Advice for Veterans – PTSD Military Sexual Trauma (MST) C&P Exams

A Navy veteran, Mel, recently posted a comment in response to my 23 November 2015 post encouraging readers to Support the Ruth Moore Act of 2015 – Senate Version. Mel related how military sexual trauma has–and is–causing him significant distress, suffering, and functional impairment.U.S. Navy Seal Today’s blog post incorporates many of the suggestions I offered to Mel in response to his courageous comment. Those suggestions, along with additional advice added for this blog post, are designed to help MST survivors file a successful claim for VA disability compensation benefits.

VA Provides Free Treatment for All MST Survivors Regardless of Service Connection Status

Image of Vet Centers LogoBefore offering some suggestions, I want to make sure you know that if you suffer from PTSD or any other mental disorder (such as depression, anxiety, panic attacks, or agoraphobia) due to military sexual trauma, you can receive free mental health treatment (psychotherapy, counseling, psychiatric medication), whether or not you are service connected for a mental disorder, at any VA medical center, outpatient clinic, or Vet Center. I told Mel:

Thank you for your openness about the horrific traumas you suffered during your service to our country in the U.S. Navy. Approximately 200,000 male veterans alive today endured sexual assault during their military service. Most of them suffer in silence. But that does not have to be the case. The more male survivors see courageous men like you talking about the abuse they lived through, the more those survivors will take the brave step of asking for help. You are doing the right things. You first sought help from your VA medical center or clinic, and you are going through the painful, but eventually healing, recovery process. And now you are seeking VA disability benefits, which you most certainly deserve to receive.

Filing a Claim for VA Disability Benefits

See the following resources, which provide detailed information about filing a disability claim with the Veterans Benefits Administration (VBA). (If you want to open these links in a new window, right-click on the link and select Open in New Tab, or similar.)

Apply online via the VA’s eBenefits website

> NOLO Legal Encyclopedia – Getting Disability Compensation for Military Sexual Trauma (MST)

Disability Compensation for Conditions Related to Military Sexual Trauma (MST) – Very helpful VA pamphlet.

VA Form 21-0781a – Statement in Support of Claim For Service Connection for Post-Traumatic Stress Disorder (PTSD) Secondary to Personal Assault

> Stateside Legal – How to File a Well-Prepared MST Claim

> Was your MST-Related VA Benefit Claim Denied in the Past? Learn about Special Review Process (from Stateside Legal)

> Consider asking for assistance from a Veterans Service Officer. If you do not have a service officer (representative), you can read about how to find a one in this Wikipedia article: Veterans benefits for post-traumatic stress disorder in the United States, under “Obtaining Assistance.”

Obtain All Relevant Medical Records

The C&P psychologist or psychiatrist, whether your exam is at a VA medical center or with a private doctor who does exams for a third-party IME company, will have computer access to all your VA treatment records. So you do not necessarily need to have your VA doctors and therapists write letters or fill out forms. Sometimes a VA psychiatrist, psychologist, clinical social worker, or other mental health clinician will write a letter of support, describing the severity of a veteran’s symptoms and associated functional impairment. But in the vast majority of claims, the record speaks for itself (referring to your treating doctors’ progress notes), and a letter of support is not necessary.picture of thousands of medical records

If you saw a private psychiatrist, family doctor, psychologist, therapist, counselor, or enrolled in a substance abuse treatment program, and you talked about MST and its effects (symptoms), try to obtain those records, as they may prove quite persuasive.

Note that ‘symptoms’ can be psychological or physical (medical) symptoms. Sexual assault survivors experience a much higher rate of medical problems than average. Some of the problems are sexual in nature, such as loss of libido (sexual desire); vaginismus; anxiety in sexual situations; erectile dysfunction; bowel disorders; rectal bleeding; etc. Other medical disorders are not necessarily sexual in nature, such as cluster-type or migraine headaches and gastrointestinal distress. (Of course, there can be other causes for those conditions, but it is something to consider and to discuss with your current doctor if they are still a problem for you.)

Also make sure that VBA (Veterans Benefits Administration) has requested and received all of your military personnel records. Request copies yourself, either from the Department of Defense or from VBA, and review them for any behavioral markers. Ask a friend or family member to review them too.

Behavioral Markers

Review the ‘behavioral markers’ for MST that might apply in your case – check the VA’s fact sheet, Disability Compensation for Conditions Related to Military Sexual Trauma (MST), and also see this post on the Veterans Benefits Network Forum, which includes an even more detailed list: Question about “markers” for PTSD/MST. (If you want to open these links in a new window, right-click on the link and select Open in New Tab, or similar.)

Lay Statements

It is also very helpful to submit lay statements (lay is short for lay witness, i.e., a non-expert who provides testimony in a legal case), if possible, from men or women with whom you served, who noticed changes in your mood, demeanor, behavior, and outlook after the sexual assault(s) or harassment. Also try to obtain lay statements from family members or friends who observed how the assault(s) or harassment affected you over the years, even if they did not know the reason at the time. Friends and family members should handwrite or type their lay statement on VA Form 21-4138 (Statement in Support of Claim).

Mail or fax the statements to the new VBA centralized intake center. If you mail the statement, do so in a way that gives you proof that it was received, e.g., U.S. Postal Service Signature Confirmation, or a similar service via FedEx or UPS. If you fax the form, you will receive a fax receipt from the VBA centralized intake center. Ask your friends or family members to review the list of behavioral markers, in case any of them apply in your case, so that they can comment on them specifically. You might want to review all this information with your Veterans Service Officer and ask for his or her advice. If you do not have a Veterans Service Officer, you can read about how to find one in this Wikipedia article: Veterans benefits for post-traumatic stress disorder in the United States, under “Obtaining Assistance.”

Preparing for Your C&P Exam

Keep an open mind about your upcoming C&P exam. Yes, you might receive a ‘bad’ examiner who does not understand the suffering MST survivors experience. On the other hand, you might see a good examiner who will conduct a thorough, objective, and compassionate evaluation. You have a right to request a female or male examiner, if you have a preference. Call the VA medical center or the IME company where your exam is scheduled to make such a request. If you have trouble reaching them, ask your Veterans Service Officer for help. See these two posts for general advice on how to prepare for your exam:

  1. Using a daily diary to track posttraumatic stress symptoms
  2. Advice for Veterans – VA PTSD Compensation and Pension Exam

After the C&P Exam

Many veterans choose to request a copy of their C&P exam report either by requesting it through your VA medical MY Health-e-Vet logocenter’s Release of Information office, or via the Blue Button feature on MyHealtheVet. (MyHealtheVet is a VA website where veterans can obtain health information, send encrypted messages to their primary care doctor, and download copies of all their VA medical records). You certainly have the right to request your exam report, but keep in mind that the Veterans Benefits Administration (VBA) adjudicates disability claims, and they may or may not agree with the C&P psychologist or psychiatrist’s opinion. I suggest waiting until you receive your Decision Letter from VBA before expending a lot of energy worrying about what the C&P examiner wrote in his or her report. Note that if a contracted examiner in private practice conducted your C&P exam (via a third-party IME company), you must obtain a copy of your C&P exam report directly from the Veterans Benefits Administration (VBA).

If VBA Denies Your Claim

If your claim is denied, or if you believe the disability rating (percentage) assigned by VBA is inaccurate, you can appeal the decision. Note that to begin your appeal, you must submit a NOD (“Notice of Disagreement”) on VA Form 21-0958. That form contains detailed instructions. In addition, see the following resources. (If you want to open these links in a new window, right-click on the link and select Open in New Tab, or similar.)

Note that you may have your Veterans Service Officer or a veterans law attorney represent you on appeal.

Legal Representation

If you decide to appeal your decision to the Board of Veterans’ Appeals (BVA), or if you need to appeal a BVA decision to the Court of Appeals for Veterans Claims (CAVC), I recommend finding an experienced veterans lawyer to represent you on appeal. Here are some ways to find a veterans law attorney. (If you want to open these links in a new window, right-click on the link and select Open in New Tab, or similar.)

  • Unless they agree to work on a pro bono basis (see below for pro bono programs), attorneys and claims agents who represent veterans before the Veterans Benefits Administration, Board of Veterans Appeals, and Court of Appeals for Veterans Claims require payment for their services. Most attorneys will agree to receive payment after your appeal is decided, and only if you ‘win’ your appeal, from a percentage of back-pay you receive, according to requirements set forth in the Equal Access to Justice Act. These are attorney fees ordered by the court to be paid by the federal government when the government’s position in litigation was not “substantially justified.”1
  • Ask other vets if they know any good veterans attorneys.
  • Also ask your Veterans Service Officer (Representative) if he or she can recommend a veterans lawyer.
  • Ask other vets for suggestions on the Veterans Benefits Network and HadIt.com forums.
  • National Veterans Legal Services Program (NVLSP) logoConsult these resources:

Note that a veterans lawyer does not need to have an office in your state of residence, since these are federal proceedings, although they do need to have been accredited by VA.

Did I Miss Something Important?

If I did not suggest something that you think is important, please comment below! (“Leave a Reply”). Also feel free to share your experience, or ask questions by commenting below.

Footnote 1. 38 C.F.R. 14.636 – Payment of fees for representation by agents and attorneys in proceedings before Agencies of Original Jurisdiction and before the Board of Veterans’ Appeals. Code of Federal Regulations. United States Government Printing Office (GPO).  

DISCLAIMER: Nothing I write on this website should be construed as representing the
views or opinions of the U.S. Department of Veterans Affairs or the federal government.