Consensus Study Report

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This activity was supported by contracts between the National Academy of Sciences and the U.S. Office of Personnel Management (Contract No. 24322624C0004) and the General Services Administration (Contract No. 47QACA25C0075) and prepared for the Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2026. Improving disability evaluations for veterans who have experienced military sexual trauma. Washington, DC: National Academies Press. https://doi.org/10.17226/29453.

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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

HORTENSIA AMARO (Chair), Florida International University

SARA KINTZLE, University of Southern California

HEATHER KRULL, RAND

HAROLD KUDLER, Duke University

MARY JO LARSON, Brandeis University

SUSAN MCCUTCHEON, Department of Veterans Affairs (retired)

MARIE-CHRISTINE NIZZI, Spaulding Rehabilitation Hospital

LOGAN C. PETERSON, Uniformed Services University of the Health Sciences

CAROLYN M. PORTA, University of Minnesota

DAVID N. SMITH, Yale University

Study Staff

LESLIE Y. KWAN, Study Director (from July 2025)

CRYSTAL J. BELL, Study Director (until July 2025)

JENNIFER ZHU, Associate Program Officer (from May 2025 until July 2025)

ANNA ADLER, Research Associate

AJA DRAIN, Research Associate (from September 2025 until January 2026)

ABIAN HAILU, Senior Program Assistant (from April 2025)

ELIZA SOUSER, Senior Program Assistant (until March 2025)

SHARYL J. NASS, Senior Program Director

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by SANDRO GALEA, Washington University in St. Louis, and PAUL A. VOLBERDING, University of California, San Francisco. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Acknowledgments

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 would like to thank the many individuals who contributed to the development of this report.

The committee acknowledges the support of staff in the Health Care and Public Health Program Area in the Center for Health, People, and Places of the National Academies of Sciences, Engineering, and Medicine, especially the guidance and efforts of Leslie Kwan, Anna Adler, Aja Drain, Jennifer Zhu, and Crystal Bell, whose work was invaluable in gathering information, organizing meetings, and shaping and editing this report. The committee also extends its gratitude to Abian Hailu and Eliza Souser for their support with meeting logistics and manuscript preparation. Sharyl Nass provided essential guidance throughout the project to both committee and staff. We also thank Anne Styka, Tracy Lustig, Stephanie Puwalski, Torrie Brown, and Rose Marie Martinez for their additional support. This study also received valuable assistance from Julie Wiltshire (Office of the Chief Financial Officer); Leslie Sim and Radiah Rose (Office of Peer Review); Rebecca Morgan (National Academies Research Center); Doug Sprunger, Beth Ewoldsen, and Sam Gerard (National Academies Office of Communications); Solomon Self (Office of News and Public Information); and Elizabeth Eide, Samantha Chao, and Lori Brenig (Center for Health, People, and Places Executive Office). Their perspectives enriched the study.

The committee would also like to extend our thanks to Henry E. Bridges, James Eggers, Earl Hutchinson, Stephanie Hyberger, Courtney

Pederzani, Stacey Pollack, Konane Stradling, Amy Street, and Abigail Werner for their informative presentations about Department of Veterans Affairs disability determination process, especially compensation and pension examinations, for claims related to military sexual trauma. The committee also thanks Carlos Fuentes and Jenny Tang for sharing the interest and origin of the congressional legislation requiring this study. The committee is grateful to Herman K. Breuer, Christine Clemens, Julie Howell, Naomi Mathis, Jennifer McGuire, and Cindy Noel for sharing their perspectives on the experiences of veterans who have experienced military sexual trauma in navigating Department of Veterans Affairs disability compensation process. Additionally, the committee thanks the representatives from the four contracted examination vendors: Leidos QTC Health Services, Loyal Source Government Solutions, Optum Serve, and Veterans Evaluation Services, especially Maria Baker, Robin Carter-Visscher, Michael Dean, Angela Gray, Shawn Mellon, Raul Mirza, Rob Nydam, Larry Schaefer, Karen Seymore, Barbara Shipp, Cindy Shore, and Lauren Skloss, who provided invaluable insight about the implementation of Department of Veterans Affairs policies, procedures, and tools for compensation and pension examinations related to military sexual trauma.

Contents

PREFACE

ACRONYMS AND ABBREVIATIONS

SUMMARY

Statement of Task and Committee Approach

Competencies, Training, and Quality Assurance

Improving C&P Examinations

1 INTRODUCTION

Statement of Task

Committee Process and Approach

Overview of This Report

References

2 MILITARY SEXUAL TRAUMA AND HEALTH

Health Conditions Related to MST

Summary

References

3 COMPETENCIES FOR CONDUCTING MILITARY SEXUAL TRAUMA-RELATED DISABILITY EXAMINATIONS

C&P Examiner Competencies

MST Training

Training Assessment and Continuous Quality Improvement

Summary and Recommendations

References

4 THE COMPENSATION AND PENSION EXAMINATION PROCESS FOR DISABILITY COMPENSATION CLAIMS RELATED TO MILITARY SEXUAL TRAUMA

Filing an MST-Related Disability Claim

Claims Development

Examination and Medical Opinion Request

The C&P Examination

Reviewing the Claim and Rating the MST-Related Disability Using the VASRD

Claims Decision and Appeal

Summary

References

5 IMPROVING THE COMPENSATION AND PENSION EXAMINATION PROCESS FOR DISABILITY COMPENSATION CLAIMS RELATED TO MILITARY SEXUAL TRAUMA

Improving the C&P Examination

Standards of Evidence in Support of MST-Related Disability Compensation Claims

Concluding Remarks

References

APPENDIXES

A Public Law 117-289

B Biographical Sketches of Committee Members and Staff

C Public Meeting Agendas

D Personal Trauma Development Checklist and Instructional Guide

E VA Form 21-0781

F Personal Trauma Incident/Marker Worksheet

G Medical Opinion Disability Benefits Questionnaire

Boxes, Figures, and Tables

BOXES

S-1 Statement of Task

S-2 Trauma-Informed Principles

S-3 Examiner Competencies

1-1 Statement of Task

1-2 Trauma-Informed Principles

3-1 Example Exemplar Medical Opinions of Service Connection for MST

3-2 Contract Medical Disability Exam Checklist

4-1 Example of a Typical Medical Opinion Request for PTSD Related to MST

FIGURES

S-1 Summary of the Department of Veterans Affairs disability determination process for military sexual trauma-related claims that include compensation and pension examinations

3-1 Miller’s Competency Pyramid

3-2 Medical Disability Examination Office fiscal year 2024 quality performance thresholds for financial incentives for contracted disability exams

4-1 Summary of the Department of Veterans Affairs disability determination process for military sexual trauma-related claims that include compensation and pension examinations

TABLES

3-1 Summary of Statutory Scope of Practice Authority for Selected Mental Health Professions Across States

3-2 Summary of VHA and VBA MST Training Courses

4-1 Monthly Veterans Disability Compensation Rates for 2026

5-1 Ten Most Frequently Service-Connected Conditions for MST-Related Disability Claims, Fiscal Year 2025

5-2 Ten Most Common Reasons for Rejection of MST-Related Claims

Preface

Since the beginning of our Republic, U.S. presidents, leaders, and the public have expressed gratitude and sought to recognize the sacrifices of those who have served in the military. This has been considered a “sacred obligation” to veterans, their families, and survivors. Indeed, the motto of the Department of Veterans Affairs is “[t]o fulfill President Lincoln’s promise to care for those who have served in the nation’s military and for their families, caregivers, and survivors.” In the spirit of Theodore Roosevelt’s call to provide veterans with a “square deal” after their service to the country, there have been continuous efforts to deliver on this promise. This report is a continuation of efforts to assess specific aspects of the disability benefits processes, in this case for claims involving military sexual trauma.

Approximately one in three women and one in 50 men veterans report having experienced sexual trauma, including incidents of sexual assault and sexual harassment, during their service in the military. Many survivors of military sexual trauma experience adverse health outcomes that can be immediate and enduring or appear years after separation from military service. The Department of Veterans Affairs provides disability compensation related to these conditions, but veterans have reported challenges pursuing these benefits, including unclear and inconsistent processes and decision-making, burdens associated with providing multiple forms of proof, and retraumatization due to claims processors and clinicians who are insufficiently trained in trauma-informed approaches.

In accordance with Public Law 117-289, this committee was formed to conduct a study to assess tools and protocols of compensation and pension examinations for claims related to military sexual trauma, as well as

the credentials and training of the clinicians performing these exams. The multidisciplinary committee of nationally recognized scientists, clinicians, and veterans offers this report with recommendations for Congress and the Department of Veterans Affairs. We hope that the information and recommendations will reduce harms to veterans, improve the experience of veterans, simplify claims development and research, modernize and strengthen training, improve rating accuracy, and increase fairness in the disability compensation process for military sexual trauma-related claims.

Hortensia Amaro, Chair
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
April 2026

Acronyms and Abbreviations