U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office,

http://bookstore.gpo.gov. For more information, contact the GPO Customer Contact Center,

U.S. Government Printing Office. Phone 202–512–1800, or 866–512–1800 (toll-free). E-mail, gpo@custhelp.com.

57–023 2010

HEALING THE WOUNDS: EVALUATING MILITARY 

SEXUAL TRAUMA ISSUES 

JOINT HEARING 

BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS 

AND THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

SECOND SESSION 

MAY 20, 2010 

Serial No. 111–79 

Printed for the use of the Committee on Veterans’ Affairs 

( 

ebenthall on DSK9Q6SHH1PROD with HEARING

ii 

COMMITTEE ON VETERANS’ AFFAIRS 

BOB FILNER, California, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

MICHAEL H. MICHAUD, Maine 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HARRY E. MITCHELL, Arizona 

JOHN J. HALL, New York 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

ZACHARY T. SPACE, Ohio 

TIMOTHY J. WALZ, Minnesota 

JOHN H. ADLER, New Jersey 

ANN KIRKPATRICK, Arizona 

GLENN C. NYE, Virginia 

STEVE BUYER, Indiana, Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

HENRY E. BROWN, JR., South Carolina 

JEFF MILLER, Florida 

JOHN BOOZMAN, Arkansas 

BRIAN P. BILBRAY, California 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

DAVID P. ROE, Tennessee 

MALCOM A. SHORTER, Staff Director 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS 

JOHN J. HALL, New York, Chairman 

DEBORAH L. HALVORSON, Illinois 

JOE DONNELLY, Indiana 

CIRO D. RODRIGUEZ, Texas 

ANN KIRKPATRICK, Arizona 

DOUG LAMBORN, Colorado, Ranking 

JEFF MILLER, Florida 

BRIAN P. BILBRAY, California 

SUBCOMMITTEE ON HEALTH 

MICHAEL H. MICHAUD, Maine, Chairman 

CORRINE BROWN, Florida 

VIC SNYDER, Arkansas 

HARRY TEAGUE, New Mexico 

CIRO D. RODRIGUEZ, Texas 

JOE DONNELLY, Indiana 

JERRY MCNERNEY, California 

GLENN C. NYE, Virginia 

DEBORAH L. HALVORSON, Illinois 

THOMAS S.P. PERRIELLO, Virginia 

HENRY E. BROWN, JR., South Carolina, 

Ranking 

CLIFF STEARNS, Florida 

JERRY MORAN, Kansas 

JOHN BOOZMAN, Arkansas 

GUS M. BILIRAKIS, Florida 

VERN BUCHANAN, Florida 

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. 

ebenthall on DSK9Q6SHH1PROD with HEARING

iii 

C O N T E N T S 

May 20, 2010 

Page 

Healing the Wounds: Evaluating Military Sexual Trauma Issues ...................... 1 

OPENING STATEMENTS 

Chairman John J. Hall, Chairman, Subcommittee on Disability Assistance 

and Memorial Affairs ........................................................................................... 1 

Prepared statement of Chairman Hall ........................................................... 23 

Hon. Doug Lamborn, Ranking Republican Member, Subcommittee on Disability Assistance and Memorial Affairs ............................................................ 3 

Prepared statement of Congressman Lamborn .............................................. 24 

Hon. Michael H. Michaud, Chairman, Subcommittee on Health, prepared 

statement of .......................................................................................................... 25 

WITNESSES 

U.S. Department of Defense, Kaye Whitley, Ed.D., Director, Sexual Assault 

Prevention and Response Office, Office of the Under Secretary of Defense 

for Personnel and Readiness ............................................................................... 17 

Prepared statement of Dr. Whitley ................................................................. 41 

U.S. Department of Veterans Affairs: 

Bradley G. Mayes, Director, Compensation and Pension Service, Veterans 

Benefits Administration ................................................................................... 18 

Susan McCutcheon, R.N., Ed.D., Director, Family Services, Women’s Mental Health and Military Sexual Trauma, Office of Mental Health Services, 

Veterans Health Administration ..................................................................... 20 

Prepared statement of Mr. Mayes and Dr. McCutcheon ........................... 47 

Benedict, Helen, Professor of Journalism, Columbia University, New York, 

NY, and Author, The Lonely Soldier: The Private War of Women Serving 

in Iraq ................................................................................................................... 6 

Prepared statement of Ms. Benedict ............................................................... 27 

Disabled American Veterans, Joy J. Ilem, Deputy National Legislative Director .......................................................................................................................... 10 

Prepared statement of Ms. Ilem ...................................................................... 31 

Iraq and Afghanistan Veterans of America, Sergeant Jennifer Hunt, USAR, 

Project Coordinator .............................................................................................. 12 

Prepared statement of Sergeant Hunt ............................................................ 37 

RAINN—Rape, Abuse, and Incest National Network, Scott Berkowitz, President and Founder ................................................................................................. 8 

Prepared statement of Mr. Berkowitz ............................................................ 28 

Service Women’s Action Network, Anuradha K. Bhagwati, Executive Director 14 

Prepared statement of Ms. Bhagwati ............................................................. 39 

Society for Women’s Health Research, Phyllis Greenberger, President and 

Chief Executive Officer ........................................................................................ 4 

Prepared statement of Ms. Greenberger ........................................................ 25 

SUBMISSIONS FOR THE RECORD 

American Legion, Denise A. Williams, Assistant Director for Health Policy, 

Veterans Affairs and Rehabilitation Commission, statement .......................... 50 

American Urological Association, Beth K. Kosiak, Ph.D., Associate Executive 

Director, Health Policy, statement ..................................................................... 52 

American Veterans (AMVETS), Christina M. Roof, National Deputy Legislative Director, statement ....................................................................................... 53 

ebenthall on DSK9Q6SHH1PROD with HEARING

Page

iv 

Brown, Hon. Henry E. Brown, Jr., Ranking Republican Member, Subcommittee on Health, statement ......................................................................... 58 

MATERIAL SUBMITTED FOR THE RECORD 

Post-Hearing Questions and Responses for the Record: 

Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance and 

Memorial Affairs, and Michael H. Michaud, Chairman, Subcommittee 

on Health, Committee on Veterans’ Affairs, to Phyllis Greenberger, President and Chief Executive Officer, Society for Women’s Health Research, 

letter dated June 14, 2010, and Ms. Greenberger’s response ....................... 59 

Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance and 

Memorial Affairs, and Michael H. Michaud, Chairman, Subcommittee 

on Health, Committee on Veterans’ Affairs, to Helen Benedict, Professor 

of Journalism, Columbia University, NY, letter dated June 14, 2010, 

and Ms. Benedict’s responses .......................................................................... 63 

Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance and 

Memorial Affairs, and Michael H. Michaud, Chairman, Subcommittee 

on Health, Committee on Veterans’ Affairs, to Joy J. Ilem, Deputy National Legislative Director, Disabled American Veterans, letter dated 

June 14, 2010, and Ms. Ilem’s responses ....................................................... 65 

Hon. John J. Hall, Chairman, and Doug Lamborn, Ranking Republican 

Member, Subcommittee on Disability Assistance and Memorial Affairs, 

and Michael H. Michaud, Chairman, and Henry E. Brown, Jr., Ranking 

Republican Member, Subcommittee on Health, Committee on Veterans’ 

Affairs, to Kay Whitley, Ed.D., Director, Sexual Assault Prevention and 

Response Office, Office of the Under Secretary of Defense for Personnel 

and Readiness, U.S. Department of Defense, letter dated June 14, 2010, 

and DoD responses ........................................................................................... 68 

Hon. John J. Hall, Chairman, and Doug Lamborn, Ranking Republican 

Member, Subcommittee on Disability Assistance and Memorial Affairs, 

and Michael H. Michaud, Chairman, and Henry E. Brown, Jr., Ranking 

Republican Member, Subcommittee on Health, Committee on Veterans’ 

Affairs, to Susan McCutcheon, R.N., Ed.D., Director, Family Services, 

Women’s Mental Health and Military Sexual Trauma, Office of Mental 

Health Services, Veterans Health Administration, U.S. Department of 

Veterans Affairs, letter dated June 14, 2010, and VA responses ................. 74 

Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance and 

Memorial Affairs, Committee on Veterans’ Affairs, to Bradley G. Mayes, 

Director, Compensation and Pension Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs, letter dated June 23, 2010, 

and VA responses ............................................................................................. 80 

ebenthall on DSK9Q6SHH1PROD with HEARING

(1) 

HEALING THE WOUNDS: EVALUATING 

MILITARY SEXUAL TRAUMA ISSUES 

THURSDAY, MAY 20, 2010 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, 

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND

MEMORIAL AFFAIRS, 

SUBCOMMITTEE ON HEALTH, 

Washington, DC. 

The Subcommittees met, pursuant to notice, at 10:05 a.m., in 

Room 334, Cannon House Office Building, Hon. John Hall [Chairman of the Subcommittee on Disability Assistance and Memorial 

Affairs] presiding. 

Present from Subcommittee on Disability Assistance and Memorial Affairs: Representatives Hall, Donnelly, Rodriguez, Lamborn, 

and Miller. 

Present from Subcommittee on Health: Representatives Michaud, 

Snyder, and Perriello. 

OPENING STATEMENT OF CHAIRMAN HALL 

Mr. HALL. Good morning, ladies and gentlemen. Welcome to the 

House Committee on Veterans’ Affairs Subcommittee on Disability 

Assistance and Memorial Affairs in a joint session with the Subcommittee on Health for a joint hearing on Healing the Wounds: 

Evaluating Military Sexual Trauma (MST) Issues. 

Would you all please rise and join me in the Pledge of Allegiance. 

[Pledge was taken.] 

Mr. HALL. Thank you. 

We will try to expedite this hearing because there is, at 11:00 

a.m., a mandatory break for the address to the Joint Session of 

Congress by the President of Mexico, President Calderon. 

I am grateful today to have the opportunity to conduct this hearing, Healing the Wounds: Evaluating Military Sexual Trauma 

Issues, with my colleagues, Ranking Member Lamborn; the Health 

Subcommittee Chair, Mr. Michaud; and Mr. Brown, the Ranking 

Member of the Health Subcommittee, and am especially enthusiastic to recognize the men and women veterans who are in this 

room today, and am looking forward to hearing about their experiences with MST. 

The purpose of this hearing today is to evaluate ways in which 

the Veterans Benefits Administration (VBA), the Veterans Health 

Administration (VHA), and the U.S. Department of Defense (DoD) 

can better address veterans who are impacted by military sexual 

ebenthall on DSK9Q6SHH1PROD with HEARING

2 

trauma or MST and to identify and better prevent, treat, and properly compensate them. 

MST refers to sexual harassment and sexual assault that occurs 

in military settings, often in a setting where the victim lives and 

works, which means that the victims must continue to live and 

work closely with the perpetrators. 

MST can also disrupt the career goals of many victims as perpetrators are frequently peers or supervisors responsible for the decisions on work-related evaluations and promotions. This means 

the victims must choose between continuing their careers at the expense of frequent contact with their perpetrators or ending their 

careers in order to protect themselves. 

Many victims shared that when they do report an incident, they 

are not believed or they are encouraged to keep silent because of 

the need to preserve organizational cohesion. 

The National Center for Posttraumatic Stress Disorder (PTSD) of 

the U.S. Department of Veterans Affairs (VA) reports that in 1995, 

DoD conducted a large-scale study of sexual victimization among 

its active-duty population. This DoD study found that the rates of 

attempted or completed sexual assault were 6 percent for women 

and 1 percent for men. 

Another study found that rates of sexual assault and verbal sexual harassment were higher during wartime than peacetime in 

their sample study population. This suggests that the stress of war 

may be associated with increases in rates of sexual harassment and 

assault. 

The National Center for PTSD also reports that the rate of MST 

among the veteran population who use the VA health care system 

appears to be higher than that of the general military population. 

One study found that 23 percent of female users of the VA health 

care system report having experienced sexual assault while in the 

military. 

MST has been a concern among many veterans who have continually expressed frustration with the disability claims process, especially in trying to prove to the VA that the assault ever happened. 

For many women and men, when their disability claims for 

PTSD are related to MST and are denied, they suffer a secondary 

injury, resulting in an exacerbation of PTSD symptoms and, thus, 

they are less likely to file an appeal. 

We cannot allow these things to continue to happen to our Nation’s veterans who have served so bravely and both VA and DoD 

need to ensure that the proper treatment is available. 

Veterans should be able to access treatment facilities and qualified staff with care and benefits delivered by employees who are 

properly trained to be sensitive to MST-related issues. These veterans need to be treated with the dignity and respect that they deserve. 

I look forward to hearing from our esteemed panels of witnesses 

today and now yield to Ranking Member Lamborn for his opening 

statement. 

[The prepared statement of Chairman Hall appears on p. 23.] 

ebenthall on DSK9Q6SHH1PROD with HEARING

3 

OPENING STATEMENT OF HON. DOUG LAMBORN 

Mr. LAMBORN. Thank you, Mr. Chairman. 

And I, too, welcome our witnesses to this important hearing to 

discuss matters concerning military sexual trauma. Occurrences of 

sexual assault with the ranks of our military are totally and completely unacceptable. It distresses me to think that anyone who volunteers to protect our Nation through service in the Armed Forces 

would ever have to contemplate much less experience being harmed 

by a fellow servicemember. 

But our military is a microcosm of society and crimes that occur 

in society unfortunately also occur in the military. So we must face 

reality and address the problems that arise. 

First, it should be made clear through training at every level and 

to every servicemember that sexual offenses will not be tolerated 

and that perpetrators will be punished to the fullest extent under 

the Uniform Code of Military Justice. 

Second, the military services should follow through and ensure 

that justice is rendered in cases involving sexual assault. 

I would also add that the military must thoroughly investigate 

and prosecute false accusers of sexual assault who unfortunately 

detract from the plight of those who really are victims of sexual assault. 

While it is important that we deliberate on the very serious topic 

of military sexual trauma, I want to also make very clear that this 

is not an indictment of our military as a whole. The vast majority 

of the men and women who volunteer for military service are honorable and patriotic individuals who courageously stand to defend 

our country and other countries from tyranny. They are some of 

our bravest citizens who abhor the type of individuals who would 

commit such a repugnant crime as sexual assault. 

As far as this topic pertains to VA benefits, I believe the Department has appropriate rules in place for adjudicating and rating 

sexual trauma cases, but I will be listening for ways that we can 

possibly improve on the existing system. 

I want to thank all of our witnesses for their participation and 

their testimony and I look forward to our discussion today. 

Mr. Chairman, I yield back. Thank you. 

[The prepared statement of Mr. Lamborn appears on p. 24.] 

Mr. HALL. Thank you, Mr. Lamborn. 

Mr. Michaud. 

Mr. MICHAUD. Thank you, Mr. Chairman. 

Due to the President of Mexico addressing the joint session, I 

would ask unanimous consent that my opening remarks be submitted for the record so that we can begin hearing from the panels. 

Mr. HALL. Without objection, so ordered. 

Mr. MICHAUD. Thank you. 

[The prepared statement of Chairman Michaud appears on p. 

25.] 

Mr. HALL. Other Members, would you agree to submit written 

opening statements so we can go to the witnesses? Thank you so 

much. So ordered. 

I would also like to recognize Megan Williams from the Disability 

Assistance and Memorial Affairs staff who is leaving to go to gradebenthall on DSK9Q6SHH1PROD with HEARING

4 

uate school in Switzerland and to thank her for her work for the 

Subcommittee. 

The first panel who I will now invite to join us at the witness 

table is Phyllis Greenberger, Chief Executive Officer (CEO) and 

President of the Society for Women’s Health Research, and Helen 

Benedict, Professor of Journalism at Columbia University, and Author of the book, The Lonely Soldier: The Private War of Women 

Serving in Iraq. 

Welcome, both of you, and your full written statements are entered in the record. You will have 5 minutes each to give oral testimony starting with Ms. Greenberger. 

You are now recognized. 

STATEMENTS OF PHYLLIS GREENBERGER, PRESIDENT AND 

CHIEF EXECUTIVE OFFICER, SOCIETY FOR WOMEN’S 

HEALTH RESEARCH; AND HELEN BENEDICT, PROFESSOR OF 

JOURNALISM, COLUMBIA UNIVERSITY, NEW YORK, NY, AND 

AUTHOR, THE LONELY SOLDIER: THE PRIVATE WAR OF 

WOMEN SERVING IN IRAQ 

STATEMENT OF PHYLLIS GREENBERGER 

Ms. GREENBERGER. Thank you. 

Mr. Chairman and Members of the Subcommittees, I want to 

thank you for calling this joint hearing on such an important and 

timely topic. 

As said, I am Phyllis Greenberger, CEO of the Society for Women’s Health Research, and we are a nonprofit patient advocacy organization dedicated to improving women’s health through advocacy, education, and research of sex and gender differences. 

The Society focus is on sex and gender differences and research 

needs to be done to explore conditions that affect women differently, disproportionately, or exclusively and to identify those differences and understand the implications for diagnosis and treatment. 

The pressing issues that bring us here today are the risks and 

ramifications of military sexual trauma or MST. MST victims are 

disproportionately, as you know, and almost exclusively women. 

A 2008 VA study reported that 15 percent of military women in 

Iraq and Afghanistan experience sexual assault or harassment and 

59 percent of those were at higher risk for mental health problems. 

This is just among those cases reported. Many more, possibly more 

than half of all MST cases go undocumented each year. 

The ramifications of MST for women persist long after the initial 

assault. While sexual assault in any setting is horrific, the combined insult of MST occurring while serving in a foreign setting, 

often in an active war zone, only exacerbates the effects. 

By VA estimates, over 70 percent of women in the military have 

been exposed to combat. Further, with most MST assaults being orchestrated by military personnel against military personnel, the 

environment of trust among those serving is broken and a chain of 

command that fails to protect from and respond to MST further degrades unit cohesion. 

Research in the area of MST and sexual assault has revealed 

some interesting sex-based differences. First, women are more likeebenthall on DSK9Q6SHH1PROD with HEARING

5 

ly than men to contract a sexually transmitted infection or STI. 

STIs are more difficult to treat in women and can have emotional 

and mental impacts over a woman’s life span. Sexual assault can 

result in an unplanned pregnancy or, conversely, leave a woman 

unable to bear children in the future. 

The impacts of MST are not limited to reproduction. Infection 

with the human papillomavirus after a sexual assault can result in 

cancer decades later. 

Second, sexual assault is a common trigger for post-traumatic 

stress disorders months and even years after the attack. Scientists 

are finding that women do not respond the same to some of the 

common medications prescribed for PTSD, often faring worse than 

men taking the same medication for the same diagnosis. 

Third, multiple traumas can increase the likelihood of developing 

PTSD and the combined impacts of working in a war zone, multiple 

deployments, MST, and for a disproportionate share of female military members exposure to early life trauma all raise the risk for 

an eventual PTSD diagnosis. 

Females in the military have twice the level of PTSD and depression as their male counterparts. 

Fourth, research suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels and can 

vary based on where she is in her menstrual cycle and whether or 

not she uses medications that alter hormone levels such as birth 

control. 

The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST and may further 

help discover more effective PTSD therapies for women, therapies 

that are responsive to sex-based hormonal differences. 

More research is critical for moving forward and determining targeted treatments for women and men. 

The VA in 2010 is in a unique position to better serve its female 

veterans at the same time becoming a leader in women’s health 

and sex-based research. Changes in care can only come from sound 

research and investments in VA research often translate into new 

knowledge, methods, screenings, and treatment for women and 

men, military and civilian. 

The VA system faces staffing, organizational, and infrastructure 

challenges when updating to meet the needs of the growing female 

veteran population. Reports as recent as March 2010 still found deficiencies in the availability of resources for female veterans. 

From providing gender-specific care at all VA medical centers to 

including female subjects in the VA’s health services research and 

development, the VA system with proper support and resources 

hopefully can transform what is needed today and what is needed 

for the future. 

The VA needs to optimize its interactions with female veterans 

by offering women the option to participate in research projects. 

The health information technology capabilities that link all VA 

medical centers and each veteran’s medical and personnel charts 

offers unmatched capabilities for research. 

Further, increasing collaboration between the DoD and the VA 

would additionally offer an improved continuum of care as women 

ebenthall on DSK9Q6SHH1PROD with HEARING

6 

transition from active duty to veteran issues. Clearly there is a 

need for more investments in the VA and sex-based research and 

we hope that these recommendations will be acted upon quickly. 

I encourage the VA and these Committees to consider the potential impact of appropriate research into women’s health and the 

wide-reaching results that can improve sex-based research as well 

as mental and sexual health for all. 

I want to thank you again for this opportunity to present to the 

Subcommittees and I would be pleased to answer any questions. 

[The prepared statement of Ms. Greenberger appears on p. 25.] 

Mr. HALL. Thank you, Ms. Greenberger. 

And I would now recognize Professor Benedict. 

STATEMENT OF HELEN BENEDICT 

Ms. BENEDICT. Hello, Mr. Chairman. Thank you very much, 

Members of the Subcommittees, for honoring me with the chance 

to testify. 

For 30 years, I have been writing about sexual assault culminating in my book, The Lonely Soldier, about military sexual assault. 

First, I would like to commend the Caregivers and Veterans Act 

signed by President Obama just last month. It was an essential 

step toward helping female veterans. This Act addresses the horrendous problem of military sexual assault by requiring the VA to 

train mental health professionals to care for women with sexual 

trauma. This is progress. Yet, I am concerned that the training be 

done properly. 

For my book, I interviewed more than 40 female veterans of our 

current wars and studied many other surveys. Too often they told 

me that when they tried to report an assault, the military and the 

VA treated them as liars and malingerers. A woman who reports 

a sexual assault should never be treated as a criminal. 

They also told me that their sexual assault response coordinators 

assigned to help them by the military often treated them with such 

suspicion that they felt retraumatized and intimidated out of pursuing justice. 

Indeed, the usual approach to a report of sexual assault within 

the military is to investigate the victim, not the perpetrator, and 

to dismiss the case altogether if alcohol is involved. 

It is, therefore, essential that the counselors used by the military 

and the VA be trained in civilian rape crisis centers away from the 

military culture that habitually blames the victim and that is too 

often concerned with protecting the image of a platoon or commander by covering up wrongdoing. 

These counselors and, indeed, anyone within the military 

charged with investigating sexual assault should be trained to understand the causes, effects, and costs of sexual abuse to both the 

victim and society. 

Within the VA, reform is also needed. The process for evaluating 

disability caused by military sexual assault needs to be automatically upgraded and victims who were too intimidated to report an 

assault while on active duty should never be denied treatment once 

they come home as they so often are now. 

ebenthall on DSK9Q6SHH1PROD with HEARING

7 

The VA needs to recognize the fact that some 90 percent of victims, according to the DoD, never report assaults within the military because its culture is so hostile to them. 

The VA must also recognize and address the fact that it can take 

years to recover from sexual assault. 

In light of the new Caregivers Act, I also want to alert this Committee to the finding that many of our troops were sexually or 

physically abused long before they enlisted. 

In two studies of Army and Marine recruits conducted in 1996 

and 2005 respectively, it was found that half the women and about 

one-sixth of the men reported having been sexually abused as children, while half of both said they were physically abused. 

This means that close to half our troops may be enlisting to escape violent homes. Thus, we need to provide counselors trained 

not only in military sexual assault but in childhood abuse and trauma. These counselors should be available to active-duty troops and 

veterans. They should be imbedded with the combat stress counseling teams already deployed. 

This is necessary not only to help troops cope with multiple traumas of childhood and military sexual assault, as well as combat 

trauma, but to help prevent further sexual violence. Psychologists 

have long known that an abused boy can grow into an abusive 

man. 

Finally, let us recognize that more effective than any rules or 

laws is the attitude of the commander on the ground. Studies have 

shown that commanders who treat their female soldiers with respect and insist that other soldiers do likewise reduce sexual persecution. Thus, we must reform the culture within officer academies 

which at the moment is rife with brutal hazing, abuse, and rape 

as the scandals at Tailhook, Aberdeen, and the Air Force Academy 

have too long demonstrated. 

This violence drums women out of the service and trains men to 

enact and condone rape and torture. 

All officer training schools for all military branches should teach 

their candidates to understand that rape is an act of anger, hatred, 

and power, not desire, and that sexual persecution destroys camaraderie and cohesion. 

Officers should learn to take pride in ensuring their troops are 

safe from disrespect and violence from their comrades just as they 

take pride in bringing them home safely from war. 

Thank you. 

[The prepared statement of Ms. Benedict appears on p. 27.] 

Mr. HALL. Thank you, Professor. 

And to both of our witnesses, thank you. Your complete written 

statements are a part of the record. 

Chairman Michaud and I spoke about the time situation before 

and if there is no objection from Members of the Subcommittees, 

we would like to submit our questions in writing and for the record 

and move on to the second panel so that we can try to hear as 

many witnesses as possible. 

Is there objection to that? Without hearing any, thank you to our 

witnesses on the first panel. And we will submit questions to you 

in writing and you are now excused. 

ebenthall on DSK9Q6SHH1PROD with HEARING

8 

And we will move to our second panel, Scott Berkowitz, President and Founder of the RAINN, Rape, Abuse, Incest National Network; Joy J. Ilem, Deputy National Legislative Director of the Disabled American Veterans (DAV); Jennifer Hunt, Project Coordinator, Iraq and Afghanistan Veterans of America (IAVA); and 

Anuradha K. Bhagwati, Executive Director, the Service Women’s 

Action Network (SWAN). 

Welcome, all of you, again. As you know, your full written statements are made a part of the record, so you each have 5 minutes 

starting with Mr. Berkowitz. 

STATEMENTS OF SCOTT BERKOWITZ, PRESIDENT AND FOUNDER, RAINN—RAPE, ABUSE, AND INCEST NATIONAL NETWORK; JOY J. ILEM, DEPUTY NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS; SERGEANT JENNIFER HUNT, USAR, PROJECT COORDINATOR, IRAQ AND AFGHANISTAN VETERANS OF AMERICA; AND ANURADHA K. 

BHAGWATI, EXECUTIVE DIRECTOR, SERVICE WOMEN’S ACTION NETWORK 

STATEMENT OF SCOTT BERKOWITZ 

Mr. BERKOWITZ. Mr. Chairman, thank you for inviting me today. 

My name is Scott Berkowitz. I am the President of RAINN which 

is the Nation’s largest anti-sexual violence organization. We run 

the National Sexual Assault Hotline, which is a partnership of 

about 1,100 local rape crisis centers across the country. We also 

run an online hotline and do public education. 

When I first testified to Congress on this issue about 6 years ago, 

a DoD task force had just published an exhaustive study. Unfortunately, at the time, that was a fairly common occurrence and about 

a dozen commission reports that preceded it had had very little impact. 

But this report had a different ending. It helped lead DoD to step 

up its efforts and I think it has resulted in some tangible progress. 

That is certainly not to say that the problem has been solved—in 

fact, we are a long way from that, as reporting and prosecution 

rates remain too low and too few victims reach out for help. But, 

at last, we are headed in the right direction. 

To put the problem in some context: in one sense, the military 

is not at all unique. About 80 percent of all rape victims are under 

age 30 and so the problems faced by the military are very similar 

to those faced by large universities, as both have disproportionately 

young populations. 

Rape is the most violent and traumatic crime that a victim lives 

to remember. The long-term mental health effects can be devastating, leaving victims at higher risk for PTSD, depression, substance abuse, and many other issues. Embarrassment and shame 

are almost universal among victims. 

In the civilian world, these reactions help explain why victims 

are so reluctant to report their attack to police, or even to their 

own friends and family. While the civilian reporting rate is going 

up, still about six out of every 10 victims do not report to police. 

Now, add to this mix that in the military, filing an unrestricted 

report, the kind that can actually lead to a prosecution, will mean 

ebenthall on DSK9Q6SHH1PROD with HEARING

9 

that everyone on base knows. Add in the fear of being ostracized, 

and the impact it might have on your career, and it is clear why 

so many victims remain reluctant to report. 

Of course, there is no single, simple solution. But there are a few 

lessons from the civilian world. One is that much research has 

shown that victims who receive prompt care and crisis intervention 

return to full strength much more quickly and, very importantly, 

they are ultimately much more likely to report their attack to law 

enforcement and to follow through with prosecution. 

Of course, more reports to law enforcement means many more 

prosecutions and more prosecutions leads directly to fewer assaults. Rapists are serial criminals. We are talking about a relatively small group who are committing a large number of crimes. 

And so every time we can convince just one more victim to come 

forward, leading to just one more successful prosecution, we are potentially preventing dozens of rapes. 

So how do we get more victims to come forward? The guarantee 

of confidentiality is one big piece. I think DoD has made some good 

progress on this score, with the introduction of restricted reporting, 

which has already encouraged more than 3,000 victims to come forward, about 15 percent of whom later decided to pursue prosecution. 

Still, the safety of a restricted report is incomplete. For example, 

DoD has determined that some State mandatory reporting laws for 

medical personnel in California, for example, supersede the protections victims enjoy under restricted reporting. And I think that is 

an issue that needs some Congressional study. 

Also, victims to date have not had the guarantee of privileged 

communications with military victim advocates, as is the case in 

most States, though I understand that DoD is in the process of implementing that change. 

Another vital part of the solution is to make use of the extensive 

civilian services available, such as the National Sexual Assault 

Hotline and local rape crisis centers. These services offer the confidentiality that victims desire and deserve while still advancing 

the military’s goal of encouraging more victims to report their attack to law enforcement. They are by no means a replacement for 

military-based services, but they are, I think, a bridge to such services. 

While time constraints limit the recommendations I can share 

today, I do want to touch on issues of leadership and prevention. 

Without sincere buy-in from leadership, evidence that zero tolerance means zero tolerance, any prevention efforts will absolutely 

fail. And so DoD leadership needs to continue to find ways to ensure that the commanders who take this seriously are recognized 

and rewarded, and that recalcitrant commanders are identified and 

reformed by training when possible, by the threat of poor performance ratings when necessary. 

In this process, we need to ensure that commanders do not fear 

that an increase in rape reports on their base will be held against 

them. In fact, such an increase will most likely be a sign that what 

they are doing is working, that a higher percentage of victims are 

coming forward and reporting, which is good news. And so that 

should be reflected in their evaluations. 

ebenthall on DSK9Q6SHH1PROD with HEARING

10 

I would like to add just one quick point about internal DoD management. I have heard reports that DoD is considering moving its 

sexual assault programs to be under its domestic violence programs. While that might seem efficient on paper, I think doing so 

has the potential to de-emphasize sexual violence and seriously 

hamper prevention and victim service efforts. 

Now that we have started to make real progress fighting sexual 

violence in the military, I think it would really be the wrong time 

to backtrack by conflating two very different issues. 

Thank you. 

[The prepared statement of Mr. Berkowitz appears on p. 28.] 

Mr. HALL. Thank you, Mr. Berkowitz. 

Ms. Ilem, you are now recognized. 

STATEMENT OF JOY J. ILEM 

Ms. ILEM. Thank you. 

Chairman Hall, Chairman Michaud, and Members of the Subcommittees, thank you for inviting DAV to testify at this joint 

hearing focused on improving treatment and disability compensation policies for veterans with conditions related to military sexual 

trauma or MST. 

This hearing takes on a topic that is very personal and sensitive 

to many servicemembers, veterans, and the respective departments 

that are responsible for the safety and well-being of their members. 

In most cases, MST profoundly changes the lives of those affected. For these reasons, all VHA patients are screened for history 

of sexual trauma and treatment is available for MST-related conditions at VA medical facilities. 

We acknowledge VHA for providing clear and concise information 

about MST on its Web site and in its written materials and, most 

importantly, information on how and where veterans can get help. 

It is clearly noted in these materials that service-connection is 

not required for eligibility for this treatment. However, if a sexual 

assault is not officially reported during military service, establishing service-connection for a related condition can be extremely 

difficult. 

An area of special concern for DAV relates to collaboration between DoD’s Sexual Assault Prevention and Response Office or 

SAPRO and VHA. Current DoD policy allows servicemembers to 

file restricted or unrestricted reports of sexual assault. 

In the case of a restricted report, the servicemember opts to forgo 

an investigation but does have the right to have an official record 

of the incident created, receive a forensic medical examination, and 

access to medical and mental health treatment as necessary. 

Obviously these records are critical to substantiating a disability 

compensation claim through VBA. For this reason, DAV is concerned that VBA policy manuals appear to lack any reference to 

SAPRO in obtaining documentation from restricted DoD MST reports. 

In reviewing VA’s testimony from this morning, it appears that 

their collaboration with SAPRO has been focused more on the VHA 

side of the house and related more to health care providers and 

treatment issues. 

ebenthall on DSK9Q6SHH1PROD with HEARING

11 

It is my understanding that VBA and SAPRO officials have spoken about the issue, but we are not aware that an official policy, 

process, or Memorandum of Understanding is currently in place or 

being developed to secure restricted MST reports. 

Once a claim is filed, VBA has a number of standard sources that 

it examines for records to support these types of claims. It does not 

appear, however, that these reports are archived in the individual’s 

military personnel or medical records for purposes of confidentiality. And we have been unable to confirm if VBA unofficially 

searches for restricted reports as an alternative evidence source for 

information to substantiate a veteran’s claim. 

We also have questions with respect to where the forensic sexual 

assault examination form and subsequent mental health treatment 

records related to a restricted MST report are archived by each 

military branch and for how long. 

We ask that VBA provide the Subcommittees with any information it has in reference to materials for claims developers and raters that reflect collaboration with SAPRO and guidance on how to 

obtain supporting MST documentation from each military service 

branch including any differences in records retention, security, or 

disposal policies. 

Establishing service-connection for related MST is important including financial stability, increased access to VA health care, but 

most meaningful for most MST survivors, being rated service-connected for disabilities attributed to the trauma represents validation that the event occurred, expresses gratitude for their service 

to their country, and recognizes the tribulations they endured while 

serving. 

One of DAV’s central purposes is to aid veterans in obtaining fair 

and equitable compensation for their service-related disability. In 

this particular area, however, many of our national service officers 

report they are deeply frustrated at the routine occurrence of MST 

claims being denied for lack of evidentiary documentation. 

It seems to DAV that the agencies responsible for preventing, 

monitoring, and reporting on MST and providing related benefits 

and health care services should work in concert to lower the burden associated with the claims process for these veterans and ensure that both servicemembers and veterans are fully assisted by 

the government in securing the benefits they deserve and have 

earned. 

If VBA does not have a policy in place to secure restricted MST 

reports and related medical records, we believe this issue can be 

resolved internally by the respective agencies through an MOU or 

some other mechanism if they simply agree to work together to address the issue. 

Again, we appreciate the Subcommittees’ interest in this area 

and efforts to identify ways to improve access to benefits and 

health services related to military sexual trauma. And we thank 

you for the opportunity to testify. 

[The prepared statement of Ms. Ilem appears on p. 31.] 

Mr. HALL. Thank you, Ms. Ilem. 

Ms. Hunt, you are recognized now for 5 minutes. 

ebenthall on DSK9Q6SHH1PROD with HEARING

12 

STATEMENT OF SERGEANT JENNIFER HUNT, USAR 

Sergeant HUNT. Good morning. 

Chairmen, Ranking Members, and Members of the Subcommittees, on behalf of IAVA’s 180,000 members and supporters, I would 

like to thank you for giving us the opportunity to testify. 

Healing the Wounds: Evaluating Military Sexual Trauma is a 

critically important topic. The issue of sexual assault has deeply affected IAVA membership, the military and veterans community as 

a whole, and me personally. 

I would like to point out that my testimony today is on behalf 

of IAVA and does not reflect the views and opinions of the United 

States Army. 

My name is Jennifer Hunt and I am a Sergeant in the Army Reserves. I have served two tours in Iraq and Afghanistan. In Iraq, 

I earned a Purple Heart when my Humvee was struck by a roadside bomb causing shrapnel injuries to my face, arms, and back. 

I also serve as my unit’s designated victim advocate as part of 

the Army’s Sexual Assault Prevention and Response Program. 

While I am proud to serve in this position, I sincerely hope that 

my duties as a victim advocate are ones I will never have to perform, but I am ready should the need arise to provide any support 

necessary to the victim. I know firsthand how frustrating that the 

healing process can be having experienced sexual assault as a civilian myself. 

Unfortunately, the reality is that servicemembers have been coping with significant and under-reported sexual assault and harassment in the military for years. Even in a war zone, troops cannot 

escape the threat of sexual assault. While sexual assault disproportionately affects female troops, large numbers of male servicemembers have been victimized as well. 

While the number of reported assaults are alarming, they grossly 

underestimate the severity of the issue. According to the military, 

only 20 percent of all unwanted sexual contact is reported to a military authority. We must find ways to encourage more victims to report sexual assault and harassment. More importantly, we must 

make it so that there are no more victims of military sexual trauma. 

Despite the urgency of this issue, it has taken decades for the 

military and the VA to finally respond. In recent years, both Departments have taken commendable steps. The military has introduced a restricted reporting option that can encourage more victims to seek care. It also completed its long-awaited review of the 

issue by the Defense Department Task Force on Sexual Assault in 

the Military Services. 

For its part, the VA began universally screening all veterans 

seeking care at the VA for MST in 1999 and every VA facility has 

a designated MST coordinator who serves as a point person for 

these issues. The VA provides free treatment to any veteran experiencing health conditions related to MST. However, as is the case 

with other VA health care, not all veterans have access to the care 

that they deserve. 

These steps are an improvement over the years of inaction, but 

more must be done. Victims deserve the very best treatment and 

support that we can provide. 

ebenthall on DSK9Q6SHH1PROD with HEARING

13 

In the interest of time, I would like to concentrate on our top recommendations for how the Subcommittees can best address this 

important issue. You can also find our recommendations in our 

written testimony that was submitted to the Subcommittees and 

our IAVA issue report on women warriors available at our Web 

site. 

First, the VA must do a better job of advertising its MST programs. According to one IAVA member, she did not know until 3 

years after returning from a deployment that the VA provided sexual trauma counseling. In her words, it is well hid and not talked 

about at the VA. 

Even the U.S. Government Accountability Office (GAO) had problems locating information about the VA’s MST program. According 

to the GAO, the VA’s Web site did not provide a complete list of 

facilities that have MST-related treatment programs. 

IAVA believes that no victim should have to chase after their 

own care. 

Second, the VA must expand availability of its specialized sexual 

trauma treatment in inpatient settings. Less than 10 percent of all 

VA medical centers offer inpatient mental health treatment for veterans that have experienced MST or other traumas. This is simply 

unacceptable. 

IAVA recommends that every Veterans Integrated Service Network (VISN) should offer at least one inpatient setting specializing 

in care for MST victims. 

Finally, the VA must ensure that these victims have access to 

preferred treatment settings and providers. Victims should not 

have to settle for mixed-gender treatment options because there are 

no facilities with separate programs for males and females in their 

area. 

According to the GAO, only nine of 153 medical centers nationally have residential treatment programs specifically for women 

suffering from mental health injuries. 

This problem is also evident in outpatient treatment programs. 

According to another IAVA member being treated for MST-related 

conditions, it is difficult to go to appointments when you have a 

full-time job and there are not enough VA counselors to care for all 

of us returning veterans on consistent basis. 

These recommendations are urgent and IAVA encourages you to 

work with the rest of your colleagues in Congress to help make 

them happen. Sexual assault is a violation of military values, values that I hold dear. It undermines the professionalism, the morale, the unit cohesion, and the effectiveness of our men and 

women in uniform. 

Sexual assault is also a crime, a crime that has gone on for far 

too long with too little done to stop it. These victims need justice. 

They need our support and they need the proper care for their 

trauma. 

I am here today on behalf of them all to issue you a call to service in their support. Again, I thank you for the time that you have 

given me to testify in front of this Committee today and I look forward to any questions that you might have. 

[The prepared statement of Sergeant Hunt appears on p. 37.] 

ebenthall on DSK9Q6SHH1PROD with HEARING

14 

Mr. HALL. Thank you, Ms. Hunt, and thank you for your service 

to our country and to our veterans. 

Ms. Bhagwati, you are now recognized. 

STATEMENT OF ANURADHA K. BHAGWATI 

Ms. BHAGWATI. Good morning, Mr. Chairman and Members of 

the Subcommittees. My name is Anuradha Bhagwati and I am a 

former Marine Corps Captain and Executive Director of Servicewomen’s Action Network or SWAN. 

SWAN’s policy work this year focuses largely on reforming DoD 

and VA’s sexual assault and harassment policies and educating the 

public about the epidemic known as MST. 

SWAN’s testimony is based on the collective input of over 120 

MST survivors, MST crisis intervention works and VA health providers. My own experience filing an equal opportunity investigation 

for sexual harassment and discrimination in the Marine Corps, and 

experiences with both VHA and VBA corroborate the input of my 

colleagues and fellow veterans below. 

Unlike the civilian world, MST survivors do not have the option 

of quitting their jobs. They are often stuck working with, nearby, 

or under the supervision of their perpetrators. There is simply no 

guarantee that the chain of command will support survivors if they 

come forward. 

Commanders have consistently ignored equal opportunity and 

sexual assault policies in order to maintain their personnel at full 

capacity. Additionally, commanders have very little incentive to 

prosecute perpetrators as documented incidents in their units reflect poorly on their leadership performance and reputations. 

MST survivors who report an incident are likely to face isolation, 

retribution, or accusations of lying, irresponsibility, or impropriety. 

There is no guarantee of anonymity from the chain of command or 

victims’ advocates and survivors are likely to face the horror of retribution from perpetrators and the anguish of being a target of 

public ridicule, scorn, and further harassment in their respective 

units. 

We cannot honestly expect people to come forward to report and 

it is irresponsible for us or for DoD to suggest that survivors do so 

without guaranteeing their protection first. DoD’s failure to protect 

our servicemembers ought to be the subject for a separate set of 

hearings as there is far too much to say here. 

Suffice it to say that without third-party civilian oversight of sexual assault and harassment cases, survivors will continue to be 

punished, taunted, isolated, or intimidated by their commands for 

speaking out and perpetrators will in most cases go unpunished. 

MST survivors universally describe the horrors of using VA medical centers nationwide. Triggers of one’s assault or harassment are 

everywhere from the prospect of running into your perpetrator, to 

being surrounded by male patients who routinely engage in sexual 

harassment of female patients, to being improperly treated by staff 

members who have no knowledge about the unique experience of 

sexual trauma in a military setting. 

One survivor said to SWAN, I do not want to be fending off advances when I am raw from dealing with my issues in therapy. 

ebenthall on DSK9Q6SHH1PROD with HEARING

15 

Survivors universally say that if they had health insurance, they 

would definitely use private health care instead of the VA. 

Many veterans are ignored, isolated, or misunderstood at VA facilities because their PTSD is not combat related. The veterans 

community still primarily considers PTSD to be a combat-related 

condition to the great detriment of MST survivors. 

Survivors who have used the VA routinely say they are fed up 

with being given endless prescription medication. One Iraq veteran 

described the experience of her MST treatment as nothing but pills 

and pep talks. Many survivors wish they had access to yoga, massage therapy, acupuncture, and gender-specific MST support 

groups. 

I strongly recommend that the Committee give MST survivors 

the option of fee-based care for all treatment, not just MST treatment. At the same time, VHA cannot be let off the hook. VA medical centers ought to have separate facilities for women patients 

generally and easy, safe, and direct access to MST treatment areas 

for both male and female MST survivors. 

With respect to MST residential treatment programs, it appears 

that most MST patients and even many VA providers do not know 

that these programs even exist. Among patients who have attended, several have experienced sexual harassment by staff or fellow patients. 

Also, several programs are collocated with mixed-gender veterans’ programs in which MST patients are not guaranteed privacy 

or safety from other patients of the opposite sex. VA needs to invest in separate facilities for MST programs and guarantee the 

safety and welfare of all participants. 

Filing for disability compensation for MST is universally considered a traumatic, agonizing, and cruel experience. Many survivors 

describe the process of rewriting one’s personal narrative for a VA 

claim and being rejected by VBA as just as traumatic as the original rape or harassment. 

VA claims officers nationwide have proven themselves entirely 

inept when dealing with MST claims. Claims are routinely rejected 

even with sufficient evidence of a stressor and a corroborating diagnosis from a VA health provider. Many survivors’ claims are rejected outright because of VBA’s lack of knowledge about sexual violence in general. 

This Committee needs to understand that until it is safe to report sexual assault or harassment in the military, the majority of 

incidents will not be reported. This bears directly on the unrealistic 

and biased nature of VA claims against veterans living with MST. 

VA must make up for DoD’s failure to protect its own by awarding 

just compensation to survivors. 

Another equal protection issue features prominently in MST 

issues. The do not ask, do not tell policy has allowed perpetrators 

to routinely abuse gays and lesbians who would otherwise report 

harassment or assault. Society has yet to measure the mental 

health impact of this insidious policy on our Nation’s lesbian, gay, 

bisexual, and transgender veterans. We must guarantee access to 

quality health care for all veterans regardless of sexual orientation 

or gender identity. 

ebenthall on DSK9Q6SHH1PROD with HEARING

16 

I must add a special note for our older MST survivors, our mothers, fathers, and grandparents who suffered at the hands of fellow 

servicemen decades ago. Much of their trauma continues to be unrecognized by VA or society. 

One Vietnam era veteran who described MST to us told us please 

help me feel validated before I die. Please honor and validate her 

service and her life by fixing this broken system now. 

Thank you. 

[The prepared statement of Ms. Bhagwati appears on p. 39.] 

Mr. HALL. Thank you, Captain, for your testimony and for your 

service to our country and to our veterans. 

We will, as with the prior panel, submit questions to you. If you 

would be so kind as to answer them in writing, and you are excused with our heartfelt thanks for your testimony, which we will 

be working seriously to address. So this panel is excused. 

And we would like to call our third panel including Kaye Whitley, the Director for Sexual Assault Prevention and Response Office 

(SAPRO), the Office of the Under Secretary for Personnel and 

Readiness, U.S. Department of Defense, accompanied by Clarence 

Johnson, Acting Deputy Under Secretary for Plans, Office of the 

Under Secretary for Personnel and Readiness, DoD; Bradley G. 

Mayes, Director of Compensation and Pension Service, Veterans 

Benefits; Susan McCutcheon, R.N. and Ed.D., Director of Family 

Health and Women’s Mental Health and Military Sexual Trauma 

Services, Veterans Health Administration, U.S. Department of VA, 

accompanied by Rachel Kimerling, Ph.D., Director, Monitoring Division of the National Military Sexual Trauma Support Team of the 

Veterans Health Administration at the VA; Patty Hayes, Ph.D., 

Chief Consultant, Women Veterans Health Strategic Health Care 

Group of the Veterans Health Administration, U.S. Department of 

Veterans Affairs. 

Welcome, all of you, and your complete statements are made a 

part of the record. 

Dr. Whitley, you are now recognized for 5 minutes. 

ebenthall on DSK9Q6SHH1PROD with HEARING

17 

STATEMENTS OF KAYE WHITLEY, ED.D., DIRECTOR, SEXUAL 

ASSAULT PREVENTION AND RESPONSE OFFICE, OFFICE OF 

THE UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND 

READINESS, U.S. DEPARTMENT OF DEFENSE; ACCOMPANIED 

BY CLARENCE JOHNSON, ACTING DEPUTY UNDER SECRETARY OF DEFENSE FOR PLANS, OFFICE OF THE UNDER 

SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS, 

U.S. DEPARTMENT OF DEFENSE; BRADLEY G. MAYES, DIRECTOR, COMPENSATION AND PENSION SERVICE, VETERANS 

BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND SUSAN MCCUTCHEON, R.N., ED.D., DIRECTOR, FAMILY SERVICES, WOMEN’S MENTAL HEALTH 

AND MILITARY SEXUAL TRAUMA, OFFICE OF MENTAL 

HEALTH SERVICES, VETERANS HEALTH ADMINISTRATION, 

U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED 

BY RACHEL KIMERLING, PH.D., DIRECTOR, MONITORING DIVISION, NATIONAL MILITARY SEXUAL TRAUMA SUPPORT 

TEAM, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND PATTY HAYES, PH.D., 

CHIEF CONSULTANT, WOMEN VETERANS HEALTH STRATEGIC HEALTH CARE GROUP, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF KAYE WHITLEY, ED.D. 

Ms. WHITLEY. Thank you. 

Chairman Michaud and Chairman Hall, Ranking Members 

Brown and Lamborn, and Members of the Subcommittees, thank 

you for inviting me today to discuss the progress the Department 

of Defense has made in recent years on caring for victims of sexual 

assault. 

The reason for our commitment is clear. Sexual assault levies a 

tremendous human toll, disrupts lives, and destroys the human 

spirit. In the military, it destroys unit cohesion and affects military 

readiness. 

And as I say at each hearing, we always try to keep in mind that 

behind all of the statistics that you hear, there is always an individual, a victim whose life has changed forever. 

I would like to start by mentioning a few issues to ensure that 

my role is clear. The term military sexual trauma was created by 

Congress for the Department of Veterans Affairs to address the 

physical and mental problems stemming from both sexual assault 

and sexual harassment. 

The office I represent is tasked with policy related to the crime 

of sexual assault. Our policy was signed just in 2005. So while all 

reports of sexual assault are of great concern to us, we are especially focused on incidents that have occurred after 2005 so that we 

can identify any necessary changes for our policy. 

In my written testimony, I provided a detailed account of our 

program and our collaboration with civilian and Federal partners. 

And given the scope of the issues faced by your two Subcommittees, 

I want to take this opportunity to highlight our collaboration with 

the Department of Veterans Affairs. 

One of the key areas of collaboration relates to documentation. 

In 2007, we contacted the staff of the Veterans Benefits Adminisebenthall on DSK9Q6SHH1PROD with HEARING

18 

tration to brief them on our victim preference reporting form 

known as DD–2910. This is the form servicemembers use to indicate if they would like to file an unrestricted report, which leads 

to commander notification and can initiate an investigation or a 

servicemember may use this form to indicate a preference to file a 

confidential report which allows them access to care without an investigation and command notification. 

Based on our discussions with the VBA, servicemembers can now 

use this form as evidence of reporting of sexual assault. This is another reason we work tirelessly to reduce the stigma of reporting. 

We want victims to come forward and report so that they can get 

the care as well as have documentation they may need later. 

While treatment for sexual assault in a VA facility does not require this document, disability evaluations require some kind of 

evidence in the military record. Our form is not typically part of 

the military record provided to the VA for disability evaluation. 

However, it can be submitted by victims as part of their paperwork 

for a disability evaluation process. 

Just as the DD–214 is the main basis for proof of military service, we would like the DD–2910 to be universally accepted of proof 

that a victim made a report of sexual assault. 

There is more our two Departments can do together to assist victims of sexual assault, but we need assistance in removing at least 

one barrier to collaboration and that is State mandatory reporting 

laws. 

Servicemembers in the State of California do not have the option 

of restricted reporting. We would welcome the opportunity to discuss this further with your staff and the VA. This is a challenge 

we need help in resolving. 

I would like to share one last thought. Each day, our servicemembers dedicate their lives to protecting our country and they deserve no less than the very best care and support in return. And 

that is why it is so important that we work together to make this 

program the best it can be. 

Again, thank you for your time and opportunity to testify today. 

[The prepared statement of Dr. Whitley appears on p. 41.] 

Mr. HALL. Thank you, Dr. Whitley. 

Mr. Mayes, you are now recognized. 

STATEMENT OF BRADLEY G. MAYES 

Mr. MAYES. Chairman Hall, Chairman Michaud, Members of the 

Subcommittees, thank you for providing me the opportunity to 

speak today about how the Department of Veterans Affairs assists 

veterans who have been subjected to military sexual trauma while 

serving their Nation in uniform. 

Dr. Susan McCutcheon, who is sitting to my left, will also provide brief oral remarks on this subject. We are accompanied by Dr. 

Rachel Kimerling, Director of the Monitoring Division of the National Military Sexual Trauma Support Team in the Veterans 

Health Administration, and Dr. Patty Hayes, Chief Consultant for 

the Women Veterans Health Strategic Health Care Group. 

In both civilian and military settings, women and men can experience a range of unwanted sexual behaviors. Within the VA, these 

sorts of experiences are described as military sexual trauma, the 

ebenthall on DSK9Q6SHH1PROD with HEARING

19 

overarching term used to refer to experiences of sexual assault or 

repeated threatening acts of sexual harassment. 

It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself. Given the 

range of distressing sexually-related experiences and crimes that 

veterans report, it is not surprising that there are a wide range of 

emotional reactions that veterans have in response to these events. 

Among users of VA health care, medical record data indicate that 

diagnoses of post-traumatic stress disorder, depression, and other 

mood disorders, psychotic disorders, and substance use disorders 

are most frequently associated with MST. 

Fortunately, people can recover from experiences of trauma and 

VA has services to help veterans do this. Dr. McCutcheon will discuss these services in greater detail in her remarks. 

Additionally, VA provides compensation payments for serviceconnected disabilities that are related to MST while serving in the 

military. As previously stated, MST may result in a number of disabling physical and mental conditions, but with respect to benefit 

claims most often manifest itself as PTSD. 

In order to better assist those veterans with PTSD claims based 

on military sexual trauma, VA promulgated special regulations at 

38 CFR Section 3.304(f)(4) in 2002. This rule change emphasized 

that if a PTSD claim is based on in-service personal assault which 

includes military sexual trauma, evidence from sources other than 

a veteran’s service, treatment, and personnel records may corroborate the in-service traumatic event. 

The change effectively lowered the evidentiary burden for veterans of either sex to prove their PTSD claim based on military 

sexual trauma. This change was made in recognition of the fact 

that oftentimes there is little or no evidence specially describing an 

MST encounter or encounters in the military. 

Therefore, we accept markers or indicators that support the veteran’s contentions. Such evidence may include but is not limited to 

records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals or physicians, pregnancy 

tests or tests for sexually transmitted diseases, and statements 

from family members, roommates, fellow servicemembers, or clergy. 

In addition, evidence of behavior changes following the claimed 

assault constitutes another source of relevant evidence. Examples 

of such behavior changes include but are not limited to a request 

for a transfer to another military duty assignment, deterioration in 

work performance, substance abuse, episodes of depression, panic 

attacks, or anxiety without an identifiable cause, or unexplained 

economic or social behavior changes. 

The regulation prohibits the denial of claims for service-connection for PTSD based on in-service personal assault without first advising the veteran that information from sources other than the 

veteran’s service records or evidence of behavior changes may constitute credible evidence of the stressor and allowing the veteran 

an opportunity to furnish this type of evidence or advise VA of potential sources of such evidence. 

The regulation also provides that VA may submit any evidence 

it receives to an appropriate medical or mental health professional 

ebenthall on DSK9Q6SHH1PROD with HEARING

20 

for an opinion as to whether it indicates that a personal assault 

may have occurred. 

VBA field personnel who adjudicate PTSD claims based on MST 

were provided with detailed information on proper claims processing methods in a training letter issued in November 2005. Additionally, all VBA Regional Offices have a woman veterans’ coordinator who is well versed in MST issues and can provide assistance 

to veterans as necessary. 

These procedural steps taken by VA assure that veterans filing 

claims for their PTSD based on military sexual trauma will receive 

fair and thorough consideration of their claims. 

We recognize the damage that MST can inflict on its victims and 

we have developed policies in response that do make it easier to 

establish entitlement to benefits based on disability as a result of 

MST. 

I believe that there is room for us to make improvements, but we 

have taken steps. 

Mr. Chairman, thank you again for the opportunity to appear before you today. And at this time, I will turn to my colleague from 

the Veterans Health Administration who can elaborate on their efforts to assist veterans suffering from MST-related conditions. 

Mr. HALL. Dr. McCutcheon? 

STATEMENT OF SUSAN MCCUTCHEON, R.N., ED.D. 

Dr. MCCUTCHEON. Good morning. 

Chairman Hall, Chairman Michaud, Ranking Members Lamborn, 

Brown, and Members of the Subcommittees, thank you for the opportunity to appear to discuss VA’s work in identifying and treating veterans for conditions related to military sexual trauma or 

MST. 

Addressing the needs of survivors of sexual assault and harassment in the military is a priority for the VA. It is a tragic fact that 

many veterans suffered sexual trauma while serving on active military duty. 

Some are still struggling with fear, anxiety, shame, or profound 

anger as a result of these experiences. A number of individuals 

have never discussed their experiences or their feelings with anyone and they are understandably reluctant to talk about them now. 

MST includes any sexual activity where someone is involved 

against his or her will. He or she may have been pressured into 

sexual activities, may have been unable to consent to sexual activities, or may have been physically forced into sexual activities. 

Other experiences that fall into the category of MST include repeated, unsolicited verbal or physical conduct of a sexual nature 

that is threatening in character. 

If these horrific experiences occurred while an individual was on 

active duty or active duty for training, they are considered to be 

MST. 

It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself. Among users 

of VA health care, medical record data indicate that diagnoses of 

post-traumatic stress disorder, depression and other mood disorders, psychotic disorders, and substance use disorders are most 

frequently associated with MST. 

ebenthall on DSK9Q6SHH1PROD with HEARING

21 

Even after severely distressing experiences, there is no one way 

that everyone will respond. For some veterans, experiences of MST 

may continue to affect their mental and physical health even many 

years later. 

Fortunately, people can recover from experiences of trauma and 

VA has services to help veterans do this. All veterans seen at a VA 

facility are asked two questions, one to assess sexual harassment 

and the other to assess sexual assault that occurred during their 

military service. 

Veterans who respond yes to either question are asked if they 

are interested in learning about MST-related services that are 

available. Not every veteran who responds yes needs or is necessarily interested in treatment. 

The VA MST screening rates only reveal how many men and 

women that seek VA health care report MST, not the actual incidence of sexual trauma among those serving in the military. 

VA data indicates that approximately one in five women and one 

in a hundred men seen in VHA respond yes when screened for military sexual trauma. 

Although rates of MST are higher among women, because of the 

disproportionate ratio of men to women in the military, there are 

actually only slightly fewer men seen in VA who have experienced 

MST than women. 

Since 1992, VA has been developing programs to monitor MST 

screening and treatment, providing staff with training on MST-related issues, and engaging in outreach to veterans who have experienced MST. 

VA established a national level MST support team in fiscal year 

2007 to achieve these objectives and promote best practices in care. 

Currently all veterans seen in VA are screened for MST. Every 

VA facility has a designated MST coordinator and has providers 

knowledgeable about treatment for MST. And VA offers both inpatient, residential, and outpatient services as needed. 

VA also collaborates with others including the Department of Defense Sexual Assault Prevention and Response Office or SAPRO to 

discuss treatment approaches for individual veterans and servicemembers. 

At the local level, many VA facilities have established partnerships with the local military installations to provide additional support and to improve outreach and awareness of MST. 

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

[The prepared statement of Mr. Mayes and Dr. McCutcheon appears on p. 47.] 

Mr. HALL. Thank you, Ms. McCutcheon. 

Unfortunately, we will have to have you answer those in writing 

because the Joint Session is convening across the street. 

Mr. Michaud, you are now recognized. 

Mr. MICHAUD. Thank you, Mr. Chairman. 

And I, too, want to thank the three panels for your testimony 

this morning. It has been very enlightening. I appreciate your coming forward. 

And I want to thank the Chairman as well. 

ebenthall on DSK9Q6SHH1PROD with HEARING

22 

Unfortunately, because the President of Mexico is here, we are 

not able to ask questions today, but we will be submitting for the 

record several questions for the witnesses. My question will be 

more for DoD since that is where the problem usually starts, before 

veterans end up in the VA system. I am very curious about what 

have been some of the repercussions of what the predators have 

done, whether all they have received is a slap on the wrist or 

whether they have been honorably discharged or lose their retirement or another punishment. 

I want to thank all of you for coming today and look forward to 

your response to our questions in writing. And thank you for your 

services to those who have served. And thank you to the audience 

as well, for those who decided to come here today. Thank you for 

your service. 

This is a very serious issue and I know the Chairman and I will 

be taking it very seriously and be looking forward to your input as 

we move forward with legislation to address this serious problem. 

Once again, thank you. 

And I yield back, Mr. Chairman. 

Mr. HALL. Thank you, Chairman Michaud. 

Thank you again to our third panel and all of our panels today. 

I regret that we have to have this hasty process. And please do not 

think that it means that we do not care as deeply about this issue 

as you do. 

I want to acknowledge that we are submitting a statement for 

the record from Denise Williams, the Assistant Director of the Veterans Affairs and Rehabilitation Commission of the American Legion, and a statement by Dr. Beth Kosiak of the American 

Urological Association for the record of this hearing as well all 

Members having 5 days to revise and extend their remarks. 

And we will submit questions for you and look forward to receiving your answers in writing. 

So, on behalf of the Subcommittees, thank you for your insight 

and your recommendations. 

And this hearing stands adjourned. 

[Whereupon, at 11:08 a.m., the Subcommittees were adjourned.] 

ebenthall on DSK9Q6SHH1PROD with HEARING

(23) 

A P P E N D I X 

Prepared Statement of Hon. John J. Hall, Chairman, 

Subcomittee on Disability Assistance and Memorial Affairs 

Good Morning Ladies and Gentleman: 

Would everyone please rise for the Pledge of Allegiance? Flags are located at the 

front and back of the room. 

I am grateful for the opportunity to be here today for a joint hearing entitled, 

Healing the Wounds: Evaluating Military Sexual Trauma Issues, with my colleagues, Health Subcommittee Chairman Michaud, and our Ranking Members, Mr. 

Lamborn and Mr. Brown. But, I am particularly enthusiastic to recognize the men 

and women veterans who are in this room today and to hear about their experiences 

with the Department of Veterans Affairs and DoD as it relates to Military Sexual 

Trauma Issues (MST). 

The purpose of this hearing today is to evaluate ways in which the Veterans Benefits Administration (VBA), Veterans Health Administration (VHA), and the Department of Defense (DoD) can better address the needs of veterans impacted by Military Sexual Trauma (MST) and identify ways to better prevent, treat and properly 

compensate them. 

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. MST 

can also disrupt the career goals of many of its victims, as perpetrators are frequently peers or supervisors responsible for the decisions on work-related evaluations and promotions. This means that victims must choose between continuing 

their military careers at the expense of frequent contact with their perpetrators or 

ending their careers in order to protect themselves. Many victims share that when 

they do report the incident, they are not believed or are encouraged to keep silent 

because of the need to preserve organizational cohesion. 

The National Center for PTSD of the Department of Veterans Affairs (VA) reports 

that in 1995, the Department of Defense (DoD) conducted a large scale study of sexual victimization among its active duty population. This DoD study found that the 

rates of attempted or completed sexual assault were 6 percent for women and 1 percent for men. Another study found that rates of sexual assault and verbal sexual 

harassment were higher during wartime than peacetime in their sample study population. This suggests that the stress of war may be associated with increases in 

rates of sexual harassment and assault. The National Center for PTSD also reports 

that the rates of MST among the veteran population who use the VA health care 

system appear to be even higher than that of the general military population. One 

study found that 23 percent of female users of the VA health care system reported 

having experienced sexual assault while in the military. 

MST has been a concern among many veterans who have continually expressed 

frustration with the disability claims process, especially in trying to prove to the VA 

that the actual assault ever happened. For many women and men, when their disability claims for PTSD related to MST are denied, they suffer a secondary injury, 

which results in an exacerbation of PTSD symptoms. Thus, they are less likely to 

file an appeal. 

There also has been frustration with the lack of appropriate health care providers 

to treat veterans who have experience working with MST. 

We cannot allow this to happen to this Nation’s veterans who have served her. 

VA and DoD need to ensure that the proper treatment is available. Veterans should 

be able to have access to treatment facilities and qualified staff with care and benefits delivered by employees who are properly trained to be sensitive to MST related 

issues. These veterans need to be treated with the dignity and respect that they deserve. 

ebenthall on DSK9Q6SHH1PROD with HEARING

24 

I look forward to hearing from the esteemed panels of witnesses assembled today 

as we attempt to heal the wounds of these veterans and get them the proper treatment and benefits without unnecessary delay. 

f 

Prepared Statement of Hon. Doug Lamborn, Ranking Republican Member, 

Subcommittee on Disability Assistance and Memorial Affairs 

Thank you Mr. Chairman, 

I welcome our witnesses to this important hearing to discuss matters concerning 

military sexual trauma. 

Occurrences of sexual assault within the ranks of our military are completely unacceptable. 

It saddens me to think that anyone who volunteers to protect our Nation through 

service in the armed forces would ever have to contemplate being harmed by a fellow servicemember. 

But our military is a microcosm of society—and crimes that occur in society unfortunately also occur in the military—so we must face reality and address the problems that arise. 

First, it should be made clear through training at every level and to every servicemember that sexual offenses will not be tolerated and that perpetrators will be punished to the fullest extent under the Uniform Code of Military Justice. 

Second, the military services should follow through and ensure that justice is rendered in cases involving sexual assault. 

And I would also add that the military must thoroughly investigate and prosecute 

false accusers of sexual assault who work to the detriment of those individuals who 

really are victims of sexual assault. 

While it is important that we deliberate on the very serious topic of military sexual trauma, I want to also make very clear that this is not an indictment of our 

military as a whole. 

There are those with anti-military views who would try to use incidences involving sexual assault to depict our entire military as a bunch of violent misogynists. 

Doing so would be a vulgar smear against the heroes this committee serves. 

I’m sure the families of the young men who died in Afghanistan this past week 

during the attack on Bagram (bah-GRAHM’) Air Field would find such a generalization offensive, and I share their perspective. 

The vast majority of the men and women who volunteer for military service are 

honorable and patriotic individuals who courageously stand to defend our country 

and other countries from tyranny. 

They are some of our bravest citizens who abhor bullies and the type of individuals who would commit such a repugnant crime as sexual assault. 

As far as this topic pertains to VA benefits, I believe the Department has the 

proper rules in place for adjudicating and rating sexual trauma cases. 

Title 38 United States Code section 1154 provides VA the authority to give proper 

consideration to the time, place and circumstances, of service when determining eligibility to compensation. 

This means that VA must consider non-specific, but corroborating pieces of evidence when considering claims based on sexual assault. 

As some of our witnesses point out—this does not always occur and VA should 

address this shortcoming through training to ensure proper consideration is afforded 

to every claim. 

I appreciate the DAV’s point that VA should be able to access the restricted DoD 

records documenting reports of sexual trauma. 

I look forward to learning whether such a policy is in place or being established 

to secure such records. 

I want to thank all of our witnesses for their participation and their testimony, 

and I look forward to our discussion today. 

Mr. Chairman, I yield back. 

f 

ebenthall on DSK9Q6SHH1PROD with HEARING

25 

Prepared Statement of Hon. Michael H. Michaud, 

Chairman Subcommittee on Health 

Good morning. I would like to thank everyone for attending today’s hearing on 

military sexual trauma. 

I am happy to join my colleagues, DAMA Subcommittee Chairman Hall and our 

Ranking Members Mr. Brown and Mr. Lamborn, in holding this joint hearing. 

Servicemembers who experience military sexual trauma and are brave enough to 

speak out about their experiences are often marginalized and for many, it means 

the end of their military career while their offenders often times remain unscathed. 

We must do better by the women and men who experience military sexual trauma. 

Last May, the House Committee on Veterans’ Affairs held a roundtable discussion 

with women veterans representing veteran service organizations and their auxiliary 

organizations. During the roundtable discussion, military sexual trauma was a commonly cited concern and the participants expressed their frustration with the shortage of appropriate health care providers to treat veterans with military sexual trauma. I am proud to say that just last month, S. 1963, the Caregivers and Veterans Omnibus Health Services Act, was enacted as Public Law 111–163. This landmark legislation included important provisions from H.R. 1211, the Women Veterans Health 

Care Improvement Act, which was introduced by Ms. Stephanie Herseth Sandlin. 

Among the key provisions, VA would be required to provide training and certification for VA mental health care providers on caring for veterans suffering from 

sexual trauma and PTSD. 

As we build a VA for the 21st century, we must ensure that it embraces the growing and unique needs of our women veterans. I am pleased to join my colleagues 

in the DAMA Subcommittee to explore ways that we can better support veterans 

with military sexual trauma. 

I look forward to hearing the testimonies of our witnesses today. 

f 

Prepared Statement of Phyllis Greenberger, President and Chief Executive 

Officer, Society for Women’s Health Research 

Mr. Chairman and Members of the Committees: 

I would like to begin by thanking you for calling this joint hearing on Military 

Sexual Trauma. I appreciate the opportunity to address both committees on this important and timely topic. I am Phyllis Greenberger, the President and CEO of the 

Society for Women’s Health Research. SWHR is a non-profit patient advocacy organization dedicated to improving women’s health through advocacy, education, and 

research of sex and gender differences. 

SWHR’s focus since 1995 has been to clearly demonstrate that sex and gender differences exist, and research needs to be done to explore conditions that affect 

women differently, disproportionately, or exclusively—to identify these differences 

and to understand the implications for diagnosis and treatment. 

Research into this area comes at a time of great need within the Department of 

Veterans Affairs (VA), as today over 10 percent of the military presence in Iraq and 

Afghanistan is female. As the Department of Defense (DoD) continues to work to 

integrate an ever-larger female presence among active military, the VA sees a comparable rise in numbers of female veterans seeking care after their time of service, 

for both service-related and non-service-related care. Women are the fastest growing 

sector of VA patients. Over 450,000 women have enrolled with VA medical centers 

for care, and that number is projected to rise by 30 percent in the next 5 years. 

The pressing issues that bring us here today are the risks and ramifications 

of military sexual trauma, or MST. 

The statistics on risk are well known. MST victims are disproportionately and almost exclusively women. A 2008 VA study reported that 15 percent of military 

women in Iraq and Afghanistan experienced sexual assault or harassment, and 59 

percent of those were at higher risk for mental health problems. This is just among 

those cases reported. Many more, possibly more than half, of all MST cases go undocumented each year. 

The ramifications of MST for women persist long after the initial assault. While 

sexual assault in any setting is horrific, the combined insult of MST occurring while 

serving in a foreign setting, often in an active war zone, only exacerbates the effects. 

By VA estimates, over 70 percent of women in the military have been exposed to 

combat. Further, with most MST assaults being orchestrated by military personnel 

against military personnel, the environment of trust among those serving is broken, 

ebenthall on DSK9Q6SHH1PROD with HEARING

26 

and a chain of command that fails to protect from and respond to MST further degrades unit cohesion. 

Research in the area of MST and sexual assault has revealed some interesting 

sex-based differences: 

First, women are more likely then men to contract a sexually transmitted infection, or STI. STIs are often more difficult to treat in women and can have emotional 

and mental impacts over a woman’s lifespan. Sexual assault can result in an unplanned pregnancy or conversely leave a woman unable to bear children in the future. The impacts of MST are not limited to reproduction. Infection with HPV after 

a sexual assault can result in cancer decades later in life. Scientists studying HIV 

in women found the virus enters and infects the cells of the vaginal wall in a way 

different from how the virus is introduced into male cells. 

Second, sexual assault is a common trigger for post-traumatic stress disorder, 

months and even years after the attack. Scientists are finding that women do not 

respond the same to some of the common medications prescribed for PTSD, often 

fairing worse than men taking the same medication for the same diagnosis. 

Third, multiple traumas can increase the likelihood of developing PTSD, and the 

combined impacts of working in a war zone, multiple deployments, MST, and for 

a disproportionate share of female military members, exposure to early life trauma, 

all raise the risk for an eventual PTSD diagnosis. Females in the military have 

twice the levels of PTSD and depression as their male counterparts. 

Fourth, research suggests that the ultimate impact of a traumatic event on a 

woman may depend on hormone levels, and can vary based on where she is in her 

menstrual cycle and whether or not she uses medications that alter hormone levels, 

such as birth control. The role of cyclical hormonal variations, as well as studies 

finding that during pregnancy PTSD symptoms decrease, may offer insight into 

which women develop PTSD after MST, and may further help discover more effective PTSD therapies for women—therapies that are responsive to sex-based hormonal differences. More research is critical for moving forward and determining targeted treatments for women and men. 

The VA in 2010 is in a unique position to better serve its female veterans, at the 

same time becoming a leader in women’s health and sex based research. Changes 

in care can only come from sound research, and investments in VA research often 

translate into new knowledge, methods, screenings, and treatments for women and 

men, military and civilian. As discussed before this Committee 1 year ago today, 

the VA system faces staffing, organizational, and infrastructure challenges when updating to meet the needs of the growing female veteran population. The VA still has 

a long way to go. Reports as recent as March 2010 are still finding deficiencies in 

the availability of resources for female veterans. From providing gender-specific care 

at all VA Medical Centers to including female subjects in the VA’s Health Services 

Research and Development, the VA with proper support and resources can transform to what is needed today and what is needed for the future. 

SWHR would like to encourage the VA to optimize its interactions with female 

veterans, by offering women the option to participate in research projects—receiving 

a high quality of care while gathering information to help other female veterans. 

The health information technology capabilities that link all VA medical centers, and 

each veteran’s medical and personnel charts, offers unmatched capabilities for research. The VA is to be praised for its electronic medical records system, and encouraged to utilize it to its full capacity. Further, increasing collaboration between 

the DoD and the VA would additionally offer an improved continuum of care, as 

women transition from active duty to veteran status. A victim of MST during her 

time of service needs streamlined care after she returns, as well as a VA system 

that is equipped to meet her sex and gender specific needs. For the female veterans 

who choose to seek care outside of the VA setting, private clinicians also depend on 

the research and clinical guidance only the VA can provide—capturing the nuances 

specific to military service, combat exposure, and MST faced by female veterans. 

The VA alone can pull together these details and offer direction to help all clinicians 

make sound choices for their female veteran patients, and all women. 

While I hope that I have made clear the need for more investments in the VA 

and sex based research, SWHR further hopes that these recommendations will be 

acted upon quickly. I encourage the VA and these committees to consider the potential impact of appropriate research into women’s health and the wide reaching results that could improve sex-based research as well as mental and sexual health for 

all. The VA today has a unique opportunity to champion the cause of women’s 

health research—not only for veterans, but for all patients. 

ebenthall on DSK9Q6SHH1PROD with HEARING

27 

i L.N. Rosen and L. Martin, ‘‘The measurement of childhood trauma among male and female 

soldiers in the U.S. Army,’’ Military Medicine 161 (1996): 6, 342–345. 

I want to again thank you for this opportunity to present to the Committee. I 

would be pleased to answer any questions. 

f 

Prepared Statement of Helen Benedict, Professor of Journalism, 

Columbia University, New York, NY, and Author, The Lonely Soldier: The 

Private War of Women Serving in Iraq 

Thank you for holding this hearing and honoring me with an invitation to testify. 

First, I would like to commend the Caregivers and Veterans Omnibus Health 

Services Act, signed by President Obama just this month, as an essential step toward helping female veterans and the families of wounded warriors. 

This Act takes an important step toward addressing the horrendous problem of 

military sexual assault by requiring the VA to train mental health professionals to 

care for women with sexual trauma. 

This is progress. Yet I am concerned that the training be done properly. For my 

book, The Lonely Soldier, I interviewed more than 40 female veterans of our current 

wars. Too often they told me that when they tried to report an assault, the military 

and VA treated them as liars and malingerers. 

They also told me that their Sexual Assault Response Coordinators, assigned to 

them by the military, often treated them with such suspicion that they felt re-traumatized and intimidated out of pursuing justice. Indeed, the usual approach to a 

report of sexual assault within the military is to investigate the victim, not the perpetrator, and to dismiss the case altogether if alcohol is involved. Counselors have 

told me of seeing case after case where a battered and abused victim has been told, 

‘‘It’s your word against his.’’ 

It is therefore essential that the counselors used by the military and the VA be 

trained in civilian rape crisis centers, away from a military culture that habitually 

blames the victim, and that is too often concerned with protecting the image of a 

platoon or commander by covering up wrongdoing. These counselors, and indeed 

anyone within the military charged with investigating sexual assault, should be 

trained to understand the causes, effects and costs of sexual abuse to both the victim and to society. 

Within the VA, reform is also needed. The process for evaluating disability caused 

by military sexual assault needs to be automatically upgraded. And victims who 

were too intimidated to report an assault while on active duty should never be denied treatment once they come home, as they so often are now. The VA needs to 

recognize the fact that some 90 percent of victims never report assaults within the 

military because its culture is so hostile to them. The VA must also recognize and 

address the fact that it can take years to recover from sexual assault, and that untreated trauma caused by sexual assault can result in depression, homelessness, 

self-destructive behavior, and suicide. No victim of military sexual assault should 

ever be denied benefits and help. 

In the light of the new Caregiver’s Act, I also want to alert this committee to the 

finding that many of our troops were sexually or physically abused long before they 

enlisted. 

In two studies of army and marine recruits, conducted in 1996 and 2005 respectively, it was found that half the women and about one-sixth of the men reported 

having been sexually abused as children, while half of both said they were physically abused.i

The picture may have shifted lately with the recession driving more people into 

the military. Nonetheless, it looks as if close to half our troops are enlisting to escape violent homes. 

Thus we need to provide counselors trained not only in military sexual assault 

but in childhood abuse and trauma. These counselors should be available to active 

duty troops and veterans. They should embedded with the combat stress counseling 

teams already deployed. 

ebenthall on DSK9Q6SHH1PROD with HEARING

28 

ii A. Nicholas Groth and H. Jean Birnbaum, Men Who Rape: The Psychology of the Offender 

(New York: Plenum Press, 1979). 

Jessica Wolfe, Kiban Turner, et al. ‘‘Gender and Trauma as Predictors of Military Attrition: 

A Study of Marine Corps Recruits,’’ Military Medicine 170(2005): 12, 1037. iii According to a 2008 DoD report, some 27 percent of men in the reserves and national guard 

reported sexual trauma in the military. Department of Veterans Affairs, ‘‘Military Sexual Trauma Among The Reserve Components Of The Armed Forces.’’ iv Sadler, et al. ‘‘Factors Associated With Women’s Risk of Rape in the Military Environment.’’ 

(2003). v ‘‘Conduct Unbecoming’’ by Cathy Booth Thomas, Time magazine, http://www.time.com/time/ 

magazine/article/0,9171,428045,00.html. 

‘‘Military Sex Scandals From Tailhook to the Present: The Cure Can be Worse Than the Disease.’’ By Kingsley R. Browne, Duke Journal of Gender Law & Policy, Volume 14:749 2007. 

This is necessary not only to help troops cope with trauma, but to help prevent 

further sexual violence. Psychologists have long known that an abused boy can grow 

into an abusive man.ii

I emphasize this because too often the focus when addressing military sexual 

trauma is on women alone, ignoring the fact that men cause the problem, and that 

they, too, are sexually assaulted in the military.iii

Violence is endemic to the military, and little can be done about that. But our 

troops are not supposed to be enacting this violence on one another. The last chapter of my book offers a list of suggestions for how to at least decrease military sexual violence. These are too numerous to list here, but I include some essential examples: 

• Promote more women. With more recognition and authority, women will help 

to increase respect for female troops, and respect is the single most important 

weapon against harassment and rape. • Distribute women more evenly. No women should serve alone with all-male platoons, as they sometimes do now, for it leaves them isolated and vulnerable to 

assault. • Strike the ‘‘Don’t Ask, Don’t Tell’’ policy, which encourages persecution of men 

and women, gay or not. • Reject recruits with records of domestic or sexual violence. • Hold commanders accountable for assaults that occur in their units. • And reward commanders and officers who pursue justice in cases of sexual assault. 

Finally, let us recognize that more effective than any rules or laws is the attitude 

of the commander on the ground. Studies have shown that commanders who treat 

their female soldiers with respect and insist that other soldiers do likewise significantly reduce sexual persecution.iv Thus we must reform the culture within officer 

academies, which at the moment is rife with brutal hazing, abuse, and rape, as the 

Tailhook, Aberdeen and Air Force Academy scandals have too often demonstrated.v

This violence drums women out of the service and trains men to enact and condone 

rape and torture. 

All officer training schools for all military branches should teach their candidates 

to understand that rape is an act of anger, hatred, and power, not desire, and that 

sexual persecution destroys camaraderie and cohesion. Officers should learn to take 

pride in ensuring their troops are safe from disrespect and violence from their comrades, just as they take pride in bringing them home safely from war. 

Thank you. 

f 

Prepared Statement of Scott Berkowitz, President and Founder, 

RAINN—Rape, Abuse, and Incest National Network 

Good afternoon Chairmen Hall and Michaud, Ranking Members Lamborn and 

Brown, and distinguished Members of the Subcommittee on Disability Assistance 

and Memorial Affairs and the Subcommittee on Health. Thank you for the invitation to participate in today’s hearing on military sexual trauma. 

My name is Scott Berkowitz and I am the founder and president of the Rape, 

Abuse & Incest National Network, or RAINN. RAINN, the Nation’s largest anti-sexual violence organization, founded and operates the National Sexual Assault Hotline. The hotline is a partnership of 1,100 local rape crisis centers across the U.S., 

and has provided free, confidential counseling and support to more than 1.4 million 

victims of sexual violence. We also run the National Sexual Assault Online Hotline, 

a web-based service that provides help to the generation of victims who are more 

ebenthall on DSK9Q6SHH1PROD with HEARING

29 

comfortable typing than talking. RAINN also educates more than 120 million Americans each year about sexual assault prevention, prosecution and recovery. 

When I first testified to Congress on this issue, about 6 years ago, a DoD task 

force had just published an exhaustive study of the problem. Unfortunately, that 

wasn’t an uncommon occurrence, as one of your colleagues vividly demonstrated 

when she lined up the reports from more than a dozen DoD task forces from the 

preceding two decades. 

Most of these task force reports had shown an understanding of the issue and proposed a number of reforms that would help address the problem. And all had been 

shelved soon afterwards, left undisturbed until the next commission was created 

and its staff started searching through the archives. While there were many smart, 

committed people within the military services who had worked for years to address 

the sexual assault problem, they lacked the institutional support, leadership commitment and resources to fix it. 

So while we were hopeful about the 2004 report, optimistic that this time would 

be different, the odds weren’t on our side. 

The good news is: it looks like this time we may have a chance to beat the odds. 

That’s not to say that the problem has been solved—in fact, we’re a long, long way 

from that. But over the last 6 years, I have been pleased to observe that the Pentagon, led by SAPRO and the services, has taken the problem seriously and made 

some tangible progress. 

The Problem in Context 

To understand the remaining challenges, we need to understand the problem in 

context. In one sense, the military isn’t unique. Nationally, about 80 percent of all 

rape victims are under age 30. So the problems faced by the military are, in fact, 

quite similar to those faced by large colleges and universities. It is unfortunate, but, 

for the moment, true: 

Where there are many thousands of young people, there are surely a large number of rape victims. While there’s no question military culture is unique—and presents unusual challenges to providing services for victims—that unique culture itself 

is certainly not the cause of the sexual assault problem. 

Much research, and our own experience serving rape victims, has shown us that 

they respond to their crime quite differently from victims of other crimes. Mental 

health professionals widely agree that rape is the most traumatic violent crime. The 

FBI ranks it as the second most violent crime, trailing only murder. In other words, 

it is the most violent and traumatic crime a victim lives to remember. 

And remembering comes naturally to victims of rape. Sexual assault can be devastating to victims, causing post-traumatic stress disorder, depression, eating disorders, sleeplessness and other mental health issues. Victims, particularly those 

who do not get help, are many times more likely to become addicted to drugs or 

alcohol or even to attempt suicide. Embarrassment and shame are near universal. 

In the civilian world, these reactions help explain why most rape victims are so 

reluctant to report their attack to police, or even to their own friends and family. 

While the percentage of civilian rates that are reported to police has increased by 

one-third in the last 15 years, the majority of victims—about six out of 10—still do 

not report. 

Now, add to this mix the fact that in the military, filing an unrestricted report, 

the kind of report that could lead to prosecution, will mean that everyone knows— 

and I do mean everyone, from your superiors to your bunkmates. And add in the 

fear of retaliation or ostracization, and the fear of the impact it might have on your 

career, which only serve to amplify the resistance to reporting. If most civilian victims are unwilling to report even without all those extra concerns, without the fear 

of sabotaging their career, it’s going to remain difficult to get military victims to report. 

Lessons from the Civilian World 

Of course, there’s no single, simple solution to this problem. But we can start by 

applying a few key lessons we have learned in the civilian world. 

• Number One: Victims who receive prompt, quality, confidential crisis intervention return to full strength more quickly, and are ultimately more likely to report their attack to law enforcement officials. 

• Number Two: More reports to law enforcement leads to more prosecutions. 

• Three: The result of more prosecutions is fewer sexual assaults. Increasingly, 

the data are clear: Rapists are serial criminals. There aren’t an enormous number of rapists in our midst, inside the military or out. There are a relatively 

small number of rapists, collectively committing an enormous number of rapes. 

So every time we can convince just one more victim to come forward, leading 

ebenthall on DSK9Q6SHH1PROD with HEARING

30 

to a successful prosecution and serious punishment, we may be preventing dozens of rapes down the line. 

Victim Services & Confidentiality 

So how do we get more victims to come forward for help? Former Congresswoman 

Tillie Fowler, who chaired the investigation into the Air Force Academy, told me at 

the time that every victim they interviewed—every single one—told the panel that 

they would never access help without the guarantee of confidentiality. This response 

matches RAINN’s own research. In the course of developing the National Sexual Assault Online Hotline, the consistent message from victims was that the service must 

guarantee confidentiality, even anonymity. This led us to go to great lengths to create a safe technology that victims would trust. 

DoD has made some progress on this score, with the introduction of restricted reporting, which allows the victim to access services without an official report that engages the chain of command. Those we have spoken to within the services believe 

restricted reporting has been a qualified success. It has encouraged more than 3,000 

victims to come forward and get help, about 15 percent of whom later decided to 

make an unrestricted report and pursue prosecution. 

Still, the safety of a restricted report is incomplete. Victims’ communications with 

military victim advocates do not enjoy the rape crisis counselor privilege that is 

found in most state laws, leaving open the possibility that the victims advocate 

could later be forced to testify against the victim in court. That possibility is sure 

to discourage some victims from coming forward, which is the reason most states 

have passed some kind of rape crisis privilege law. I understand that DoD recently 

submitted this change to OMS for the president’s approval, and I hope the administration acts swiftly to approve and implement the change. 

At the same time, DoD has determined that mandatory reporting laws for medical 

personnel, in California for example, supersede the protections victims enjoy under 

restricted reporting. The result is that victims in those states are forced to forego 

the medical care they urgently need—even treatment for major injuries, and testing 

for STls and HIV—unless they’re willing to sacrifice the confidentiality promised by 

restricted reporting. If they do choose medical care—and, by the way, RAINN 

strongly recommends that all victims receive a medical exam as soon as possible following the crime—they may trigger a chain of events that ends in civilian law enforcement informing military law enforcement, resulting in the very chain-of-command report that restricted reporting was meant to avoid. We encourage Congress 

to investigate this issue and determine whether a federal solution is feasible. 

Fortunately, there are steps Congress can take to address these remaining barriers to victims receiving confidential help. 

Another part of the solution is to make good use of the extensive civilian services 

offered by the National Sexual Assault Hotline, the Online Hotline, and local rape 

treatment centers across the Nation. By functioning outside the chain-of-command, 

civilian services can offer the confidentiality and security victims desire and deserve, 

while simultaneously advancing the military’s goal of encouraging more victims to 

report their attack to military law enforcement. They are by no means a replacement for military-based victim services. Rather, they are a bridge to such services, 

and an alternative for those victims who are unwilling to ask for help through official channels. 

Leadership & Prevention 

While time constraints limit the recommendations I can share regarding prevention programs, I do want to mention the most important kind of prevention program. The most effective prevention—the one without which all other efforts are 

sure to fail—is discipline and leadership. 

To be effective, any prevention program must be able to credibly communicate 

leadership’s personal commitment to zero tolerance of sexual assault and to the punishment of all who commit such crimes. Our soldiers are smart enough to know the 

difference between orders they need to obey and lectures they must endure and then 

are free to ignore. 

Without sincere buy-in from leadership, without real evidence that zero tolerance 

means zero tolerance, any prevention efforts will fail. 

As you would expect in an institution as large as the U.S. military, there are plenty of examples of leadership both good and bad. DoD leadership needs to continue 

to find ways to ensure that the commanders who take this seriously are recognized 

and rewarded. 

And recalcitrant commanders need to be identified and reformed, by training 

when possible; by the threat of poor performance ratings and limited upward mobility when necessary. 

ebenthall on DSK9Q6SHH1PROD with HEARING

31 

If DoD leadership makes it clear that sexual assault is a force readiness issue 

that deserves the time and effort of those in command, that attitude will filter down 

through the commanding officer of a unit to the soldiers he or she oversees. Commanders who are vocal about and maintain a focus on their commitment to preventing sexual assault will positively influence their units. 

This point is highlighted in the DTFSAMS report, which noted that commanders 

themselves identified this as an issue that needed to be addressed. According to the 

report, interviews with commanders concluded that they ‘‘need better training on 

sexual assault prevention and response.’’ 

As continued improvements in prevention programs and victim services show results, we all have a duty to ensure that the public and the media understand that 

a higher number of reported rapes in the military is almost certainly a sign of suc- cess, not of increased danger in the ranks. Such an increase is most likely evidence 

that we’re successfully increasing the percentage of victims who pursue justice. 

That’s also an important point when assessing commander performance. Commanders must not fear that an increase in rape reports on their base will be held 

against them. Rather, they should be accountable for instituting an effective program that encourages increased reporting. 

I’d like to add one point about process. There have been news reports recently 

about DoD’s plan to restructure its personnel office. I defer to DoD as to whether 

that’s a good idea. But I am concerned about one idea I’ve heard floating around— 

the idea of putting DoD’s sexual assault programs under its domestic violence programs. While on the surface it sounds plausible to combine sexual assault with domestic violence, or even sexual harassment, the effect of that could be to set back 

efforts to prevent sexual assault and help victims. 

Sexual assault is a very different issue than domestic violence. The relationship 

between attacker and victim is different; the factors that influence the decision to 

get help or report to law enforcement are different; the entire nature and cause of 

the two crimes are different. Equating the two issues might seem like an efficiency 

move on paper, but doing so has the potential to de-emphasize sexual violence and 

hamper prevention and victim-service efforts. Now that we’ve started to make 

progress, it’s the wrong time to backtrack like that. 

In summary, the problem of sexual assault is not unique to the military, nor is 

the reluctance of victims to report the crime. To successfully combat this problem, 

we must continue to improve services on base. We must provide Servicemembers 

with alternative, confidential services off base. We must implement effective prevention and education programs on every base. And all this must be backed up by personal commitment by base commanders and Pentagon leadership to zero tolerance 

and routine prosecutions. The result will be fewer sexual assaults, healthier and 

safer soldiers, and an improved public image of the greatest military the world has 

ever seen. 

f 

Prepared Statement of Joy J. Ilem, Deputy National Legislative Director, 

Disabled American Veterans 

Messrs. Chairmen and Members of the Subcommittees: 

Thank you for inviting the Disabled American Veterans (DAV) to testify at this 

joint oversight hearing focused on collaboration between the Department of Veterans Affairs (VA) and the Department of Defense (DoD) to better address military 

sexual trauma (MST) and to identify better ways to treat and properly compensate 

veterans for conditions related to MST. We also continue to express a fervent hope 

that DoD is effectively addressing methods to prevent and in fact eliminate the incidence of sexual assaults and harassment within all branches of the military services. 

This hearing takes on a topic that is extremely personal and sensitive to many 

servicemembers, veterans and the respective Departments that are responsible for 

the safety and well-being of their members. Sexual trauma is not a ‘‘sex crime.’’ It 

is a violent personal crime perpetrated against an innocent and unwilling person, 

and attended by both physical and mental legacy wounds. In that sense, the title 

of today’s hearing, ‘‘Healing the Wounds,’’ is most appropriate. When a servicemember is wounded by enemy rifle fire or mortar shrapnel on the field of battle, 

as a society we are shocked and dismayed by the sacrifice and loss of our wounded 

military personnel, but when someone is wounded by sexual violence, society responds in a very different way. We hope this hearing can begin to heal these deep 

wounds that are often invisible but have profoundly changed the lives of those affected. 

ebenthall on DSK9Q6SHH1PROD with HEARING

32 

1 Amy Street, PhD., Dept of Veterans Affairs, National Military Sexual Trauma Support 

Team; DVA Response to MST,’’ PowerPoint presentation for the DCOE Webinar Series, April 

22, 2010. 2Dept of Veterans Affairs; VA Research Currents. Nov-Dec 2008. http://www.research.va.gov/ 

resources/pubs/docs/va_research_currents_nov-dec_08.pdf 3 Ibid. 

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, 2007. 

MILITARY SEXUAL TRAUMA: AN UPHILL BATTLE FOR 

VA DISABILITY COMPENSATION 

An area of concern for DAV relates to veterans’ compensation claims for disabilities resulting from MST. The prevalence of sexual assault in the military is alarming and has been the object of numerous military reports, media coverage, and Congressional hearings over the past decade and before. Servicemembers who have suffered MST often do not report these assaults during their military service, but many 

do experience lingering physical, emotional and psychological scars and symptoms 

following these incidents. Unfortunately, many men and women who experience 

these types of trauma do not disclose them to anyone until years after the fact. 

According to VA, during fiscal year (FY) 2009, 21.9 percent of women and 1.1 percent of men screened by the Veterans Health Administration (VHA) reported MST. 

We note, however, that the size of each VA clinical population gender cohort (women 

to men) who reported military sexual trauma within VA treatment programs is almost equal: 53,295 women and 46,800 men, respectively.1

Another VA study found that of 125,000 veterans screened, about 15 percent of 

Operations Enduring and Iraqi Freedom (OEF/OIF) women veterans who use VA 

health care, reported experiencing sexual assault or harassment during their 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. According to VA, women with MST had a 59 percent 

higher risk for mental health problems, with the risk among men slightly lower, at 

40 percent.3 The most common conditions linked to MST were depression, post-traumatic stress disorder (PTSD), anxiety and adjustment disorders and substance-use 

disorders. 

Unfortunately, if an assault is not reported by the victim during his or her military service, establishing service connection later on for disabling conditions related 

to MST can be daunting. These claims are frequently denied by the Veterans Benefits Administration (VBA) due to lack of required documentary evidence to support 

the occurrence of a personal assault stressor. Although VHA provides comprehensive 

treatment for nearly 100,000 MST victims, many would be eligible for compensation 

benefits but are unable to support their claims with documented evidence of the 

stressor incidents. According to an Institute of Medicine (IOM) National Research 

Council report on PTSD compensation, 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 specifically. The Committee noted that 

available information suggests that women veterans are less likely to receive service 

connection for PTSD and that this is related to being unable to substantiate noncombat traumatic stressors such as MST. The Committee further noted that VA administrative procedures and rules for adjudicating and rating these types of cases 

address MST related PTSD claims but that little attention is paid to the unique 

challenges of obtaining documentation of an in-service stressor. 

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 military service branch complies with DoD policy. SAPRO serves as a 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: 1) prevention through 

training and education programs; 2) treatment and support of victims; and 3) system accountability. 

Under DoD’s MST confidentiality policy, active duty 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 his 

or her assault to specified individuals and to receive medical treatment and counseling, without triggering any official criminal or civil investigative process. Servicemembers who are sexually assaulted and desire to file a restricted report under this 

ebenthall on DSK9Q6SHH1PROD with HEARING

33 

5Dr. Kaye Whitley, Director, Office of the Sec. of Defense, Sexual Assault Prevention and Response Office; Sexual Assault in the Military, PowerPoint presentation for the DCOE Webinar 

Series, April 22, 2010. 

policy may only report the assault to the Sexual Assault Response Coordinator 

(SARC), Victim Advocate or an appropriate health care personnel member. According to SAPRO, health care personnel will initiate the appropriate care and treatment, and report the sexual assault to the SARC in lieu of reporting the assault 

to law enforcement or to the victim’s unit commander. Upon notification of a reported sexual assault, the SARC will assign a Victim Advocate to the victim. The 

assigned Victim Advocate will provide information on the process of restricted 

versus unrestricted reporting. At the victim’s discretion, appropriately trained 

health care personnel will conduct a sexual assault forensic examination (SAFE), 

which may include documentation of the injuries and collection of physical evidence. 

According to SAPRO, in the absence of a DoD provider, the servicemember can be 

referred to an appropriate civilian facility for the SAFE [examination]. 

According to DoD, unrestricted reporting is recommended for victims of sexual assault who request an official investigation of the crime in addition to treatment and 

counseling. When selecting unrestricted reporting, these victims permit current reporting channels to be used, e.g. notifying the chain of command, military police or 

civilian law enforcement, reporting the incident to SARC, or requesting health care 

personnel to notify law enforcement. Upon notification of a reported sexual assault, 

the SARC assigns a Victim Advocate. At the victim’s discretion, health care personnel may conduct a SAFE examination, with similar collection of information and 

potential physical evidence. According to SAPRO policy, personnel access to details 

regarding the incident are limited to those who have a legitimate need to know. 

In FY 2009, DoD reported an 11 percent increase from the prior year in all categories of sexual assault reporting. There were a total of 3,320 reports to DoD in 

FY 2009, with 2,516 unrestricted and 714 restricted reports. These reports represent 

the largest annual increase DoD has seen since yearly data collection began. The 

rise is attributed to DoD’s release of its MST social marketing campaign last year, 

and SAPRO officials have stated they believe their message appealing for more reporting of MST within the ranks of the active force is achieving breakthrough and 

generating this recent jump in reporting. Since June of 2005, when the Department 

implemented the new restricted reporting option for victims of MST, SAPRO has 

documented 3,486 restricted reports having been filed.5

While DoD reports that it prefers complete (meaning, unrestricted) reporting of 

sexual assaults to activate both victims’ services and law enforcement actions, it recognizes that some victims desire only health care and support services, without command or law enforcement involvement. The Department states its first priority is 

for victims to be protected, treated with dignity and respect, and receive the best 

possible medical treatment, counseling and care. DAV acknowledges that DoD policy, but we also want to protect MST victims’ rights and benefits when they transition to veteran status. 

DAV’s primary concern is that VA be able to access the restricted DoD records 

documenting reports of MST for an indeterminate period. On several occasions over 

the past 2 years, DAV has contacted VBA and SAPRO staff to try to verify that the 

organizations are collaborating to ensure access to these records, if authorized by 

the veteran, in support of a VA benefits claim for conditions related to MST. It is 

my understanding that they have spoken but that to date there is not an official 

policy, process or Memorandum of Understanding (MOU) in place to secure such 

records. To establish service connection for PTSD there must be credible evidence 

to support a veteran’s assertion that the stressful event actually occurred. Once a 

claim is filed VA has a number of standard sources it examines for records to support a claim for a condition secondary to personal trauma or MST. However, we do 

not see SAPRO-related reports listed in any of VA’s training and reference materials/manuals for developing claims for service connection for PTSD based on MST. 

At this juncture we are unable to confirm if VBA unofficially searches for ‘‘restricted’’ reports as an alternative evidence source for information to substantiate 

the veteran’s claim. VA does list medical reports from civilian physicians or caregivers who treated the veteran immediately after the trauma as alternative evidence 

to seek out in these cases; however, we do not know if VBA staff developing these 

claims are aware of DoD SAPRO policies and would contact the veteran to see if 

a restricted report was in fact filed, a physical examination conducted and if followup medical or mental health treatment records exist. 

To maintain confidentiality in the case of restricted reporting, DoD policy prevents release of MST-related records, with limited exceptions. Also, VA is not specifically identified as an ‘‘exception’’ for release of records in DoD’s policy, and it is 

ebenthall on DSK9Q6SHH1PROD with HEARING

34 

unclear if VA could gain access to these records even with permission of the veteran. 

Nevertheless, DoD does list VA as an advisor to the DoD Sexual Assault Advisory 

Council or (SAAC), a council that coordinates policy and review of the Department’s 

sexual assault prevention and response policies and programs. We also have questions with respect to where and how physical assessment records that are completed 

following the assault and subsequent mental health treatment records related to the 

restricted MST reports are kept and for how long. It does not appear that these reports, whether restricted or unrestricted, are archived in the individual’s official 

military personnel record, even subsequent to discharge from active duty. We are 

concerned that VBA adjudication staff may not be aware or attempt to gain access 

to these records that for privacy reasons are being kept separate from victimized 

servicemembers’ medical treatment and personnel records. Additionally, we are not 

clear on how each military service branch maintains these records. According to 

DoD policy, physical evidence collected associated with a restricted report of the 

event is destroyed after 1 year if the servicemember or veteran does not wish to pursue civil or criminal sanctions against the perpetrator. However, we are not aware 

of the policies for maintaining DD Form 2911 (Forensic Medical Report Sexual Assault Examination form) completed by the examining clinician following the reported assault. The information on this form would in many cases validate the 

stressor associated with subsequent PTSD or other mental health consequences of 

MST. 

We hope to confirm with the Subcommittee’s oversight that VA is indeed fully collaborating with DoD to ensure veterans who have suffered MST and have filed 

claims for benefits for related conditions gain VA’s full assistance in accessing these 

important records in support of their claims for disability. Additionally, we concur 

with the recommendation made in the 2008 report of the VA Advisory Committee 

on Women Veterans that suggested VBA identify and track claims related to personal assault/MST to determine the number of claims submitted annually, grant 

rates, denial rates, and types of conditions most frequently associated with these 

claims. The Committee stated that development of tracking systems could further 

guide studies on research on all aspects of MST. Finally, we ask that VBA provide 

the Subcommittees any information it has in its reference materials for claims developers/raters that reflect its collaboration with DoD/SAPRO and guidance to MSTrelated claims developers on how to access supporting documentation from each 

military service in the case of both restricted and unrestricted reporting options, including any differences in records retention, security and disposal policies. 

VBA REQUIREMENTS FOR MST–RELATED CLAIMS 

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. 

However, if the claimant did not engage in combat with the enemy, or the claimed 

stressors are not related to combat, then the claimant’s testimony alone is not sufficient to establish occurrence of the claimed stressors, and his or her testimony must 

be corroborated by credible supporting evidence. If a PTSD claim is based on inservice 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 center, mental health counseling centers, hospitals, or physicians; 

pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow servicemembers, 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 

CFR § 3.304(f)(4).) 

Unfortunately, in many cases, even when the veteran has been diagnosed with 

PTSD based in part on claimed in-service sexual trauma, his or her claim is denied 

because there is no independent evidence (credible supporting evidence) to corroborate their statements as to the occurrence of any claimed in-service stressor. Even 

in cases where a VA physician indicates that a veteran was being followed for symptoms of military related sexual trauma, these lay and medical statements do not 

constitute credible supporting evidence. For more information, see Moreau v. Brown, 

ebenthall on DSK9Q6SHH1PROD with HEARING

35 

6Dept of Veterans Affairs, Office of the Inspector General; Health Care Inspection, Review of 

Inappropriate Copayment Billing for Treatment Related to Military Sexual Trauma, February 

4, 2010. http://www4.va.gov/oig/54/reports/VAOIG-09-01110-81.pdf. 

9 Vet. App 389, 396, (1996), wherein the court concluded that corroboration of an 

in-service stressor cannot consist solely of after-the-fact medical nexus evidence. 

As noted above, to receive disability compensation from an MST-related condition, 

as noted above, the standard of evidence is stricter than for combat injuries, or even 

for military occupational injuries. Service connection for a condition related to MST 

is important on a number of levels. Specifically, veterans with service connection 

have improved access to VA health care—for veterans with VA disability ratings of 

50 percent or more disabling—access to VA health care for any condition. Disability 

compensation can also make a tremendous difference in a disabled veteran’s financial status. 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. 

COUNSELING AFTER MST: AN OPEN DOOR FOR VA TREATMENT 

In accordance with section 101 of Public Law 103–452, the Veterans Health Programs Extension Act of 1994, any veteran self-reporting a history of in-service sexual trauma is eligible for VA health care for conditions related to that trauma. In 

compliance with this mandate, all patients are screened for MST, and treatment is 

available for MST-related conditions at all VA health care facilities. Service connection or disability compensation is not required for eligibility for this treatment, and 

veterans in these MST programs are exempt from co-payments for care provided.6

We congratulate VHA for making available on its Web site, http:// 

www.mentalhealth.va.gov/msthome.asp, clear and concise information related to definition, screening and treatment for MST. VHA notes that both men and women 

have experienced MST during their military service, and that all veterans seen in 

the VA health care system are screened and asked about experiences of sexual trauma. VA provides a fact sheet to answer commonly asked questions including the 

commonality of MST and ways MST can affect veterans. VA also includes a list of 

possible signs and symptoms survivors of MST may experience, and most importantly, the Web site provides information on how and where veterans who experienced MST can get help from VA. Information is provided regarding the Women 

Veterans Program Managers, the MST Coordinators and VA’s general benefit information hotline. VHA’s Web site, outreach posters and brochures clearly indicate 

that VA provides confidential counseling and treatment for mental health and physical health conditions related to experiences of MST, all without copayment. VA also 

holds that service connection or disability compensation is not required to receive 

VA MST treatment, and that a veteran need not have reported the incident, nor 

have documented that it occurred, to obtain these services. In some cases a veteran 

may be able to receive VA MST treatment even if he or she is not otherwise eligible 

for VA care. 

We are pleased that VHA makes a point to convey that recovery from personal 

trauma is possible; and that VA has the resources and services to help veterans 

through this extremely difficult challenge. We acknowledge the many experts, specialized research conducted and programs that have been established through the 

VA’s National Center for PTSD, many of which are focused on MST and its consequences in mental health of victims. Nationwide, VA offers specialized MST inpatient and outpatient services, and evidence-based treatments and counseling by specially trained sexual trauma counselors in its Vet Center community-based facilities. 

Veterans can also request a same-sex provider if it makes them feel more comfortable in their counseling sessions. 

In testimony before the Health Subcommittee on March 9, 2009, VA testified that 

it had established an MST support team in VA Central Office to monitor MST 

screening and treatment, oversee MST-related education and training, and promote 

best practices for screening and treatment. 

Despite this progress, VHA staff across the nationwide system needs to be more 

sensitive and knowledgeable and recognize the importance of environment of care 

delivery when evaluating these veterans for their physical and mental health conditions. For years we have encouraged VHA to develop a MST provider certification 

program, guarantee at least 50 percent protected time for MST coordinators to devote to position responsibilities, provide separate and secure women’s subunits for 

inpatient mental health and residential services, ensure privacy and safety, and improve coordination with the DoD in transition of veterans, especially those with 

ebenthall on DSK9Q6SHH1PROD with HEARING

36 

7Dept of Veterans Affairs News Release; Health Care Report Card Gives VA High Marks, 

June 13, 2008. 8 Bryan Bender, The Boston Globe; More Female Veterans Are Winding Up Homeless, July 6, 

2009. http://www.boston.com/news/nation/washington/articles/2009/07/06/more_female_veterans_ 

are_winding_up_homeless/. 

complex behavioral health needs related to MST. The Government Accountability 

Office (GAO) released a GAO ‘‘Watchdog Report #12’’ on April 7, 2010, in which 

GAO’s Director of Federal Health Care stated: ‘‘One challenge is a [VA] difficulty 

in hiring primary care providers with specific training and experience in women’s 

health. For example, officials at many VA facilities we visited noted they had difficulty attracting mental health care providers with experience in treating post-traumatic stress disorder and military sexual trauma, which are prevalent [among] 

women veterans.’’ Based on the continuing reports we have received from our National Service Officer (NSO) corps and veterans themselves, DAV strongly endorses 

GAO’s observation. 

We are pleased that Public Law 111–163, the Caregivers and Veterans Omnibus 

Health Services Act of 2010, recently approved by the President, includes a provision to mandate graduate education, training and certification for VA mental health 

providers delivering counseling, care and services for MST-related conditions, to ensure veterans have access to mental health clinicians with specialized expertise in 

this unique area. DAV urges VA to promptly begin implementation of the MST Congressional mandate in Public Law 111–163, to begin to address some of these unmet 

needs. 

In 2007, VA’s National Center for PTSD published the first-ever randomized controlled trial to assess PTSD treatment for active duty women and women veterans. 

In the study, the women who received prolonged exposure therapy had greater remissions of PTSD symptoms than women who received present-centered therapy. 

Additionally, the prolonged exposure group was more likely than the present-centered therapy group to no longer meet the criteria for a diagnosis of PTSD and 

achieve total remission. However, mental health experts report that these case-intensive treatments are not universally available at VA medical centers (VAMCs) nationwide. This study documented the importance of spreading this evidence-based 

practice throughout VA’s system. DAV is pleased that VA has developed a program 

to train its mental health providers to provide the most effective treatment for 

PTSD due to sexual trauma and combat trauma and is examining how best to address complex combat and MST issues.7 However, further expansion of these training programs is still needed. 

HOMELESS WOMEN VETERANS AND MST—A SPECIAL CONCERN 

Finally, we note another area in relationship to MST that warrants the Subcommittees’ attention. VA has excellent programs for homeless veterans but women 

veterans present some unique challenges for VA within those programs. Frequently 

women are reluctant to take advantage of VA’s stellar programs such as transitional 

housing, substance-use disorder programs and residential rehabilitation and treatment programs, due to personal safety concerns and because often they are the sole 

or primary caretakers of minor children. In some facilities VA has struggled to 

maintain a welcoming, secure and safe treatment setting especially for women who 

have serious mental illness and/or have been victims of MST. 

According to VA, the overall number of homeless veterans has been declining (now 

approximately 131,000 on any given night), but the number of homeless women veterans has nearly doubled to 6,500 over the last decade, about 5 percent of the total 

homeless veteran population. In a recent newspaper report, VA was cited as reporting that overall, female veterans are now between two and four times more likely 

to end up homeless than their civilian counterparts.8 This alarming jump is coupled 

with the report that 1 in 10 homeless veterans under the age of 45 are women, and 

as more veterans return from deployments in Iraq and Afghanistan, these numbers 

are expected to rise. Combat-related stress and MST are both risk factors for homelessness. These women present unique challenges to the VA system, designed for 

use primarily by men, and very few VA facilities have homeless programs designed 

specifically for women, and none are able to accommodate children. It is also noted 

that about 75 percent of these female veterans have been victims of sexual abuse 

and many have substance-use and mental health problems that require specialized 

care. Programs and treatment services for mental health, MST, substance-use disorders, and maintaining independent housing and gainful employment are all essential to this vulnerable population. Therefore, we must ensure that VA programs are 

ebenthall on DSK9Q6SHH1PROD with HEARING

37 

properly adjusted to meet the unique and growing needs of women veterans and ensure that women have equal access to these specialized services. 

SUMMARY 

In summary, DAV recommends the Subcommittees provide oversight to ensure 

VA, DoD and SAPRO work collaboratively to develop a joint policy directive and system for each military service branch to maintain and share with VA when needed 

critical medical records related to MST cases; provide servicemembers information 

on how and where to access these records and information about VA benefits and 

services should they decide in the future to file claims for disability compensation 

with VA for conditions related to MST. We also ask that VBA provide the Subcommittees any information it possesses in its reference materials or guidance for 

claims developers and raters that reflect VBA’s collaboration with SAPRO, as well 

as any guidance to claims developers working on MST-related claims on how to access supporting documentation from each military service branch in cases of both 

restricted and unrestricted reporting options, including acknowledgements of differences in records retention across branches, and security and records disposal policies within the DoD service branches. 

Unfortunately, we continue to see increasing numbers of servicemembers and veterans who report MST and seek care from VA as well as file claims for disability 

compensation through our NSO corps. One of DAV’s central purposes is to aid veterans in obtaining fair and equitable VA compensation for their service-related disabilities. We believe our NSO corps provides a premier service to help veterans rebuild their lives, and we have aided millions of veterans since the founding of our 

organization. In this one particular area, however, our NSOs are deeply frustrated 

at the routine occurrence of MST claims being denied for lack of evidentiary documentation. 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 victims of MST, as well as preventing the problem at its source, to work in 

concert to lower the burden of this claims process and ensure servicemembers and 

veterans are fully assisted by the government and their advocates in securing the 

benefits they deserve and have earned. We believe this issue can be resolved internally by the respective agencies involved through a memorandum of understanding 

agreed to by both parties, or through some other mechanism short of a new statutory mandate, if they simply agree to work in a cooperative spirit on a seemingly 

very solvable problem. 

Finally, we recommend the Subcommittee on Health request VHA provide a report to the Subcommittee on its safeguards and efforts to ensure all women veterans 

and especially women veterans with combat-related stress and/or MST histories 

have access to secure and safe treatment settings in all VA facilities and programs. 

As indicated above, MST is not a ‘‘women’s issue’’ in VA; however, VA is still primarily populated with men and male oriented. As such women’s safety, security and 

comfort must remain a special concern. 

Messrs. Chairmen, again we thank you for the opportunity to share our views at 

this important hearing focused on healing the wounds of military sexual trauma— 

and your efforts to identify ways to improve treatment and properly compensate veterans for conditions related to MST. We appreciate the attention to these issues and 

hope the Subcommittees will consider the issues of concern and recommendations 

we have brought forward in our statement. Thank you once again for the opportunity to provide testimony at this hearing. I would be pleased to address your questions, or those of other Subcommittee members. 

f 

Prepared Statement of Sergeant Jennifer Hunt, USAR, Project 

Coordinator, Iraq and Afghanistan Veterans of America 

Chairmen, Ranking Members, and Members of the Subcommittees on Disability 

Assistance and Memorial Affairs and Health, on behalf of Iraq and Afghanistan Veterans of America’s one hundred and eighty thousand members and supporters, I 

would like to thank you for inviting us to testify today. ‘‘Healing the Wounds: Evaluating Military Sexual Trauma’’ is a critically important topic. The issue of sexual 

assault has deeply affected IAVA membership, the military and veterans’ community as a whole, and me personally. I would like to point out that my testimony 

today is on behalf of IAVA and does not reflect the views and opinions of the United 

States Army. 

ebenthall on DSK9Q6SHH1PROD with HEARING

38 

My name is Jennifer Hunt, and I am a Sergeant in the U.S. Army Reserves. I 

grew up in Shelton, CT and enlisted in the Army Reserves shortly after September 

11th. I’ve served combat tours in Iraq and Afghanistan as a Civil Affairs Specialist 

and, in Iraq, I earned a Purple Heart when my Humvee was struck by a roadside 

bomb, causing shrapnel injuries to my face, arms and back. 

Whether deployed or drilling stateside, I also serve as my unit’s designated Victim 

Advocate, as part of the Army’s Sexual Assault Prevention and Response program. 

I sincerely hope that my duties as Victim Advocate are ones that I will never have 

to perform. 

But if I was called upon to serve as a Victim Advocate my official responsibilities 

would include: acting as the first point of contact for the victim; counseling them 

on what their options are for reporting the attack; notifying the installation’s Sexual 

Assault Response Coordinator; and accompanying victims to medical appointments 

or related meetings. And I am ready, should the need arise, to provide personal support to the victim. I know first-hand how difficult and frustrating the healing process can be, because I was a victim of sexual assault as a civilian. 

Unfortunately, the reality is that servicemembers have been coping with significant and underreported sexual assault and harassment in the military for decades. 

While sexual assault disproportionately affects female troops, male servicemembers 

are impacted too. And they may face even greater stigma when deciding whether 

to report it or seek care. In FY 2009, there were more than 3,200 reports of sexual 

assault involving servicemembers. Even in the warzone, troops cannot escape the 

threat of sexual assault; there were 279 reported sexual assaults in combat areas 

last year. While these numbers are alarming, they grossly underestimate the severity of the issue. According to the Defense Department, only 20 percent of all unwanted sexual contact is reported to a military authority. This must change—and 

the time is now. 

But despite the urgency of the issue, it has taken several congressional hearings, 

extensive media attention, and the increasing number of victims coming forward to 

share their trauma publicly for the military and the Department of Veteran Affairs 

to finally respond to the staggering number of incidents. In recent years, both departments have taken commendable steps. The military introduced a ‘‘restricted reporting option’’ to encourage more victims to seek care and counseling and completed its long awaited review of the issue by the Defense Department Task Force 

on Sexual Assault in the Military Services. 

MST can lead to the development of major health problems, such as depression, 

eating disorders, miscarriages, and hypertension. Victims may also be eligible for 

disability compensation from the VA. Consequently, the VA began universally 

screening all veterans seeking care at the VA for Military Sexual Trauma in 1999 

and the VA provides care to any veteran who has experienced MST. However, as 

is the case with other VA health care, treatment is inconsistent and not all veterans 

receive the care they deserve. IAVA was extremely concerned to learn that the VA’s 

Inspector General had to review the billing practices of VA health facilities and clinics after it was revealed that patients at one Texas clinic were being improperly 

charged copays for MST-related care. VA hospitals need to be trained in the proper 

treatment of and benefits for MST victims. 

These steps are an improvement over the years of inaction, but much more must 

be done to adequately prevent and respond to Military Sexual Trauma. Our women 

warriors deserve the best treatment and support on the planet. Therefore, IAVA recommends the following steps to ‘‘Help Heal the Wounds’’: 

For the Department of Defense—— 

• Adequately fund the Department of Defense’s Sexual Assault Prevention and 

Response Program (SAPR) to achieve its mission of prevention, response, training and accountability. As recommended by the DoD’s Task Force on Sexual Assault, the Secretary should include the SAPR Program in its Program Objective 

Memorandum budgeting process ensuring a separate line of funding is allocated 

to the services. 

• Conduct a study to identify a more comprehensive system that will accurately 

measure the incidence of sexual assault within the military—not just reported 

assaults. DoD should also conduct its gender relations survey bi-annually to 

more accurately assess the rate of sexual harassment. 

• Require the Secretary of Defense to review sexual assault prevention and response efforts in the Reserve Components—which is not happening now. 

• Require all military installations to have a Sexual Assault Response Coordinator (SARC) and deployable SARC on base. SARCs must be full-time military 

or DoD civilian personnel. 

ebenthall on DSK9Q6SHH1PROD with HEARING

39 

• Ensure all servicemembers have access to a restricted reporting option, and improve avenues for restricted reporting by allowing victims to reserve their right 

to a restricted report even after disclosing an assault to a third party, with the 

exception of chain of command or law enforcement. Additionally, a hotline 

should be established to allow victims to report sexual assault and harassment 

even when in-theatre. And that hotline must be connected with a local Sexual 

Assault Response Coordinator. 

• Guarantee that all military personnel have access to qualified medical personnel to conduct evidence collection in sexual assault cases in a safe, timely, 

confidential, and gender—unbiased manner, even in deployed and remote locations. 

For the Department of Veterans Affairs— 

• Expand availability of specialized sexual trauma treatment inpatient and residential settings. 

• Ensure that victims have access to preferred treatment settings and providers. 

For example, victims should not have to settle for mixed-gender treatment facilities because there are no facilities with separate programs for males and females in their area. 

• Conduct a fully independent review of VA medical facilities to assess whether 

or not they are adequately complying with VA standards for safety and privacy 

for MST victims. 

• Ensure the use and implementation of a method specifically designated to track 

MST-related care at all VHA medical facilities, so that MST treatment data are 

readily accessible across the VA system, as recommended by the VA’s Office of 

Inspector General. 

• Identify, track and report to Congress the outcomes of disability claims that involve MST. This will better measure the number of MST-related claims submitted annually, length of processing times, denial rates, and the types of disabilities that are associated with MST. 

These recommendations are urgent. And IAVA encourages you to enlist the support of the President and the first lady to help make them happen. 

Sexual Assault is a violation of military values and professionalism. It undermines unit cohesion, morale and effectiveness. The majority of assailants are older 

and of higher rank than their victims. They abuse not only their authority, but the 

trust of those they are responsible for protecting. 

Sexual assault, whether it occurs in the military or in the civilian world, is also 

a crime. It is a crime that threatens the individual victim and the strength of the 

United States military. 

Sexual assault is a crime that has gone on for too long, with too little done to 

stop it. While not all of IAVA’s recommendations fall in the jurisdiction of these 

Subcommittees, we look forward to working with you to fully address the issue of 

Military Sexual Trauma. Our women warriors have served nobly. And I am here 

today on behalf them all, to issue to you a call to service. We have done our part. 

Now it’s time for you to do yours. 

Thank you. 

f 

Prepared Statement of Anuradha K. Bhagwati, Executive Director, 

Service Women’s Action Network 

Good morning, Mr. Chairman, and Members of the Committee. My name is 

Anuradha Bhagwati. I am a former Marine Corps Captain and Executive Director 

of Service Women’s Action Network (SWAN), an advocacy and direct services organization for servicewomen and women veterans. 

SWAN’s policy work this year focuses largely on reforming DoD and VA Sexual 

Assault and Harassment policy and educating the public about the epidemic known 

as Military Sexual Trauma (MST). 

MST is an intensely personal issue for us and for the veterans we represent. This 

testimony is based on the collective input of over 120 MST survivors, MST crisis 

intervention caseworkers and VA health providers. My own experience filing an 

Equal Opportunity investigation for sexual harassment and discrimination in the 

military and the unfortunate follow-on experiences I’ve had with both VHA and 

VBA regarding treatment and benefits corroborate the experiences of my colleagues 

and fellow veterans below. 

ebenthall on DSK9Q6SHH1PROD with HEARING

40 

I. Department of Defense (DoD): 

Sexual trauma in a military setting is unique and must be recognized as such before suggesting appropriate policy remedies. We must first understand why a 

servicemember would choose to stay silent after being sexually assaulted or harassed. 

DoD puts MST survivors in an awful predicament in which they are likely to be 

further traumatized if they come forward. Unlike the civilian world, MST survivors 

don’t have the option of quitting their job; they are often stuck working with, nearby, or under the supervision of their perpetrators. There is simply no guarantee that 

the chain of command will support survivors if they come forward. Commanders 

consistently ignore equal opportunity and sexual assault policy in order to maintain 

the personnel in their unit at full capacity. Additionally, commanders have little incentive to prosecute perpetrators, as documented incidents reflect poorly on their 

leadership performance and reputation. 

MST survivors who report an incident are likely to face isolation, retribution, or 

accusations of lying, irresponsibility or impropriety; there is no guarantee of anonymity from the chain of command or Victim Advocates, and survivors are likely 

to face the horror of retribution from perpetrators and the anguish of being a target 

of public ridicule, scorn and further harassment in their respective units. We cannot 

honestly expect people to come forward to report—it is irresponsible for DoD to suggest that survivors do so, without guaranteeing protection. 

Despite overtures by DoD in recent years to prevent sexual assault and harassment, nothing on the ground has changed for women and men in uniform. DoD’s 

failure to protect our servicemembers ought to be the subject for a separate set of 

hearings, as there is far too much to say here. Suffice it to say that without third 

party oversight of sexual assault and harassment cases, a culture of impunity and 

hatred of women within the military makes it almost certain that survivors will be 

punished, taunted, isolated, or intimidated by their commands for speaking out, and 

that perpetrators will in most cases go unpunished. 

II. Veterans’ Health Administration (VHA): 

MST survivors universally describe the horror of using VA Medical Centers nationwide. The climate at VA hospitals is still largely unwelcoming to women, but 

for MST survivors, the experience of going to an appointment can be life-threatening—triggers of one’s assault or harassment are everywhere, from the prospect of 

running into your perpetrator, to being surrounded by male patients who routinely 

engage in sexual harassment of female patients, to being improperly treated by staff 

members who have no knowledge about the unique experience of sexual trauma in 

a military setting. 

One survivor said to SWAN, ‘‘I don’t want to be fending off advances when I’m 

raw from dealing with my issues in therapy’’ while another said, ‘‘I have no [private] 

health care. I have to use the VA. Therefore I have to go through all the embarrassment.’’ Survivors universally say that if they had health insurance, they would definitely use private health care instead of the VA. 

Many veterans are ignored, isolated, or misunderstood at VA facilities because 

their PTSD is not combat-related. The veterans’ community still primarily considers 

PTSD to be a combat-related condition, to the great detriment of MST survivors. 

Survivors who have used the VA routinely say they are fed up with being given 

endless prescription medication—one Iraq veteran described the experience of her 

VA MST treatment as nothing but ‘‘pills and pep talks.’’ Many survivors wish they 

had access to yoga, massage therapy, acupuncture, and gender-specific MST support 

groups. 

Lots of MST patients echo the comments of other veterans generally—that a lack 

of privacy, child care and availability of evening or weekend appointments prevents 

them from accessing care at VA Medical Centers. 

I strongly recommend that the Committee give MST survivors the option of feebased care for all treatment. At the same time, VHA cannot be let off the hook. VA 

Medical Centers ought to have separate facilities for women patients, and easy, safe, 

and direct access to MST treatment areas for both male and female MST survivors. 

I’d like to say a few words about MST Residential Treatment programs. It appears that most MST patients do not know that these programs exist, and it’s apparent that many VA providers also don’t know about them. Survivors have mixed 

reactions to these treatment programs. Most describe agonizing wait lists for the 

programs, along with a shortage of VA funding to travel to the program. Among 

those patients who have attended, several have experienced sexual harassment by 

staff or fellow patients. Another disturbing trend is VA’s integration of residential 

programs with other mixed-gender veterans’ programs, in which MST patients are 

not guaranteed privacy or safety from other patients of the opposite sex. VA needs 

ebenthall on DSK9Q6SHH1PROD with HEARING

41 

to invest in separate facilities for MST programs, and guarantee the safety and welfare of all participants. 

III. Veterans’ Benefits Administration (VBA): 

Filing for disability compensation for MST is universally considered a traumatic, 

agonizing, and cruel experience. Many survivors describe the process of re-writing 

one’s personal narrative for a VA claim as just as traumatic as the original rape 

or harassment. 

VBA claims officers nationwide have proven themselves entirely inept when dealing with MST claims. Claims are routinely rejected, even with sufficient evidence 

of a stressor and a corroborating diagnosis from a VA health provider. Many survivors’ claims are rejected because of VBA’s lack of knowledge about sexual violence. 

For example, many servicemembers have been denied VBA compensation because 

their job performance did not decline after the assault or harassment—which in the 

sexual violence community is a perfectly normal survival reaction to a life-threatening situation. Countless more survivors failed to report through official channels, 

or cannot fathom the agony of attempting to file a claim when military culture and 

the VA are so rigged against women. 

Current VBA policy is forcing women and men with insufficient evidence of their 

assault and harassment to suffer in silence and shame, to numb their pain through 

use of substances, and to take or attempt to take their own lives. This Committee 

needs to understand that until it is safe to report sexual assault or harassment in 

the military, the majority of incidents will not be reported. You cannot continue to 

punish veterans with MST twice. VA must take responsibility for DoD’s failure to 

protect its own by awarding just compensation to survivors. 

Another equal protection issue features prominently in the work we do on MST. 

The ‘‘Don’t Ask, Don’t Tell’’ policy has allowed gay and lesbian servicemembers, as 

well as those who are perceived to be gay, to be systematically sexually harassed 

and assaulted in uniform. Perpetrators have routinely abused gays and lesbians who 

would otherwise report harassment or assault. Society has yet to measure the mental health impact of this insidious policy on our Nation’s LGBT veterans. We must 

guarantee access to quality health care for all veterans, regardless of sexual orientation or gender identity. 

I must add a special note for our older MST survivors, our mothers and grandmothers whose sacrifice years ago both on the battlefield and in the barracks forged 

the way for women like us to join the military—we must not forget them. Many of 

them suffered at the hands of fellow servicemen decades ago, and their trauma continues to be unrecognized. One Vietnam-era veteran who survived MST told us, 

‘‘Please help me feel validated before I die.’’ Honor and validate her service and her 

life by fixing this broken system now. 

Thank you. 

f 

Prepared Statement of Kaye Whitley, Ed.D., Director, Sexual 

Assault Prevention and Response Office, Office of the Under Secretary of 

Defense for Personnel and Readiness, U.S. Department of Defense 

Chairmen Michaud and Hall, Ranking Members Brown and Lamborn, and Members of the Subcommittees, thank you for inviting me today to discuss the progress 

the Department of Defense has made in recent years on caring for victims of sexual 

assault. I would like to focus on the efforts of my office, the Sexual Assault Prevention and Response Office (SAPRO), working in partnership with the Military Services. As a team, we are making great headway to standardize, professionalize, and 

institutionalize our programs. Once we achieve all three, we hope to realize our vision: A culture free of sexual assault. Until that time, ensuring an effective response 

for victims is one of our highest priorities. 

At the beginning of my testimony, it is important to clarify a few issues. 

• The Department of Veterans Affairs is tasked by Congress to address the physical and mental problems of veterans stemming from physical assault or sexual 

assault or sexual harassment that occurred while the verteran was serving on 

active duty or active duty for training. VA utilizes the umbrella term ‘‘military 

sexual trauma’’ to refer to these experiences. 

• In the Department of Defense, the office that I represent is tasked with policy 

relating to the prevention and response of sexual assault. Sexual harassment 

is addressed by the Equal Opportunity Program. Reported incidents of sexual 

harassment are not included in my statistics. 

ebenthall on DSK9Q6SHH1PROD with HEARING

42 

1Smith, et al., (2008). Prior Assault and Posttraumatic Stress Disorder After Combat Deployment, Epidemiology, 19, 505–512. 2 U.S. Department of Defense (2008). 2006 Workplace and Gender Relations Survey of Active 

Duty Members. Washington, DC: Defense Manpower Data Center. Retrieved from http:// 

www.sapr.mil/contents/references/WGRA_OverviewReport.pdf. 

• Finally, I 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 are especially concerned with reports of incidents that occurred 

after 2005 in that we want to examine them to determine if there are any necessary changes in our policy. 

Sexual Assault: An Underreported Crime 

One of the challenges facing the Departments of Defense and Veterans Affairs is 

the fact that sexual assault is one of the most underreported crimes in our society. 

National studies indicate that most sexual assaults go unreported in the civilian 

sector—largely because victims are fearful of the life-changing events, public scrutiny, and loss of privacy that often come with a public allegation. The potential medical and psychological costs and consequences of sexual assault are extremely high. 

Unfortunately, the military is not immune to the problems faced by the rest of 

American society—and sexual assault is no exception. Sexual assault in the military 

has similar costs and consequences for victims—but there are other factors that 

complicate a victim’s experience in the military and interfere with reporting. First, 

sexual assault can occur where a victim works and lives. Victims are not always 

able to escape painful reminders that keep them from putting the incident behind 

them. 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. Third, 

recent research has found that a history of sexual assault doubles the risk of 

posttraumatic stress when the victim is exposed to combat.1

Some victims may not want to come forward to report for many of the same reasons cited by their civilian counterparts: DoD studies indicate that about eight of 

ten sexual assaults in the military go unreported.2 Victims are concerned about losing their privacy, fearful about being judged, fearful of retaliation, and afraid that 

people will view them differently. In addition, female and male military victims 

alike mistakenly believe that reporting their victimization somehow makes them 

weak and less of a warrior. They worry that their career advancement will be disrupted and their security clearances revoked. 

Bringing Sexual Assault Victims into Care 

In order to bring more victims forward, the Department offers two reporting options: Restricted and Unrestricted Reporting. The addition of Restricted Reporting 

as an option was critical to our program. Restricted Reporting allows victims to confidentially access medical care and advocacy services. Although Restricted Reporting 

does not trigger the investigative process, commanders are provided with non-identifying personal information that allows them to provide enhanced force protection. 

Also, victims who initially make a Restricted Report may change their minds and 

participate in an official investigation at any time. 

Restricted Reporting is having the desired effect. At the end of FY 2009, the Department had received 3,486 Restricted Reports since the option was made available 

in 2005. We believe that number represents 3,486 victims who would not have 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 Unrestricted Reports, allowing us to take action to hold those offenders 

accountable. 

Bringing as many victims forward to report the crime of sexual assault is one of 

our strategic goals. During the past 3 years, reports of sexual assault have been increasing by about 10 percent annually. While our goal is to decrease sexual assaults, 

we do want to increase the numbers of victims coming forward and are engaging 

in a variety of activities that encourage victims to report. For example, in 2008, the 

Secretary of Defense identified reducing the stigma of reporting sexual assault as 

one of his priorities. Since then, each of the Services has taken steps to educate 

their members that reporting the crime and seeking help are a sign of strength, not 

weakness. In 2009, the Department issued a memorandum underscoring that being 

the victim of a crime like sexual assault is not grounds for losing one’s security 

clearance. The memo further encouraged all members of the Department of Defense, 

military and civilian alike, to engage care services as soon as possible following 

traumatic events. 

ebenthall on DSK9Q6SHH1PROD with HEARING

43 

Military Sexual Assault Response 

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. Victim care begins immediately upon an initial report of a sexual 

assault. At the heart of our sexual response system are the Sexual Assault Response 

Coordinator (SARC) and Victim Advocates. Servicemembers worldwide have access 

to a 24/7 response. Every military installation in the world—both in garrison and 

deployed—has a SARC and Victim Advocates who provide the human element to 

our response. Our SARCs and Victim Advocates will: 

• Work with victims to identify and address issues related to their physical safety 

and needs as well as concerns about their commander and the alleged perpetrator; • Listen to victims’ needs and then connect them with appropriate and necessary 

resources, including medical care, mental health care, and legal and spiritual 

resources; and • Connect victims to off-base resources when necessary. 

SARCs and Victim Advocates also work with victims to help them decide whether 

to make a Restricted or Unrestricted Report. In order to ensure that victims make 

an educated decision in which they are fully informed of their choices, we developed 

a Victim Preference Reporting Form (called DD 2910) which explains their options. 

This form is completed by the victim with the assistance of the SARC or Victim Advocate in every case. In each case, the SARC or Victim Advocate emphasizes that 

the victim should keep a copy of the DD 2910 in his or her personal files, as noted 

on the bottom of the form. (A sample of DD 2910 is included at the end of my testimony.) 

Tracking Victim Care 

The Department believes that comprehensive data collection and analysis are 

vital to policy analysis and program implementation. Thus, a Department-wide sexual assault database is currently under development. We have secured funding and 

will be soon awarding a contract for development. 

Collaborating to Enhance Victim Care 

Effectively preventing and responding to sexual assault are demanding undertakings. We know that we cannot do it alone. As a result, we have been collaborating with other Federal, state, and non-profit agencies to maximize our effectiveness. We have been working with the Department of Veterans Affairs since the inception of the program in 2005. In addition, we have recently begun to meet with 

a variety of veterans groups to identify what gaps there might be related to our 

issue as Servicemembers transition from active duty to veterans status. Meeting 

with non-governmental groups, such as Iraq and Afghanistan Veterans of America 

and the National Organization for Women, has helped us gain a fuller understanding of the challenges that veterans might be experiencing. 

One of the key areas of collaboration has been related to documentation. In 2007, 

we contacted the staff of the Veterans Benefits Administration (VBA) and briefed 

them on our Victim Preference Reporting Form (DD 2910). We forwarded copies of 

the form to VBA, which said that it would agree to accept a copy of the form, signed 

by both the victim and the SARC or Victim Advocate, as evidence of reporting of 

sexual assault. While treatment for sexual assault in a VA facility does not require 

this document, service connection determinations require some kind of evidence in 

the military record. Our form is not typically part of the medical record that is provided to VA for service connection determinations; however, it can be submitted by 

victims as part of their paperwork for a service connection determination. 

As noted throughout my testimony, reporting a sexual assault can be very challenging for a military victim—and many do not want the sexual assault in any kind 

of permanent record until they are ready to separate. As a result, corroborative evidence of sexual assault may be difficult to come by in a medical chart or other 

record system if the victim never reported the matter or if the member made a Restricted Reported and opted to not use medical care. Just as the DD 214 is the main 

basis for proof of military service, we would like the DD 2910, the Victim Preference 

Reporting Form, to be universally accepted as proof that a victim made a report of 

sexual assault. 

Past this coordination on reporting form, let me mention a few additional ways 

we have collaborated: 

• A representative from VA participates, per our request, on our Sexual Assault 

Advisory Council, which was the main oversight body for the Sexual Assault 

Prevention and Response program in the Department. 

ebenthall on DSK9Q6SHH1PROD with HEARING

44 

• We have teamed with members of VA’s Military Sexual Trauma Support Team 

to present our respective programs at national conferences. 

• Members of my staff have attended VHA’s annual training conference for Military Sexual Trauma Coordinators and presented on the DoD Sexual Assault 

Prevention and Response Program for the past 3 years. In addition, my staff 

has also participated in VA webinars to educate VA providers about sexual assault and the DoD and VA programs. 

• The MST Support Team and SAPRO often work together to ensure that victims 

of sexual assault are connected with the appropriate services. We have referred 

a number of victims to each other’s offices for assistance. 

Challenges in Caring for Military Victims of Sexual Assault 

In addition to what has been done to date, there is more our two Departments 

can do together to assist victims of sexual assault, but we need assistance in removing at least one barrier to collaboration: that is, state mandatory reporting laws. 

As I explained previously, 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, Servicemembers 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. California is an example of a state with this type of law. Section 11160 of California’s Penal Code requires health care practitioners to make a report to law enforcement if they provide medical services for a physical condition to a patient whom 

he or she knows or reasonably suspects is a victim of various crimes of a sexual 

nature. That report must include the victim’s name, whereabouts, and a description 

of the person’s injury. There is no discretion on the part of a health care provider; 

the law requires mandatory reporting. Once the health care provider notifies civilian 

law enforcement, we cannot guarantee that 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 available in California. This is a challenge that we need help in resolving. 

Conclusion 

The Department of Defense and the Department of Veterans Affairs have made 

significant progress since 2005 in assisting victims of sexual assault. Both Departments have programs that truly address the needs of the victim. 

As I conclude my testimony, I would like to share one last thought. Each day, our 

Servicemembers dedicate their lives to protecting our country and deserve no less 

than the very best care and support in return. This is why it is so very important 

that we work together to make this program the best it can be. We can thank our 

SARCs, Victim Advocates, and first responders for dedicating their lives to those in 

need and giving back to those who serve. 

As mentioned earlier, since 2005, 3,486 individuals would not have received care 

and support had it not been for the creation of the Restricted Reporting and our 

program. That’s remarkable progress. It’s up to all of us (Department of Defense, 

Department of Veterans Affairs, and Congress) to continue to take the lead by working together to resolve issues so that our policy is effective for all of our Servicemembers. 

Thank you for your time and for the opportunity to testify today. I would be 

happy to answer your questions. 

ebenthall on DSK9Q6SHH1PROD with HEARING

45 

DD Form 2910 

ebenthall on DSK9Q6SHH1PROD with HEARING


57023a.001
46 

f 

ebenthall on DSK9Q6SHH1PROD with HEARING


57023a.002
47 

Prepared Statement of Bradley G. Mayes, Director, 

Compensation and Pension Service, Veterans Benefits Administration, 

U.S. Department of Veterans Affairs 

Good Morning, Chairman Hall, Chairman Michaud, Ranking Members Lamborn, 

Brown, and Members of the Subcommittees: Thank you for the opportunity to appear to discuss the Department of Veterans Affairs’ (VA’s) work in identifying, treating and compensating Veterans for conditions related to military sexual trauma 

(MST). We are accompanied by Dr. Rachel Kimerling, Director of the Monitoring Division of the National Military Sexual Trauma Support Team in the Veterans 

Health Administration (VHA); and Dr. Patty Hayes, Chief Consultant for the 

Women Veterans Health Strategic Health Care Group (VHA). 

It is a tragic fact that many Veterans suffered sexual trauma while serving on 

active military duty. Some are still struggling with fear, anxiety, shame, or profound 

anger as a result of these experiences. A number of individuals have never discussed 

their experiences or their feelings with anyone, and they’re understandably reluctant to talk about them now. That is why we would like to thank the Members of 

the Subcommittees for their diligent efforts to address this very important issue. 

What Is Military Sexual Trauma (MST)? 

In both civilian and military settings, women and men can experience a range of 

unwanted sexual behaviors. Within VA, Veterans are likely to hear these sorts of 

experiences described as ‘‘military sexual trauma,’’ the overarching term VA uses to 

refer to experiences of sexual assault or repeated, threatening acts of sexual harassment. The definition used by VA is from the U.S. Code (1720D of Title 38) and is 

‘‘psychological trauma, which in the judgment of a VA mental health professional, 

resulted from a physical assault of a sexual nature, battery of a sexual nature, or 

sexual harassment which occurred while the Veteran was serving on active duty or 

active duty for training.’’ Sexual harassment is further defined as ‘‘repeated, unsolicited verbal or physical contact of a sexual nature which is threatening in character.’’ 

More concretely, MST includes any sexual activity where someone is involved 

against his or her will—he or she may have been pressured into sexual activities 

(for example, with threats of negative consequences for refusing to be sexually cooperative or with implied faster promotions or better treatment in exchange for sex), 

may have been unable to consent to sexual activities (for example, when intoxicated), or may have been physically forced into sexual activities. Other experiences 

that fall into the category of MST include unwanted sexual touching or grabbing; 

threatening, offensive remarks about a person’s body or sexual activities; or threatening and unwelcome sexual advances. If these horrific experiences and often criminal acts occurred while an individual was on active duty or active duty for training, 

they are considered to be MST. 

How Common Is MST? 

Information about how commonly MST occurs comes from VA’s universal screening program. Under this program, all Veterans seen at Veterans Health Administration (VHA) facilities are asked two questions—one to assess sexual harassment and 

the other to assess sexual assault that occurred during their military service; Veterans who respond ‘‘yes’’ to either question are asked if they are interested in learning about MST-related services available. Not every Veteran who responds ‘‘yes’’ 

needs or is necessarily interested in treatment. It is important to note that rates 

obtained from VA screening cannot be used to make any estimate of the rate of MST 

among all those serving in the U.S. military, as they are drawn only from Veterans 

who have chosen to seek VA health care. Also, a positive response does not indicate 

that the perpetrator was a member of the military. Approximately 1 in 5 women 

and 1 in 100 men seen in VHA respond ‘‘yes’’ when screened for MST. Though rates 

of MST are higher among women, because of the disproportionate ratio of men to 

women in the military, there are actually only slightly fewer men seen in VA who 

have experienced MST than women. 

How Can MST Affect Veterans? 

It is important to remember that MST is an experience, not a diagnosis or a mental health condition in and of itself. Given the range of distressing sexually-related 

experiences and crimes that Veterans report, it is not surprising that there are a 

wide range of emotional reactions that Veterans have in response to these events. 

Even after severely traumatizing experiences, there is no one way that everyone will 

respond—the type, severity, and duration of a Veteran’s difficulties will all vary 

based on factors like whether he or she has a prior history of abuse, the types of 

responses from others he or she received at the time of the experiences, and whether the experience happened once or was repeated over time. For some Veterans, exebenthall on DSK9Q6SHH1PROD with HEARING

48 

periences of MST may continue to affect their mental and physical health, even 

many years later. Some of the difficulties both female and male survivors of MST 

may have include: 

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

Feelings of numbness: feeling emotionally ‘‘flat’’; difficulty experiencing 

emotions like love or happiness; 

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

Difficulties with attention, concentration, and memory: trouble staying 

focused; frequently finding their mind wandering; having a hard time remembering things; 

Problems with alcohol or other drugs: drinking to excess or using drugs 

daily; getting intoxicated or ‘‘high’’ to cope with memories or emotional reactions; drinking to fall asleep; 

Difficulty with things that remind them of their experiences of sexual 

trauma: feeling on edge or ‘‘jumpy’’ all the time; difficulty feeling safe; going 

out of their way to avoid reminders of their experiences; difficulty trusting others; 

Difficulties in relationships: feeling isolated or disconnected from others; 

abusive relationships; trouble with employers or authority figures; and 

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

problems; gastrointestinal problems. 

Among users of VA health care, medical record data indicate that diagnoses of 

post-traumatic stress disorder (PTSD), depression and other mood disorders, psychotic disorders and substance use disorders are most frequently associated with 

MST. Fortunately, people can recover from experiences of trauma, and VA has services to help Veterans do this. 

How Has VA Responded to the Problem of MST? 

Since 1992, VA has been developing programs to monitor MST screening and 

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

• All Veterans seen in VA are asked whether they experienced MST and all treatment for physical and mental health conditions related to experiences of MST 

is free for both men and women. • Every VA facility has a designated MST Coordinator who serves as a contact 

person for MST-related issues. This person can help Veterans find and access 

VA services and programs. He or she may also be aware of state and federal 

benefits and community resources that may be helpful. • Every VA facility has providers knowledgeable about treatment for the 

aftereffects of MST. Many have specialized outpatient mental health services focusing on sexual trauma. Vet Centers also have specially trained sexual trauma 

counselors. 

• Nationwide, there are programs that offer specialized sexual trauma treatment 

in residential or inpatient settings. These are programs for Veterans who need 

more intense treatment and support. 

• To accommodate Veterans who do not feel comfortable in mixed-gender treatment settings, some facilities have separate programs for men and women. 

Collaboration 

VA has developed a number of initiatives that promote coordination of care for 

active duty personnel and recently discharged personnel more broadly, but most coordination of clinical care for individual Veterans and active duty personnel seeking 

MST-related care happens on the local level and depends on the relationships that 

specific VA facilities have negotiated with local military installations. Local MST 

Coordinators often participate in or ensure inclusion of MST-related materials in 

local outreach events, particularly those post-deployment. At a national level, the 

VA MST Support Team has developed an ongoing relationship with the Department 

of Defense’s Sexual Assault Prevention and Response Office (SAPRO). The OMHS 

MST Support Team and SAPRO have presented at each others’ training events in 

order to share information about VA and DoD responses to sexual trauma with 

frontline clinicians. Staff from both the MST Support Team and SAPRO have given 

informational presentations about VA and DoD responses to sexual assault at a national VA training conference and at the International Society for Traumatic Stress 

Studies research conference. The two groups also communicate as necessary regardebenthall on DSK9Q6SHH1PROD with HEARING

49 

ing individual Veterans needing assistance in locating appropriate services to match 

their treatment needs. 

VBA Procedures for PTSD Claims Based on MST 

VA provides compensation payments for service-connected disabilities. The VA 

schedule for rating disabilities is based on the average earning loss resulting from 

the disabilities in the schedule. As the role of women in the military has expanded, 

the number of disability compensation claims received by VBA related to MST has 

increased. As you have already heard, MST may result in a number of disabling 

physical and mental conditions, but most often manifests itself as PTSD. 

In order to better assist those Veterans with PTSD claims based on MST, VA promulgated 38 CFR § 3.304(f)(4) in 2002, which emphasizes that, if a PTSD claim is 

based on in-service personal assault, which includes MST, evidence from sources 

other than a Veteran’s service treatment and personnel records may corroborate the 

in-service traumatic event. Such evidence may include, but is not limited to: records 

from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow servicemembers, or 

clergy. In addition, evidence of behavior changes following the claimed assault constitutes another source of relevant evidence. Examples of such behavior changes include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. The regulation prohibits the denial of claims for 

service connection for PTSD based on in-service personal assault without first advising the Veteran that information from sources other than the Veteran’s service 

records or evidence of behavior changes may constitute credible evidence of the 

stressor and allowing the Veteran an opportunity to furnish this type of evidence 

or advise VA of potential sources of such evidence. The regulation also provides that 

VA may submit any evidence it receives to an appropriate medical or mental health 

professional for an opinion as to whether it indicates that a personal assault occurred. 

This regulation takes into account the sensitive nature of MST and the difficulty 

with obtaining supporting evidence in many of these cases when service connection 

is claimed following the Veteran’s separation from service. In those cases where 

PTSD is diagnosed during service and the claimed stressor is related to that service, 

VA regulations state that the Veteran’s lay testimony alone may establish occurrence of the claimed stressor, provided that the claimed stressor is consistent with 

the circumstances, conditions, or hardships of the Veteran’s service and in the absence of evidence to the contrary. 

VBA field personnel who adjudicate PTSD cases based on MST were provided 

with detailed information on proper claims processing methods in a training letter 

issued in November 2005. Additionally, all regional offices have a Women’s Veteran 

Coordinator, who is well-versed in MST issues and can provide assistance to Veterans as necessary. These procedural steps taken by VA ensure that Veterans filing 

claims for PTSD based on MST will receive a fair and thorough consideration of 

their claims. 

CONCLUSION 

VA recognizes the damage that MST can inflict on its victims, and it has developed responses that are focused on providing Veterans the care and support they 

need. We have achieved much, and are continually evaluating ways to improve. VA’s 

MST Support Team is conducting a comprehensive study of providers of MST related mental health care. This will help us determine the number of unique providers at each facility who deliver MST related care, describe the characteristics of 

these providers, and assess the relationship of provider gender to patient gender to 

determine whether VA can consistently honor patients‘ expressed preferences for 

providers of a particular gender, as is VA’s policy. These results will provide important information to help us ensure there is sufficient capacity for specialized MST 

related services at each VA facility. We look forward to sharing the results of this 

analysis with Congress when it is ready later this year. 

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

questions you may have. 

f 

ebenthall on DSK9Q6SHH1PROD with HEARING

50 

Statement of Denise A. Williams, Assistant Director for Health Policy, 

Veterans Affairs and Rehabilitation Commission, American Legion 

Messrs. Chairmen, Ranking Members and Members of the Subcommittees: 

The American Legion appreciates the opportunity to submit for the record our 

views on this very important issue. 

Background 

The Department of Veterans Affairs (VA) defines Military Sexual Trauma (MST) 

as sexual assault or sexual harassment that occurred while in the military. This includes any sexual activity where someone is involved against his or her will. In 1992 

P.L. 102–585 authorized VA to provide up to 1 year of treatment to women veterans 

for psychological trauma resulting from physical assault, battery or harassment of 

a sexual nature. The Veterans Health Care Extension Act of 1994 (P.L. 103–452) 

granted VA the authorization to provide MST counseling to male veterans as well. 

On March 25, 2005 the Veterans Health Administration directive 2005–015 mandated that all enrolled veterans be universally screened for MST. In addition, the 

directive mandated that all VA medical facilities designate a MST coordinator to 

oversee MST screening and treatment and standardized training materials for MST. 

The VA provides treatment and counseling to all veterans that are suffering from 

MST and any mental and physical conditions related to MST. This service is afforded to all veterans free of charge. It is not necessary to have reported the incident while in the military or be service connected for this condition in order to receive this treatment and counseling. 

The Department of Defense (DoD) defines sexual assault as intentional sexual 

contact, characterized by use of force, physical threat or abuse of authority or when 

the victim does not or cannot consent. This includes rape, nonconsensual sodomy, 

indecent assaults, or attempts to commit these acts. In 2005, Congress directed the 

Secretary of Defense to develop a comprehensive policy for DoD to address the prevention and response to sexual assault involving servicemembers. In addition, the 

law requires that a standard definition for sexual assault be developed, DoD submits an annual report to Congress on reported sexual assault incidents involving 

servicemembers. 

Issues 

VA reported that in FY 2008 a total of 48,106 female veterans (21 percent) and 

43,693 male veterans (1.1 percent) screened positive for Military Sexual Trauma. 

According to the DoD Sexual Assault Prevention and Response Office (SAPRO), in 

FY 2008 there were a total of 2908 official reports of sexual assault in the United 

States military; this is an increase from 2688 reported in FY 2007. Messrs. Chairmen, these numbers are alarming and The American Legion urges Congress, DoD 

and VA to act now to eliminate this disturbing trend. 

In addition to these astounding numbers of MST and sexual assault cases, The 

American Legion is deeply concerned to learn that VA and DoD actions to address 

this dire issue are lagging. In March 2010 the Government Accountability Office 

(GAO) published a final report entitled VA Health Care: VA Has Taken Steps to 

Make Services Available to Women Veterans, but Needs to Revise Key Policies and 

Improve Oversight Processes (GAO–10–287). It was based on site visits to nine VA 

medical centers (VAMCs) and ten Community Based Outpatient Clinics (CBOC) affiliated with these nine VAMCs, and eight Vet Centers, which are counseling centers that help combat veterans readjust from wartime military service to civilian 

life. GAO was asked to examine the on-site availability of health care to women veterans, the extent to which VA facilities are following VA policies that apply to the 

delivery of health care to women veterans, and key challenges that VA facilities face 

in providing health care to women veterans and how VA is addressing these challenges. The GAO report stated that only two of the VAMCs that they visited had 

specialized residential treatment programs specifically for women who have experienced MST. Although VA has taken steps to inform staff about their various programs offering MST treatment and counseling, this information is only available internally and VA has not provided this information on their external Web site where 

it can be easily accessed by veterans. The American Legion encourages VA to improve their transparency by making this information readily accessible to veterans 

and to also collaborate with the Veteran Service Organizations (VSOs) to disseminate this valuable information. 

In order to help address this problem, The American Legion has made dealing 

with such issues with the proper sensitivity a priority in the training of its Departebenthall on DSK9Q6SHH1PROD with HEARING

51 

ment Service Officers (DSOs). There are American Legion DSO’s located in every 

State. These service officers can assist veterans and their families in filing a claim 

for benefits and gaining access to VA health care. DSO’s are trained to recognize 

and handle benefits issues, claims and discharge upgrades for women veterans. 

DSOs are also encouraged to increase their own awareness of the available resources so as to better assist and inform veterans suffering from MST of those resources. 

The American Legion has also made tackling the issues faced by women veterans 

a high priority by conducting seminars and panel discussions at various of its national meetings. We publish an annually updated guide for Women Veterans that 

is one of our most sought after resources, even used by VA at Vet Centers to inform 

women veterans of the resources available for their specific needs. While The American Legion is proud to provide such materials and resources to veterans, VA should 

not lag behind what is offered in the private sector in such matters. 

Returning to the GAO study, the report also noted a lack of uniformity in the 

training practices of mental health professionals. VA policy on mental health (MH) 

professionals training is ambiguous and does not detail the necessary training for 

MH professionals who treat/counsel victims of MST or other sexual trauma. As a 

result, some VA facilities have implemented their own guidance on training and experience of MH providers. The American Legion recommends that the Secretary of 

VA intervene and amend the policy to clearly define the MH professional’s requirement to treat/counsel MST patients. This effort would assure that our veterans are 

not deprived of the best quality of care available to them. 

Unfortunately, the prevalence of sexual assault in the United States military continues to increase, regardless of the implementation of the DoD’s Sexual Assault 

Prevention and Response (SAPR) program in 2005. In 2008, the Defense Manpower 

Data Center conducted a Service Academy Gender Relations Survey to assess the 

incidences of sexual assault and harassment at the three academies. The report 

found that 8.6 percent of women and 0.6 percent of men reported that they experienced unwanted sexual contact at the United States Military Academy. At the 

United States Naval Academy, 8.3 percent of women and 2.4 percent of men indicated they experienced unwanted sexual contact. At the United States Air Force 

Academy 9.7 percent of women and 1.4 percent of men reported they encountered 

unwanted sexual contact. 

The American Legion recommends that the Department of Defense aggressively 

enforce sexual assault prevention training on a more frequent basis. Additionally, 

we recommend that all servicemembers be educated on the procedures of how to report a sexual assault. Servicemembers in leadership positions should be trained on 

how to recognize physical and psychological signs of sexual assault. The American 

Legion declares that DoD has to effectively enforce zero-tolerance towards sexual assault across the board with no exceptions. 

There is a certain aspect of the military’s culture that may discourage a victim 

from reporting their sexual assaults. According to the American Journal of Public 

Health, perpetrators are typically other military personnel, and victims often must 

continue to live and work with their assailant daily, which increases the risk for 

distress and for subsequent victimization. Unit cohesion may create environments 

where victims face strong encouragement to keep silent about their experiences, 

having their reports ignored or even being blamed by others for the sexual assault. 

The DoD themselves admitted that only a small percentage of sexual assault is reported. The American Legion believes that in order to combat this appalling issue, 

there needs to be more involvement from top leadership within the Department of 

Defense. 

To further add to the aforementioned issues, veterans who suffer from MST encounter barriers when they file a claim for disability compensation through the Veterans Benefits Administration (VBA). The veterans are left with the burden to prove 

that they are eligible to receive compensation even though they have a diagnosis 

of Military Sexual Trauma from the Veterans Health Administration. As noted 

above, The American Legion has implemented a mandatory bi-annual training of 

our Department Service Officers to educate them on how to handle women veterans’ 

issues and all MST claim cases whether male or female in a sensitive manner. We 

are trying to do our part to assist veterans in the handling of these difficult benefits 

claim cases and with the issue, in general. But it is incumbent on all of us, DoD, 

VA and the veterans’ advocacy community, to make sustained efforts to deal with 

this growing problem or it will continue to fester. By having this hearing today, the 

Committee is obviously demonstrating its commitment to addressing the problem 

and we very much appreciate it. 

ebenthall on DSK9Q6SHH1PROD with HEARING

52 

1The figure of 12.5 percent was most recently supplied to us by Michael O’Rourke, head of 

Health Policy for the Veterans of Foreign Wars (VFW) in a personal communication on May 11, 

2010. 

Once again The American Legion thanks you for the opportunity to provide our 

views. We are happy to answer any questions the Subcommittees may have and look 

forward to working with both Subcommittees on rectifying this issue. 

f 

Statement of Beth K. Kosiak, Ph.D., Associate Executive Director, Health 

Policy, American Urological Association 

I would like to thank the Subcommittee on Disability Assistance & Memorial Affairs and the Subcommittee on Health of the House Committee on Veterans’ Affairs 

for your invitation to testify about urotrauma, a specific battlefield injury affecting 

a growing number of wounded military service personnel. Urotrauma is the term 

coined to refer to physical injury to the genitourinary system. 

We are receiving reports from our physician members, particularly from our urologists who have recently served in the armed forces in Iraq and Afghanistan, that 

urotrauma is an increasingly prevalent condition among our active military personnel and veterans. An escalating number of soldiers suffer extensive, debilitating 

injuries to the genitourinary system. These injuries have far reaching effects for 

years to come—including impaired sexual function and difficulty conceiving children. While not as readily apparent as the loss of limb or scarring to an exposed 

area of the body, urotrauma is a serious and growing problem. 

Urologists are disturbed that the knowledge and practice base is inadequate to 

meet this challenge. The American Urological Association (AUA), on behalf of its 

concerned surgeons, welcomes the opportunity to provide testimony and raise 

awareness about this condition. 

I am Beth Kosiak, Ph.D., the head of Health Policy for the AUA, a member organization that represents over 92 percent of the more than 10,000 practicing urologists in the United States and over 16,000 world-wide. The long-standing mission 

of the AUA is to promote the highest standards of clinical urological care through 

education, research, and formulation of health care policy. Urologists are the specialists who most often diagnose and treat prostate cancer, the second leading cause 

of cancer deaths among men in the United States. In addition, urologists diagnose 

and manage the care for kidney stones, urinary incontinence, urinary tract infections, and benign prostatic hyperplasia (BPH), among other conditions. 

There is insufficient data regarding the management of wartime genitourinary 

trauma. Neither a recent comprehensive review that examined available data from 

the 1960s to the present, nor a 1-year retrospective review of the United States 

Army trauma registry revealed substantial information on genitourinary trauma. 

While this latter registry provides valuable data on combat injuries, it does not 

record data specific to each genitourinary organ, nor does it detail what treatment 

modalities were used by urologists to manage genitourinary trauma. 

This dearth of data presents serious challenges to the appropriate diagnosis and 

management of these injuries. 

As battlefield rescues increase, more returning service personnel, particularly 

those who are victims of Improvised Explosive Devices (IEDs), are living with 

urotrauma injuries. Unfortunately, physicians must treat patients without the benefit of knowledge of the most effective treatments. Injury to urogenital organs accounts for between 1 percent and 12.5 percent 1 of all war injuries and most are associated with multiple lesions, especially abdominal. 

Most injuries observed during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) were due to IEDs and other explosive ordinance, and gunshot wounds. The extensive soft tissue loss seen with blast and high velocity bullet 

injuries necessitated a staged approach to genital reconstruction in many patients. 

More information needs to be gathered on the use of modern body armor in the 

prevention or minimization of genitourinary injury and to encourage improvements 

in the design of body armor to better protect the genitourinary area. The Joint Theater Trauma Registry was used to conduct a retrospective study of 2,712 trauma 

admissions to a United States Army Combat Support Hospital in Iraq. Casualties 

wearing body armor had a 2.1 percent rate of genitourinary injury versus 3.4 percent for those not wearing body armor. 

The Department of Defense (DoD) is sponsoring a major effort to focus on traumatic brain injury (TBI), and considers this one of the signature military medical 

challenges facing the Department for years to come. The DoD will fully implement 

ebenthall on DSK9Q6SHH1PROD with HEARING

53 

a comprehensive TBI registry including a single point of responsibility to track incidents and recovery and expand corresponding treatment services. This effort provides a strong model for genitourinary trauma for which dedicated research on prevention and appropriate treatment could minimize long-term/permanent damage, 

and encourage the development of more effective body armor. 

Given the urgent need for better data, information and clinical practice knowledge 

to treat and rehabilitate servicemen and women who experience such injury, the 

AUA has already taken several steps and plans to take more. 

First, and most significantly, we have authored a bill recently introduced in the 

House by Representatives Zack Space (D–OH) and Carol Shea-Porter (D–NH), H.R. 

5106, which would establish an Interagency Commission on Urotrauma, led by the 

U.S. Department of Defense, to investigate and advise on the research and action 

needed to advance treatment of this important condition. The urotrauma legislation 

includes the following key provisions: 

• Creation of ‘‘The National Commission on Urotrauma,’’ which will conduct a 

comprehensive study of the present state of knowledge and research on 

urotrauma, evaluate existing education and research resources, and identify 

knowledge and programmatic gaps. • A long-range plan, based on the Commission’s comprehensive study, for the use 

and organization of national resources to effectively deal with urotrauma, including: (1) researching innovations in the care and treatment of persons affected by urotrauma, (2) identifying ways to prevent or minimize these types 

of injuries, and (3) improving education and training to medical personnel caring for these individuals and raising awareness among the general public. 

Second, we have prepared and asked the Representatives to circulate a letter to 

their colleagues that asks for their support for this bill. 

Third, the AUA regularly produces evidence-based clinical practice guidelines 

which are gaining national attention for their scientific rigor, transparent methodology and timeliness. The AUA’s Board of Directors has approved development of 

a clinical practice guideline on urotrauma; we anticipate that work will begin early 

in 2011. Our guidelines are publicly available on our Web site and are listed on the 

Federal National Guidelines Clearinghouse, sponsored by the Department of Health 

and Human Services’ Agency for Healthcare Research and Quality (AHRQ). Thus, 

once completed, the urotrauma clinical practice guideline would be similarly available. 

Fourth, we have begun to engage our member urologists, particularly those who 

have served in military theaters, to provide their expertise to raise awareness and 

advance treatment knowledge about urotrauma. 

Finally, we have reached out to the Deputy Undersecretary for the Office of 

Wounded Warrior Care and Transition Policy of the Department of Defense, and 

supplied information in response to their request. We plan to contact other organizations and Federal agency offices where appropriate, to help educate relevant parties 

about urotrauma as well as offer the expertise of our member surgeons. 

I thank you for the opportunity to submit written testimony on this important 

topic, and offer the services of the AUA and its members to the Subcommittees if 

we can be of any further assistance. 

f 

Statement of Christina M. Roof, National Deputy Legislative Director, 

American Veterans (AMVETS) 

Mr. Chairman, Ranking Members Lamborn and Brown, and distinguished committee members, on behalf of AMVETS, I would like to extend our gratitude for 

being given the opportunity to share with you our views and recommendations regarding the treatment of military sexual trauma within the Department of Veterans 

Affairs (VA), more specifically the Veterans Health Administration (VHA). 

AMVETS feels privileged in having been a leader, since 1944, in helping to preserve the freedoms secured by America’s Armed Forces. Today our organization 

prides itself on the continuation of this tradition, as well as our undaunted dedication to ensuring that every past and present member of the Armed Forces receives 

all of their due entitlements. These individuals, who have devoted their entire lives 

to upholding our values and freedoms, deserve nothing less. 

By way of background and clarification, AMVETS understands that Military Sexual Trauma (MST) is in no way exclusive to the female veterans population, however much of our testimony today will be based on specialized treatments for women 

whom have experienced and are being treated for MST. 

ebenthall on DSK9Q6SHH1PROD with HEARING

54 

Women veterans are the fastest growing subgroup of the American military veterans’ population today. In fact, 2009 estimates show that women compose 14 percent of today’s military forces, and within the next 10 years this number is expected 

to nearly double. If those estimates hold true than upwards of 30 percent of America’s military forces and veteran community will be comprised of women. Women are 

also being deployed to combat zones at a rate in which this country has never seen 

and are carrying out vital roles on the frontlines. A 2008 VA study showed that 45– 

49 percent of female OEF/OIF veterans were enrolled in the VA Health Care System and were using VA provided services on a regular basis. This same study also 

showed that over 50 percent of the women currently enrolled in the VA health care 

system, 46 percent were under the age of 30. Now, more than ever, we must make 

sure that VA is ready and equipped with the necessary staff, facilities, and gender 

specific care programs to offer the best available care to today’s returning women 

servicemembers. According to VHA officials more than 1,000 new cases involving 

MST are uncovered each month, yet little is known to VHA staff about mental 

health needs of MST-exposed patients, or access to and utilization of services by 

these patients. While AMVETS understands that the VA health system is facing a 

very large endeavor in providing and implementing effective care models to their patients regarding MST, we also find self proclaimed lack of knowledge on the subject 

unacceptable. VA’s health care providers must have the experience and knowledge 

to treat all wounds of war. 

Treatment and care models of MST do not differ so dramatically from VHA to 

care provided by private sector physicians to the extent that VHA should be having 

trouble understanding MST and the related metal disorders that often accompany 

it. There are already many established and long used models that can serve as guiding principles for VA in the establishment and implementation of care relating to 

MST. If VHA believes they are lacking in the prior experience needed to effectively 

provide care, AMVETS believes VHA may be best served in reaching out to private 

sector or other agency care providers for guidance and assistance. In fact, on March 

3, 2009, VA’s Principal Deputy under Secretary for Health, Dr. Gerald Cross, stated 

‘‘We believe it is essential that our medical professionals across the system be able 

to effectively recognize and treat the manifestations of sexual trauma and PTSD,’’ 

further proving VA’s agreement with AMVETS on this matter. 

VA defines Military Sexual Trauma as sexual or psychological trauma resulting 

from sexual harassment or abuse that either men or women are subjected to while 

serving in the military. Due to further research by AMVETS, we were able to gather 

a further breakdown of the terms used to define MST as recognized by VA. 

AMVETS research of current VA policies produced the following definitions: 

1. Sexual Assault is defined as intentional sexual contact, characterized by the 

use of force, physical threat, and/or abuse of authority when the victim does 

not consent. 

2. Sexual Assault is further defined as encompassing force or the threat of force, 

coercion is used, or when the un-consenting party is asleep, incapacitated, or 

unconscious. 

3. Sexual Abuse is defined as, but not limited to, insistence on unwanted touching, forcing of unwanted sexual acts and demeaning remarks, treating as a sexual object with no regards to emotional well-being. 

4. Sexual Harassment is defined as a form of gender discrimination involving unwanted sexual advances, the requesting of sexual acts, and any other verbal 

or physical conduct of a sexual nature when a person’s job, pay or rank are 

placed in jeopardy, creates an intimidating or hostile workplace, and/or offensive work environment. 

5. Sexual Misconduct is defined as an act committed without intent to harm another and where, by failing to correctly assess the circumstances, a person believes unreasonably that effective consent was given without having met his/ 

her responsibility to gain effective consent. Situations involving physical force, 

violence, threat or intimidation fall under the definition of Sexual Assault, not 

Sexual Misconduct. 

AMVETS believes that it is very important to bring attention to the fact that the 

Department of Defense does not currently include ‘‘Sexual Harassment’’ in their definition of sexual assault, as VA does. This difference of definition poses a problem 

in itself. AMVETS believes there needs to be a single definition on what constitutes 

‘‘Military Sexual Assault’’ used by both VA and DoD to better recognize and treat 

victims of MST, as well as removing any questions regarding reporting of sexually 

related incidents. 

Studies conducted by VHA and private sector organizations from 2006–2009 show 

that on average 24 percent of all female veterans screened during their initial VA 

ebenthall on DSK9Q6SHH1PROD with HEARING

55 

i Coyle BS, Wolan DL, Van Horn AS. The prevalence of physical and sexual abuse in women 

veterans seeking care at a Veterans Affairs Medical Center. Mil Med. 1996 Oct; 161(10):588– 

93. ii Suris A, Lind L, Kashner M, Borman PD, Petter F. Sexual assault in women veterans: an 

examination of PTSD risk, health care utilization, and cost of care. Psychosom Med. 2004; 

66:749–56. iii Deborah Yaeger, MD, Naomi Himmelfarb, PhD, Alison Cammack, BS, and Jim Mintz, PhD. 

DSM–IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma. J Gen Intern Med. 2006 March; 21(S3): S65–S69. iv Deborah Yaeger, MD, Naomi Himmelfarb, PhD, Alison Cammack, BS, and Jim Mintz, PhD. 

DSM–IV Diagnosed Posttraumatic Stress Disorder in Women Veterans With and Without Military Sexual Trauma. J Gen Intern Med. 2006 March; 21(S3): S65–S69. 

health care assessment displayed the criteria necessary for having experienced a 

MST event during their service. One must remember that these numbers were obtained during initial screenings and do not factor in the female veteran population 

that were later given a diagnosis of a condition stemming from a MST event. Furthermore, with DoD and VA using separate definitions of MST it is impossible to 

know how many veterans have truly experienced a sexually traumatic event during 

their service. 

MST and its correlation to a magnitude of mental health disorders has been long 

documented and accepted within the medical community. However, it has not been 

until recently that women veterans under VA care have been specifically studied for 

the correlations of MST to PTSD and other mental health disorders. In 1996, a survey to determine the prevalence of physical and sexual abuse experiences, during 

and outside of military service, was conducted among 828 women veterans at the 

Baltimore Veterans Affairs Medical Center. Data collection was through an anonymous, mailed questionnaire. Three questions were used to elicit histories of physical 

abuse, sexual abuse, and rape. From the survey, 429 completed forms (52 percent) 

were returned. Most of the veterans had at least some college education and about 

50 percent served 4 or more years on active duty. About 68 percent of the respondents reported at least one form of victimization, while 27 percent reported to have 

undergone all three forms, of which sexual abuse was the most common, followed 

by physical abuse and then rape. It was during adulthood that all three forms of 

abuse took place, with one-third of the women reporting victimization during active 

duty. Coyle also found that single women and divorced women were more likely to 

report victimization than married women. In conclusion, physical and sexually 

abused women veterans were the ones more likely seeking care at the center.i

Research has shown that veterans who have experienced MST are at a high risk 

for developing a range of mental health conditions such as PTSD, major depression, 

anxiety, and panic disorder. MST victims may also struggle with other problems, including low self-esteem, difficulties with interpersonal relationships, and sexual dysfunction. To the best of AMVETS’ knowledge, there have only been two scientifically 

valid studies conducted since 2001 that examined rates of DSM–IV PTSD diagnoses 

in women veterans with MST. First, Suris et al.,ii using a sample of female Veterans 

Administration (VA) patients, compared rates of PTSD related to two types of civilian sexual trauma with PTSD rates related to MST. Suris found that MST was 

more frequently traumatizing than civilian assault. Thus, the data indicates that 

MST is more predictive of PTSD than are other types of military trauma or civilian 

sexual trauma. 

The second study was conducted in 2006 by Dr. Deborah Yaeger. Yaeger et al.,iii

compares rates of Post Traumatic Stress Disorder (PTSD) in female veterans who 

had military sexual trauma (MST) with rates of PTSD in women veterans with all 

other types of trauma. Both studies had findings that suggested that MST is common and that it is a trauma especially associated with PTSD. Yaeger’s research actually showed correlation between the MST group and Other Trauma group (r=.13, 

P=.07) reflected a weak relationship. Dr. Yaeger also conducted a logistic regression 

analysis in which PTSD was regressed on MST and Other Trauma. Both the MST 

group (Wald χ2=20.3, df=1, P=.0001) and Other Trauma group (Wald χ2=5.4, df=1, 

P=.02) significantly predicted PTSD, but MST predicted it more strongly. This finding is significant because the number of women positive for MST was less than half 

of those positive for Other Trauma, yet the relationship of the MST group with 

PTSD was stronger.iv This is only one example of data showing the almost unquestionable link between MST and PTSD. Finally, in 2007, the Medical University of 

South Carolina wrote an article that reviewed the literature documenting the nature and prevalence of traumatic experiences, trauma-related mental and physical 

health problems, and service use among female veterans. Existing research indicates that female veterans experience higher rates of trauma exposure in comparison to the general population. Emerging data also suggest that female veterans may 

ebenthall on DSK9Q6SHH1PROD with HEARING

56 

v Zinzow HM, Grubaugh AL, Monnier J, Suffoletta-Maierle S, Frueh BC. Trauma among female veterans: a critical review. Trauma Violence Abuse. 2007 Oct; 8(4):384–400. Review. 

PubMed PMID: 17846179. 

be as likely to be exposed to combat as male veterans, although not as directly or 

as frequently. Female veterans also report high rates of posttraumatic stress disorder, which has been associated with poor psychiatric and physical functioning. 

USC concluded that while sexual assault history has been related to increased medical service use, further research is needed to understand relationships between 

trauma history and patterns of medical and mental health service use. Researchers 

also are encouraged to employ standardized definitions of trauma and to investigate 

new areas, such as treatment outcomes and mediators of trauma and health.v

AMVETS believes this review further demonstrates the importance of a uniformed 

definition of MST throughout all agencies, more specifically DoD and VA. AMVETS 

also believes these studies to show the importance of integrating mental health care, 

as outlined by VHA 1160.01, into all VAMCs and CBOCs providing primary care. 

In 2005, VHA published VHA Directive 2005–015, authorized under P.L. 102–85 

outlining specific policies, procedures and staffing requirements as they relate to the 

treatment and care of veterans who have experienced military sexual trauma 

(MST). To build upon this directive VHA 1160.01, as published in September of 

2008, provided even more policies and procedures that all Veteran Affairs Medical 

Centers and Community Based Outpatient Clinics should employ when treating veterans having suffered MST. These policies and procedures provide guidance and 

outline all legally binding requirements of the treatment of veterans having experienced MST by all VAMCs and CBOCs. The measures are as follows: 

• The constant availability, isolation and safety of ‘‘women only’’ areas in each 

medical facility treating women veterans. 

• That all medical directors ensure that every patient receiving care is screened 

for MST. 

• The use of MST software that allows tracking of VA’s screening of veterans. The 

Women Veterans Health Program and the Mental Health Strategic Work Group 

utilize the national MST report to respond to Congressional inquiries and for 

expansion of MST programs and initiatives. 

• Veterans receiving MST-related counseling and treatment are not billed for inpatient, outpatient, or pharmaceutical co-payments; however, applicable co-payments may be charged for services not related to military sexual trauma or for 

other non-service connected conditions. 

• Scheduling priority for outpatient sexual trauma counseling, care, and services 

is consistent with the VHA performance standard of scheduling within 30 days 

for special populations and mental health clinics. 

• Accurate documentation of screening, referral, and treatment services provided 

to veterans, aggregated by gender, is maintained. This process includes use of 

the MST software and the MST clinical reminder to track and monitor the level 

of compliance with the standard (100 percent of enrolled veterans screened). 

The nationwide tracking system to ensure consistent data on screening and 

treatment of victims of military sexual trauma must be used. 

• MST counseling is provided by contract with a qualified mental health professional if it is clinically inadvisable to provide in Departmental facilities or when 

VA facilities are not capable of furnishing such counseling to the veteran economically because of geographic inaccessibility or the inability of the medical 

center to provide counseling in a timely manner. 

• Veterans who report experiences of MST, but who are otherwise deemed ineligible for VA health care benefits based on length of military service requirements, may be provided MST counseling and related treatment only. 

• The MST software application that activates the MST Clinical Reminder within 

CPRS has been installed at the facility. All veterans receiving VHA health care 

must be screened for MST using this clinical reminder. 

• Veterans screening positive and requesting treatment are provided free care, 

with no inpatient, outpatient, or pharmacy copayments, for mental and physical 

health conditions resulting from their experiences of MST. Determination as to 

whether care is MST-related is made by the clinician providing care. All MSTrelated care must be designated by checking the MST box on the encounter 

form for the visit. 

• The time frames for evaluations of veterans for possible mental disorders resulting from MST must follow the requirements in paragraph 13, of VHA 1160.01. 

• Evidence-based mental health care is available to all veterans diagnosed with 

mental health conditions resulting from MST. 

ebenthall on DSK9Q6SHH1PROD with HEARING

57 

While AMVETS does realize that VA has been making efforts to provide better 

care to all women veterans, we were quite troubled by two recent GAO reports on 

the standards of care our female veteran population has been receiving at VAMCs 

and CBOCs, especially in the areas of mental health and MST treatments. In March 

2010, GAO published a report entitled ‘‘VA Has Taken Steps to Make Services 

Available to Women Veterans, but Needs to Revise Key Policies and Improve Oversight Processes,’’ as a follow up report to the July 2009, GAO report entitled’’ VA 

Health Care: Preliminary Findings on VA’s Provision of Health Care Services to 

Women Veterans.’’ 

AMVETS believes that what GAO reported in March 2010 is unacceptable and 

quite negligent by many VAMCs in providing the most basics of care to our women 

veterans. For example, in the 2009 report GAO found that none of the facilities they 

visited were compliant with privacy requirements outlined by VA. Regrettably, in 

the more recent 2010 report, GAO reported that most facilities still had not improved their measures to provide the required privacy to women veterans. Another 

area in need of compliance, as pointed out by GAO numerous times, are the requirements for treating veterans who have experienced any sort of MST, as outlined by 

P.L. 102–85 and 38 U.S.C. § 1720D. Federal law specifically requires VA to establish 

a program to provide these MST-related services and to provide for appropriate 

training of mental health professionals and such other health care personnel as the 

Secretary determines necessary to carry out the program effectively. These laws 

state that every VA facility to be equipped and able to provide immediate care for 

any veteran who has experienced any psychological trauma as a direct result of a 

physical assault or harassment that was sexual in nature during their time in service. 

VA’s MST-related policies require that VAMC directors appoint an MST Coordinator and that necessary staff education and training be provided. The MST coordinators are responsible, among other things, for monitoring and ensuring that VA 

policies related to MST screening, education, training, and treatment are implemented at the facility. GAO reported that VA had taken some steps internally to 

make information about MST programs more readily available to VA providers. Specifically, VA has conducted monthly, nationwide MST conference calls which have 

included basic information on the structure and focus of the various residential and 

outpatient programs offering MST or sexual-trauma-specific treatment, as well as 

detailed presentations by key providers from several programs. VA also has a list 

of the various programs on its internal Web site, which is accessible by VA providers. However, GAO went on to say that VA had not made the same information 

accessible to veterans through VA’s external Web sites or printed literature accessible to all veterans. As of November 2009, the Web site pages reviewed by GAO 

from VA’s national Web site did not provide complete lists of facilities that have 

MST-related treatment programs or specialized programs for women veterans. The 

sites that did list specific residential treatment programs usually listed a single program, while nine VAMCs have relevant programs. AMVETS is quite concerned that 

VA’s outreach to women veterans is falling short. While most of us here today are 

very familiar with VA programs, the average veteran is not. It is the responsibility 

of VA to not only design and implement these MST specific programs, but to also 

educate the veterans living in all parts of the country on the services available to 

them. How can a veteran receive the care and assistance they need if they do not 

even know that the care exists? 

It was the understanding of AMVETS that ensuring the privacy and integrity of 

all women veterans seeking care in a VAMC or CBOC was a requirement of federal 

law, not a suggestion. Women veterans seeking care for the most private and potentially damaging experiences, such as MST, must feel safe and that only their best 

interests are at hand by VA medical providers. What sort of message are we sending 

our returning female servicemembers, who have suffered a traumatic sexual experience, when VA is not able to offer them something as simple as an OB table facing 

away from the examine room door or a private and separate sleeping area from the 

male patients? Can VA honestly say, to this congressional Subcommittee and to all 

veterans, that the oversight they have exercised over the implementation of these 

care measures has been nothing less than their best? Can AMVETS be assured that 

every VAMC and CBOC is doing everything in their power to correct the deficiencies 

that have been repeatedly pointed out to them regarding the care of America’s returning war fighters? 

AMVETS offers the following recommendations regarding military sexual trauma 

care and treatment issues: 

1. AMVETS recommends these Subcommittees set forth a strict timeline in which 

VA will have to report all updates on the implementation of MST policies and 

ebenthall on DSK9Q6SHH1PROD with HEARING

58 

procedures in every VAMC and CBOC, and that the Committee holds VA accountable to a specific date of systemwide total implementation. AMVETS further recommends that any requests for exception on meeting the specified 

deadline are required to be made in writing directly to the Secretary for final 

approval. 

2. AMVETS recommends VA immediately update the information on their Web 

site, as well as written literature, to guarantee that all veterans are aware of 

the services available to them and where they may go to receive said services. 

3. AMVETS recommends these Subcommittees maintain strict oversight on the 

implementation of VHA 1160.01 as it pertains to the availability of treatment 

for MST and all mental health care provided by VA, in efforts to implement 

and maintain uniformed mental health care systemwide. 

f 

Statement of Hon. Henry E. Brown, Jr., Ranking Republican Member, 

Subcommittee on Health 

Thank you, Mr. Chairman. 

We are here this morning with our colleagues from the Subcommittee on Disability Assistance and Memorial Affairs to discuss issues surrounding Military Sexual Trauma (MST). 

Sexual assault and harassment is unacceptable in any sector of American society 

and is a particularly serious matter in our military and veteran populations. 

Because it occurs in a hierarchical and highly stressed environment, the negative 

physical and psychological effects of MST can be intensified and make one more 

likely to develop a mental health condition. The most common mental health condition observed among those veterans who report MST is post-traumatic stress disorder (PTSD). 

It is particularly troubling to me that a servicemember who is a victim of sexual 

assault is often hesitant to disclose their experience because they fear negative social stigma, peer pressure, and risking their career. 

It is encouraging that VA has come a long way since initially establishing a program to provide MST treatment in the 1990’s. In 2003, VA began screening every 

patient seeking health care at a VA facility for MST and providing those who disclose it with free, confidential treatment and counseling. To receive such care, a veteran does not need to be service-connected, have reported the incident previously, 

or have documented that it occurred. 

Additionally, each VA facility has a designated MST point of contact, coordinated 

through VA’s national MST Support Team. With the recently enacted Caregivers 

and Veterans Omnibus Health Services Act, Congress mandated sexual trauma 

training and certification for VA mental health providers to ensure proper provision 

of the supportive services veterans with MST experience need and deserve. 

VA’s universal screening program is a good model to promote early detection and 

increase access to mental health care. However, there is still a great need to promote and develop effective therapies and conduct research to help us learn more 

about how to successfully treat veterans who experienced MST. 

When the men and women of our Armed Forces devote their time in service to 

our country, they knowingly accept the threat of danger from America’s enemies. 

But what they should never have to accept is the threat of sexual trauma from their 

fellow servicemembers. 

I look forward to hearing from our witnesses on how we can all do a better job 

of combating MST and supporting the healing of those who have tragically experienced it. I thank you all for being here for this difficult and important conversation. 

Most importantly, I hope that any servicemember or veteran with MST who may 

be listening today will be encouraged to report their experiences and seek help at 

their local VA. I yield back the balance of my time. 

ebenthall on DSK9Q6SHH1PROD with HEARING

59 

MATERIAL SUBMITTED FOR THE RECORD 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Phyllis Greenberger 

President and Chief Executive Officer 

Society for Women’s Health Research 

1025 Connecticut Avenue, NW Suite 701 

Washington, DC 20036 

Dear Ms. Greenberger: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. We would greatly appreciate if you 

would provide answers to the enclosed follow-up hearing questions by Wednesday, 

July 21, 2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Jian Zapata 

by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Subcommittee on Disability Assistance 

and Memorial Affairs 

Michael H. Michaud 

Chairman 

Subcommittee on Health 

Questions from the House Committee on Veterans’ Affairs 

Subcommittees on Disability Assistance and Memorial Affairs and Health 

‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues’’ 

May 20, 2010 

Question 1: In your opinion, what training is needed to ensure that commanders 

treat military sexual trauma as it is, a crime? 

Response: The Society for Women’s Health Research (SWHR) is dedicated to improving women’s health through advocacy, education, and research. We appreciate 

the opportunity to offer insight into proven approaches in responding to sexual assault and to offer suggestions as to what we believe needs to be done in order for 

military sexual trauma (MST) to be taken seriously as a crime. 

First, it is clear that a top-down approach needs to be integrated into all MST 

training. Leaders within the military must emphasize that MST is not just an acronym—it is rape and it is a crime that affects a person both on an emotional and 

physical level. This must be clearly conveyed to those servicemembers that they 

lead. The actions and level of seriousness that leaders take toward MST should be 

reflected in the actions and behavior of those being instructed. By making clear 

from the beginning what is not tolerated or appropriate, leaders will be doing their 

part to foster an atmosphere of zero tolerance for sexual harassment and assault. 

SWHR commends the efforts of the Sexual Assault Prevention and Response Office (SAPRO) within the Department of Defense (DoD) for their efforts educating 

servicemembers and commanders about MST, and for their bystander outreach campaign targeting the vast majority of military members who are not sexual offenders. 

However, according to SAPRO reports, almost 100 percent of MSTs occur with the 

knowledge of, help of, or assistance from another individual. By educating what 

words and behaviors to watch for, and learning ways to respond and report as a 

bystander, SAPRO is helping to equip members with information to help stop these 

crimes from happening and to prevent the trauma and destruction in the first place. 

ebenthall on DSK9Q6SHH1PROD with HEARING

60 

SAPRO has different training programs specific for commanders within the military; 

these programs help to educate commanders and leaders on sexual assault and harassment throughout their careers. SWHR applauds the leadership SAPRO has 

taken in addressing MST within the military, and hopes that their research and reporting on this topic will guide policy decisions that will eliminate the risk of MST 

for those who serve. 

Second, we will not understand the full scope of the problem unless better and 

more complete reporting systems are in place that emphasize coming forward for 

treatment, reduce stigma, and eliminate any threats to the victim’s career. To ensure MST is treated as a crime, reporting of MST must be uninhibited, provide for 

privacy and be held with the highest discretion, and the repercussions must be 

swift, severe, and uniformly applied. According to a Department of Defense (DoD) 

report in 2009, only 10 percent or fewer of sexual assaults are estimated to have 

been reported to law enforcement or military Sexual Assault Resource Centers. 

Studies completed by the VA in 2007 conclude that 20–30 percent of female veterans 

were raped or assaulted while serving. It is likely that there is a higher number 

of MST survivors not yet accounted for, as less than 50 percent of female veterans 

have come forward to claim VA benefits or care, and as a result have not been included in the most recent VA surveys. 

Treatment is especially important for female victims of MST because of their likelihood to develop subsequent complications, such as sexually transmitted infections 

((STI) or Post Traumatic Stress Disorder (PTSD). Sex-based research has found that 

women are more likely to acquire a STI than a man, and many of these infections 

can have potentially lifelong consequences. Additionally, women are twice as likely 

as men to develop depression and PTSD because of exposure to traumas. Prolonged 

feelings of fear, if not treated, can lead to increased levels of stress and anxiety, all 

with body wide impacts. Appropriately timed and sex-based interventions after MST 

could prevent overwhelming mental and physical health burdens on the victim as 

well as an avoidable financial burden to the Department of Veteran Affairs (VA). 

One reason why both men and women do not report MST stems from threats (explicit or implied) from the person(s) whom harmed them sexually and the stigma 

that comes with reporting being a victim of MST. An August 2009 article in The 

Seattle Times relayed a story from a male MST victim and his fear in coming forward because of death threats he had received. The men who gang raped him 

worked alongside him day in and day out; because of the close ties and personal 

connections with these fellow military men, he reports he felt lost on how to deal 

with the problem. Victims of MST are often filled with shame and humiliation, at 

a loss for what to do, especially when threatened if they speak up about their issues. 

This case highlights the fact that MST can and does happen to both men and 

women. If both sexes fear coming forward after MST because of threats of harm or 

career loss, stigmatization or because of the humiliation they as victims feel, the 

military faces a great challenge in overcoming this atmosphere of shame and suffering in silence. 

The VA Web site discusses the fact that victims of MST can experience a disturbance in their career goals (delayed promotions, demotions or dishonorable discharges) possibly due to factors such as a perpetrator who is a superior not recommending her for promotion, or because the woman is not performing at her best due 

to PTSD or avoiding certain assignments to avoid her assaulter. This is a great disadvantage to those who wish to advance up the ladder, however, choose not to once 

they realize they will be working alongside their perpetrator(s). 

Question 2: What training would you recommend for VBA benefits staff to ensure that they are properly recognizing the connections between MST and PTSD? 

Response: In response to the near doubling of female veterans in the past 5 

years the Veterans Benefits Administration (VBA) is making great strides in improving the resources available to the increased number of women veterans. With 

45.9 percent of servicewomen surviving MST going on to develop PTSD according to 

the VA’s Web site update in 2009, the connection between MST and PTSD is strong. 

In order to properly recognize, best assist, effectively treat, and ideally prevent 

PTSD in MST victims, a few interventional steps should be taken. The VBA will 

benefit from recognizing the numerous symptoms and side effects that can occur in 

any combination and with varying levels of severity; distinguishing the unique 

stresses and environmental triggers, addressing the looming emotional toll, and formulating individualized assistance. 

While the VBA coordinates benefits in addition to disability payments including 

reintegration, housing, education and rehabilitation, the medical personnel practicing within the VA medical centers must also take a multifaceted approach to best 

ebenthall on DSK9Q6SHH1PROD with HEARING

61 

serve those surviving MST, with or without PTSD, including combining psychotherapy, medication and group reinforcement when appropriate. 

Symptoms of PTSD can appear immediately after the trauma, relatively late or 

in fluctuating intervals. The VA reports that while 94 percent of females suffering 

from MST will experience some symptoms of PTSD within 2 weeks, 30 percent will 

experience some symptoms nine or more months later. With such a great variety 

in time between the trauma and onset of symptoms, and with many women trying 

to cope with MST on their own, it is especially important that all medical personnel 

are actively looking for and using medical questioning and testing to highlight any 

symptoms. Accordingly, the VBA must be flexible in designating timelines for claiming PTSD and related assistance. A report in July 2010 from the VA discusses the 

new regulations broadening the range of incidents that could cause PTSD and easing access to the benefits a veteran could receive. Increased research into the different experiences for women after MST, with or without PTSD, will help VA and 

civilian medical providers stand ready to better serve all victims with more targeted 

treatment regimens. Improved sex-based responses to MST and PTSD are not only 

crucial to preventing long term consequences of MST and effectively treating PTSD, 

but also to preventing the 13 percent of women suffering from PTSD that are more 

likely to abuse alcohol, the 26 percent of women that are more likely to abuse drugs 

and the countless female veterans that have contemplated suicide. 

Triggers, anything from a scent to a situation that causes the body to be reminded 

of the sexual assault, can reinforce PTSD caused by MST, enhancing memory consolidation and often causing a woman to react more negatively than a man. The 

case of MST with PTSD is especially unique in that the veteran had oftentimes 

lived side-by-side with the aggressor for some period of time, including after the assault. The unique stresses and overexposure to environmental triggers greatly influence the sufferer’s psychological state and tend to have an even greater impact on 

women due to fluctuations in hormone levels and rates of memory consolidation. According to Margaret Alternus, speaking on the issue of sex differences at a 2008 Society for Women’s Health Research conference on Posttraumatic Stress Disorder in 

Women Returning from Combat, women tend to react more negatively to interpersonal stressors, have a greater frequency and intensity of negative emotions due 

to fluctuating hormone levels, and have a heightened sensitivity to the hormone 

catecholamine, which is key to memory reconsolidation. While ultimately the DoD 

needs to be cognizant of the impact triggers may have on a woman who survived 

MST but continues to serve, it is imperative that the VA is equipped with a full 

scope of sex-specific treatment options for all veterans, and the VBA stand ready 

to provide assistance where necessary. Veteran benefits, health care, and reintegration efforts all need to coordinate to help the victim regain a sense of normalcy and 

reenter the community after the assault and after a tour of duty. 

The psychological ramifications of PTSD take a severe emotional toll on the sufferer and influence the ability to maintain conventional relationships, even long 

after the attack. By recognizing any prominent or underlying signs of relationship 

problems in the victim and a spouse, child or other immediate family members, a 

personalized and targeted care regimen could be created. A veteran’s return to civilian life is a difficult adjustment for the individual and family, and the VBA is 

uniquely equipped to aid the veteran and family members during the transition 

with training, compensation, and education benefits. VBA should expect that a victim of MST, with or without PTSD, may require aid that is different from a servicemember not experiencing MST or PTSD. In addition, some regular family counseling 

should be made readily accessible, so that veterans will have a strong, well-informed 

emotional support system. 

The most important aspect to recognizing the connection between MST and PTSD 

and effectively treating it is through individualized attention. Flexibility within the 

VBA structure will allow for sex-based and individual-based differences in needed 

assistance. Every woman’s suffering was caused by a different event, is perpetuated 

by varying triggers, is influenced by unique hormone levels, and is characterized by 

personal combinations of symptoms. By recognizing these various factors, whether 

apparent or concealed, and creating individualized treatments, each female veteran 

has the ability to overcome her PTSD. 

Question 3: For female MST victims, you recommend that VA provide treatment 

and benefits that meet their gender specific needs. Do you believe that MST related 

benefit claims should be processes only by VBA staff of the same gender as the veteran claimants? 

Response: MST related benefit claims can be processed equitably and uniformly 

by a well-trained VBA staffer of either sex, however, the VBA may consider making 

case review by same-sex staffers an option if requested by a veteran. 

ebenthall on DSK9Q6SHH1PROD with HEARING

62 

While the sex of the VBA staff adjudicating MST and PTSD related claims should 

not make a difference, there are obvious concerns about the sex of the health care 

provider and the participants of group therapy within VA medical centers that must 

be acknowledged and worked into VA care models. SWHR strongly believes that the 

VA should strive to provide evidence-based, gender-specific treatment options at 

each level of care. According to a June 2010 article in Time magazine, the VA has 

been working to implement policies to provide and improve sex-specific care and 

treatment for veterans. One example includes all-female therapy groups, especially 

for those women surviving sexual assault. This is a step in the right direction and 

SWHR hopes to see more improvements for veterans through the research and application of sex-specific care. 

Question 4: Your testimony discussed the importance of VA working with nonVA providers to ensure that veterans receiving private treatment for MST issues are 

nonetheless afforded the highest quality of care that meet VA’s standards. Please 

elaborate on how VA can better collaborate with such providers to share clinical 

guidance and other important information on the treatment of conditions that result 

from military sexual trauma. 

Response: SWHR has learned through interviews with women veterans that a 

common reason why women seek care with non-VA providers is to ensure confidentiality. For the VA to ensure veterans are receiving the best care possible within 

their facilities they should start by making their care models more accessible and 

inviting, while ensuring privacy of records and during appointments. 

Another suggestion deals with training for non-VA providers. According to an article within The New York Times in July 2010, the VA is equipped with its own training programs that help to ensure proper treatment and care specifically for veterans. Tom Pamperin, an Associate Deputy under Secretary for Policy and Programs 

at the Veterans Department, states ‘‘VA and VA-contact clinicians go through a certification process. They are familiar with military life . . .’’ The VA could consider 

allowing non-VA providers to take this certification course, allowing public or private medical centers an opportunity to better ensure that veterans seen in these settings are provided with tailored treatment and care that fully meet VA standards. 

Another possibility would include allowing medical groups to model their own training session after the VA’s model or seek consulting from the VA for proper treatment and care. In the setting of rising numbers of veterans, the VA may benefit 

from drawing up well trained non-VA providers to help in addressing in a timely 

fashion the needs of all veterans. SWHR supports recent recommendations calling 

for permitting outside clinicians to document PTSD for the purpose of claiming VA 

benefits, given the number of women who feel most comfortable seeking non-military assistance in dealing with MST or PTSD related issues. 

Also within The New York Times article, Eric Shinseki, Secretary of the VA, 

states ‘‘This Nation has a solemn obligation to the men and women who have honorably served this country and suffer from the emotional and often devastating hidden 

wounds of war’’. The VA’s new policy for veterans with PTSD, easing barriers to 

claiming compensation, is a step in the right direction; however, considering the 

high number of war veterans, both male and female, who have PTSD because of 

MST, the VA should consider additional expansions in care and benefits recognizing 

the unique hardships and challenges faced by returning victims of MST. 

Question 5: Do you have suggestions on how the VA and DoD can better work 

together to ensure a smooth transition for servicemembers who have experienced a 

military sexual trauma? 

Response: The efforts of the VA and DoD to implement a mutually shared electronic health record is commendable. These advancements in technology and communication are establishing an unprecedented path towards seamless medical coverage that will certainly improve the health care delivered to servicemembers 

throughout their lifetime. Currently, the Virtual Lifetime Electronic Record (VLER) 

system is being strategically implemented, monitored and improved so as to facilitate the transition from military to civilian life. With some slight modifications, this 

system can also better monitor the effects of MST in the increasing number of female veterans. 

The VLER system right now seems to focus primarily on the sharing of medical 

records pertaining to pharmaceuticals and drug allergies. These records should conversely cover all aspects of the medical realm so as to allow for the complete interoperability of personal health information between the VA and DoD. This might include all the tests, screenings and any forms of therapy undergone while in the military. In addition, medical records prior to deployment could be scanned into the system, providing the most complete picture. This would highlight any previous condiebenthall on DSK9Q6SHH1PROD with HEARING

63 

tions or trauma that might potentially impact a servicemember’s health or susceptibility to PTSD. By integrating all medical records, the DoD and VA would be able 

to provide seamless medical coverage to individuals entering the military, throughout their deployment and as a veteran. With their unique access to data concerning 

male and female servicemembers, both the VA and DoD have an opportunity to be 

leaders in sex-based differences research, improving health for women and men, 

military and civilian. 

As a record number of women join the military scene and an increasing number 

of women are achieving veteran status, the VA and DoD must also collaborate to 

recognize the unique medical problems women are facing, and the various treatment 

options. It is imperative that the VA increase the amount of sex-based research 

being conducted, in order to meet its goal of creating evidence-based practices that 

are beneficial for the health and health care of women. One crucial topic of research 

should be studying the effects that MST and PTSD have on a woman’s life span 

and health. 

f 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Helen Benedict 

Professor of Journalism, Columbia University 

2950 Broadway 

New York, NY 10027 

Dear Ms. Benedict: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. We would greatly appreciate if you 

would provide answers to the enclosed follow-up hearing questions by Wednesday, 

July 21, 2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Jian Zapata 

by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Subcommittee on Disability Assistance 

and Memorial Affairs 

Michael H. Michaud 

Chairman 

Subcommittee on Health 

Answers to Questions from the House Committee on Veterans’ Affairs 

Subcommittees on Disability Assistance and Memorial Affairs and Health 

‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues’’ 

May 20, 2010 

From Professor Helen Benedict 

Question 1: Professor Benedict, you suggest that MST could be reduced by promoting women and taking other steps to increase respect for women amongst commanders and the troops overall. As a member of the Visitors Board at West Point, 

I’ve long supported women military leaders, what steps do you suggest be taken to 

better promote women servicemembers within the ranks? 

Response: I have heard many stories of individual officers and NCOs who so resent the presence of women in their units that they deny them deserved promotion, 

recognition and even medals. In one case in my book, for example, a female army 

ebenthall on DSK9Q6SHH1PROD with HEARING

64 

specialist helped to save four soldiers in a mortar attack at great risk to herself. 

Her immediate superiors recommended her for a Bronze Star, but the commander 

of her platoon, who had a long history of antagonism toward all the women in his 

unit, blocked the reward. She was never recognized for her bravery. 

Officers should be taught not to overlook women in this way, of course. But there 

should also be some oversight from the command to check whether the promotions 

and rewards in any particular mixed-sex unit shows a conspicuous lack of women 

recipients. 

The adequate recognition of women is a problem in the civilian realm, too, a product of the age-old habit of not taking women seriously or recognizing their work. 

Within the military, this attitude is exacerbated by the Pentagon’s ban against 

women in combat, which relegates them to second-class status in many eyes. 

Fixing this bias against women usually takes conscious and deliberate attention. 

I am not suggesting that the military use quotas for rewards and promotions, only 

that if no women are among those put up in any particular unit, a high-ranking 

commander or review board should sound the alarm and start an investigation. 

Question 2: You also recommend that the military screen and perhaps reject recruits with history of being sexual violent perpetrators and victims. What impact 

do you predict this type of scrutiny can have on reducing MST? 

Response: First, to make clear, I absolutely did NOT recommend rejecting victims of sexual violence from enlisting in the military. That is a misreading of my 

statement. If we did that, we would lose about one sixth of our male recruits and 

about half of our female recruits. And we would be further punishing the victims 

of a crime that is no fault of their own. 

No, what I said was that we should reject anyone who has a history of COMMITTING sexual or domestic violence. The reason is clear: rape is a serial crime. Most 

rapists rape again and again, and most men who are violent against women at home 

will continue that behavior in the military. Rejecting those men will screen out 

many potential assailants from the military. 

I also recommend child sexual and physical abuse counselors for all the military, 

because VA studies show that about half our troops come from violent homes. Such 

counselors may be able to prevent anger, sexual violence and suicidal behavior 

among servicemembers with troubled backgrounds. 

Question 3: Since a DoD survey reveals that men may make up more than onethird of military sexual harassment victims, what type of training do you recommend DoD and VA employ to prevent MST amongst both men and women? 

Response: It is essential that all sexual assault prevention training begin with 

a proper definition of sexual assault and rape. It needs to be made clear that assailants are not acting out of pent-up lust, or responding to seduction, but are predators 

taking advantage of their power or circumstances to force others into sexual contact. 

Sexual predators are more interested in dominating and degrading their victims 

than in satisfying sexual frustration. 

In short, it should be emphasized that the victim is never to blame. Even if he 

or she is drunk or flirtatious, or makes a careless or even serious mistake (such as 

leaving a weapon unattended), this is not the same thing as asking to be assaulted. 

The lack of blame and de-sexualization of rape and assault will help men and 

women feel safer to report and to seek treatment. 

For men, it needs to be emphasized that rape does not happen because either the 

victim or the perpetrator are homosexual. In fact, studies show that most rapists 

of men are heterosexual. 

For male victims, it is also essential that the Don’t Ask, Don’t Tell rule be repealed. While it exists, most male victims are too afraid to report an assault in case 

they are then labeled as homosexual and expelled from the military. 

Question 4: In your testimony, you mentioned that victims who did not report 

an assault while on active duty have often been denied treatment through VA. However, VA is responsible for treating all servicemembers who screen positive for MST, 

even if they do not have a service-connection. Can you elaborate on this point? 

Response: The contradiction here is about the gap between the rules and the 

practice. Even though troops are entitled to MST counseling, in practice many are 

told that their problems are a ‘‘pre-existing personality disorder,’’ and so are not covered by the military or the VA. Others are told that their problems are in their 

heads, that they are malingering, or otherwise lying. I say this because I have heard 

dozens of stories from soldiers themselves about this. 

Several news stories have come out about the way this diagnosis of pre-existing 

personality disorders is used by the VA to deny treatment and save money. It will 

ebenthall on DSK9Q6SHH1PROD with HEARING

65 

take congressional oversight and condemnation to end this practice. The need is urgent, because the problem is widespread and devastating, and it affects not only 

MST victims, but even soldiers with physical wounds and traumatic brain injury. 

I know Congress has already held hearings on the problems soldiers face getting 

the counseling and treatment they need and deserve. National Public Radio and several other news outlets have been covering this problem for some time. The bottom 

line seems to be that the VA is instructing its psychologists and doctors to deliberately misdiagnose problems as pre-existing conditions in order to save money. 

This needs to be unearthed and stopped immediately. 

In short, the answer to this question is to better police the medical practices toward our troops both within the military and the VA. 

See http://veterans.house.gov/news/PRArticle.aspx?NewsID=111. 

Yours, 

Helen Benedict 

f 

Professor, Columbia University 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Joy Ilem 

Deputy National Legislative Director 

Disabled American Veterans 

807 Maine Avenue, SW 

Washington, DC 20024 

Dear Ms. Ilem: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. We would greatly appreciate if you 

would provide answers to the enclosed follow-up hearing questions by Thursday, 

July 21, 2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Jian Zapata 

by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Subcommittee on Disability Assistance 

and Memorial Affairs 

Michael H. Michaud 

Chairman 

Subcommittee on Health 

POST–HEARING QUESTION FOR JOY J. ILEM, DEPUTY NATIONAL 

LEGISLATIVE DIRECTOR OF THE DISABLED AMERICAN VETERANS 

FROM THE SUBCOMMITTEES ON DISABILITY ASSISTANCE AND 

MEMORIAL AFFAIRS AND HEALTH HEARING, Healing the Wounds: 

Evaluating Military Sexual Trauma Issues, COMMITTEE ON VETERANS’ 

AFFAIRS, UNITED STATES HOUSE OF REPRESENTATIVES, MAY 20, 2010 

Question 1: Ms. Ilem, you raise a good point, that military sexual trauma (MST) 

victims, both men and women, often do not report sexual trauma when it happens 

initially. As a result, these MST victims have difficulty in demonstrating the injuries caused by sexual trauma are ‘‘service-connected’’ in the context of VA disability 

ebenthall on DSK9Q6SHH1PROD with HEARING

66 

claims. Can you elaborate on the particular challenges faced by men in the military 

in reporting sexual trauma? What can DoD and VA do to increase prompt reporting 

of MST by victims, men and women alike? 

Answer: It has been my experience in working with male veterans who report 

MST, that they too find it extremely difficult to come forward and report the incident to their superiors. They report feeling shame, humiliation, weakness, and a 

loss of trust among other military servicemembers along with many other typical 

responses to personal assaults. Some male victims have noted it is especially difficult to report these incidents given the ‘‘warrior’’ culture of the military, and the 

general (and mistaken) belief in our society that this type of assault is a crime 

against women. In fact, even in VA, it is most generally and incorrectly associated 

with women veterans—and is often considered ‘‘a women veterans’ issue.’’ It is not. 

For a more detailed explanation, see my response below to Question no. 4. 

In our opinion, DoD and VA have many similar challenges before them to increase 

prompt reporting of MST incidents. The issue of stigma cuts across both agencies 

and likely only a concerted and lengthy campaign to reduce the stigma associated 

with MST would enable noticeable change to occur. Over the past several decades, 

this issue has been a catalyst for a number of high profile scandals in the military 

service branches, and has stimulated task force reports, policy changes, negative 

media coverage, as well as new research. A continuing focus on prevention of MST 

in the ranks, along with a no-tolerance policy and accountability of military leadership to address MST, would be critical and necessary steps to be made before victimized servicemembers will readily come forward to report these incidents. Until 

victims of MST feel assured that they will be believed, the incident will be properly 

investigated, the perpetrators appropriately punished and their military careers will 

not be negatively impacted because of their reporting MST incidents—it is unlikely 

that DoD will be able to increase prompt and routine reporting from within this 

population. 

Within VA health care programs, it is clear there is a much better chance that 

a veteran (male or female) will report MST in conjunction with seeking medical care 

or mental health services for conditions consequent to sexual trauma. However, 

male and female veterans still face a number of barriers in the Veterans Benefits 

Administration (VBA) related to verifying stressors and establishing service connection for conditions related to sexual assaults when those events were not reported 

during their military service. Many of these claims are denied, and veterans report 

that the VA’s denial of their claim adds to the mental anguish resulting from the 

assaults. 

Question 2: From your testimony, it appears that the key differences between restricted and unrestricted reporting is that restricted reporting permits MST victims 

to secure examinations and treatment assisted by a Sexual Assault Response Coordinator (SARC) and Victim Advocate without notifying the victim’s chain of command or law enforcement authorities. According to DoD, nearly 4,000 cases of sexual assault have been documented via a restricted reporting system, with just 15 

percent of these cases ultimately being moved to the ‘‘unrestricted’’ category, which 

I understand is necessary for prosecution under the Uniform Code of Military Justice (UCMJ). What are your thoughts on the two track reporting system? Do you 

have any concerns? 

Answer: Although somewhat controversial at first the ‘‘two track’’ reporting system does allow servicemembers, who in the past may have stayed silent, to come 

forward and receive necessary medical and mental health services for conditions related to sexual assaults—and most importantly the time to reflect (up to 1 year) and 

choose if they wish to pursue criminal actions against their perpetrators. DAV’s biggest concern, highlighted in our testimony, is these same veterans’ inability (and ultimately VA’s) to access examination and treatment records that could be used to 

verify reports of sexual assault to establish service connection for MST-related conditions. For all essential purposes these critical records seem to be in permanent 

limbo or even worse, destroyed, due to an ineffective DoD administrative policy, and 

overabundance of caution concerning privacy, or simple bureaucratic red tape. We 

believe DoD needs to revamp its all-service branch policy dealing with standardizing 

the retention rules and making these records available to both the victims themselves, and to their official representatives, or VA benefits personnel, in appropriate 

circumstances, and with proper controls to protect privacy and confidentiality. 

Question 3: Your testimony cited several studies by VA on the number of veterans who reported having suffered a military sexual trauma while being screened. 

Do you think that the screening is capturing most of the veterans who suffered an 

ebenthall on DSK9Q6SHH1PROD with HEARING

67 

MST, or is it likely that there is a significant number slipping through the cracks, 

due to stigma or otherwise? 

Answer: Research on this issue reflects that an effective screening program that 

promotes the detection of MST and access to evidence-based mental health care 

helps to reduce the burden of illness for those who have experienced MST. To that 

end, VHA’s nationwide policy and universal screening program for MST represents 

one of the most comprehensive responses to sexual violence in any health care system in the United States. MST screening in VHA is part of all veterans’ routine 

medical visit protocol that provides an opportunity for clinical staff to educate patients on mental and physical health conditions associated with a history of such 

trauma, inform them of specialized programs and treatment options to ultimately 

increase access to effective treatments. Performance monitoring indicates that in FY 

2006, 86.7 percent of all VHA patients had been screened for MST, and prior research indicates that the remaining 13.3 percent who were not screened were atypical users of the system—those who used significantly fewer VHA services than 

screened patients. 

Even with this prospective approach to screening in VA, it is likely that some veterans are still falling through the cracks, but probably more so due to the general 

nature of stigma associated with sexual trauma and reporting. According to research findings, only 26 percent of sexual assaults in the United States are ever reported. That said, most victims likely will never feel comfortable disclosing that a 

sexual assault occurred. However, VA’s universal screening opens the door for the 

providers to counsel patients about mental and physical outcomes of a victim of sexual assault or other trauma who does not receive services. It is suggested that universal screening may be an effective and non-stigmatizing means of detection—especially for assessment of male patients for whom sexual trauma is rarely a focus of 

provider attention. VA researchers stated that although not all patients who screen 

positive for MST require mental health treatment, men and women with positive 

screens are approximately three times more likely than those with negative screens 

to be diagnosed with having a mental disorder. These research findings strongly 

suggest that VHA’s screening program for MST has increased rates of mental health 

treatment among patients who screen positive for such trauma, and DAV believes 

that this finding represents very good progress. 

Additionally, research findings from female veterans of the 1991 Persian Gulf War 

note that rates of sexual assault, physical sexual harassment and verbal sexual harassment were higher than those typically reported in a peace-time military sample, 

suggesting that exposure to these types of experiences may be more prevalent during times of combat. Researchers stated that given the longer deployments and increased stressors associated with the current wars in Iraq and Afghanistan relative 

to the Gulf War, recent war veterans eventually could report even higher rates of 

sexual assault and harassment. 

Question 4: You noted that the population of women being treated by VA for 

MST is nearly equal to the number of men receiving such treatment. Yet VA reports 

that, during FY 2009, 21 percent of women screened reported MST, compared to 1.1 

percent of men. Is the discrepancy between the percent of each gender population 

screening positive for MST and the total number receiving treatment simply attributable to the fact that the population of men receiving treatment in VHA is far larger than the population of women? Or do some women who screen positive for MST 

not receive treatment? If so, why not? 

Answer: There is no discrepancy in the information provided to the Subcommittees. In my testimony I noted that, ‘‘. . . the size of each VA clinical population 

(men to women) who reported MST within VA treatment programs is almost equal: 

53,295 women and 46,800 men respectively.’’ To be clear this reference refers to how 

many veterans seen in VHA have reported or screened positive for MST, not the 

number of veterans who were treated. According to VA’s FY 2009, Military Sexual 

Trauma Screening Report, 21.9 percent (or 53,295) of female veterans screened positive for MST, compared to male veterans at 1.1 percent (or 46,800). In the same 

report, VA also stated that every VA facility provided MST-related care to both men 

and women in FY 2008 with specifically: 

• 474,966 MST-related [treatment] encounters, comprising 314,128 encounters 

with female veterans (80.2 percent of these were mental health care) and 

160,838 encounters with male veterans (78.0 percent of these were mental 

health care) 

The VHA has over 6 million unique users of its health care system. Approximately 

95 percent of those users are men and approximately 5 percent are women. Of the 

ebenthall on DSK9Q6SHH1PROD with HEARING

68 

95 percent of male users or 5.5 million patients, 1.1 percent or (46,800) screened 

positively (meaning, they reported MST). Of the 5 percent of women (approximately 

500,000) using the system, 21.9 percent or (53,295) screened positively (meaning, 

they reported MST). VHA testified that 1 in 5 women and 1 in 100 men seen in 

VHA respond ‘‘yes’’ when screened for MST. Although rates of MST are higher 

among women than men, the disproportionate ratio of men-to-women serving in the 

military, results in only slightly fewer men being seen in VHA with MST than 

women. In other words, the actual number of men-to-women who were screened and 

reported MST is nearly equivalent. 

VA researchers concluded that the high numbers of MST reported among its entire patient population underscore the contention that military sexual trauma represents a significant problem with particular relevance to VHA. Of particular note 

is the opportunity for VHA to focus on early detection and treatment of MST to prevent chronic long-term health consequences associated with MST such as chronic 

post-traumatic stress disorder, anxiety, depression and substance-use disorders—especially in the most recent generation of veterans coming to VHA for care. 

For further information and data related to my responses to questions no. 3 and 

4, please see Evaluation of Universal Screening for Military-Related Sexual Trauma, 

ps.psychiatryonline.org, June 2008, Vol. 59, No. 6. [a VA Research and Development-funded study published in the journal of the American Psychiatric Association]. 

f 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Kaye Whitley, Ed.D. 

Director, Sexual Assault Prevention and Response Office 

Office of the Under Secretary of Defense for Personnel and Readiness 

U.S. Department of Defense 

1400 Defense Pentagon 

Washington, DC 20301 

Dear Ms. Whitley: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. We would greatly appreciate if you 

would provide answers to the enclosed follow-up hearing questions by Wednesday, 

July 21, 2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Jian Zapata 

by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Subcommittee on Disability Assistance 

and Memorial Affairs 

Doug Lamborn 

Ranking Member 

Subcommittee on Disability 

Assistance and Memorial Affairs 

Michael H. Michaud 

Chairman 

Subcommittee on Health 

Henry E. Brown, Jr. 

Ranking Member 

Subcommittee on Health 

ebenthall on DSK9Q6SHH1PROD with HEARING

69 

Hearing Date: May 20, 2010 

Committee: HVAC, Member: Congressman Hall, Congressman Brown, 

Congressman Michaud, Congressman Lamborn, Witness: Dr. Whitley 

Date of Sexual Harassment and Sexual Assault in the Military 

Question 1: According to DoD’s study issued over 15 years ago, in 1995, before 

the current conflicts in Iraq and Afghanistan, it was estimated that 78 percent of 

women and 38 percent of men had been victims of sexual harassment. What is the 

rate of sexual harassment and sexual assault in the military today? And what training is in place for commanders (both at the officer and non-commissioned officer 

level) to ensure that military sexual trauma is treated as it is—a crime? 

Answer: In order to generate an estimate of the incidence of sexual assault in 

the military, the Department of Defense (DoD) relies on the information collected 

through its quadrennial Gender Relations Survey (GRS). The most recent GRS from 

2006 found that 6.8 percent of women and 1.8 percent of men on active duty experienced some form of unwanted sexual contact (e.g., a sexual assault) during the previous year. In the same study, 34 percent of women and 6 percent of men experienced some form of sexual harassment. The 2010 GRS is currently underway and 

this data will be available in FY 2011. 

Regarding the issue of training, the DoD Instruction 6495.02, Sexual Assault Prevention and Response Program Procedures, specifies sexual assault program training requirements for both commanders and senior enlisted leadership. This training 

occurs at numerous stages throughout their military careers and addresses their responsibility in appropriate prevention and response to the crime of sexual assault. 

Impact of Screening Military Recruits for Prior Sexual Violence 

Question 2: Military Sexual Trauma (MST) experts have suggested MST could 

be curbed by DoD screening its recruits for history of sexual violence. What is the 

potential impact of this type of scrutiny to DoD’s mission? Also, if such screening 

was implemented, would you prefer barring sexual assault perpetrators and victims 

from military service or rather providing them with extra training and counseling 

if needed? 

Answer: The Department already screens and denies entry for recruits with a 

history of sexual assault perpetration. Paragraph 4.7 of Department of Defense 

(DoD) Directive 6495.01, Sexual Assault Prevention and Response (SAPR), makes 

it DoD Policy to ‘‘Prohibit the enlistment or commissioning of personnel in the active 

duty Armed Forces, National Guard or Reserve components when the person has 

a qualifying conviction for a crime of sexual assault.’’ 

Screening out victims of sexual violence would not realistically contribute to reducing the incidence of sexual assault in the military. Such a disqualifier would only 

serve to punish a victim for having reported a crime that occurred prior to service. 

Servicemembers who have been victims of sexual violence prior to accession into the 

military may currently report that abuse to SAPR personnel and receive assistance, 

to include counseling and treatment in a military treatment facility. 

Retention and Disposition Policy of DoD for MST Records 

Question 3: What is the retention and disposition policy of DoD for MST records, 

restricted and unrestricted, and is that policy different across military service 

branches? 

Answer: The Department has two primary forms used in for documentation of 

sexual assaults, DD Form 2910, Victim Reporting Preference Statement, and DD 

Form 2911, Forensic Medical Report: Sexual Assault Forensic Examination. 

• Currently, signed and dated copies of DD Form 2910, Victim Reporting Preference Statement, are kept indefinitely by the Military Services by the Sexual 

Assault Response Coordinator (SARC) to whom the sexual assault was reported. 

In the Air Force and Army, the forms are kept at the installation where the 

sexual assault was reported. In the Navy, the forms are entered into its Case 

Management System—an electronic database. In the Marine Corps, the SARC 

maintains the form for 3 years and after that time period, the SARC forwards 

the forms to be maintained at HQ Marine Corps. The Department of Defense 

is currently formulating additional guidance to standardize the retention, storage and retrievability of both documents in the long term. 

• When the DD Form 2911, Forensic Medical Report: Sexual Assault Forensic Examination, is completed by a Department of Defense medical care provider, the 

ebenthall on DSK9Q6SHH1PROD with HEARING

70 

form is to be included as part of the victim’s military medical record if the report is unrestricted. 

In a restricted report, the DD Form 2911 remains with the Sexual Assault Forensic Examination kits that is maintained by a designated custodian and then is destroyed at the 1-year mark. 

Each Service has its own forms and retention policies for sexual harassment complaints: 

• In the Army, a formal sexual harassment complaint is filed using a DA Form 

7279, Equal Opportunity Complaint Form. After a complainant’s case is closed, 

the complaint packet (with DA Form 7279) will be filed by the first Equal Opportunity Advisor (EOA) in the complainant’s chain of command. The EOA retains the file for 2 years from the date of the final decision on the case. 

• The Navy uses the Navy Equal Opportunity Formal Complaint Form 

(NAVPERS 5354/2) for recording formal harassment complaints. Per the Navy 

policy, a command must maintain completed complaints and investigations for 

36 months. 

• The Marine Corps uses the Equal Opportunity Contact Sheet to record reports 

of sexual harassment. Closed complaints are maintained by the receiving command for 2 years. 

• The Air Force uses two forms for documenting allegations of sexual harassment: 

AF Form 1587, Equal Opportunity Formal Complaint Summary, and AF Form 

1587–1, Equal Opportunity Informal Complaint Summary. Hardcopy forms 

must be kept for a period of 2 years after complaint closure at the installation 

EO office where the sexual harassment complaint was filed. Additionally, all 

complaint information is entered in the Air Force Complaint Management System, Equal Opportunity Network (EONet). 

Unrestricted Sexual Assault Records 

Question 4: If a record of a sexual assault is made unrestricted by the victim, 

this means a DoD criminal investigation is triggered. It also usually means that the 

victim has agreed that details of the attack, and his or her identity, can be used 

in prosecuting a suspect for a sexual assault. What is the reason for maintaining 

the record associated with the investigation of the unrestricted case (as well as the 

forensic examination record) in a different place than that of the individual’s military personnel record when the victim has given consent that this information can 

be made available to others? Is there a basis at some point, after the case is disposed of, and perhaps after the victim leaves the military, for the MST record to 

be filed in the official military personnel record? 

Answer: According to the 2006 Defense Manpower Data Center (DMDC) Gender 

Relations Study, one of the primary reasons victims choose not to report a sexual 

assault is because they are afraid that doing so negatively impacts their career. 

Given that, including a copy of the DD Form 2910, Victim Reporting Preference 

Statement, in a Servicemember’s official personnel record could discourage reporting 

of sexual assault by victims, as they could perceive it could disparage their record 

and halt their career advancement. Victims also fear losing control of private information. Requiring the DD Form 2910 in official personnel records would further 

erode a victim’s control and privacy, which is already partially destroyed by a sexual 

assault. 

Copies of DD Form 2910, Victim Reporting Preference Statement, are kept indefinitely by the Military Services. For unrestricted reports, the completed DD Form 

2911, Forensic Medical Report: Sexual Assault Forensic Examination is part of the 

Servicemember’s military medical record. For restricted reports, DD Form 2911 remains with the Sexual Assault Forensic Examination (SAFE) Kit that is maintained 

by the designated custodian, and then is destroyed at the 1-year mark. 

Restricted Sexual Assault Records 

Question 5: In a case of MST where a restricted record is created, does the victim 

who wants no investigation or prosecution of the perpetrator receive a copy of that 

completed record for his or her personal information? If not, can you explain why 

not? 

Answer: Yes. The victim receives a signed and dated copy of the completed DD 

Form 2910, Victim Reporting Preference Statement, for his or her personal information. Below is text from that form encouraging victims to keep a copy for their 

records: 

ebenthall on DSK9Q6SHH1PROD with HEARING

71 

‘‘NOTICE: DOCUMENTATION FOR RECORD KEEPING PURPOSES. Victims 

are advised to maintain a signed and dated copy of this form for their records. This 

form may be used by the victim in other matters before other agencies (e.g., Department of Veterans Affairs) or for any other lawful purpose.’’ 

Centrally Archiving MST Records within SAPRO 

Question 6: Has consideration been given to centrally archiving MST records 

within SAPRO itself so that Veterans Business Administration and Veterans Service Officer National Service Officers with power of attorney would have one unified 

DoD source for searching such records? What are the negative implications for 

SAPRO’s collecting all such reports in a central archive? 

Answer: Yes, consideration has been given to centrally archiving MST records. 

The Department will have a central archive of sexual assault reports when the Defense Sexual Assault Incident Database (DSAID) managed by SAPRO comes online. 

In order to prevent negative implications such as the unapproved release of personally identifying information (PII), DSAID will not record PII of victims who make 

restricted reports. Inquiries from the Department of Veterans Affairs about supporting documentation on restricted and unrestricted Reports of sexual assault 

should be answered by the Military Service that provided assistance, care, and investigative support to that victim. 

Percentage of Reported Sexual Assaults 

Question 7: Your testimony noted that DoD has found that about 8 of 10 sexual 

assaults in the military go unreported. Does this number represent an improvement 

from the percentage that went unreported prior to the implementation of the ‘‘restricted reporting’’ disclosure option? 

Answer: The number of victims opting to make a restricted report has increased 

18 percent since FY 2007, and has been rising since the inception of the restricted 

reporting option in 2005. The Department believes these victims would not have 

come forward had there not been the option for restricted reporting. In addition, 

given the rise in restricted reporting, the Department believes that the percentage 

of sexual assaults going unreported is decreasing. 

Since 2005, 3,486 victims have made restricted reports. The Department’s baseline data started in 2005 when the Sexual Assault Prevention and Response (SAPR) 

program was put in place. 

VA Services for DoD Victims of Sexual Assault 

Question 8: Please discuss in greater detail how DoD and VA work together to 

ensure that transitioning servicemembers who have suffered a military sexual trauma are referred to or informed of the appropriate VA services. 

Answer: The Department of Defense (DoD) has been working with the Department of Veterans Affairs (VA) since the inception of the Sexual Assault Prevention 

and Response (SAPR) program in 2005. One of the key areas of collaboration has 

been related to documentation. Victims of sexual assault are provided with a signed, 

dated copy of DD Form 2910, Victim Reporting Preference Statement, that they may 

present during a disability evaluation should they so choose. The Department provided a blank copy of this form and education about its use to the Veterans Benefits 

Administration (VBA) in 2007. The VBA agreed to accept the document as evidence 

of having made a report of sexual assault. 

Additional areas of coordination include: 

• A representative from VA sits on the Sexual Assault Advisory Council, which 

is the main oversight body for the Sexual Assault Prevention and Response program in the Department. 

• DoD’s Sexual Assault Prevention and Response (SAPR) staff team with members of VA’s Military Sexual Trauma Support Team brief on their respective 

programs at national conferences. 

• Members of the Department of Defense’s SAPR staff have attended Veterans 

Health Administration’s annual training conference for Military Sexual Trauma 

Coordinators and briefed on the DoD Sexual Assault Prevention and Response 

Program for the past 3 years. 

• DoD participates in VA seminars to educate VA providers about sexual assault 

and the DoD and VA programs. 

ebenthall on DSK9Q6SHH1PROD with HEARING

72 

• DoD and VA are working on a joint brochure for distribution to Servicemembers 

leaving active duty to remind them of the sexual assault support services available within each Department. 

To ensure the Department of Defense does not overlook any potential area of connection, the DoD SAPR staff meet with a variety of veterans groups to identify any 

gaps there might be related to the issue of sexual assault as Servicemembers transition from active duty to veteran status. Meeting with non-governmental groups, 

such as Iraq and Afghanistan Veterans of America and the National Organization 

for Women, has provided a fuller understanding of the challenges that veterans 

might be experiencing. 

Disciplinary Actions Taken against Servicemembers 

Convicted of Sexual Assault 

Question 9: Please describe in detail the disciplinary actions taken against 

servicemembers convicted of a sexual assault. Please describe the range of severity 

of the punishments available, and how the specific disciplinary action taken is determined in each case. 

Answer: Disciplinary actions taken against Servicemembers convicted of a sexual 

assault follow the Uniform Code of Military Justice (UCMJ). Convictions for sexual 

assault may result in confinement, reductions in rank, forfeiture of pay and allowances, and/or punitive discharge from Service, or any combination. Under Article 

120 of the UCMJ, the maximum punishment for the crime of rape is ‘‘Death or such 

other provided punishment as a court martial may direct.’’ 

Commanders have discretion under the UCMJ to dispose of offenses by members 

of their command. Disposition of offenses range from administrative action to 

courts-martial, depending on the severity of the offense and the evidentiary considerations. 

Educating Servicemembers on Reporting MST 

Question 10: What steps has DoD taken to educate servicemembers on how to 

go about reporting MST and how to do so anonymously, if they feel that is necessary? 

Answer: The DoD Instruction 6495.02, Sexual Assault Prevention and Response 

Program Procedures, requires that every Servicemember receive training on the restricted and unrestricted reporting options for sexual assault, and how to report an 

incident. As a result, the Military Services have incorporated training about sexual 

assault reporting and prevention into a wide variety of settings, including: 

• Accession Training 

• Annual Training 

• Professional Military Education 

• Leadership Development Training 

• Pre-Command Training 

• Flag and General Officers/Senior Executive Service Training 

• Training for civilians who supervise Servicemembers 

• Pre-Deployment Training 

• Post-Deployment Reintegration Training 

This training is supported by a numerous reminders of how to prevent and respond to sexual assault, including posters, brochures, Web sites, and public service 

announcements. 

The assessment of the lasting awareness of these outreach and training efforts is 

key to ensuring these messages are being retained as desired. To that end, as part 

of the strategic plan for the Office of the Under Secretary of Defense for Personnel 

and Readiness, the Department will be measuring awareness levels and adjusting 

outreach and training as appropriate. 

Deployed vs. Home Reporting 

Question 11: Where do most reporting events occur? How easy is it for someone 

to report an event in a combat theater of operations vs. being on home base. 

Answer: According to the 2006 Gender Relations Survey of the Active Duty by 

the Defense Manpower Data Center, of the 6.8 percent of women and 1.8 percent 

of men who indicated they had experienced an incident of unwanted sexual contact 

in the 12 months prior to the survey, three-quarters of respondents indicated that 

it occurred at a military installation. Also, about two-thirds of respondents indicated 

ebenthall on DSK9Q6SHH1PROD with HEARING

73 

the incident occurred at their current permanent duty station which could also be 

a military installation. Additionally, 28 percent of women and 44 percent of men indicated that the incident occurred while deployed. 

Sexual assault may be reported anywhere. The Department has sexual assault response coordinators, victim advocates, and other personnel who may receive a restricted or unrestricted report are stationed in garrison and deployed around the 

world. Annual refresher training and pre-deployment training is designed to remind 

Servicemembers of their sexual assault reporting options and how to make a report 

no matter their location. 

Given the nature of war, certain areas in the combat theater of operations may 

pose unique challenges to Servicemembers’ immediately accessing sexual assault response personnel. Sexual assault response personnel receive specialized training on 

how to receive reports at home base and in combat theater of operations. 

Access to DoD Restricted MST Reports 

Question 12: Some other witnesses testified about the need for gaining access to 

DoD’s restricted MST reports in order to provide documentation for service connection. What do you think of that suggestion? Do you have any concerns regarding 

privacy or other issues when outsiders are given access to these confidential documents? 

Answer: The greater the number of individuals given access to confidential documents, the less confidential those records become. Even with strict safeguards, the 

situation that many victims fear is losing control of their private information. Department surveys show that victims of sexual assault do not report the assault to 

an authority because they feel uncomfortable making a report, think they will be 

labeled a troublemaker, and do not want anyone to know about the incident. Victims 

who make restricted reports do so because they fear the negative repercussions of 

being a victim of sexual assault. 

Victims should certainly have access to their records. For example, they can access their records under the Privacy Act. That access should be provided in a way 

that best guards their confidentiality. Others who seek documentation to determine 

service connection should inquire with the Military Service that provided assistance, 

care, and investigative support, and obtain consent from the victim to access the victim’s records. 

Sexual Assault Prevention and Response efforts with National Guard and 

Reserve Forces 

Question 13: Can you comment on sexual assault prevention and response efforts 

with National Guard and Reserve forces? Is data from Guard and Reserve components studied and included in your reports? If not, why not and how can we correct 

this oversight? 

Answer: The Department’s Sexual Assault Prevention and Response (SAPR) policy applies to activated National Guard and Reserve members who are sexually assaulted when performing active service and inactive duty training. The Service Secretaries are responsible for establishing comprehensive SAPR policies, procedures, 

and programs and ensure implementation, monitoring, and evaluation at all levels 

of military command, including those levels at the National Guard and Reserve components, and training for members of their Military Departments. 

The Department has also incorporated the National Guard and Reserve components into its oversight framework and works with closely with the respective SAPR 

program managers to ensure program accountability. Data from the Guard and Reserve components are studied and included in the Department of Defense Annual 

Report on Sexual Assault in the Military. The National Guard Bureau is currently 

working with the Department in the development of the Defense Sexual Assault Incident Database to record and manage all reports of sexual assault involving members of the National Guard into the system. 

f 

ebenthall on DSK9Q6SHH1PROD with HEARING

74 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Subcommittee on Health 

Washington, DC. 

June 14, 2010 

Susan McCutcheon, R.N. Ed.D. 

Director, Family Services, Women’s Mental Health and Military Sexual Trauma 

Office of Mental Health Services, Veterans Health Administration 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20240 

Dear Ms. McCutcheon: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. We would greatly appreciate if you 

would provide answers to the enclosed follow-up hearing questions by Wednesday, 

July 21, 2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Jian Zapata 

by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Subcommittee on Disability Assistance 

and Memorial Affairs 

Doug Lamborn 

Ranking Member 

Subcommittee on Disability 

Assistance and Memorial Affairs 

Michael H. Michaud 

Chairman 

Subcommittee on Health 

Henry E. Brown, Jr. 

Ranking Member 

Subcommittee on Health 

Questions for the Record 

The Honorable John Hall, Chairman, The Honorable Doug Lamborn, 

Ranking Member, Subcommittee on Disability and Memorial Affairs 

and The Honorable Michael Michaud, Chairman, The Honorable Henry 

Brown, Jr., Ranking Member, Subcommittee on Health, House Committee 

on Veterans Affairs, Healing the Wounds: Evaluating Military Sexual 

Trauma Issues, May 20, 2010 

Question 1: In addition to PTSD, experts point out that Military Sexual Trauma 

(MST) can also lead to women’s cancer and sexual transmitted diseases amongst 

men and women. To combat these diseases, stakeholders recommend that DoD and 

VHA dedicate greater funding on research and screening that is gender specific. 

What is VHA’s position and plans on this viewpoint? 

Response: VA fully supports research on the critically important impact of military sexual trauma (MST) on the health of Veterans—both women and men. VA research has clearly indicated that MST is associated with wide range of diverse physical and mental health outcomes, including sexually transmitted diseases (STDs) 

and Post-Traumatic Stress Disorder (PTSD). MST research will continue to be a 

high priority for VA, as our understanding of its health consequences (including possible links to cancer) leads to better screening, treatment, and improvements in care 

and health. 

VA research has recognized the need for gender specific approaches and for better 

understanding of gender differences related to MST. Currently, VA has a number 

of research studies that are examining gender differences related to MST. One of 

these studies is examining the impact of gender, combat and sexual trauma, and 

ebenthall on DSK9Q6SHH1PROD with HEARING

75 

other factors on medical and psychiatric outcomes and stress associated condition. 

A second study is examining the stigma and gender differences in barriers to health 

care use, including those related to sexual assault. 

The first comprehensive evaluation of VA’s mandated MST screening and treatment program included both female and male Veterans, and suggested that the 

comprehensive VA policies surrounding MST are of significant clinical benefit for 

patients. An ongoing study is further analyzing VA’s MST screening assessment 

tools including differences in interpretation and responses to the screening questions 

by gender. 

In addition to focusing on gender-specific issues, several studies addressing the 

health consequences of sexual assault, MST, and other military traumas include a 

focus on STDs and women’s cancer. VA research has found that MST is associated 

with a number of chronic medical conditions, as well as obesity or weight loss 

among women. Several VA studies are now analyzing the relationships between sexual violence and women Veterans’ gynecological health, including associations between sexual assault and sexual risk behaviors, barriers to obtaining gynecological 

examinations and cervical cancer screening, and the incidence and prevalence of abnormal cervical cytology (which could lead to cervical cancer if untreated). 

A longitudinal study of both male and female Marines is also examining MST effects on health behavior, including the association between MST and cancer and 

STDs, as well as actual health outcomes related to cancer and STDs. A new VA 

study of Vietnam women Veterans will provide another opportunity to assess the 

relationships between stressful and traumatic experiences and mental and physical 

health outcomes, including cancers. 

VA plans to continue the important focus on research related to the health consequences of MST. Expanded research informatics (for example, linking screening 

and clinical reminders) and research infrastructure capabilities, like the Women 

Veterans’ Practice-based Research Network (PBRN) will support this research and 

gender-specific approaches to improve screening, access to care and treatments that 

best meet the needs of Veterans who have experienced MST. The PBRN involves 

development of infrastructure and building of research capacity in order to examine 

new treatments, quality performance and improvements, models of care (e.g., integrated mental health and primary care), and provider education and training innovations. The PBRN will facilitate VA research-clinical partnerships to enhance the 

implementation and dissemination of innovations and best practices. It also seeks 

to build capacity in VA women’s health research, facilitate meeting Federal requirements to recruit and include women in relevant VA research locally and across sites, 

and to facilitate testing and disseminating VA-based women’s health-related interventions. 

Question 2: We also understand that many MST treatment programs and residential facilities don’t offer separate settings for men and women victims. MST victims complain that Veterans Health Administration (VHA) treatment programs lack 

the privacy needed for them to open up concerning their injuries. More alarming are 

reports that MST victims in mixed-gender settings are being sexually harassed by 

other patients and even health providers. Can you point out any downside of segregating patients by gender, and if you favor gender specific treatment facilities for 

MST victims, what resources are needed to make this a reality? 

Response: The recently issued Uniform Mental Health Services Handbook codifies the longstanding VA practice of promoting treatment in environments that are 

sensitive to gender-related issues. For example, all inpatient and residential programs must provide separate and secured sleeping accommodations for women. 

Mixed gender units must ensure safe and secure sleeping and bathroom arrangements, including, but not limited to, door locks and proximity to staff. 

For a subset of Veterans, there are advantages to models of care in which treatment occurs in an environment where all Veterans are of one gender. Both male 

and female survivors of MST may have concerns about their safety, ability to disclose and engage fully in treatment, and address gender-specific concerns in mixed 

gender environments. 

Among VA’s residential programs that provide specialized MST-related care, approximately half treat only women, and one treats only men. Veterans who feel a 

strong need for a same gender treatment environment would be able to receive 

MST-related mental health care from these programs with a single gender environment. 

There are also advantages to mixed gender programs that provide specialized 

MST-related care to include: helping survivors to challenge assumptions and confront fears about the opposite sex; fostering respect for appropriate boundaries in 

relationships; and promoting an emotionally corrective experience. Also, mixed-genebenthall on DSK9Q6SHH1PROD with HEARING

76 

der treatment programs can help improve accessibility to care and maximize efficient use of resources. This is particularly true for programs operating on ‘‘cohort’’ 

models in which a program runs a specified number of weeks with a group of patients beginning and ending the program together. 

Given there are advantages associated with each approach, VA does not promote 

one model as universally appropriate for all treatment settings. Rather, we encourage careful consideration of the needs of specific Veterans and use of single-gender 

programs when they are clinically appropriate. 

Sexual harassment from VA employees is unacceptable and is subject to disciplinary action. Sexual harassment by another Veteran resident is also unacceptable 

and subject to disciplinary action. With respect to sexual harassment from other 

Veterans, each resident is provided sexual harassment prevention training as part 

of his/her orientation to the program. Annual safety and security reviews of mental 

health residential programs carefully monitor compliance with this requirement. 

Should sexual harassment occur, victims are provided support and more extensive 

clinical intervention and psychotherapeutic support as clinically indicated. The 

treatment team also addresses the sexual harassment clinically with the perpetrator 

to ensure that it does not re-occur. During this clinical interaction, staffs work with 

the perpetrator to assess the factors leading up to the event and provide counseling 

to the Veteran and any needed adjustments to the treatment plan. As one potential 

result of such an event, disciplinary action by the treatment team can include counseling, restrictions and/or discharge from the program. Staffs treat reports of possible criminal activity with the highest priority, including notifying the appropriate 

law enforcement agency, which could include VA Police in accordance with VA policy and regulations. More generally, the VA’s MST Support Team, a national education and monitoring team established by VA Office of Mental Health Services, fosters discussion among providers and program directors about the potential impact 

of additional sexual harassment for survivors of previous sexual trauma. 

Question 3: If a Veteran is uncomfortable with the gender of an MST coordinator 

at a given VA facility, is there a protocol to match them with somebody else able 

to perform a similar role? 

Response: The facility MST Coordinator focuses on ensuring that the facility 

meets mandates related to screening, treatment, education/training, and outreach. 

MST Coordinators in many cases serve as the initial point of contact for MST survivors entering the system before they are assigned to a clinical provider who will 

work with them on an ongoing basis. If a Veteran does not feel comfortable having 

even this initial contact with an individual of a certain gender, facilities will make 

arrangements as needed to assist the Veteran in engaging in care without necessitating a meeting with the MST Coordinator. With regard to treatment, national outreach materials specifically state that ‘‘Veterans should feel free to ask to meet with 

a provider of the same or opposite sex if it would make them feel more comfortable.’’ 

Furthermore, the Uniform Mental Health Services handbook strongly encourages facilities to give Veterans the option of being assigned a same-sex mental health provider or an opposite-sex provider if the trauma involved a same-sex perpetrator. 

Ensuring the capacity of facilities to be able to meet this request for a preferred 

provider gender is a priority for the Office of Mental Health Services. To determine 

this capacity the VA’s MST Support Team is preparing an in depth study of providers of MST-related mental health care. This study will elucidate several important factors about providers of MST-related care, and will: a) determine the number 

of unique providers at each facility who deliver MST-related mental health care and 

describe the characteristics of those providers, and b) assess the relationship of provider gender to patient gender to determine whether patients are able to express 

preferences for same gender providers, as is VHA policy. These study deliverables 

will provide important information in helping to ensure sufficient capacity for specialized MST-related mental health services at each VHA facility. 

Question 4: Please elaborate on VA’s separate-gender treatment programs. How 

many women-only programs does VA have for treatment of MST and PTSD? 

Response: Many facilities have specialized outpatient mental health services focusing on women and/or sexual trauma. For Veterans who need more intense treatment and support, there are also 8 programs that provide specialized women’s mental health care in residential or inpatient settings. One additional VA program provides specialized care for women in a residential setting in conjunction with a local 

non-VA non-profit program for homeless and at-risk Veterans. These programs are 

considered regional and/or national resources, not just a resource for the local facility. Some of these specialized women’s programs focus on MST only, while others 

focus on specialized women’s care in general (including MST). These programs are 

ebenthall on DSK9Q6SHH1PROD with HEARING

77 

a subset of the larger number of programs able to provide specialized care in a VA 

residential or inpatient setting for mental health conditions related to MST. 

Question 5: Dr. McCutcheon, we understand that VHA is treating almost 75,000 

Veterans for sexual trauma related injuries. Your testimony suggests that Veterans 

who are denied VBA disability benefits based upon the finding that their sexual 

trauma-related injuries are not service-connected, may still be entitled to treatment 

by the VHA if your therapists conclude that the injuries suffered by Veterans are 

service-connected. Should VBA provide greater weight to the medical findings of 

trained VHA therapists and health professionals re: service-connection injuries from 

MST? 

Response: As stated in testimony, Veterans are entitled to free VHA counseling 

and care and services to overcome psychological trauma, which in the judgment of 

a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while the Veteran was serving on active duty or active duty for training whether or not their disabilities are service-connected. 

Service-connection and disability ratings are determined by the Veterans Benefit 

Administration (VBA) based on all the evidence of record. VBA considers the findings of VHA’s trained therapists with respect to diagnosis, service connection, and 

extent of a Veteran’s disability. VBA adjudicators assign weight to the evidence according to its credibility and other factors. In some cases, VBA asks VHA professionals to review a Veteran’s records to see if there are markers that can be found 

denoting reduced level of functioning. 

Question 6: In your estimation, of the Veterans treated by VHA for sexual trauma injuries, what percentage of such Veterans has service-connected conditions? 

Response: Of the 37,132 female MST positive Veterans who received MST-related outpatient care from VHA in fiscal year (FY) 2009, 68.1 percent had service 

connection as indicated on their VHA medical record. Of the 24,826 male MST positive Veterans who received MST-related outpatient care from VHA in FY 2009, 54.9 

percent had service connection as indicated on their VHA medical record. Based on 

the available data we are unable to determine if their service connection was for 

injuries or conditions related to their MST. 

Question 7: Disabled American Veterans (DAV) cited in its testimony the effectiveness of prolonged exposure therapy and advocated for its universal expansion to 

VA Medical Centers for treating MST. Does VA have plans to expand the use of 

such therapy? If so, please elaborate. 

Response: As part of its commitment to making the best treatments available to 

Veterans, VA has provided national training to disseminate and implement both 

Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT), and 

continues to provide such training to additional staff. These two evidence-based 

psychotherapies for PTSD are recommended in the VA/Department of Defense Clinical Practice Guidelines for PTSD at the highest level, indicating ‘‘a strong recommendation that the intervention is always indicated and acceptable.’’ Both PE 

and CPT have been examined in a number of randomized controlled trials and 

shown to be effective, in similar degree, for PTSD related to multiple types of trauma, including sexual trauma and combat-related trauma. In addition, they are recognized in the 2008 Institute of Medicine report, ‘‘Treatment of Post-Traumatic 

Stress Disorder’’, as the only therapies with proven effectiveness for treatment of 

PTSD. PE and CPT are used throughout VHA to treat Veterans with PTSD related 

to military sexual trauma (as well as to other types of trauma), and VHA Handbook 

1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics, now 

requires that all Veterans with PTSD have access to PE or CPT. 

As part of VA’s efforts to make PE and CPT widely available to Veterans, VA’s 

national-level programs have trained more than 2,700 VA mental health staff in PE 

and/or CPT. In addition, more than 400 VA mental health staff are being trained 

in the use of Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment 

Therapy (ACT) for depression, the second most common mental health diagnosis for 

women Veterans clinically judged to be a consequence of MST. The training for all 

of these psychotherapies includes specific information relevant for adapting the clinical approach for Veterans whose mental health problems are a result of MST. The 

MST Support Team has worked with each of these national initiatives to include 

materials relevant to MST survivors and to promote attendance by clinicians working with MST survivors. 

Initial program evaluation data show significant gains in therapist competency 

following the training, as well as significant clinical improvements among Veterans 

ebenthall on DSK9Q6SHH1PROD with HEARING

78 

receiving these treatments. Plans are underway to provide additional, intensive staff 

training in PE, CPT, CBT, and ACT in FY 2011, with a focus on sites that have 

fewer trained staff in these therapies. Plans are also underway to establish decentralized training capacity within all Veterans Integrated Service Networks (VISNs), 

further broadening dissemination and promoting sustainability over time. 

Question 8: VA’s efforts to screen all Veterans accessing VHA for MST are to 

be commended. However, this screening does not capture Veterans who are not 

seeking care through VHA. What is VA doing to reach out to Veterans who are victims of MST but who have not accessed VHA? 

Response: VA recognizes the importance of engaging in outreach to ensure that 

Veterans are aware VA has MST-related services available. VA conducts outreach 

in accordance with existing statutory authority and VHA policy. To this end, the 

VA’s MST Support Team has developed MST-related educational handouts, posters 

and brochures to educate Veterans about VA services, describe symptoms associated 

with sexual trauma, and highlight the availability of effective treatments. These 

materials are distributed to MST Coordinators who display them in VHA facilities 

and distribute them to local communities. This includes reaching out to local military bases and/or attending demobilization events when appropriate. MST Coordinators often receive invitations to present at local events and will take this opportunity to speak about VA’s services and general commitment to this issue. 

Question 9: The American Legion’s statement for the record discusses the work 

of their services officers in helping women Veterans receive treatment and compensation for conditions that result from military sexual trauma. Does VA collaborate with American Legions service officers and those of other VSOs? 

Response: Yes, VA has coordinated nationally with the American Legion to distribute outreach materials. Also, at the local level many MST Coordinators and facilities work collaboratively with partner organizations to engage in outreach and 

other activities. 

Question 10: In her testimony, Dr. Whitley stated that reports of sexual assault 

have increased about 10 percent annually over the past 3 years, due to outreach 

and education. As DoD has persuaded more victims of MST to come forward, has 

VA experienced an increase in the number of Veterans seeking treatment for MST? 

If not, do you anticipate an increase, or were many of the Servicemembers now coming forward while in service already willing to seek treatment through VA? 

Response: Surveillance reports from the VA’s MST Support Team indicate that 

in the past 3 years, the proportions of VHA patients who report MST have remained 

relatively constant, ranging from 21.9–22.2 percent among women, and 1.1–1.3 percent among men. However, as the total numbers of Veterans seeking VHA care increases, there has been a corresponding increase in absolute numbers of MST patients. The proportions of these patients who receive MST-related care each year is 

also increasing, with the highest increases being among Veterans recently returned 

from Iraq and Afghanistan. 

However, it is important to note that there are several complications to comparing 

DoD figures and VHA MST surveillance data. First, pursuant to 38 U.S.C. 1720D, 

VA is authorized to treat both sexual assault and sexual harassment under a single 

construct, Military Sexual Trauma. DoD’s Sexual Assault Prevention and Response 

Office (SAPRO) figures reflect only sexual assault. Also, because only a portion of 

Veterans ever seek VA care after separation from military service, estimates of the 

prevalence of MST in VA health care are not reliable indicators of overall increases 

in the prevalence of sexual assault or sexual harassment in the general Veteran 

population. Shifts in DoD rates of reported sexual assault may or may not correspond with an increased rate of Veterans seeking care from VHA. Finally, Veterans need not have reported MST during military service to receive MST-related 

care from VHA after separating from military service. Veterans captured in VA figures may or may not be the Veterans captured by SAPRO figures. 

Question 11: Does VA offer any other intensive inpatient MST programs besides 

the National Women’s Trauma Recovery Program in California? 

Response: Veterans with experiences of MST can receive treatment through most 

of VA’s residential/inpatient treatment programs. There are 14 programs able to 

provide specialized care in a VA residential or inpatient setting for mental health 

conditions related to MST. One additional program provides specialized care in a 

residential setting in conjunction with a local non-profit program for homeless and 

at-risk Veterans. These programs are considered regional and/or national resources, 

not just a resource for the local facility. Eight of these residential/inpatient proebenthall on DSK9Q6SHH1PROD with HEARING

79 

grams are MST/sexual trauma treatment programs. Six of these residential/inpatient program are more general treatment programs that have multiple staff with 

expertise in MST/sexual trauma. Although these programs do not necessarily have 

an explicit focus on MST/sexual trauma, staff can often work individually with Veterans who need MST-specific care as an adjunct to the care they receive through 

the more general program. Veterans also may be able to receive specialized MSTrelated group or individual therapy through the outpatient clinic at the facility that 

offers the specialized residential or inpatient program. 

Question 12: Once a Veteran screens positive for having suffered an MST, what 

steps does VA take? What happens to those Veterans who decline treatment? Does 

VA take special steps to help this subset of Veterans? 

Response: All Veterans seen in VHA are screened for MST. Those Veterans who 

screen positive are offered a referral for free MST-related care. If a Veteran refuses 

this referral, clinicians respect this decision, recognizing that there are many good 

reasons why a Veteran may decline a referral for care at the time of screening positive. Some Veterans may not feel ready to enter treatment; others may have engaged in treatment in the past and/or feel that their experiences of MST are not 

currently impacting their lives in a way that warrants current treatment. Veterans 

who screened positive but who decline a referral are informed that if they change 

their mind, they may request services at any time in the future. Clinicians also 

make outreach and informational materials on MST and the local MST Coordinator’s name and contact information available to Veterans who screen positive. 

Question 13: What is the extent of the coordination between VA and DoD to prevent incidents of MST? 

Response: As a health care system working primarily with Veterans and other 

individuals already discharged from the military, VA’s prevention efforts mainly address secondary and tertiary prevention issues—that is, prevention of developing or 

worsening of aftereffects related to MST. VA is not in a position to address primary 

prevention—that is, prevention of experiences of MST to begin with—but has developed a strong collaborative working relationship with the DoD’s SAPRO in order to 

facilitate coordination of responses across the Departments. In an effort to ensure 

that all providers and staff are aware of each Department’s services, VA’s national 

MST Support Team and DoD’s SAPRO have presented at each others’ national 

MST/sexual assault trainings. The two entities also communicate as needed to help 

connect individual Veterans to services that match their treatment needs. 

Question 14: Ms. Bhagwati’s testimony stated that MST survivors describe the 

horror of using VA Medical Centers nationwide. She also asserts that Veterans are 

often ignored, isolated, or misunderstood at VA facilities because their PTSD is not 

combat-related and that women who do attend the residential treatment programs 

have experienced sexual harassment by staff or fellow patients. Please respond to 

this testimony. 

Response: We regret that Ms. Bhagwati has this perspective of VA care, and 

would be happy to work with her to hear more about her concerns and share more 

about what we have done and continue to do to ensure accessible, quality care for 

MST survivors. Please also note the earlier response to Question 2. VA’s commitment to such care is established in longstanding VA policies and most recently reinforced in VHA Handbook 1160.01, ‘‘Uniform Mental Health Services in VA Medical 

Centers and Clinics.’’ The Handbook contains key provisions addressing the treatment of conditions related to MST. For example, all Veterans seeking VA care must 

be screened for MST and all Veterans who screen positive for MST are entitled to 

free VHA counseling and care and services to overcome psychological trauma as described in 38 U.S.C. 1720D(a)(1). Every facility must have a designated MST Coordinator who serves as the point of contact for MST-related issues, including staff education and training and monitoring of MST-related screening and treatment. MST 

is an experience that is associated with a number of health conditions, necessitating 

both widespread working knowledge of issues related to MST among VA staff in 

general as well as the availability of providers with specialized expertise in this area 

who can provide targeted evidence-based care. 

Further reflecting its commitment to ensuring that Veterans receive the support 

they need and deserve, in FY 2007, the OMHS established a national-level VA Military Sexual Trauma (MST) Support Team to conduct monitoring of MST screening 

and treatment, to oversee MST-related education and training, and promote best 

practices in care for Veterans who experienced MST. As noted earlier, OMHS has 

funded national training initiatives to promote evidence-based practices for PTSD, 

depression, and anxiety. Because these conditions are commonly associated with 

ebenthall on DSK9Q6SHH1PROD with HEARING

80 

MST, these national initiatives have been an important means of expanding MST 

survivors’ access to cutting-edge treatments. Several of these treatments were developed and originally tested primarily with rape victims and child sexual abuse survivors. As such, the MST Support Team has worked with each of these national initiatives to include materials relevant to MST survivors and to promote attendance 

by clinicians working with MST survivors. 

Additionally, the MST Support Team is completing a study of patient perceptions 

of the quality of VHA health care among Veterans who are MST survivors. Results 

revealed that patient perceptions of overall quality ratings were fairly high for both 

men (78.5 percent) and women (72.3 percent), and did not significantly differ among 

patients who did and did not report MST. These results suggest that MST patients’ 

perceptions of overall quality of care are commensurate to those of other VHA outpatients. 

f 

Committee on Veterans’ Affairs 

Subcommittee on Disability Assistance and Memorial Affairs 

Washington, DC. 

June 23, 2010 

Bradley G. Mayes 

Director, Compensation and Pension Service 

Veterans Benefits Administration 

U.S. Department of Veterans Affairs 

810 Vermont Avenue, NW 

Washington, DC 20402 

Dear Mr. Mayes: 

Thank you for testifying at the House Committee on Veterans’ Affairs’ Subcommittee on Disability Assistance and Memorial Affairs’ and Subcommittee on 

Health’s joint oversight hearing on, ‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues,’’ held on May 20, 2010. I would greatly appreciate if you would 

provide answers to the enclosed follow-up hearing questions by Thursday, July 21, 

2010. 

In an effort to reduce printing costs, the Committee on Veterans’ Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting 

changes for material for all full committee and Subcommittee hearings. Therefore, 

it would be appreciated if you could provide your answers consecutively on letter 

size paper, single-spaced. In addition, please restate the question in its entirety before the answer. 

Due to the delay in receiving mail, please provide your responses to Cecelia Thomas by fax at (202) 225–2034. If you have any questions, please call (202) 225–3608. 

Sincerely, 

John J. Hall 

Chairman 

Questions for the Record 

House Committee on Veterans’ Affairs, The Honorable John J. Hall, 

Chairman, Subcommittee on Disability Assistance and Memorial Affairs, 

‘‘Healing the Wounds: Evaluating Military Sexual Trauma Issues’’ 

May 20, 2010 

Question 1. One witness today urged DoD to enter into a MOU to share with 

VA records and other information related to MST claims. Does VBA believe that it 

has the access to DoD files, particularly restricted records, needed to properly adjudicate MST claims? 

Response: An MOU between VA and DoD outlining each agency’s role will be 

explored. VBA released Fast Letter 10–25 on July 15, 2010, outlining the roles and 

responsibilities of each agency, and a process will be put in place to ensure that 

these procedures are clear and available to all. The Fast Letter also updated procedures that require regional offices to request and accept DoD Form 2910, Victim Reporting Preference Statement and Form 2911, Forensic Medical Report: Sexual Asebenthall on DSK9Q6SHH1PROD with HEARING

81 

sault Examination, along with other similar forms, as corroborating evidence of a 

report of MST. 

Question 2. I appreciate that VBA has provided its claims personnel a training 

letter describing special processing methods involving MST related claims and that 

all regional offices have a Women’s Veteran Coordinator, who is well-versed in MST 

issues. Yet, given the complexity of MST and the often hidden wounds, many stakeholders suggest that VBA provide more training and other resources to its staff to 

address MST related claims. How does VBA respond to this recommendation? What 

more do you plan to do or should be done? 

Response: VBA agrees with this recommendation and has already increased the 

number of conference calls with WVCs from quarterly to monthly. These conference 

calls routinely address the sensitivity of handling MST claims and feature guest 

speakers who specialize in the needs of women Veterans and personal trauma 

issues. At the 2009 WVC Training Conference, a VHA staff psychologist spoke on 

the care that VA provides for MST and how MST affects the men and women who 

experience this trauma (physiologically, emotionally and cognitively). VBA will continue to provide this specialized training in future conferences. Meanwhile, VBA 

hosts information regarding Women Veterans on our WVC SharePoint site. VBA 

continues to strengthen the training programs for all staff engaged in claims development and rating of MST cases. 

Æ 

ebenthall on DSK9Q6SHH1PROD with HEARING