Sadly, a veteran may have MST PTSD due to an in-service incident, such as a rape, assault, battery, robbery, mugging, stalking, or other form of harassment.
For VA disability purposes, PTSD MST VA claims are an extremely personal and sensitive issue, and oftentimes lack sufficient evidence to prove that the in-service stressor event occurred.
In compliance with 38 CFR 3.159(c)(4), an examination for MST PTSD will always be needed when a thorough review shows:
- A current medical diagnosis of PTSD or the Veteran’s lay statements, aka, Buddy Letter for PTSD, describing PTSD symptoms (VA Claims Insider recommends at least one Buddy Letter to support your MST PTSD VA claim).
- Credible supporting evidence of the personal trauma incident or evidence of a marker in the in-service or post-service records
- Indication that the PTSD symptoms may be associated with the claimed MST stressor (established by applying a low threshold and liberal approach satisfied by virtue of a current diagnosis or symptoms and the presence of a marker), and
- Medical evidence adequate for rating purposes is not already of record.
Veterans MST PTSD Claims Information
Personal trauma for the purpose of VA disability compensation claims based on PTSD refers broadly to stressor events involving harm perpetrated by a person who is not considered part of an enemy force.
Examples: Assault, battery, robbery, mugging, stalking, harassment.
Military sexual trauma (MST) is a subset of personal trauma and refers to sexual harassment, sexual assault, or rape that occurs in a military setting.
Reference: For more information on processing claims for PTSD based on personal trauma, see
- M21-1, Part III, Subpart iv, 4.O.3
- The PTSD Personal Assault Information site on the Compensation Service Intranet, and
- 38 CFR 3.304(f)(5).
When a Veteran claims SC for PTSD based on in-service personal trauma, undertake required development of the claim for credible evidence to support the Veteran’s assertion that the stressful event occurred.
Because a personal trauma is an extremely personal and sensitive issue,
- Many incidents of personal trauma are not officially reported, and
- The victims of this type of in-service trauma may find it difficult to produce evidence to support the occurrence of the stressor.
- Identifying possible sources of evidence to support the claim may require asking the Veteran for information concerning the traumatic incident. Make this request as compassionately as possible in order to avoid causing further trauma.
- Although personal trauma is most often thought of as involving female Veterans, male Veterans may also be involved. Be sure requests for evidence/information reflect the appropriate gender of the Veteran.
Note: The development activity must work closely with the rating activity when developing personal trauma cases.
References: For more information on applying the benefit-of-the-doubt rule, see
Negative evidence, see
- Forshey v. Principi, 284 F.3d 1335 (Fed. Cir. 2002) (en banc), and
- Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000), and
Absence of military documentation of an in-service sexual assault, see
In cases where the only evidence of the personal trauma stressor are behavioral changes that may be markers of the claimed trauma, an examination is almost always needed because the marker itself does not establish the occurrence of the stressor, but the opinion of the qualified examiner can provide credible and probative evidence to make that determination.
The examination is needed specifically to determine:
- Whether a medical opinion can provide evidence for occurrence of the claimed in-service personal trauma stressor based on the marker and the Veteran’s lay statement, and
- Whether that claimed stressor is related to current PTSD symptoms.
Important: In order to ensure the examination request language is adequate, use the Exam Request Builder or Supplemental Language Matrix, as appropriate, and select the necessary PTSD MST or PTSD personal trauma (non-MST) medical opinion template/language based on the nature of the claimed stressor.
References: For more information on
- Requesting examinations, see M21-1, Part III, Subpart iv, 3.A
- Evidence that may constitute markers of trauma, see M21-1, Part III, Subpart iv, 4.O.3.d, and
Medical opinions to interpret evidence of behavioral changes, see
For MST PTSD claims, VA Raters, also known as RVSRs must request a medical opinion based on MST, and the only evidence of the MST stressor are behavioral changes that may be markers of the claimed trauma.
Example VA PTSD MST Medical Opinion Request
TYPE OF MEDICAL OPINION REQUESTED: Military Sexual Trauma (MST)
OPINION: MST PTSD
This examination is being conducted to assist with determining whether the Veteran experienced an in-service personal assault stressor related to military sexual trauma (MST) that has resulted in a current PTSD diagnosis. Please review the claims file and state in your report that it was reviewed. In your review of the claims file, please pay special attention to signs, events, or circumstances that may represent markers for the MST stressor described by the Veteran. Your review is not limited to the evidence identified on this request form or tabbed in the claims folder. If additional testing is required, please obtain it prior to rendering your opinion.
Based upon your review of the evidence, please provide a medical opinion as to whether the MST stressor event described by the Veteran is at least as likely as not (50 percent or greater probability) supported by and consistent with the in-service marker evidence. Please provide a rationale for the opinion and list the marker evidence used to arrive at your decision.
1. IF YOUR EXAMINATION DETERMINES THE VETERAN HAS A CURRENT DIAGNOSIS OF PTSD, please provide an opinion as to whether the current PTSD diagnosis is at least as likely as not (50 percent or greater probability) caused by or a result of the in-service MST-related marker(s), and provide a rationale. Please note that only PTSD can be service connected based on circumstantial marker evidence (38 CFR 3.304(f) (5)).
2. IF YOUR EXAMINATION DETERMINES THAT, IN ADDITION TO PTSD, THE VETERAN HAS ADDITIONAL MENTAL DISORDERS, please state whether the additional mental disorders are at least as likely as not (50 percent or greater probability) secondary to the PTSD and provide a rationale. For each mental disorder diagnosed, identify and clearly list which symptoms are attributed to each diagnosis. If one or more symptoms overlap and cannot be separated without speculation, please state so and provide a rationale (38 CFR 3.310).
3. IF YOUR EXAMINATION DETERMINES THE VETERAN DOES NOT HAVE PTSD, BUT HAS A DIFFERENT MENTAL DISORDER(S), please review the service treatment records (STRs) and service personnel records for in-service direct evidence. Direct evidence is clear, undisputable proof of an event, injury, or disease. Such evidence includes, but is not limited to, mental health treatment, mental health symptoms, or a mental health diagnosis. If direct evidence exists in the STRs or service personnel records, please provide an opinion as to whether the mental disorder(s) diagnosed on examination is at least as likely as not (50 percent or greater probability) caused by or a result of the direct evidence noted in service. Please provide a rationale for the opinion and list the evidence used to arrive at your decision. (38 CFR 3.303).
Rationale must be provided in the appropriate section. If more than one mental disorder is diagnosed, please comment on their relationship to one another, and, if possible, please state which symptoms are attributed to each disorder.
PTSD MST Compensation Rating Criteria
100 Disability Ratings for PTSD due to MST
Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.
70 VA Disability Rating for PTSD MST
Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships.
50 VA Disability Rating for PTSD MST
Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.
30 VA Disability Rating for PTSD MST
Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).
10 VA Disability Rating for PTSD MST
Occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication.
0 VA Disability Rating for PTSD MST
A mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.
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