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“A Lot of Gray”: Ambiguity, Beliefs, and Discretion in Veterans Benefits Administration Military Sexual Trauma-Related Posttraumatic Stress Disorder Disability Claims
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  • Aliya R. Webermann,
  • Stephanie M. Bonnes,
  • Sonia Rupcic,
  • Ryan Holliday,
  • Lindsey Monteith,
  • Marc I. Rosen,
  • Galina A. Portnoy,
  • Maureen Murdoch
Aliya R. Webermann
VA Connecticut Healthcare System

Corresponding Author:aliya.webermann@va.gov

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Stephanie M. Bonnes
University of New Haven
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Sonia Rupcic
VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research
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Ryan Holliday
Veterans Integrated Services Network 19 Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention
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Lindsey Monteith
Veterans Integrated Services Network 19 Rocky Mountain Mental Illness Research Education and Clinical Center for Suicide Prevention
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Marc I. Rosen
VA Connecticut Healthcare System
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Galina A. Portnoy
VA Connecticut Healthcare System
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Maureen Murdoch
Minneapolis VA Medical Center
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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.
Submitted to Journal of Clinical Psychology
Submission Checks Completed
Assigned to Editor
Reviewer(s) Assigned
11 Jul 2024Review(s) Completed, Editorial Evaluation Pending
11 Jul 2024Reviewer(s) Assigned