As more and more women have entered the military, awareness of sexual harassment, sexual assault, and rape occurring in service has increased. Relatedly, the number of claims for PTSD resulting from Military Sexual Trauma (MST) – sexual activity where a servicemember is involved against his or her will — has risen significantly over the past several decades.
As the Department of Defense (DoD) and the Department of Veterans Affairs (VA) began to respond to the increase in these claims, they realized that many male servicemembers and veterans (not just women) were survivors of in-service MST as well. According to the Veterans Health Administration, about 1 in 4 women and 1 in 100 men (that use VA healthcare) report that they have experienced an in-service MST event.
Because sexual assault is such a personal, sensitive, and potentially overwhelming experience, it is often difficult (or even impossible) for an MST survivor to report or document the event when it happens. There are many potential reasons for this, including fear of retaliation, feelings of shame and guilt, or the perception of an unresponsive military chain of command. As a result, MST survivors who experience PTSD or MST-related conditions often do not have sufficient evidence to show that the sexual trauma occurred.
In this post, we’ll discuss VA’s policies and procedures on claims for PTSD related to MST and common mistakes they make on MST-related claims. We’ll also explore possible evidence for an MST-related claim that comes from outside the veteran’s service records and re-evaluations for veterans who submitted MST-related claims before December 2011.
VA’s Definition of MST
Generally, Military Sexual Trauma (MST) refers to any sexual activity where a servicemember is involved against his or her will, including sexual harassment.
More formally, VA defines Military Sexual Trauma 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.”
VA defines sexual harassment as “repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”
Examples of MST
On their website, VA identifies some examples of MST (though incidents of MST are not limited to the following):
- The veteran may have been pressured into sexual activities (for example, with threats of negative consequences for refusing to be sexually cooperative or with implied better treatment in exchange for sex),
- may have been unable to consent to sexual activities (for example, when intoxicated), or
- may have been physically forced into sexual activities.
- Other experiences that fall into the category of MST include unwanted sexual touching or grabbing; threatening, offensive remarks about a person’s body or sexual activities; and threatening and unwelcome sexual advances.
Identity of the Perpetrator, Where MST Occurred
The identity or characteristics of the perpetrator do not matter. So, when applying for service connection, it doesn’t (legally) matter whether the perpetrator was a servicemember (of any rank) or a civilian, a male or a female, etc.
Whether the servicemember was on or off duty at the time does not matter.
And whether he or she was on or off base at the time does not matter.
If the servicemember experienced sexual trauma while on active duty, active duty for training, or inactive duty for training, they are considered by VA to have experienced MST.
Service connection for PTSD due to MST
VA considers MST to be the actual traumatic event or experience, not a diagnosis. Thus, a veteran cannot be service connection for the traumatic event itself, but can be granted service connection for conditions resulting from MST.
Though Military Sexual Trauma can result in a wide range of conditions (like depression and other mood disorders, or substance abuse disorders), the most common diagnosis for MST survivors is post-traumatic stress disorder (PTSD). VA refers to this diagnosis as “PTSD due to MST” in most of their publications and correspondence.
Service connection for PTSD in general
In general, service connection for PTSD requires:
- A medical diagnosis of PTSD;
- Credible supporting evidence that the claimed in-service “stressor” (the event that caused the PTSD) occurred; and
- A link, established by medical evidence, between current PTSD symptoms and the in-service stressor.
In the case of PTSD resulting from MST, the “stressor” would be the event in which the veteran was sexually harassed, sexually assaulted, or raped.
Importance of establishing a stressor in MST cases
As mentioned, finding “credible supporting evidence” that the stressor (e.g. the MST event) occurred is often more difficult in MST cases because of the difficulty of reporting MST events.
But establishing a stressor is very important in MST-related PTSD claims–not only because a confirmed stressor is necessary for granting service connection (and thus compensation), but also because a plausible stressor is necessary for VA to even order a Compensation and Pension exam (C&P exam) for the veteran.
Without a C&P exam, the veteran’s case will be weaker. At an exam, a VA medical examiner will review the veteran’s entire file and get additional details about the assault and associated symptoms. After completing the records review and the in-person exam, the examiner writes a ‘medical opinion’ – essentially, their judgment of whether or not the MST event actually occurred and whether it is associated with the vet’s current PTSD symptoms. These medical opinions carry a lot of weight for VA raters who make the final decision on a claim.
But, you may be asking, how are you supposed to establish a plausible enough stressor to get a C&P exam if there are no service records that document the MST?
Personal Assault PTSD & “Liberalized” Considerations
Fortunately, VA has recognized (after significant prodding from lawmakers and veterans advocates) that it is unreasonable to expect all MST survivors to have direct documentation (like service medical records or an official report) of their traumatic event, given the difficulty of reporting MST.
As a result, the evidence standard for establishing the stressor in certain types of PTSD claims has been “liberalized” – made easier. Though VA adjudicators do not always accurately follow these more liberal standards, it’s important to be aware of them so that you can appeal if you are denied service connection or even a C&P exam.
MST-related PTSD claims fall under the “personal assault” category of PTSD, in VA law. For claims that fall under this category of PTSD, objective documentation of the actual stressor is not necessary.
When objective documentation doesn’t exist, VA adjudicators are supposed to rely on “markers” found in the veteran’s service records or post-service records (usually from the VA or submitted by the veteran). “Markers” are instances of indirect evidence –like certain types of reports, lay statements, or behavorial changes—that “mark” (indicate) that the stressor may have occurred.
“Markers” & Potential Evidence
As discussed above, veterans need evidence to indicate that the stressor (the sexual trauma) actually occurred during service. But evidence can be hard to come by if the Military Sexual Trauma was not initially reported, so VA has special, more relaxed standards for what counts as relevant and credible evidence in MST cases.
Throughout the claims process—when deciding whether to grant a C&P exam, making a final decision, or any other step involved—VA adjudicators and VA medical examiners are required to rely on “markers” when direct evidence does not exist. Adjudicators are also instructed to apply a “liberal and open-minded approach” when reviewing the veteran’s file for markers.
The term marker refers to signs, events, or circumstances (in the available evidence) that indicate a possibility that the claimed stressor occurred (such as reports, lay statements, or behavioral changes) and that may be associated with the approximate timeframe of the claimed stressor. According to VA’s standard training on MST-related claims, any marker appearing during the approximate timeframe of the MST stressor should be sufficient to go forward with scheduling a C&P examination.
The applicable law identifies two categories of markers: those involving “records” other than service records, and those involving “behavior changes” occurring during service or at some (relevant) point following service.
The personal assault PTSD law specifies some examples of sources of records that can be used in Military Sexual Trauma cases and that might contain markers that could substantiate an MST claim. Sources of records include, but are not limited to:
- Law enforcement authorities,
- Rape crisis centers,
- Mental health counseling centers,
- Pregnancy tests,
- Tests for sexually transmitted diseases,
- Statements from:
- Family members,
- Fellow service members,
- Clergy members.
Under its Duty to Assist law, VA is required to help the veteran find and obtain these records if possible. Every VA Regional Office has at least one MST coordinator that can help you gather evidence. You can request a male or female coordinator if it makes you more comfortable discussing your case.
Lay statements – written statements from non-experts – can be very useful in PTSD due to MST claims if they are credible and relevant to the case. VA law (see list above) includes statements from family members, roommates, fellow service members, and clergy members as potential sources of evidence/markers. Veterans are not limited to these sources either.
But the credibility of lay statements is judged on a case-by-case basis and statements that adjudicators do not consider credible will not necessarily count as a marker. On the other hand, statements that seem very credible may carry more weight than other types of evidence in the case.
So what makes a lay statement credible? Ideally, lay statements would have been produced during the time frame of the claimed stressor – like a report, letter, email, text, or journal entry written on the day of the incident or in the following months. But lay statements produced years after the MST stressor can also be seen as credible as long as they reference the time frame of the stressor “in a credible manner.” That is, the statement should not contain details that conflict with the veteran’s account of the MST event or its aftermath and the writer of the statement should have personal knowledge of the event and/or how it affected the veteran.
Even if an MST survivor did not report his or her MST to the military, otherwise unexplained changes in his or her behavior can often be found in service records or other evidence. So, under VA law, evidence of behavior changes during the relevant time frame (after the MST event) constitute a marker.
Performance evaluations or records of disciplinary action or special treatment are often sources for this kind of information and are already included in your service record. So, for example, adjudicators should be looking for and labeling as a marker any performance reviews that show the veteran was less efficient or competent, more irritable or angry, less social or positive, etc. after the claimed date of the MST event.
Records from after service can also show behavioral changes. For example, treatment for mental disorders or substance abuse (especially treatment during the immediate years following separation from service) can indicate behavioral change as long as the reason for treatment was not another potentially stressful or traumatic incident – like an automobile accidents, the death of a significant other, domestic conflicts, etc.
In the relevant VA law, manifestations of behavior changes include, but are not limited to:
- Requests for transfer to another military duty assignment,
- Deterioration in work performance,
- Substance abuse,
- Episodes of depression, panic attacks, or anxiety without an identifiable cause,
- Unexplained economic or social behavior changes.
Re-evaluations for pre-Dec. 2011 MST-related claims
VA’s failure to follow the liberalized standards for MST-related claims resulted in special training beginning in December 2011. They re-trained all VA regional office personnel who process MST-related claims and the mental health clinicians conducting the examinations related to these claims. The (ongoing) training focuses on getting VA officials to recognize “markers” that support the claim instead of looking for direct, objective evidence that the stressor occurred.
For this reason, VA allows all veterans who filed MST-related PTSD claims before December 2011 to request a re-evaluation from their local VA regional office.
New evidence for Re-evaluations
VA will accept new evidence to be reviewed when a claim is re-evaluated. It’s best to send any new evidence at the same time as you request a re-evaluation. MST specialists and/or Women Veterans Coordinators (there’s one at every VA regional office), can help you determine what type of information is best to submit.