Military Sexual Trauma (MST) Claims: The Markers Pathway and What VA Will Accept

Most military sexual trauma is never reported at the time, and the regulation was written knowing that. 38 CFR 3.304(f)(5) lets the record speak through markers instead: a sudden transfer request, a performance drop, a pregnancy test, a new prescription. The claim is built from the aftermath, not from paperwork of the event, and no report or investigation is required.

The rule, and why it matters

Most MST is never reported at the time. VA knows that. The regulation at 38 CFR 3.304(f)(5)(5)) explicitly addresses PTSD claims based on in service personal assault and provides:

"Evidence from sources other than the veteran's service records may corroborate the veteran's account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes."

A few hard-won points are worth repeating because they get lost:

Reporting the assault at the time is not required.
A conviction or a formal military investigation is not required.
The standard the rater applies for MST is relaxed. The Court of Appeals for Veterans Claims has called it a special weight on lay and indirect evidence.
The veteran's own statement on VA Form 21-0781, Statement in Support of a Claimed Mental Health Disorder Due to an In Service Traumatic Event, is the centerpiece of the file. In March 2024 VA folded the older Form 21-0781a for personal assault into this single Form 21-0781, so personal assault and MST stressors now go on the 21-0781.

What VA calls a marker

A marker is any sign, event, or circumstance that points at a traumatic event. Markers replace the contemporaneous report. The VA's M21-1 adjudication manual (III.iv.4.H) and 38 CFR 3.304(f)(5) both group markers along these lines.

Military markers

A sudden request for change of duty station
A sudden drop in performance ratings or rank
AWOL or disciplinary action that has no other explanation
Sudden change in MOS or job assignment
Repeated requests for a particular shift, a particular roommate, or to be removed from one
A pregnancy test, sexually transmitted infection test, or emergency contraception in service records

Medical and mental health markers

Counseling, chaplain visits, or mental health visits in service after the assault
Civilian mental health treatment after discharge
New prescriptions for antidepressants, anxiolytics, sleep medications
Episodes of depression, panic attacks, or anxiety without another cause
Self-harm or suicidal ideation documented in any record
New substance use or escalation of existing use
Eating disorder behavior, including major weight gain or loss
New sexual dysfunction or arousal problems

Behavioral and social markers

A noticeable decrease in personal self-care (clothing, grooming, makeup)
Withdrawal from friends, family, religious community, or hobbies
Trouble with intimate relationships, repeated breakups, or new avoidance
New trouble sleeping in a shared space, refusal to sleep in barracks, or insistence on locked rooms
New trouble with authority figures who share a demographic with the assailant
Sudden interest in firearms, sudden purge of social media, or sudden moves

People who can write a statement

All of these statements go on VA Form 21-10210, Lay/Witness Statement.

A fellow service member who witnessed the event
A fellow service member you told at the time or after
A roommate, suitemate, or friend who saw the immediate aftermath
A spouse, partner, parent, or sibling who saw the change in you after
A civilian therapist, pastor, or rape crisis advocate (the form is for them too)
A supervisor, mentor, or coworker who can describe before-and-after performance

The claim itself

Start a claim using [VA Form 21-526EZ](https://www.vba.va.gov/pubs/forms/VBA-21-526EZ-ARE.pdf). List the conditions you are claiming as secondary to the MST (PTSD, depressive disorder, anxiety disorder, eating disorder, sexual dysfunction, sleep disorder, and any physical conditions caused by the trauma).
Submit [VA Form 21-0781](https://www.va.gov/forms/21-0781/) with your account of the in service event. Be as specific as you can about date, place, unit, perpetrator, and the immediate aftermath. If you cannot remember an exact date, give a window ("between June and August 2010, at Fort X"). It is OK.
Submit a personal statement on [VA Form 21-4138](https://www.vba.va.gov/pubs/forms/VBA-21-4138-ARE.pdf) explaining the markers in your own life: behavioral changes, medical changes, military markers, relationship changes, sleep, employment, mental health.
Collect markers from your records: service treatment records, performance reviews, military police records, requests for transfer or reassignment, any pregnancy or STI tests in the file, AWOL or NJP entries.
Collect markers from outside service: civilian therapy notes, ER visits, hospital records, court records (orders of protection, divorce filings), employment records.
Lay statements on VA Form 21-10210 from one to four people. Quality beats quantity.
Consider an Independent Medical Opinion if you can. A psychologist familiar with the MST literature can review your records and write a nexus opinion stating that the markers, combined with the current diagnosis, are at least as likely as not consistent with the claimed in service stressor.

Free resources every MST survivor can use

[VA Military Sexual Trauma Home](https://www.mentalhealth.va.gov/msthome.asp). The national VA page. Counseling and treatment are free for any veteran who experienced MST, regardless of discharge characterization, length of service, or whether the veteran has filed a claim. This is the 38 USC 1720D entitlement and it is one of the most under-used benefits VA has.
MST Coordinator at every VA medical center. Every VAMC is required to have one. Ask for them at the front desk or call your VA primary care team.
Vet Centers (https://www.vetcenter.va.gov/). Confidential readjustment counseling, no copay.
Safe Helpline (1-877-995-5247, safehelpline.org). DoD-funded, available 24/7, anonymous and confidential.
State Department of Veterans Affairs. Most states staff a Women's Veteran Coordinator (a regional role created by Congress in Public Law 116-315 for veterans broadly). They can help you find a local MST coordinator and an accredited representative.

What VA looks for at the C&P exam

A Personal Assault PTSD exam follows a specific protocol. The examiner is supposed to:

Review the entire claims file, the markers, and the 21-0781 statement.
Confirm or rule out a current PTSD diagnosis under DSM-5 (Criteria A through H).
Determine whether the markers, taken together, are at least as likely as not consistent with a personal assault stressor.
Address every diagnosis raised by the record, not just PTSD. Many MST claims also include depressive disorder, anxiety, eating disorders, sleep disorders, and sexual dysfunction.
State the opinion in the required language: "at least as likely as not" or "less likely than not," with a clear rationale.

If the C&P examiner's report does not address the markers or skips one of the secondary conditions, that is a basis for a Higher Level Review or a request for a clarification opinion.

The one principle to remember

VA's MST claim rule is more forgiving than its rule for other stressors, by design. The work is to assemble enough markers and lay statements that the rater can credibly conclude something happened. The veteran's own voice is the centerpiece. Everything else corroborates it.

Where this comes from

[38 CFR 3.304(f)(5)](https://www.ecfr.gov/current/title-38/chapter-I/part-3/subpart-A/section-3.304#p-3.304(f)(5)), PTSD claims based on in service personal assault
[38 USC 1720D](https://www.law.cornell.edu/uscode/text/38/1720D), MST counseling and treatment entitlement
M21-1 Adjudication Procedures Manual, Part III, Subpart iv, Chapter 4, Section H (Personal Assault and MST)
VA Form 21-0781 (Statement in Support of a Claimed Mental Health Disorder; replaced the older 21-0781a in March 2024)
VA Form 21-4138 (Statement in Support of Claim)
VA Form 21-10210 (Lay/Witness Statement)
VA MST Home

This page is educational. Work with a VA accredited representative when you can.

Related on this site

Common questions

Do I need to have reported the assault for an MST claim?

No. Reporting at the time is not required, and neither is a conviction or a formal investigation. The regulation at 38 CFR 3.304(f)(5) explicitly allows evidence from sources other than service records to corroborate the stressor, and the Court of Appeals for Veterans Claims has described the MST standard as placing special weight on lay and indirect evidence.

What counts as a marker?

Any sign, event, or circumstance pointing at the trauma: a sudden transfer request, a drop in performance ratings, unexplained disciplinary action, a pregnancy or STI test in service records, counseling or chaplain visits, new prescriptions, substance use, withdrawal from friends and family, sleep changes, and relationship difficulties. Markers replace the contemporaneous report and are grouped in the M21-1 manual and 3.304(f)(5).

What forms does an MST claim use?

VA Form 21-526EZ starts the claim, VA Form 21-0781 carries your account of the in-service event (since March 2024 it covers personal assault stressors too, replacing the old 21-0781a), VA Form 21-4138 works for a personal statement walking through your markers, and lay witnesses use VA Form 21-10210. An approximate date window ("between June and August 2010") is acceptable.

Can I get free MST treatment without filing a claim?

Yes. Under 38 USC 1720D, counseling and treatment for MST are free for any veteran, regardless of discharge characterization, length of service, or whether a claim was ever filed. Every VA medical center has an MST Coordinator, Vet Centers offer confidential counseling, and the DoD Safe Helpline (1-877-995-5247) is anonymous and available around the clock.

What should the C&P exam address in an MST claim?

The examiner must review the whole file including the markers and the 21-0781, confirm or rule out PTSD under DSM-5, state whether the markers taken together are at least as likely as not consistent with the claimed stressor, and address every diagnosis the record raises, not just PTSD. A report that skips the markers or a raised condition supports a Higher Level Review or a clarification request.