Veterans who are transgender or intersex can now know more clearly what services are covered for them by the Veterans Health Administration, thanks to a new VHA Directive.
The document, released on June 9, 2011, states 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 postoperative and long-term care following sex reassignment surgery.” The policy states further that “sex reassignment surgery cannot be performed or funded by VHA or VA.”
According to the Directive, each director of a Veterans Integrated Service Network “must ensure that necessary and appropriate health care is provided to all enrolled or otherwise eligible veterans based on the veteran’s self-identified gender, regardless of sex or sex reassignment status.”
Three members of the transgender community who are also working in the mental health field are, overall, pleased with the VHA Directive.
Zander Keig, a transsexual second-year MSW student at San Diego State University who did his internship with the VA Association of Social Workers, states that the Directive is not “brand new, but more of a clarification. ”When I started hormone treatment in 2005 at a VA clinic, they always had a policy against surgical procedures but provided hormones and counseling,” Keig says.
Still, there were inconsistencies, in that VA policy was applied differently in different clinics. Keig had to ask a doctor outside the VA system to give him a prescription for the hormone treatment and then present it to the VA pharmacist to be filled. He believes the issuing of the Directive may have resulted from these gaps.
“They either had to take a stand or admit they didn’t have the services when it comes to hormones,” he says. “Some medical centers prescribed them, and others didn’t. Some doctors allowed their personal bias to influence their decision making.”
Keig notes that the National Center for Transgender Equality is still in conversation with the VA about the exclusion of surgery—which he says may be partly due to “misinformation about the costs of sex reassignment surgery.”
Knowledge of and sensitivity to transgender issues vary by individual within the staff of VA centers and most likely by region, notes Rylan Testa, transmale employee of the VA in Palo Alto, California, who recently received a Ph.D. in clinical psychology.
“For this reason, I think it’s great the VA is taking formal and public steps to ensure that all employees are clear which services transgender veterans are entitled to,” he says. “One helpful change is that the VA now clearly states it ‘will give preference to the self-identified gender, irrespective of appearance and/or surgical history.’ ”
Testa says it is very important to get the word out to LGBT veterans that they can get confidential and sensitive services at the VA—“that it’s as good a place to try, maybe even better, than any other.”
Still, he is concerned about the exclusion of surgery in covered services. “I hope in the future the VA moves toward covering sex reassignment surgeries. Research has revealed that people who appear gender-nonconforming are at the highest risk for discrimination and [victims of] violence. For those who wish to present as male or female and require surgery to do so, it seems cruel and medically irresponsible to not provide the surgery that would allow them the ability to interact with the world in a gender role consistent with their self-identity and to reduce this risk.”
Testa believes providing one-time sex reassignment surgeries may even result in long-term health care savings for the VA, since the individuals who undergo the surgeries may need less housing/employment support and fewer mental-health resources afterward.
“Just as the VA has been in front of other health care providers in recognizing the need to cover hormone therapy for transgender individuals, I hope they will take the next step and lead on providing the also-needed sex reassignment surgeries in the near future,” Testa adds.
Josephine Tittsworth, a transfemale licensed social worker (LMSW) is both satisfied and not with the VA Directive. “It puts in black and white what was already done, but makes it uniform across the board,” she says.
Tittsworth started treatment at a VA facility in Michigan, but after moving to Houston, the pharmacist would not fill his (then) prescription. The doctor at the facility said nothing could be done to influence the pharmacist’s decision. But after that individual left, the pharmacist who took his place was willing to honor the prescription.
“What the Directive does is help provide uniform policy, rather than one that changes from person to person,” she says.
Tittsworth also points out that there are cases in which surgery is covered by the VA—such as when a person is considered intersex—individuals who are born with reproductive or sexual anatomy and/or chromosome patterns that don’t seem to fit typical definitions of male or female.”
In the words of the Directive, exclusion of sex reassignment surgery does not apply in the case of “intersex Veterans in need of surgery to correct inborn conditions related to reproductive or sexual anatomy or to correct a functional defect.”
Barbara Trainin Blank is a freelance writer based in Harrisburg, PA.This article appeared in THE NEW SOCIAL WORKER, Fall 2011, Vol. 18, No. 4, page 14. |
