1. The VBA should conduct more detailed data gathering on the determinants of service connection and ratings level for MSA-related PTSD claims, including the gender-specific coding of MSA-related traumas for analysis purposes.

2. The VBA should develop and disseminate reference materials for raters that more thoroughly address the management of MSA-related claims.

3. Training and testing on MSA-related claims should be a part of the certification program addressed in Chapter 4 for raters who deal with PTSD claims.

The committee observes that appropriate management of MSA-related claims begins with the proper documentation of incidents that occur during active service. Therefore, improved training of military medical and nursing personnel on how to document and collect evidence regarding sexual assault is needed. Civilian sector SANE¹⁷ and Forensic Nursing programs are models for such training. The committee also observes that more research is needed on the as yet unexplained gender differences in vulnerability to PTSD, which could help identify useful sex-specific approaches to prevention and treatment, and on more effective means for preventing military sexual assault and sexual harassment.

On the basis of the review of the papers, reports, and other information presented in this chapter, the committee has reached the following findings, conclusions, and recommendations, and identified the following research needs.

• The most effective strategy for dealing with problems with self-reports of traumatic exposure is to ensure that a comprehensive, consistent, and rigorous process is used throughout the VA to verify veteran-reported evidence.

• In the absence of a definitive measure, the most effective way to detect inappropriate claims is to require a consistent and comprehensive state-of-the-art examination and assessment that allows the time to conduct