Guest Blogger

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

Filed By Guest Blogger | May 24, 2010 1:00 PM | comments

Filed in: Politics, Transgender & Intersex
Tags: Congress, Don't Ask Don't Tell, ENDA, military, shinseki, tava, transgender, VA, Veterans Health Administration

Editors' note: Monica F. Helms is the president of the Transgender Americans Veterans Association.

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.

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 2008, they began drafting a directive to rectify the problem. In March 2009 (after Obama 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's 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 directive says that the VA will not, does not, and cannot cover sex reassignment/gender reconstruction surgery. That particular restriction is written into 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.

Does this sound familiar? The difference between this and DADT repeal 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. All we ask is that the VA stop sitting on this and release it to their 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.


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Being a Trans veteran and working for the VA Healthcare System. There are roughly a half a dozen VA's that do give quality care to Trans veterans. I also do know that the said directive is suppose to be imposed through the whole VA system. Sounds great, but the problem that will occur is that not many VA's have the qualified staff to support the care needed. Currently in the VA system we have 5 VA GLBT EEO Special Emphasis Programs. I am the GLBT Special Emphasis Program Manager at my facility. We were formed in January of 2010, since then I have been addressing some concerns within our own facility. This will be my 2nd year educating staff with various diversity awareness training. I am confident that this directive will be instituted but I think they are looking at the whole picture as to how do we get all of the VA's on the same page which is not an easy task.

Allison, the training for certain medical aspect of this directive may be needed, but I refuse to take that as an excuse for not putting it out now. This will require doctors, nurses and staff members to treat transgender veterans with the respect they treat others. No mis-gendering people on purpose, no showing the trans patient's medical records to other patients, no forcing trans veterans to use the wrong restroom, EVEN AFTER total transition, no denying hormones, no denying mammograms, no denying pap smears, no denying prostate exams, no denying necessary hysterectomies, no denying PTSD psychotherapy, no denying the patient's legal name change in the records. None of those things have anything do to with training, but they have everything to do with them doing their jobs without acting out their bigotry. Is that too much to ask?

I know that some VA medical facilities are wonderful places for trans people, Boston being one of the best. But, that is not in every facility in this country. What about Columbia, SC, Mobile, AL, Waco, TX, Cheyenne, WY, Ogdon, UT? Trans veterans shouldn't think about that, but they do all the time. This directive will help them worry about their medical issues and not have to worry about a hateful doctor they have to see. It needs to come out now. The training can happen afterwords.

Hopefully they'll release the directive soon!

Like I said it will happen eventually, but it will be a slow process. As for remote locations it would not be feasible if their is lets say one transperson to have a therapist on board for that person. Perhaps those cases can be dealt with on a fee based service.

I use Sepulveda, not not as trans. How do I get service as I want to transition? What can they do for me. I really don't need psych, but it is part of the drill.

Thanks for the good work, Monica.
For the record, my VA medical facility (Sepulveda, in L.A.'s San Fernando Valley) is one of the better ones. I'm one of several transwomen treated through the Women's Clinic but for that, and to get hormones, I had to be post-op. And since they persist in ID'ing me as ts (over my persistent objections), everyone accessing my chart (it's computerized) knows my status, whether it's relevant to the reason they're treating me or not.

jackie russell | June 1, 2010 10:46 PM

i am 70% service connected vet,, recently i came out my counsler that i was transgender.. i found out latter he never put it in my records.. he also said there wasent anyone who would or could help me .. this was at the buffalo va center in ny.. just a month ago....

m.a. Ray ( Ellen) | March 9, 2011 12:37 PM

I have ben working through the arkansas VA system as a TG vetren. At first they worked with me on everything but now after 4 years of hrt therpy someone in Littlerock has deciced I don't meat there criteria & my primary has decided he's not comfortable with treating TG patients & has stoped my HRT. Now I'm In trouble.My supplies run out in 90 days......What now ?