WASHINGTON — The U.S. Department of Veterans Affairs and Congress should take steps to improve the disability evaluation process to ensure that veterans receive timely and accurate compensation for disabilities related to sexual trauma experienced during military service, says a new congressionally mandated report from the National Academies of Sciences, Engineering, and Medicine.

Approximately 1 in 3 women and 1 in 50 men report having experienced sexual trauma during their service in the military, including incidents of sexual assault and sexual harassment. Evidence indicates a higher prevalence of sexual assault and sexual harassment in the military compared to the general population. Many survivors of military sexual trauma (MST) experience health problems — such as injuries, sexually transmitted infections, post-traumatic stress disorder (PTSD), anxiety, depression, or chronic pain, among others — that can be immediate and enduring or appear years after military service ends.

The VA provides disability compensation related to these conditions, but veterans have reported challenges pursuing these benefits, including unclear and inconsistent processes and decision-making, as well as burdens associated with providing multiple forms of proof. Veterans have also reported that the claims process is retraumatizing.

“We hope that our recommendations will reduce harms to veterans and improve their experience when making MST-related claims, modernize and strengthen training, and improve accuracy and fairness in the disability compensation process,” said Hortensia Amaro, distinguished university professor and senior scholar on community health at the Wertheim College of Medicine and Stempel College of Public Health and Social Work at Florida International University, and chair of the committee that wrote the report.

Improving Training for Examiners

The report recommends strengthening training for examiners (including trainees) who conduct compensation and pension examinations for claims related to MST. Before performing any MST-related examinations, all examiners should complete training and demonstrate proficiency in five core competencies:

• Military sexual trauma and health: Knowledge about MST and its health consequences and the application of that knowledge to assess claimed conditions, their effect on functioning, and their relation to MST.

• Trauma-informed approach: An approach to caring for patients to minimize the potentially harmful effects of the trauma and of healthcare encounters.

• Laws and regulations governing MST claims: The knowledge and application of the legal and regulatory context in which disability determinations for MST-related claims occur.

• Military structure and culture: Knowledge of military structure, norms, culture, and values and the application of that knowledge in understanding how they may cause challenges for service members and veterans in healthcare encounters and how they affect the risk and disclosure of MST.

• Medical opinions: Skills to develop clinical opinions about service connection and impairment sufficient for the Department of Veterans Affairs to adjudicate claims.

Ensuring a Trauma-Informed Disability Examination Process

The report recommends improvements to the examination process, including improving coordination when scheduling multiple examinations; establishing standards for information systems and examination facilities; clarifying inconsistent procedures; and ensuring that conditions associated with MST are captured in the VA’s disability rating system. 

Simplifying Evidentiary Requirements for Military Sexual Trauma

The report also urges the simplification of statutory and regulatory requirements to produce evidence of MST, which has been a major barrier to substantiating disability claims related to MST.

Currently, the VA has two standards of evidence for MST-related disability compensation claims. For PTSD claims, the VA allows lay evidence such as statements from friends and family and evidence of behavioral changes to support a claim that the condition is related to MST. For claims related to other health conditions, federal law and VA regulations require evidence from military and in-service medical records, such as a formal report or diagnosis of MST. This means that if service members do not report sexual traumas at the time they occur, the lack of a record can impede their future access to VA disability benefits.

Certain elements of military structure and culture — an emphasis on hierarchy, authority, masculinity, and team cohesion — can add to a survivor’s reluctance to report their experiences of MST, the report notes. Requiring formal documentation of MST creates a standard of evidence that many veterans are unable to meet, thus likely leading to claims denials for genuinely service-connected conditions. MST-related claims are more likely to be denied than combat-related claims, the report notes, and the likelihood of denial increases for men and Black claimants.

To remedy this, the VA should use a single evidentiary standard and process to assess all claims related to MST. Congress should enact legislation directing the secretary of veterans affairs to accept evidence of MST from laypeople or other sources as sufficient proof of its occurrence, regardless of whether there is an official service record of the sexual trauma or an associated health condition. Assuming there is no evidence to the contrary, such information should be sufficient to establish service connection for any condition claimed to be related to MST if a VA or VA-contracted clinician also confirms that the claimed disability is related to MST and if the MST described is consistent with the veteran’s service.

The study was undertaken by the Committee on the Assessment of Department of Veterans Affairs Physical and Mental Health Examinations and the Department's Schedule of Rating Disabilities for Disability Compensation Claims Related to Military Sexual Trauma and sponsored by U.S. Department of Veterans Affairs and the Office of Personnel Management.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, engineering, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

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