ST. PETERSBURG, Fla. — Every morning for more than two years, retired Army Sgt. Brenda Reed had the infuriating chore of screwing on what she calls her “man foot.” The prosthetic was given to her by the Department of Veterans Affairs after her left leg was amputated in 2013, but the replacement was so bulky and ill-fitting that it kept falling off in public. She pleaded with VA officials for “a foot that fits, a female foot,” only to be told repeatedly that the agency doesn’t carry that kind of customized prosthetic, which is available on the private market.
Reed tried to have a sense of humor about it. So she put bright red press-on nails on the wide “man” toes.
“I just wanted to get this man’s foot off of me,” she said. “Does it really have to be this hard for female veterans to get the right kind of care?”
Women are streaming home from war and through VA doors in record numbers. But a health-care system that for generations catered almost exclusively to men has been slow to recognize that the 2.3 million female veterans represent the fastest-growing population turning to the agency. In myriad ways, VA is struggling to address the urgent needs of these women for medical and mental health services.
VA hospitals and clinics don’t offer prenatal care; instead they outsource it. And they don’t deliver babies. Dozens of VA facilities don’t have full-time gynecologists, and some don’t have any gynecological staff. Even for basic female wellness services, such as mammograms, some facilities have to refer women elsewhere.
There is also a severe shortage of VA mental health therapists who are women, an especially pressing problem for female veterans trying to come to terms with sexual assaults suffered in the military.
While some VA hospitals have premier women’s clinics, others offer women little privacy, forcing them to share rooms with men and separating them at most with a curtain. Even recently, as VA Secretary Robert McDonald has acknowledged, some hospitals didn’t have separate restrooms for women.
“Look, the VA is great if you are a 65-year-old guy with a prostate problem. But if you are pregnant or a woman with breast cancer, I would run the other way,” said retired Air Force Col. Kimberly Olson, former president of the women’s veterans group Grace After Fire.
American fighting forces have experienced a revolution over the last generation. Once barred from combat situations, women have piloted aircraft over the mountains of Afghanistan and patrolled rural villages of Iraq alongside male troops.
But when the women return from overseas, they often discover that VA and the wider American society haven’t changed as quickly as the military and that they face difficulties not experienced by their male counterparts. They confront challenges not only in finding suitable health care, but also in reintegrating into society, finding jobs, homes and love, and reconciling their identity as both a woman and a warrior.
“The problem is we are coming home to a society and unfortunately a VA that still defines veterans as male — that’s what Americans picture when they think veteran,”said former Army medic Joy Ilem,who focuses on VA’s women’s health-care policy for the advocacy group Disabled American Veterans (DAV).
The number of female veterans using the VA health service increased by 80 percent between 2003 and 2012, the agency says. And that demand is certain to skyrocket over the next five years as the total number of female veterans is projected to double, reaching about 4.5 million, according to the agency.
Reed says she has been fighting for respect her entire military career, ever since she was in the first class of Army recruits to go through coed basic training 30 years ago. But no struggle has filled her with such rage as her campaign for a foot that fits properly, said Reed, who often wears wide black sandals to fit her wide prosthetic.
Last year, a VA specialist cut off the toes on Reed’s prosthetic and shaved off the sides in an effort to make it fit into her shoes. Reed said not only didn’t it fit, but she also found that she couldn’t walk on it. She was given another prosthetic and told to make do.
She didn’t. She “nearly went ballistic” and took her case to the VA secretary’s office, calling and emailing McDonald repeatedly.
Finally, this summer, the VA hospital in Tampa notified Reed that the agency had located a foot that it could customize for her. Of an estimated 2,100 female veterans with amputated limbs, now at least one has a VA-issued prosthetic tailored for a woman.
Reed remains unsatisfied, resentful that she had to go to “absurd lengths to get what male veterans receive within days.”
Army National Guard Spec. Crystal Sandor almost died in a nighttime roadside bomb blast when she was driving an armored five-ton truck with a gun box in the back northeast of Baghdad.
She was 19 at the time and was awarded the Purple Heart.
But when she returned home to Ohio and told her doctor at the VA hospital about her injuries, Sandor recalled, “he stopped me and stated that he didn’t understand how I was injured by an IED since ‘women didn’t leave the base and weren’t involved in combat roles.’ I was amazed by his ignorance. This was a VA doctor!”
To make matters worse, Sandor, now 30 and a mother, said she was mocked and catcalled by some of the older veterans who work as volunteers and greeters throughout VA hospitals.
“You’re the finest specimen of a woman I’ve ever seen,” one told her. Another asked: “What did you do in Iraq? Sell cookies?”
“It almost makes you feel isolated and alone in a system which is meant to help you,” she said.
These tensions were typical of a generational clash with male veterans from the World War II and Vietnam eras.
This year at a VA hospital in Los Angeles, a group of World War II veterans brought in cheerleaders dressed like 1940s pinup girls and Playboy bunnies as a “morale booster” for former troops. The event provoked a furor among female veterans of the Iraq and Afghanistan wars, who took to Facebook to vent their dismay.
“We have already been through the trauma of war and then we walk into this place that we think will be safe, that we are told will be a place that cares for you, and instead it’s like walking into a USO party in 1948,” said retired Navy Airman Amy Quinn, 30, who served during the Iraq and Afghanistan wars.
It’s part of a VA culture in which she still receives paperwork and phone calls that address her as “Mister” or “Sir.”
“It sure doesn’t honor your service,” she said.
Patricia Hayes, VA’s top official for women’s health-care issues, stressed that the agency is committed to improving its services but acknowledged that there’s much more to do.
Hayes said agencies officials are working hard to reeducate staff and change the male-dominated culture, with campaigns that include posters and videos that say, “This is not your father’s VA,” and pictures of women in combat gear with the slogan, “Not every GI is a Jane.”
“It’s not your father’s VA — it really isn’t,” Hayes said in an interview. She added, “We have geared up and are gearing up. But we have a lot of catching up to do.” VA does provide prenatal vitamins and breast pumps, she said, and it recently expanded its coverage to pay for care during the first seven days of a newborn’s life.”
She said VA also has opened a women’s call center so staff can be more proactive.
But for some female veterans, the frequent slights are not just insulting, but they also make them wonder about the quality of their care.
When former Air Force Master Sgt. Kimberly Tatham went in to her VA hospital in Missouri for an initial checkup, she noticed that there was a blood-work and exam order to check her prostate.
“It’s like medically we are invisible,” she said. When her doctor pulled back the curtain and saw she was a woman, “he just looked really confused. I was like, ‘Does it look like I have a prostate?’ ”
After surviving the roadside bombing in Iraq, Sandor needed treatment not just for physical injuries but also for psychological ones. She and other women who sought care for post-traumatic stress said they found the process itself traumatic.
There’s only a handful of treatment centers specifically for women. Sandor said she was put into an all-male therapy group. “I felt like an outsider,” she said. “I never opened up in the group. Never said one word.” Then, although she needed the therapy, she stopped attending altogether.
Increasingly, female veterans are linking their post-traumatic stress disorder to sexual assaults they suffered while in the military. A recent VA survey found that 1 in 4 women said they experienced sexual harassment or assault. And agency officials said they expect that number to rise as more women return from war and come forward.
Advocacy groups say VA has been slow to adjust to providing mental health and benefits to women suffering from “military sexual trauma” (MST), which covers any unwanted contact, including sexual innuendo, groping and rape.
At times, female rape survivors are put into group therapy that largely serves men suffering from combat-related trauma.
Greg Jacob, a former Marine and policy director with the advocacy group Service Women’s Action Network, found that when female veterans with MST are put in therapy with male veterans, “they are face-to-face once again with that bravado and bro-culture, and that type of climate can cause them to be triggered and they will shut down.”
An increasing number of VA hospitals, including in the District, have opened well-regarded women’s health centers, which have private entrances and offer women-only group therapy.
In another small step forward, Hayes said VA has started a child-care program at six sites, allowing female patients to leave their children there while they attend weekly therapy sessions for PTSD and military sexual assault. Sen. Patty Murray, D-Wash., has introduced legislation to fund the program and wants to see it expanded to all hospitals.
And while VA officials say the agency will never be in the business of delivering babies, they are working on a “maternity tracker,” a computer app that will help VA doctors keep track of outside pregnancy care to ensure, for example, that the veterans’ PTSD medications are safe to use during pregnancy.
When retired Army police Capt. Dawn Halfaker, now 36, came home from Iraq after losing her arm in an ambush and then got pregnant, she thought VA would help.
Instead, she said, she felt “abandoned. … There was a wide gap in the VA’s written policy and what you actually get.” The maternity care coordinator at her VA hospital in the District was little help, she said, for instance asking her to wait weeks before she could have a suspected fetal heart problem checked with an echocardiogram.
Halfaker said there “was an almost hands-off approach, and VA didn’t even pay the bills like they said they would. And I was soon getting collection notices that were jeopardizing my credit.”
Reed’s troubles with the “man foot” began with a man’s boot.
As a 22-year-old Army private serving in Germany, Reed, like all female soldiers, was issued combat boots made for men. Not long after, she badly injured her foot while running on cobblestone streets. But a health-care provider on base told her to “shake it off,” she said, recounting how she was “lectured, ignored and then made fun of.”
In excruciating pain, she went back three months later and demanded an X-ray. It revealed that her foot was broken in four places.
“That was the beginning of recurring injuries for decades due to existing damage that would years later end in amputation,” she said.
(It was only four months ago, after multiple studies showing that female service members are more susceptible to stress fractures because they are put into male boots, that Congress asked the armed forces to design a special line of women’s combat boots.)
Over the years, VA officials and doctors have given Reed various excuses for her ill-suited prosthetic. Some said there was no money for customized prosthetics while others said they didn’t know they existed.
Prosthetics were first invented for those wounded in war and were one size fits all. But today, state of the art prosthetics can be customized to a male or female body and even for swimming or biking.
But female veterans are more likely to get a prosthetic that doesn’t fit, which can cause further medical problems, such as socket burn, and higher rates of hip and knee osteoarthritis, according to a report by Ilem and the DAV advocacy group.
VA officials said in interviews that they are aware of the problem facing female amputees and are working to bring customized prosthetics into the agency rehabilitation centers. The officials noted that VA teamed up this summer with the Ipsos Girls’ Lounge, a networking group for corporate women, to host an exhibit promoting ways to personalize prosthetics, particularly for women. VA says it is also working on artificial limbs tailored for women, including those who need prosthetics that can be adjusted over the course of a pregnancy.
But Reed and other female veterans said that while they welcomed the news, the deeper issue is giving women timely access to equal treatment.
“It’s been 2 1/2 years of tripping over feet that were too large,” Reed said. “Women served their country, too. We shouldn’t have to fight this hard.”