T ransgender A merican
V eterans A ssociation
Frequently Asked Questions
Public Law 104-262, a 28-page document on all the health services that the VA provides.
Boston VA Policy -Management of Transgender Veteran patients (NEWLY UPDATED)
Q1. Will the VA Health System pay for my Sex Reassignment/Gender Reassignment/Gender Confirmation Surgery (SRS/GRS/GCS)?
A1. No. The VA is prohibited from accomplishing what is termed Gender Alteration, Gender Reorientation, or Genital Identity Revision. The last term effectively rules out even intersex corrective surgery.
[CITE: 38CFR17.38]Code of Federal Regulations Title 38, Chapter 17, Section 38.c)
c) In addition to the care specifically excluded from the "medical benefits package" under paragraphs (a) and (b) of this section, the "medical benefits package" does not include the following:
(1)... ...(4) Gender alterations.
Department of Veteran Affairs Health Affairs Manual, M-2, Part 17, Chapter 11. GENDER REORIENTATION (SEX CHANGE)
This chapter establishes the Department of Veterans Affairs (VA) policy for gender reorientation (sex change).
It is VA policy that transsexual surgery will not be performed in VA medical centers or under VA auspices. Veterans Health Administration (VHA) will not carry out any process or procedure involving genital identity revision.
Q2. Does VA distinguish between transsexual gender-confirmation surgery and intersex surgery?
A2. No. The VA considers intersex surgery to be gender alteration (genital identity revision), which is prohibited.
Q3. Will VA pay for pre- and post-op care?
A3. There does not appear to be any decisive policy regarding such pre-op services and care as psychological counseling for Gender Identity Disorder (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)) or hormone therapy in accordance with the Benjamin Standards of Care. Some doctors and administrators consider such to fall under the Gender Alteration prohibition. Others do not. Programs for transsexual veterans in some VISNs, hospitals, or clinics have been summarily shut down. Psychological and/or hormone therapy treatment of individual pre-op transsexual veterans is provided quietly at certain other locations. Information concerning availability of treatment for pre-op transsexuals is spotty, anecdotal, and subject to change. Post-op treatment in the new sex is not a problem, in general. Changing the sex marker in the VA national database and in the local health care facility is straightforward and without controversy. Once recognized in the database as female, for example, there is no gender-related reason to refuse such services as hormone replacement therapy, mammograms, and pelvic exams. Even so, there is anecdotal evidence that some post-op FTMs (female to male) have had to travel to different health facilities to obtain testosterone prescriptions.
Q4. Can I establish a service connection and disability rating based solely on Gender Identity Disorder?
A4. Although Gender Identity Disorder (GID) is a treatable condition catalogued in the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) and the World Health Organization International Statistical Classification of Diseases and Related Health Problems - Revision 10, it is not recognized in and of itself as a service connected disability. The Department of Defense does not change the service records following a veterans SRS/GRS/GCS, arguing that one's name at time of discharge or retirement is an historical fact. The Service Discharge Record Form DD-214 does not show gender, nor do military retiree ID cards. (The Service Secretaries will authorize a separate Statement of Service showing that one served under the new name and new sex during the historical service period. Some active duty members have been successful in changing their names in military records prior to discharge or retirement. There is some "Don't Ask Don't Tell" risk in this if done too early.) Pertinent DSM-IV and ICD-10 definitions are presented in the The World Professional Association for Transgender Health's Standards of Care.
Q5. If GID can't be treated in and of itself as a service-connected disability, can I receive mental health benefits and/or disability compensation based on the fact that GID is often intermingled with other mental health problems such as post-traumatic stress disorder (PTSD, depression, anxiety disorder, etc.?
A5. Although GID may be present and may be a chronic and serious problem, any disability rating granted will be based on other factors, such as PTSD, hearing loss, paraplegic, etc. In other words, your doctors and therapists may agree that you suffer from GID, but it would not be a direct consideration in your service connected disability evaluation.
Q6. What is the best way to go about presenting GID within the context of other mental health problems in order to get VA benefits?
A6. The shared experience of a sampling of transsexual veterans indicates that it may be best to gain the confidence of one's doctors and therapists with care for service-connected conditions and for routine authorized conditions before broaching the subject of GID. Approaching the topic in a polite, non-demanding manner seems to produce the best results or -- at least -- the fewest repercussions should one's request for support be rejected. As noted in Answer 4, the response to one's request for gender counseling and hormone therapy is highly dependent on each facility's interpretation of the gender alteration prohibition.
Q7. Assuming VA health services do not have the in-house expertise necessary for treating GID, can I be referred to civilian doctors and have the costs underwritten by VA?
A7. If one has treated the VA personnel with respect, there is a good chance that they would provide unofficial advice on how to locate a gender therapist and other trans-friendly health care providers, if they have the information. It is highly unlikely that the VA would provide any financial coverage for such outside support.
Q8. As an MTF receiving estrogen, I should be screened regularly for breast cancer like all other women. Are there any problems with receiving the same VA health care benefits in this regard that are extended to all other women?
A8. If your VA health care provider prescribes estrogen, then he or she will likely provide whatever lab work and mammography is deemed necessary. The likelihood of receiving such care is greater following SRS/GRS/GCS.
Q9. Both MTFs and FTMs may be at higher risk for liver problems. MTFs may develop pituitary problems, and FTMs may run a higher risk of cardiovascular disease. Will VA provide screening for these potential problems as part of the provided health care services in light of these increased risks?
A9. See Answer 8.
Q10. How can I have my VA and DOD records changed to reflect my new name and gender identity?
A10. Name. Veterans may change their names in the VA databases (national and local healthcare facility) by forwarding a letter request with a certified copy of the court ordered name change to both the regional VA office that holds one's records and one's primary healthcare facility. Retirees may do the same with DoD by providing their parent service's personnel command retiree section and the DFAS Columbus Retired Pay Office a certified copy of the court ordered name change. A new retired ID card can be issued and a DEERS name change entry made at any military Pass and ID office by presenting a certified copy of the court ordered name change. Note that the DD-214 cannot be changed once issued; however, if one legally changes name in the military records prior to discharge or retirement, the original DD-214 may be issued in the new name.
Gender (VA). Veterans may change their gender markers in the VA databases (national and local healthcare facility) by forwarding a notarized copy of the surgeon's letter that confirms accomplishment of SRS/GRS/GCS to both the regional VA office that holds one's records and one's primary healthcare facility.
Gender (DoD). Veterans may request a change of gender marker in DoD records by submitting a Form DD 149, Application for Correction of Military Record parent service's records correction activity (e.g., the Board for Correction of Naval Records). Include as a minimum a certified copy of the court-ordered name change and a notarized copy of the surgeon's SRS/GRS/GCS confirmation letter. Expect the process to take a year or more. The corrections activity, acting in the name of the Service Secretary (e.g., Secretary of the Army), will task the appropriate military personnel command to issue a Statement of Service in your new name and gender. The Form DD 214 -- which does not show gender -- will NOT be changed or amended because the name at time of discharge or retirement is considered to have been correct at that time. Issue of the Statement of Service can take up to an additional six months.
Retirees can send a copy of the Statement of Service by letter to the Retired Pay Office, DFAS Columbus, requesting the gender marker to be changed 'wherever recorded in DFAS databases.' This is important because DFAS issues a periodic master tape that overrides any data in the DEERS database.
Changing the retiree's DEERS gender marker can be done at a military Pass and ID office by presenting the surgeon's letter and the Statement of Service showing your new gender. If the retiree is unmarried, the Pass and ID personnel can make the change. If the retiree is married, attempting to change the gender marker would result in a same sex marriage; so the change is blocked. Advise the local personnel to call their DEERS Help Desk (Research and Analysis), which can override the block on same-sex spouses. If the retiree's spouse has also changed sex (i.e., an MTF/FTM couple), the local office can change both gender markers before pressing the Enter key. Patience and a sense of humor are advised when coaching local military personnel through this procedure.
Q11. If VA personnel refuse to treat me in accordance with my gender identity, to whom should I complain?
A11. If the problem is a lack of sensitivity or understanding on the part of local VA personnel, a visit with the facility's Patient Advocate may resolve the situation. If, on the other hand, the problem is that facility's interpretation of what the Gender Alteration prohibition means, there is little that one person can do. Anger or threats are likely to make the matter worse and increase the risk of being denied any service for being an uncooperative patient. For information concerning denial of service, please email our Veterans Administration Liaison.
Public Law 104-262, a 28-page document on all the health services that the VA provides.