Military Sexual Trauma (MST) is defined by the Department of Veterans Affairs (VA) as experiences of sexual assault or repeated, threatening sexual harassment that is experienced while on active duty for training, active duty, or inactive duty training.
This definition comes from Title 38 United States (U.S.) Code 1720D. The individuals who perpetrate MST can vary. For example, they can be male or female or superiors or subordinates in the chain of command.
The following are examples of MST:
- Lewd or inappropriate sexual remarks
- Unwanted physical contact
- Repeated advances that are sexual in nature
- Offers to exchange sexual favors for something in exchange (like better duty assignments)
- Pressured or physically forced sexual encounters that are engaged in without consent
The element of no consent is tantamount to MST. For example, MST includes any and all sexual activity experienced during your time of service that happened without your consent, against your will, and where you were unable to say no to it.
MST Signs and Symptoms
Just like a diverse group of people can perpetrate MST, people who experience MST vary as well. Individuals of all genders, sexual orientations, ages, ethnic and racial backgrounds, and branches of the military experience MST.
MST can have both short-term and long-standing negative impacts on your physical and mental health. Signs and symptoms include but are not limited to:
- Challenges enjoying sex, feeling safe in relationships, and having trusting relationships (intimate and peer-to-peer)
- Concentration and memory challenges
- Difficulty feeling safe (alone, in groups, or with others)
- Easy to become agitated or irritated
- Eating or weight issues
- Excessive/Explosive anger and irritability
- Feelings of numbness or depression
- Feelings of self-doubt, self-blame, and shame
- Flashbacks of the event(s)/reliving them
- Inability to have strong emotions such as happiness
- Isolating or feeling isolated from others, even family and friends
- Issues with sleep, such as nightmares, difficulty falling asleep, and/or staying asleep
- Jumpy or easily startled
- Lowered self-esteem
- Other mental health conditions such as anxiety, depression, and bipolar disorder
- Physical health problems such as chronic pain
- Substance abuse such as alcohol and/or other drugs, in order to escape or become numb from negative feelings
- Upsetting and disturbing memories
The presence of these signs and symptoms is an indication of when it is appropriate to reach out for help. The VA has options to seek help, and you can also contact a veterans disability lawyer to help you navigate the VA system to earn a VA disability rating.
MST and PTSD
There is a strong connection between MST and post-traumatic stress disorder (PTSD). Experiencing MST usually causes a PTSD diagnosis. While MST can also contribute to or lead to other physical and mental health disorders, the MST-PTSD connection is strong and extremely prevalent. For example, survivors of sexual assault, whether it occurs within the military or civilian domain, show a higher lifetime rate of PTSD for both women and men. This is because a key causal factor leading to/contributing to the development of PTSD is sexual trauma. There is an overlap between causal factors of MST and PTSD and signs and symptoms. For example, PTSD is defined as a mental health condition triggered by a terrifying event. This could be a result of either witnessing or experiencing the event. By definition, the experiences of MST are terrifying. Symptoms of PTSD would be similar to those of MST:
- Challenges feeling safe
- Difficulty concentrating
- Difficulty sleeping
- Easy to startle
- Isolating, feelings of depression and shame
- Reexperiencing the event (flashbacks)
The data from VA medical records show (reflect and support the fact) that PTSD is a frequently associated diagnosis with MST. Depression and substance use disorders are also top mental health conditions frequently associated with MST.
Prevalence of MST
The prevalence of MST is unfortunate, and often times people do not realize how frequently it occurs because it can go unreported or be reported significantly later than it occurred. This can be years later in some cases. It is estimated that 1 in 4 female veterans in the VA healthcare system report experiencing MST and are at greater risk for experiencing MST than men. While the number for males is lower at 1 in 100, it is important to note that nearly 40% of veterans who disclose MST are male. The VA has taken initiatives to support veterans who disclose MST and need treatment. For example, the Department of Defense (DOD) released its most recent annual report on MST in 2019. It indicated that there was a 13% increase in reported MST cases from 2017. While this statistic could be shocking and troubling because it indicates an increase in reported cases between 2017 and 2019, it may also be that more people are disclosing MST.
Coping and Treatment for MST
There are empowering ways for you to cope with and receive treatment for symptoms resulting from MST. For example, you can do or try the following:
Make Lifestyle Changes
If you are not already doing so, you can start an exercise or movement program. You can make healthier food choices by eating low glycemic foods or whole foods. You can stay away from eating processed foods and foods high in sugar. You can volunteer and increase time spent with your friends, family, and loved ones. You can also interact with other survivors of MST. You can practice optimism with a healthy combination of realism.
Mindfulness is a practice involving being aware of the present, focusing on what you are doing right now rather than spending excess time worrying about the future or ruminating about the past. While planning for the future and processing the past is healthy, mindfulness helps you balance living in the present and allows you to focus on a current task you are partaking in.
You can either focus on your breath, or if you are doing a household chore such as washing dishes, you can focus on just washing dishes with a single pointed focus on just the dishes. If you are eating your favorite food(s), you can chew slowly and focus on the taste of the food. The key is to focus on one task or one thing at a time to stay in the here and now.
Join Peer Support Group(s)
Finding others who have experienced and survived MST can be helpful because you can share your experience(s), to the level of your comfort and safety, with each other. This can be a safe opportunity to work through intense emotions associated with MST.
Adopt an Emotional Support Animal
You can adopt an emotional support animal who will help you feel more comfortable and at ease in situations that may be triggering or create undue stress. Emotional support animals are usually dogs, and it is a process to be paired with one and go through the training. However, individuals who have adopted an emotional support animal tend to be happy with the decision and find them very useful and wonderful companions.
But our research and our experiences with some of our clients indicates that many veterans are experiencing success with donkeys as therapy animals.
By writing down things that are going well and sharing what you are grateful for, it balances the burden of the symptoms of MST. This is a practice that can be done at any point in the day and can be as simple as reflecting on the good things that have occurred in your life during that day or the past 24 hours. It is important to note that this practice is not meant to minimize what you have gone through or any symptoms you are having. It helps to switch focus and bring the positive things in your life to your attention.
Explore Other Options
The more you practice these coping techniques and search for ways to find balance and feel grounded after experiencing MST, the more the likelihood of finding other options become. You may find a new hobby, such as drumming or sound healing, drawing, expressing yourself through writing, and the list goes on. Exploring different options allows you to remain open-minded and receptive to potential helpful solutions to your situation. It is also important to note that while being open-minded is being encouraged, you should always research any modality, class, group, or additional option you are going to try.
You are recovering from MST symptoms and would want to mind how vulnerable you may become while exploring healing possibilities. Seeing if the instructor is credentialed or being referred by a credible source are great safety practices.
Seek Professional Help
There is no shame in asking for help with recovering from MST. Asking for help is not a sign of weakness. Rather, it is a sign of strength to realize that you need help and take action steps to obtain it. The VA and Disabled American Veterans (DAV) have a number of professional treatment options for MST survivors.
Every VA center has a designated Coordinator who serves as a contact person for MST-related conditions and issues. This Coordinator can walk you through the process of getting the help you need and direct you to available resources. You may also be eligible for disability compensation and would need to file for a VA rating for your disability. If this is the case, you can contact a veterans disability lawyer to help you navigate through the process.
The VA offers many services to assist you in your recovery from MST signs and symptoms and MST-related conditions. These include:
- Outpatient programs
- Inpatient treatment
- Residential services
- Pharmaceutical/drug therapy
Sometimes, the programs can be provided directly at a VA location, while others will be referrals to VA-approved locations, which meet VA criteria to be able to help veterans with MST and their other associated conditions.
The details are provided in a fact sheet titled Quick Facts About VA’s Health Care Services for Military Sexual Trauma (MST).
The fact sheet discusses that:
- Care for MST-related health problems is free of charge and confidential.
- VA disability rating is not needed in order to receive care.*
- There is no required documentation of the MST experience.
- You can still receive care even if you did not report the MST.
- There is no time limit/statute of limitations from the time you experienced the MST to the time you sought care through the VA.
- If you are not eligible for other VA services, you may still qualify for care.*
- The doctors, counselors, and healthcare personnel used by the VA are specifically VA trained to address MST and its related conditions.
- The MST does not need to be service-connected in order to receive care.
- Every VA healthcare facility has an MST Coordinator designated as the contact person.
- Every VA healthcare facility has medical and clinical personnel equipped to address MST and its associated conditions. This person can assist us in locating and accessing VA programs and services.
If you believe you fit the criteria and need disability compensation, you can go through the VA rating process. If you need assistance navigating the system, you can contact a veterans disability attorney to assist.
VA Ratings for MST
As stated earlier in this piece, there is a very strong connection between MST and PTSD. There is a very high likelihood that survivors of MST will develop PTSD as a result of MST. You may also develop depression, substance use disorder, or other related conditions. If this is the case, you would want to have a VA evaluation for the disorder you have as a result of MST. For example, a temporary disability rating of 100% is available if you have been hospitalized for 21 days or more due to a mental health illness or condition. The treatment needs to have been received at a VA medical center or a VA-approved facility in order for you to qualify for the temporary total disability rating.
For a more long-term rating, if your MST caused the development of PTSD or other health issues that negatively impact your Activities of Daily Living (ADL), make it challenging for you to work and provide for yourself/your family, and hinder other areas of your life, you may qualify for a significant rating for MST provided you are service connected for the condition, which is usually PTSD.
VA Rating for PTSD as a Result of MST
According to the VA, 94% of claims connected to MST were for PTSD as of 2014, with Major Depressive Disorder (MDD) and Anxiety Disorder being the second and third most prevalent. Because of the issues in proving that the MST occurred, the VA has developed some special accommodations in regard to its evidence standards for PTSD as a result of MST claims. This is also because it is oftentimes very challenging to completely prove the event(s) of the sexual trauma(s) associated with the MST in the claim.
Another challenge to proving MST is that it is not always reported. When it is reported, many times, it is delayed, and way after the original incident(s) occurred. The VA has therefore created a concept called markers when you file a VA rating claim for PTSD as a result of MST.
Markers are circumstances, events, or signs providing circumstantial evidence that the MST did, in fact, take place.
The following are examples of markers:
- Tests for sexually transmitted diseases
- Pregnancy test
- Lowered work performance
- Request(s) to be transferred to another duty assignment/post
- Records from official sources such as hospitals, and other relevant parties to the claim
- Break-up of a primary relationship
- Sexually transmitted disease, and rape crisis centers
- Substance abuse
- Panic attacks, and/or anxiety without a clear cause
- Sexual dysfunction
- Statements from others, clergy, counseling centers, counselors, depression, law enforcement, loved ones, other fellow service members, physicians, roommates, such as family
It is important to note that 2011 was a turning point in VA approval for PTSD claims related to MST and PTSD claims in general. Since this is the case, if you made your claim prior to 2011 and it was denied, you are encouraged to refile because many cases have been approved since then. For example, as of 2011, 60% of all claims for PTSD (unrelated to MST) were granted, and only 35% of claims for PTSD as a result of MST were approved. The current rate of approval for both PTSD (unrelated to MST) and PTSD as a result of MST is 55%. Currently, PTSD (unrelated to MST) rates have fallen by 5%, while PTSD as a result of MST has increased from 35% to 55%, which is a 20% increase in VA approval. The change may reflect that VA is acknowledging the need to assist those who have experienced MST and now have PTSD as a result, and that more veterans are coming forward to make a claim.
Problems Proving MST Cases
Problems proving MST Cases are specific to MST, and while the VA has taken initiatives to help resolve them, they still exist. Hence, this topic deserves a stand-alone category.
Some problems proving MST cases are as follows:
- Years go by, or veterans wait for an extended time after experiencing the MST before disclosing and/or seeking help. While this is not always the case, it occurs frequently. The reason behind this could be shame and/or stigma. You may feel ashamed to need help or that you have experienced MST. Experiencing MST can negatively impact your self-esteem. Also, to avoid stigma, you may not speak up right away. In our experience, male victims are especially reluctant to report the MST due to intense shame or fear of being branded a homosexual.
- Historically, MST disclosures had the possibility to be normalized or referred to as simple hazing. Today, it is being taken much more seriously, as evidenced by VA fact sheets. VA provides a Coordinator and trained personnel in each of its facilities with the ability to provide treatment regardless of proof or VA rating, and the treatment is confidential and free. Rather than the MST disclosure being normalized or called hazing, you are more likely to be heard and provided supportive services and solutions.
- The VA estimates that more than 2/3 of all MST occurrences are unreported. This may make you feel like you are alone since such a high rate of MST happenings are not being reported. Also, when MST is reported, it is typically done confidentially, and you may not be discussing it with colleagues and peers. This may lead you to feel or believe you are the only one going through MST.
You may also blame yourself for allowing it to happen. It is important to remember experiencing MST is not your fault, and MST should never be justified.
Most often, claims involving the effects of MST are characterized as PTSD claims when filing for a VA rating for MST. For PTSD as a result of MST, you can use markers in your claim (Please see VA Rating for PTSD as a Result of MST section for more details).
In practical terms, the immediate response to MST may be subtle, and in our experience, a psychiatric expert is often needed to opine that the behaviors you may have exhibited following the MST were “markers” of MST. Too often, individuals that are the victims of MST in service may also have been sexually abused as children. In these cases, it becomes very complicated to factor out any mental health issues that may have stemmed from pre-service sexual trauma. We usually see veterans who may have experienced abuse as children presenting as normal at military induction and doing relatively well. But if they are victimized again by an MST during active duty, they are more likely to develop severe PTSD as a result.
How Can You Obtain a 100% VA Rating for MST?
You must first be service connected for the condition caused by the MST—usually PTSD. So our discussion of the path to a maximum 100 percent rating for MST assumes you are already service connected. Since PTSD can impact your ADL, ability to work, and other major areas of your life, the VA could potentially award a full disability rating of 100% for PTSD as a result of MST. VA ratings are consistent with symptom severity. For example, if your PTSD as a result of MST impairs you completely from being able to work or complete basic functions, you are eligible for a higher VA rating. If you are able to work, take care of your daily needs and grooming, and other major life responsibilities, and have some effective relationships, there is a strong likelihood you will receive a lower VA rating.
While the VA has become more amenable to approving ratings for PTSD as a result of MST, it is still important to be prepared and to file a well-organized claim with substantial evidence that your situation warrants a 100% rating. For a 100% VA PTSD rating, you need to be considered totally occupationally and socially impaired. The VA’s General Rating Formula for Mental Disorders should be consulted.
This would include such symptoms as follows:
- Being disoriented
- Gross impairment of communication and thought processes (executive functioning)
- Hallucinations and delusions that are persistent in nature
- Inability to perform Activities of Daily Living (ADL) such as personal grooming and self-care: showering, brushing teeth, shaving, etc).
- Loss of memory in terms of work, names, and other relevant knowledge
- Performing or partaking in grossly inappropriate behavior
- You are a danger to yourself or others
In order to obtain a 100% VA rating for MST (PTSD as a result of MST), not all of these criteria need to be met. When you file a claim, you will be assigned a Rating Service Representative (RVSR) who will consider all of the submitted evidence. The final rating will be assigned based on what is referred to as a preponderance of symptoms.
How Can I be Considered for a VA Rating for PTSD as a Result of MST?
As noted above, you must be service connected first before a rating can be considered. It is important to note that because MST has caused your PTSD and MST is not in of itself the condition you are filing the claim for, you must have a PTSD diagnosis or some other diagnosed condition (i.e., depression, anxiety, HIV, etc.). So, you need to discuss this with your medical practitioner, be it a psychiatrist or your PCP, or another approved and credentialed provider.
The medical practitioner can evaluate you for PTSD. If, after your evaluation is completed, your medical practitioner diagnoses you with PTSD, you will need to obtain a nexus letter or report from a psychiatric expert.
A nexus letter is one that explains how your PTSD is connected to your MST. The opinion of the expert should also explain that you had markers of MST during service even if you did not report the MST. Then you may assemble the documents to actually file the claim using VA Form 21-0781a. This form is used in cases where the disability is linked to MST.
Since MST is very difficult to prove, having strong medical expert evidence explaining how you had markers of MST during service and connecting your diagnosed PTSD to your MST is important. It is critical that you not overlook focus on finding and explaining the markers. For example, a dramatic decline in work performance or the immediate onset of disciplinary problems following the MST would go a long way to corroborate that the MST happened. Also, if you had a sudden onset of substance abuse or going AWOL, these would also indicate markers for MST.
If you need assistance navigating the form or the system, you may reach out to a veterans benefits attorneys.