How to File a Well-Prepared MST Claim

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How to File a Well-Prepared MST Claim

Elements of Your Claim

Military sexual trauma (MST) is sexual harassment that is threatening or physical assault of a sexual nature. Both men and women serving in the military can suffer from MST. MST is an experience, not a diagnosis. MST may cause disabling conditions such as post traumatic stress disorder (PTSD), anxiety, depression and sexual arousal disorder. Your claim for VA Disability Compensation (“VA benefits”) must identify at least one “disabling condition.” The VA addresses MST differently than other issues because of its severity and complexity.

To win an MST claim you will need the following:

  1. Completed VA Form 21-526
  2. Diagnosis of PTSD, anxiety, or depression from your healthcare provider.
  3. Nexus Letter (see definition of “nexus” below) signed by your doctor.
  4. Evidence

Filing Your Claim

It is important to file your claim as soon as you can. When a claim is awarded, the compensation is calculated back to the date you filed your claim. Do not rush while filling out the form. Every section must be filled out except for sections VII, VIII, IX, and X. If something does not apply to you, then put ‘N/A,” “not applicable.” Do not leave any of the required boxes blank as this may delay your claim. You do not need to attach all of your evidence when you first file. You can send your nexus letter (see explanation below) and other evidence as you collect it. Go to our "How to File A VA Claim for Disability Compensation" guide for more help on filling out VA Form 21-526.  Make copies of everything you send to the VA.

Diagnosis

You must have a diagnosis, for example PTSD, anxiety, depression and/or sexual arousal disorder from your doctor. Again, filing for “MST” won’t work because MST is the cause, not the condition.

Nexus Letter/Note

A letter from your doctor or a note in your medical record saying it is “more likely than not” that your disability was caused/aggravated by an event during your military service (service-connected) is a “nexus letter or note.”

For example, a nexus letter needs to say:

"After reviewing the medical records of [Veteran's name], it is my opinion that more likely than not, her/his [insert the condition you are filing for] is a direct result of military sexual trauma s/he experienced while serving on active duty."

Evidence

One way that MST claims are treated differently is the use of “alternative evidence.” In the past, evidence of sexual assault (service medical records (SMR), police reports, and rape-kits) was often "sanitized" (deleted) from military records. Or, evidence never existed in the first place because the victim did not come forward for fear of retaliation and/or reprisal. Because MST claims usually lack “traditional” evidence, a person filing for a service-connected condition, mental illness and/or a physical disability caused by MST can fill out VA Form 21-0781a. The information requested through this form can help you supply the evidence you will need to substantiate your claim. 

If you have recently experienced repeated harassment, assault and/or rape and are currently in the service, it is very important to request that your military records be saved and unaltered for 50 years. This is referred to, in military terms, as “retention of restricted report documentation.” This means that your military records cannot be “sanitized or destroyed.” This is important so that evidence critical to your claim will not be destroyed.

When gathering evidence, you must:

  • establish the event (sexual harassment and/or personal assault),
  • prove that the event caused (or aggravated) your condition, and
  • prove that you still suffer from the condition.

If military records have not been sanitized or destroyed, then the VA will more readily find records from any military institution you went to for assistance, such as the military police or medical facilities. Also, civilian police departments, hospitals and clinics are more likely to keep your records unaltered. Evidence from a hospital can help win your claim. The VA can request treatment records from non-military hospitals or clinics only if you complete a VA Form 21-4142 consent form. You must complete a form for each medical facility you are trying to get records from.

You can accomplish the first two requirements noted above by completing the alternative evidence form, VA Form 21-0781a.

Important: While the form allows for two incidents to be used as evidence, many experts advise against filling out a second incident. That is because the extra time needed for investigation will further delay what may become an already long claims process. If you can get police or treatment records of any kind for any incident, use that incident to complete the alternative evidence form.

Send in copies of any records that show changes or problems in your military service after the assault:  a decline in performance, going to sick call, being AWOL, Article 15, civilian hospital appointments, abortion clinic records, etc. Also, send letters from people who knew you at the time or who knew you before and after your service.  They should describe your behavioral changes. Each letter should be signed: “I swear this is true and accurate to the best of my knowledge.”

Global Assessment of Function (GAF) scores can be assigned by your mental health provider at each appointment you have. Attach your GAF score to VA Form 21-526 or send it in with your VA file number (usually your social security number) by certified mail, return receipt requested. To get a GAF score, you may need to specifically ask for one.


October 2015 update:  The Department of Veterans Affairs has established an MST Coordinator position at each of its Regional Benefit Offices. Each office has designated one male and one female MST Coordinator to assist Veterans filing disability claims related to MST.  Go here for the state-by-state VA listing, including email contact information.

More MST resources

May 2013; partially updated October 2015

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Comments

Submitted by JoeyAnderson on Tue, 2013-04-30 05:49

This is excellent advice for MST survivors. :o)

A couple of suggestions:

Global Assessment of Function (GAF) scores can be assigned by your doctor at each appointment you have.

That is a true statement regarding mental health professionals (who may, or may not be, 'doctors'), but not other healthcare professionals. In other words, primary care physicians rarely assign a GAF score--it's part of a psychiatric diagnosis, not a primary care assessment.

People with PTSD will typically score around the 35-45 range.

I'm not sure where you got that data, but it is not accurate. A GAF score in the 30's indicates very serious symptoms and/or major social and occupational functional impairment. A lot of patients with GAF scores in that range are either in the psych hospital; should be in the hospital; or suffer from severe, chronic disorders like refractory schizophrenia, dementia, brain damage from substance dependence, etc.

Of course, *some* Veterans suffering from MST-related PTSD will have a GAF score in this range, but most will not.

Of course, you can always find a psychologist or psychiatrist or other mental health professional willing to pretty much say what you want them to say after a 45-minute interview and a cursory review of some records. Every city seems to have a clinician like that but believe me, the VBA Raters and C&P examiners quickly learn who the charlatans are in their area and they subsequently discount any reports or letters from such individuals. A typical example is a clinician who makes nearly identical statements in every one of his PTSD evaluation reports, e.g., "This veteran suffers from severe and persistent chronic PTSD, which is totally and permanently disabling and renders him incapable of securing or maintaining gainful employment. He will require ongoing intensive psychotherapy and psychopharmacological treatment for the rest of his life. GAF = 30." Once you've seen that same sentence in 3 or 4 different reports, and you find no evidence from any other source for such severely impaired functioning, you quickly discount anything that clincian writes.

Btw, I don't meant to imply that you are advocating such unethical practices. I mention this point because Veterans and advocates will hear through the grapevine things like, "Dr. Jones really cares about Veterans. You should see him for a PTSD evaluation." On the surface, that sounds like a good recommendation, and it might very well be. But you should investigate a bit and find out more about the clinician before scheduling an appointment.

Also, send letters from people who knew you at the time or who knew you before and after your service. They should describe your behavioral changes.

Excellent recommendation. A letter from a friend, family member, fellow Servicemember, etc. can be very helpful. In addition to describing behavioral changes, such letters of support might:

- Describe how the veteran looks today, compared to before the sexual assault. "Before her deployment we always called her "Miss Suzie Sunshine" because she was always smiling and cracking jokes and cheering people up. Since she returned home six months ago, I have never seen her smile. She doesn't look me in the eyes half the time and if she does she quickly turns away. She looks like she is 10-15 years older!"

- Talk about changes in sexual functioning (most relevant for spouses or partners), since this is, as I'm sure you know, an area that (understandably) affects many MST survivors. "She had a normal, healthy sex drive before but now she never wants to have sex. Whenever we try, she seems so fragile and empty or something. I feel like a monster so then I don't want to have sex either."

- Ask for as many letters from family and close friends as you can. Emphasize to them that they should not try to make the Veteran "look good" - this is the time to 'tell it like it is' with specifics, details, descriptions, quotes, and even drawings or photographs. Of course, family members and friends shouldn't try to embellish or exaggerate, but I frankly rarely saw that when I did these evaluations.

Finally, be persistent, determined, and even relentless about obtaining all relevant--or possibly relevant--records. If the Veteran saw a mental health professional in the service after the assault (or in the midst of repeated harassment), understand that detailed behavioral health records are almost always kept separate from other medical records. And by separate, I mean 'physically separate' when it comes to paper records; and 'digitally separate' when it comes to computer records. In almost all cases, across all three primary services (no offense to the Coast Guard, I just saw so few cases I can't assess), you will not find narrative summaries of psychotherapy sessions or psychiatric assessments or psychological testing results via DoD Remote Access, VistaWeb, in the paper copies of the service medical records, or even in the new electronic c-files (or so I hear). You have to specifically ask for the detailed behavioral health notes "that are stored separately." Most VBA and C&P staff don't even know about that. No one is trying to keep it a secret, it's simply a decades-old practice that was developed to respect the sensitive, private nature of mental health records--a laudable goal, but it unfortunately can hurt an MST survivor applying for compensation benefits.