Editors' note: Monica F. Helms is the president of the Transgender Americans Veterans Association.
On June 10, 2011, the day that many transgender veterans had been waiting for finally arrived. The Veterans Health Administration, a division of the Veterans Affairs Department, released the much anticipated directive toward transgender and intersex veterans. It's called, "Providing Health Care for Transgender and Intersex Veterans," VHA Directive 2011-024. A .pdf file can be found on the VA website.
This has been a decade long journey, when the community first discovered the inconsistency of treatment in VA facilities for our transgender, transsexual and intersex veterans. In January of 2003, they formed the Transgender American Veterans Association and later became a 501 (c)3 organization. TAVA helped to make this issue well known with people in Congress and many others in the VA and veterans organizations.
The biggest accomplishment was the creation of a survey that ran from December 2007 to May 2008. 827 transgender veterans took the survey. Questions asked them about all aspects of their life, including how the VA treated them if they used it. The results were shocking. Transgender veterans faced discrimination, disrespect and in some case, denial of all services. It didn't matter how long they served. The survey was compiled and put out in a white paper document by the Palm Center in California.
In the middle of 2008, the VA started creating a draft of a directive that was supposed to resolved the issues transgender veterans faced, but when they sent it out for review, it didn't quite do the job transgender veterans hoped for. They asked several people for help and had an effective draft in hand in July of 2008.
Then trans people waited. And, waited. And waited. But the wait was worth it. The version that finally came out on June 10, 2011 turned out stronger and even more effective than what the VA had in July of 2008.
It is important to note that this new directive does not cover sex reassignment surgery. This is because it is denied by a written law that would take Congress to fix.
All this directive really does is to emphasize to the VA facilities that transgender and intersex people who served this country in the military are veterans too, and should be treated as such. All veterans are covered by the VA Patient's Bill of Rights, and the VA facilities needed to be reminded of this. This directive will not cost the VA a single dime, because transgender and intersex veterans will only be getting everything that other veterans were already being given.
Here are some highlights to the new directive:
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.
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.
It is VHA policy that medically necessary care is provided to enrolled or otherwise eligible intersex and transgender Veterans, including hormonal therapy, mental health care, preoperative evaluation, and medically necessary post-operative and long-term care following sex reassignment surgery.
Patients will be addressed and referred to based on their self-identified gender.
The documented sex in the Computerized Patient Record System (CPRS) should be consistent with the patient's self-identified gender.
A diagnosis of GID, or other gender dysphoria diagnoses, 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.
Mandated diversity awareness is maintained and a zero-tolerance standard for harassment of any kind.
In the directive, you will see this line: THIS VHA DIRECTIVE EXPIRES NOVEMBER 30, 2012. What we found out is that the "directive" aspect will indeed expire and this document will be placed in the VA manual when they do their revisions at the end of 2012 and will then be considered "policy" at that time.