Mr. Thomas Murphy
Good afternoon, Chairman Runyan, Ranking Member McNerney, and Members of the Subcommittee. I am accompanied today by Ms. Edna MacDonald, Director of the Nashville Regional Office and former Deputy Director for Policy and Procedures in Compensation Service.
Thank you for inviting me to speak today on the timely and important topic of VA disability benefits for posttraumatic stress disorder (PTSD) based on military sexual trauma (MST) and sexual harassment.. The Department of Veterans Affairs (VA) is committed to serving our Nation’s Veterans by accurately adjudicating MST claims in a thoughtful and caring manner, while fully recognizing the unique evidentiary considerations involved in such an event. Under Secretary for Benefits Allison Hickey has spearheaded the efforts of the Veterans Benefits Administration (VBA) to ensure that these claims are adjudicated compassionately and fairly, with sensitivity to the unique circumstances presented by each individual claim.
Increase in MST Related PTSD Claims
Over the last several decades, women have entered the military in increasing numbers and now comprise a significant percentage of the Veteran population. Associated with this growth, VA has seen an increase in the filings of PTSD claims based on MST. However, VA recognizes that both men and women can be victims. According to the Veterans Health Administration (VHA), of the population of Veterans screened at its health care facilities, about one in five women and one in one hundred men state that they have experienced such an in-service event.
VA is aware that, because of the personal and sensitive nature of the MST stressors in these cases, it is often difficult for the victim to report or document the event when it occurs. Reasons for this may include fear of reprisal, feelings of shame or guilt, or the perception of an unresponsive military chain of command. As a result, if the MST event subsequently leads to post-service PTSD symptoms and a claim is filed, the available evidence is often insufficient to establish occurrence of the stressor. To remedy this, VA developed regulations and procedures that appropriately allow more liberal evidentiary development and adjudication procedures for these claims.
Under VA regulations at 38 C.F.R. § 3.304(f), service connection for PTSD requires:
- Medical evidence diagnosing the condition;
- A link, established by medical evidence, between current symptoms and an in-service stressor; and
- Credible supporting evidence that the claimed in-service stressor occurred.
VA recognizes that certain in-service stressful events may be difficult to document. As a result, there are five categories of PTSD with particularized rules for establishing occurrence of the in-service stressor. These include stressors related to:
- In-service diagnosis of PTSD;
- Fear of hostile military or terrorist activity;
- Former prisoner-of-war status; and
- In-service personal assault.
MST Claims Processing
As with other PTSD claims, VA will initially review the Veteran’s military service records for evidence of MST. Such evidence may include:
- DD Form 2910, Victim Reporting Preference Statement; and
- DD Form 2911, Sexual Assault Forensic Examination Report.
VA's regulation pertaining to in-service personal assault also provides that evidence from sources other than a Veteran's service records may corroborate the Veteran's account of the stressor incident, such as:
· Law enforcement authorities;
· Rape crisis centers;
· Mental health counseling centers;
· Pregnancy tests;
· Tests for sexually transmitted diseases; and
· Statements from:
o Family members;
o Fellow Servicemembers;
o Clergy members; and
o Sexual assault response coordinators and victim advocates.
Evidence of behavior changes is another type of relevant evidence that may establish occurrence of an assault, such as:
· 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; and
· Unexplained economic or social behavior changes.
Veterans are provided notification regarding the types of evidence that may establish occurrence of an in-service personal assault and are requested to submit or identify any such evidence. When this type of evidence is obtained, VA will schedule the Veteran for an examination with a mental health professional and request an opinion as to whether the claimed in-service MST stressor occurred. This opinion can serve to establish occurrence of the stressor, one element necessary for establishing service connection for PTSD.
VA Efforts to Assist MST Claimants
VA has recently taken numerous other steps to assist Veterans with a timely, equitable, and consistent resolution of these claims.
VBA has placed a primary emphasis on informing VA regional office personnel of the issues related to MST and providing training in proper claims development and adjudication. During August 2011, VBA reviewed a statistically valid sample of approximately 400 MST related PTSD claims. The goal was to assess current processing procedures and formulate methods for improvement. This led to development of an enhanced training curriculum with emphasis on standardizing evidentiary development practices. The VBA “Challenge Training Program,” which all newly hired claims processors are required to attend, now includes a module on MST within the course on PTSD claims processing. MST topics are also included in the standard “PTSD and Other Psychological Conditions” training course that all claims adjudicators are required to complete. Additionally, the VA electronic Learning Management System includes learning topics on MST.
To further reinforce the importance of proper MST claims processing, VBA developed and issued Training Letter 11-05, Adjudicating Posttraumatic Stress Disorder Claims Based on Military Sexual Trauma, in December 2011. This was followed by a nationwide Microsoft Live Meeting broadcast on MST claims adjudication. The broadcast focused on describing the range of potential markers that could indicate occurrence of an MST stressor and the importance of a thorough and open-minded approach to seeking such markers in the evidentiary record.
In addition to these general training efforts, VBA provided its designated Women Veterans Coordinators with updated specialized training. These employees are located in every VA regional office and are available to assist both female and male Veterans with their claims resulting from MST. They also serve as a liaison with the Women Veterans Program Managers at the local VHA health care facility to coordinate any required health care. As a further means to promote adjudication of these claims consistent with VA's regulation, VBA has recently created dedicated specialized MST claims processing teams within each VA regional office for exclusive handling of MST-related PTSD claims. Additionally, because the medical examination process is often an integral part of determining the outcome of these claims, VBA has worked closely with the VHA Office of Disability and Medical Assessment to ensure that specific training was developed for clinicians conducting PTSD compensation examinations for MST-related claims. This training was provided at a conference attended by VHA clinicians during November 2011. VBA and VHA further collaborated to provide a training broadcast targeted to VHA clinicians and VBA raters on this very important topic which aired initially in April 2012 and has been rebroadcast numerous times. VA is committed to applying the PTSD regulations related to MST in a manner most favorable to our Nation’s Veterans and providing those who suffer from PTSD as a result of an in-service personal assault with disability compensation.
In summary, VA has recognized the sensitive nature of MST-related PTSD claims and the difficulty inherent in obtaining evidence of an in-service MST event. Current PTSD regulations provide multiple means to establish an occurrence, and VA has initiated additional training efforts and specialized handling procedures to ensure thorough, accurate, and timely processing of these claims.
This concludes my testimony. I would be happy to address any questions from Members of the Subcommittee.