An advocacy group for transgender veterans is suing the government over its exclusion of gender-affirmation surgery from veterans’ health benefits.
The U.S. Department of Veterans Affairs, or VA, covers nearly all transition care for veterans, including hormone therapy, voice education, fertility preservation and hair removal. However, if trans veterans want surgery, they must either use private health insurance or pay out-of-pocket.
The Transgender American Veterans Association, or TAVA, which was founded in 2003, filed a petition in May 2016 asking the VA to begin a rulemaking process to change health benefits for transgender veterans to include gender confirmation surgery. For nearly eight years, the VA has not responded or denied the petition, despite agency officials publicly saying over the years that the department would change the policy.
TAVA’s lawsuit, filed Thursday in the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., asks it to compel the VA to respond to the 2016 petition within a reasonable time.
Before addressing NBC News on Wednesday, TAVA President Rebecca Eshler said that transgender veterans often email her asking when the policy will change because they struggle with ongoing gender dysphoria and sometimes even suicidal thoughts — seeking the care they need. they can’t. . Gender dysphoria is an anxiety disorder caused by a mismatch between the sex assigned at birth and the gender identity.
“That’s enough,” he said. “How can I stand here and say, ‘Just be patient,’ and do nothing while these veterans are reaching out as they’re on death’s door?” They can’t handle it anymore. It’s about rebuilding that trust with the VA. They use us for political purposes, but they don’t keep their word, they don’t keep their promises.”
VA public affairs officer Gary Kunich said the department does not comment on potential or pending litigation.
In June 2021, Veterans Affairs Secretary Denis McDonough announced that the department was “taking the first necessary steps to expand VA care to include gender confirmation surgery,” which he said would take time. CNN reported on this.
“But we are moving forward methodically because we want this important policy change to be implemented in a thoroughly reviewed manner to ensure that services provided to veterans meet VA’s rigorous quality health care standards,” heh said. time.
However, more than two years later, Eshler said, TAVA has not received any updates on the policy change or response to the 2016 petition, making it difficult for the group to move the process forward without a lawsuit.
Meanwhile, Natalie Kastner, a veteran who served as an Army combat engineer, said she was beginning to lose hope that the policy would ever change.
Shortly after starting hormone therapy about a year and a half ago, he told his doctor that he wanted an orchiectomy, or surgical removal of the testicles, for various reasons. He is diabetic and was concerned about the long-term effects of the testosterone blocker spironolactone. in his kidneysand she struggled with gender dysphoria. But her doctor told her the VA excludes gender-affirming surgery from benefits.
On March 5, 2022, Kastner said she woke up feeling intense gender dysphoria. He went into the bathroom with a knife and scissors and cut his vein, removing his right testicle. A few hours later, he was bleeding enough that he took himself to the hospital’s emergency room, where doctors were able to stitch up the wound.
“I almost died that night,” he said. “I nearly died trying to fix myself, and I can imagine other veterans out there doing the same thing. They say suicide rates are high among transgender people. How many of these were random? How many of them were the ones who saw no other option and took matters into their own hands like me? But unlike me, who was lucky, they were not.”
Trans people are two to three times more likely to serve in the military, and at least 10,000 trans veterans currently receive transition care through the VA. According to the information shared on the department’s website.
TAVA’s lawsuit alleges that the VA’s “failure to provide gender-affirming surgery puts transgender veterans at increased risk of physical harm, psychological distress and suicide.”
The group notes that major medical societies have recognized that sex-affirmation surgery may be critical to the treatment of gender dysphoria. For example, A 2021 study published in JAMA Surgery found that gender-affirming surgeries were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal ideation compared to transgender people who did not have surgery but wanted it.
In 2020, the age- and sex-adjusted suicide rate among veterans was 57.3% higher than the rate among non-veteran US adults. According to VA. Suicide-related incidents are 20 times more common among veterans with gender dysphoria, TAVA claims. Article published in 2013 In American Journal of Public Health.
Kastner, who says she has three children who are “everything to me,” said last March that she didn’t want to die that night, but wanted to “fix” her body so she could feel more herself. She said she tried to get private insurance but was told there were no private health insurance plans in Texas that would cover gender confirmation surgery. Out-of-pocket, the surgery would cost him about $60,000, something he wouldn’t have been able to save for as a disabled veteran on a fixed income.
“These surgeries are truly life-saving care,” he said. “The VA says they serve those who serve, and those words seem hollow right now.”
If the VA rejects TAVA’s application, Eshler said, the group can continue to push for change, citing the importance of these operations to veterans. If the VA says yes and agrees to begin the formal rulemaking process, it could take about two years, including a public comment period, before a final rule is published.
“If they say yes, it gives us a little more room at the table to say, ‘Hey, let’s go ahead with this.’ Here is some information. Let’s talk,” Eshler said.