impacts over a woman’s lifespan,” Greenberger noted. “The impacts of MST are not limited to reproduction.  Infection with HPV after a sexual assault can result in cancer decades later.”
Also, sexual assault can be a common trigger for post-traumatic stress disorder, which researchers—many of whom are based in VA facilities—are finding presents differently in women than in men. “Women do not respond the same to some of the common medications prescribed for PTSD, often fairing worse than men taking the same medication for the same diagnosis,” Greenberger explained. “[Also] multiple traumas can increase the likelihood of developing PTSD, and the combined impacts of working in a war zone, multiple deployments, MST, and for a disproportionate share of female military members, exposure to early life trauma, all raise the risk for an eventual PTSD diagnosis.  Females in the military have twice the levels of PTSD and depression as their male counterparts.”
Research also suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels. “The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST, and may further help discover more effective PTSD therapies for women—therapies that are responsive to sex-based hormonal differences,” Greenberger explained. “There is clearly a need for more sex-based research at VA.”
At the very least, a better understanding by VA physicians of MST and its effects could help veterans suffering from it to feel more comfortable seeking VA treatment. “Many veterans are ignored, isolated, or misunderstood at VA facilities because their PTSD is not combat-related. The veterans’ community still primarily considers PTSD to be a combat-related condition, to the great detriment of MST survivors,” Bhagwati noted. “Survivors who have used the VA routinely say they are fed up with being given endless prescription medication—one Iraq veteran described the experience of her VA MST treatment as nothing but ‘pills and pep talks.’”
She recommended that VA allow MST survivors to seek fee-based care where they feel most comfortable, if such care is not provided by their local VA facility, including giving them access to alternative treatments, such as yoga, massage therapy, and acupuncture.

Department of Veterans Affairs VHA DIRECTIVE 2010-033 Veterans Health Administration Washington, DC 20420 July 14, 2010

MILITARY SEXUAL TRAUMA (MST)
PROGRAMMING
1. PURPOSE: This Veterans Health Administration (VHA) Directive provides policy for
clinical care, monitoring, staff education, and informational outreach related to military sexual trauma (MST) counseling, care, and services.
2. BACKGROUND
a. Based on Title 38 United States Code (U.S.C.) 1720D, the Department of Veterans Affairs (VA) provides counseling, care, and services to Veterans and certain other Servicemembers who may not have Veteran status, but who experienced sexual trauma while serving on active duty or active duty for training. MST is defined as “psychological trauma, which in the judgment of a mental health professional employed by the Department, resulted 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.” Sexual harassment is further defined as “repeated, unsolicited verbal or physical contact of a sexual nature, which is threatening in character.” MST-related care must be provided in a setting that is therapeutically appropriate, taking into account the circumstances that resulted in the need for such counseling. Public Law 103-452 removed limits on the duration of this care and specified that it must be available to both male and female survivors of MST. Public Law 108-422 made VA’s authorization to provide this care permanent.
b. VA has determined that because VA provides sexual trauma counseling and care pursuant to 38 U.S.C. Section 1720D only for sexual trauma-related disabilities that are incurred in service, there are no requirements for the condition to be adjudicated as service connected. Length of service or income eligibility requirements do not apply in order to receive this benefit. Veterans and eligible individuals who experienced MST while on active duty or active duty for training do not need to have filed a disability claim, be service connected, or provide evidence of the sexual trauma to receive MST-related care. Veterans and eligible individuals who report experiences of MST, but who are deemed ineligible for other VA health care benefits or enrollment, may be provided MST-related care only. This benefit extends to Reservists and members of the National Guard who were activated to full-time duty status in the Armed Forces. Veterans and eligible individuals who received an “other than honorable” discharge may be able to receive free MST-related care with the Veterans Benefits Administration (VBA) Regional Office approval. NOTE: For purposes of this Directive, “eligible individual” means someone without Veteran status who experienced sexual trauma as described in subparagraph 2a while on active duty or active duty for training. Because eligibility accrues as a result of events incurred in service and is not dependent on length of service some individuals may be eligible for MST-related care even if they do not have Veteran status.
c. All health care for treatment of mental and physical health conditions related to MST, including medications, is provided free of charge. Fee basis is available when it is clinically
THIS VHA DIRECTIVE EXPIRES JULY 31, 2015
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inadvisable to provide counseling in a VA facility, when VA facilities are geographically inaccessible, or when VA facilities are unable to provide care in a timely manner. Referral to the local Readjustment Counseling Service (Vet Center) may also be an appropriate option. NOTE: Policies specific to the availability of MST-related care in Community-based Outpatient Clinics (CBOCs) are specified in VHA Handbook 1160.01.
d. Staff training and informational outreach are important components of MST-related programming. Mental health and other health care personnel must receive appropriate training on MST-related issues. VA engages in efforts to ensure that Veterans and potentially eligible individuals are informed about MST-related services available through VHA.
3. POLICY: It is VHA policy to provide Veterans and eligible individuals who report having experienced MST with free care for all physical and mental health conditions determined by their VA provider to be related to experiences of MST.
4. ACTION
a. Veterans Integrated Service Network (VISN) Director. The VISN Director is responsible for ensuring:
(1) Appointment of MST VISN-level Point of Contact (POC). Each VISN must have a designated MST VISN-level POC whose responsibilities are described in subparagraph 4b. The VISN MST POC needs to be a professional knowledgeable about mental health and informed about MST and treatment of its after-effects. This is a collateral position, but the MST POC needs to be given adequate protected time to fulfill the responsibilities of the role.
(2) Access to Specialized Residential or Inpatient Care. Veterans and eligible individuals must have access to residential or inpatient programs able to provide specialized MST-related mental health care, when clinically needed, for conditions resulting from MST. VISNs or VA medical centers that do not have these programs need to develop Memoranda of Understanding with VISNs that do have these services. NOTE: At a national level there is a need to consider developing a number of these programs as national resources and to arrange processes for referral, discharge, and follow-up.
b. VISN-level MST POC. The VISN-level MST POC is responsible for:
(1) Monitoring and helping to ensure national and VISN-level policies related to MST are implemented at individual facilities and associated CBOCs within the VISN;
(2) Providing support, assistance, and opportunities for communication and networking to MST Coordinators within the VISN; and
(3) Communicating with national, VISN, and facility-level leadership and other stakeholders.
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c. Facility Director. The Facility Director is responsible for ensuring:
(1) Appointment of an MST Coordinator. Every facility must have a designated MST Coordinator whose responsibilities are described in subparagraph 4d. The facility MST Coordinator needs to be a professional who is knowledgeable about trauma and mental health and who possesses expertise in issues specific to MST. Given that part of the role of the MST Coordinator is to provide information and assistance to Veterans and eligible individuals in accessing MST-related care at the facility and associated CBOCs, the MST Coordinator must be sensitive to issues arising in the clinical care of MST survivors, in order to handle these contacts appropriately. Although some facilities have established the MST Coordinator as a full-time position, it is permissible for the role to be assigned as a collateral duty. If this is the case, care must be taken to ensure that the MST Coordinator is given adequate protected time to fulfill the responsibilities of the role. Facility size and complexity, number of associated CBOCs, the size of the facility’s catchment area, and the size of the local MST population are to be considered in making this assessment. NOTE: Although the MST Coordinator may engage in the provision of clinical care to MST survivors as part of the MST Coordinator’s primary position, the MST Coordinator role is defined by screening and treatment program development, monitoring, staff education and training, informational outreach to Veterans and potentially eligible individuals, and other administrative responsibilities.
(2) Universal Screening. All Veterans and potentially eligible individuals seen in VHA facilities and associated CBOCs must be screened for experiences of MST. This must be done using the MST Clinical Reminder in the Computerized Patient Record System (CPRS), (see subpar. 4c(5)). Screening is to be conducted in appropriate clinical settings by providers with an appropriate level of clinical training; screenings are not to be conducted by clerks or health technicians.
(3) Availability of MST-related Care. Facilities and associated CBOCs must have appropriate physical and mental health care available for conditions related to MST. NOTE: Policies specific to the availability of MST-related care in CBOCs are specified in VHA Handbook 1160.01. Care must be delivered by staff with appropriate qualifications and training. Facilities must ensure that there is a sufficient number of clinicians trained in the provision of specialized mental health care related to MST to adequately meet the demand for care. Scheduling priority for outpatient sexual trauma counseling, care, and services is consistent with VHA performance standards for scheduling clinics. NOTE: When clinically indicated, facilities are strongly encouraged to accommodate the requests of Veterans and eligible individuals for a provider of a particular sex for their care for conditions related to MST.
(4) Co-payments. Veterans and eligible individuals are provided free care, with no inpatient, outpatient, or pharmacy co-payments, for mental and physical health conditions resulting from their experiences of MST. The provider of services makes the determination of whether the visit involved care related to a Veteran’s experiences of MST and must indicate this by checking the MST checkbox on the encounter form for the visit. Neither individuals nor health insurance plans are billed co-payments for MST-related inpatient, outpatient, or pharmaceutical treatment; however, applicable co-payments may be charged for services not related to MST. Facilities and associated CBOCs must have mechanisms in place to ensure that
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Veterans and potentially eligible individuals who may have conditions related to MST that require care, but who are not eligible for other VHA care, are able to be evaluated by a clinician to determine the applicability of the free care benefit.
(5) Monitoring of Screening, Referral, and Treatment. To ensure that national data on MST-related screening, referral, and treatment is accurate, the national MST software application must be installed and function properly at every facility and associated CBOCs. The national MST software application activates both the MST Clinical Reminder and, when applicable, the MST-related care encounter form checkbox in CPRS. The MST Clinical Reminder must be activated for all Veterans and potentially eligible individuals. Veterans and eligible individuals who screen positive for MST must have the MST-related care checkbox activated on their encounter forms and all MST-related care must be indicated by checking this box on the encounter form for the visit. Purpose of visit code 55, of the fee package, is recommended to indicate fee basis MST-related care. Because MST is an experience and not a diagnosis and because patients who report MST are provided free care for both physical and mental health conditions related to MST, care is often provided through a variety of clinics identified by a range of clinic stop codes. NOTE: Although some facilities have historically used clinic stop code 524 (Active Duty Sexual Trauma) as an indicator for MST-related care, this is not recommended as it cannot capture the full range of services for which patients are eligible.
(6) Education. Staff must receive education and training about MST-related issues appropriate to their role with Veterans and potentially eligible individuals. Providers of clinical services must be aware of the requirement to screen for MST and know how to screen sensitively, when appropriate to their role. They must also be aware of referral processes for treatment and recognize how a history of MST may affect their provision of care.
(7) Informational Outreach to Veterans. Information regarding VA’s services related to MST must be made available through appropriate public information services and must be visibly posted or displayed in appropriate places within the facility.
d. Facility MST Coordinator. The facility MST Coordinator is responsible for:
(1) Monitoring and helping to ensure national and VISN-level policies related to MST screening and treatment to ensure they are implemented at the facility and associated CBOCs. For example, MST has unique eligibility guidelines and monitoring requirements that MST Coordinators must help ensure are implemented. The MST Coordinator establishes and monitors mechanisms to ensure that all Veterans and potentially eligible individuals receiving VHA health care are screened for experiences of MST using the clinical reminder in CPRS, that those who screen positive have expedient access to a continuum of appropriate MST-related care, and that this care is provided free of charge. The MST Coordinator monitors local MST-related programming and, as needed, makes efforts to expand the program’s scope. MST survivors often have complex clinical needs and may be high utilizers of care; depending upon local needs and resources, programming may involve development of a specialized MST treatment team to ensure adequate coordination of care.
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(2) Monitoring and helping to ensure that national and VISN-level policies about staff education related to MST are implemented at the facility and associated CBOCs. The MST Coordinator directly provides or establishes and monitors mechanisms to ensure that staff at the facility and associated CBOCs receive legally-mandated education and training related to MST. Given VA policy of universal MST screening and the tendency for MST survivors to present with multiple mental and physical health comorbidities, education must occur in clinics throughout the facility and associated CBOCs. Depending upon a staff member’s role and level of contact with MST survivors, training needs to cover such topics as: sensitivity and confidentiality; treatment options; importance of, and rationale for, screening; potential impact of an MST history on provision of care; and background information on MST (e.g., prevalence of MST, impact of sexual trauma, etc.).
(3) Monitoring and helping to ensure that national and VISN-level policies about informational outreach related to MST are implemented at the facility and associated CBOCs. The MST Coordinator directly engages in and establishes and monitors mechanisms to provide informational outreach to Veterans and potentially eligible individuals and facilitates their engagement in care. The MST Coordinator ensures that Veterans and potentially eligible individuals are aware of the MST Coordinator role and contact information; and are familiar with local services available.
(4) Serving as a point of contact, source of information, and problem solver for MST-related issues at the facility and associated CBOCs.
(a) The MST Coordinator establishes formal mechanisms for communication and problem-solving related to MST issues at the facility and associated CBOCs, with a particular emphasis on establishing relationships with the facility Business Office (or other offices dealing with enrollment, eligibility, and billing issues); Information Resource Management Service; Women Veterans Health Program Manager; clinical directors in Mental Health, Primary Care, and other relevant clinical areas; and facility leadership among others.
(b) MST Coordinators serve as POC for Veterans and other individuals with questions about MST-related services at the facility and associated CBOCs. Accordingly, the MST Coordinator ensures that staff at various points of entry into the system (e.g., telephone operators, information desk staff, Mental Health clerks, Business Office staff) know the MST Coordinator’s role and contact information.
(c) MST Coordinators address systems issues that may create barriers to Veterans and eligible individuals entering care and act as an advocate for Veterans and eligible individuals in their interactions with relevant VHA clinics and offices. For example, when fee basis care is warranted, the facility credentialing and privileging system must be notified prior to the initial visit with the fee basis provider; this notification alerts the credentialing and privileging system to obtain information needed to update the provider’s file and authorize prescription of medications.
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(d) MST Coordinators help ensure that systems are in place to prevent Veterans and eligible individuals from encountering difficulties in obtaining reimbursement, filling prescribed medications, or receiving appropriate care.
(5) Communicating with national, VISN, facility-level leadership, and other stakeholders. The MST Coordinator communicates regularly with the VISN-level MST POC and other MST Coordinators in the VISN, as well as local mental health and national MST leadership in order to remain knowledgeable about policies and trends related to MST. In addition, the MST Coordinator responds to requests for information about local MST programming from VA Central Office’s Office of Mental Health Services.
5. REFERENCES
a. Public Law 103-452, Veterans Health Care Extension Act, dated November 2, 1994.
b. Public Law 108-422, Veterans Health Program Improvement Act of 2004, dated November 30, 2004.
c. Title 38 U.SC. 1720D, Counseling and treatment for sexual trauma.
d. Office of General Counsel document, Military Sexual Trauma, dated June, 2006.
e. VHA Handbook 1160.01.
6. FOLLOW-UP RESPONSIBILITY: Office of Mental Health Services (116) is responsible for the contents of this Directive. Questions may be referred the Director, Family Services, Women’s Mental Health, and Military Sexual Trauma, at: 202-340-4192.
7. RECISSIONS: VHA Directive 2005-015 is rescinded. This VHA Directive expires
July 31, 2015.
Robert A. Petzel, M.D.
Under Secretary for Health
DISTRIBUTION:
E-mailed to the VHA Publications Distribution List 7/15/2010

Military Sexual Trauma

What is military sexual trauma (MST)?

In both civilian and military settings, service members can experience a range of unwanted sexual behaviors that they may find distressing. These experiences happen to both women and men. "Military sexual trauma" or MST is the term used by the Department of Veterans Affairs to refer to experiences of sexual assault or repeated, threatening acts of sexual harassment.
The definition of MST used by the VA is given by U.S. Code (1720D of Title 38). It is "psychological trauma, which in the judgment of a VA mental health professional, resulted 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." Sexual harassment is further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character."
In more concrete terms, MST includes any sexual activity where you are involved against your will. You may have been pressured into sexual activities. For example, you may have been threatened with negative consequences for refusing to go along. It may have been implied that you would get faster promotions or better treatment in exchange for sex. You may not have been able to consent to sexual activities, for example, if you were intoxicated. You may have been physically forced into sexual activities. Other MST experiences include:

• Unwanted sexual touching or grabbing.
• Threatening, offensive remarks about your body or your sexual activities.
• Threatening and unwelcome sexual advances.

If these experiences occurred while you were on active duty or active duty for training, they are considered to be MST.

How common is MST?

Data from VA's universal screening program give us an idea of how common MST is. Under this program, all Veterans seen at Veterans Health Administration (VHA) facilities are asked whether they went through sexual trauma during their military service. Veterans who respond "yes" are asked if they are interested in learning about MST-related services. Not every Veteran who responds "yes" needs to be treated or wants to learn about treatment.
Please note that the rates obtained from VA screening cannot be used to estimate the rate of MST among all those serving in the U.S. military. The screening data are drawn only from Veterans who have chosen to seek VA health care. Also, keep in mind that a positive response does not mean that the person who committed the sexual trauma was a member of the military.
About 1 in 5 women and 1 in 100 men seen in VHA respond "yes" when screened for MST. Though rates of MST are higher among women, there are almost as many men seen in VA that have experienced MST as there are women. This is because there are many more men in the military than there are women.

How can MST affect Veterans?

It's important to remember that MST is an experience. It is not a diagnosis or a mental health condition in and of itself. Given that Veterans report a wide range of distressing sexually-related experiences, it is not surprising that they have a wide range of emotional responses.
There is no one way that every person will respond, even after a very distressing experience. A Veteran's response may vary in terms of the type of response, how severe it is, and how long it lasts. For some Veterans, experiences of MST may continue to affect their mental and physical health, even many years later. Your response may depend on factors such as:

• Whether you have a prior history of trauma.
• The types of responses you received from others at the time of the experience.
• Whether the experience happened once or was repeated over time.

Here are some of the difficulties both female and male survivors of MST may have:

• Strong emotions: feeling depressed; having intense, sudden emotional responses to things; feeling angry or irritable all the time
• Feelings of numbness: feeling emotionally "flat"; trouble feeling love or happiness
• Trouble sleeping: trouble falling or staying asleep; bad dreams or nightmares
• Trouble with attention, concentration, and memory: trouble staying focused; often finding your mind wandering; having a hard time remembering things
• Problems with alcohol or other drugs: drinking to excess or using drugs daily; getting drunk or "high" to cope with memories or unpleasant feelings; drinking to fall asleep
• Trouble with reminders of the sexual trauma: feeling on edge or "jumpy" all the time; not feeling safe; going out of your way to avoid reminders of the trauma; trouble trusting others
• Problems in relationships: feeling alone or not connected to others; abusive relationships; trouble with employers or authority figures
• Physical health problems: sexual issues; chronic pain; weight or eating problems; stomach or bowel problems

Among users of VA healthcare, medical record data indicates that the mental health problems most often seen with MST are:

• PTSD
• Other anxiety disorders
• Depression and other mood disorders
• Substance use disorders (alcohol and drug problems)

How has VA responded to the problem of MST?

Fortunately, people can recover from experiences of trauma.VA has services to help Veterans do this. Since 1992 VA has been developing programs related to:

• MST screening and treatment.
• Training staff on MST-related issues.
• Outreach to Veterans about available services.

Services available to Veterans include:

• All Veterans seen in VA are asked whether they experienced MST. All treatment for physical and mental health problems related to MST is free for both men and women.
• Every VA facility has an MST Coordinator who serves as a contact person for MST-related issues. This person can help Veterans find and access VA services and programs. The MST Coordinator may also be aware of state and federal benefits and community resources that may be helpful.
• Every VA facility has providers that know about treatment for the effects of MST. Many facilities have special outpatient mental health services for sexual trauma. Vet Centers also have specially trained sexual trauma counselors.
• Across the country, VA also has special residential (live-in) or inpatient sexual trauma treatment programs. These are programs for Veterans who need more intense treatment and support.
• Some Veterans do not feel comfortable in mixed-gender treatment settings. For this reason, some facilities have separate programs for men and women. All residential and inpatient MST programs have separate sleeping areas for men and women.

Veterans can receive free, confidential counseling and treatment for mental and physical health conditions related to MST. Veterans do not need to be service-connected (have a VA disability rating). You may be able to receive this benefit even if you are not eligible for other VA care. You do not need to have reported the incident(s) when they happened. You do not need to have proof that they occurred.

How can Veterans get help?

For more information, you can:

• Speak with your VA health care provider.
• Contact the MST Coordinator at your nearest VA Facility
• Contact a Vet Center near you.
• Call VA's general information hotline at 1-800-827-1000 begin_of_the_skype_highlighting              1-800-827-1000      end_of_the_skype_highlighting.
• Feel free to ask for a provider of the gender -- male or female -- with which you would feel more comfortable.

People can recover from experiences of trauma. Please contact VA to learn more.

Date Created: 01/01/2007 

VET CENTER LIST THANKS TO Stop Military Rape is a division of the Military Rape Crisis CenterStop Military Rape, Org. 2006-2010 All rights reserved

Counseling is available at Vet Centers across the country free of charge for all veterans that experienced Military Sexual Trauma. Any veteran who was sexually traumatized while serving in the military is eligible to receive counseling regardless of gender, era of service or time in service.
Military sexual trauma counseling may include individual or group counseling, marital and family counseling, referral for benefits assistance, liaison with community agencies or substance abuse information and referral to help you deal with the emotions of military sexual trauma and regain confidence in your everyday life.
Below is a complete list of Vet Centers in the United States and abroad. (clicking on link would sent you to the Vet Center official website)

Alabama
Birmingham:	Birmingham Vet Center
Huntsville:	Hunstville Vet Center
Mobile:	Mobile Vet Center
Montgomery:	Montgomery Vet Center

Alaska
Anchorage:	Anchorage Vet Center
Fairbanks:	Fairbanks Vet Center
Soldotna:	Kenai Vet Center Satellite
Wasilla:	Wasilla Vet Center

Arizona
Chinle:	Chinle Vet Center Outstation
Hotevilla:	Hopi Vet Center Outstation 2
Mesa:	Mesa Vet Center
Phoenix:	Phoenix Vet Center
Prescott:	Prescott Vet Center
Tucson:	Tucson Vet Center
Yuma:	Yuma Vet Center

Arkansas
Fayetteville:	Fayetteville Vet Center
North Little Rock:	Little Rock Vet Center

California
Bonita:	Chula Vista Vet Center
Capitola:	Santa Cruz County Vet Center
Chico:	Chico Vet Center
Citrus Heights:	Citrus Heights Vet Center
Colton:	San Bernardino Vet Center
Commerce:	East Los Angeles Vet Center
Concord:	Concord Vet Center
Corona:	Corona Vet Center
Culver City:	West Los Angeles Vet Center
Eureka:	Eureka Vet Center
Fairfield:	4B Pacific Western Regional Office
Fresno:	Fresno Vet Center
Garden Grove:	North Orange County Vet Center
Gardena:	Los Angeles Veterans Resource Center
Mission Viejo:	South Orange County Vet Center
Modesto:	Modesto Vet Center
Oakland:	Oakland Vet Center
Palmdale:	Antelope Valley Vet Center
Redwood City:	Peninsula Vet Center
Rohnert Park:	Northbay Vet Center
Sacramento:	Sacramento Vet Center
San Diego:	San Diego Vet Center
San Francisco:	San Francisco Vet Center
San Jose:	San Jose Vet Center
San Marcos:	San Marcos Vet Center
Sepulveda:	Sepulveda Vet Center
Temecula:	Temecula Vet Center
Ventura:	Ventura Vet Center
Victorville:	High Desert Vet Center

Colorado
Denver:	4A Western Mountain Regional Office
Boulder:	Boulder Vet Center
Colorado Springs:	Colorado Springs Vet Center
Denver:	Denver Vet Center
Fort Collins:	Fort Collins Vet Center Outstation
Grand Junction:	Grand Junction Vet Center
Pueblo:	Pueblo Vet Center

Connecticut
Danbury:	Danbury Vet Center
Norwich:	Norwich Vet Center
Rocky Hill:	Hartford Vet Center
West Haven:	New Haven Vet Center

Delaware
Wilmington:	Wilmington Vet Center

District of Columbia
Washington:	Washington DC Vet Center

Florida
Bay Pines:	3A Southeast Regional Office
Brooksville:	Dade City Vet Center
Clearwater:	Clearwater Vet Center
Coral Springs:	Coral Springs Vet Center
Ft. Lauderdale:	Fort Lauderdale Vet Center
Ft. Myers:	Ft. Myers Vet Center
Gainesville:	Gainesville Vet Center
Holly Hill:	Daytona Beach Vet Center
Jacksonville:	Jacksonville Vet Center
Jupiter:	Jupiter Vet Center
Key Largo:	Key Largo Vet Center Outstation
Lake Worth:	Palm Beach Vet Center
Melbourne:	Melbourne Vet Center
Miami:	Miami Vet Center
Orlando:	Orlando Vet Center
Pensacola:	Pensacola Vet Center
Sarasota:	Sarasota Vet Center
St. Petersburg:	St. Petersburg Vet Center
Tallahassee:	Tallahassee Vet Center
Tampa:	Tampa Vet Center

Georgia
Atlanta:	Atlanta Vet Center
Lawrenceville:	Lawrenceville Vet Center
Macon:	Macon Vet Center
Marietta:	Marietta Vet Center
Savannah:	Savannah Vet Center

Hawaii
Hilo:	Hilo Vet Center
Honolulu:	Honolulu Vet Center
Kailua-Kona:	Kailua-Kona Vet Center
Lihue:	Kauai Vet Center
Wailuku:	Maui Vet Center

Idaho
Boise:	Boise Vet Center
Pocatello:	Pocatello Vet Center

Illinois
Aurora:	DuPage County Vet Center
Chicago:	Chicago Veterans Resource Center
Chicago Heights:	Chicago Heights Vet Center
East St. Louis:	East St. Louis Vet Center
Evanston:	Evanston Vet Center
Moline:	Quad Cities Vet Center
Oak Park:	Oak Park Vet Center
Orland Park:	Orland Park Vet Center
Peoria:	Peoria Vet Center
Rockford:	Rockford Vet Center Outstation
Springfield:	Springfield Vet Center

Indiana
Evansville:	Evansville Vet Center
Fort Wayne:	Fort Wayne Vet Center
Indianapolis:	Indianapolis Vet Center
Merrillville:	Gary Area Vet Center

Iowa
Cedar Rapids:	Cedar Rapids Vet Center Satellite
Des Moines:	Des Moines Vet Center
Sioux City:	Sioux City Vet Center

Kansas
Manhattan:	Manhattan Vet Center
Wichita:	Wichita Vet Center

Kentucky
Lexington:	Lexington Vet Center
Louisville:	Louisville Vet Center

Louisiana
Baton Rouge:	Baton Rouge Vet Center
Kenner:	New Orleans Veterans Resource Center
Shreveport:	Shreveport Vet Center

Maine
Bangor:	Bangor Vet Center
Caribou:	Caribou Vet Center
Lewiston:	Lewiston Vet Center
Portland:	Portland Vet Center
Springvale:	Sanford Vet Center

Maryland
Towson:	Readjustment Counseling Service, Mid-Atlantic Region
Aberdeen:	Aberdeen Vet Center Outstation 2
Annapolis:	Annapolis Vet Center
Baltimore:	Baltimore Vet Center
Bethesda:	Silver Spring Vet Center
Cambridge:	Cambridge Vet Center Outstation 1
Elkton:	Elkton Vet Center

Massachusetts
Boston:	Boston Vet Center
Brockton:	Brockton Vet Center
Fairhaven:	New Bedford Vet Center
Hyannis:	Hyannis Vet Center
Lowell:	Lowell Vet Center
Springfield:	Springfield Vet Center
Worcester:	Worcester Vet Center

Michigan
Clinton Township:	Macomb County Vet Center
Dearborn:	Dearborn Vet Center
Detroit:	Detroit Vet Center
Escanaba :	Escanaba Vet Center
Grand Rapids:	Grand Rapids Vet Center
Pontiac:	Pontiac Vet Center
Saginaw:	Saginaw Vet Center
Traverse City:	Traverse City Vet Center

Minnesota
Brooklyn Park:	Brooklyn Park Vet Center
Duluth:	Duluth Vet Center
New Brighton:	St. Paul Veterans Resource Center

Mississippi
Biloxi:	Biloxi Vet Center
Jackson:	Jackson Vet Center

Missouri
St. Louis:	2 Central Regional Office
Columbia:	Columbia Vet Center
Kansas City:	Kansas City Vet Center
Springfield:	Springfield Vet Center
St. Louis:	St. Louis Vet Center

Montana
Billings:	Billings Vet Center
Missoula:	Missoula Vet Center

Nebraska
Lincoln:	Lincoln Vet Center
Omaha:	Omaha Vet Center

Nevada
Henderson:	Henderson Vet Center
Las Vegas:	Las Vegas Vet Center
Reno:	Reno Vet Center

New Hampshire
Auburn:	1A Northeast Regional Office
Gorham:	Berlin Vet Center
Manchester:	Manchester Vet Center

New Jersey
Bloomfield:	Bloomfield Vet Center
Ewing:	Trenton Vet Center
Lakewood:	Lakewood Vet Center
Secaucus:	Secaucus Vet Center
Ventnor:	Ventnor Vet Center

New Mexico
Albuquerque:	Albuquerque Vet Center
Farmington:	Farmington Vet Center Satellite
Las Cruces:	Las Cruces Vet Center
Santa Fe:	Santa Fe Vet Center

New York
Albany:	Albany Vet Center
Babylon:	Babylon Vet Center
Binghamton:	Binghamton Vet Center
Bronx:	Bronx Vet Center
Brooklyn:	Brooklyn Veterans Resource Center
Buffalo:	Buffalo Vet Center
Middletown:	Middletown Vet Center
New York:	Harlem Vet Center
New York:	Manhattan Vet Center
Plainview:	Nassau Vet Center
Rochester:	Rochester Vet Center
Staten Island:	Staten Island Vet Center
Syracuse:	Syracuse Vet Center
Watertown:	Watertown Vet Center
White Plains:	White Plains Vet Center
Woodhaven:	Queens Vet Center

North Carolina
Charlotte:	Charlotte Vet Center
Fayetteville:	Fayetteville Vet Center
Greensboro:	Greensboro Vet Center
Greenville:	Greenville, NC Vet Center
Raleigh:	Raleigh Vet Center

North Dakota
Bismarck:	Bismarck Vet Center Outstation
Fargo:	Fargo Vet Center
Minot:	Minot Vet Center

Ohio
Cincinnati:	Cincinnati Vet Center
Cleveland:	Cleveland Heights Vet Center
Cleveland:	McCafferty Vet Center Outstation
Columbus:	Columbus Vet Center
Dayton:	Dayton Vet Center
Parma:	Parma Vet Center
Toledo:	Toledo Vet Center

Oklahoma
Lawton:	Lawton Vet Center
Oklahoma City:	Oklahoma City Vet Center
Tulsa:	Tulsa Vet Center

Oregon
Bend:	Central Oregon Vet Center
Eugene:	Eugene Vet Center
Grants Pass:	Grants Pass Vet Center
Portland:	Portland Vet Center
Salem:	Salem Vet Center

Pennsylvania
Bristol:	Bucks County Vet Center
DuBois:	DuBois Vet Center
Erie:	Erie Vet Center
Harrisburg:	Harrisburg Vet Center
Lancaster:	Lancaster Vet Center
McKeesport:	McKeesport Veterans Resource Center
Norristown:	Montgomery County Vet Center
Philadelphia:	Philadelphia Vet Center
Philadelphia:	Philadelphia Vet Center NE
Pittsburgh:	Pittsburgh Vet Center
Scranton:	Scranton Vet Center
Williamsport:	Williamsport Vet Center

Rhode Island
Warwick:	Providence Vet Center

South Carolina
Columbia:	Columbia Vet Center
Greenville:	Greenville, SC Vet Center
N. Charleston:	Charleston Vet Center

South Dakota
Martin:	Pine Ridge Vet Center Outstation
Rapid City:	Rapid City Vet Center
Sioux Falls:	Sioux Falls Vet Center

Tennessee
Chattanooga:	Chattanooga Vet Center
Johnson City:	Johnson City Vet Center
Knoxville:	Knoxville Vet Center
Memphis:	Memphis Vet Center
Nashville:	Nashville Vet Center

Texas
Dallas:	3B South Central Regional Office
Abilene:	Taylor County Vet Center
Amarillo:	Amarillo Vet Center
Austin:	Austin Vet Center
Corpus Christi:	Corpus Christi Vet Center
Dallas:	Dallas Vet Center
El Paso:	El Paso Vet Center
Ft. Worth:	Fort Worth Vet Center
Harker Heights:	Killeen Heights Vet Center
Houston:	Harris County Vet Center
Houston:	Houston Vet Center
Houston:	Houston Veterans Resource Center
Laredo:	Laredo Vet Center
Lubbock:	Lubbock Vet Center
McAllen:	McAllen Vet Center
Mesquite:	Dallas County Vet Center
Midland:	Midland Vet Center
Pantego:	Tarrant County Vet Center
San Antonio:	San Antonio NE Vet Center
San Antonio:	San Antonio NW Vet Center

Utah
Provo:	Provo Vet Center
Salt Lake:	Salt Lake Vet Center

Vermont
South Burlington:	South Burlington Vet Center
White River Junction:	White River Junction Vet Center

Virginia
Alexandria:	Alexandria Vet Center
Norfolk:	Norfolk Vet Center
Richmond:	Richmond Vet Center
Roanoke:	Roanoke Vet Center
Virginia Beach:	Virginia Beach County Vet Center

Washington
Bellingham:	Bellingham Vet Center
Everett:	Everett Vet Center
Seattle:	Seattle Vet Center
Spokane:	Spokane Vet Center
Tacoma:	Tacoma Vet Center
Yakima:	Yakima Vet Center

West Virginia
Beckley:	Beckley Vet Center
Charleston:	Charleston Vet Center
Henlawson:	Logan Vet Center Outstation
Huntington:	Huntington Vet Center
Martinburg:	Martinsburg Vet Center
Morgantown:	Morgantown Vet Center
Pakersburg:	Parkersburg Vet Center Outstation
Princeton:	Princeton Vet Center
Wheeling:	Wheeling Vet Center

Wisconsin
Green Bay:	Green Bay Vet Center
La Crosse:	La Crosse Vet Center
Madison:	Madison Vet Center
Milwaukee:	Milwaukee Vet Center

Wyoming
Casper:	Casper Vet Center (Satellite)
Cheyenne:	Cheyenne Vet Center

American Samoa
Pago Pago:	American Samoa Vet Center

Guam
Hagatna:	Guam Vet Center

Puerto Rico
Arecibo:	Arecibo Vet Center
Ponce:	Ponce Vet Center
Rio Piedras:	San Juan Vet Center

Virgin Islands
St. Croix:	St. Croix Vet Center Satellite
St. Thomas:	St. Thomas Vet Center Satellite

Stop Military Rape is a division of the Military Rape Crisis CenterStop Military Rape, Org. 2006-2010 All rights reserved