HOUSE COMMITTEE ON VETERANS’ AFFAIRS
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
MAY 20, 2010
STATEMENT OF BRADLEY G. MAYES
DIRECTOR, COMPENSATION AND PENSION SERVICE,
VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

May 20, 2010

 Good Morning, Chairman Hall, Chairman Michaud, Ranking Members Lamborn, Brown, and Members of the Subcommittees:  Thank you for the opportunity to appear to discuss the Department of Veterans Affairs’ (VA) work in identifying, treating and compensating Veterans for conditions related to military sexual trauma (MST).  We are accompanied by Dr. Rachel Kimerling, Director of the Monitoring Division of the National Military Sexual Trauma Support Team in the Veterans Health Administration (VHA); and Dr. Patty Hayes, Chief Consultant for the Women Veterans Health Strategic Health Care Group (VHA).

It is a tragic fact that many Veterans suffered sexual trauma while serving on active military duty.  Some are still struggling with fear, anxiety, shame, or profound anger as a result of these experiences.  A number of individuals have never discussed their experiences or their feelings with anyone, and they’re understandably reluctant to talk about them now.  That is why we would like to thank the Members of the Subcommittees for their diligent efforts to address this very important issue.

What Is Military Sexual Trauma (MST)? 

In both civilian and military settings, women and men can experience a range of unwanted sexual behaviors.  Within VA, Veterans are likely to hear these sorts of experiences described as “military sexual trauma,” the overarching term VA uses to refer to experiences of sexual assault or repeated, threatening acts of sexual harassment.  The definition used by VA is from the U.S. Code (1720D of Title 38) and 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 further defined as "repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.”  More concretely, MST includes any sexual activity where someone is involved against his or her will—he or she may have been pressured into sexual activities (for example, with threats of negative consequences for refusing to be sexually cooperative or with implied faster promotions or 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; or threatening and unwelcome sexual advances.  If these horrific experiences and often criminal acts occurred while an individual was on active duty or active duty for training, they are considered to be MST.

How Common Is MST?

Information about how commonly MST occurs comes from VA’s universal screening program.  Under this program, all Veterans seen at Veterans Health Administration (VHA) facilities are asked two questions—one to assess sexual harassment and the other to assess sexual assault that occurred during their military service; Veterans who respond “yes” to either question are asked if they are interested in learning about MST-related services available.  Not every Veteran who responds “yes” needs or is necessarily interested in treatment.  It is important to note that rates obtained from VA screening cannot be used to make any estimate of the rate of MST among all those serving in the U.S. military, as they are drawn only from Veterans who have chosen to seek VA health care.  Also, a positive response does not indicate that the perpetrator was a member of the military.  Approximately 1 in 5 women and 1 in 100 men seen in VHA respond “yes” when screened for MST.  Though rates of MST are higher among women, because of the disproportionate ratio of men to women in the military, there are actually only slightly fewer men seen in VA who have experienced MST than women. 

How Can MST Affect Veterans?

It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself.  Given the range of distressing sexually-related experiences and crimes that Veterans report, it is not surprising that there are a wide range of emotional reactions that Veterans have in response to these events.  Even after severely traumatizing experiences, there is no one way that everyone will respond—the type, severity, and duration of a Veteran’s difficulties will all vary based on factors like whether he or she has a prior history of abuse, the types of responses from others he or she received at the time of the experiences, and whether the experience happened once or was repeated over time.  For some Veterans, experiences of MST may continue to affect their mental and physical health, even many years later.  Some of the difficulties both female and male survivors of MST may have include:

Strong emotions: feeling depressed; having intense, sudden emotional reactions to things; feeling angry or irritable all the time;

Feelings of numbness: feeling emotionally “flat?; difficulty experiencing emotions like love or happiness;

Trouble sleeping: trouble falling or staying asleep; disturbing nightmares;

Difficulties with attention, concentration, and memory: trouble staying focused; frequently finding their mind wandering; having a hard time remembering things;

Problems with alcohol or other drugs: drinking to excess or using drugs daily; getting intoxicated or “high” to cope with memories or emotional reactions; drinking to fall asleep;

Difficulty with things that remind them of their experiences of sexual trauma: feeling on edge or “jumpy” all the time; difficulty feeling safe; going out of their way to avoid reminders of their experiences; difficulty trusting others;

Difficulties in relationships: feeling isolated or disconnected from others; abusive relationships; trouble with employers or authority figures; and 

Physical health problems: sexual difficulties; chronic pain; weight or eating problems; gastrointestinal problems.

Among users of VA health care, medical record data indicate that diagnoses of post-traumatic stress disorder (PTSD), depression and other mood disorders, psychotic disorders and substance use disorders are most frequently associated with MST. Fortunately, people can recover from experiences of trauma, and VA has services to help Veterans do this.

How Has VA Responded to the Problem of MST?

Since 1992, VA has been developing programs to monitor MST screening and treatment, providing staff with training on MST-related issues, and engaging in outreach to Veterans.  More recently, VA’s Office of Mental Health Services (OMHS) established a national-level MST Support Team to support these objectives and promote best practices in care.  Services available to Veterans include:

All Veterans seen in VA are asked whether they experienced MST and all treatment for physical and mental health conditions related to experiences of MST is free for both men and women. 
Every VA facility has a designated MST Coordinator who serves as a contact person for MST-related issues.  This person can help Veterans find and access VA services and programs.  He or she may also be aware of state and federal benefits and community resources that may be helpful. 
Every VA facility has providers knowledgeable about treatment for the aftereffects of MST.  Many have specialized outpatient mental health services focusing on sexual trauma.  Vet Centers also have specially trained sexual trauma counselors. 
Nationwide, there are programs that offer specialized sexual trauma treatment in residential or inpatient settings.  These are programs for Veterans who need more intense treatment and support. 
To accommodate Veterans who do not feel comfortable in mixed-gender treatment settings, some facilities have separate programs for men and women.
Collaboration

VA has developed a number of initiatives that promote coordination of care for active duty personnel and recently discharged personnel more broadly, but most coordination of clinical care for individual Veterans and active duty personnel seeking MST-related care happens on the local level and depends on the relationships that specific VA facilities have negotiated with local military installations.  Local MST Coordinators often participate in or ensure inclusion of MST-related materials in local outreach events, particularly those post-deployment.  At a national level, the VA MST Support Team has developed an ongoing relationship with the Department of Defense’s Sexual Assault Prevention and Response Office (SAPRO).  The OMHS MST Support Team and SAPRO have presented at each others’ training events in order to share information about VA and DoD responses to sexual trauma with frontline clinicians.  Staff from both the MST Support Team and SAPRO have given informational presentations about VA and DoD responses to sexual assault at a national VA training conference and at the International Society for Traumatic Stress Studies research conference.  The two groups also communicate as necessary regarding individual Veterans needing assistance in locating appropriate services to match their treatment needs.

VBA Procedures for PTSD Claims Based on MST:

VA provides compensation payments for service-connected disabilities.  The VA schedule for rating disabilities is based on the average earning loss resulting from the disabilities in the schedule.  As the role of women in the military has expanded, the number of disability compensation claims received by VBA related to MST has increased.  As you have already heard, MST may result in a number of disabling physical and mental conditions, but most often manifests itself as PTSD. 

In order to better assist those Veterans with PTSD claims based on MST, VA promulgated 38 C.F.R. § 3.304(f)(4) in 2002, which emphasizes that, if a PTSD claim is based on in-service personal assault, which includes MST, evidence from sources other than a Veteran’s service treatment and personnel records may corroborate the in-service traumatic event.  Such evidence may include, but is not limited to:  records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy.  In addition, evidence of behavior changes following the claimed assault constitutes another source of relevant evidence.  Examples of such behavior changes include, but are not limited to:  a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes.  The regulation prohibits the denial of claims for service connection for PTSD based on in-service personal assault without first advising the Veteran that information from sources other than the Veteran's service records or evidence of behavior changes may constitute credible evidence of the stressor and allowing the Veteran an opportunity to furnish this type of evidence or advise VA of potential sources of such evidence.  The regulation also provides that VA may submit any evidence it receives to an appropriate medical or mental health professional for an opinion as to whether it indicates that a personal assault occurred. 

This regulation takes into account the sensitive nature of MST and the difficulty with obtaining supporting evidence in many of these cases when service connection is claimed following the Veteran’s separation from service.  In those cases where PTSD is diagnosed during service and the claimed stressor is related to that service, VA regulations state that the Veteran's lay testimony alone may establish occurrence of the claimed stressor, provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service and in the absence of evidence to the contrary. 

VBA field personnel who adjudicate PTSD cases based on MST were provided with detailed information on proper claims processing methods in a training letter issued in November 2005.  Additionally, all regional offices have a Women’s Veteran Coordinator, who is well-versed in MST issues and can provide assistance to Veterans as necessary.  These procedural steps taken by VA ensure that Veterans filing claims for PTSD based on MST will receive a fair and thorough consideration of their claims.

CONCLUSION

VA recognizes the damage that MST can inflict on its victims, and it has developed responses that are focused on providing Veterans the care and support they need.  We have achieved much, and are continually evaluating ways to improve.  VA’s MST Support Team is conducting a comprehensive study of providers of MST related mental health care.  This will help us determine the number of unique providers at each facility who deliver MST related care, describe the characteristics of these providers, and assess the relationship of provider gender to patient gender to determine whether VA can consistently honor patients‘ expressed preferences for providers of a particular gender, as is VA’s policy.  These results will provide important information to help us ensure there is sufficient capacity for specialized MST related services at each VA facility.  We look forward to sharing the results of this analysis with Congress when it is ready later this year.

Thank you again for the opportunity to appear.  We are prepared to answer any questions you may have. 

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