Mickiela Montoya's male coworker confronted her as she walked across the pitch-black compound. It was 2005, and she had just finished an exhausting 12-hour shift at Camp Speicher's supply warehouse. "He said, ‘You know, if I was to rape you right now, no one could hear you scream,'" Montoya remembers. "Then he asked, ‘What would you do?'" Montoya knew she had no way of summoning help – the night was filled with the rumble of diesel generators powering the U.S. Army base 90 miles northwest of Baghdad. So the 19-year-old National Guard specialist from Los Angeles bluffed. "I would stab you," she told the soldier threatening her. He didn't quite believe her, she says, and questioned if she actually had a knife. Montoya didn't blink or give him any clue she was intimidated. Finally, he backed away. After that night, Montoya never went anywhere without a knife. She practiced pulling it quickly in case anyone tried to jump her. "I will never know if he was serious," Montoya says. "I didn't want to find out." She eventually transferred to one of the base's most dangerous places: guarding a checkpoint on the main highway. There, she wouldn't have to work alongside the man who had confronted her. "It was really scary," she says of night-guard duty at the checkpoint. "The crazy thing is, I did feel safer there." But Montoya kept the rape threat to herself. "Telling someone wasn't going to help the situation," she says. "I didn't want it to be like I was all shook up about it." Montoya's decision to keep quiet is not rare. The majority of sexual-trauma victims – ranging from repeated sexual harassment to rape – never report what happened, whether they are citizens or soldiers, men or women. But others are through with silence. More military women than ever are fighting back, helping to raise awareness of a difficult problem confronting the armed forces and society. Military sexual trauma, as VA calls it, isn't new, nor is it gender-specific. There are nearly as many male victims as female. DoD and VA were increasing their efforts to deal with sexual trauma even before Montoya came home four years ago. DoD opened the Sexual Assault Prevention and Response Office and established a comprehensive care program for victims that includes sexual-assault response coordinators, victim advocates, chaplains and health-care personnel. The program assists victims with medical care and counseling, and, with victim approval, can also include talking to victims' commands and supporting them through the military judicial process. More sexual assaults are being reported, but it's unclear if that increase is a result of greater awareness, a growing number of assaults, or both. In addition, sexual assaults only reflect part of the picture. Military sexual trauma includes repeated and threatening sexual harassment. VA, meanwhile, is encouraging victims to break their silence – at least with a counselor – rather than try to push it aside. "The experience of military sexual trauma, especially the experience of rape, puts the victim at very high risk for post-traumatic stress disorder – more so than heavy combat exposure, more so than a motor-vehicle accident," says Amy Street, a clinical psychologist with the VA Boston Healthcare System's National Center for PTSD. The resulting problems – including depression, substance abuse and relationship problems – can be compounded when victims don't seek care. "Victims are often reluctant to come forward and tell others about their experiences out of fear that they will be judged or blamed," says Street, who is also director of education and training for VA's Military Sexual Trauma Support Team. "These men and women were harmed in the service of their country in the same way someone who experienced combat injuries was. We can help them get to a place where their lives are not defined by the experience." Conventional Mythology. Military sexual trauma started getting serious attention after the 1991 Tailhook scandal, in which a group of Navy pilots assaulted 83 female officers and seven male officers at a Las Vegas hotel. Incidents at Aberdeen Proving Ground in 1996 and the Air Force Academy in 2003 pushed the issue back in the spotlight. One result was a law requiring free medical and mental health care for veterans dealing with any issue connected to military sexual trauma. It's difficult to get an accurate assessment of the problem. Sexual assault is one of the most under-reported crimes in the United States. VA says about 20 percent of its female patients and about 1 percent of male patients report some sort of military sexual trauma. Because so many more men serve, there are nearly as many male victims as female victims, VA says. Some 43,693 men and 48,106 women who were seen at a VA facility in fiscal 2008 reported experiencing sexual trauma during military service. This includes veterans from World War II through today. "These numbers suggest that the problem of military sexual trauma is not simply caused by women's increasing service as part of combat operations," Street says. "Women have conducted themselves superbly in both air and ground combat, and are here to stay," adds Helen Benedict, a Columbia University journalism professor and author of "The Lonely Soldier." "They need to be given all the respect any soldier deserves, and they need to not be afraid of soldiers on their side." Sexual trauma is not just a problem in the military, health-care experts emphasize. It's also pervasive in civilian society. Military sexual trauma, however, differs because incidents occur where victims live and work, keeping them in close proximity to perpetrators, Connie Lee Best, a clinical psychologist at the Medical University of South Carolina and retired Navy reserve captain, told Congress two years ago. The perpetrator often has a higher rank and can influence the victim's promotion and assignments. And "the risk of re-victimization is real," Best said. These are all reasons victims are reluctant to report sexual trauma. Victims may also see reporting assaults as conflicting with the military ethos of "strength and excellence, of sucking it up and getting on with the mission," Street says. Servicemembers are reluctant to even report sexual harassment because they fear retribution. It's a well-founded worry, Montoya says. A woman in her company complained about relentless sexual harassment and was blackballed by the rest of her unit, compounding her misery, she said. Such reluctance to report is understandable for other reasons. "In the civilian world, if you're sexually harassed at your workplace, you can legally quit your job," says Anuradha K. Bhagwati, executive director of the Service Women's Action Network. "If it happens in the military, you'd go to jail if you attempted to leave your job. It can be unbearable, even life-threatening, to be sexually harassed within an institution that fails to prosecute perpetrators and encourages silence, and oftentimes blames or punishes victims for reporting harassment, painting them as unfairly ruining the careers or reputations of servicemen, or for destroying unit cohesion." A Deeper Silence. Men find it particularly difficult to come forward. "There is the idea that, as a woman, you may experience a sexual assault," Street says. "There's not that idea in society when it comes to men. So when it happens to a man, there's no way to make sense of it." Veterans advocate Susan Avila-Smith agrees that, for men, the issue can be extremely difficult. Those who do come forward, she says, find "there are not a lot of services for them." Smith is a military rape victim and founder of Women Organizing Women, a group that assists both sexes. Jeff Elizalde kept silent about his rape for 30 years. Even today, he struggles with the memories, outrage and a sense of disbelief over what happened when he was a young Marine Corps private stationed on Okinawa in the late 1970s. "There were rumors that the staff sergeant had sexually assaulted other people, and they moved him around base to base," Elizalde recalls. "There were enough people there, I didn't think anything would happen." One night, he says, the sergeant invited Elizalde to accompany him to a party. Along the way, the sergeant knocked him out and dragged him into an empty hut. "When I came to , he was raping me," says the gray-haired 49-year-old veteran, his eyes watering. "I fought him off and ran." Elizalde soon was drinking as many as two cases of beer a day and blacking out. The 7th Marines put him in an inpatient alcohol-treatment program at Camp Pendleton that ultimately failed. Eighteen months after the assault, Elizalde hastily agreed to an "other than honorable discharge" instead of being court-martialed for drinking offenses and other disciplinary problems. Had he remained in the Marines, Elizalde feared he would be sent to Okinawa to finish his tour. Elizalde worked in his family's restaurant in northern California, then followed construction jobs to Oregon. He ruptured two disks in his neck in 1995 and, after battling with the Social Security Administration for five years, was declared 100-percent disabled. "If I had not had a brother during that time, I'd have been out on the street," Elizalde says. Today, he struggles to survive on his monthly Social Security check. He's fortunate to have access to some mental-health care as a result of his years as a union laborer, but he would prefer VA treatment. Three years ago, a television program about sexual abuse prompted Elizalde to finally tell a mental-health counselor at Kaiser Permanente about the rape. A letter from the counselor details Elizalde's flashbacks, outbursts of anger, and his tendency to barricade himself in his tiny condo after a nightmare. "It is my opinion that you suffer from post-traumatic stress disorder, secondary to being sexually assaulted in 1977," the counselor wrote. "In addition, I believe it is likely that your heavy drinking afterward was indeed a misguided effort to ‘self-medicate.'" The Portland VA Medical Center is willing to treat any assault-related problem for free, Elizalde says. But he cannot easily access the care because he lives 50 miles south of the facility and no longer has a car – a consequence of a drunk-driving arrest in early 2008. Meanwhile, Elizalde is frustrated by many failed attempts to have the terms of his discharge modified so he can access the full range of VA health care. "I want help from the military," Elizalde says, leaning against the edge of his weathered front door, which bears Marine Corps insignia. "I want them to admit I was wronged." He looks at the ground and slowly shakes his head. "I don't know what the future holds for me," he adds. "I do know that if there's me, then there's a lot more people like me." Coming Wave. Increasing awareness of military sexual trauma, veterans outreach, and repeated long deployments to Iraq and Afghanistan are expected to continue pressuring VA's mental-health resources. "I believe VA is staffed by some of the best mental-health providers and some with exceptional experience in military sexual trauma," Best, the clinical psychologist and university professor, told Congress in April 2007. But one of the problems VA faces in dealing with veterans who have experienced military sexual trauma is one of sheer numbers. As a character in the movie "Jaws" put it after seeing the legendary shark, "We're gonna need a bigger boat," Best said. "That is what I would say to VA: we are going to need a bigger boat." Last June, the U.S. House of Representatives passed legislation requiring VA to enhance programs for victims of military sexual trauma and PTSD, as well as expand health-care services for female veterans and their children. Meanwhile, military sexual-assault victims are running into the same type of bureaucratic hurdles that bog down many VA disability cases. VA ratings staff are often quick to reject military sexual-trauma claims because the VA Clinician's Guide deems the symptoms of PTSD "relatively easy to fabricate," says Rachel Natelson of the Service Women's Action Network. Claims raters also tend to dismiss mental-health diagnoses made by VA physicians. "Despite the fact that the majority of my own clients have submitted military sexual-trauma diagnoses from VA counselors, most have received decisions indicating they have failed to establish the condition, much less connected it to their service." Establishing service connection also can be difficult because sexual harassment reports are removed from personnel files every two years, adds Benedict, author of "The Lonely Soldier." Veterans often cannot produce the required records. Not all VA medical centers are complying with the mandate that they treat military sexual-trauma issues for free. VA's Inspector General launched a national review of the issue in May at the request of Sen. Daniel Akaka, D-Hawaii, after an audit revealed that nearly 90 veterans at the Austin Outpatient Clinic were inappropriately billed for military sexual-trauma care. Making a Difference. Victims find it difficult to use VA care for other reasons. The VA women's clinic closest to Mickiela Montoya is only open a few hours each Wednesday. That makes it inaccessible to Montoya, who works as a caregiver for a disabled teenager during the day, and as a waitress at night to make ends meet for herself and her 2-year-old daughter. "It's so absurd," Montoya says. "I go to a free women's clinic if I need anything." In addition to expanding programs for women, the military should take a tougher stand on sexual harassment as it steps up efforts to reduce the problem internally, Montoya says. "When the commander and the first sergeant are aware of it and make it clear they won't tolerate it, soldiers won't do it. But if they don't care about it ...." Meanwhile, Montoya plans to return to college to study political science, with the aim of speaking out and making a difference. "I'm not the first," she says of the troubles she's encountered as a female combat veteran, an assault victim and a single mother. "But I want to be one of the last." Ken Olsen is a freelance writer living in Oregon.