“A Lot of Gray”: Ambiguity, Beliefs, and Discretion in Veterans
Benefits Administration Military Sexual Trauma-Related Posttraumatic
Stress Disorder Disability Claims
Abstract
Objectives: Thousands of Veterans file claims for military sexual trauma
(MST)-related posttraumatic stress disorder (PTSD) disability through
the Department of Veterans Affairs’ (VA) Veterans Benefits
Administration (VBA) annually to receive covered healthcare benefits and
monthly nontaxable compensation for MST-related conditions. Although
72% of MST claims in 2021 were granted, prior reporting found claims
had been erroneously denied due to insufficient evidence-gathering and
scheduling of disability exams for sufficiently developed claims. The
present study explores decision-making processes around
evidence-gathering for MST-related disability claims through interviews
with VBA and Veterans Health Administration (VHA) staff who develop,
rate, and evaluate MST disability claims ( n = 21). Methods:
Interviews occurred from October 2021-January 2024 and were analyzed
using rapid qualitative methods and inductive coding, revealing themes
of ambiguity, beliefs, and discretion. Results: Participants described
MST “markers”(e.g., behavioral events or patterns indicating effects
of MST) as difficult to reliably identify and demonstrated disagreements
about what constituted a marker. Within this ambiguity, factors that
shaped participants’ decision-making included beliefs about the MST and
its impacts, the veracity of Veteran PTSD and/or MST claims, and the
role of VA staff. Participants’ judgments appeared to depend in part on
personal beliefs; those who generally believed Veterans advocated for
and centered survivors, whereas those who endorsed sexual assault myths
or that Veterans were not truthful about PTSD and/or MST were skeptical
and tended to gatekeep VA resources for those deserving. Conclusion:
Future policy and programming around MST claim processing should focus
on reducing ambiguity and impacts of personal beliefs on discretion and
objectivity.