Military Sexual Assault

Abstract

Military sexual assault (MSA) remains a persistent problem with substantial public health ramifications. This chapter reviews the history of military and Veterans Affairs (VA) responses to MSA, as well as the complex web of administrative, legal, and medical aspects that complicate societal responses to this crime. Survivors of MSA underreport medical problems while on active duty yet increasingly utilize VA services for a host of associated medical and psychological concerns. MSA survivors have heightened rates of medical comorbidity in a variety of bodily systems, beyond just the psychological, to include muscular, cardiovascular, gastrointestinal, sexual, respiratory, and neurological systems. Public outcry and congressional intervention have resulted in substantial modification of military law and novel response interventions to encourage reporting and treatment of MSA. To improve low reporting rates and low conviction rates, the military has greatly broadened sexual assault laws to include nonresisting, incapacitated, and same-sex victims. The military now offers treatment and legal counsel without requiring survivors to report to law enforcement. Larger numbers of survivors may choose to pursue prosecution after interacting with these resources, while others may receive superior alleviation of stress when compared with going through a courtroom process. The VA now allows for free lifetime medical service for any MSA survivor. Overall, the requirements of proof beyond a reasonable doubt in criminal court may never allow for 100% conviction in MSA cases, but the military and VA strive to achieve alternative means to provide comfort to MSA survivors.