The VA has a New Directive on the Treatment of Transgender Veterans

By Monica F. Helms

The VA has a new directive on the treatment of Transgender Veterans, BUT they won’t release it. This is becoming a theme with the Obama Administration. Tell LGBT people that their issues are important then do nothing to make them a reality. Transgender veterans have decided not to be quiet about this issue any longer.

First, a little history. In January of 2003, the Transgender American Veterans Association was formed with the primary mission to work with the Department of Veteran Affairs to have their medical facilities treat transgender people with dignity and respect.

In 2008, TAVA created a survey where 827 transgender veterans gave us information on all kinds of issues, especially their treatment at the VA. One third of those who took the survey had used a VA medical facility at one time of another. More than twenty percent of them had been mistreated by staff members, other patients, nurses and even doctors. The survey ended on May 1, 2008, and the raw data became public record. The Palm Center put out the White Papers in August.

TAVA was told by a VA insider that the raw data from the survey had reached the Veterans Health Administration, the medical department of the VA, and in June of 2008, they began drafting a directive to rectify the problem. In March of 2009 (after the Obama Administration took over,) the VHA sent a draft of their proposed directive to a few VA medical facilities for review by their transgender veterans. They didn’t contact TAVA or NCTE on this. The draft had misinformation, inaccuracies, incorrect descriptions and disrespectful definitions. It looked bad.

TAVA spent the next month communicating with some of the new people in the VA, some of whom had previous experience with transgender people and their medical issues. They agreed that the problem of mistreatment of transgender veterans needed to be fixed. TAVA felt hopeful that these new people now leading the VA would help us.

In May of 2009, the VHA sent a draft of their proposed directive, called “Providing Healthcare for Transgender and Intersex Veterans,” to NCTE to have them be the point organization in assuring the directive’s language looked correct in every way. With the help of trans lawyers and TAVA, NCTE put together a wonderful directive that would greatly improve how transgender veterans will be treated. The VA received our corrected version in July of 2009.

What the directive does cover is all the things that are available to other veterans, such as psychotherapy for PTSD, mammograms, prostate exams, pap smears and other important medical services, which had been denied to many transgender veterans in the past. This directive does indeed ensure that transgender veterans will be treated with dignity and respect.

I will not show the entire directive, because it may not be the final version. It has three pages total, with one page of definitions, a half page of references and the rest covering what the VA can and cannot do for transgender veterans. The language we will show you is from the draft of the directive we sent to the VHA and may have some tweaking before they release it. Sounds like we stepped into the ENDA territory.

Here are some of the important parts as they appeared in the revised draft:

-- This directive does not apply to patients who receive benefits under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
-- A diagnosis of Gender Identity Disorder (GID) is not a pre-condition for receiving care consistent with the Veteran’s self-identified gender.
-- All staff, including medical and administrative staff, are required to treat as confidential any information about a patient’s transgender status or any treatment related to a patient’s gender transition, unless the patient has given permission to share this information.
-- Diversity awareness training, (which educates staff on providing unbiased, respectful care to ALL Veterans) is available to supervisors and employees.

The following has to be said in bold capital letters for the good of those who will try to spread lies about this new directive. “THE DIRECTIVE SAYS THAT THE VA WILL NOT, DOES NOT AND CANNOT COVER SEX REASSIGNMENT/GENDER RECONSTRUCTION SURGERY.” That particular restriction is written into the Public Law that the VA has to follow in order to provide health care for veterans. It cannot be overridden by a simple directive change. However, it might be affected by other recent federal rulings. We’ll have to see.

As I stated, the VHA received our changes in July. They told us we would see it come out in August . . . then October . . . then February . . . and here it is May, a year from when we started making the changes, and still no directive.

To those LGBT people fighting for the repeal of DADT and the passage of ENDA, does this sound familiar? The difference is that this is not something Congress has to vote on. It’s a directive that can be implemented in a heartbeat and not a law that takes time to pass the House and the Senate. What is with the Obama Administration’s VHA when they hold back a simple directive that will instantly help part of the veteran community? I’ll let the conspiracy theorists play with that one. All we ask is to stop sitting on this and put it out to the VA medical facilities. It that so hard?

Since July of last year, when the VA had this directive in their hands, several transgender veterans have contacted TAVA saying that they had been treated badly at the VA, so we know that it could have prevented this if it had been introduced. And, even if these issues happen after implementation of the directive, the veterans would finally have it in hand to give them more clout when talking to the VA Patient Advocate. What is holding up the process? Who in the Administration is preventing this from coming out?

TAVA hasn’t been sitting idle since July. We have faxed a letter to the current DVA Secretary, retired Gen. Eric K. Shinseki and his secretary assured us he read it. Nothing happened. In early March, I personally presented the problem to the top administrator for Rep Joe Sestak, a retired Admiral and a champion for veterans’ rights, and Rep Sestak read the information. Sestak then sent me a letter saying he was “investigating and will respond soon.” Since then, he entered the final stages of a Senate race to replace Senator Arlen Specter and won. We hope to hear from him soon.

Other people have spoken to Representatives and Senators on our behalf, including NCTE, but still nothing happens. We wait for people to do the right thing, while transgender veterans have their basic health care denied. This issue will probably not cause a blip on the LGBT radar, and no one will be handcuffing themselves to the front doors of the DVA building. The transgender veterans will have to go it alone on this, as they have all along. The directive will eventually come out. We just hope it’ll be sooner than later.