A Black Rose

During their service, both female and male Service members sometimes have upsetting, unwanted sexual experiences, including sexual assault or sexual harassment. “Military sexual trauma” or MST is the term used by the U.S. Department of Veterans Affairs to refer to these experiences.  The official definition of MST used by VA is given by federal law (U.S. Code 1720D of Title 38). It is:

Psychological trauma, which in the judgment of a VA mental health professional, 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.

Sexual harassment is defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”

In more concrete terms, MST includes any sexual activity where you were involved against your will. You may have been physically forced into sexual activities. Or, no physical force may have been used but you were coerced or pressured into sexual activities. For example, you may have been threatened with negative consequences for refusing to cooperate. Or it may have been suggested that you would get faster promotions or better treatment in exchange for sex. MST also includes sexual experiences that happened while you were not able to consent to sexual activities, such as if you were intoxicated. Other MST experiences include unwanted sexual touching or grabbing, threatening, offensive remarks about your body or your sexual activities, and threatening and unwelcome sexual advances. If these experiences occurred while you were on active duty or active duty for training, they are considered to be MST.

“I remember the faces, the words, the smells, the negative, the unwarranted, unsolicited touches. I remember all of that. And I have friends who also are Veterans and went through worse than I did.”

It’s important to know that MST can occur on or off base, and while a Service member is on or off duty. Perpetrators can be men or women, military personnel or civilians, superiors or subordinates in the chain of command. They may have been a stranger to you, or even a friend or intimate partner. Veterans from all eras of service have reported experiencing MST.

If you experienced military sexual assault or harassment, you may blame yourself or feel ashamed. It is important to remember that MST is not your fault. Nothing ever justifies someone harassing or assaulting you.

Air Force veteran Lisa Wilken, second from left, testifies Friday before the House Veterans' Affairs Committee's health panel during a hearing entitled 'Safety for Survivors: Care and Treatment for Military Sexual Trauma' in Washington. (Mike Morones / Staff)

The Defense and Veterans Affairs departments are failing to provide adequate mental health services to troops and veterans with post-traumatic stress disorder caused by sexual assault — a deficiency that contributes to lifelong struggles, military rape survivors told Congress on Friday.

Earlier this week, the DoD Inspector General reported that more than 10 percent of sexual assault allegations within the military are not adequately investigated.

Speaking before the House Veterans’ Affairs Committee’s health panel, four former troops said the military and VA also fail to provide adequate, timely access to health services and counseling for sex assault victims.

“Why is PTSD related to sexual assault so long lasting? It’s because it’s not properly treated or dealt with,” said Lisa Wilken, a former airman who was raped at age 22 by a co-worker.

The Pentagon estimates that 26,000 incidents of sexual assault, ranging from unwanted sexual contact to rape, occur each year across the services. But only about 3,600 are reported, according to anonymous surveys conducted by DoD.

Many don’t file reports out of fear of reprisal, concern for military careers or because they didn’t want anyone to know, according to the surveys.

But victims also don’t seek help because they have no faith the system, according to lawmakers.

None of the speakers was ever asked about their military history or sexual assault by initial screening physicians at VA and DoD; just one had received one-on-one mental health counseling for PTSD; and all wanted to avoid getting care at VA because of the prior treatment they’d received.

“When I had appointments at VA where [the sexual assault] was not addressed or acknowledged, I felt victimized and belittled again,” said former Marine Corps Maj. Tara Johnson, who said she was assaulted by a senior officer while attending Officer Candidate School in 1994.

For men, proper treatment at VA for sexual assault-related PTSD is even more elusive, said Brian Lewis, a former sailor and victims advocate who was beaten and raped in 2000 by a male senior on the submarine tender Frank Cable.

According to Lewis, only one of VA’s 12 residential treatment programs for sexual assault-related PTSD accepts male patients.

He attended that program, at Veterans Affairs Medical Center Bay Pines, Fla., to find that group therapy often was coeducational, a situation he found uncomfortable.

And when he attended outpatient therapy at his local VA hospital, he found there were no outpatient groups for male rape victims and he was not allowed to attend the women’s group. Instead, he went to a PTSD group where he was reluctant to discuss his issues around combat veterans.

“This marginalizes male survivors by forcing them to maintain their silence about their experience,” Lewis said.

Last year, VA treated 85,474 patients for care related to sexual trauma, an increase of 11 percent over 2011.

Each VA medical center has a military sexual trauma coordinator responsible for patient oversight, said Dr. Rajiv Jain, VA assistant deputy under secretary for health for patient care services.

“VA is committed to ensuring eligible veterans have access to the counseling and care they need to recover” from military sexual trauma, Jain said.

Last year, the VA Inspector General reviewed the health records of 166 female veterans with a history of military sexual assault to determine their access and quality of care received. The IG found that more than three-quarters of patients were involved in two or more types of outpatient treatment, 72 percent received individual therapy, 67 percent were on medication and 37 percent participated in group therapy.

It also found that most of VA’s inpatient programs for sexual assault-related PTSD were underutilized.

The IG recommended VA establish a comprehensive resource list on military sexual trauma for providers and ensure that coordinators have time to fulfill their outreach roles.

According to the IG, most VA programs for military sexual assault “are a valuable resource available to serve clinically complex veterans with a history of military sexual trauma, and associated mental health and psychosocial burden,” Dr. Michael Shepherd of the VA IG office testified at the hearing.

But lawmakers said that response falls short of veterans’ expectations.

“Hearing the first panel was disconcerting, devastating. Your response to the testimony doesn’t seem that the sense of urgency is there,” said Rep. Julia Brownley, D-Calif.

“I feel like we’re in two separate worlds,” said Rep. Jackie Walorski, R-Ind. “We just heard gut-wrenching testimony from courageous people whose lives have been ruined, and I’m frustrated because I’ve been asking questions since I’ve been here. The customer service may be going great for those who access the programs, but for tens of thousand of people, it isn’t working.”

House and Senate lawmakers of both parties continue to press the Pentagon to revamp the military justice system to remove decisions on prosecution, trial and punishment for sexual assault from the chain of command.

The House in June passed a bill sponsored by Walorski that would require the inspector general to investigate allegations of retaliation in connection with service members reporting sexual assault and to treat reports on sexual assault as communications protected by military whistleblower laws.

Veterans at the hearing said they have little hope VA will be able to provide adequate care and pressed for the department to bolster programs that would allow them to see private practitioners at VA expense.

“We need the ability to go out of VA if the services we need are not available,” Wilken said. “There are a lot of men and women who will not come to VA because of the experience they had in the military.”

By, Patricia Kime

Elements of Your Claim Military sexual trauma [6] (MST) is sexual harassment that is threatening or physical assault of a sexual nature. Both men and women serving in the military can suffer from MST. MST is an experience, not a diagnosis. MST may cause disabling conditions such as post traumatic stress disorder (PTSD), anxiety, depression and sexual arousal disorder. Your claim for VA Disability Compensation (“VA benefits”) must identify at least one “disabling condition.” The VA addresses MST differently than other issues because of its severity and complexity.

To win an MST claim you will need the following:

1. Completed VA Form 21-526 [7]
2. Diagnosis of PTSD, anxiety, or depression from your healthcare provider.
3. Nexus Letter (see definition of “nexus” below) signed by your doctor.
4. Evidence

Filing Your Claim It is important to file your claim as soon as you can. When a claim is awarded, the compensation is calculated back to the date you filed your claim. Do not rush while filling out the form. Every section must be filled out except for sections VII, VIII, IX, and X. If something does not apply to you, then put ‘N/A,” “not applicable.” Do not leave any of the required boxes blank as this may delay your claim. You do not need to attach all of your evidence when you first file. You can send your nexus letter (see explanation below) and other evidence as you collect it. Go to our "How to File A VA Claim for Disability Compensation" [8] guide for more help on filling out VA Form 21-526 [7].  Make copies of everything you send to the VA.

Diagnosis You must have a diagnosis, for example PTSD, anxiety, depression and/or sexual arousal disorder from your doctor. Again, filing for “MST” won’t work because MST is the cause, not the condition.

Nexus Letter/Note A letter from your doctor or a note in your medical record saying it is “more likely than not” that your disability was caused/aggravated by an event during your military service (service-connected) is a “nexus letter or note.”

For example, a nexus letter needs to say:

"After reviewing the medical records of [Veteran's name], it is my opinion that more likely than not, her/his [insert the condition you are filing for] is a direct result of military sexual trauma s/he experienced while serving on active duty."

Evidence One way that MST claims are treated differently is the use of “alternative evidence.” In the past, evidence of sexual assault (service medical records (SMR), police reports, and rape-kits) was often "sanitized" (deleted) from military records. Or, evidence never existed in the first place because the victim did not come forward for fear of retaliation and/or reprisal. Because MST claims usually lack “traditional” evidence, a person filing for a service-connected condition, mental illness and/or a physical disability caused by MST can fill out VA Form 21-0781a [9]. The information requested through this form can help you supply the evidence you will need to substantiate your claim. 

If you have recently experienced repeated harassment, assault and/or rape and are currently in the service, it is very important to request that your military records be saved and unaltered for 50 years. This is referred to, in military terms, as “retention of restricted report documentation.” This means that your military records cannot be “sanitized or destroyed.” This is important so that evidence critical to your claim will not be destroyed.

When gathering evidence, you must:

• establish the event (sexual harassment and/or personal assault),
• prove that the event caused (or aggravated) your condition, and
• prove that you still suffer from the condition.

If military records have not been sanitized or destroyed, then the VA will more readily find records from any military institution you went to for assistance, such as the military police or medical facilities. Also, civilian police departments, hospitals and clinics are more likely to keep your records unaltered. Evidence from a hospital can help win your claim. The VA can request treatment records from non-military hospitals or clinics only if you complete a VA Form 21-4142 [10] consent form. You must complete a form for each medical facility you are trying to get records from.

You can accomplish the first two requirements noted above by completing the alternative evidence form, VA Form 21-0781a [9].

Important: While the form allows for two incidents to be used as evidence, many experts advise against filling out a second incident. That is because the extra time needed for investigation will further delay what may become an already long claims process. If you can get police or treatment records of any kind for any incident, use that incident to complete the alternative evidence form.

Send in copies of any records that show changes or problems in your military service after the assault:  a decline in performance, going to sick call, being AWOL, Article 15, civilian hospital appointments, abortion clinic records, etc. Also, send letters from people who knew you at the time or who knew you before and after your service.  They should describe your behavioral changes. Each letter should be signed: “I swear this is true and accurate to the best of my knowledge.”

Global Assessment of Function (GAF) scores can be assigned by your mental health providor at each appointment you have. Attach your GAF score to VA Form 21-526 [7] or send it in with your VA file number (usually your social security number) by certified mail, return receipt requested. To get a GAF score, you may need to specifically ask for one.

Military sexual trauma [6] (MST) is an event, not a diagnosis. MST may cause disabling conditions such as post traumatic stress disorder (PTSD), anxiety, depression and sexual arousal disorder (SAD). Any veteran suffering from any one or more of these or other conditions as a result of MST can seek free treatment for the MST-related conditions at Veterans Health Administration (VHA) facilities, as well as VA Vet Centers.

Who is eligible? Veterans who have experienced MST are eligible for VA health care services specific to their MST.  Veterans with MST may have served stateside or overseas, in non-combat and/or combat assignments, during any war or peacetime era and for any length of time. “Veteran” includes Reservists and National Guard members who were activated to full-time duty status in the Armed Forces. This also includes service members who were activeduty for training (ADUTRA). You only need to state that you experienced MST to be eligible for counseling.

How much does the treatment cost? Once a Veteran asks for the care, the VA, including Vet Centers, must provide free care for mental and physical health conditions related to MST. The clinician providing care determines whether the care is MST-related or not. Veterans receiving MST-related counseling and treatment don’t need to pay inpatient, outpatient, or pharmaceutical co-payments.

How does VHA treat MST? Every VA facility has an MST Coordinator who can help you find and access VA services and programs. These include counseling and out-patient programs. VA also has special residential (live-in) or in-patient sexual trauma treatment programs. To begin treatment, find a VA medical facility near you [7] and ask to speak with the MST Coordinator. If you are uncomfortable asking for these services directly, you can:

• ask to speak to the VHA Medical Center Women Veteran Program Manager (WVPM),
• make an appointment with a VHA primary care or other trusted provider, or
• go to a VA Vet Center counselor

Then you can tell your clinician in the privacy and safety of the exam room about your MST issue.

You can also bring support with you—a family member, friend or buddy—if this will help you get connected with the VA providers.

You have the right to request a provider of a specific gender to ensure you feel safe and comfortable, such as a counselor who is the opposite gender of the person who assaulted you.

All veterans are required to be screened for MST when they visit a VA facility.

Where do I find treatment? ● Medical Centers: VHA Medical Centers are hubs for VHA healthcare where you can receive counseling and referrals to other services. These are also usually the sites of the medical center MST Coordinators who oversee MST treatment efforts and can be an informative resource. 

● Outpatient Clinics and Community-Based Outpatient Clinics: CBOCs offer outpatient sexual trauma counseling, care, and services. Scheduling for outpatient MST-related care should occur within 30 days, consistent with VHA performance standards of scheduling for special populations and mental health clinics. MST-related care is not subject to outpatient co-payments.

● Vet Centers: Sexual Trauma and Harassment Counseling is offered to male and female veterans, non-combat and combat with stateside and overseas assignments of all eras.  Vet Center services include individual readjustment counseling, referral for benefits assistance, group readjustment counseling, liaison with community agencies, marital and family counseling, substance abuse information and referral, job counseling and placement, sexual trauma counseling*, and community education.

*Assessment and referral for sexual trauma counseling are available at all Vet Centers [8], but on site counseling is only available at select Vet Centers across the country.

What other help can I find? Many treatment options and resources exist.  MST can happen to any male or female servicemember. There are residential and non-residential gender-specific care services and programs available.  If you qualify for an in-patient or residential program that is not close to home, the VA is required to provide travel assistance. Veterans who experience MST can gain some closure and validation through filing a well-prepared MST disability claim. Our How to File a Well-Prepared MST claim [9] guide gives a step-by-step guide to filing a successful MST service-connection claim. Continue to MST Resources for  Women [10]  for information on female-specific treatment and support.

http://statesidelegal.org/military-sexual-trauma

Military Sexual Trauma (MST) The U.S. Department of Veterans Affairs (VA) defines military sexual trauma (MST) [6] as sexual harassment that is threatening or physical assault of a sexual nature. This includes all traumas that occur while serving in the military. It is not limited by:

• the location of the event,
• the genders of the people involved, or
• the parties’ relationship

Military sexual trauma is an event, not a diagnosis. MST may cause disabling medical conditions such as post traumatic stress disorder (PTSD), anxiety, depression and sexual arousal disorder (SAD).  You can base a claim for VA disability benefits [7] on these medical conditions, but not on the event itself.  The VA addresses MST differently than other issues because of its severity and complexity. 

The VA is comprised of the Veterans’ Health Administration (VHA) and the Veterans’ Benefits Administration (VBA). It is important to understand this separation of VA services. The VHA is where you go for medical health care treatment. The VBA is where you go to file a claim for VA benefits.

Follow these links for help on finding treatment and filing an MST claim:

Health Care:  Getting Treatment for MST [8]

Benefits:  How to File a Well-Prepared MST Claim [9]

MST can happen to any female or male servicemember. Residential and non-residential gender-specific care services and programs are available.  If you are eligible for an in-patient or residential program that is not close to home, the VA is required to provide travel assistance.

The VA is trying to increase services for women. Continue to our Women Who Serve [10] page on MST Resources for Women [11]. It highlights services available to women for help with:

• filing a service-connected claim, and
• accessing healthcare

More help: 

• Safe Helpline [12] offers confidential one-on-one 24/7 assistance for MST victims. You can go to www.safehelpline.org [12] for a live chat or to view resources. Or call 877-995-5247 from anywhere in the world. Or text your zip code or base/installation name to 55-247 inside the US (or 202-470-5546 outside the US) to get the contact information for your nearest Sexual Assault Response Coordinator (SARC).
• Call VA's general information hotline at 1-800-827-1000.
• MakeTheConnection.net [13]: Visit this site to view stories of veterans who have overcome military sexual trauma. MakeTheConnection.net is a one-stop resource where veterans and their families and friends can privately explore information on mental health issues, hear fellow veterans and their families share their stories of resilience, and easily find and access the support and resources they need.
• Watch video testimonials [14] from veterans who have found ways to address the effects of military sexual trauma, and to learn more about veterans’ experiences with finding treatment and recovery.
• After Deployment [15] provides support to service members who are healing after experiencing sexual trauma.
• MyDuty.mil [16]: If you are an active duty service member and have been a victim of Military Sexual Assault (or know someone who has), MyDuty.mil provides information and guidance on your reporting options and rights.

March 2013

According to Rep. Jackie Speier (D-CA14), if a soldier sexually assaults a fellow service member, they have an 86.5 percent chance that their victim won’t say anything. Even if the victim comes forward, there is a 92 percent chance the perpetrator will never see a court-martial.

Other disturbing statistics paint a grim picture, including:

• In 2012, it was estimated that 6.1 percent of the entire active-duty female force had been the victim of military sexual trauma, which was an increase from the previous year, according to a Department of Defense press conference held on May 7. Based upon command climate surveys, that accounts for about 12,000 women.
• In the same year, the same surveys estimated that 1.2 percent of the active-duty male force suffered military sexual trauma, accounting for about 14,000 men.
• In 2012, only about 17 percent of incidence were reported, and far fewer were ever prosecuted.
• The military does not maintain a sex offender registry, which means that offenders can simply be transferred to a new unit or command or voluntarily leave the military and no one would know that they had victimized someone unless they are prosecuted, convicted, and discharged, in which case they are subject to civilian registration laws.
• A study by Dr. Gene Abel, a leader in sex offender research, found that the average number of victims for an un-incarcerated sex offender is seven. The same study showed that, of those surveyed, 126 men admitted to committing 907 rapes against 882 victims, which means that some were victimized more than once.

“We’re all outraged and disgusted over these very troubling allegations. Sexual assault is a despicable crime and one of the most serious challenges facing this department. It’s a threat to the safety and the welfare of our people and the health, reputation and trust of this institution,” said Secretary of Defense Chuck Hagel at the May 7 presser.

“This department may be nearing a stage where the frequency of this crime and the perception that there is tolerance of it could very well undermine our ability to effectively carry out the mission and to recruit and retain the good people we need,” he added.

Given the widespread accounts of military sexual trauma, occurring from recruiting offices to the Sexual Assault Prevention and Response office for the Air Force, Hagel’s assessment could well be an understatement of the problem.

The Silent Victims

Perhaps one of the most startling realizations for some is that men are victimized just as much as women are. There is still a widespread myth that men can’t be sexually assaulted, that they must have “wanted it” or that they are simply being troublemakers. They are nearly always discouraged from reporting the attacks, often having to endure working and living in the same close quarters as their attackers.

According to Brian Lewis, a male survivor, not only do men experience this form of “secondary victimization,” there are few services immediately available to male victims afterward, even though the Veteran’s Administration reports that 40 percent of those seeking mental health treatment for military sexual trauma were male.

It often takes significantly longer for male victims to seek treatment than female victims — decades in some cases — because of the intense shame that male victims experience and the tough-guy culture of the military itself.

Long-Term Costs

While the VA doesn’t break down the individual costs associated with treating military sexual trauma, figures show that more than 85,000 veterans sought treatment and more than 4,000 sought disability benefits.

According to the Service Women’s Action Network (SWAN), the VA spent nearly $872 million on treatment related to military sexual trauma. Whatever the monetary costs of treating military sexual trauma are, it’s clear that the number is staggering and only goes up as more victims seek treatment.

According to a May 20 article by the AP, “a veteran with a 50 percent rating and no dependents would get $810 a month. A veteran with a 100 percent rating and a spouse and child to support would get nearly $3,088 a month.” This illustrates the wide range of disability payments.

Maintaining Order or Encouraging Predators?

Perhaps one of the hardest questions for victims rights groups is whether or not current policies are maintaining order or encouraging predators.

The Uniform Code of Military Justice, the law that governs the military, is very different from the civilian justice system. It allows individual military commanders enormous power to determine who is punished for perpetrating sexual trauma and what the punishment will be.

Even if the attacker is formally charged, the commander, called the “convening authority,” can overturn any decision that a court-martial makes with no explanation as to why and it’s all in the name of maintaining military order.

But, there are many who believe that these policies, which are meant to preserve good order, are actually encouraging predators simply because they know there is little chance they will be prosecuted. Often victims, both male and female, are told to “suck it up” and not report the trauma. Even if they do report the assaults, victims are often treated as if they are the ones guilty of a crime.

Solutions

One thing is clear, the Department of Defense desperately needs a solution — or several solutions — to this ongoing problem. Many victims and advocates believe the DoD will make some minor and ineffective policy changes and there will be little to no follow through.

There are currently multiple bills working their way through Congress that would possibly have some impact, but whether or not they will pass remains to be seen.