Reversals in initially denied Department of Veterans Affairs’ PTSD disability claims after 17 years: a cohort study of gender differences

Background In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims’ outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims’ outcomes after 2011, determine whether disability awards (also known as “service connection”) for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. Methods From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans’ benefits. Results 51.4% of men and 31.3% of women were service connected for PTSD by study’s end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study’s end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men’s mean total disability rating was substantially greater than women’s (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men’s versus women’s odds of PTSD service connection. Conclusion Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women’s lower rate of PTSD service connection, but, ultimately, men’s total disability ratings exceeded women’s. Gender discrepancies in service connection should be monitored beyond the initial claims period.

Assessing Institutional Betrayal Among Female Veterans Who Experienced Military Sexual Trauma: A Rasch Analysis of the Institutional Betrayal Questionnaire.2

Military sexual trauma (MST; i.e., sexual harassment and/or sexual assault during one’s military service) is highly prevalent among female veterans and is associated with numerous adverse health and psychosocial sequelae. When institutions fail to prevent sexual trauma from happening or respond in an unsupportive manner (i.e., institutional betrayal [IB]), MST survivors typically report more severe health-related outcomes. Although the Institutional Betrayal Questionnaire.2 (IBQ.2) was developed to assess IB, no studies have examined the factor structure or dimensionality of the IBQ.2 among MST survivors. In addition, initial research has reported differing factor structures for this measure. The present study examined the dimensionality and factor structure of the IBQ.2, and tested for differential item functioning (DIF) based on whether military sexual assault was experienced. The sample comprised 235 female veterans who reported a history of MST in an anonymous national survey. Rasch analysis suggested multidimensionality and DIF based on history of military sexual assault. Exploratory factor analysis and parallel analysis suggested the IBQ.2 comprises three factors: (1) Environment Leading to MST, (2) Institutional Response to MST, and (3) Institutional Belongingness following MST. Although these results suggest that the IBQ.2 is multidimensional, the three-factor model had significant issues with respect to dimensionality, item fit, and person separation and reliability. Thus, using the full IBQ.2 may be more advantageous. Further examination of the IBQ.2 is warranted to ensure optimal assessment of IB in relation to MST, irrespective of whether the MST comprised sexual harassment or sexual assault, as well as to ensure that the IBQ.2 is culturally meaningful for MST survivors.

IOP Assessment and Structure

This chapter presents key assessment issues and recommendations to assist in patient selection and examination of response across the prolonged exposure-intensive outpatient (PE-IOP) treatment program. The authors discuss key issues including dissociation, suicide and self-harm risk, anger, moral injury, complex trauma, personality disorder, guilt, and comorbidity. Specific patient populations are discussed, including military, sexual assault, and traumatic brain injury populations. Discussion of a process for screening, assessment, and treatment planning using an interdisciplinary treatment team is presented.

Victim Behavior in a Sample of Military Sexual Assault Cases

This study explored victim responses to sexual assault within a military context. Victim behavior was identified in forensic case files of service members charged with sexual assault ( N = 58) and referred for forensic evaluation or consultation. The identified victim behavior was coded and quantified for description. Of the sample 87.9% of victims were female and 12.0% of victims were male; 37.9% of the victims reported their assault in less than 1 month. Forceful resistance to the assault occurred in 15.5% of the cases. Physical injury associated with the sexual assault was absent in 96.5% of the cases. The description of victim behavior can inform forensic expert testimony on victim behavior within the military justice system while also offering empirical evidence to better understand this public health problem in the U.S. military.

I’ll Trade You Skittles for a Blowjob: Assessing the Role of Anti-Female Memes in Military Sexual Harassment and Assault

Humor is a foundational element of culture and can have both positive and negative effects within a group or society. One such group with its own well-defined culture is the United States military. Sexual assault has been highlighted of late as a major challenge facing military leadership, policymakers, and military personnel themselves. This study is a content analysis that examines 35 internet memes taken from a Google search of military memes and identifies emergent themes. Four thematic units were identified within the sample. The results indicate possible focal points for the future construction of education programs geared toward military sexual assault and harassment training, as well as a jumping off point for future research concerning military workplace culture and sexual assault.