As the news broke on this story yesterday, I was at the San Diego VA Medical Center’s Dental Clinic. I was having a root canal on a molar. My healthcare provider is the Veterans Healthcare Administration; the appropriateness of my healthcare experience at the VA Medical Centers depends a great deal on which VA Medical Center I receive my healthcare from.

Nationwide, there hasn’t been a standardized policy for disabled, transgender veterans’ healthcare at VA Medial Centers.

Thumbnail Link to Veterans Heathcare Administration (VHA) Directive 2011-024: Providing Health Care For Transgender And Intersex VeteransWell, that’s changed as of Thursday, June 9, 2011, and announced on Friday.

The Veterans Health Administration (VHA), part of the Veterans Administration (VA), released a new policy document on Friday setting policy for transgender and intersex veterans — it was released as a VHA Directive. The VHA Directive is entitled Providing Health Care For Transgender And Intersex Veterans, and sets the purpose of the policy document as follows:

This Veterans Health Administration (VHA) Directive establishes policy regarding the respectful delivery of health care to transgender and intersex Veterans who are enrolled in the Department of Veterans Affairs (VA) health care system or are otherwise eligible for VA care.

The VHA Directive spells out the background for the directive in this way:

In accordance with the medical benefits package (title 38 Code of Federal Regulations (CFR) Section 17.38), VA provides care and treatment to Veterans that is compatible with generally accepted standards of medical practice and determined by appropriate health care professionals to promote, preserve, or restore the health of the individual.
  1. VA provides health care for transgender patients, including those who present at various points on their transition from one gender to the next. This applies to all Veterans who are enrolled in VA’s health care system or who are otherwise eligible for VA care, including: those who have had sex reassignment surgery outside of VHA, those who might be considering such surgical intervention, and those who do not wish to undergo sex reassignment surgery, but self-identify as transgender. Intersex individuals may or may not have interest in changing gender or in acting in ways that are discordant with their assigned gender.
  2. VA does not provide sex reassignment surgery or plastic reconstructive surgery for strictly cosmetic purposes.

Transgender American Veteran Association White Paper: Transgender People In The U.S. MilitaryYou can trace back the need for the policy to the white paper the Transgender American Veterans Association (TAVA) and the Palm Center released in 2009 2008, entitled Transgender People In The U.S. Military. Relating to transgender veterans, two key findings of the study were this:

  • About a third of those [disabled transgender veterans] using the VA hospital had broached the subject of medical gender transitions with the VA staff. Most of them had their requests denied.
  • Respondents reported organizational discrimination at the VA in a lack of clear and consistent practice, with little support for gender transitions. In addition, there were many reports of interpersonal discrimination, via lack of respect from VA doctors, non-medical staff, and nurses.

And when discussing the number of veterans in transgender community in the United States as compared to the general population of the nation, the Task Force‘s Injustice at Every Turn; A Report of the National Transgender Discrimination Survey (emphasis added):

[More below the fold.]

Twenty percent (20%) of respondents said they are or had been a member of the armed forces. Seventy-eight percent (78%) said they had not, while 2% said they were denied entry. According to the American Community Survey for the same year as this survey, 10% of the adult United States population had served in the military.

Thumbnail link: National Center for Transgender Equality's (NCTE's) 'NEWS: Transgender Veterans Guaranteed Care'The National Center for Transgender Equality — the key non-profit in Washington DC working quietly behind the scenes on this policy clarification — sent this out in a message today (June 10, 2011):

Today (June 10, 2011), the Veterans Health Administration (VHA) issued a Directive to all of its facilities establishing a policy of respectful delivery of healthcare to transgender and intersex veterans who are enrolled in the Department of Veterans Affairs (VA) healthcare system or are otherwise eligible for VA care.

“Far too often, veterans are denied the benefits we have earned when we face discrimination at our local VA health facility,” noted Stephanie White, NCTE’s Managing Director and a veteran. She also said, “this Directive addresses that head on. All veterans deserve to be treated equally.”

The new directive does several things:

  • Indicates that all VA staff must provide care to transgender patients “without discrimination in a manner consistent with care and management of all Veteran patients.”
  • Clearly states that all personal information about transgender status and medical care is kept confidential.
  • Reiterates that under existing regulations sex reassignment surgery cannot be performed or paid for by the VA.
  • Reiterates that all other medically necessary healthcare for transgender veterans is covered, including sex specificcare like mammograms and pap smears, as well as transition-related care such as hormones and mental health services.

NCTE has created a guide to the new policy with common questions and answers that can be accessed through the NCTE website here. From the NCTE pamphlet:

  • Indicates that all VA staff are to provide care to transgender patients “without discrimination in a manner consistent with care and management of all Veteran patients;”
  • Thumbnail link to the National Center for Transgender Equality's (NCTE's) 'Veterans Health Administration Transgender Healthcare Directive'

  • Clearly states that all personal information about transgender status and medical care is kept confidential;
  • Reiterates that, under existing regulations, sex reassignment surgery cannot be performed or paid for by the VA;
  • Reiterates that all other medically necessary healthcare for transgender veterans is covered, including sex-specific care like mammograms and pap smears, as well as transition-related care such as hormones and mental health services.

And of key interest to me from its question and answer section:

Does the new VA policy affect my medical records?

Yes. The documented gender in the VA’s medical records will now reflect an individual’s self-identified gender. In order to change the name and gender in VA medical records, the individual must provide official documentation as per Veterans Health Administration policies.

The NCTE pamphlet also explains why sex reassignment surgery isn’t included in the new VA policy, the identified privacy requirements for transgender patients in the new directive, and includes information regarding genital reconstruction surgery for intersex veterans.

There are key points to take away from this policy change:

  • Transgender veterans are to be treated as other veterans are treated, and that includes being treated respectfully.
  • Confidentiality is a VA requirement for how patient records for transgender veterans are handled.
  • One can change one’s VA record to reflect one’s gender without genital reconstruction surgery.
  • Sex reassignment surgery (also referred to as genital reconstruction surgery), as well as other transition related surgeries (such as breast augmentation and breast removal), are still prohibited by VA regulation.
  • Transition surgery means transition surgery, and not anything but transition surgery. This means mental health services and hormones will be made available to transgender veterans; and surgeries for disabled intersex veterans aren’t considered transition surgeries.
  • The prohibition against transition surgeries doesn’t mean sex specific care that’s contra to the gender marker in one’s medical records.

This policy isn’t just a good thing for transgender veterans — it has broader implications for wider transgender community. This policy sets a healthcare standard that will no doubt have implications for other federal agencies of the executive branch of government, and for non-government medical centers, will demonstrate what a federal example of appropriate healthcare policy for transgender patients looks like.

We can thank the Palm Center, as well as TAVA and its exectuive director Monica Helms, for the work they did on the White Paper that set this VA change in policy in motion. And, we can especially thank NCTE, and its executive director Mara Keisling, for all their behind the scenes work that resulted in this policy coming into being.

And, of course, we can thank the Obama Administration for taking this strong step towards leaving no veterans behind — now to clearly include transgender and intersex veterans as veterans who aren’t to be left behind.

It’s good to know that, when I need medical or dental care — as I did on the day this policy change was announced — whether or not I receive appropriate care from the VA won’t be dependent on which VA Medical Center I receive my healthcare from.

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Further reading:

* HRC Back Story: Obama Administration Announces Two Important Steps Toward Equal Access to Healthcare

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Related:

* TAVA And The Palm Center: A Look At Transgender Military And Veteran Experiences

* Guest Column by Monica Helms: We Won One!

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