Unique risks for women who serve in combat

Women have served in the U.S. Armed Forces since the Revolutionary War, but not always as combat soldiers. The issue of women in combat was tangentially before the public following the end of the draft in 1973. Two years later, registration for the military draft was discontinued. But after the Soviet Union invaded Afghanistan in 1980, President Jimmy Carter determined it was necessary to reinstitute the registration process. The president requested funds to reactivate the Selective Service system for registration of both men and women, but Congress only allocated funds for the registration of men. In 1981, Rostker v. Goldberg was issued by the U.S. Supreme Court. The case held that Congress had acted well within its constitutional authority to raise and regulate armies and navies when it authorized the registration of men but not women. It noted that deference to Congress is perhaps most appropriate in the areas of national defense and military affairs. The court stated that Congress held hearings in response to the president's request for authorization to register women, and its decision to exempt them was not the accidental byproduct of a traditional way of thinking about women.

Over a decade after the Rostker decision, limitations on women in combat were made official. In 1994, the Department of Defense issued a "ground combat exclusion policy, excluding women from assignment to units below the brigade level whose primary mission is to engage in direct combat on the ground. In 2012, 14,000 additional jobs were opened for women in the military, primarily in the Army and Marine Corps. Nonetheless, upward of 238,000 military jobs were still off limits to women. Since Jan. 24, 2013, however, women have been officially authorized to serve in combat. They fought long and hard for that right. But we are learning the physical challenges to women who serve in combat are sometimes different than those faced by men.

At the conclusion of military service, just like the men, women transition back into civilian life. It is expected that by 2020, more than 2 million women will be in the veteran population. Their health experiences and needs are often unlike those of male veterans.

Surprise, surprise, that testosterone makes a difference. The hormone causes the development of a heavier and stronger skeleton in males and shapes the male pelvis in a way that allows for greater strength and load bearing. It also increases heart and lung function, affecting endurance. Because of estrogen, women have less lean body mass and greater laxity of ligaments. The upper and lower body mass muscles are much greater in men than in women. Military studies report that women have 40 to 50 percent less muscle strength than men.

Just like the men, the women are expected to carry 100-pound packs, and, depending on their jobs, other heavy equipment. In armor units, for example, they have to load 35-pound rounds again and again. Long term pelvic pain can result from routine military maneuvers performed repeatedly. All in all, women have to exert themselves more to achieve the same output as men. Consequently, the attrition rate of women versus men in combat units is greater. An article published by the Office of the Surgeon General reports that the diagnosis of pelvic stress fracture has been reported in one out of 367 female recruits as compared to one in 40,000 male recruits. Army women are approximately 67 percent more likely than Army men to receive a physical disability discharge for a musculoskeletal disorder.

Another difference is that women are typically shorter than men. And shorter soldiers are usually assigned to the rear of marching formations. Thus, the shorter soldiers need to overstride to keep pace with the taller ones, increasing the tension placed on ligaments and sometimes causing stress fractures.

Gynecology related conditions such as urinary tract infections are more common in severe climate and environment. Some literature suggests abnormal Pap smears are increased in war zones. Sometimes pelvic organ prolapse comes about from repeated load bearing. Even menstruation can be logistically challenging in combat settings, resulting in problems. Sleep deprivation and stress can cause a cessation of menstruation, a decrease in female hormones, and eventually may result in osteoporosis.

We must not forget military sexual trauma. Several law review articles report that the likelihood that a woman veteran suffered from sexual abuse in the service is so high that a woman serving in combat is far more likely to be sexually assaulted by a fellow service member than to be killed by enemy fire. Rapes are sometimes referred to as friendly fire. Women suffer from the effect of these assaults for years after leaving the military. Sexual violence contributes to chronic illness, major depression and diminished overall health. It can also lead to chronic alcohol and drug abuse.

Where do women receive treatment for their injuries? Many women who have accessed treatment at hospitals operated by the Department of Veterans Affairs feel unwelcome, perceiving the staff to be under-skilled and insensitive to their needs. So they often discontinue their care at the VA and seek civilian help instead.

Alarmingly, a 2016 press release issued by Vietnam Veterans of America states that since 2001, "the rate of suicide among female veterans who use VA services increased 4.6 percent, while the rate of suicide increased 98 percent among female veterans who do not use VA services."

The military is aware that much of its equipment such as backpacks, vehicles, weapons, camouflage gear are designed and structured to fit the average male soldier's physique, and is trying to deal with the challenges. The Department of Veterans Affairs is also well aware of the increased needs of women veterans for health services, and has been trying to prioritize improved services for female veterans. Hopefully, adjustments will be made to assign soldiers to their physiological abilities, and improvements in health care for women veterans will be forthcoming.

Most of us don't think of women as veterans, and lawyers should be aware that women don't tend to identify themselves as veterans. Accordingly, women should be asked if they ever served. The answer to such a question could lead to a discussion that might be important in personal injury cases where past, current and future health matters are at the heart of the action. Employment disputes could be somehow associated with problems encountered in the military. Child custody disagreements may very well be related to injuries or illnesses arising from military service. Domestic violence issues appear across the gamut of cases throughout the courthouse, and a woman's exposure to violence in both combat and non-combat situations in the military may have bearing on how that topic is presented to the court. In criminal matters, a woman's prior military service might make all the difference in the disposition of her case. A routine question ought to be, "Have you ever served in the military?"