“A Lot of Gray”: Ambiguity, Beliefs, and Discretion in Veterans Benefits Administration Military Sexual Trauma-Related Posttraumatic Stress Disorder Disability Claims

This is the authors' abstract. We don't add key points for this paper.

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.