VA backpedals on gender reassignment surgery

Citing a lack of funding, the Department of Veterans Affairs has backpedaled on a proposed rule change that would have covered sex-change surgeries for transgender veterans. But the agency pledged in a statement to “continue to explore regulatory change in the medical benefits package when appropriate funding is available.”

Transgender advocates vowed not to abandon efforts to get the expensive surgeries covered.

“Even though they are changing their minds right now, there’s going to be a way and we’re going to find that way. … We’re not going to be set back,” Leila Ireland, a transgender soldier who served in the Army as a man and was medically retired last year, told Military.com.

The proposed regulation changes are due out Monday and would have included gender reassignment surgery, but the VA did not have a plan for funding the procedures, a requirement President Barack Obama signed as an executive order in 2011.

That same year, the VA mandated standardized care for transgender veterans to include hormone therapy, mental healthcare, preoperative evaluation and long-term care after a sex reassignment surgery for qualified veterans. But the department stopped short of covering sex-reassignment surgery, deeming it something for “strictly cosmetic purposes.”

In June, the Department of Defense lifted its ban on transgender people serving in the military. From 2006 to 2013, the VA identified 2,662 diagnoses related to transgender status, with the number of transgender veterans rising since 2008. Since the 2011 directive, transgender cases have increased substantially, according to a paper by VA officials published in the American Journal of Public Health.

The VA originally announced its plan to lift the longstanding ban on gender reassignment surgery in May.

“Increased understanding of both gender dysphoria and surgical techniques in this area have improved significantly, and surgical procedures are now widely accepted in the medical community as medically necessary treatment for gender dysphoria,” the statement read.

But not every veteran advocate sees the effort to fund gender reassignment surgery as good news for veterans.

“In case you have been in a drug-induced coma for the past two years, VA has a well-known problem getting veterans in for major procedures in a timely manner. … I have no idea why anyone would allow VA to train residents on gender reassignment. It’d be a death wish,” wrote Benjamin Krause, a lawyer and author of the guide Voc Rehab Survival Guide for Veterans.

Six Democratic lawmakers called on the VA to expedite the coverage of sex reassignment surgeries and remove “the outdated restriction that prohibits VA from providing medical services to treat gender dysphoria.”

But 30 Republican lawmakers also wrote to Secretary Robert McDonald stating the VA should focus on improving service-related medical care.

“Many veterans struggle to receive appropriate and timely treatment for service-connected conditions, such as Post-Traumatic Stress Disorder (PTSD), due to significant backlogs and inadequate access within the VA’s healthcare system,” the letter read. “We do not believe the VA should be discussing the potential coverage of gender alteration surgeries as the agency faces challenges in delivering healthcare to those veterans whose service directly resulted in their need for medical treatments.”

Responding to concerns about costs, LGTB activists touted a study that states about 687 veterans would seek the gender reassignment surgery at a cost of $20.6 million a year. VA’s budget for 2017 is $176.9 billion.

But the study does not consider the training and facility changes needed at VA hospitals to perform such surgeries. If the surgery gains widespread acceptance, the estimated number seeking the procedure likely would increase as well. And not everyone sees the surgery as compassionate care.

“Real compassion for those struggling with a gender identity disorder is to offer mental health treatments that help men and women become comfortable with their actual biological sex—not to advocate for costly and controversial surgeries subsidized by taxpayers,” Leanna Baumer, a senior legislative assistant with the Family Research Council, told The Washington Post.