The Department of Veterans Affairs has proposed something transgender activists have long called for: allowing the VA and its hospitals to provide gender-confirmation procedures.
VA officials revealed the proposal in response to a query from Time magazine, which reported on the matter today. They would not say when it was first proposed, but said the VA has been working on it since 2014. Information on pending rule change has now been published on the VA’s website.
Gender-confirmation surgery has been banned at VA facilities since the early 1990s; it also cannot be performed at other facilities if the VA is paying for it. In 2011 the agency announced a standardized policy of equal access to medically necessary health care for transgender veterans — with the exception of transition-related procedures. The VA called such surgery “cosmetic,” although the American Medical Association and other health care groups have said it is a therapeutic treatment and medically necessary for many transgender people, even though not all of them seek surgery.
A VA official said the proposal to lift the ban reflects new medical knowledge and improvements in transition-related surgery. When the ban was put in place, “some of these surgical procedures were not as well developed as they are now,” Jillian Shipherd, a codirector of the VA’s LGBT health care program, told Time. “The science about what the international standards of care are was very different from where we are today.”
Transgender veterans, represented by Lambda Legal and the Transgender Law Center, had petitioned the VA to end the ban. "We definitely welcome the news," M. Dru Levasseur, director of Lambda's transgender rights project, told The Advocate. He was encouraged, he said, that the VA acknowldged that serious consequences, including suicide, can result from the denial of surgery, and that surgical procedures have evolved.
Lambda and the Transgender Law Center are representing two individual plaintiffs and one group, Transgender Veterans of America, in their action, and since the petition was filed, one member of the vets' group has ended her life, Levasseur said. Every day the ban stays in place, he said, is potentially harmful. "We hope the VA acts quickly to remove this discriminatory exclusion," he added.
There is a long process ahead before the ban is lifted. The federal Office of Management and Budget will review the proposal’s language, and if it approves, the VA will take public comment on the matter before finalizing the new rule. All this could take up to 22 months, Time notes.
Lambda and the law center are prepared to take further action if the new rule does not go through, Levasseur said, but for now they are hopeful. He noted that the VA has taken other positive actions regarding transgender vets in recent years, such as the 2011 policy.
Other LGBT groups welcomed the news as well. "We're very excited to see that," Mara Keisling, executive director of the National Center for Transgender Equality, told The Advocate. She called the ban an "old-fashioned, nonsensical exclusion."
She also pointed out that the process will take a while — the VA has made clear its intention to change the rule, but hasn't submitted the actual rule change for commentary and approval. "We're not quite at the stage that everybody thinks we are," she said.
Keisling is optimistic that the VA will make good on this, though. The agency already covers all pre- and post-surgery care for trans vets, including hormone treatment, she noted.
The American Military Partner Association, which represents the partners of LGBT service members and vets, also praised the VA's move. “This is incredibly welcome news for so many transgender veterans and their families," said Ashley Broadway-Mack, the group's president, in a press release. “So many veterans rely on the VA for important medical care that they have earned serving our nation, including transgender veterans. Gender confirmation surgery is often a critically important and medically necessary treatment for transgender veterans, and lifting this ban is long overdue.”