In 2024, the Department of Defense received 8,195 reports of military sexual assault (MSA). However, experts estimate this number represents a mere 25% of total sexual assaults, suggesting approximately 22,000 cases in fiscal year 2024 were never reported. Large estimates of unreported MSA indicate a low rate of engagement with post-assault care. Service members who experience MSA have an increased risk of developing symptoms of PTSD, depression, suicidality, and substance abuse disorders. Additionally, MSA has the potential to limit the contributions of service members, disrupt unit morale and cohesion, and undermine mission readiness. Victims of MSA experience adverse health outcomes with more intensity and for a longer duration than their civilian counterparts which may be attributed to polyvictimization. The differences in these outcomes may also be multifactorial, including the service members’ own trauma history, the culture in which an assault occurs, and their perceived or actual experience of disclosure to sexual assault response personnel. Mental health interventions following MSA have been effective at reducing symptoms of PTSD and depression among military service members. Enhanced access to behavioral healthcare services that may improve long-term health outcomes and recovery from sexual assault are imperative to institute cultures of healing for MSA victims and maintain a fit and ready force. The purpose of this qualitative study is to explore service members’ post-assault reporting decisions through narrative inquiry. Application of the Traumageneic social ecological model (SEM) framework may help explain how prior experience with the medical and legal system(s), previous experiences of violence, and/or lack of social support and lived experiences of harm and resilience may contribute to service members’ reporting decisions. The decision to report can also be influenced by the military’s unique culture. Some of these influences include an emphasis on handling conflict at the lowest administrative level, prioritizing the unit and mission over individuals, and/or retaliation on the victim or victim blaming for the assault. Studies also suggest toxic military leadership and environments where sexual harassment is pervasive may increase instances of sexual assault and further dissuade victims to report. Combined with the Traumagenic SEM, application of the SEM for Military Women’s Health may help to explain how military culture and the initial discussions with sexual assault response personnel impacts reporting decisions. The decision to report, which is necessary to receive assault-related health services, often starts with contact between victims and sexual assault response personnel. The initial contact with the sexual assault response coordinator, victims’ advocate, or sexual assault medical forensic examiner plays a significant role in MSA reporting decisions. These interactions are not well understood; but may influence reporting decisions. There are many DoD reports and surveys that address MSA, however a gap remains in understanding reporting decisions of service members. This proposed research study is designed to analyze data collected from participants to identify factors that impact MSA reporting decisions. New knowledge about reporting decisions can inform the development of specific interventions to increase reporting and/or the uptake of healthcare services that improve health outcomes.