[House Hearing, 112 Congress]
[From the U.S. Government Publishing Office]
INVISIBLE WOUNDS: EXAMINING THE DISABILITY COMPENSATION BENEFITS
PROCESS FOR VICTIMS OF MILITARY SEXUAL TRAUMA
=======================================================================
HEARING
before the
SUBCOMMITTEE ON DISABILITY ASSISTANCE
AND MEMORIAL AFFAIRS
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED TWELFTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, JULY 18, 2012
__________
Serial No. 112-70
__________
Printed for the use of the Committee on Veterans' Affairs
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COMMITTEE ON VETERANS' AFFAIRS
JEFF MILLER, Florida, Chairman
CLIFF STEARNS, Florida BOB FILNER, California, Ranking
DOUG LAMBORN, Colorado CORRINE BROWN, Florida
GUS M. BILIRAKIS, Florida SILVESTRE REYES, Texas
DAVID P. ROE, Tennessee MICHAEL H. MICHAUD, Maine
MARLIN A. STUTZMAN, Indiana LINDA T. SANCHEZ, California
BILL FLORES, Texas BRUCE L. BRALEY, Iowa
BILL JOHNSON, Ohio JERRY McNERNEY, California
JEFF DENHAM, California JOE DONNELLY, Indiana
JON RUNYAN, New Jersey TIMOTHY J. WALZ, Minnesota
DAN BENISHEK, Michigan JOHN BARROW, Georgia
ANN MARIE BUERKLE, New York RUSS CARNAHAN, Missouri
TIM HUELSKAMP, Kansas
MARK E. AMODEI, Nevada
ROBERT L. TURNER, New York
Helen W. Tolar, Staff Director and Chief Counsel
______
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS
JON RUNYAN, New Jersey, Chairman
DOUG LAMBORN, Colorado JERRY McNERNEY, California,
ANN MARIE BUERKLE, New York Ranking
MARLIN A. STUTZMAN, Indiana JOHN BARROW, Georgia
ROBERT L. TURNER, New York MICHAEL H. MICHAUD, Maine
TIMOTHY J. WALZ, Minnesota
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
__________
July 18, 2012
Page
Invisible Wounds: Examining The Disability Compensation Benefits
Process For Victims of Military Sexual Trauma.................. 1
OPENING STATEMENTS
Chairman Jon Runyan.............................................. 1
Prepared Statement of Chairman Runyan........................ 48
Hon. Jerry McNerney, Ranking Democratic Member................... 3
Prepared Statement of Hon. Jerry McNerney.................... 49
Hon. Michael R. Turner, prepared statement only.................. 50
Hon. Chellie Pingree, prepared statement only.................... 51
WITNESSES
Anu Bhagwati, Executive Director, Service Women's Action Network. 4
Prepared Statement of Ms. Bhagwati........................... 52
Executive Summary of Ms. Bhagwati............................ 54
Joy Ilem, Deputy National Legislative Director, Disabled American
Veterans....................................................... 6
Prepared Statement of Ms. Ilem............................... 55
Lori Perkio, Assistant Director of Veterans Affairs and
Rehabilitation, The American Legion............................ 8
Prepared Statement of Ms. Perkio............................. 60
Executive Summary of Ms. Perkio.............................. 62
Dr. Barbara Van Dahlen, Executive Director, Give an Hour......... 21
Prepared Statement of Dr. Dahlen............................. 62
Executive Summary of Dr. Dahlen.............................. 66
Margaret Middleton, Executive Director, Connecticut Veterans
Legal Center................................................... 23
Prepared Statement of Ms. Middleton.......................... 66
Ruth Moore, Constituent Witness.................................. 30
Prepared Statement of Ms. Moore.............................. 68
Accompanied by:
Alfred ``Butch'' Moore, Jr., Husband to Ruth Moore
Col. Alan Metzler, Deputy Director, Sexual Assault Prevention and
Response Office, U.S. Department of Defense.................... 35
Prepared Statement of Mr. Metzler............................ 69
Accompanied by:
Dr. Nate Galbreath, Senior Researcher and Training Advisor,
Sexual Assault Prevention and Response Office, U.S.
Department of Defense
Thomas Murphy, Director of Compensation and Pension Service, U.S.
Department of Veterans Affairs................................. 37
Prepared Statement of Mr. Murphy............................. 75
Accompanied by:
Ms. Edna MacDonald, Director, Nashville Regional Office,
U.S. Department of Veterans Affairs
QUESTIONS FOR THE RECORD
Response From: DoD - To: Hon. Robert L. Turner, Subcommittee on
Disability Assistance and Memorial Affairs, Committee on
Veterans' Affairs.............................................. 77
MATERIALS SUBMITTED FOR THE RECORD
Letter From: Anu Bhagwati, MPP, Executive Director, Service
Women's Action Network - To: The Hon. Eric K. Shinseki,
Secretary, U.S. Department of Veterans Affairs, Washington,
D.C............................................................ 77
Additional Materials From: Anu Bhagwati, MPP, Executive Director,
Service Women's Action Network................................. 79
INVISIBLE WOUNDS: EXAMINING THE DISABILITY COMPENSATION BENEFITS
PROCESS FOR VICTIMS OF MILITARY SEXUAL TRAUMA
----------
Wednesday, July 18, 2012
U.S. House of Representatives,
Committee on Veterans' Affairs,
Subcommittee on Disability Assistance
and Memorial Affairs,
Washington, D.C.
The Subcommittee met, pursuant to call, at 2:09 p.m., in
Room 334, Cannon House Office Building, Hon. John Runyan
[Chairman of the Subcommittee] presiding.
Present: Representatives Runyan, Turner, McNerney, and
Michaud.
Also Present: Representatives Pingree, Speier.
OPENING STATEMENT OF CHAIRMAN JON RUNYAN
Mr. Runyan. Good afternoon, and welcome to our hearing,
Invisible Wounds: Examining the Disability Benefits
Compensation Process for Victims of Military Sexual Trauma.
First I ask unanimous consent to welcome a number of
honorable colleagues who have asked to be allowed here to
participate as guest members of the Subcommittee today. Hearing
no objection, so ordered.
As a Nation, we call on our armed servicemembers to
sacrifice bravely on our behalf. They courageously put their
lives at risk and face deadly enemies on the battlefield.
When we think of these enemies, we think of those who
oppose our freedom and our American way of life. We certainly
do not think of soldiers needing to defend themselves from
their fellow servicemembers. However, many of our
servicemembers are required to do just that.
Women are the fastest growing population among veterans,
making up eight percent of the armed forces. However, the
Department of Defense estimates that one in four women who join
the armed services will be raped or assaulted, but that only
about ten percent of such instances are ever reported.
Even more alarming is that of those few who did report the
incidence of military sexual trauma, over 75 percent stated
that they would not have made the same decision about reporting
the incident again due to the consequences it had on their
military career.
Despite the fact that many of these incidents go
unreported, VA currently estimates that over half a million
veterans have experienced military sexual trauma. This includes
17 percent of veterans from recent conflicts in Iraq and
Afghanistan.
Although this is not the Committee's jurisdiction, there
must be zero tolerance for this behavior in our military and
the VA must recognize immediately the trauma inflicted on these
men and women.
Accordingly, the focus of today's hearing is how to assist
these veterans in obtaining VA benefits for post-traumatic
stress disorder or PTSD. This is often a difficult task given
the sensitive nature of these claims and the lack of evidence
documenting such incidents at the time that they occurred.
Although VA has made great progress in adjudicating
military sexual trauma claims by providing relaxed evidentiary
standards and retraining employees on this issue, SWAN, one of
the organizations testifying today, estimates that less than
one-third of military sexual trauma PTSD claims are approved by
the VA even though 53 percent of PTSD claims are granted
overall.
Although military sexual trauma is not a new issue, it is a
serious matter which more light needs to be shed on. In recent
years, as more and more of our brave servicemembers find the
inner strength to overcome military cultural challenges and
come forward to seek justice, help and healing, the more the
Members of this Committee, DoD, and VA can understand the best
means of assisting victims of military sexual trauma by
obtaining the VA benefits that they need.
One such veteran will be testifying before us today and I
would like to personally thank Ms. Ruth Moore for coming to
Washington and sharing her story with us today.
Victims of military sexual trauma like Ms. Moore can carry
scars in their hearts for the rest of their lives as a result
of what they have endured. Such veterans are indeed deserving
of VA benefits to help them enjoy the American way of life that
their service has helped to secure.
As the Department of Defense continues to address the
issues arising from cultural resistence to reporting such
abuse, the VA must continue to work to ensure that the proper
benefits so needed by these victims are easily obtainable.
So I will reiterate that the focus of the hearing today is
precisely that. What benefits does the VA provide for victims
of military sexual trauma, how are these claims adjudicated,
and how can this process be improved?
We welcome several witnesses to testify before us today
ranging from representatives from veteran service organizations
to experts on the effects and treatments of military sexual
trauma to officials from the VA and the Department of Defense.
I appreciate all of you taking the time to speak with us
today about this issue of such importance to so many members of
our American community.
Because we have many distinguished guests with us today, I
would like to reiterate my request that our witnesses abide by
the decorum and rules of this hearing by summarizing your
statements in five minutes or less during the oral testimony.
Doing so will ensure that the Committee has the opportunity to
hear from everyone.
I would also like to remind all present that without any
objection, your written testimony will be made part of the
hearing record. Hearing none, so ordered.
I now call on the distinguished Ranking Member from
California, Mr. McNerney, for his opening statement.
[The prepared statement of Chairman Jon Runyan appears in
the Appendix]
OPENING STATEMENT OF HON. JERRY MCNERNEY,
RANKING DEMOCRATIC MEMBER
Mr. McNerney. Thank you.
Good afternoon. I would like to thank everyone for
attending today's hearing which examines the VA's disability
compensation process as it pertains to military sexual trauma
or MST.
I am happy to join DAMA Subcommittee Chairman Runyan and my
colleagues today in holding this hearing. I am also pleased
that two leading voices of the Congress on this issue,
Representative Shellie Pingree of Maine and Representative
Jackie Speier of California, are accompanying the Subcommittee
on the panel today.
I also welcome and thank Ms. Pingree's constituent, Ruth
Moore, accompanied by her husband, for testifying about her MST
experience with the VA.
Servicemembers who experience military sexual trauma, who
are brave enough to speak out about their experiences often do
so at great risk to their reputation and their careers.
The purpose of today's hearing is to evaluate ways in which
the Veterans Benefits Administration and the Department of
Defense can better address the needs of veterans affected by
MST, to identify ways to prevent these horrible assaults and to
treat and properly compensate the victims.
MST refers to sexual harassment, sexual assault that occur
in military settings. MST often occurs in a setting where the
victim lives and works which means that the victims must
continue to live and work closely with their perpetrators.
Many MST victims state that when they do report an
incident, their story is dismissed or they are encouraged to
keep silent because of the need to preserve organizational
cohesion.
This is unfair to the victims. We must put protections in
place to ensure a safe haven exists for women and men who
experience military sexual trauma. Unfortunately, the
consequences of MST are a pervasive problem within the veteran
community.
According to the Institute of Medicine, prevalence rates of
MST range from 20 to 43 percent. Many veterans who are victims
of MST express frustration with the VA's disability claims
process, especially in trying to prove that the assault ever
happened.
For many women and men, their disability claims for post-
traumatic stress related to MST are denied. However, I am
pleased that in July of 2010 in a response to action taken by
this Committee, the VA relaxed its stressor evidentiary
standards for post-traumatic stress which also includes MST.
While representing a step in the right direction, there are
still hurdles that men and women face in receiving the benefits
they deserve.
As SWAN will point out in its testimony, there are still
disparities in compensation and confusion within the VBA on
when service-connected compensation for MST is warranted.
Training at the VA has improved slightly, but VBA claims
decisions are still inconsistent and more must be done.
As we build a VA for the 21st century, the VA and the DoD
need to ensure that proper prevention, counseling, treatment,
and benefits are available for MST victims.
Veterans should also have access to VA personnel who are
qualified to advise on often sensitive MST related issues.
These veterans need to be treated with the dignity and respect
they deserve.
I look forward to hearing from the esteemed panel of
witnesses. I thank you, and I yield back.
[The prepared statement of Hon. Jerry McNerney appears in
the Appendix]
Mr. Runyan. I thank the gentleman.
And at this time, I want to invite the first panel up to
the witness table who are going to represent various veteran
service organizations, and I welcome you to all come forward.
Our first guest is, and bear with me----
Ms. Bhagwati. Anu Bhagwati, sir.
Mr. Runyan. Anu Bhagwati, thank you, who is the Executive
Director of the Service Women's Action Network known as SWAN.
Then we will welcome Ms. Joy Ilem, Deputy Legislative Director
for Disabled American Veterans, and finally we will welcome Ms.
Lori Perkio, the Assistant Director for Veterans Affairs and
Rehabilitation for The American Legion.
We appreciate all of our witnesses for taking the time to
testify before us today.
And, Ms. Bhagwati, you are now recognized for five minutes
for your oral testimony.
STATEMENTS OF ANU BHAGWATI, EXECUTIVE DIRECTOR, SERVICE WOMEN'S
ACTION NETWORK; JOY ILEM, DEPUTY NATIONAL LEGISLATIVE DIRECTOR,
DISABLED AMERICAN VETERANS; LORI PERKIO, ASSISTANT DIRECTOR OF
VETERANS AFFAIRS AND REHABILITATION, THE AMERICAN LEGION
STATEMENT OF ANU BHAGWATI
Ms. Bhagwati. Thank you.
Dear Mr. Chairman and Members of the Committee, thank you
for holding this hearing on a critical issue facing our
veterans' community and for the opportunity to present the
views of the Service Women's Action Network or SWAN on the
challenges confronting veterans who file PTSD claims related to
military sexual assault or sexual harassment.
According to VA, PTSD is the most common mental health
condition associated with military sexual trauma or MST. For
women veterans, MST is a greater predictor of PTSD than combat.
Studies also indicate that sexual harassment causes the
same rates of PTSD in women as combat does in men and 40 to 53
percent of homeless women veterans have been sexually assaulted
while in the military. Simply put, MST has devastated the
veterans' community.
I would also like to point out that many men suffer from
the effects of military sexual violence. According to the
Department of Defense, 12 percent of all unrestricted sexual
assault reports are made by men. Additionally, according to VA,
almost 46 percent of the veterans who screened positive for MST
in 2010 were men.
Veterans who suffer from the debilitating effects of MST
face unique challenges in obtaining disability compensation
from the VA.
In 2011, SWAN and the American Civil Liberties Union, ACLU,
filed a Freedom of Information Act request with the VA for data
on MST claims. The data obtained through litigation showed that
between fiscal year 2008 and 2010, only 32.3 percent of MST-
based PTSD claims were approved by VA compared to an approval
rate of 54.2 percent for all other PTSD claims during this
time.
Also, veterans who had their MST PTSD claims approved by VA
or among those veterans who had those claims approved, women
were more likely to receive a 10 to 30 percent disability
rating whereas men were more likely to receive a 70 to 100
percent disability rating.
To reiterate, veterans who file a PTSD claim based on MST
only have a one in three chance of getting their claim
approved. Also, data suggests a strong gender bias in PTSD
disability ratings in favor of men.
The MST claims process is broken at best. VA's PTSD policy
discriminates in practice against veterans who are sexually
assaulted or harassed while in uniform by holding them to an
evidentiary standard which is not only higher than that of
other groups of veterans suffering from PTSD but also
completely unrealistic for the majority of survivors to meet.
The language in the regulation that establishes the
required evidence for what VA calls an in-service personal
assault differs radically from the language used to describe
the evidence required for all other PTSD claims.
In fact, CFR 3.304, paragraph (f), the regulation, allows
for lay testimony as acceptable evidence in all other PTSD
cases except in cases of an in-service personal assault.
VA policy fails veterans for a variety of reasons. First,
sexual assault and sexual harassment in the military are
notoriously under-reported. According to DoD, almost 87 percent
of assaults go unreported meaning that official documentation
of an assault rarely exists.
Secondly, prior to the new evidence retention laws passed
in the 2011 NDAA, the services routinely destroyed all evidence
and investigation records in sexual assault cases after two to
five years leaving gaping holes in MST claims filed prior to
2012.
Lastly, the allowance of so-called secondary evidence
described in the regulation does not take into consideration
the reality that many victims do not report the incidents to
anyone including family members and for a variety of legitimate
reasons including shame, stigma, embarrassment, or fear of
retaliation.
Although sexual assault increases the chance of adverse
emotional responses and behaviors, it does not mean that all
MST claimants will experience those symptoms. In fact, SWAN has
spoken to survivors who demonstrate changes in behavior not
included in the regulation such as improved job performance as
a means of coping with the trauma.
After a series of conversations, SWAN had with the Under
Secretary of Benefits last year about VA's discriminatory
practices, the under secretary issued a memo in June 2011
providing further guidance to claims officers and instituting
training requirements for processing MST claims.
However, both the letter and the training simply reinforced
the existing regulation which places a double standard on MST
claimants.
To fix MST claims policy, VBA must immediately revise the
regulation to provide language that establishes the same
evidentiary requirements for MST-based PTSD claims that it does
for other claims.
Furthermore, there should be no requirement that veterans
filing MST claims go through an independent compensation and
pension or C&P exam to verify that they have PTSD or any other
conditions associated with MST. Veterans should not be forced
to dig up their trauma for complete strangers who often lack
the sensitivity or professional qualifications to speak to
survivors of sexual trauma and who often unfairly reverse the
PTSD diagnosis made by qualified VHA or other mental health
providers.
Additionally, claims reviewers should not have the
authority to second guess evaluations by agency medical
professionals or to discount VA treatment records in favor of
these one-time C&P exam results.
Thank you very much for your attention. I would be happy to
answer any questions.
[The prepared statement of Anu Bhagwati appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Bhagwati.
Next we will hear from Ms. Ilem.
STATEMENT OF JOY ILEM
Ms. Ilem. Thank you, Mr. Chairman and Members of the
Subcommittee. We appreciate DAV being invited to testify on the
disability claims process for post-traumatic stress disorder
based on military sexual trauma or MST.
In preparing for this hearing, members of our National
Service Officer Corps contacted a number of local VBA officials
to determine what sources are being used by rating specialists
in developing MST claims.
A December 2011 VBA national training letter was identified
as an important guide. It provides detailed and comprehensive
guidance regarding these claims including pertinent
regulations, definitions, court cases, specific markers to
examine, timing for ordering PTSD examinations, and proper
development actions to be taken all before a decision is made.
Most notably we found a number of clear examples and
statements to raters emphasizing that a special obligation
exists on VA's part to assist claimants in gathering from
sources other than military service records evidence
corroborating a stressor and to help fully develop their
claims, particularly in MST cases.
The current regulation recognizes the difficulties inherent
in establishing service-connection for conditions related to
MST and provides a basis for a relaxed evidentiary standard.
The most salient point made in the training letter is to
emphasize that current regulations and court cases do not
require actual documentation of a claimed stressor and that the
opinion of a qualified mental health clinician can be
considered credible supporting evidence that the claimed
stressor occurred.
Nevertheless, the letter notes that the final decision on
service-connection remains with VBA raters.
To DAV, the question at hand for this Subcommittee is
whether VBA rating specialists are applying the unique
provisions in the regulation and following the specific
guidelines.
In cases where veterans indicate that no official report of
an assault exists, VA adjudicators must consider the stressor
statement provided by the veteran to determine if other reports
may document the event.
Additionally, rating specialists should examine military
personnel records for any sign of deterioration in work
performance, requests for transfer to another duty station,
disciplinary action, or unexplained social or behavioral
changes in the claimant.
Likewise, there are a number of medical complaints that may
indicate a sexual assault took place such as a request for a
pregnancy test or sexually transmitted diseases, repetitive
trips to sick call with chronic, unresolved medical complaints
can also be used collectively to help substantiate a stressor.
It appears that these cases require special attention and
efforts by raters, but it remains unclear whether these efforts
are consistently and exhaustively being made in each case.
Based on feedback from DAV national service officers, it
appears that many of these claims are denied even when there
appears to be sufficient documentation to support the claim
under the liberal guidelines and lowered evidentiary standards.
We also continue to hear reports from veterans who have had
to pursue their cases for years and ultimately seek
congressional intervention before their claims were approved.
Additionally, a recent press report citing a Yale
University legal services director documented a significantly
lower percentage between VA's approval rates of claims for
service-connection for MST related PTSD claims compared to
service-connection of other PTSD claims as noted by Ms.
Bhagwati.
However, we have not seen this type of data provided or
substantiated by VBA.
In preparing for this hearing, we did, however, learn that
VBA has an electronic capability to segregate and account for
MST and personal assault cases from other types of PTSD claims.
We believe open reporting of the status should be helpful to
the Subcommittee in its oversight role and could help to
determine if there is truly an inequity in establishing
service-connection in these cases.
Although VA has developed regulations and procedures that
provide for a liberal approach to evidentiary development and
adjudication of these claims, we urge VBA to conduct its own
internal oversight and review of these cases to ensure that
across the system its claims staff are properly trained and
compliant with the procedures and policies set forth in the
2011 training letter.
In closing, we appreciate the Subcommittee's attention to
this important issue and in the past decade, we note that
progress has been made, but much more needs to be done to
ensure that these disabled veterans are properly compensated
for conditions related to MST on an equitable basis in
comparison to veterans disabled by other causes.
Many of these veterans endured long, unnecessary waits for
their claims to be approved and many report they have been re-
traumatized by the process and bureaucracy that seems to
surround these cases and ask only for a fair measure of justice
given the indignities they have endured.
That concludes my remarks and I am happy to answer any
questions you may have.
[The prepared statement of Joy Ilem appears in the
Appendix]
Mr. Runyan. Thank you, Ms. Ilem.
Ms. Perkio, you are now recognized for five minutes.
STATEMENT OF LORI PERKIO
Ms. Perkio. Mr. Chairman and Members of the Subcommittee,
thank you for the opportunity to provide The American Legion's
views on the invisible wounds, examining the disability and
compensation benefits process for victims of military sexual
trauma.
Today's media provides a snapshot of the number of sexual
assaults that are currently reported in the military. DoD
estimates only 14 percent of all military sexual assaults are
reported each year. It is estimated that a victim of military
sexual trauma will wait an average of 12 years to report an
incident.
VA health care screens all veterans for military sexual
trauma and provides free treatment and health care for those
related conditions. It is often through this screening and
treatment that veterans learn about filing a claim for VA
disability benefits secondary to military sexual trauma.
Filing a claim for PTSD due to military sexual trauma often
causes extreme stress on behalf of the claimant as they have to
repeat the events of the assault in support of their claim. It
is highly recommended the veteran obtain an advocate familiar
in the VA claims process to help them understand the
requirements.
VA reported 704 MST claims were granted from October 2011
through February 2012. Seven hundred and twenty-six MST claims
were denied in that same timeframe. I would like to provide you
with some of the reasons that VA regional offices have denied
claims for military sexual trauma.
The Veterans Benefits Administration requires three
elements to grant a claim for disability benefits. The first is
a current diagnosis of a disability from a medical
professional.
The second is credible evidence that the claimed stressor
occurred while the veteran served on active duty and proper
recordkeeping by the military unit may be critical to this
requirement.
The third element is a nexus statement from a medical
professional that the claimed condition is at least as likely
if not due to the event which occurred while the veteran
served. The requirements of the nexus statement are not clearly
defined to the veteran.
In order for a medical statement to be accepted as
credible, the medical professional must also have reviewed
service treatment records, all private and VHA behavioral
health treatment records, and reviewed all pertinent
information submitted in support of the claim. The nexus
statement must list all the records reviewed.
Rating veteran service representatives will not consider a
medical statement as credible evidence if it is based solely on
the verbal account of the veteran. VA may consider other
evidence if there is no documentation within the military
record such as a police report or medical examination specific
to sexual assault.
If documentation of behavioral changes are not mentioned
within the service treatment records and were provided by a
behavioral health department instead, these records need to be
requested separately and by the veteran.
The VA will obtain these records only if given the dates of
treatment and the exact address of that treating facility. Most
veterans do not realize this is not automatically included in
their service treatment records.
VA states it will consider documentation of pregnancy tests
or tests for sexually transmitted diseases around the time of
the incident or treatment for physical injuries around the time
of the incident that were not claimed as due to trauma.
While this information may be listed in the service
treatment records, it may not state why the servicemember
sought that type of treatment, especially if it is a result of
sexual trauma they are not yet ready to discuss.
If the service medical records have any type of notation
that treatment was requested due to other than sexual assault,
it may be considered as conflicting evidence and often used as
a reason to deny the claim.
Sudden requests for change in military occupation skill or
requests for assignment changes without justification and
changes in performance evaluation may be considered as credible
evidence, especially if the documentation is within the
military personnel file.
Not all RVSRs request a personnel file when requesting
medical records. Without the personnel file to corroborate the
alternate evidence listed in 38 CFR 3.304, this evidence is
often based solely on the word of the veteran, which at this
time VA does not consider as credible evidence.
The VA has the ability to use their own authority to reduce
the number of denied claims for PTSD due to MST. In 2010, VA
implemented the reduced criteria for post-traumatic stress
disorder due to combat.
Obtaining personnel records must be a mandatory requirement
with all PTSD claims in the VA's duty to assist. In addition,
provide clear explanation and clarification of credible
evidence to support the claim as outlined in 38 CFR 3.304.
I would like to thank you on behalf of The American Legion
for providing testimony today.
[The prepared statement of Lori Perkio appears in the
Appendix]
Mr. Runyan. I would like to thank you for your testimony.
And with that, I will begin the questioning of the first
panel starting in order of our Members' arrival.
My first question is going to be to Ms. Ilem. You mentioned
in your written testimony about collaborative efforts between
the DoD and the VA in dealing with MST claims.
Do you believe that collaboration is adequate and how do
you think this process can be improved?
Ms. Ilem. I think we have seen more collaboration with
Secretary Hickey coming in, in terms of we looked at our last
testimony that was before this Committee and specifically we
had requested that VBA collaborate with SAPRO, the DoD's SAPRO
office to make sure that the SAPRO information was included in
their M21 manual.
And we were pleased that following that hearing, it did
take about a year, but eventually it did make its way into the
M21 manual as an opportunity for raters to look at, you know,
one other location for either one of the DoD forms, 2910 or 11.
So I think we have seen an increase in the cooperation.
However, we still have questions outstanding in our mind in
terms of if VA requests that information, even with the
permission of the veteran, due to the highly sensitive nature
and DoD's wanting to protect the privacy of the veteran, if
those will--will those records be forwarded because we had not
seen that in SAPRO's documentation that VA is an exception of
one of the people that can receive that documentation.
So I look forward to the panels following this, to hearing
from them if that has been clarified and that they, in fact,
are collaborating together to make sure that evidence is
available for veterans who want it to be made available to VA
in support of their claims.
Mr. Runyan. Thank you.
I think this Committee recognizes that many veterans are
having difficulty receiving benefits related to MST. And
despite the relaxed evidentiary standard, many veterans still
have difficulty providing the evidence required for the award
of service-connection.
In each of your opinions, can you touch upon, why that is
happening?
Ms. Bhagwati. I would not refer to them as relaxed
evidentiary standards. I would refer to them as actually harder
evidentiary standards.
There is a two-tier system right now, one for PTSD
generally and then one for MST PTSD, and for veterans who
suffer from MST, 87 percent of these assaults were never
reported for very good reasons including fear of retaliation
within the military and a variety of other factors related to
rape, assault, and the trauma that results.
We have to think more strategically about what counts as a
fair evidentiary standard. It is clear in all other cases of
PTSD that the veteran's lay testimony is sufficient as long as
that veteran has a diagnosis of Post-Traumatic Stress Disorder
from a qualified medical provider as well as proof of time and
service.
There is language in that regulation for every other
veteran suffering from PTSD with the exception of rape,
assault, and harassment. It is completely unfair.
Mr. Runyan. Thank you.
Ms. Ilem.
Ms. Ilem. I think probably we would like to see the data.
For years, we have asked for data specific to MST related cases
versus non-personal assaults. The first information that we had
really seen was the FOIA information. And certainly we believe
VA does have the capability to extract that information and
perhaps has it, just briefly looking at their testimony, VA
appears to have evaluated some of the raters' decisions.
And I think we would definitely want to look at if these
was there compliance with the rules and regulations and the
policies that have been set forth so far. That is where I think
probably the biggest, problem may lie because, there are
oftentimes, a significant number of other opportunities to
support those claims, but it appears perhaps they are not being
consistent throughout the country because we continue to hear
these complaints repeatedly from people that are saying I have,
submitted a number of, everything that they have asked me and
my claim was still denied.
Mr. Runyan. Ms. Perkio?
Ms. Perkio. Thank you.
I have been a service officer for 16 years and I have been
working VA claims. And that included military sexually trauma
claims. And my experience as a service officer is that the
evidence was not given the weight that it should have.
I worked with one man. He had been raped and the next
morning as he was walking around feeling very dejected and
trying to figure out what he was going to do with the rest of
his life, he chose to commit suicide by throwing himself under
a truck.
Not only did he have to live with the results of the
medical injuries from that, the treatment that he received did
not get used in support of his claim because he did not report
that he had actually been sexually assaulted. The medical
records and nobody in the VA would take into account the
reasons why he may have tried to commit suicide when it was
plain that there was definitely a change in his attitude, his
personality, and his will to live.
Those are the types of things that we would like to see the
VA take more into account in supporting claims for military
sexual trauma.
In their own adjudication manual, it states behavioral
changes will be considered. These are things that while the
regulation is already there, the adjudication manual is there,
more information needs to be provided to the raters on how to
look at that information and apply it.
Mr. Runyan. Thank you.
And with that, I recognize the Ranking Member, Mr.
McNerney.
Mr. McNerney. Thank you, Mr. Chairman.
Ms. Bhagwati, I believe that you mentioned that one of the
problems that claimants have is that records have been purged
after a certain number of years.
Do you know if that is a policy or what regulates when
records are purged and how can we change that so that there is
more evidence that would be maintained?
Ms. Bhagwati. There are some records that are still purged
and some that are no longer purged thanks to the last National
Defense Authorization Act. Perhaps Congresswoman Pingree can
add to that.
Unrestricted sexual assault reports are kept for 50 years
and restricted reports for five years. What is still destroyed,
however, is EO or sexual harassment investigations.
So if you were sexually harassed and reported it, and this
happened to me, I can tell you my firsthand experience, those
EO reports are destroyed within two to five years. And it is
done branch to branch. I served in the Marines, so the
Department of the Navy is not tracking those or not keeping
those copies forever.
Mr. McNerney. So there is no policy with regard to keeping
those?
Ms. Bhagwati. Not for sexual harassment investigations.
Mr. McNerney. Well, you concluded in your testimony that
when you look at the VA's policies on paper, it is no surprise
that veterans who suffer from MST related PTSD have only a one
in three chance of having their claims approved.
Could you please elaborate on that conclusion and how the
VA regulations could be change to improve the outcomes of that?
Ms. Bhagwati. It is an absolutely murderous process. We
heard the example of one veteran who killed himself because of
this process. But, you know, I went through it myself. It took
four years.
Frankly, VBA is inept at the regional office level. You can
give them all the evidence you have. I had plenty of eyewitness
statements, everything they asked for, all the sort of
secondary evidence that is in the regulation, but it was flat
out ignored.
What happens when those claims get rejected is a lot of
veterans fall into a downward spiral of worsening trauma,
suicidal ideation, maybe attempted suicide, maybe completed
suicide.
We are really looking at a life and death situation here
with this claims process. And we do not need----
Mr. McNerney. So it is not----
Ms. Bhagwati. It is not rocket science. We do not need to
rewrite, you know. It is not an issue of allowing more
evidence. It is requiring less evidence. It is a very simple
fix. We should have one universal standard for PTSD claims.
Right now lay testimony is not enough for sexual trauma
survivors, but it should be in addition to the other
requirements for all PTSD claims, a doctor's diagnosis or a
mental health provider's diagnosis.
Mr. McNerney. In your opinion, does it more have to do with
the regulations or with the culture?
Ms. Bhagwati. It is both. Unless there is a formal change
in policy written in the regulation, you are counting on the
individual regional officer, the claims person or claims
provider to make a judgment about whether or not a VHA
diagnosis or a mental health provider's diagnosis of PTSD is
accurate or enough based on their years of experience doing
rape crisis counseling work or sexual trauma counseling work.
Essentially what happens is VBA gets to deny the expertise
of its VHA experts or mental health professional experts. It is
a completely backward system.
And, unfortunately, you are right. There is bias within
each individual claims officer who rejects these claims. And we
cannot risk that bias. A fix to this regulation is very simple.
Mr. McNerney. Okay. Well, that is a good segue into Ms.
Pingree's bill, H.R. 930. Do you think the provisions in this
bill would help the veterans affected by MST in facing the
hurdles that they have, Ms. Bhagwati?
Ms. Bhagwati. Yes, absolutely. I think H.R. 930 is a
comprehensive solution that includes, not just post-traumatic
stress but all the other mental health conditions associated
with sexual trauma.
Not everyone has PTSD from sexual assault, rape, or
harassment. Other common conditions are other anxiety
disorders, depression, and those are also life threatening.
Mr. McNerney. Ms. Ilem, what in your opinion should be done
to help the veterans that were denied claims prior to the
recent improvements?
Ms. Ilem. I think certainly having VBA, you know, do a
review of cases is extremely important since it sounds like
they have invested in doing some training with their people. If
they are really committed to making sure that people are
consistently following these rules, they have to do the
oversight internally.
I mean, it does take some work to develop these claims
properly. And unless they go back and look, have those
procedures been followed, and in those cases, I mean, they
should, you know, think about reevaluating those claims. This
has been a difficult process for so many people.
Mr. McNerney. Do you think the VA should proactively do a
system-wide review of the cases that have been denied?
Ms. Ilem. Well, I think they should definitely look back
from their previous training letter that was done, I believe in
2005 prior to the update of the 2011 one, and would be a first
good measure of looking at how well these standards have been
applied in the regulation throughout those cases.
They did indicate, I believe in their statement, that
following a review, I think that they did, that they decided
to, you know, make changes in their letter and make it very
clear and concise about how they wanted their raters to
approach these cases. But we are not seeing the evidence in
terms of were there cases denied that should have been approved
based on the evidence.
Mr. McNerney. Thank you.
Mr. Chairman, my time has expired.
Mr. Runyan. I thank the gentleman.
I now recognize the gentleman from Maine, Mr. Michaud.
Mr. Michaud. Thank you very much, Mr. Chairman and Mr.
Ranking Member, for having this very important hearing today
and also for the Committee for allowing my colleague from
Maine, Ms. Pingree, to serve here as well.
And you do have the entire Maine delegation from the House
here today, so it shows you the importance of this issue to
have all of us here.
But I also want to thank Ruth Moore and her family for
coming today as well and taking the time to talk about your
personal story which is extremely important.
Unfortunately, Mr. Chairman, I will not be able to stay for
the whole hearing as I have to meet with several employees from
New Balance in Maine. They are currently negotiating the
transpacific partnership agreement and depending on how that is
negotiated would mean whether or not they will have to close
the facilities or not. So I will not be able to stay for the
whole hearing.
But I do have a quick question for our panelists. When you
talk about, you know, some of the soldiers and veterans not
reporting when they have been sexually assaulted, have you
heard anything from the experience with the MST survivors as
how soldiers actually should start documenting their issues
when they are in the military? Have they given you any advice
of what they should do for that documentation for any of the
panelists?
Ms. Perkio. I know that DoD has implemented a new program
where victims of military sexual trauma can go in and receive
counseling and they get to choose whether their records will be
held or destroyed.
So if that servicemember says I just want treatment for
this, I want you to help me through this program, but I do not
want anything to follow me after this, and those records will
stay destroyed.
And so DoD actually is working on a new program. I could
not tell you the particulars or who that person is, but I could
get you the point of contact after the hearing.
Mr. Michaud. That is what DoD is doing. But for those who
have been sexually assaulted that you have talked to, have they
given any additional suggestions on what DoD should do because
clearly if they go in there, they are in the service, at that
point in time, they might want to have everything destroyed,
but when they start receiving help or what have you, they might
decide to change their mind? So I am just looking for things
that DoD can do differently that you might have heard from
those who have been assaulted.
Ms. Perkio. I have not been given any input from
servicemembers, but I can tell you that working those claims,
if all of the documentation was submitted and there was not a
timeline to destroy behavioral health records and that they
were, you know, integrated in with the service treatment
records as well as their personnel records and file clerks were
able to make sure that those records were complete, it would
make a big difference on whatever action that servicemember
chose to take at any point in their career either medically
discharged or after they have been out filing a claim.
Ms. Ilem. I would just add that, you know, that was one of
the problems with regard to SAPRO that we had that we spoke
about at the last hearing here in 2010, our concern over the
destruction, not only the destruction of records, but the
recordkeeping process.
And as Ms. Bhagwati indicated, you know, that is still
being sorted out. For the unrestricted, those records will be
maintained for 50 years, but for the restricted ones, that is
still in the works and they may be only maintained for up to
five years.
And as well as any of these other additional records, it
has been up to each military service, as we understood,
determining when those would be destroyed or how long they
would be kept. And we are concerned about where are they being
kept and can VA get them if the veteran requests or indicates
that they did have counseling or, you know, outside help.
So I think that is still a major issue on the DoD side and,
again, look forward to the, you know, testimony by SAPRO if
that has been worked out. We understand that, you know,
Secretary Hickey and General Hertog have been talking about
that, but to what extent, I do not know. We have not seen any
formal agreements yet between the agencies.
Mr. Michaud. Thank you.
Ms. Bhagwati. Survivors will universally talk about the
bias in the system within DoD and the bias specifically within
the chain of command. One of the reasons we have such a high
under-reporting rate is because of that bias, because of that
fear of retaliation. It is not just fear of retaliation, but
actual retaliation which very often happens.
Here again, we are just talking about approximately the 13
percent that actually report and whose evidence can then, if it
is not destroyed, actually be used for a VA claim. But VA's
responsibility now has to be to the entire percentage of
survivors including the 87 percent who do not report for very
good reasons, for fear of their lives many times.
So in order to do that, there has got to be a change to the
military judicial system so that there is no bias in that chain
of command. And that is a longer conversation.
Mr. Michaud. Great.
Thank you very much, Mr. Chairman.
Mr. Runyan. I thank the gentleman.
And the gentleman from Minnesota, Mr. Walz, is now
recognized.
Mr. Walz. Thank you, Mr. Chairman, the Ranking Member, and
thank you for once again holding important hearings on
substantive matters and trying to make things right. I am very
appreciative of that to both of you.
And to our witnesses, thank you for helping educate us,
helping bring it forward.
As you do, I have such deep emotions on this as a retired
military person. The anger and the disgust and the frustration
all boil up on how do we end up in this point. It is just hard
for me to fathom units that allow this to happen. And I
recognize that it does.
On the VA side, I think Ms. Bhagwati brought up a very good
point here. That 100 percent of folks here have to be dealing
with it. But we have to go back to the DoD side. We have got to
figure out the prevention measures, too.
And I know Ms. Pingree and Ms. Speier have worked heavily
on this, that we have to continue to push that side of it.
As we are dealing with this tragedy after the fact. I think
many of you brought up really good points of how this situation
arose.
If you all three had the magic wand or were sitting over
there at VA's position on this, what exactly would this look
like? How we would deal with this? What exactly would happen
from when the claim comes in and how we go forward? What would
be your suggestion if you can help me as we are going to hear
from them?
And I certainly know that we are trying to train specific
raters to deal with this so they know what is there. I am just
trying to get a feel from all of you. Are they going about this
the right way? Are we approaching it? Are we piecemealing
together? What would you tell me?
I know it is subjective here, but I think this is too
important for us not to figure out something big to go about
it. So if you would like to take a stab at that of what a claim
should look like and how we should adjudicate these things that
would be in the best interest of our servicemembers after the
fact.
So, please, go ahead.
Ms. Bhagwati. I am beating a dead horse here. I think this
is, the third time I have said it.
Mr. Walz. Yes.
Ms. Bhagwati. It is a very easy fix. If the evidence
establishes a diagnosis of post-traumatic stress during service
and the veteran's mental health provider connects that claimed
stressor to the patient's service, then in the absence of clear
and convincing evidence to the contrary and provided that the
claimed stressor is consistent with the circumstances,
conditions, or hardships of the veteran's service, the
veteran's lay testimony should sufficiently establish the
occurrence of the claimed in-service stressor.
Mr. Walz. Ms. Bhagwati, are you convinced that that will
bring those 87 percent forward?
Ms. Bhagwati. Absolutely. You trust your mental health
providers and you accept the lay testimony and the military
record of the veteran period.
Mr. Walz. What is the push-back of why we do not do that in
your opinion?
Ms. Bhagwati. It is rape mythology, sir. It is the sort of
unspoken feeling that women make up that they were raped,
assaulted, or harassed. And I say women specifically because I
think there is a gender bias.
Mr. Walz. That does go back to the bigger cultural issue
both military and social----
Ms. Bhagwati. Absolutely. It is a complete ignorance about
the nature of rape, sexual assault, and sexual harassment.
Mr. Walz. Don't you believe, and I have always believed
this, the military has the potential to break those and set the
precedence for a larger society, too?
Ms. Bhagwati. Absolutely. The military can lead the way if
it wants to.
Mr. Walz. Okay. Well, I appreciate that.
Ms. Ilem, I do not know if you have anything to add to
that.
Ms. Ilem. I think Ms. Bhagwati has brought up a couple of
issues that there is really a differentiation between somebody
who may have some alternative evidence that can be considered
and the current regulations that exist today to rate these
cases because there is that aspect of it and making sure there
is consistency throughout the system across the board and then
that there is oversight for them to really be reviewing it,
and, yes, having claims raters that are familiar with these
cases and really know how to dig in.
It seems to me they really have to make a special effort to
kind of piece together other things and really work with the
veteran and the RO military sexual coordinator may have to be
involved to try and assist the veteran along with the veteran
service organizations to get the evidence that is needed under
the current regulation.
But the cases where somebody really keeps this a secret,
does not tell anyone, there are not any indicators in the
record to substantiate that.
We have seen legislation in the Senate recently that DAV
testified on where, you know, if you are being treated for a
condition, you have been diagnosed, and you then, you know,
have, even though that stressor is not reported that can
support, you know, support your claim, I mean, I think that is
the only change that could be, you know, available to people
who have--there is absolutely no other evidence available to
them.
Mr. Walz. And I think all of you brought up a great point
on this, too. I cannot imagine what a claim denial feels like
because it is basically a denial that the incident happened.
And, you know, I do not know if there is data that support
the number of claims versus the number of denied claims. There
definitely has to be a large number that were denied that the
assault absolutely did happen. This is all a difficult process,
from the psychological effects and treatment, to trying to get
somebody well again, and that has to be taken into
consideration. This process of claim adjudication on this is
they are always important, that this is especially important.
My time has expired, and I will yield back. But I thank you
all.
Mr. Runyan. I thank the gentleman.
The chair now recognizes the gentleman from New York, Mr.
Turner.
Mr. Turner. Thank you, Mr. Chairman.
And I would like to thank the panelists.
I have one question for Ms. Perkio. You mentioned advocates
to help negotiate or navigate people through this bureaucratic
maze and through the legal system.
Could you give us a little more on that, what you have in
mind, how that might work? Where would you get these people?
Ms. Perkio. The American Legion has 2,000 accredited
American Legion service officers who are trained in assisting
veterans in all types of claims. And we provide training twice
a year for our service officers. There is no fee to work with
an American Legion accredited service officer.
I myself have been accredited and we are given training
both from the VA and through The American Legion on how to, and
through VHA, on how to handle claims. So just understanding the
process and working with claims, working with senior veteran
service officers.
For instance, the process that I went through, you learn
something new on every claim and every MST claim is going to
have another element. And working with behavioral health has a
big impact on how that claim is going to turn out so that that
behavioral health provider understands what they need to do to
support that veteran's claim as well.
And that is where in my testimony, if the VBA would be more
transparent in what they were really looking for in their
information, for instance, on the letter from the medical
professional that says that this is a nexus statement, that it
is due to military sexual trauma, to know that the VBA wants to
review all those documents in order to be an informed
professional to write that letter and that they will not accept
a statement just on the veteran's hearsay.
And our service officers are well trained in that. All of
our service organizations, actually the DAV, VFW, we all have
service officers who will assist those veterans free of charge
in filing claims. And so there is help available without going
to an attorney.
Mr. Turner. And how does the process start? Does the VA
make the connection between a claimant and an advocacy group
such as yours?
Ms. Perkio. Typically a nurse case manager will be involved
and they have a list of the service organizations that may be
available right in the regional office next to them. And they
will allow that servicemember to choose which service
organization they may feel that they would like to work with.
And so that referral process has worked very well in the
past and that service officer will come in. And sometimes they
will interview each department service officer with each
organization to determine how well they fit with that.
The credibility and the empathy and the understanding that
goes with a claim regarding MST is going to go a long way in
the trust that that person will put with you. They have to
repeat that story not only to their medical care provider, but
they repeat that story to that service officer and then the
service officer will tell that veteran this is what we are
going to do for you and this is what we are going to need. And
that kind of helps that situation along.
It is the servicemember who does not have an advocate that
is really going to struggle and to meet a lot of road blocks.
And being able to work with behavioral health makes a big
difference.
Mr. Turner. Is the VA obligated to provide an advocate or--
--
Ms. Perkio. No, the VA does not provide an advocate. But in
their letters, they will advise the veteran that there are
advocates available and will give a list or a Web site that
they can go and look to find an advocate for them.
Mr. Turner. So all they do is dispense the advice on maybe
how to best navigate this by contacting American Legion or----
Ms. Perkio. Correct.
Ms. Ilem. And it also depends on if you are talking about
within VHA or VBA, but VHA does have military sexual trauma
coordinators in each of its medical facilities. And oftentimes
veterans do work directly with them to talk about how they can
pursue their case, you know, for claims.
And they may be referred to someone in a regional office.
They also have that equivalent of a military sexual
coordinator. So those people should also be able to provide
that additional information if they want to have a veteran
service organization assist them.
Mr. Turner. All right. My time is up. Thank you.
Mr. Runyan. I thank the gentleman.
Mr. Turner. Yield back. Thank you.
Mr. Runyan. The chair now recognizes the other half of the
Maine delegation, Ms. Pingree.
Ms. Pingree. Thank you very much. I really appreciate the
opportunity to be here with your Committee and also to sit on
my fellow delegation Member's Committee for a few minutes.
But thank you very much, Chairman Runyan and to Ranking
Member McNerney, both for holding this hearing and for everyone
on this Committee's very thoughtful questions and being willing
to take on what I think is an extremely important issue.
I want to make just a couple of comments and then I have
some questions as well.
I think generally the VA is doing a good job providing
counseling and treatment to victims of MST, but when it comes
to awarding benefits, as we have heard so much already today,
MST survivors face tremendous roadblocks and bureaucratic red
tape.
Since most attacks, as we have heard, go unreported, it is
very hard for victims to provide the documentation during the
claims and therein lies some of the source of our problem here.
The current policy states that they will be very liberal in
deciding MST cases and should accept secondary markers as the
proof that the assault occurred, things like counseling reports
for PTSD from MST, letters from family members citing
behavioral changes, drug and alcohol abuse, but it has been our
experience in my office that this policy is not being followed.
The VBA remains vastly inconsistent when deciding on MST
cases and what one regional office accepts, as we heard
earlier, accepts as a secondary marker, another might deny and
still not be violating VBA policy.
I think we have to be sure that VBA gives MST survivors the
benefit of the doubt, especially when so many of these
survivors have lost faith in the system they swore to uphold.
That is why I introduced the bill that you were asking
about earlier and I appreciate the Chairman signing on to that
bill. Basically it would provide service-connection for MST
survivors if they provide a diagnose of PTSD and a medical link
stating that the PTSD is caused by the assault similar to the
policy now in place for combat related PTSD claims.
I want to be clear about this. The bad guy in these stories
are the perpetrators. They are the villains and the ones who
should be held accountable. But by creating this policy that
denies justice to the victim and forces them to spend years or
even decades fighting for the benefits that they deserve, we
are deepening the wounds for those veterans and making it much
harder for them to get on with their lives.
Ms. Bhagwati, thank you very much for your wonderful work
and being here today.
And thank you to everyone on the panel.
A couple of questions. You have already talked a little bit
about this very issue of the VBA and how it is working.
Do you think it is enough to ease the PTSD evidentiary
burden for MST claimants or do you think we also need to ease
the burden for other common conditions associated with MST like
depressive disorders and other anxiety disorders?
Ms. Bhagwati. As I said in my testimony, according to the
Veterans Affairs Department, PTSD is the most common mental
health condition associated with MST, but depressive disorder
and other anxiety disorders can be just as life threatening.
And we certainly know that from the rest of the veterans'
community.
Many combat veterans are also suffering from depression
rather than post-traumatic stress. So, no, it is not enough
just to focus on PTSD. We have veterans committing suicide
every day from major depressive disorder and other very, very
serious conditions and very common conditions.
Ms. Pingree. Either of the rest of you would like to answer
that or talk about that?
Ms. Ilem. I would agree. I mean, those are certainly other
factors, mental health conditions that we see associated with
MST related incidents.
Ms. Perkio. In addition, all of the characteristics,
anxiety, depression, those are all part of the PTSD criteria
and so they should all be looked at because you never know when
that claim may eventually be granted as a PTSD claim.
Ms. Pingree. Thank you.
Ms. Bhagwati, you also had mentioned that rape mythology
when you talked about this earlier and the VA's fear of fraud.
It is my impression that fraud is likely to be low in a
situation like this. As you have reported and others have, very
few people come forward to talk about a rape, a sexual assault,
a sexual harassment because of the implications of doing that.
But can you talk a little bit that since that is one of the
reasons that we understand we do not have a better process
here? Is there data to back it up or how can we sort of get rid
of the mythology here?
Ms. Bhagwati. The VA interestingly had the same concerns
when it was debating whether or not to change the regulations
related to combat and then the language ended up being about
fear of hostile military or terrorist activity.
But the VA had that discussion after the regulatory change
and decided that there would not be any false allegations or
false claims as a result of this regulatory change. And I think
the same thing can apply to this MST change.
We have looked through VA claims data. What often happens
as a result of these mistakes, the first kind of rejection
phase, is that the veteran, if they can tolerate it will
appeal. Ultimately after a very, very lengthy appeals process
or the very end of the phase, VA will reverse the decision and
end up sort of siding with the veteran, but that can take years
if not decades.
Why not just get it right the first time and give the
veteran the benefit of the doubt and just simplify the system?
According to the FBI and numerous other agencies and
studies, only two to eight percent, again, two at the low end,
eight percent at the high end, of rape allegations are so-
called false allegations. That is a very low percentage.
I would like to think that VA, is rooting for the 92 to 98
percent of rape and assault survivors that are telling the
truth and, who have investigations that can prove that they are
telling the truth. That is all that that means. False reporting
represents a very low percentage and is pretty much on par with
other false allegations of crimes.
Ms. Pingree. I have 30 seconds. Either of the other two of
you like to say anything that was not covered about this?
Ms. Ilem. I would just note DAV also, you know, has spoken
to or consulted with clinicians that have had a long history of
treating, especially in VA, for treating military sexual trauma
issues.
And we had the same sort of, you know, discussion that, you
know, there may be a handful of cases in their career of 30
years where they really feel that, you know, they cannot really
come forward, to feel that, you know, that that was a truthful
statement.
But in the majority, the overwhelming majority of cases,
they do. I mean, it takes a lot of commitment to come forward,
to seek treatment, to have a diagnosis, and generally you have
these long-term treatment records available, you know, that are
consistent with an assault occurring.
Ms. Pingree. Thank you. I am out of time, but thank you
very much.
Mr. Runyan. I thank the gentle lady.
And on behalf of the Subcommittee, I want to thank each of
you for your testimony and your service to our Nation's
veterans. And with that, you are all now excused.
And I want to invite the second panel to the table. Among
our guests on the second panel today is Dr. Barbara Van----
Ms. Van Dahlen. Dahlen.
Mr. Runyan. --Dahlen, the president and founder of the Give
an Hour organization which encourages doctors to volunteer
their time to help victims of military sexual trauma. And we
also welcome Ms. Margaret Middleton, the Executive Director of
Connecticut's Veterans Legal Center, which works to seek
justice and proper benefits on behalf of victims of military
sexual trauma.
Ms. Van Dahlen, you are now recognized for your oral
testimony for five minutes.
STATEMENTS OF BARBARA VAN DAHLEN, EXECUTIVE DIRECTOR, GIVE AN
HOUR; MARGARET MIDDLETON, EXECUTIVE DIRECTOR, CONNECTICUT
VETERANS LEGAL CENTER
STATEMENT OF BARBARA VAN DAHLEN
Ms. Van Dahlen. Thank you for this opportunity to provide
testimony regarding the issue of providing and improving access
to care for veterans who have been sexually assaulted while
serving in our military. It is an honor to appear before this
Committee and I am proud to offer my assistance to those who
serve our country.
Over the past several months, we have seen an increase in
the attention given to a very serious issue affecting our
military community, military sexual assault.
Understandably this type of attack and betrayal often leads
to the development of severe mental health difficulties for the
men and women who are victimized.
And as we have heard, many of the female veterans treated
by the Department of Veterans Affairs and other programs
receive a diagnosis of military sexual trauma and this type of
trauma is now the leading cause of post-traumatic stress
disorder among female veterans, but it results in many other
mental health issues as well, now surpassing combat trauma.
In addition, the experience of military sexual assault
increases the likelihood of other serious and devastating
conditions and consequences such as substance abuse,
homelessness, and suicide.
While this issue is getting significant attention today,
sexual assault has been affecting and often destroying the
lives of those who serve for decades.
As I began to prepare testimony for this hearing, I had
occasion to speak with a colleague who devoted over 20 years of
service to the military. He continues to serve as a civilian
with the Department of Defense.
I happened to mention to him that I was invited to testify
before this Committee on this important topic. After stating
that he was about to share something with me that he had never
shared with anyone, not even his wife, he told me the following
story.
He enlisted in the military at the age of 17. It was the
late 1970s. Within the first year of his service, he was
sexually assaulted by two men with whom he served as part of an
initiation process.
He was humiliated and devastated. He told no one. He said
there was no one to tell. Reporting would have made my life
much worse. The stigma would have further damaged me and my
career. I felt overwhelming guilt and shame.
This veteran suffered the consequences of the attack
psychologically and physically for years. At one point, he
contemplated suicide and went so far as to put all his affairs
in order and make arrangements for the care of his two-year-old
daughter and young wife.
His marriage fell apart and he and his wife separated.
Fortunately, this veteran found help, repaired his marriage,
and healed psychologically, though he continues to have
significant physical problems that stem from the attack that
shattered his life 30 years ago.
He shared his story with me now because he wants the
Members of this Committee to understand that servicemembers who
are sexually assaulted are unlikely to report the assault to
their command, to their peers, to anyone. And you cannot often
tell from looking at them that they have been affected, not for
years.
We in the mental health profession know that it is critical
for victims of sexual trauma to seek and receive assistance,
support, and treatment as soon as possible. We also know that
it is likely that many who suffer sexual attacks within the
military will not seek care while they continue to serve.
We must, therefore, ensure that all of those who seek
services through the VA for sexual assault once they leave the
service are treated as quickly and as supportively as possible
by allowing trained mental health clinicians to determine the
veracity of a veteran's claim of sexual assault.
The signs and symptoms are well-known and VA mental health
providers have already been given the appropriate
responsibility for making this type of determination regarding
reports of combat stress injuries.
Moreover, given the humiliation survivors of sexual assault
contend with, it is highly unlikely that many women or men will
fabricate stories of military sexual trauma in order to receive
VA benefits.
In addition, the lives that are saved by adjusting the
process by which victims of sexual assault can qualify for and
receive services through the VA will far outweigh the very few
cases that beat the system.
In addition to changing the process for victims of sexual
assault to apply for and receive services through the VA, we
should continue to expand the network of providers available to
meet the growing needs of the military community at large.
The VA has made tremendous strides in recognizing that
partnerships with community-based organizations are critical if
we are to provide the mental health services that the men,
women, and families who serve our country need when they come
home to our communities.
The VA recently signed an MOA with my organization, Give an
Hour, which provides free mental health services to military
personnel, veterans, and their loved ones. This MOA will
facilitate appropriate referrals to our providers from the VA's
veterans crisis line.
It is easy to imagine how community-based efforts such as
those provided by Give an Hour and other organizations can
assist the VA in their efforts to provide swift and effective
care to those who have given so much to our country.
Thank you so much.
[The prepared statement of Barbara Van Dahlen appears in
the Appendix]
Mr. Runyan. Thank you, Dr. Van Dahlen.
Next we will hear from Ms. Middleton.
You are now recognized.
STATEMENT OF MARGARET MIDDLETON
Ms. Middleton. Chairman Runyan, Ranking Member McNerney,
and Members of the Subcommittee, thank you very much for asking
me to testify about the VA disability compensation process for
victims of military sexual trauma.
My name is Margaret Middleton. I am the Executive Director
and Co-Founder of the Connecticut Veterans Legal Center. Our
mission is to help veterans recovering from homelessness and
mental illness overcome barriers to housing, health care, and
income.
I am also a visiting clinical lecturer at Yale Law School
and I co-teach at the Veterans Legal Services Clinic there.
In both of those capacities, I work with veterans seeking
VA compensation for PTSD caused by sexual assault in the
military.
There are several experts at this hearing from the last
panel who testified about the military culture, the extent of
sexual assault in the military, and the scope of the VA's
failure to assist those victims.
Rather than repeat that testimony, I would like to share
some personal experiences I have had helping veterans confront
the evidentiary standard of 38 CFR 3.304(f)(5) which is the
current standard.
In my teaching capacity, I co-supervised a team of students
who helped a female marine establish service-connection for
PTSD stemming from a rape at Camp Lejeune in the early 1970s.
At that time, she was 18 years old and extremely proud to be
serving in the marines.
She was out drinking at an NCO club where she was not
supposed to be and the acquaintance who was walking her home
pushed her through a window and raped her in an empty barracks
room.
This veteran felt tremendous shame and personal
responsibility for having been out at night, for having been
drinking, for having trusted the wrong person. She feared her
romantic partner would leave her if she talked about the rape.
And her assailant who bragged about his conquest caused the
warrant officer she considered sort of a father figure to tell
her that she was the reason why women should not be allowed in
the military.
This veteran was plagued for PTSD for decades following
this assault and was diagnosed and is currently treated by a VA
doctor for PTSD.
Assisting this veteran get connected for service-connection
was incredibly complicated. Her parents had died. Her marriage
had failed. There were no surviving letters of hers, no
journals, no court records. She had lost contact with anyone
she had served with 30 years earlier. She had been too ashamed
and afraid to seek medical help at the time. Mental health
treatment then was even less common and more stigmatized than
it is now.
She was not demoted. She did not seek a transfer. She just
continued to do her job and was honorably discharged from the
marines.
Under the current standard, it took hours of work by two
incredibly talented Yale students and an unusually cooperative
VA physician to build her case based on what meager
contemporaneous evidence they could sort of scrape together.
Almost no veteran has access to this kind of support and
representation and they should not have to.
Another option might have been an independent forensic
psychiatric evaluation that would have cost several thousand
dollars that my client did not have and VA does not pay for.
This veteran's lack of documentary evidence is the rule and
not the exception in these types of cases.
I recently interviewed a female veteran who was raped by
two sergeants in her barracks 30 years ago. They ordered
everybody else out and they kept her behind.
Decades later, similar to what the doctor just said, I was
the first person that she had ever told. She did not tell
anyone at the time because it would have meant the end of her
career. And if you think her career was not important to her,
she served in Iraq. She achieved the rank of master sergeant
and she was retired honorably after 28 years serving in the
military.
This incredibly strong soldier held back tears when she
told me the story and it was only one of the several episodes
of MST that she described to me.
This veteran's claim faces an almost impossible evidentiary
burden because of this particular provision. She did not tell
anyone what happened, so there are no medical records, no
letters home, no actions taken against her assailants.
In order to succeed in the army, this veteran felt forced
to stay silent and now she will be punished for her silence
because the VA will refuse to credit her story based on her
testimony alone.
As her advocate, it will take me and my team hours of phone
calls to family members and old friends, combing through
service personnel records, and begging doctors to provide a
free forensic psychiatric evaluation to support her claim.
This is surely not what the VA anticipated when it adopted
Section (f)(5), but it is the reality of how this provision is
working in practice. We know that this is grossly unfair. We
know how to fix it.
The VA can and should remedy this situation by amending the
section to provide victims of military sexual trauma the same
benefit of the doubt that other veterans are already afforded
who seek compensation for PTSD.
There is no excuse for permitting the current regulation to
stand and I hope this Subcommittee exercises its responsibility
to America's veterans by correcting this injustice. Holding
this hearing is a really important step towards change.
And I thank you again for the opportunity to testify and I
would be happy to answer any questions.
[The prepared statement of Margaret Middleton appears in
the Appendix]
Mr. Runyan. Thank you very much.
And, again, both of you, thank you for coming today and
sharing your testimony with us.
Doctor, I have a question. It is actually two questions for
you.
In your written testimony, you stated that despite the
cultural differences between military and civilian life, the
symptoms of sexual trauma are consistent and easily
identifiable by mental health professionals.
Accordingly, you suggest VA should expand the network of
qualified mental health specialists to assist the veterans who
are victims of MST which in turn will assist VA claims
processors review of the evidence in such claims. And now the
two questions: how do organizations like yours become involved
in this process?
Ms. Van Dahlen. Mm-hmm.
Mr. Runyan. And do you believe that having such access to
an expanded network of mental health providers will encourage
more victims of MST to come forward and report what has
happened to them?
Ms. Van Dahlen. Absolutely, to the second question. I think
we have already seen through, and our network now has provided
57,000 hours of free mental health care to servicemembers,
veterans, and their families. It is an option outside the VA,
outside DoD, that many desperately need and want for a variety
of reasons. So expanding the opportunity for victims of
military sexual trauma to seek a provider in their community
who would then be able to provide that confirmation of the
military sexual attack would, I think, bring many more victims
to be able to receive services and benefits. It is an issue in
discussion right now, and has been for quite some time,
regarding Post-Traumatic Stress in general. That currently only
VA clinicians are allowed to provide that assessment. But there
are many who believe that opening that door and allowing
community-based mental health providers to provide expertise in
areas that they are fully capable of making that diagnosis and
assessment would assist in providing care, would assist in
moving the process along more quickly in terms of benefits,
services, etcetera.
Mr. Runyan. I remember, and I know many of the other
Members who are here do also, when Secretary Shinseki sat in
that exact same seat a couple of months ago saying our capacity
to deal with the mental health issues we have in the VA, we are
behind the ball on it. And it was a challenge that day to say,
well, what is the number? How serious is the issue? And this is
another unfortunately prime example of it. We do have the get a
grasp on it. And if organizations like yours are an avenue to
do something like that, I would hope that the VA would be open
to something like that. Because it is a problem that we do not
really know the magnitude of and what the sheer numbers of it
are going to end up being.
Ms. Van Dahlen. I think that is absolutely right. And I
would say that there has been tremendous progress. And I am
very optimistic. Because up until a few months ago we were
really working separately. Even though we had been there for
several years now, since I began this organization seven years
offering services. And they were happening. But it was only
until very, very recently that we have now formed the first
little step in an official relationship. And we are very
optimistic. Because the numbers are very clear that this is,
many refer to it as, you know, a tidal wave, a tsunami. There
will be more and more of those who come home who are in need of
assessment, treatment, support. Not just for themselves, but
their families. So I agree completely. And I believe we are
moving in the right direction. But as this issue gets more
attention then more, which is a good thing, of those who have
been assaulted will step forward. Which will create more
backlogs within the VA. So again, I totally agree we need to
move in that direction and hopefully we will.
Mr. Runyan. Thank you. Ms. Middleton, can you elaborate a
little on some of the frustrations you have experienced dealing
with the VA as an advocate on behalf of the victims?
Ms. Middleton. Sure. Absolutely. I think the, our
experience at the Connecticut Veterans Legal Center is that the
way the regulations look on paper and the way they get used is
very different. And that is why I really hope that the
leadership here will use their bully pulpit to push the VA to
change this regulation. Because it is not enough to say just
bring in some extra documentation, what is the big deal? There
is no reason why these veterans should be required to produce
documents that other veterans do not have to. There is no, I
cannot understand any reasonable explanation for that. And so
it actually seems like kind of an easy fix from my point of
view.
Mr. Runyan. Thank you. And with that I will recognize the
Ranking Member, Mr. McNerney.
Mr. McNerney. Thank you, Mr. Chairman. I want to thank both
of the panelists here for their volunteer efforts in this
issue. And not only you panelists but the organizations that
you represent. It is a lot of work and it is not easy work. So
thank you very much.
Dr. Van Dahlen, what is your view of how well the military
sexual trauma coordinators are doing? Is this an effective
program?
Ms. Van Dahlen. Well I think that what we have seen over
time, and again this is the good news, there is more and more
that is happening that is working well. But the problem is so
large and the VA system is so vast that it is as, it is the
case with many issues. Not only military sexual trauma but
other situations, combat trauma that result in Post-Traumatic
Stress. It depends very much on the leadership in that
particular region. It depends on that particular person. So we
hear very mixed reviews. That in some areas it is working very
well and in others not so much. And I think again it is about
coordination of services. It is about leadership. It is about
coordinating with organizations like ours so that we have more
conversations that are happening. So I think the answer is good
news that in fact they now exist, but we are not there yet.
Mr. McNerney. Well what in your opinion would be the
biggest barriers to determining appropriate VA services to MST
victims?
Ms. Van Dahlen. Well I think the biggest barrier right now
is what we have been talking about today. That there is not any
reason to require--and here is another issue that we sort of
talked about but I want to make very, very clear. For a large
number, especially this is a way that military victims are in
some ways perhaps different than civilians, the men and women
who serve, they are so dedicated to their service. They want to
stay in the service. They want to maintain their focus on
mission. We may not be able to find evidence of behavior
change, even if we have the best detectives on the planet going
back and looking at, well, what else was happening to them at
that period? Can we find it in their employment records? Can we
ask other members of their community did you see a change to
verify, to validate? You will not be able to find that. And so
requiring them to provide some kind of evidence is contrary to
the reality of who these men and women are. And that is a huge
barrier.
Mr. McNerney. Ms. Middleton, one of the things that
interested me about your testimony was that you are advocating
regulatory change as opposed to legislative change. Why does
that make more sense to you?
Ms. Middleton. I would love to see victims of MST get the
compensation they deserve. And whether that requires an act of
Congress or it requires the VA to change their own rule is not
really of importance to me. I mean, however, however these
folks receive justice is going to be great.
Mr. McNerney. But I mean, in your opinion it could be done
purely regulatory?
Ms. Middleton. I mean, my understanding is that the VA
promulgated this regulation in the first place. So they could
change it. But I do not see why given the opportunity Congress
would not fix this problem.
Mr. McNerney. Well it was clear from your description of
the case in Camp Lejeune that the soldier had few options if
she wanted to remain in the military. She faced big obstacles,
monumental obstacles really. Would you, how would you compare
that experience to what somebody in the service would
experience today? Is there any improvement?
Ms. Middleton. I mean, the two veterans who I spoke about,
one of them, I mean both of those instances I described were
quite old. One of these veterans was discharged not that long
ago, because she had such a long career in the military. And
she described a later episode of MST that was very similar to
the extent that she was completely unable to talk about it
without jeopardizing her career. And I think that Dr. Van
Dahlen summed it up very well. There is no incentive for these
people to talk about this in the context of their work
environment. And there is no reason that we should expect to
see some kind of reflection of this in their personnel file.
Which really makes, it really reflects the fact that this
regulation reflects a misunderstanding about the way military
sexual trauma actually works.
Mr. McNerney. Okay. So we have quite a bit of work to do
yet then. Thank you. I yield back.
Mr. Runyan. I thank the gentleman. The chair now recognizes
Ms. Pingree.
Ms. Pingree of Maine. Thank you very much, Mr. Chairman.
Thank you both for your testimony. And I concur with my
colleagues here, I really very much appreciate the work that
you are doing and the assistance that you and your
organizations give to so many people who need our assistance
who frankly should not have to be in the position where they
require such complex assistance. And I hope we can fix that.
I will ask this question of both of you. We see many
denials where the VA states that the veteran could not be
service-connected because they were sexually assaulted prior to
their military service. VA examiners tell them their condition
is related to the earlier assault, not the one that occurred in
the military. I think that for these veterans a service assault
would at least aggravate a preexisting condition but it seems
like an inappropriate way to look at it. Do you see these types
of denials in your work? And do you have comments about them?
Ms. Van Dahlen. Yes. And unfortunately one of the things
that happens with victims of sexual assault is they, if that
sexual assault is untreated they are more likely to be victims
again. And so to say that because a man or woman was sexually
assaulted before they entered the military, somehow then the
psychological damage that we are seeing is not related to the
additional assault, makes no sense psychologically. It makes no
sense. It is like it is almost the, in fact it is, the opposite
logic that we use for combat stress. Combat stress, we
understand, we know this, the more deployments, the more
exposure to trauma, the more significant the psychological
damage. We have kind of gotten that right, finally. But here we
are saying the opposite. It makes no sense psychologically in
any way. And in fact we know that victims are more likely if
gone, if they are untreated, to become victims in the future.
Ms. Middleton. I would say I have almost never spoken to a
veteran who reported to me an incident of military sexual
trauma who did not also experience some kind of trauma prior to
entering the military. It is very, very common in my
experience. And it is just one more reason why we should not
hold the veterans to this unnecessary evidentiary standard.
Because we do not need to muddy the water for the VA RO folks
who already apply the rule pretty haphazardly.
Ms. Pingree of Maine. Any other specific patterns of
denials that you see, besides some of what we have discussed
today? Obviously you are looking at a lot of different
situations.
Ms. Van Dahlen. Well, I would like to just go back to the
question that was asked about how prior generations, how much
different is it today? I would say not that different, not in
terms of the reports that we hear. And one thing again that has
changed, which is good news, there are many, many in the
Department of Defense who are outraged and coming forward. Men
and women both who tell me that they have witnessed in their
own units, these are leaders who will say that they see now
signs. And sometimes that they feel like they are, that the
system has not caught up quite with the change that is
happening in the culture. So men and women are still faced
with, and it is, combat stress, the impact of combat stress is
slightly different. I think that curve we are kind of getting a
little bit closer to more acceptance and support. But this one
is even further behind the curve. But at least there are men
and women in the Department of Defense, many, many clinicians
in the VA, who would say, you know, we know, we know what we
are seeing, we know what we are looking at, we can diagnose
this. That is the good news. But in terms of the obstacles for
reporting, and the way that women and men are often treated
when they do report, very similar stories for this generation
as well.
Ms. Pingree of Maine. That is very discouraging when you
think about how we feel our culture has moved forward. Yet that
somebody who experienced this 30 years ago might have the,
someone else might have a similar experience today. Did you
have a comment, Ms. Middleton?
Ms. Middleton. Only that we see veterans applying for
compensation who are denied in all kinds of areas. It just
happens to be that for claimants who are applying for PTSD
connected to military sexual trauma there is an extra burden
that as advocates we are really disheartened by. Because it
creates a tremendous amount of unnecessary work and time away
from other veterans we could be helping.
Ms. Pingree of Maine. Great. Thank you very much. Thank
you, Mr. Chair.
Mr. Runyan. On behalf of the Subcommittee I would like to
thank you both for your testimony and all that you do to
support our veterans. And with that you are dismissed.
Ms. Van Dahlen. Thank you.
Ms. Middleton. Thank you.
Mr. Runyan. I would now like to welcome our third panel to
the table, Ms. Ruth Moore, who is an extremely brave woman here
today to tell her story about the military sexual trauma she
experienced and her fight to obtain VA benefits. Ms. Moore is
accompanied by her husband, Mr. Alfred ``Butch'' Moore, Jr. Ms.
Moore has been working with Representative Pingree and I now
turn to my honorable colleague for any remarks she might wish
to make.
Ms. Pingree of Maine. Well, thank you very much Mr. Chair.
Let me just give another brief introduction and thank Ruth
Moore and her family, her husband and her daughter, for joining
us today. She is a MST survivor who fought the VBA system, as
we are about to hear, for many years before she was finally
service-connected. They made the long trip down from Maine. And
I want to correct the record here, I share, I share Ruth Moore
with Congressman Michaud. She actually lives in his district.
But we were able to speak with her soon after we introduced the
piece of legislation and have been happy to be in contact with
her really appreciated her telling her story.
For 25 years Ruth has had to battle with the Navy, the VA,
and frankly her own memories. I do not think many of us can
truly appreciate all of what she and her family have been
through. And I totally appreciate how brave she is to come with
us today and tell her story. It is not an easy thing to do. But
I think Ruth would say she knows if she keeps silent, and if
all of the survivors of MST are silent, the problem will never
go away. I appreciate your courage in coming here today. And I
want to add one last thing.
Our local newspaper wrote a story about Ruth last week. And
when the reporter asked her her biggest fear about testifying
she said that they will hear my words but will not understand
the depth of it. Well I want you to know you are in good hands.
This is a Committee that cares deeply about this issue. I
appreciate your holding the hearing today, and I appreciate you
inviting Congressman Michaud's and my constituent to join us
today. Thank you very much, Ruth.
Mr. Runyan. I thank the gentle lady. And with that we will
recognize Ms. Moore for her testimony. You are now recognized.
STATEMENT OF MS. RUTH MOORE, CONSTITUENT WITNESS; ACCOMPANIED
BY ALFRED ``BUTCH'' MOORE, JR., HUSBAND TO RUTH MOORE
STATEMENT OF RUTH MOORE
Ms. Moore. Thank you. Good afternoon, ladies and gentlemen.
My name is Ruth Moore and it is an honor to be among you today.
As you know, I am a military sexual trauma survivor who lives
with PTSD and depression. I am here today to share my 23-year
struggle to get help from the Veterans Health Administration
and disability compensation from the Veterans Benefits
Administration.
In 1987 I was a bright, vivacious 18-year-old serving in
the United States Navy. After my training school my first
assignment was to an overseas duty station in Europe. Two and a
half months after I arrived, I was raped by my supervisor
outside of the local club, not once but twice. I sought help
from the chaplain but did not receive any. I tried to move
beyond this nightmare but had contracted an STD.
At this point my life spiraled downward and I attempted
suicide. Shortly thereafter I was MedEvac'd to Bethesda Naval
Hospital and ultimately discharged from the Navy. No
prosecution was ever made against my perpetrator. In hindsight
it was easier for the military to get rid of me than to admit
to the rape.
My problems began at the point of separation as the
psychiatrist diagnosed me with a borderline personality
disorder. I did not have a borderline personality disorder.
This was the standard diagnosis that was given to all MST
survivors at that time to separate them from active duty and to
protect the military from any and all liability. This travesty
continued and I was counseled by outprocessing to waive all
claims to the VA as I would get health care through my former
spouse, who was on active duty.
From 1987 to 1993, I struggled with interpersonal
relationships, could not trust male supervisors, and could not
maintain employment. I filed my first VA claim in Jacksonville,
which was denied despite having several markers for PTSD and
gynecological issues. My life continued to spiral downward and
I was not able to maintain my marriage. In 1997 I fled from my
house and lived out of my van for two weeks before I was able
to start rebuilding my life with my present spouse. Things were
very difficult and I developed additional markers of PTSD,
including night terrors, panic attacks, severe migraines, and
insomnia.
In 2003 I filed for disability and was denied again.
However, I enlisted the aid of the Disabled American Veterans.
With their help I was awarded 30 percent compensation for
depression. I was denied PTSD and was told that I did not
submit enough evidence to prove that I was raped, despite
having submitted a letter from my former spouse who remembered
the rape and the chlamydia. Given this eyewitness testimony,
the VA still denied this as credible proof. There was no record
of my medical treatment for STD from that duty station as my
medical records had been expunged. Additionally, I was coded by
Togas VA as having a traumatic brain injury or brain syndrome.
In 2009, I entered into my first comprehensive treatment at
the VA hospital in White River Junction, Vermont. I met an MST
coordinator who truly listened to me. She began a systemic
review of my records and determined that they had been
expunged, by noting the glaring inconsistencies between my lab
work notes and service record. My psychiatrist and counselor
determined that I did not have borderline personality disorder,
nor traumatic brain syndrome. My MST coordinator and I refiled
for an increase in disability and my clinicians wrote
supportive records for the VBA to make an accurate
determination. They readjudicated my claim to 70 percent but
denied my status as individually unemployable, citing that I
did not complete the necessary paperwork.
At this point I was very frustrated and suicidal with the
stresses of the VBA system and claims process. In my final
effort, I called the Honorable Bernie Sanders and his staff
agreed to investigate why the VA was taking so long and denying
my claim. I took Mr. Sanders copies of all the paperwork I had
filed, including the VBA time and date stamped missing
information. Within two weeks my claim was finally adjudicated
to 70 percent with IU and it was total and permanent. My rating
should have been 100 percent by the VBA criteria, but I was so
grateful for a favorable determination that I have not pursued
it.
Ladies and gentlemen, this process took me 23 years to
resolve. And I am one of the fortunate ones. It should not be
this way. If I had been treated promptly and received benefits
in a timely manner back at the time of my discharge, my life
would have been much different. I would not have had to endure
homelessness and increased symptomology to the point where I
was suicidal. I would not have miscarried nine children. And I
firmly believe that I would have been able to develop better
coping and social skills. Instead my quality of life has been
degraded to the point where I am considering the possibility of
getting a service animal to relieve the stress that my husband
endures as my unpaid caretaker. I am asking you, no I am
pleading with you, to please favorably consider the legislation
that would prevent this from happening to others.
Congresswoman Pingree's legislation is one way to change
the burden of proof that is required to enable MST survivors to
receive proper adjudication for MST and PTSD. Please do what is
right. Support this legislation. It is urgently needed. And
thank you for your time and audience today.
[The prepared statement of Ruth Moore appears in the
Appendix]
Mr. Runyan. Thank you very much, Ms. Moore. And we truly do
appreciate you being here. Once you volunteered to serve our
Nation through the armed services, but you being here today and
continuing to share your story, you are continuing to serve by
shining a light on this. Sharing your experience to us is only
going to help us make sure that this does not happen to anyone
else. And I know you have endured some horrific challenges, as
you just discussed in your time in the military and in your
personal life after that. And, I am kind of choked up. I just
really again would thank you for being here today. I know
working with Ms. Pingree on this piece of legislation is one of
many steps we discovered here today, that we will look into.
If there is anything I or my colleagues can do, and this
goes out to any veteran, do not ever hesitate to call us.
Because that is truly what we are here for, is to serve you
because of your service to this great Nation. I again thank you
for being here. I know it is not easy to sit here and talk
about something like this. And I am going to refrain from any
questions that I might have. And thank you again for our
testimony. And I yield to the Ranking Member, if he would have
anything to say.
Mr. McNerney. Well thank you, Mr. Chairman. Ms. Moore, Mr.
Moore, thank you for serving our country. Thank you for taking
that service enough to be here in front of us today. It is
important to hear your testimony and your testimonial. And it
will have an effect. We will do what is necessary. We cannot
promise immediate change. But certainly, you know, having that
in front of us and reminding us of how difficult life can be as
a result of this sort of experience will remotivate us to work
as hard as we can on this issue. So I am not going to ask any
questions. But I want to thank you for coming, and bringing
your husband and your daughter.
Ms. Moore. Thank you.
Mr. Runyan. Ms. Pingree?
Ms. Pingree of Maine. Well thank you very much. And Ruth, I
will thank you again, and to your family for being here with
you today. It really does mean a lot and I really appreciate
the chair and the Ranking Member for their sentiment. And I
appreciate the Ranking Member for saying what I think is
important to say. That you are serving your country twice
today, coming forward and speaking here and providing us with
another firsthand story about how difficult this situation is.
I will not torture you much. But I will let you just have
the opportunity if you would like to speak a little more about
the many markers. We have talked a lot today about the burden
of proof and how we just put it back and back and back. And the
number of times that you have gone through the process in
attempting to resolve your own situation, which took an
enormous amount of strength and determination and resolve to
continue to go back and try to find the assistance that you
needed. Can you talk a little bit to the extent that you would
like to about the markers that you provided and how they were
rejected?
Ms. Moore. I would be happy to. The markers that I have. As
it was addressed here, there are many markers for PTSD. Some of
them are recognized, some of them are not recognized, and it
all depends upon the clinician who is making the diagnosis. I
am happy to say that over time the process has improved in the
VA and we now have more capable and competent providers who are
able to recognize these markers and make appropriate diagnoses.
I am also happy to say that the general perception of the
military is improving with respect to MST survivors. At the
time that I was in it was an embarrassment to the command to
have an MST case. The commanding officer did not want this to
be a record on their, or a mark on their record for poor
administration or poor leadership.
I think what it really boils down to is we need to have
capable, competent providers who are trained to understand
these things. I think the burden of proof that I submitted was
credible proof. Having an eyewitness testimony being shot down
and told that that was not credible proof to the VA was
certainly very disturbing. It was documented and received in
2004, and it was mysteriously lost from my records. And then in
2009, Mr. Sanders brought it forward again because I had a copy
of it. I was one of the few people that made copies of
everything and kept them. Many people do not. Many people are
told just move on with this. If you want to have a career you
need to just forget this and move on. I was not so intelligent
back then and I did not forget it, and I did not move on with a
career. It was very hard for me. So I think that the markers
that we have now are much better. And I think the legislation
that you are proposing would make it much better for many
veterans. Because, you know, we need to be believed and heard.
I would also encourage the panel to consider the fact that
VA systems are different from region to region. I live in Maine
now. I lived in Maine at the time. And I was denied in Maine. I
was denied in Florida. It was not until I reached the White
River Junction VA Center that I actually found what an MST
coordinator was. And I actually found out that what happened to
me happened to other people. She was so sympathetic and she was
so helpful. And the first thing she did was look at my record
and she says, ``Well this is missing, and this is missing, and
this is missing.'' These are classic things that happen with
MST cases. Their files are expunged. And to clarify for the
panel, I will say that in a medical record the left side of the
record is your lab notes, the right side of the record is your
treatment record. And my record had been expunged so badly that
things were missing out of one side but not the other. So it
was like a great big puzzle without the pieces. And you could
see part of the picture but not all of the picture. And then by
the VBA standards that basically meant that nobody wanted to
take the time to look, so I was denied.
Ms. Pingree of Maine. Well thank you for providing that
information. And I do want to add that while we are looking at
the problems with the system today and the things that need to
be changed, and many of the challenges that people faced, I do
want to acknowledge that when you did encounter a competent and
thoughtful and well trained MST coordinator who was able to be
in the position to help solve your problem it was very useful.
And, you know, we have many hardworking people at the VA who
are struggling under a system that is in the process of change
and often with a huge workload. So I do want to acknowledge
there are times when you meet those people who really do offer
you assistance in your life. And certainly Senator Sanders as
well.
Just in closing, again, thanking you very much for your
testimony here today. And I know you have talked a lot about
the challenges that you have gone through. But I want to
acknowledge your daughter Samantha who is in the room today.
Who as I understand is getting a Girl Scout Medal of Honor this
year, only the 21st person in America to receive one for many
of her heroic acts. So you two are clearly wonderful parents
and have done many great things in your life, and we are proud
to have you in Maine.
Ms. Moore. Thank you.
Mr. Runyan. With that, on behalf of the Committee I would
like to thank you for your testimony, and thank you for your
service to this country, and your continued service to our
country. And with that, you are now dismissed. And I will
invite the fourth panel to the witness table.
Today we welcome Colonel Alan Metzler, Deputy Director of
the U.S. Department of Defense's Sexual Assault Prevention and
Response Office; and we also welcome Mr. Tom Murphy, Director
of Compensation and Pension Service for U.S. Department of
Veterans Affairs. Mr. Murphy is accompanied by Ms. Edna
MacDonald, Director of the Nashville Regional Office at the
U.S. Department of Veterans Affairs. And Colonel Metzler, you
are now recognized for five minutes for your testimony.
STATEMENTS OF COL. ALAN METZLER, DEPUTY DIRECTOR, SEXUAL
ASSAULT PREVENTION AND RESPONSE OFFICE, U.S. DEPARTMENT OF
DEFENSE; ACCOMPANIED BY DR. NATE GALBREATH, SENIOR RESEARCHER
AND TRAINING ADVISOR, SEXUAL ASSAULT PREVENTION AND RESPONSE
OFFICE, U.S. DEPARTMENT OF DEFENSE AND MR. THOMAS MURPHY,
DIRECTOR OF COMPENSATION AND PENSION SERVICE, U.S. DEPARTMENT
OF VETERANS AFFAIRS; ACCOMPANIED BY MS. EDNA MACDONALD,
DIRECTOR, NASHVILLE REGIONAL OFFICE, U.S. DEPARTMENT OF
VETERANS AFFAIRS
STATEMENT OF COL. ALAN METZLER
Colonel Metzler. Chairman Runyan, Ranking Member McNerney,
and Members of the Subcommittee, thank you for inviting us to
appear today. I am the Deputy Director of the Department's
Sexual Assault Prevention and Response Office and my colleague
is Dr. Nate Galbreath, the Senior Executive Advisor for
Research and Training.
Let me begin by restating Secretary Panetta's bottom line
on this serious issue. Sexual assault has no place in the
Department of Defense. Secretary Panetta has put great emphasis
on dealing with the crimes of sexual assault. It is an affront
to the basic American values we defend and it is a stain on the
good honor of our armed forces. Since our policy was instituted
in 2005 we have remained committed to our vision, a culture
free from sexual assault.
Our uniformed leadership is committed to driving this
change. In May, the Joint Chiefs of Staff issued an
unprecedented strategic direction signed by eight four-star
leaders, including the Chairman and Vice Chairman of the Joint
Chiefs, and the Chiefs of Staff of each of the military
services, and the National Guard. This direction calls on the
entire force to focus on four areas. Enhancing awareness;
encouraging open communication and timely reporting; holding
offenders accountable; and providing responsive victim
services. Our goal is to create a culture that will not
tolerate sexual assault.
While we are absolutely committed to combating and
eliminating sexual assault from the armed forces, we remain
acutely aware of the brutal facts that point to the challenges
we face. Although the department received 3,100 sexual assault
reports in 2011, offenses ranging from wrongful sexual contact
to rape, our anonymous survey data suggests that in 2010 as
many as 19,000 servicemembers were victims of some form of
sexual assault. It remains unacceptable to us that we would
have even one of these crimes occurring in our armed forces.
We have undertaken many enhancements to support victims,
encourage reporting, increase the availability of documents for
veterans. And I would like to talk briefly about some of those
efforts. In February, 2011 we launched the DoD Safe Helpline, a
worldwide 24/7 crisis support service for members who are
sexual assault victims. To date, more than 47,000 unique users
have visited that Web site, and more than 4,000 individuals
have received live services. We are professionalizing our key
positions that support victims by designing a Sexual Assault
Response Coordinator (SARC) and victim advocate certification
program that will consist of credentialing that aligns with the
National Advocate Credentialing Program.
In December the Secretary of Defense mandated increased
retention for sexual assault documentation. For unrestricted
reports, documents will be kept for 50 years, and this was
specifically designed to allow transitioning servicemembers and
our veterans who may desire to make a claim at a later date.
Also in December the Secretary created a new protection for
victims. They now have the option to request a permanent or
temporary transfer from their command or base, or to a
different location within their command or base. Victims make
the request to their commander, and they must receive an answer
in 72 hours. If denied for some reason the victim may appeal to
the first general officer in the chain of command.
I would also like to mention, Mr. Chairman, several new
initiatives that will enhance prevention and accountability. In
December the President signed an Executive Order that added a
new privilege that protects communications between a victim and
victim advocate, enhancing victim trust in the department's
response system. Our sexual assault incident database has now
gained initial operational capability. This tool will
standardize reporting for oversight and accountability and it
will help us manage victim care. For victims making an
unrestricted report, the reporting form will be maintained in
this database and it will be maintained for 50 years, a
capability we designed into the system specifically for
transitioning servicemembers.
To advance accountability, Secretary Panetta directed the
initial decision on cases of rape, sexual assault, forcible
sodomy, and attempts, they will be elevated to a commander who
is at least a colonel or a Navy captain who holds special court
martial convening authority. And this mandate became effective
on June 28th and it ensures an experienced commander will make
these important decisions.
In April, Secretary Panetta also directed several other new
policies. Establishing special victim unit capabilities;
requiring sexual assault policies be explained to all
servicemembers within 14 days of their entrance on active duty;
allowing Reserve and Guard members who have been sexually
assaulted to remain in their active duty status to obtain
treatment and support; and the requirement for annual
organizational climate assessments.
Finally at the Secretary's discretion in May, we conducted
a review of existing precommand and senior enlisted training in
the Marine Corps, the Navy, and the Air Force, and we have
reviewed the Army's new program as well. We completed our
report last month. We have made recommendations to the
Secretary and there are other additional oversight assessments
ongoing, to include a review of our sexual assault response
coordinator training and joint base assessments.
We also want the Committee to be aware of the work we have
done to collaborate directly with the Department of Veterans
Affairs. During the last two years our office has visited 20 VA
facilities to provide education on our program. These sessions
have been well attended by administrators, providers, and even
patients. We have also provided educational briefings to the
VA's military sexual trauma coordinators, training hundreds on
the specific elements of our program. Just last month we
augmented our DoD Safe Helpline for transitioning
servicemembers. This tool recognizes the special needs of
victims of sexual assault and helps smooth the transition to
the Department of Veterans Affairs. And while the hearing was
going on, we did research and look into our Web site and I can
confirm to you that we have links to the veterans service
organizations that can help our members transition and we are
open to adding many more.
Finally in its June, 2011 Veterans Benefits Manual, the
Department of Veterans Affairs has added our Department of
Defense reporting forms to help document a sexual assault.
Mr. Chairman, Members of the Committee, despite these many
efforts we have much more to do. Secretary Panetta and our
uniformed leaders are committed to creating a climate of mutual
trust, respect, and dignity. We are committed to creating a
climate in which victims feel confident that they will be
believed, that their reports will be taken seriously, and that
there will be no fear of retaliation. We are committed to
creating a climate in which bystanders act to intervene. We are
committed to providing the full range of services to all
victims of sexual assault. We are committed to continue our
work with the Department of Veterans Affairs to further improve
victims' transition from active duty to veteran status. And
most important, we are committed to ensuring that the
discretion over how to report and decisions regarding treatment
and support services rest entirely with the victim.
Through this approach we aim to create a culture that is
intolerant of sexual assault, one that cares for our victims,
one that inspires trust and confidence, one that encourages
reporting, and one that enables our military justice system to
hold offenders accountable.
We appreciate the Subcommittee's attention to this
important issue and we look forward to your questions.
[The prepared statement of Alan Metzler appears in the
Appendix]
Mr. Runyan. Thank you, Colonel Metzler. I next recognize
Mr. Murphy for his testimony.
STATEMENT OF THOMAS MURPHY
Mr. 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 today to speak
about the VA disability benefit for PTSD based on MST and
sexual harassment.
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 claim
based on MST. However, VA recognizes that both men and women
can be victims.
Because of the personal and sensitive nature of MST
stressors, victims find it difficult to report or document
these events. Due to this fact, it is often difficult to
establish the occurrence of the stressor. In order to address
this, VA developed regulations and procedures that allow more
liberal evidentiary development and adjudication procedures for
this type of claim. Under VA regulations service-connection for
PTSD requires three things. First, medical diagnosis of the
condition; second, a medical opinion connecting current
symptoms and an in-service stressor; and third, credible
supporting evidence that the claimed in-service sterssor
occurred.
As with all PTSD claims, VA initially reviews the veteran's
military service record for evidence of MST. Such evidence may
include a DD form 2910, the victim reporting performance
statement, and the DD form 2911, sexual assault forensics
examination report. VA's personal assault regulation also
provides that evidence from sources other than a veteran's
service records may corroborate the veteran's account of the
stressor. This includes, but is not limited to, law enforcement
authorities, rape crisis centers, pregnancy tests, tests for
sexually transmitted diseases, and statements from family
members, roommates, clergies, etcetera. Evidence of behavior
change called markers is also used. Examples are request for a
transfer, deterioration or hyper work performance, substance
abuse, and so on.
When this type of evidence is obtained VA schedules the
veteran for a C&P examination and requests an opinion as to
whether the claimed in-service MST stressor occurred. This
opinion serves to establish the occurrence of the stressor.
VA has recently taken numerous other steps to assist
veterans with timely, equitable, and consistent resolution of
these claims. In August 2011, VBA reviewed a statistically
valid sample of approximately 400 MST related PTSD claims. The
goal was to assess the current process and procedures and
formulate methods for improvement. This led to development of
an enhanced training curriculum with emphasis on standardized
evidentiary development practices. VBA issued Training Letter
11-05, Adjudicating Post-Traumatic Stress Disorder Claims Based
on Military Sexual Trauma, in December of 2011. This was
followed by a nationwide Microsoft Live Meeting broadcast
focused on describing the range of potential markers that could
indicate occurrence of an MST stressor.
We recently created dedicated, specialized MST claims
processing teams within each VA regional office for exclusive
handling of MST related PTSD claims. VHA has developed and
implemented specific training for clinicians conducting PTSD/
C&P examinations for MST related claims in November of 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.
The results of these efforts are substantial. The grant
rate for PTSD based on MST when we started this effort in
October of 2012 was 41.7 percent. Following the completion of
the process changes and training outlined just a moment ago, we
are seeing a steady grant rate of 53.9 percent for the period
of January through June, 2012. Due to the significant change in
the outcome for these veterans, we are sending each veteran
that was denied prior to receiving a VA examination a letter
notifying them of the opportunity to have their claim
reexamined. VA will make every effort to ensure that the
claimants receive the benefits they deserve and secure the
maximum rating and effective date to which they are entitled.
In summary, VA recognizes the sensitive nature of MST
related PTSD and the difficulty of obtaining evidence of an in-
service sterssor. Currently PTSD regulations provide multiple
means to establish an occurrence and VA initiated initial
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 the Members of the Subcommittee.
[The prepared statement of Thomas Murphy appears in the
Appendix]
Mr. Runyan. Thank you, Mr. Murphy. I have a group of
questions and I am not sure if I am going to put them out there
in the right order. But two years ago when VA amended 38 CFR
3.04(f) making certain claims for noncombat PTSD easier to
verify, during the notice and comment period, several
commenters asked that the amended regulation apply to MST. In
response, VA stated that they did not feel this was necessary
because the relaxed evidentiary standard already provided to
the regulation specific for MST was adequate. We have had
testimony earlier and having been briefed by the VA on this, I
can imagine your stance. You feel that it is easier. But I
think the users that are doing it do not have the same feeling,
or the same experience. Is there any way you can clear this up?
Because it is, in the statement and the comments, it
specifically said it was outside the scope of the rule when VA
made the comment back to the commenter about the issue. Do you
have any idea how we can clarify this? And maybe we have to
change the regulation to actually make it work for those who we
are trying to help?
Mr. Murphy. Mr. Chairman, I am going to ask Ms. MacDonald
to address this concern. She has significantly more depth and
expertise in this area.
Ms. MacDonald. Thank you, Tom. Chairman, when we looked at
the regulation based on Fear, there is this misunderstanding
that we have heard so far in testimony today that, specifically
a veteran's lay statement is accepted for all other forms of
PTSD except MST. It is a slight misunderstanding. In other
forms of PTSD we do require what we call objective
documentation. Not just the fact that a veteran served in the
military. But for combat veterans, before we can accept their
lay statement, we have to have a military documentation that
they were actually in a combat zone. For Fear, for that
regulation, it also requires documentation that they were in an
environment where there was hostile military or terrorist
activity before you ever get to the lay statement. Why we
believe that the MST regulation is a lower evidentiary
threshold is that, because we know so many do not get reported,
there is no requirement for any military objective
documentation of occurrence of the stressor. That is why the
regulation was written, to allow us to look for markers and
other sources that are what we would call in the regular world,
circumstantial evidence. That is not concrete proof. And what
we have heard today is what you were just talking about. Is it
adequately being applied, that liberal threshold? And that is
what Mr. Murphy was alluding to in his testimony that we do
believe we have made significant strides to make sure that we
dedicated resources and we trained VA employees properly in the
way we want this and the way we expect it to be applied.
Mr. Runyan. Is amending the regulation necessary? I think
Congressman Walz and Ms. Pingree both agree that, the chances
of a false claim are very minimal in cases like this. Do we
need to change the regulation to make sure this works for MST
victims?
Mr. Murphy. No, sir. I do not believe we need to do that.
And I think when you look at the performance numbers of the
grant rate of PTSD today versus the grant rate for all other
types of PTSD that are not MST related, you see that the
numbers track very closely. Now, I am not sitting here saying
by any means that we have got this thing completely nailed down
and its is perfect. There is no process on earth that is that
way. So this is a process that we are going to continue to look
at, and we are going to focus on, and continue to ensure that
MST tracks at the same rate. In addition, we have heard many
testimony on different ideas, different processes, different
thoughts. And we will continue to gather those and look for
ways to make the process even better and more consistent than
it is today, so that no veteran is wrongly denied. But I do not
believe we need to go back and do a regulation change in order
to put that down and make it solid. I think the performance
over the last six months is proving that we have consistency in
process.
Mr. Runyan. And if you could, I am sure you do not have it
on hand, but throughout, I know there has been reference to
when the policy was changed and when VA revisited the
regulations, which was in 2010. Because we have sat up here all
day, we have heard that sexual assaults are underreported. And
actually the execution of adjudicating the MST claim, we are
not seeing the whole picture all the time. And I think this is
the big frustration we have with the VA a lot of time. You are
telling us what sounds good when you are sitting at that table,
but we are not seeing the whole picture. Because I think most
people, and the people who have been here and testified today,
would agree that there is room for more improvement. And I
think we all agree on that. The issue at hand is what are the
improvements that we take in this Congress to do that? I think
we all agree, and I think the Ranking Member agrees, we are not
going to fix it today. But we have to get the ones that we can
tackle the most with. And I would appreciate the statistics
that say it was this way, and when we did the change in `10 we
got better results. Maybe it is time to address that again
because I think we all agree and we need different results. And
I would appreciate it if you could submit that to the
Committee.
Mr. Murphy. Yes, sir. We will do that. We will take it back
before the release in 2010 and we will point out the
significant changes that happened in that data as the results
of different actions that were taken from then to now.
Mr. Runyan. I appreciate that. And with that I recognize
the Ranking Member Mr. McNerney.
Mr. McNerney. Thank you, Mr. Chairman. Colonel Metzler,
thank you for serving our country and wearing that uniform, and
taking on this difficult issue. One of the things we are
hearing today over and over is the reluctance of servicemembers
to come forward because of the cohesion of the unit that they
are in. And that is important. I mean, you want a military unit
that can go into a difficult situation and trust each other,
and that is a characteristic that is hard to nuture. So what
happens to a unit when this sort of an issue comes up? Does it
disrupt the unit? I mean, does the leader get disposed? Is
there training that takes place in the unit? I mean, this is,
if there is a unit where people are preying on each other, then
you are not going to have unit cohesion anyway. So it does not
hurt to go in and actually do some stuff to that unit. What
happens when this kind of a charge comes forward and is
verified?
Colonel Metzler. Good order and discipline, unit cohesion,
a climate of trust and a climate of respect all come from the
command and the leadership. And the effectiveness of a unit
derives from the effectiveness of that commander and those
senior leaders who set the appropriate climate, who set those
standards, and communicate those standards, and enforce those
standards. And when those standards are failed to be followed,
the unit, cohesion breaks down, the mission is placed in
jeopardy, and lives are placed in jeopardy, both in a combat
environment and in a peacetime environment. And what we need to
do is ensure that we teach every single member of our armed
forces that if there is violence being committed against them,
sexual violence being committed against them, that we will take
those reports seriously, that we will investigate them fully,
and that we will hold the offenders appropriately accountable.
Mr. McNerney. So I take it there is an anonymous, a Web
site a member can go to anonymously and make a report?
Colonel Metzler. There is a couple of tools available.
There is the DoD Safe Helpline. It has been in operation since
February of 2011. It is 24/7, worldwide capable. You can call,
click, or text into that capability. And there are crisis----
Mr. McNerney. Is the unit leader advised when there is a
report from someone within their unit?
Colonel Metzler. The installation commander is advised of
all unrestricted and restricted reports and the unit commander
is notified for unrestricted reports. And then the commander is
required by policy to report that to a military criminal
investigative organization for investigation.
Mr. McNerney. Okay. Are servicemembers routinely screened
for MST?
Colonel Metzler. Sir, military sexual trauma and the
screening and the diagnosis for that is outside the scope of
our office's oversight. What we do know are the specifics in
terms diagnosing military sexual trauma (MST). And so what we
have done is built a structure to ensure that we have the
records, to make sure that they are available, that our
counselors know how to retrieve them. We have this 24/7
worldwide hotline that can access crisis intervention
counselors who can advise them of all the processes associated
with MST. And as I mentioned in my opening statement, we have
been doing a lot of partnership with the VA to train their
military sexual trauma coordinators, and to train our
coordinators that work with wounded warriors.
Mr. McNerney. Well it sounds good. I would like to have
confidence that it was being effective. Mr. Murphy, what do you
feel about HR 930? Do you think that is going to make things
better? Do you think that is going to make it so that people
that are suffering and going through the experiences that Ms.
Moore experienced, is it going to make it easier for them? Or
do you think it is going to make it harder? Or do you think it
is going to make a difference at all within the VA?
Mr. Murphy. Mr. McNerney, that is a bill that we have not
completed formal views on from the VA perspective, so I am not
prepared to comment on that today.
Mr. McNerney. So now, and my limited understanding is that
H.R. 930 will result in reduced evidentiary standards. Is that
what your understanding is of H.R. 930?
Mr. Murphy. Yes. That is my understanding of the bill.
Mr. McNerney. Is there a need to reduce evidentiary
standards?
Mr. Murphy. As I told Mr. Runyan a few moments ago, I think
that we adequately cover it with the existing regulations that
we have today. But that is not a comment on the nature of the
bill. And the reason I say it is not a comment on the nature of
the bill that we hit the main topic in it. As with most bills,
they come through, there are many fine points and details in
there that need to be considered by a general counsel in VA
before we can pull an official position on it.
Mr. McNerney. If that bill were to be signed into law, how
difficult would it be to enforce its requirements?
Mr. Murphy. Assuming the bill was signed into law, then it
would just take us the time that it would take to put, to
modify existing regulations to be in compliance with the
requirements of the law, to put some training in place for the
existing dedicated teams that we have inside of VA and in VHA,
and start adjudicating claims under the new law.
Mr. McNerney. All right. I yield back.
Mr. Runyan. The chair now recognizes Ms. Pingree.
Ms. Pingree of Maine. Thank you, Mr. Chair. Thank you to
the panel for testifying. I do appreciate the tremendous change
in attitude and awareness that has gone on, both at the DoD and
VA. I, you know, say in view of the testimony, and what many of
us here in our offices, we still have a long way to go in
changing the culture of the military and in dealing with
victims of MST. But I do appreciate both of your testimony
today and the work that is being done to move us in the right
direction.
I want to just talk for a minute about the exam threshold.
So the exam threshold in the MST claims process, we have been
told by the VBA, and this is for Mr. Murphy, that a veteran's
statement alone is not sufficient to trigger a compensation and
pension exam. However, in the background information you
provided my office, and presumably sent out to regional
offices, it clearly states that the veteran's lay statement is
sufficient to prove the assault occurred. So my question is,
how does this work? Is the veteran's testimony enough to prove
the assault happened? And how can it not be enough to get an
exam?
Mr. Murphy. Again, I am going to ask Ms. MacDonald to
answer that.
Ms. Pingree of Maine. Fine. Fine.
Mr. Murphy. Again, she is the expert on this area.
Ms. MacDonald. Thank you, Congresswoman Pingree. It, by
itself, in the absence of any other supporting marker would not
be enough to request an exam.
Ms. Pingree of Maine. Okay. So thank you for clarifying
that. And I think that reinforces why we hear in our helpful
conversations with the VBA, or the VA, that you know, we are
moving forward on setting a different standard. But on almost a
weekly basis, I hear from a veteran who was sexually assaulted
while serving in the military. And when they go to the VA with
that claim, they are denied because they could not produce a
court filing, or a report, or some other kind of proof that the
attack occurred. So even though we are often told that the
proof is not required, that is not what seems to be happening
in your offices. And I do appreciate the increased training,
the difficult in changing even the culture of the system. But I
guess I have two views and I want to ask your comments on it. I
mean, A, I think we have further to go before the
implementation of what we are hoping will happen, happens. And
while I am not here to promote a piece of legislation, but that
is why I submitted the bill that, in a sense, does have reduced
evidentiary standards. It would provide a service-connection
for MST survivors if they provide a diagnosis of PTSD and a
medical link stating that the PTSD is caused by the assault. I
believe that is similar to what happens with combat related
PTSD claims. And I am of the belief that until we get there,
possibly with legislation, possibly with a change in
regulation, we are not going to be there. So if you want to
talk a little more about that, I just think we see it
differently. And I guess my concerns are the testimony we have
heard today, the difficulty that people are having getting the
assistance that they need.
Mr. Murphy. I do have a couple of comments. First of all,
as you stated, we are a long way from having this down pat and
making sure every veteran is taken care of and getting what
they are due. Second, that we have made the improvements in the
process today that you are seeing because of the consistency of
training, the focusing of only a select few individuals that
received a much higher level of training than what the general
population gets. And specifically focused and targeted around
identifying the very subtle markers. This is something that is
not public knowledge. It is not generally reported. But some
minor, barely noticeable behavior on the part of the veteran is
all it takes to say, ``Yes, there is something here, plus the
veteran's statement, let us move forward with this claim.'' In
fact, I just learned one earlier listening to a previous
statement talking about the absence of evidence in a file is
also a marker. And I am not saying that, that we are not doing
that. I am saying that that was beyond my level of expertise in
this area, which is why Ms. MacDonald is sitting next to me
today. So again, we have a long way to go. We have made
significant progress. But we are not done yet.
Ms. Pingree of Maine. Well again, thank you for the work
that you are doing. I think we are all here today because we
hear with deep concern the number of people who serve this
country and then find themselves victim of military sexual
trauma. And we started out with some very stark figures in the
beginning here about the difficulty of people being able to get
assistance, the difficulty of crimes being prosecuted, the
difficulty even for a veteran to come forward. And I think we
have to remember over and over that these are very special
circumstances. That people who served their country want to
continue to serve. We have enormous work to do to change the
culture. But I think on the other side we have a lot of work to
do to make sure we help those people who need our help. Thank
you very much.
Mr. Runyan. I thank the gentle lady. The chair now
recognizes Ms. Speier.
Ms. Speier. Mr. Chairman, thank you for allowing me to sit
in on this hearing and to participate in it. I want to thank
all the panelists for participating in the hearing today, and
for your service. I was, the first bit of good news I heard
this morning was from General Hickey at a Committee down at
Oversight and Government Reform Committee where we were looking
at the delays in VA, the handling of VA cases. And she actually
on her own volition went back and looked at the MST cases
versus the other PTSD cases and saw that there was a
discrimination in the cases as it related to MST/PTSD and that,
and you reflected that, I think Mr. Murphy, in your comments.
And that now you are sending letters out to those that were
declined or denied their claims and asking them to reapply.
Which really makes the case over and over again about what
the military has done consistently, which is sweep this issue
under the rug. We have done a horrible job. It has gone on now
for a quarter of a century. We keep messing around the edges.
We create SAPR, we do hearings, we create reports, and then
nothing changes. And now we have an absolute scandal at
Lackland Air Force Base, where we have 12 trainers implicated,
and 31 victims. Only one victim, however, has come forward on
her own to file a complaint. Which makes the case over and over
again, people, both men and women, are not filing complaints
because they know what happens. They find a way to slap them
with a disability of personality disorder and then discharge
them involuntarily from the military.
So to Congresswoman Pingree's point, if we know that 19,000
occur a year, only 3,000 actually report, of those 3,000 only
200 actually get convictions. There is no motivation for anyone
who wants to make a career in the military to report.
So if we know it is 19,000 a year, I think the figures are
thrown out as something like 500,000 victims of MST in this
country right now. And to think that we are still going to
require, knowing that we have done such a lousy job in dealing
with these cases and somehow finding the victim at fault, why
would we not take the position that we have taken with Agent
Orange? Which is basically if you come down with one of these
cancers, or one of these conditions, the presumption is that
you got it in the military, you got it when you were serving in
Vietnam, and there is a presumption made. Why do we not just
create a presumption? If someone comes forward and says they
are a victim of military sexual assault or trauma, that we
believe them because we have done such a lousy job in terms of
handling these cases? Colonel, can you respond to that?
Colonel Metzler. I have some comments on some of the issues
that you raised. I think one of the most important that I would
like to address is that the department does take this
seriously.
Ms. Speier. Well you know----
Colonel Metzler. We are absolutely committed to solving
this problem.
Ms. Speier. I am so tired of hearing persons in your
position and higher say there is zero tolerance for MST and yet
there is another scandal underway right now, and a court
martial taking place at Lackland Air Force Base. We are not
doing a good enough job. Until we take it out of the chain of
command, these problems will continue to exist because we are
not dealing with the conflict of interest that is inherent in
that situation. And why would we have unit commanders who have
no legal training, have not gone to law school, have no
judicial experience, making decisions as to someone's relevance
in terms of having an investigation or prosecution move
forward?
Colonel Metzler. Ma'am, it is the position of the
department that commanders will lead this change. Commanders
set the tone in their units. Commanders set standards of
discipline. Commanders set the climate of their units. What
commanders pay attention to is what gets done and what gets
fixed. That is why we are assessing commanders----
Ms. Speier. Excuse me, Colonel, but I am about to run out
of time, so let me just ask a number of questions and see if
you can answer them. How many permanent or temporary transfers
have been granted since this new ruling went into effect? How
many have been declined? How many special victims units have
been created? And have you considered at all the relevance of
having an MST/PTSD therapy program that is different from the
PTSD program that exists for the general military veterans
population? And maybe that is a question to you, Mr. Murphy.
Colonel Metzler. Under the transfer authority that the
Secretary ordered, there are transfers that are happening. I do
not have the specific data. We have met with all of the
services in the last week, talked to them about it. Ma'am, we
are happy to get that information and we will provide it to
you.
Ms. Speier. And actually to the Committee as well. I think
that would be----
Colonel Metzler. Absolutely. And that will also be part of
our annual report, and it will be part of our official record.
So we will make that available to the Committee. With regard to
special victims units, that is a process that is underway. The
Secretary has asked us to create that in April. We have had
meetings with folks to work on the concept. The Army is already
working----
Ms. Speier. So there is not one?
Colonel Metzler. The special victims unit capability is
being created. It was guidance from the Secretary to create
that capability. The Army has a very good program that we are
modeling that we have met with. I think it is Mr. Strand who
has worked on that.
Ms. Speier. Russell Strand?
Colonel Metzler. You are familiar with his work. And we are
working with the U.S. Army Military Police School because of
the special training that they are already providing to some
attorneys and to investigators. And it is a concept and a
capability that we intend to----
Ms. Speier. So the Army has it, but they had it even before
the guidance by the Secretary. So when do you anticipate the
other services will have these SVUs?
Colonel Metzler. Ma'am, I do not have a specific date. But
we will make sure we get that to you.
Ms. Speier. And then to you, Mr. Murphy. The question of
having a separate kind of therapy program for MST PTSD
survivors?
Mr. Murphy. The separate kind of therapy program falls
under the Veterans Health Administration. I do not have any of
the VHA folks with me here today. However, I can talk a little
bit about that they have dedicated counseling and professionals
that we work closely with DoD to ensure that we are getting the
handoff of what little evidence does exist. So I cannot answer
that for you in detail today.
Ms. Speier. Mr. Chairman, can I ask one more question?
Mr. Runyan. You may.
Ms. Speier. I think the issue that was raised earlier is a
relevant one, and you raised it, Mr. Chairman. And I was
wondering if it would be helpful to the Committee, and to
Members who are concerned about this issue, if the VA would on
a quarterly basis provide information to you as Chair of the
Committee about how many of these cases are being handled. How
many are actually being, claims that are being filed, and how
many are actually being granted, and what the percentage of the
disability is being granted as a result. To just track to see
if the change is permanent and to what extent it is
comprehensive.
Mr. Runyan. That is very possibly something we can put in
Ms. Pingree's piece of legislation.
Ms. Speier. Thank you.
Mr. Runyan. All right. Well with that----
Colonel Metzler. Mr. Chairman, with your permission there
was one other issue that was raised that I did not get a chance
to respond to. And it is an important fact that we would like
to point out. Since 2006 to 2010, we do have very good data
that tells us that the incidents of sexual assault, of all
ranges of sexual assault are down. And that the reporting
trends are up, the reporting trends have doubled. Now it has
been said many times that the trend right now is about 14
percent of victims report. We are not satisfied with that. The
data is moving in the right direction. But we are focused on
solving this problem. And Congresswoman, we will work this
problem, I can assure you.
Mr. Runyan. Well I thank you all for your testimony. And
ladies, gentle ladies, thank you for coming and being guests
here today.
I am not going to make a big closing statement. But I would
say this, specifically dealing with this Committee, and I have
said it directly to Secretary Shinseki sitting right there at
that exact same table. One of the biggest metrics we miss in
the VA is customer service. We measure everything else, but was
the job we are there to do, which is service the veteran, done
right? And were they satisfied with the result? Because if the
VA were a private entity, a company, you would not be in
business very long because you would not have very many happy
customers. That is the metric we miss every single day. It is
three or four or five down the list sometimes. And that is
really something that I continue to press and, I hope every
other Member of this Committee, and every other Member of this
Congress, would agree with that. Because that is truly, what
these men and women do for us by putting their lives on the
line to sacrifice for our freedoms, the least we can do is give
them what, give them by the laws we have created what they are
due. Just to that. And most of us would agree we owe them more
than that. It is how do we get there?
But with that, on behalf of this Committee I thank all of
our distinguished witnesses for their testimony today. I
appreciate your service to our Nation's veterans. And you are
all now excused. And I ask unanimous consent that all Members
have five legislative days to revise and extend their remarks
and include extraneous material. Hearing no objections, so
ordered. I thank the Members for their attendance today and
urge that all of you be vigilant participants in the
Committee's efforts to ensure that victims of military sexual
trauma have access to the benefits they need to live happy and
health lives. And this hearing is now adjourned.
[Whereupon, at 4:38 p.m., the Subcommittee was adjourned.]
A P P E N D I X
----------
Prepared Statement of Hon. Jon Runyan, Chairman
Remarks:
Good afternoon. Welcome to our hearing, ``Invisible Wounds:
Examining the Disability Benefits Compensation Process for Victims of
Military Sexual Trauma.''
First, I ask unanimous consent to welcome a number of our honorable
colleagues who have asked to be allowed to participate as guest Members
of the Subcommittee today. Hearing no objection, so ordered.
As a Nation, we call on our armed servicemembers to sacrifice
bravely on our behalf. They courageously put their lives at risk and
face deadly enemies on the battlefield.
When we think of these enemies, we think of those who oppose our
freedom or are American way of life. We certainly do not think of
soldiers needing to defend themselves from their fellow servicemembers.
However, many of our servicemembers are required to do just that.
Women are the fastest growing population among veterans, making up
8% of the armed forces. However, the Department of Defense estimates
that one in four women who join the armed services will be raped or
assaulted, but that only about 10% of such incidents are ever reported.
Even more alarming is that of those few who did report incidents of
military sexual trauma, over 75% stated that they would not make the
same decision about reporting the incident again, due to the
consequences it had on their military career.
Despite the fact that many of these incidents go unreported, VA
currently estimates that over half a million veterans have experienced
military sexual trauma. This includes 17% of veterans from the recent
conflicts in Iraq and Afghanistan.
Although this is not the Committee's jurisdiction, there must be
zero-tolerance for this behavior in the military, and VA must recognize
immediately the trauma inflicted on these men and women.
Accordingly, the focus of today's hearing is how to assist these
veterans with obtaining VA benefits for post-traumatic stress disorder,
or PTSD. This is often a difficult task given the sensitive nature of
these claims and the lack of evidence of documenting such incidents at
the time that they occurred.
Although VA has made great progress in adjudicating military sexual
trauma claims by providing relaxed evidentiary standards and re-
training employees on this issue, SWAN, one of the organizations
testifying today, estimates that less than one-third of military sexual
trauma PTSD claims are approved by VA, even though 53% of PTSD claims
are granted overall.
Although military sexual trauma is not a new issue, it is a serious
matter on which more light has been shed in recent years.
As more and more of our brave servicemembers find the inner
strength to overcome military cultural challenges, and come forward to
seek justice, help and healing, the more the Members of this Committee,
DoD, and VA can understand the best means of assisting victims of
military sexual trauma with obtaining the VA benefits that they need.
One such veteran will be testifying before us today, and I would
like to personally thank Ms. Ruth Moore for coming to Washington and
sharing her story with us today.
Victims of military sexual trauma like Ms. Moore carry scars in
their hearts for the rest of their lives as a result of what they have
endured. Such veterans are indeed deserving of VA benefits to help them
enjoy the American way of life that their service has helped to secure.
As the Department of Defense continues to address issues arising
from the cultural resistance to reporting such abuse, the VA must
continue to work on ensuring that the proper benefits, so needed by
these victims, are easily obtainable.
So, I will reiterate - the focus of our hearing today is precisely
that--what benefits does VA provide for victims of military sexual
trauma, how are these claims adjudicated, and how can this process be
improved?
We welcome several witnesses to testify before us today, ranging
from representatives of veterans service organizations, to experts on
the effects and treatments of military sexual trauma, to officials from
VA and the Department of Defense.
I appreciate all of you taking the time to speak with us today
about this issue of such importance to so many members of our American
community.
Because we have many distinguished guests today, I would like to
reiterate my request that our witnesses abide by the decorum and rules
of this hearing by summarizing your statements to five minutes or less
during oral testimony. Doing so will ensure that the Committee has the
opportunity to hear from everyone.
I also remind all present that without any objection, your written
testimony will be made part of the hearing record.
I now call on the distinguished Ranking Member for his opening
statement.
Prepared Statement of Hon. Jerry McNerney,
Ranking Democratic Member
Good afternoon. I would like to thank everyone for attending
today's hearing focused on examining the VA disability compensation
process as it pertains to military sexual trauma or MST.
I am happy to join DAMA Subcommittee Chairman Runyan and my
colleagues in holding this hearing.
I am also pleased that two of the leading voices in Congress on
this issue, Representative Chellie Pingree of Maine, and Representative
Jackie Speier of California are accompanying the Subcommittee Members
on the dais today. I also welcome and thank Ms. Pingree's constituent,
Ruth Moore, accompanied by her husband, for testifying about her MST
experience with VA.
Servicemembers who experience military sexual trauma and are brave
enough to speak out about their experiences often do so at great risk
to their careers and reputation.
The purpose of this hearing today is to evaluate ways in which the
Veterans Benefits Administration (VBA) and the Department of Defense
(DoD) can better address the needs of veterans affected by MST and
identify ways to prevent these horrible assaults, treat and properly
compensate the victims.
MST refers to sexual harassment and sexual assault that occurs in
military settings. MST often occurs in a setting where the victim lives
and works, which means that the victims must continue to live and work
closely with their perpetrators.
Many MST victims state that when they do report an incident, their
story is dismissed or they are encouraged to keep silent because of the
need to preserve organizational cohesion.
This is unfair to the victims. We must put protections in place to
ensure a safe haven exists for the women and men who experience
military sexual trauma.
Unfortunately, the consequences of MST are a pervasive problem
within the Veteran community. According to the Institute of Medicine,
prevalence rates of MST range from 20-43%. Many veterans who are
victims of MST express frustration with the VA's disability claims
process, especially in trying to prove to that the assault ever
happened.
For many women and men, when their disability claims for post-
traumatic stress related to MST are denied.
However, I am pleased that in July 2010, in response to action
taken by this Committee, the VA relaxed its stressor evidentiary
standards for post-traumatic stress, which also includes MST.
While this represented a step in the right direction, there are
still hurdles that women and men face in receiving the benefits they
deserve.
As SWAN points out in its testimony, there are still disparities in
compensation and confusion within VBA on when service-connection
compensation for MST is warranted.
Training at VA has improved slightly, but VBA claims decisions are
still inconsistent and more must be done.
As we build a VA for the 21st century, VA and DoD need to ensure
that the proper prevention, counseling, treatment and benefits are
available for MST victims.
Veterans should be able to have access to VA personnel who are
qualified to advise on the often-sensitive MST related issues. These
veterans need to be treated with the dignity and respect that they
deserve.
I look forward to hearing from the esteemed panels of witnesses.
Thank you, I now yield back.
Prepared Statement of Hon. Michael R. Turner
Thank you, Chairman Runyan, for holding this important hearing. I
would also like to recognize your advocacy on this issue within the
House Armed Services Committee. Special thanks, as well, to all the
panelists for their advocacy of victim's rights and determination to
address the military culture and climate. I have worked with Anu and
SWAN for several years now and their contribution to this issue has
been instrumental in achieving many legal and policy changes.
Before I start my remarks, I would like to point out that the great
majority of the Servicemembers are patriotic citizens that serve their
country honorably and selflessly. And while today's hearing may focus
on the criminal behavior of a relative few, their behavior should not
be used to broadly tarnish the reputation of the many Servicemembers
who have honorably sacrificed for their country.
I became involved in this issue in 2008 following the tragic murder
of Lance Corporal Maria Lauterbach. Maria reported being sexually
assaulted and was later murdered by a fellow Marine while she was
stationed at Camp LeJeune, North Carolina. During the course of the
investigation a Marine Corps representative told me that ``we lost two
good Marines today.'' When, in fact, we had only lost one good Marine,
Maria Lauterbach, and another Marine who was a rapist and murder that
tarnished the reputation of the Corps. Later, during the course of
Congressional hearings on the subject, a Lieutenant General stated that
Maria ``never alleged any violence or threat of violence in either
sexual encounter.''
These and several other incidents demonstrated a fundamental lack
of understanding of the problem and how to deal with it. In addressing
the issue of military sexual assault it is necessary to address some
fundamental areas, namely: Command, Culture and Accountability. I think
the hearing today strikes at the heart of the cultural element. Culture
within the Department of Defense and the Department of Veterans
Affairs.
In working on sexual assault issues on the House Armed Services
Committee and the Military Sexual Assault Prevention Caucus, which I
co-chair with Niki Tsongas, we have sculpted legislation that aims to
facilitate a culture that encourages victims to come forward and
punishes the criminal actors that degrade our military. The personal
nature of sexual assault makes it difficult for victims to come forward
and discuss the details of their experience. This is compounded by
policies that require victims to repeatedly relive the experience and
re-victimize the victims. These additional stresses decrease the
likelihood of victims coming forward and permit the retention of
criminals. As Anu pointed out in her testimony, the DoD Sexual Assault
Prevention and Response Office (SAPRO) report indicated that 86.5% of
sexual assaults go unreported. The end result is that some of these
criminal later draw DoD and VA benefits, while their victims are left
to fight to substantiate their PTSD claims.
Addressing the issue before the Committee today is a step towards
creating a more victim-centric system that improves our military by
rewarding victims for coming forward and punishing the bad actors. In
addressing this issue, Niki Tsongas and I included a provision in the
Defense STRONG Act last year requiring the DoD to retain records
prepared in connection with sexual assaults involving members of the
Armed Forces or dependents of members. That provision was later
included in the FY12 NDAA. This provision requires the Department of
Defense to permanently retain records of sexual assault in the
military, and ensures that a servicemember who is a victim of sexual
assault has access to these records. Servicemembers find it difficult
to obtain documentation proving their sexual assault once they have
left the services because DoD destroys many of these documents after
only a few years. It is our hope that improving this process will
contribute to removing the negative stigma that surrounds the process
and, thereby, improves military culture and climate.
Question:
Col. Metzler and Mr. Murphy. What is the status of implementation
of this new policy (HR1540 Sec 586)?
Prepared Statement of Congresswoman Chellie Pingree
Thank you Chairman Runyan and Ranking Member McNerney for allowing
me to participate in today's hearing. I also want to thank you for
holding this hearing--the topics covered today are extremely important,
as the welfare of our veterans' mental health and the disability and
mental health system that cares for them should be one of Congress's
highest priorities.
Military sexual trauma continues to be a pervasive problem in our
Armed Forces. DoD data shows that roughly 19,000 reported assaults
occur each year, and that approximately 85% of these assaults go
unreported. It happens to both men and women at increasingly high
rates.
These attacks on our service men and women are occurring in the
active duty ranks and even at the military academies--it is a disgrace
that needs to stop now. I commend Defense Secretary Panetta for the
changes he is making to DoD policy to prevent MST and prosecute these
attackers, but more needs to be done.
Data shows that survivors of MST are very likely to suffer from
Post Traumatic Stress Disorder and other mental health conditions,
leading many of these veterans to file claims with the VBA. I commend
the Veterans Health Administration, which has an ``open door'' policy,
where MST survivors can get free treatment and counseling based on self
reported MST.
While the VHA's MST policy does what it can for MST victims, there
is another side of the VA that in far too many cases fails MST
survivors by producing roadblocks and bureaucratic red tape. Countless
MST survivors are so affected by the personal assault they experienced
that they file PTSD claims with VBA, only to be denied service
connection because they cannot prove the assault occurred.
Since most attacks go unreported, leaving no military documentation
for victims to produce during the claims process with VBA. VBA's
current policy states that they will be very liberal in deciding MST
cases, and should accept ``secondary markers'' as proof the assault
occurred--things like counseling reports for PTSD from MST, letters
from family members citing behavioral changes, drug and alcohol abuse,
etc . . .
On the surface it appears VBA's policy gives veterans the benefit
of the doubt and that VA understands current DOD shortcomings around
MST, and common sense prevails when adjudicating these sensitive cases.
I would like to commend VBA under Secretary Allison Hickey for her
commitment to MST survivors and the increased emphasis she has put on
these types of claims while serving as VBA undersecretary.
Unfortunately, however, I am of the opinion that the VA is just too
big an agency for anything short of a regulation change to fix this
problem. No amount of training can ensure raters take the larger
picture into account when reviewing these cases. VBA remains vastly
inconsistent when deciding MST cases, and what one Regional Office
accepts as a secondary marker, another might deny and still not be
violating VBA policy. For instance, I have seen veterans denied service
connection for lack of sufficient proof, even after they provided
medical reports from in patient counseling for MST-related mental
health conditions--at VA Medical Centers.
We have to be sure that VBA gives MST survivors the benefit of the
doubt, especially when so many of these survivors have lost faith in
the system they swore to uphold. That is why I introduced a bill that
would provide service connection for MST survivors if they provide a
diagnosis of PTSD and a medical nexus stating the PTSD is caused by the
assault.
This language in this bill is very similar to the July 2010 change
VBA implemented for veterans suffering from PTSD related to fear of
hostile enemy action or terrorist activity. These veterans need only
show a diagnosis of PTSD, a medical link and the claimed stressor must
be consistent with the types of events consistent with military
service. Unfortunately, the data continues to show that sexual assault
in the military is so pervasive that it is consistent with the types of
events consistent with military service. I want to thank Chairman
Runyan for his support of the bill, as I know it would go along way to
addressing the issues we continue to hear about from veterans and their
families.
Let's be clear. The bad guys in these stories are the perpetrators.
They are the villains and the ones who should be held accountable. But
by creating a policy that denies justice to the victims and forces them
to spend years or even decades fighting for the benefits they deserve,
we are deepening the wounds for these veterans and making it all that
much harder for them to get on with their lives.
Prepared Statement of Anu Bhagwati
Dear Mr. Chairman and Members of the Committee:
Thank you for holding this hearing on a critical issue facing our
veterans' community, and thank you for the opportunity to present the
views of the Service Women's Action Network (SWAN) on the challenges
confronting veterans who file claims for PTSD suffered as a result of
sexual assault and sexual harassment in the military.
SWAN has been advocating for changes to the VA claims process for
several years. We actively supported the VA's change to the claims
process for combat related PTSD-claims and have provided testimony many
times to both House and Senate committees on issues and challenges
facing women veterans at both the VHA and VBA, and the unique
challenges faced by veterans filing Military Sexual Trauma (MST)
claims.
According to VA, PTSD is the most common mental health condition
associated with MST. For women veterans, MST is a greater predictor of
PTSD than combat. \1\ Studies also indicate that sexual harassment
causes the same rates of PTSD in women as combat does in men. \2\ And
40 to 53% of homeless women veterans have been sexually assaulted in
the military. \3\ Simply put, MST has devastated the veterans'
community.
---------------------------------------------------------------------------
\1\ Maureen Murdoch, et al., ``Gender Differences in Service
Connection for PTSD,'' Medical Care 41, no. 8 (2003), 950-961.
\2\ Maureen Murdoch, et al., ``The Association between In-Service
Sexual Harassment and Posttraumatic Stress Disorder among Compensation-
Seeking Veterans,'' Military Medicine 171, no. 2 (2006), 166-173.
\3\ Erik Eckholm, ``Surge Seen in Number of Homeless Veterans,''
The New York Times, November 8, 2007; b. Donna L. Washington, et al.,
``Risk Factors for Homelessness among Women Veterans,'' Journal of
Health Care for the Poor and Underserved 21 (2010): 81-91.
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The MST claims process is broken at best. VA's PTSD policy
discriminates against veterans who were sexually assaulted or harassed
while in uniform by holding them to a standard which is not only higher
than that of other groups of veterans suffering from PTSD, but also
completely unrealistic for the majority of survivors to meet. As we
discovered by analyzing VA claims data (see below), the process fails
the majority of survivors. The process also serves to betray and re-
traumatize these veterans, often directly contributing to worsening
symptoms and increasing rates of suicide.
First, it should be noted that the MST PTSD claims process
adversely affects all veterans, not just women. Many men suffer from
the effects of sexual violence experienced while serving in the
military. According to the Department of Defense, 12% of all
unrestricted sexual assault reports are made by men. \4\ Additionally,
according to VA, 45.7% of the veterans who screened positive for MST in
2010 were men, and 39% of veterans receiving treatment for MST were
men. \5\
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\4\ Department of Defense, SAPRO. 2012. ``Fiscal Year 2011 Annual
Report on Sexual Assault in the Military''.
\5\ Department of Veterans Affairs, Office of Mental Health
Services. 2011. ``Summary of Military Sexual Trauma-related Outpatient
Care Report, FY 2010.'' Washington, D.C.: Department of Veterans
Affairs, Office of Mental Health Services.
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Veterans who suffer from the debilitating effects of Military
Sexual Trauma face unique challenges in obtaining disability
compensation from the VA. In 2011, SWAN and the American Civil
Liberties Union (ACLU) filed a Freedom of Information Request with the
VA for data on MST claims. The data obtained through litigation showed
that during FY 2008, 2009 and 2010, only 32.3% of MST-based PTSD claims
were approved by VBA compared to an approval rate of 54.2% of all other
PTSD claims during that time. \6\ As a point of comparison, data
obtained by Veterans for Common Sense indicates that 53% of Iraq and
Afghanistan deployment related PTSD claims through October 2011 were
approved. \7\
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\6\ In conjunction with the ACLU, SWAN filed a Freedom of
Information Act (FOIA) request to obtain data concerning approval/
rejection rates of MST-based PTSD disability claims. Based on data
analyzed for fiscal years 2008-2010, 32.3% of MST- based PTSD claims
were approved vs. 54.2% of all other PTSD claims over the same period.
!
\7\ Veterans for Common Sense. 2012. ``Iraq and Afghanistan Impact
Report''. Washington D.C.: Available at http://
veteransforcommonsense.org/wp-content/uploads/2012/01/VCS--IAIR--JAN--
2012.pdf.
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Looking more deeply at the MST data, SWAN discovered that among
veterans who had their MST-PTSD claims approved by VA, women were more
likely to receive a 10% to 30% disability rating, whereas men were more
likely to receive a 70% to 100% disability rating. \8\
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\8\ In conjunction with the ACLU, SWAN filed a Freedom of
Information Act (FOIA) request to obtain data concerning gender
differences in compensation awarded for MST-related PTSD claims. The
data showed men are more likely than women to receive 70% to 100%
ratings for MST-related PTSD claims, and women were more likely to
receive 10% to 30% ratings (p<.001).
---------------------------------------------------------------------------
We drew several important conclusions from these findings. First,
under current VA policy, veterans who file a PSTD claim based on their
Military Sexual Trauma have only a 1 in 3 chance of getting their claim
approved. Also, among women veterans with MST-related PTSD, data
suggests a strong gender bias in disability ratings in favor of men.
When we look at VA's PTSD claims policies on paper, we shouldn't be
surprised that so few MST PTSD claims get approved: the evidentiary
standard for claims based on rape, sexual assault or sexual harassment
is higher, and completely unrealistic.
The language in the regulation that establishes the required
evidence for what the VA calls a ``in-service personal assault'' (38
CFR 3.304, Chapter 1, Part 3, Subpart A) differs radically from the
language used to describe the evidence required for combat, deployment,
prisoners of war, and all other PTSD claims. In fact, Paragraph (f)
allows for lay testimony as acceptable evidence in all other PTSD cases
except in cases of an in-service personal assault.
Instead the regulation lists a litany of other hypothetical
evidence which can be submitted by a veteran ranging from police
reports, statements by family members, pregnancy and tests for sexually
transmitted diseases. The regulation also allows for negative changes
in behavior to be taken into consideration. It is worth noting that the
regulation does require VA claims officers to accept such evidence, it
only allows for the veteran to submit it. \9\
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\9\ 38 C.F.R. Sec. 3.304: Pensions, Bonuses, and Veterans' Relief.
(2012).: Available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-
idx?c=ecfr&tpl=/ecfrbrowse/Title38/38tab--02.tpl
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If 2 out of 3 MST claimants still cannot meet this PTSD evidentiary
burden, the policy can hardly be called generous. VA policy fails
veterans for a variety of reasons. First, sexual assault and sexual
harassment in the military are notoriously under-reported. According to
the Pentagon's Sexual Assault Prevention and Response Office (SAPRO),
86.5% of sexual assaults go unreported, \10\ meaning that official
documentation of an assault rarely exists. Secondly, prior to the new
evidence retention laws passed in the 2011 National Defense
Authorization Act, the services routinely destroyed all evidence and
investigation records in sexual assault cases after 2 to 5 years,
leaving gaping holes in MST claims filed prior to 2012. Lastly, the
evidentiary standard described in the regulation does not take into
consideration the reality that many victims do not report the
incident(s) to anyone, including family members, for a variety of
legitimate reasons, including shame, stigma, embarrassment, or
disorientation associated with sexual trauma. Although sexual assault
increases the chance of adverse emotional responses and behaviors, \11\
it does not mean that all MST claimants will experience these symptoms.
In fact, SWAN has spoken to many assault survivors who demonstrate
changes in behavior that are not included in the regulation, such as
improved job performance as a means of coping with the trauma.
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\10\ Department of Defense. SAPRO, 2012.
\11\ Dean G. Kilpatrick, Ph.D. 2000. ``The Mental Health Impact of
Rape''. National Violence Against Women Prevention Research Center,
Medical University of South Carolina. Available at: http://
www.musc.edu/vawprevention/research/mentalimpact.shtml.
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In the MST community, the failures of the VA claims process are
notorious. SWAN has spoken with veterans who suffer PTSD related to
both MST and combat--what veterans cynically call the ``double
whammy''. These veterans chose to abandon their MST claims and submit a
claim only for combat related PTSD, as they felt their combat claim was
more likely to be approved, and that the uphill battle to file an MST
claim wasn't worth the agony.
SWAN has presented our data to VA Secretary General Eric Shinseki
and to General Allison Hickey, the Under Secretary for Benefits at VBA,
to demand change to VA policy on MST claims. After a series of
conversations SWAN had with VBA about its discriminatory practices, the
Under Secretary issued a memo in June 2011 providing further guidance
to claims officers and instituting training requirements for processing
MST claims. However, examination of both the letter and the training
revealed it simply reinforced the existing regulation which our data
shows is not working. Rather than resolve the problem by easing the
double standard placed on MST claimants, the VBA has done nothing but
reinforce failure.
To fix MST claims policy, VBA must immediately revise the
regulation (38 CFR 3.304, Chapter 1, Part 3, Subpart A) to provide
language that establishes the same evidentiary requirements for MST-
based PTSD claims that it does for other claims. Specifically, if the
evidence establishes a diagnosis of PTSD during service and the
veterans' mental health provider connects that claimed stressor to the
patient's service, then in the absence of clear and convincing evidence
to the contrary, and provided that the claimed stressor is consistent
with the circumstances, conditions, or hardships of the veteran's
service, the veteran's lay testimony alone should sufficiently
establish the occurrence of the claimed in-service stressor.
Furthermore, there should be absolutely no requirement that
veterans filing MST claims go through an independent Compensation and
Pension exam to verify that they have PTSD. We know from talking to
countless veterans that these exams often unfairly reverse the
diagnosis that was made by qualified VA MST counselors or other mental
health providers. C & P exams are terrifying for veterans who have been
assaulted or harassed as it forces them to talk about traumatic and
devastating experiences with complete strangers. These experiences
often taken years or even decades for veterans to come to grips with,
or to talk comfortably about, and veterans should not be forced to
repeat them to complete strangers who often lack the sensitivity or
professional qualifications to speak to survivors of sexual trauma. The
trust that is built between a MST counselor or mental health provider
and his/her patient is one that cannot be replaced by strangers. VBA
must trust the expertise of VHA or other sexual trauma experts who have
worked intimately with their patients.
Additionally, to sensitize claim reviewers to the needs of assault
and harassment victims, the VA should implement the recommendations of
the Institute of Medicine Committee on Veterans' Compensation to
collect gender-specific data on MST claim decisions, develop additional
MST-related reference materials for raters, and incorporate training
and testing on MST claims into its rater certification program. \12\
The agency should also establish a presumption of soundness for the
diagnoses of its own treating physicians and counselors; claim
reviewers should not have the authority to second-guess evaluations by
agency medical professionals or to discount VA treatment records in
favor of one-time Compensation and Pension (C&P) exam results.
---------------------------------------------------------------------------
\12\ Committee on Veterans' Compensation for Posttraumatic Stress
Disorder, Institute of Medicine and National Research Council of the
National Academies, PTSD Compensation and Military Service (Washington
DC: The National Academies Press, 2007).
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Finally, SWAN proposes revising the current VA work credit system,
which paradoxically prolongs the adjudication process by privileging
speed over accuracy in initial claim determinations. By measuring
employee productivity strictly by number of cases processed, the VA
offers reviewers an incentive to take any shortcut necessary to clear
their desks of pending claims. The resulting combination of too much
work and too little time ultimately gives rise to premature--and
inaccurate--determinations, setting in motion years of appeals. In
order to encourage accurate determinations at the Regional Office level
and remove the incentive to recycle claims, the agency should award
work credit only after the final stage of review.
Thank you very much for your attention. I would be happy to answer
any questions.
Executive Summary
The Service Women's Action Network (SWAN) has worked on the issue
of Military Sexual Trauma (MST)- related Post Traumatic Stress Disorder
(PTSD) claims for a number of years now with the VA, VBA and Congress.
SWAN has advocated for a relaxation in the evidentiary standards for
MST-based PTSD claims to allow lay testimony of the veteran to be used
to reflect the standards of evidence used in other PTSD claims. In
2011, SWAN and the ACLU filed Freedom of Information Act requests with
the VA to ascertain the scope of MST-based PTSD claims, and to
specifically examine approval rates and disability ratings of those
claims.
Examination of the documents produced by the VA clearly shows that
the current system in use by the VBA that employs a higher standard of
evidence for sexual assault claims results in only 1 in 3 (32.3%) MST-
based PSTD claims being approved. This is much lower than the 1 in 2
(54.2%) acceptance rate of all other PTSD claims. Additionally, an
examination of disability ratings revealed a strong bias, as women were
more likely to receive a 10 to 30 percent rating and men were more
likely to receive a 70 to 100 percent disability rating.
This data reinforces what SWAN and many other veterans' advocates
already know: the possibility of getting an MST-based PTSD claim
approved by the VBA under the current regulations continues to be an
arduous and overwhelmingly difficult process for the veteran, and is a
process that more often than not results in a ruling unfavorable to the
veteran.
To improve MST claims policy, VBA must immediately revise the
regulation (38 CFR 3.304, Chapter 1, Part 3, Subpart A) to provide
language that establishes the same evidentiary requirements for MST-
based PTSD claims that it does for other claims. Specifically, if the
evidence establishes a diagnosis of PTSD during service and the
veterans' mental health provider connects that claimed stressor to the
patient's service, then in the absence of clear and convincing evidence
to the contrary, and provided that the claimed stressor is consistent
with the circumstances, conditions, or hardships of the veteran's
service, the veteran's lay testimony alone should sufficiently
establish the occurrence of the claimed in-service stressor.
Furthermore, there should be absolutely no requirement that
veterans filing MST claims go through an independent Compensation and
Pension (C &P) exam to verify that they have PTSD. We know from talking
to countless veterans that these exams serve no purpose and in fact
often unfairly reverse the diagnosis that was made by qualified VA MST
counselors or other mental health providers. C & P exams are terrifying
for veterans who have been assaulted or harassed as it forces them to
talk about traumatic and devastating experiences with complete
strangers. These experiences often take years or even decades for
veterans to come to grips with, or to talk comfortably about, and
veterans should not be forced to repeat them to complete strangers who
often lack the sensitivity or professional qualifications to speak to
survivors of sexual trauma. The trust that is built between a MST
counselor or mental health provider and his/her patient is one that
cannot be replaced by strangers. VBA must trust the expertise of VHA
mental health experts who have worked intimately with their patients.
Additionally, to sensitize claim reviewers to the needs of assault
and harassment victims, the VA should implement the recommendations of
the Institute of Medicine Committee on Veterans' Compensation to
collect gender-specific data on MST claim decisions, develop additional
MST-related reference materials for raters, and incorporate training
and testing on MST claims into its rater certification program. The
agency should also establish a presumption of soundness for the
diagnoses of its own treating physicians and counselors; claim
reviewers should not have the authority to second-guess evaluations by
agency medical professionals or to discount VA treatment records in
favor of one-time C&P exam results.
Finally, SWAN proposes revising the current VA work credit system,
which paradoxically prolongs the adjudication process by privileging
speed over accuracy in initial claim determinations. By measuring
employee productivity strictly by number of cases processed, the VA
offers reviewers an incentive to take any shortcut necessary to clear
their desks of pending claims. The resulting combination of too much
work and too little time ultimately gives rise to premature--and
inaccurate--determinations, setting in motion years of appeals. In
order to encourage accurate determinations at the Regional Office level
and remove the incentive to recycle claims, the agency should award
work credit only after the final stage of review.
Prepared Statement of Joy J. Ilem
Messrs. Chairman and Members of the Subcommittee:
Thank you for inviting the Disabled American Veterans (DAV) to
testify at this oversight hearing focused on the process and procedure
involved in veterans' obtaining disability compensation benefits for
post-traumatic stress disorder (PTSD) associated with military sexual
trauma (MST), specifically on the types of evidence that may be
submitted to substantiate a claim related to MST, and an exploration of
ideas that may improve the evaluations of these claims.
For a number of years, DAV has advocated greater collaboration
between offices of the Department of Veterans Affairs (VA) and the
Department of Defense (DoD) to address conditions related to MST and to
identify better ways to treat and properly compensate veterans for
those conditions. We also continue to express a fervent hope that DoD
is effectively addressing methods to prevent the incidence of sexual
assaults and harassment within all branches of the military services.
This topic is obviously extremely sensitive to many service
members, veterans and the respective Departments that are responsible
for the safety and well-being of service members and veterans. When a
service member is wounded by enemy rifle fire or mortar shrapnel in
engagement with an enemy, as a society we recognize the sacrifice and
loss of our wounded military personnel, but when a military service
member is wounded by personal or sexual violence, often perpetrated by
a fellow service member, military authorities and society in general
respond in a very different way.
The continued prevalence of sexual assault in the military is
alarming and has been the object of numerous military reports,
Congressional hearings, documentaries and media coverage.
Unfortunately, recent media reports do not lend confidence that DoD is
succeeding in its goal of reducing and eliminating this scourge;
however, it appears from recent developments that the Secretary of
Defense has determined to address MST in a new and enlightened manner
compared to the past. He announced the establishment of independent
special victims units to investigate incidents of MST in the military
ranks. He also indicated DoD will address some of its historic problems
in archiving records associated with the incidence of MST.
In 2005, the DoD established the Sexual Assault Prevention and
Response Office (SAPRO). This organization is responsible for all DoD
sexual assault policy and provides oversight to ensure that each of the
military service's programs complies with DoD policy. SAPRO serves as
the single point of accountability and oversight for sexual assault
policy, provides guidance to the DoD components, and facilitates the
resolution of issues common to all military services and joint
commands. The objectives of DoD's SAPRO policy are to specifically
enhance and improve prevention through training and education programs,
ensure treatment and support of victims, and enhance system
accountability.
According to SAPRO, in 2011 reports of sexual assault were filed by
3,192 service members across all military service branches, a 1%
increase over 2010 and a 1.1% decrease from 2009. \1\ However, DoD
recognizes that these types of crimes are remarkably under-reported.
For last year, DoD projected a more accurate number, likely closer to
19,000 assaults, based on its bi-annual Workplace and Gender Relations
Survey of Active Duty Members (WGRA).
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\1\ Department of Defense Sexual Assault Prevention and Response,
Annual Report on Sexual Assault in the Military, Fiscal Year 2011;
April 2012. http://www.sapr.mil/media/pdf/reports/Department--of--
Defense--Fiscal--Year--2011--Annual--Report--on--Sexual--Assault--in--
the--Military.pdf.
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VA data bears out the significant reports of MST. According to VA,
during fiscal year 2009, 21.9 percent of women and 1.1 percent of men
screened by the Veterans Health Administration (VHA) reported that they
had experienced an in service stressful MST event. Another VA study
found that of 125,000 enrolled veterans screened, about 15 percent of
women veterans from Operations Iraqi and Enduring Freedom reported
experiencing sexual assaults or harassment during military service. \2\
VA research also indicates that men and women who report sexual assault
or harassment during military service were more likely to be diagnosed
with a mental health condition. Women with MST had a 59 percent higher
risk for mental health problems; the risk among men was slightly lower,
at 40 percent. \3\ The most common conditions linked to MST were
depression, PTSD, anxiety, adjustment disorder, and substance-use
disorder.
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\2\ US Dept of Veterans Affairs, VA Research Currents. November-
December 2008. http://www.research.va.gov/resources/pubs/docs/va--
research--currents--nov-dec--08.pdf.
\3\ Ibid.
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The complaints we hear from veterans regarding MST are primarily
focused on the VBA disability claims process. Many survivors indicate
that they are frustrated with the process particularly in cases when
the sexual assault was not officially reported. They express a feeling
of being ``re-traumatized'' in their efforts to get help from VBA even
when they have provided significant evidence; statements from
witnesses, friends or family; a detailed account of the incident; along
with a diagnosis and extensive treatment records from a VA or non-VA
mental health provider--only to have the claim for service-connection
denied.
Unfortunately, many service members who experience these types of
traumas do not disclose them to anyone until many years after the fact
but frequently experience lingering physical, emotional or
psychological symptoms following these incidents. When a service member
experiences sexual assault during military service there are a number
of complicating factors that often prevent or discourage survivors from
coming forward and reporting the incident to their superiors. Fear of
retribution within the military unit structure; the perpetrator is
their superior or a friend of the superior to whom they must report;
and negative impact on military career are just a few reported barriers
to coming forward and reporting such incidents. Traditional military
culture and the military's closed system for reporting, investigating
and prosecuting these types of crimes also constitute barriers against
reporting such incidents. Despite DoD's ``zero-tolerance'' policy,
reports continue to document these incidents. Not only is there stigma,
shame, guilt, and feelings of isolation associated with sexual assault
in general, to add insult to injury, in some cases, these incidents are
not being properly addressed as mandated by policy through the chain of
command. Perpetrators often are not punished.
On their discharge from military service many survivors of MST end
up seeking health care and mental health counseling services for MST
from the VA health care system. Under a current Veterans Health
Administration (VHA) policy, all patients are screened for MST and
receive medically necessary treatment and counseling without charge for
MST-related conditions at VA health care facilities and in VA Vet
Centers. Service connection or disability compensation is not required
for eligibility to gain access to this treatment.
Establishing a veteran's service connection for PTSD requires: (1)
medical evidence diagnosing PTSD; (2) credible supporting evidence that
the claimed in-service stressor actually occurred; and (3) medical
evidence of a link between current symptoms and the claimed in-service
stressor.
According to current VBA policy, if a PTSD claim is based on in-
service personal assault, evidence from sources other than a veteran's
service records may corroborate a veteran's account of the stressor
incident. Examples of such evidence include, but are not limited to:
records from law enforcement authorities, rape crisis or 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. Additionally, evidence of
behavioral changes following the claimed assault is one type of
relevant evidence that may be found in these sources. Examples of
behavioral changes that may constitute credible evidence of the
stressor 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
behavioral changes (title 38 C.F.R. Sec. 3.304(f)(5).)
Also noteworthy, VBA's policy prohibits the denial of claims for
service connection for PTSD based on in-service personal assault
without a rater's first advising the veteran claimant that information
from sources other than the veterans' 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. Finally, the
regulation 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.
Unfortunately, even with the liberalization of the regulations, if
an assault is not officially reported during military service,
establishing service connection later for conditions related to MST can
be very challenging. According to an Institute of Medicine (IOM)
National Research Council report on PTSD compensation in 2007,
significant barriers prevent women from being able to independently
substantiate their experiences of MST, especially in combat arenas. \4\
The IOM report concluded that little research exists on the subject of
PTSD compensation and women veterans and noted that available
information suggests that women veterans are less likely to receive
service connection for PTSD and that this gap is related to their being
unable to substantiate non-combat traumatic stressors such as MST. The
committee stated that VA guidance for rating these cases at that time
addressed MST specifically, but that little attention was being paid to
the unique challenges of documenting an in-service stressor or
approaches for solving this problem. DAV is pleased to report that the
Veterans Benefits Administration has made numerous improvements in
adjudication policies on MST since that report was filed.
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\4\ Institute of Medicine and National Research Council of the
National Academies, Committee on Veterans' Compensation for PTSD, Board
on Military and Veterans Health, Board on Behavioral, Cognitive, and
Sensory Sciences; PTSD Compensation and Military Service. Washington
DC, 2007.
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In May 2010, VBA officials testified that all rating specialists in
VA regional offices were provided with detailed information on proper
claims processing methods in a 2005 training letter, in an effort to
ensure that veterans who filed claims associated with MST received fair
and thorough consideration of those claims. \5\ Following the joint
hearing on May 20, 2010, VBA responded to DAV's request to include
SAPRO information in its M-21-1MR, Part IV, Subpart ii, Chapter 1,
Section D for these types of claims. In December 2011, VBA amended its
guidance to VA rating specialists, expanding requirements for raters
examining personal trauma cases based on MST, including using SAPRO as
a source for possible documentation.
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\5\ Bradley G. Mayes & Susan McCutcheon, RN, EdD; Joint Statement
before the House Veterans Affairs Committee, Subcommittee on Disability
Assistance and Memorial Affairs, ``Healing the Wounds: Evaluating
Military Sexual Trauma Issues,'' May 20, 2010. http://
democrats.veterans.house.gov/hearings/
Testimony.aspx?TID=72876&Newsid=577&Name=%20Bradley%20G.%20Mayes.
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We appreciate these specific changes made by VBA, including the
information about SAPRO, but DAV remains concerned about how many
claims may have been denied prior to that information being included in
the manual or on faulty application of the existing regulations.
In preparing for this hearing we contacted VBA officials, through
our National Service Officer (NSO) Corps, to see what references are
currently being used by rating specialists/adjudicators in developing
PTSD claims based on MST. A document associated with a December 2011
``Fast Letter'' provides very detailed and comprehensive guidance
regarding these claims to include: pertinent regulations; statutory
definition of MST; related court decisions; specific ``markers'' to
examine in veterans' records; timing for ordering a PTSD examination;
and proper development actions to be taken prior to a decision being
rendered in the case.
Most notably in the document we found a number of clear examples
and statements to raters emphasizing the fact that a special obligation
exists on VA's part to assist claimants in gathering, from sources
other than in-service records, evidence corroborating an in-service
stressor and to help fully develop their claims particularly in MST
cases given the unique problems of documenting personal-assault claims.
The instructions are concise--that evidentiary development must proceed
under the special requirements of title 38, C.F.R., Sec. 3.304(f)(5)
and that a veteran's complete military record should be obtained if
necessary, and reasonable efforts expended to obtain any other evidence
a veteran may identify as a potential source to support the claim. The
document goes on to explain the purpose of the liberalizing categories
in the regulation is to recognize the difficulties inherent in
establishing service-connection for PTSD claims based on MST and other
personal assaults and to provide the basis for a relaxed evidentiary
standard and a liberal approach to evaluation of these claims.
The most salient feature made in the Fast Letter's attachment is to
emphasize that current regulations and court cases do not require
actual documentation of the claimed stressor, and that the opinion of a
qualified mental health clinician is considered credible supporting
evidence of the claimed MST stressor. Nevertheless, the letter notes
that the final decision on service connection remains with VBA raters.
To DAV, the question at hand for this Subcommittee is whether VBA
adjudicators and rating specialists who are responsible for developing
and rating MST claims are using all the amended provisions in M21-1 and
following those prescribed VBA-wide guidelines in the Code of Federal
Regulations to assist veterans in uncovering potential evidence that
may be available to support their claims, even if unreported. In cases
where veterans indicated that no official report of assaults were
filed, VA adjudicators should be asking veterans detailed questions or
considering stressor statements provided by veterans to determine if
other reports could have documented these events (such as calls or
visits to rape crisis centers or mental health counseling centers;
requests for pregnancy tests or tests for sexually transmitted
diseases; statements in personal diaries or letters to clergy or family
members immediately following personal assaults).
In our view, if a veteran indicates an assault took place on a
specific date(s), he or she should be asked about subsequent treatment
for any health or mental health problems following the sexual assault,
i.e., complaints of stomach pain; nausea; vomiting; headaches; anxiety;
panic attacks; depression; or suicidal ideation, etc. Rating
specialists should be examining military personnel records for requests
for transfer filed by individuals following assault to another duty
assignment; a deterioration in work performance noted; or documentation
of a sudden onset of substance abuse or other unexplained social or
behavioral changes. The M21-1 guidance lists additional options to
assist VBA claims developers but it unclear whether these efforts are
consistently and exhaustively being made. DAV asks this Subcommittee to
require VBA to examine compliance with this guidance system-wide and
submit a report of its findings to aid the Subcommittee in its
oversight role.
We bring one more issue to the Subcommittee's attention on this
topic. Under DoD's confidentiality policy, military victims of sexual
assault have two reporting options, ``restricted'' reporting and
``unrestricted'' reporting. Restricted reporting allows a sexual
assault victim to confidentially disclose the details of the assault to
specified individuals and receive medical treatment and counseling,
without triggering any official criminal or civil investigative
process. Despite the progress on the VA's part to include SAPRO
information in its M21-1 manual, to maintain confidentiality in the
case of restricted reporting, DoD policy prevents release of MST-
related records with limited exceptions. However, VA is not
specifically identified as an ``exception'' for release of records in
DoD's policy and it is unclear if VA could gain access to these records
even with permission of the veteran. One of DAV's primary concerns is
that VA be able to access restricted DoD records (with the veterans'
permission) documenting reports of MST for an indeterminate period. To
establish service connection for PTSD there must be credible evidence
to support a veteran's assertion that the stressful event actually
occurred. Restricted records are highly credible resources but it is
questionable if they are readily available, even with the consent of
the veteran. With the veteran's authorization, we believe DoD should
provide VA adjudicators access to all MST records, whether restricted
or unrestricted, to aid VBA in adjudicating these cases.
We also have questions with respect to where and how physical
assessment records that are completed following assaults and subsequent
mental health treatment records related to the restricted MST reports
are kept and for how long. We are concerned that these records are
being maintained separately from victimized service members' medical
treatment and personnel records and whether each service maintains MST
records in a consistent manner. According to DoD policy physical
evidence associated with a restricted report of an MST event is
destroyed after one year if the service member or veteran does not wish
to pursue civil or criminal sanctions against the perpetrator.
Legislation is pending in the Senate that would extend this period of
records retention for restricted MST records to five years. DAV
supports an extension of this period to 50 years, matching the current
DoD policy on retention of unrestricted records of sexual assaults.
DAV NSOs continue to assist MST victims with their claims for
disability compensation. In this work, however, our NSOs are frustrated
at the routine occurrence that MST claims are denied by VA for lack of
evidentiary documentation. This suggests that, in some cases, VBA
rating specialists are not following current policy as detailed in this
statement. For these reasons and more, it seems to DAV that the
agencies that are responsible for monitoring and reporting on MST, and
providing benefits and services to survivors of MST, as well as
preventing the problem at its source, should work in concert to lower
the burden of this claims process and ensure service members and
veterans are fully assisted by the government and their advocates in
securing the benefits they deserve and have earned. In recent days we
are advised that more collaboration is now occurring between leaders of
VBA and SAPRO, but we await the results of these efforts, especially in
relation to records keeping, archiving and accessing MST documentation.
Additionally, we urge VBA to identify and map claims related to
personal trauma with a focus on MST to determine the number of claims
submitted annually, their award rates, denial rates, and the conditions
most frequently associated with these claims. We believe this type of
reporting would be helpful to the Subcommittee in its oversight role.
Therefore, DAV renews our request that VBA develop this important data-
set and make it public. Finally, VBA is responsible for ensuring that
its claims staffs are properly trained and compliant with the
procedures and policies outlined in this testimony to assist veterans
in producing fully developed claims; therefore, VBA should conduct its
own oversight to review these claims to ensure the directives that have
been issued are in fact being followed.
Mr. Chairman, again DAV thanks you for the opportunity to share our
views at this important hearing focused on MST related disability
claims. We strongly believe that survivors of sexual assault during
military service deserve recognition, assistance in developing their
claims and compensation for any residual conditions found related to
the assault. DAV believes these cases need and deserve special
attention. Because of the circumstances of these injuries, victimized
individuals who have come forward are courageous, and their courage
needs to be recognized by the government.
In the past decade, progress has been made on this issue; however,
more needs to be done to ensure that these disabled veterans are
properly compensated for conditions related to MST on an equitable
basis in comparison to veterans disabled by other causes. We continue
to hope hearings of this nature can not only help heal these deep
wounds that are often invisible but have profoundly changed the lives
of those affected, but also stimulate both Departments to improve their
efforts to address them and the underlying causative factors.
Establishing service connection for a condition related to MST is
important on a number of levels. Specifically, veterans with service
connection gain improved access to VA health care. Disability
compensation can also make a significant difference in a disabled
veteran's financial stability and overall health and well-being.
Finally, and most importantly for many MST survivors, being rated
service connected for mental and physical disabilities attributed to
MST represents validation, connotes gratitude for their service to
their country and recognizes the tribulations they endured while
serving.
We appreciate the attention to these issues and hope the
Subcommittee will consider the issues of concern and recommendations
DAV has made today. I would be pleased to address your questions, or
those of other Subcommittee members.
Prepared Statement of Lori Perkio
Mr. Chairman and Members of the Subcommittee:
Thank you for the opportunity to provide testimony on behalf of The
American Legion regarding the obstacles faced by veterans applying for
compensation benefits related to military sexual trauma. Disability
compensation is, in its most basic sense, based on the residual effects
of injury or disease incurred in service. There are many potential
residual effects resulting from sexual trauma incurred in the military,
ranging from disorders of the genitourinary system to sexually
transmitted diseases to Posttraumatic Stress Disorder (PTSD). As with
any service connected disability, in order to establish service
connection, a veteran must prove three points of fact in conjunction
with the disorder. A veteran must prove there is a current condition. A
veteran must establish evidence showing the occurrence of the event or
disease during their period of service. Finally a medical opinion from
a doctor is required, providing a nexus between the event in service
and the present condition.
For victims of Military Sexual Trauma (MST) the most difficult
point to prove is usually the occurrence of the event in service. There
are a variety of reasons for this difficulty. Some of these reasons are
institutional or even societal. Some of these reasons revolve around
the circumstances and culture often associated with the triggering
incidences.
The VA is clearly aware of the difficulties the victims of MST face
in conjunction with the claims process. In 2004 a document produced by
the Veterans Health Initiative (VHI) on MST recognized some of the
challenges and offered advice to VA health care providers regarding
patients of theirs who might be seeking service connection and
compensation for residual effects of MST incurred in service.
The guide recognizes some of the ``downsides'' veterans might face
filing a claim. Veterans will be forced to undergo detailed
descriptions of the horrifying events which have resulted in their
present PTSD symptoms. Many veterans attach symbolic value to receiving
service connection and could be further traumatized by repeated
rejections and denials. Citing a 1995 Armed Forces Sexual Harassment
Survey which stated ``59 percent of women filing rape charges while
they were in service said they were not taken seriously.'' The guide
worries that ``For sexually traumatized veterans whose attempts for
redress in the military were disbelieved, minimized or even punished,
denial of service-connection [sic] may represent a re-enactment of
earlier `betrayals'''
Further complicating the process is that in many cases there may be
no records which could verify a veteran's claim of assault or sexual
trauma in service. As mentioned above, some long standing patterns
which are now changing slowly in the military created a negative
environment for victims to file charges of rape or assault in the
service. When such a culture existed, many chose not to even file due
to the arduous task ahead where the victim was as much on trial as the
attacker, if not more so.
Even new military programs developed to help victims deal with
sexual trauma in the military are often based on anonymity, to assuage
concerns of victims who feel their reporting of the incident may
adversely impact their career. While this may actually be increasing
the number of victims who receive needed help, and is important, it can
be disastrous in a long term sense for veterans who file claims for
disability related to these assaults, as there are no records to link
specifically to them in service.
The lack of available data is noted in 38 CFR Sec. 3.304(f)(5)
which clearly recognizes the frequent absence of concrete information
in the military record to indicate the occurrence of such traumatic
events and notes in the adjudication of posttraumatic stress disorder
claims that alternate sources of information can be used to indicate
the presence of such an event. Recognizing the importance of types of
evidence such as behavior changes, deterioration in work performance,
substance abuse, episodes of depression, unexplained economic or social
behavior changes and the like, the regulations show the difficulty
inherent in proving the existence of the event in question.
Paradoxically, often these events must be theorized as existing in the
holes left by gaps in what records are actually present.
Despite the regulatory requirement to pay special attention to
these types of information, American Legion service officers frequently
report that this is not how these claims are actually adjudicated in
the field. Oftentimes, the special attention required is only evident
once the claim reaches the Board of Veterans Appeals after many years
of an arduous appeals process. Some veterans do not even see the proper
deference towards these types of evidence until their claim appears
before the Court of Appeals for Veterans Claims. Simply put, despite
regulations which require VA to pay ``special attention'' to alternate
sources of information, all too often veterans are told the additional
information is not compelling enough to make a difference. All too
often it seems, there is no special attention granted to this
information.
In a statement released on July 11th of this year, VA delineated an
express lane process for veterans' claims including ``Special
Operations'' treatment for PTSD claims associated with MST. Presumably,
under this ``Special Operations'' treatment these MST PTSD claims will
finally receive the proper deference due alternative forms of evidence,
although it is entirely too early to see what impact, if any, the
special treatment will have on MST PTSD claims.
Interestingly, the VA has recently tackled the difficult issue of
adjudicating claims for PTSD in cases where there was a known lack of
records to corroborate a veteran's claim. In 2010, in recognition of
the frequent absence of concrete records to documented occurrences in
combat zones, VA changed their regulations relating to the adjudication
of PTSD claims related to combat type stressors that occurred in combat
zones. The decision to change these procedures came about after careful
consideration, and involved a procedure which mandated a VA doctor's
opinion diagnosing PTSD related to a stressor consistent with the
rigors and experiences of a combat zone.
Subsequent to this regulatory change, VA has seen accuracy results
in PTSD claims greatly improve. This change has improved the process
for adjudicating combat PTSD claims, and the veterans who served with
those invisible wounds have been able to receive some measure of
justice.
At the time of the regulatory change, the issue of MST claims for
PTSD was raised in conjunction with the proposed changes for combat
related PTSD. VA's response at the time, noted in the July 13, 2010
Federal Register, was to cite the existence of the special rules for
adjudicating these types of claims noted in 38 CFR Sec. 3.304(f)(5)
and seemed to indicate the mere presence of this special rule obviated
the need for any further liberalization of regulations related to PTSD
adjudication in MST cases.
The American Legion believes VA's response in that instance needs
to be revisited. There are clear parallels to the struggles of veterans
fighting to be recognized with service connection for PTSD in combat
situations and in situations of sexual trauma. In both cases, the
trauma contributes to lasting effects which can reach into every aspect
of the veteran's life. In both cases, the reliving of the event as a
necessary part of the process of service connection can be devastating
and contribute to further trauma. In both cases, there is a long
established understanding of the lack of available records to help
validate the claim.
The recent change to the PTSD claims model for combat veterans has
shown there is a remedy to the failing of the claims process where
there is an absence of records. The American Legion believes this is
the directions we must look to in order to solve the problems faced by
victims of MST in the claims process as they seek service connection
for PTSD related to their trauma. Whether this is accomplished through
internal regulatory change by VA along the lines of the initiative
displayed in improving the process for combat veterans, or by change of
law, the important message is that the system needs to change to help
these veterans.
If a victim of sexual trauma in the military is currently
experiencing symptoms of PTSD related to that trauma, a doctor is fully
qualified to make that assessment according to the Diagnostic and
Statistical Manual of Mental Disorders (DSM) whether the currently
utilized DSM-IV or the upcoming DSM-V the important factor is ensuring
a diagnosis conforms to careful medical understanding. With a doctor's
detailed evaluation, and relating the PTSD to an event in service, the
evidentiary requirement for MST victims could be treated in the same
manner in which we treat combat veterans. If the described incident is
consistent with the nature of sexual trauma and conforms to the
diagnosis, the existence of the in service stressor should be conceded
by VA.
The veterans in question have already been terribly victimized.
Unlike combat veterans, they are unlikely to be hailed as heroes,
although the courage to come forward and seek treatment is no less
admirable. As a nation we must be reaching out to these veterans and
telling them it is not only okay to come forward, but we have to
reestablish trust with them.
It is easy to miss this critical consideration when addressing the
issue of MST. These are veterans who came forward to serve their
country, and their trust has been shattered. In many cases their trust
in the system is nil. It is not enough to be a cold, dispassionate
system to adjudicate their benefits. We owe them an attempt to restore
faith and trust in the system. We owe them an attempt to show their
country does not think less of them.
The system needs fixing, but it is not a complicated fix. The
lessons of combat PTSD have shown us VA can make these changes on their
own initiative, and The American Legion urges them to act now to do so
for victims of MST.
The American Legion thanks this subcommittee for the opportunity to
come before you today to express our views on this critical issue, and
furthermore thanks to this subcommittee for ensuring that the victims
of Military Sexual Trauma are not forgotten or allowed to fall by the
wayside.
Executive Summary
The American Legion recognizes the obstacles faced by victims of
Military Sexual Trauma (MST) when filing for service connection in the
disability benefits system. The lack of data in the military records
system is a great obstacle to veterans trying to prove service
connection. In this way, victims of MST filing for PTSD face very
similar obstacles to combat veterans filing for PTSD, in both cases the
lack of records is one of the biggest obstacles to obtaining service
connection.
In 2010 VA voluntarily fixed their regulations to make it easier
for veterans who had served in combat zones to obtain service
connection for PTSD related to combat and combat conditions, by
relaxing evidentiary requirements for veterans with a diagnosis of PTSD
related to combat.
The American Legion believes VA must use its authority to change
their regulations in a similar fashion for MST victims seeking service
connection for PTSD. Despite the existence of regulations for MST
victims that require VA to pay special attention to alternate sources
of information which could confirm the occurrence of an event in
service, VA adjudicators are inconsistent in applying that special
consideration. Therefore, a more substantial regulatory change, on the
level of what was done in 2010 for combat victims, is in order to
provide justice for MST victims seeking service connection for PTSD.
Prepared Statement of Dr. Barbara Van Dahlen
Thank you for this opportunity to provide testimony regarding the
issue of improving the access to care through the Department of
Veterans Affairs for veterans who have been sexually assaulted while
serving in our military. It is an honor to appear before this
Committee, and I am proud to offer my assistance to those who serve our
country.
Background on Military Sexual Trauma
Over the past several months we have seen an increase in the
attention given to a very serious issue affecting our military
community: military sexual assault. One reason for the increase in
interest has been the release of a documentary film called The
Invisible War. The film--which debuted at the Sundance Film Festival
and opened in theaters in June--presents the stories of several women
and men who were sexually assaulted while serving in the military. The
service members who stepped forward to share these stories chose to
serve our country by joining the armed forces--and were devastated by
the assault they experienced and the lack of support they received from
the institution they had devoted themselves to.
The film has received critical acclaim and has stimulated
conversations in both the civilian and military communities regarding a
brutal reality that affects far too many men and women who serve. In
2011 alone, 3,192 men and women reported that they were sexually
assaulted while serving. By telling the painful stories of several
victims of sexual assault, the film provides an important framework to
understand the impact of this type of attack on those who serve and
their families. It sets the stage for discussions and actions that must
be taken if we are to protect those who defend our country from attacks
that can occur from within. And it confirms that we must ensure
services are available for those who have already been harmed.
Understandably, this type of attack and betrayal often leads to the
development of severe mental health difficulties for the men and women
who are victimized. Indeed, today many of the female veterans treated
by the Department of Veterans Affairs and other programs receive a
diagnosis of Military Sexual Trauma (MST), and this type of trauma is
now the leading cause of post-traumatic stress disorder among female
veterans, surpassing combat trauma. In addition, the experience of
military sexual assault increases the likelihood of other serious and
devastating conditions and consequences such as substance abuse,
homelessness, and suicide.
This hearing focuses on a set of very important questions related
to assisting the victims of military sexual trauma who seek care
through the Department of Veterans Affairs (VA). Specifically, this
committee seeks to explore the process and procedures involved in
obtaining VA disability compensation benefits for post-traumatic stress
disorder based on military sexual trauma. And it aims to determine how
to improve the evaluation process for veterans who have been sexually
assaulted so that those in need are quickly identified and treated.
While this issue is getting significant attention today, sexual
assault has been affecting--and often destroying--the lives of those
who serve for decades. As I began to prepare testimony for this
hearing, I had occasion to speak with a colleague who devoted over 20
years of service to the military. He continues to serve as a civilian
in a high level position with the Department of Defense. I happened to
mention to him that I was invited to testify before this committee on
this important topic. After stating that he was about to share
something with me that he had never shared with anyone, not even his
wife, he told me the following story.
He enlisted in the military at the age of 17. It was the late
1970s. Within the first year of his service, he was sexually assaulted
by two men with whom he served, as part of an initiation process. He
was humiliated and devastated. He told no one. He said, ``There was no
one to tell--reporting would have made my life much worse. The stigma
would have further damaged me and my career. I felt overwhelming guilt
and shame.'' This veteran suffered the consequences of the attack,
psychologically and physically, for years. At one point he contemplated
suicide and went so far as to put all his affairs in order and make
arrangements for the care of his two-year-old daughter and young wife.
His marriage eventually fell apart and he and his wife separated.
Fortunately, this veteran found help, repaired his marriage, and has
healed psychologically--though he continues to have significant
physical problems that stem from the attack that shattered his life 30
years ago.
He shared his story now because he wants the members of this
committee to understand that service members who are sexually assaulted
are unlikely to report the assault to their command, to their peers, to
anybody. Data from the Department of Defense substantiate his claim.
Reports indicate that an estimated 86% of service members do not report
an assault when it occurs. There are many reasons for this, one being
that for 25% of military sexual assault survivors, the person they
would report the assault to is the perpetrator.
We in the mental health profession know that it is absolutely
critical for victims of sexual trauma to seek and receive assistance,
support, and treatment as soon as possible. We also know, however, that
many who suffer sexual attacks within the military will not seek care
while they continue to serve. We must, therefore, ensure that all of
those who seek services through the Department of Veterans Affairs for
sexual assault once they leave the service are treated as quickly and
as supportively as possible.
Trained mental health clinicians are quite capable of determining
the veracity of a veteran's claim of sexual assault. The signs and
symptoms are well known, and VA mental health providers have already
been given the appropriate responsibility for making this type of
determination regarding reports of combat stress injuries. It would be
appropriate and consistent, therefore, to allow trained mental health
professionals to determine--as they currently do within the VA for
combat-related trauma--that the claimed stressor of military sexual
trauma is adequate to support a diagnosis of post-traumatic stress
disorder and that the veterans symptoms are related to the claimed
stressor for the purposes of seeking and receiving appropriate care and
services through the VA.
Moreover, given the humiliation survivors of sexual assault contend
with, it is highly unlikely that many women or men will fabricate
stories of military sexual trauma in order to receive VA benefits. In
addition the lives that are saved by adjusting the process by which
victims of sexual assault can qualify for and receive services through
the VA will far out weigh the very few cases that ``beat the system.''
In addition to changing the process for victims of sexual assault
to apply for and receive services through the VA, we should continue to
expand the network of providers available to meet the growing needs of
the military community at large. The VA has made tremendous strides in
recognizing that partnerships with community-based organizations are
critical if we are to provide the mental health services that the men,
women, and families who serve our country need when they come home to
our communities. For example, the Department of Veterans Affairs
recently signed an MOA with my organization, Give an Hour, which
provides free mental health services to military personnel, veterans,
and their loved ones. This MOA will facilitate appropriate referrals to
GAH providers from the VA's Veterans Crisis Line. It is easy to imagine
how community-based efforts such as those provided by Give an Hour and
other organizations can assist the VA in their efforts to provide swift
and effective care to those who have given so much to our country.
Scope and History of the Problem
The issue of military sexual trauma has indeed received increased
attention over the past few years. Looking at the number of reports
filed with DoD in recent years confirms the magnitude of the problem.
In 2010 there were 3,158 total reports of sexual assault in the
military. The Department of Defense estimates that this number
represents only 13.5% of total assaults in 2010. If this estimate is
accurate then the total number of military sexual assaults would have
been upwards of 20,000. Of the 3,158 reports that were made in FY2010,
only 529 ever went to trial.
Of the 3,192 military sexual assaults reported in 2011, service
members were the victims in 2,723 of those assaults. Eighty-four
percent of the incidents reported occurred in FY11, 14% were related to
incidents occurring from FY08 to FY10, and 2% concerned incidents
occurring in FY07 and prior. Of the 3,192 reports filed in 2011, only
791 individuals received some form of disciplinary action, and of that
group 489 individuals had courts martial charges initiated against
them.
On February 15, 2011, fifteen female and two male military veterans
filed a class action lawsuit against former Defense Secretaries Donald
Rumsfeld and Robert Gates. The case was ultimately dismissed but an
appeal is being considered. The film The Invisible War profiles several
of the victims involved in this class action suit.
But this is not the first time that the issue of military sexual
assault has received this type of public attention. Americans became
aware of the issue during the Tailhook scandal in 1991. Tailhook refers
to a series of incidents in which more than 100 U.S. Navy and Marine
Corps aviation officers were alleged to have sexually assaulted or
otherwise engaged in ``improper and indecent'' conduct with at least 87
women at the Las Vegas Hilton.
In July 1992, a series of hearings on women veterans' issues
conducted by the Senate Committee on Veterans Affairs brought the
problem of military sexual assault to policy makers' attention.
Congress responded to these hearings by passing a public law that,
among other things, authorized health care and counseling for women
veterans who were experiencing mental health consequences resulting
from sexual assault or sexual harassment during their military service.
Signed into law in November 1992, this public law was later expanded to
include male veterans. Following the passage of these laws, a series of
Department of Veterans Affairs directives mandated universal screening
of all veterans for a history of military sexual trauma and mandated
that each facility identify a Military Sexual Trauma Coordinator to
oversee the screening and treatment referral process.
Although careers ended and policies changed following the Tailhook
scandal, far too many men and women serving in our armed forces
continue to be sexually assaulted at home and abroad. Most of these
(often young) men and women were unable to protect themselves from an
attack from one of their ``battle buddies.'' But why would they think
that they would ever need to protect themselves from this type of
assault? They joined the military to serve their country. They were
taught that those with whom they serve share their dedication and
commitment, are there to protect them, are closer than family. It is no
surprise that military sexual assault often leads to a shattering of
trust and a sense of despair. Many have likened military sexual assault
to incest in the sense that many victims of military sexual assault are
devastated by the betrayal and brutality they experience at the hands
of one of their own.
Fortunately, additional measures are now under way within the
military to protect those who serve and to prosecute those who prey on
them. Secretary of Defense Panetta has proposed new steps the military
will take to address the problem of sexual assaults. One recommended
policy change is the requirement that a higher authority within the
military review the most serious cases, a step to ensure that cases
remain within the chain of command and leaders are held responsible.
Secretary Panetta also announced the creation of a special victims unit
within each of the services and an explanation of sexual assault
policies to all service members within 14 days of their entry into the
military. In addition, the secretary has proposed intensified
investigations, heightened training, and more resources. These are all
excellent recommendations that may begin to stem the tide of
victimization. We must also increase access to care for those who have
already been affected.
Impact of Military Sexual Assault/Trauma
Military sexual assault has been associated with an increased risk
of depression, post-traumatic stress disorder, and substance abuse.
Women who have been sexually assaulted in the military are more than
four times more likely to have post-traumatic stress disorder than
peers who have not been sexually assaulted. They are also more likely
to suffer from multiple mental health concerns. In FY2011 19.4% of the
OEF/OIF/OND female veterans reported a history of military sexual
assault. In addition, one in five women veterans who present to the VA
for health care screen positive for Military Sexual Trauma. Not
surprisingly, women who enter the military at younger ages and those of
enlisted rank appear to be at an increased risk for MST.
Women and men in the military must face unique challenges
associated with the experience of sexual assault. They must decide if
they are willing to report the incident--and face whatever personal or
professional reprisals that follow. But there are symptoms that all
victims of sexual assault share, whether the attack occurs within the
military or civilian community. Indeed, in addition to the physical and
psychological pain of the attack itself, women and men who are sexually
assaulted often experience years of emotional distress, damaged
relationships, and overall dysfunction.
Post-traumatic stress disorder refers to a collection of symptoms
that occur for a prolonged period of time following a severe trauma. As
we know, many victims of sexual assault develop post-traumatic stress.
These symptoms can be grouped into three main categories:
-- Re-Experiencing: This is a repeated reliving of the event that
interferes with daily functioning. This cluster of symptoms includes
flashbacks, frightening thoughts, recurrent memories or dreams, and
physical reactions to situations that remind a person of the event.
-- Avoidance: These symptoms stem from the desire of a person to
change his or her routine to escape similar situations to the trauma.
Victims might avoid places, events, or objects that remind them of the
experience. Emotions related to avoidance are numbness, guilt, and
depression. Some individuals have a decreased ability to feel certain
emotions like happiness. They might also be unable to remember major
parts of the trauma and feel that their future offers fewer
possibilities than other people have.
-- Hyper-arousal: Hyper-arousal symptoms are primarily
physiological. They include difficulty concentrating or falling asleep;
being easily startled; feeling tense and ``on edge''; and being prone
to angry outbursts.
It is easy to see how the presence of one or more of these symptoms
can dramatically interfere with one's ability to pursue a career,
engage in meaningful relationships, or live one's life.
In addition, victims of sexual assault often turn to alcohol or
other substances in an attempt to relieve their emotional suffering.
Victims of sexual assault report higher levels of psychological
distress and higher levels of alcohol consumption than non-victims. And
when compared to non-victims, sexual assault survivors are 3.4 times
more likely to use marijuana, 6 times more likely to use cocaine, and
10 times more likely to use other major drugs. Many of the women
veterans who are now living among the homeless population in the United
States have what is referred to as a ``dual diagnosis''--a consequence
of the sexual trauma they endured. They have a mental health condition
such as post-traumatic stress disorder, depression, or severe anxiety
and they have a substance abuse problem, making it even more difficult
for them to receive or benefit from treatment for the assault that
injured them.
Furthermore, it is common for victims of sexual assault to engage
in behaviors that result in physical and/or psychological harm to
themselves. Deliberate ``self-harm'' or ``self-injury'' refers to
incidents when a person inflicts physical harm on him or herself,
usually in secret. Some victims of sexual assault may use self-harm to
cope with the difficult or painful feelings associated with their
experience of sexual trauma. Self-harm can cause permanent damage to
the body, as well as additional psychological problems that hinder the
healing process, such as guilt, depression, low self-esteem or self-
hatred, along with a tendency toward isolation. Some common methods of
self-harm include cutting, burning, pulling out hair, scratching, and
eating disorders.
For sexual assault victims specifically, self-injury may
-- provide a way to express difficult or hidden feelings
-- provide a way of communicating to others that support is needed
-- provide a distraction from emotional pain
-- provide self-punishment for what they believe they deserve
-- provide a feeling of control--it is not uncommon to feel that
self-harm is the only way to have a sense of control over life,
feelings, and body, especially if other things in life seem out of
control
Finally, one of the most concerning consequences of sexual assault
is associated with the depression that so many experience following an
attack. Depression that goes untreated can continue for years following
the attack. And untreated depression results in an increased risk of
suicide. Indeed, of the group of men and women who have experienced
sexual assault many experience suicidal thoughts, and many attempt or
complete suicide.
Access to Care
We know that early intervention following the experience of trauma
promotes healing and decreases the likelihood that the trauma will
result in chronic and disabling mental health conditions. And we know
that it is extremely difficult for victims to overcome the common
feelings of fear, guilt, and shame they feel following an assault. As a
result, many are reluctant to come forward to report an assault or seek
treatment. And we know that if veterans are further victimized by the
reporting and investigative process itself, they are likely to suffer
additional psychological damage that worsens their condition. We must,
therefore, assure that those who seek care for military sexual assault
are treated with respect and given the attention and treatment they
need and deserve.
We have the systems and programs in place--through the Department
of Veterans Affairs, through state and local governmental agencies, and
through community-based programs like Give an Hour--to provide the
education, support, and treatment that service members who have been
sexually assaulted and their families need and deserve. We have
treatment strategies that can relieve suffering and heal relationships.
We have trained clinicians working within the VA and in surrounding
communities who have the requisite skills to accurately assess those
who present with symptoms related to sexual trauma. We must allow our
trained clinicians to make these determinations so that the veterans
who have suffered these acts of betrayal and violation are able to
reclaim and rebuild their lives.
Executive Summary
Over the past several months we have seen an increase in the
attention given to a very serious issue affecting our military
community: military sexual assault. The brutal reality is that in 2011
alone, 3,192 men and women reported that they were sexually assaulted
while serving. Meanwhile, reports indicate that an estimated 86% of
service members do not report an assault when it occurs. There are many
reasons for this, one being that for 25% of military sexual assault
survivors, the person they would report the assault to is the
perpetrator.
Understandably, this type of attack and betrayal often leads to the
development of severe mental health difficulties for the men and women
who are victimized. Indeed, today many of the female veterans treated
by the Department of Veterans Affairs and other programs receive a
diagnosis of Military Sexual Trauma (MST), and this type of trauma is
now the leading cause of post-traumatic stress disorder among female
veterans, surpassing combat trauma. In addition, the experience of
military sexual assault increases the likelihood of other serious and
devastating conditions and consequences such as substance abuse,
homelessness, and suicide.
We in the mental health profession know that it is absolutely
critical for victims of sexual trauma to seek and receive assistance,
support, and treatment as soon as possible. We also know, however, that
it is likely that many who suffer sexual attacks within the military
will not seek care while they continue to serve. We must, therefore,
ensure that all of those who seek services through the Department of
Veterans Affairs for sexual assault once they leave the service are
treated as quickly and as supportively as possible by allowing trained
mental health clinicians to determine the veracity of a veteran's claim
of sexual assault. The signs and symptoms are well known, and VA mental
health providers have already been given the appropriate responsibility
for making this type of determination regarding reports of combat
stress injuries.
In addition to changing the process for victims of sexual assault
to apply for and receive services through the VA, we should continue to
expand the network of providers available to meet the growing needs of
the military community at large. The VA has made tremendous strides in
recognizing that partnerships with community-based organizations are
critical if we are to provide the mental health services that the men,
women, and families who serve our country need when they come home to
our communities.
Prepared Statement of Margaret M. Middleton
Chairman Runyan, Ranking Member McNerney and Members of the
Subcommittee, thank you very much for the opportunity to appear before
you today and offer my testimony on the highly important issue of
military sexual trauma and the VA's disability compensation benefits
process. My name is Margaret Middleton. I am the Executive Director and
co-founder of the Connecticut Veterans Legal Center. Our mission is to
help veterans recovering from homelessness and mental illness overcome
barriers to housing, healthcare, and income. I am also a visiting
clinical lecturer co-teaching the Veterans Legal Services Clinic at
Yale Law School. In both of these capacities I work with veterans
seeking VA compensation for PTSD caused by sexual assault in the
military.
There are several experts at this hearing who have eloquently
testified as to the appalling extent of sexual assault in the military
and the scope of the VA's failure to assist those victims. Rather than
repeat those statistics I'd like to share some personal experiences I
have had in representing veterans to illuminate how the evidentiary
standard set forth in Title 38 of the Code of Federal Regulations
section 3.304 prevents worthy claimants from receiving compensation
they deserve.
As written, 38 CFR 3.304(f) requires that a veteran seeking
disability compensation for PTSD caused by MST must provide VA with
``credible supporting evidence that the claimed in-service stressor
occurred.'' Part Five of this section includes a long list of potential
evidence including police records and medical reports that could be
used to corroborate the personal assault. On paper, this requirement
seems reasonable. Don't we all like to believe we would seek justice or
medical treatment if we were attacked? Working with victims of MST
taught me how misinformed that view is. What I have learned from these
men and women is that the response to assault in the military is very
particular to the military culture and military justice system and
should not be thought of as analogous to sexual assault in civilian
society. Current Department of Defense practices disincentivize victims
from coming forward and seeking justice. Reporting an offender could
jeopardize a servicemember's career, destroy his working relationships,
or subject her to further harassment or even official punishment. The
current regulation demonstrates a fundamental misunderstanding of the
nature of sexual assault in the military and it is past time to correct
it.
I would like to share with you two examples of veterans I have
assisted in applying for VA compensation for PTSD caused by rape in the
military and the difficulty of using 38 CFR 3.304(f)(5) in these real
world cases. In my teaching capacity, I co-supervised a team of
students who helped a female veteran establish service connection for
PTSD stemming from a rape at Camp Lejeune in the early 1970's. This
veteran had been out drinking at an NCO club. She was 18. The
acquaintance walking her home pushed her through a window and raped her
in a barren room. This veteran felt tremendous shame and personal
responsibility for having been out at night, for having been drinking,
and for having trusted the wrong person. She feared that her romantic
partner would leave her if she told him she had been raped. What's
worse, her assailant bragged about his conquest and her warrant officer
told her that ``she was the reason why women should not be allowed in
the military.'' She was plagued by PTSD for decades following this
assault and was diagnosed and is treated for it by a VA doctor.
Section 3.304 places a heavy burden on a traumatized veteran like
this client. The culture and atmosphere of the military discouraged her
from reporting this rape, but winning a PTSD claim like hers requires
the kind of documentation that can only come from speaking about the
event. As time passes producing this type of documentation becomes
increasingly difficult. For veterans like our client, whose rape
occurred in the 1970s, this is a monumental obstacle to overcome.
As her advocates, assisting this veteran was incredibly involved.
Her parents had died, her marriage failed, there were no surviving
letters of hers from that time, and no journals or court records. She
had lost contact with anyone she had served with thirty years earlier.
She had been too ashamed and afraid to seek medical help. Mental health
treatment was even less common and more stigmatized then than it is
now. She didn't seek a transfer and she wasn't demoted - she just did
her job and suffered silently. What documentary evidence is she
supposed to provide to corroborate her experience? In a civil case, a
judge or jury would be able to weigh the credibility of her testimony
and the testimony of a doctor treating her; why does the VA demand
more?
Under the current standard, it took hours of work by two incredibly
talented Yale law students and an unusually cooperative VA psychiatrist
to build her case based on the meager contemporaneous evidence of
weight loss and missed duty assignments available in her service
records. Most veterans do not have the benefit of a team of law
students tirelessly scrutinizing their records, or a VA psychiatrist
willing to draft and redraft letters with law students to include the
type of language the VA requires. Another option might have been an
independent forensic psychiatric evaluation that would have cost
several thousand dollars my client did not have and for which the VA
would not pay.
The lack of documentary evidence is the rule, not the exception. I
recently met with a female veteran being treated at the VA for PTSD
caused by MST. While in boot camp, two sergeants had sent everyone out
and kept her behind; they raped her in the barracks. Decades later I
was the first person she ever told. She didn't tell anyone at the time
because it would have meant the end of a career. This veteran, who
served in Iraq, achieved the rank of Master Sergeant and retired after
28 years in the military fought back tears as she related this
experience. This was only one of the episodes of MST she described.
This veteran's claim also faces an almost impossible evidentiary
burden because of 38 CFR 3.304(f)(5). She did not tell anyone what had
happened so there are no medical records, no letters home, and no
action taken against her assailants. In order to succeed in the Army
this veteran felt forced to stay silent and now she will be punished
for her silence because the VA will refuse to credit her story based on
her testimony alone. As her advocate, it will take me and my team hours
of phone calls to family members and old friends, combing through
service personnel records, and begging doctors to provide free
psychiatric evaluations to prove her claim. This is surely not what the
VA anticipated when it adopted 38 CFR 3.304(f)(5), but it is the
reality of how it is working in practice.
We create the conditions that compel traumatized people like these
two women to remain silent, and then we punish them for that silence by
refusing to accept their story when they come forward to tell it. We
know that this is grossly unfair, and we know how to fix it. The VA can
and should remedy this situation by amending 38 CFR 3.304(f)(5) to
provide victims of military sexual trauma the same benefit of the doubt
that combat veterans are afforded under 38 CFR 3.304(f)(2). There is no
excuse for permitting the current regulation to stand. I hope this
subcommittee exercises its responsibility to America's veterans to
correct this injustice. Holding this hearing is an important step
towards change and I thank you again for the opportunity to testify.
Prepared Statement of Ruth Moore
Good Afternoon Ladies and Gentlemen of the House. My name is Ruth
Moore and it is an honor to be among you today. As you know, I am a
Military Sexual Trauma survivor who lives with PTSD and Depression. I
am here today to share my 23-year struggle to get help from the
Veterans Health Administration and disability compensation from the
Veterans Benefits Administration.
In 1987, I was a bright, vivacious 18-year-old, serving in the
United States Navy. After my training school, my first assignment was
to an overseas duty station in Europe. 2\1/2\ months after I arrived, I
was raped by my supervisor outside of the local club. Not once, but
twice. I sought help from the Chaplain, but did not receive any. I
tried to move beyond this nightmare, but had contracted a STD. At this
point, my life spiraled downward and I attempted suicide. Shortly
thereafter, I was medivac'd to Bethesda Naval Hospital, and ultimately
discharged from the Navy. No prosecution was ever made against the
perpetrator. In hindsight, it was easier for the military to get rid of
me, than admit to a rape.
My problems began at the point of separation, as the psychiatrist
diagnosed me with a Borderline Personality Disorder. I did not have a
personality disorder; this was the standard diagnosis that was given to
all victims of MST at that time, to separate them from active duty and
protect the military from any and all liability. This travesty
continued when I was counseled by ``Outprocessing'' to waive all claims
to the VA, as I ``would get healthcare'' through my former spouse who
was on active duty.
From 1987 to 1993, I struggled with interpersonal relationships,
could not trust male supervisors, and could not maintain employment. I
filed my first VA claim in Jacksonville which was denied, despite
having several markers for PTSD and gynecological problems. My life
continued to spiral downward, and I was not able to maintain my
marriage. In 1997, I fled from my house and lived out of my van for two
weeks before I was able to start rebuilding my life with my present
spouse. Things were very difficult, and I developed additional markers
of PTSD including night terrors, panic attacks, severe migraine
headaches, and insomnia.
In 2003, I refiled for disability and was denied again; however, I
enlisted the aid of the Disabled American Veterans. With their help, I
was awarded 30% compensation for depression. I was denied PTSD and was
told that I did not submit enough evidence to prove that I was raped,
despite having submitted a letter from my former spouse who remembered
the rape and when I was treated for Chlamydia. Given this eyewitness
testimony, the VA still denied this as credible proof. There was no
record of my medical treatment for STD from that duty station as my
medical records had been partially expunged. Additionally, I was coded
by the Togus VA as having a Traumatic Brain Injury or Brain Syndrome.
In 2009, I entered into my first comprehensive treatment at the VA
hospital in White River Junction, Vermont. I met a MST Coordinator who
truly listened to me. She began a systemic review of all my records,
and determined that they had been expunged by noting the glaring
inconsistencies between my lab work, treatment notes, and service
record. My psychiatrist and counselor determined that I did not have
Borderline Personality Disorder, and the later diagnosis of Traumatic
Brain Syndrome was inaccurate. My MST coordinator and I refiled for an
increase in disability, and my clinicians wrote supportive records for
the VBA to make an accurate determination. They readjudicated my claim
to 70% but denied my status as individually unemployable, citing that I
did not complete the necessary paperwork.
At this point, I was very frustrated and suicidal with the stresses
of the VBA system and claims process. In my final effort, I called the
Honorable Bernie Sanders and his staff agreed to investigate why the VA
was taking so long and denying part of my claim. I took Mr. Sanders
copies of all the paperwork I had filed, including the VBA time and
date stamped ``missing information'' to prove that they had originally
received it. Within two weeks, my claim was finally adjudicated to 70%
with IU and it was a total and permanent decision. My rating should
have been 100% by the VBA criteria, but I was so grateful for a
favorable determination that I have not pursued it further.
Ladies and Gentleman, this process took me 23 years to resolve, and
I am one of the fortunate ones. It should not be this way. If I had
been treated promptly and received benefits in a timely manner, back at
the time of my discharge, my life would have been much different. I do
not believe that I would have been totally and permanently disabled in
my 40's. I would not have had to endure homelessness and increased
symptomology to the point where I was suicidal, I would not have
miscarried 9 children, and I firmly believe that I would have been able
to develop better coping and social skills. Instead, my quality of life
has been degraded to the point where I am considering the possibility
of getting a service animal to relieve the stress that my husband
endures, as my unpaid caretaker.
I am asking you, no - pleading with you, to please consider
favorably the legislation that would prevent this from happening to
others. Congresswoman Pingree's legislation is one way to change the
burden of proof that is required to enable MST survivors to receive
proper adjudication for MST and PTSD.
Please, do what is right. Support this legislation, as it is
urgently needed. Thank you for your time and audience today.
Prepared Statement of Colonel Alan R. Metzler
Chairman Runyan, Ranking Member McNerney, and members of the
subcommittee, thank you for inviting me today to provide you with an
update on the progress the Department of Defense has made in caring for
victims of sexual assault. I am here as the Deputy Director of the
Sexual Assault Prevention and Response Office (SAPRO).
When we last briefed you in 2010, we told you of our efforts to
standardize professionalize and institutionalize our Sexual Assault
Prevention and Response - or SAPR - program. Since that time, we have
pushed forward to expand and improve our support of victims of sexual
assault and hold offenders appropriately accountable. Secretary Panetta
has put great emphasis on dealing with the problem of sexual assault in
the military. He has emphasized that sexual assault is an affront to
the basic American values we defend, and it is a stain on the good
honor of the great majority of our troops and families.
Before beginning my testimony today, we think is important to start
with a baseline of understanding on several important issues:
Congress has authorized the Department of Veterans
Affairs (VA) to provide counseling and appropriate care and services to
overcome the psychological trauma that results from a physical assault
of a sexual nature, battery of a sexual nature, or sexual harassment
which occurred while a veteran served on active duty or active duty for
training.
In the Department of Defense (DoD), the office that I
represent is tasked with policy and oversight relating to the
prevention and response of sexual assault only. Sexual harassment is
addressed by the Equal Opportunity Program. Reported incidents of
sexual harassment are not included in our statistics.
Finally, we would like to remind everyone that our DoD-
wide sexual assault policy has been in place since 2005. All reports of
sexual assault are of concern to us and we have focused on incidents
post-2005, so that we can modify our current policy.
Since our Sexual Assault Prevention and Response policy was
instituted in 2005, we have remained committed to our vision: A culture
free from sexual assault. One sexual assault is too many. Given the
recent changes to the program, we are optimistic that we have set the
right initiatives in motion to achieve that vision. The horror of
sexual assault demands an immediate response to those persons and
behaviors that violate our shared military values of trust, honor and
integrity. However, the solution requires more than just an immediate
response to the crime. The solution comes from working this problem at
every level of military - and civilian - society. From policies that
improve the capabilities of institutions, down to the prevention skills
and knowledge that empower our individual Service members, these
initiatives must be supported and then be allowed to work. I can tell
you that the Department will not ignore, tolerate or condone sexual
assault. This is our problem. We own it. We must fix it.
Overcoming Barriers to Reporting and Care-Seeking
In 2010, we told you that a chief challenge facing DoD and VA is
the fact that sexual assault is one of the most underreported crimes in
both civilian and military society. As you know, sexual assault has
severe effects on civilian and military victims - but there are other
factors that complicate a victim's experience in the military and act
as barriers to reporting:
First, sexual assault often occurs where a victim works
and lives. Until recently, a victim was unable to escape painful
reminders that keep him or her from moving on from the incident.
Victims are also concerned that making a report will cause them to lose
their privacy, subject them to unwanted scrutiny, and potentially mark
them as weak. They worry that their career advancement will be
disrupted.
Second, when the perpetrator resides in the same unit as
the victim, sexual assault sets up a potentially destructive dynamic
that can rip units apart. The bond of trust is broken, and when the
perpetrator is in a position of authority, victims feel isolated,
exploited, and powerless.
Third, research has found that a history of any kind of
assault doubles the risk of posttraumatic stress symptoms when the
victim is exposed to combat. \1\ We also know that military sexual
assault victims are also at greater risk for depression, anxiety
disorders, and substance abuse. \2\ These psychological problems -
these ``invisible wounds'' - have insidious effects that disrupt lives,
families, and military units. Long-term physical effects can include
disabilities that impact a person's ability to work, gastrointestinal
health, and pain disorders. \3\
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\1\ Smith, et al., (2008). Prior Assault and Posttraumatic Stress
Disorder After Combat Deployment, Epidemiology, 19, 505-512.
\2\ Kimerling, et al., (2007) American Journal of Public Health,
vol. 97, issue 12.
\3\ Consequences of Sexual Violence, retrieved from http://
www.cdc.gov/ViolencePrevention/sexualviolence/consequences.html.
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Research shows that making a report is the primary means whereby
victims access medical care and other support. \4\ In 2005, the
Department launched a policy to encourage victims to report the crime.
The Department offers two reporting options: Restricted and
Unrestricted Reporting. The addition of Restricted Reporting as an
option was critical first step in our program. Restricted Reporting
allows victims to confidentially access medical care and advocacy
services to heal their wounds and maintain their privacy by not having
to report their victimization to their commander or law enforcement.
Restricted Reporting is having the desired effect. By the end of FY11,
the Department had received 5,245 Restricted Reports since the option
was made available in 2005. We believe that number represents 5,245
victims who would have not otherwise come forward to access care had it
not been for the Restricted Reporting option. In addition, 15 percent
of those victims who made a Restricted Report converted to an
Unrestricted Report, allowing us the potential to hold those offenders
appropriately accountable.
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\4\ Department of Justice. (2002). Rape and Sexual Assault:
Reporting to Police and Medical Attention, 1992-2000. Washington, DC:
Rennison, Callie Marie.
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New Enhancements and Expansion of the DoD Sexual Assault Prevention and
Response Program
In recent months we have expanded or implemented several new
initiatives that will further support our victims and encourage
prevention.
Military Rule of Evidence 514
Recently the Uniform Code of Military Justice was amended to
further institutionalize victim privacy. In December 2011, the
President signed an Executive Order that added Military Rule of
Evidence (MRE) 514 into military law. \5\ MRE 514 is a privilege that
took effect on January 12 of this year to protect the communications
between a victim and a victim advocate when a case is handled by a
military court. This rule allows victims to trust that what is shared
with these helping professionals will remain protected. The privilege
fills an important gap that once allowed DoD victim advocates and
sexual assault response coordinators to be compelled to testify about
their communications with victims. We believe MRE 514 is an invaluable
contribution to the climate of confidence we are building.
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\5\ Executive Order 13593, effective on January 12, 2012.
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DoD Safe Helpline
The Department is also reaching out to victims with a new
initiative that was launched last year. In April 2011, the Department
launched DoD Safe Helpline as a crisis support service for adult
Service members of the DoD community who are victims of sexual assault.
Available 24/7 worldwide, users can ``click, call or text'' for
anonymous and confidential support. The Safe Helpline is owned by the
Department and operated by the non-profit Rape, Abuse and Incest
National Network (RAINN), the nation's largest anti-sexual violence
organization, through a contractual agreement with DoD SAPRO. Safe
Helpline has a robust database with a wide-range of military and
civilian services available for referral. The database also contains
SARC contact information for each Military Service, the National Guard,
and the Coast Guard as well as referral information for legal
resources, chaplain support, healthcare services, the Departments of
Labor and VA, including VA's Veterans Crisis Line, Military OneSource,
and 1,100 civilian rape crisis affiliates. In its first year of
operation, from April 2011 to April 2012, the Safe Helpline had more
than 36,000 unique visitors to its website. Additionally, the DoD Safe
Helpline assisted more than 2,700 individuals through its online and
telephone hotline sessions and texting referral services. Please note
that website visitors and the people helped are not filing reports of
sexual assault. Rather, they are confidentially accessing information
and finding out about services available to them.
While we designed this service as a crisis hotline, we are finding
that many of our service users are talking to us not only about events
that just occurred, but also about incidents that occurred several
months or even years ago. Given this opportunity for additional
assistance, Safe Helpline has expanded its services through the launch
of a mobile site and an app that can be downloaded for the iPhone,
iPad, and devices with Android operating systems. The mobile site
offers all the functionality of the standard website, but packages the
content into a format that is easily displayed on a smart phone. The
Safe Helpline app gives members of the DoD community affected by sexual
assault access to resources and tools to help manage the short-and
long-term effects of sexual assault. The app helps users create a plan
that is right for them, from exercises that aid in reducing stress to
tools to help them transition to civilian life. They can even customize
plans and exercises so they can refer back to them at any time. The app
is available in the Apple App Store or the Android Market.
DoD Safe Helpline Services for Transitioning Service Members
In order to help our transitioning Service members, we are working
to provide a continuum of care with VA for our Service members who have
experienced sexual assault. We launched the Safe Helpline Transitioning
Service Members (TSM) enhancements on 1 June 2012.
TSMs seeking assistance following a sexual assault may be either
unaware of or overwhelmed by the options and resources available to
them upon leaving the military. TSMs seeking benefits related to an
assault often are dealing with much more than paperwork. They may face
concerns over confidentiality, privacy, and stigma. Safe Helpline
offers an anonymous, confidential service that provides a safe space to
discuss what options are best suited to their needs.
SAPRO collaborated with VA and Department of Labor to streamline
pertinent information for military sexual assault victims via the SHL.
Through leveraging Safe Helpline's existing infrastructure, the
Department is able to present clear and easily accessible information
on counseling, benefits determinations, transitions, and employment,
which may enable them to reach out for long-term support upon leaving
the military. By bridging the gap from DoD to VA for sexual assault
victims, we provide a continuum of care from active duty to veteran.
TSM resources are easily accessible through the Safe Helpline via
telephone, text, safehelpline.org, and through the Safe Helpline app.
DoD-wide Victim Assistance Standards
As we improve our assistance to victims of sexual assault, we are
sharing these important lessons with other programs within the
Department. Last year, DoD SAPRO worked with the Military Services and
other DoD offices to improve the effectiveness and standardization of
response to victims of all crimes. The DoD Working Group on Victim
Assistance, led by DoD SAPRO, and comprised of victim assistance-
related offices at the Office of the Secretary of Defense (OSD) level
and Military Service representatives, was established in January 2011,
to explore opportunities for achieving efficiencies, improvements, and
standardization in victim assistance.
The DoD Working Group determined that standards for victim
assistance were needed across the Department. The DoD Working Group
drafted standards that establish a foundational level of assistance for
victims of crime and harassment across the military community,
regardless of DoD program or physical location. These standards are
intended to be consistent with those established by national victim
assistance organizations and also incorporate the unique needs of the
military community. In addition, the DoD Working Group drafted a
charter for a senior-level Victim Assistance Leadership Council to
promote efficiencies, coordinate victim assistance-related policies,
and assess the implementation of victim assistance standards across the
Department's victim assistance-related programs. We are now working to
codify these victim assistance standards into Department policy.
It is also important that victims get the best medical care
possible. Sexual assault victims receiving assistance from DoD have
always had an option to receive a general medical examination or a
Sexual Assault Forensic Examination, or ``SAFE,'' that recovers
evidence of sexual assault for later use in legal proceedings. However,
recent improvements in laboratory capabilities and examination
procedures required we update the Department's SAFE kit. For this
reason, the Department called together civilian and military experts to
improve the Sexual Assault Forensic Examination kit, the kit's
instructions, and the DD Form 2911 - the SAFE Report. These updates
were deployed to the field last year and better align the Department's
procedures with national standards recommended by the Department of
Justice.
SARC and Victims Advocates Certification Program
Encouraging victim reporting is just one way that the Department is
building a climate of confidence - a climate where victims know they
will be supported and treated fairly with dignity and respect. When we
created our policy in 2005, we established the framework for a
coordinated, multidisciplinary response system modeled after the best
practices in the civilian community. At the heart of our sexual
response system are the Sexual Assault Response Coordinator (SARC) and
Victim Advocates. Service members worldwide have access to a 24 /7
response. Because the SARC and Victim Advocate play such an important
role in the SAPR program, we have recently moved to professionalize
these positions by designing a certification process. Once finalized,
the proposed certification program will consist of credentialing that
meets national standards, a competencies framework, and training
oversight that will help us standardize the assistance provided to
sexual assault victims. This certification process will also
professionalize roles within the SAPR program and ensure all victims
receive assistance from a certified SARC or SAPR Victim Advocate.
Expanded Document Retention
SARCs and Victim Advocates work with victims to help them decide
whether to make a Restricted or Unrestricted Report. To ensure that
victims make an educated decision in which they are fully informed of
their choices, we developed the Victim Reporting Preference Statement
(the DD Form 2910) to explain their reporting options. The completed DD
Form 2910 is an important record by which the Department documents the
victim's report of sexual assault and which of the reporting options he
or she selected. In each case, the SARC or Victim Advocate emphasizes
that the victim should keep a copy of the DD 2910 in their personal
files. This recommendation, to keep the completed DD 2910, is also
noted on the bottom of the form.
However, we know that not every individual can keep track of this
important document over the course of a military career. We want to
ensure victims of sexual assault have access to this and other
documents that may be helpful to them. For example, such documents may
be needed to establish a Service-connected disability should they
suffer lasting effects from the crime. Consequently, the Department
issued a Directive Type Memorandum in December 2011 that mandates
increased retention time for this and other sexual assault records. For
records that pertain to Unrestricted Reports, including investigative
documentation, the SAFE report, and the victim's Reporting Preference
Statement, documents will be kept for 50 years.
For Restricted Reports, we also expanded retention times. We
expanded retention time for the SAFE kit and associated documentation
from one year to five years. As I noted before, a victim making a
Restricted Report of sexual assault may convert to an Unrestricted
Report at any time. However, at the one-year point following a
Restricted Report, the SARC will contact the victim and inform him or
her that the SAFE kit and documentation will be available for an
additional four years should he or she wish to convert the report.
SARCs will also keep a hard copy of the DD Form 2910 - the Reporting
Preference Statement - in Restricted Reports for five years.
Expedited Transfer Option
Victims of sexual assault are also informed by the SARC that they
now have the option to request a permanent or temporary transfer from
their assigned command or base, or to a different location within their
assigned command or base. Victims making an Unrestricted Report may
make such a request to their commanding officer and must receive an
answer within 72 hours. If the victim's commanding officer denies the
request for transfer, the victim may appeal this decision to the first
general or flag officer in their chain of command, who again has 72
hours to provide a response. Procedures for this new expedited transfer
option were issued to the Services in a Directive Type Memorandum in
December 2011. The Services were also directed in this memorandum to
make every reasonable effort to minimize disruption to the normal
career progression of a Service member who reports that he or she is a
victim of sexual assault, and to protect victims from reprisal or
threat of reprisal for filing a report.
Defense Sexual Assault Incident Database
The Department believes that comprehensive data collection and
analysis is vital to policy analysis and program implementation. The
Defense Sexual Assault Incident Database (DSAID) received its operating
authority in March 2012. The Air Force and National Guard Bureau
received training earlier this year and are now actively entering cases
into the system. The Marine Corps began using the system on July 1. The
Navy SARCs are currently being trained on DSAID and will begin using
the system August 1, 2012. We are currently working to interface with
the Army's existing data systems and expect DSAID to be fully
implemented by the end of August - which is on the schedule that we
have been reporting to Congress since January 2010. DSAID has two
primary functions: standardization of reporting of sexual assault and
managing victim care. Once we have full implementation, we expect that
our ability to analyze sexual assault data will be greatly enhanced. In
addition, the Victim Reporting Preference Statement (the DD Form 2910)
for Unrestricted Reports will be uploaded to DSAID, so they can be
maintained for 50 years.
Pre-command Training for Officers and Senior Enlisted Leaders
Changing our culture to achieve our goals involves prevention as
well as accountability. One of the methods we are employing is
oversight assessments. In January, the Secretary of Defense directed
that we conduct a review of pre-command and senior enlisted leader
Sexual Assault Prevention and Response (SAPR) training to identify
strengths and areas for improvement. DoD SAPRO visited pre-command and
senior enlisted leader training conducted by the Marine Corps, Navy,
and Air Force and reviewed Army's newly developed Sexual Harassment /
Assault Response and Prevention (SHARP) Program training support
package for senior enlisted leaders that will be deployed in Summer
2012. DoD SAPRO training experts, subject matter experts, and Service
representatives evaluated both the method of delivery of SAPR training,
as well as the content of the training, to identify strengths and areas
for improvement. SAPRO identified a number of practices the Military
Services should continue in their SAPR training for commanders. SAPRO
has developed a number of recommendations that are designed to build on
the successful practices the Military Services have already put into
place, will drive improvements in SAPR training for commanders, and
will support the strategic goals of the Department's SAPR program.
These recommendations are currently before the Secretary of Defense for
his consideration.
Sexual Assault Offense Withhold Policy
To advance accountability, one of the most recent changes in
Department policy was directed by the Secretary of Defense in April of
this year. Effective on June 28, 2012, the initial disposition of cases
of rape, sexual assault, forcible sodomy, and attempts to commit these
crimes will be withheld from any officer who is below the O-6 level and
who does not hold special court-martial convening authority. This
means, commanders at the company or squadron level no longer have
authority to decide the initial disposition of cases of rape, sexual
assault, forcible sodomy, or associated attempts. In the past, victims
have stated that they do not want to report because they believed the
offender was more popular or more important to their commander than
they were. The presumption was that unit commanders may be less likely
to believe the victim and more likely to believe the offender. Now,
disposition decisions for these very serious reports of sexual assault
will be decided by someone above the level of the unit commander, a
commander with greater experience, and senior officers more neutral in
perception and in fact will make a reasoned decision.
In April, Secretary Panetta also directed a number of other new
policies that we are now working to implement or standardize across the
Services:
Establishing ``Special Victims Unit'' capabilities within
each of the Services, to ensure that specially trained investigators,
prosecutors, sexual assault nurse examiners, SARCS, and victim-witness
assistance personnel are available to assist with sexual assault cases;
Requiring sexual assault policies be explained to all
Service members within 14 days of their entrance on active duty;
Allowing reserve and National Guard members who have been
sexually assaulted while on active duty to remain in their active-duty
status to obtain the treatment and support afforded to active-duty
members;
Requiring annual organizational climate assessments; and
Mandating wider public dissemination of DoD resources,
including information about the DoD Safe Helpline.
Challenges in Caring for Military Victims of Sexual Assault
We need your assistance in removing at least one barrier to victim
care; that is state mandatory reporting laws.
Prior to the implementation of Restricted Reporting, victims could
not access medical care or advocacy services without the involvement of
law enforcement and command. Restricted Reporting is critical to
reducing the barriers that prevent victims from accessing care in the
military. Despite all of its benefits, Service members in a number of
states, including California, do not have the option of Restricted
Reporting if they wish to access medical care for a sexual assault.
Victims cannot access private medical care and treatment either on or
off base. Section 11160 of California's Penal Code requires healthcare
practitioners to make a report to law enforcement when a victim
presents to them with an injury suspected to be from a criminal act.
That report must include the victim's name, whereabouts and a
description of the person's injury. There is no discretion allowed by
the law on the part of a healthcare provider. Once the healthcare
provider notifies civilian law enforcement, we cannot guarantee they
will not notify military law enforcement. Once military law enforcement
is aware of a sexual assault, it must investigate and command must be
notified.
If our active duty members could make Restricted Reports in
federally funded facilities, such as a VA Medical Center - no matter
where it is located--we believe this would allow us a wider variety of
options to offer victims for care. We do not know how many more reports
we would have received had the Restricted Reporting option been more
available in California. Despite our efforts, no action has been taken
to remove this important barrier to reporting. This is a legislative
challenge we need help in resolving.
Conclusion
The Department of Defense has made significant progress since 2005
in assisting victims of sexual assault. However, much work remains. Our
policy has changed substantially in the last two years since we last
appeared before this committee and we are pleased that we have the
personal attention of the Secretary of Defense, who has played an
invaluable role in helping us push the Sexual Assault Prevention and
Response program forward.
Thank you for your time and for the opportunity to testify today. I
would be happy to answer your questions.
Prepared Statement of Thomas J. 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.
PTSD Regulations
Under VA regulations at 38 C.F.R. Sec. 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;
Combat;
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;
Hospitals;
Physicians;
Pregnancy tests;
Tests for sexually transmitted diseases; and
Statements from:
I Family members;
I Roommates;
I Fellow Servicemembers;
I Clergy members; and
I 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.
Conclusion
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.
Question For The Record
Response From: DoD - To: Hon. Robert L. Turner
Question: What is the status of implementation of this new policy
(HR1540 Sec 586)?
Answer: The Department of Defense issued Directive-Type Memorandum
(DTM) 11-062 to direct the retention of DD Forms 2910 (Victim Reporting
Preference Form) and 2911 (Report of Sexual Assault Forensic Exam) for
five (5) years in Restricted cases and fifty (50) years in Unrestricted
cases. These provisions will be incorporated into Department of Defense
Sexual Assault Prevention and Response Program Procedures (Department
of Defense Instruction (DoDI) 6495.02) when it is reissued. The
document retention provisions relating to archived investigative
records will be incorporated into the new Inspector General
``Investigation of Sexual Assault in the Department of Defense''
(Department of Defense Instruction (DoDI) 5505.mm) when issued.
Materials Submitted For The Record
Service Women's Action Network (SWAN)
July 12, 2011
The Honorable Eric K. Shinseki
Secretary, U.S. Department of Veterans Affairs
810 Vermont Avenue, NW
Washington, DC 20420
Dear Secretary Shinseki:
My name is Anu Bhagwati. I am a former Marine Corps Captain and now
serve as Executive Director of Service Women's Action Network (SWAN), a
national advocacy organization founded by women veterans. It is our
goal to transform military culture so that all uniformed personnel have
equal opportunity and the freedom to serve in uniform without threat of
harassment, discrimination, intimidation, or assault, and to transform
the VA so that all veterans, including women, receive the health care
and benefits they deserve. Our National Peer Support Helpline receives
hundreds of calls each year from veterans and servicemembers. The vast
majority of our clients were sexually assaulted or harassed in service,
and many report having negative encounters with the VA. Their
experiences directly inform our policy work.
I am writing to request a meeting with you and your staff to
discuss the need for specific VA reforms with respect to both health
care and benefits for Military Sexual Trauma (MST) survivors. We have
testified before Congress on the issue of MST reform five times in the
last three years. I have no doubt that if you fully understood the
obstacles survivors of sexual trauma face both in VHA and VBA, you
would implement immediate common sense reforms to help our veterans get
the services and benefits they so desperately need.
I am writing to you today not only as the Executive Director of
SWAN, but also as a veteran who is intimately familiar with VA's
services for MST patients, and for women veterans generally. Since
leaving the Marine Corps in 2004, my experiences with VA have been
enormously painful and dangerously re-traumatizing due to the poor
quality of care I have received on numerous occasions and the
inordinate amount of effort it has required to survive and navigate the
VHA and VBA bureaucracy.
VBA denied my initial claim for depression and Post-Traumatic
Stress Disorder (PTSD) based on sexual harassment despite overwhelming
in-service evidence, statements from witnesses, my own detailed
testimony, and several diagnoses from both non-VA and VA mental health
providers, including a MST counselor whom I have been seeing for four
years. VBA's rejection was devastating. It is only through the support
of close family and friends that I continued to fight through my own
betrayal, disappointment, and trauma to get what I earned for my
service.
Just last month (four years, six lawyers, two Representatives and
one Senator later), VBA finally approved my claim.
Had I not finally enlisted the intervention of government
officials, I have no doubt my claim would have languished in VBA's
bureaucratic labyrinth for several more years. Despite years of trauma
reinforced by VBA's ineptitude, I consider myself incredibly lucky. My
clients, peers and colleagues continue to suffer because VBA has failed
them. Many have been lost to substance abuse or the streets after
rejection by VBA, while others have attempted or completed suicide. MST
survivors often suffer alone, re-living the shame, hatred and betrayal
of a psychological or physical attack by their own peers. When VBA
rejects a veteran's MST claim, the department re- triggers the
veteran's emotional anguish and psychological turmoil. This heart-
wrenching rejection is often a reminder of every betrayal that was
first experienced when the veteran was raped, assaulted or harassed in
uniform. It causes the veteran to re-live the worst moments of his or
her life. VBA's denial of a veteran's trauma is an experience from
which many veterans simply do not recover.
As you may know, SWAN sued the VA and the Department of Defense
last fall for FOIA documentation related to domestic violence, military
rape, sexual assault, and sexual harassment. We have received and
analyzed the data your department provided, and the results are
astonishing. VBA approves only 32% of MST-related PTSD claims. This
acceptance rate is far less than the acceptance rate of PTSD claims
overall. In fact, 53% of total PTSD claims are granted. The evidence
suggests enormous bias against veterans whose PTSD originated from MST.
There is no doubt that VBA's system for handling MST-related claims
needs immediate repair.
It is time now for the VA to treat all veterans with respect, and
to provide the same level of care and benefits to our wounded warriors,
regardless of the source of their wounds. In 2010, the VA finally
adjusted its compensation policy for combat veterans suffering from
PTSD, but denied justice to tens of thousands of MST survivors by not
doing the same for them. As the policy stands now, VA has set up a
cruel double standard that is directly contributing to the re-
traumatization and further betrayal of our veterans who suffer from the
effects of military rape, sexual assault, and sexual harassment.
The VA's failure to recognize the sacrifices of all wounded
warriors is no longer knowledge exclusive to survivors. SWAN helped
Representative Chellie Pingree (D-ME) introduce H.R. 930, a common
sense bill that would bring parity to the VBA claims process and
justice for survivors of military rape, sexual assault, and sexual
harassment who suffer from PTSD and other mental health conditions by
providing the same standard of evidence as combat PTSD survivors. In
addition to creating a single standard for applicants, it would also
acknowledge that the wounds of MST survivors are as legitimate as those
of combat survivors. It is a bill overwhelmingly supported not only by
SWAN but by the veterans' community at large, including Veterans of
Foreign Wars, Vietnam Veterans of America, and Iraq and Afghanistan
Veterans of America. Additionally, Wounded Warrior Project and Disabled
American Veterans have written to the VA to express their support for
the proposed evidentiary standard reform for MST survivors.
SWAN has read the VA's recent letter dated June 27, 2011 written by
Undersecretary Allison Hickey regarding the processing of MST claims,
and finds that it is an insufficient and unsuitable remedy to a
systemic institutional problem. The guidance issued in that memo is not
based on fact, but rather, on the misplaced hope that regional claims
officers will put aside their biases and instead simply trust the
evidence presented to them. I and tens of thousands of others over the
years have put our faith in the system, and the system betrayed us,
once again. MST survivors have put their lives in the hands of far too
many individual claims officers for far too long. I urge you therefore
to make this evidentiary change a permanent policy for the VA as you
have done in the past, without forcing Congress to intervene.
I will be attending the VA's National Training Summit on Women
Veterans this weekend in Washington DC, and would be delighted to meet
with you before or after your scheduled address to the community. We
look forward to hearing from you.
With great respect for your service to our nation,
Anu Bhagwati, MPP
Executive Director, Service Women's Action Network
Former Captain, United States Marine Corps
cc: Brigadier General Allison Hickey, Undersecretary, U.S. Dept. of
Veterans Affairs
Major General Irene Trowell-Harris, Director, U.S. Dept. of
Veterans Affairs Center for Women Veterans
Dr. Patricia Hayes, Chief Consultant, U.S. Dept. of Veterans
Affairs Women Veterans Health Strategic Healthcare Group
Susan McCutcheon, RN, EdD, Director, U.S. Dept. of Veterans Affairs
Family Services, Women's Mental Health and Military Sexual Trauma
Members, Senate Veterans' Affairs Committee Members, House
Committee on Veterans' Affairs Representative Chellie Pingree (D-ME)
In 2011, the Service Women's Action Network (SWAN), in conjunction
with the American Civil Liberties Union (ACLU), filed a Freedom
oflnformation Act (FOIA) to obtain data from the Veterans
Administration (VA) on gender differences in claims and compensation
award for MST- related PTSD claims over the past 10 years. The VA
provided the requested data for the fiscal years 2008, 2009 and 2010.
Upon analysis SWAN discovered that during that time only 32.3% of
all PTSD claims related to sexual trauma were accepted. Conversely,
54.2% ofPTSD claims overall are accepted. This overall percentage
correlates with secondary data obtained by Veterans for Common Sense
which shows that 53% of all PTSD claims filed by Iraq and Afghanistan
veterans are accepted.
Additionally, a series of difference of proportions test revealed
that across 2008-2010 and in each individual year, women are more
likely than men to be granted compensation for lv!ST-based PTSD claims.
When looking at how much compensation men and women receive, women
awarded compensation are more likely than men to receive 10-30%
ratings, while men who are awarded compensation are more likely to
receive 70-100% ratings.
Gender differences by year SA/SH Claims by Fiscal Year
----------------------------------------------------------------------------------------------------------------
Year Percent granted--Men Percent granted--Women PIN
----------------------------------------------------------------------------------------------------------------
2008 22% 34% <.001/2587
----------------------------------------------------------------------------------------------------------------
2009 25% 37% <.001/3108
----------------------------------------------------------------------------------------------------------------
2010 27% 36% <.001/3825
----------------------------------------------------------------------------------------------------------------
Count of Unique Veterans with Initial PTSD Grant By Fiscal Year
----------------------------------------------------------------------------------------------------------------
Year Granted(%)
----------------------------------------------------------------------------------------------------------------
2008 52.9%
----------------------------------------------------------------------------------------------------------------
2009 53.3%
----------------------------------------------------------------------------------------------------------------
2010 56.4%
----------------------------------------------------------------------------------------------------------------
Rates of Evaluation Percentage ofSA/SH PTSD Claims by Gender
--------------------------------------------------------------------------------------------------------------------------------------------------------
10% 30% 50% 70% 100%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Men 5% 25% 28% 26% 14%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Women 6.5% 34% 31% 19% 8%
--------------------------------------------------------------------------------------------------------------------------------------------------------
Sexual Assault/Harassment PTSD Claims, FY08-10
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Sexual Trauma/Harassment FYO8 FY09 FY10
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Grant Denial Total Grant Denial Total Grant Denial Total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
A. GranUDenial Summary Male 186 651 837 242 740 982 350 943 1293
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Female 601 1149 1750 787 1339 2126 919 1613 2532
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Unknown 8 16 24 5 26 31 12 32 44
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
B. Grant Detail %Eva! Male Female Unknown Total Male Female Unknown Total Male Female Unknown Total
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
0 1 6 7 1 9 10 9 9
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
10 13 53 66 5 48 53 21 50 71
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
20 0 1 1 2 1 1
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
30 49 221 4 274 69 263 2 334 80 306 4 390
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
40 0 1 1 2 2
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
SO 51 177 2 230 63 242 1 306 107 298 5 410
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
60 0 0 0
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
70 40 102 2 144 72 157 1 230 94 175 1 270
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
80 0 0 0
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
90 0 0 0
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
100 32 42 1 75 30 67 1 98 48 78 2 128
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------