Swords to Plowshares' Comment to Support Transgender Veterans

For over 40 years, Swords to Plowshares has provided community-based, wrap-around services to homeless and low-income veterans in our community and advocated for improved care and services for all veterans. Our mission is to heal the wounds of war, restore dignity, hope, and self-sufficiency to all veterans in need. We are leaders in the veterans’ rights movement, advocating for marginalized and vulnerable veterans, including LGBTQ+ veterans. Swords to Plowshares currently runs a weekly support group—Pride & Patriots—for LGBTQ+ veterans. For many veterans that attend, this group has become a safe space where they can discuss their need for trans-specific medical care.

The VA’s current policy of excluding care for those who have served their country is harmful to veterans.

Swords to Plowshares’ Legal Services Unit provides free attorney advice, consultation, and representation to veterans who identify as LGBTQ+ for military records corrections and discharge upgrades. We also help veterans access VA healthcare.

This work is critical. For decades, the military discriminated against LGBTQ+ veterans under “Don’t Ask, Don’t Tell” (“DADT”). Many service members received less-than-honorable discharges as a direct result of their sexual orientation and were therefore barred from VA healthcare.

The harmful effects of exclusion from VA care are clear: veterans with “bad paper,” including LGBTQ+ veterans, are seven times as likely to become homeless and twice as likely to commit suicide. In other words, access to VA care can literally save lives. This power, however, is only as strong as the services the VA provides. By denying medically-necessary care, the Veterans Health Administration (“VHA”) is putting LGBTQ+ veterans’ lives at risk.

The VHA’s current rule perpetuates the discrimination of the DADT era. Just as service members should not be punished for their sexual orientation or identity, LGBTQ+ veterans should not be singled out for deprivation of core healthcare rights when they come home.

Veterans support the VA’s inclusion of gender alteration surgery.

Swords to Plowshares’ Institute for Veteran Policy works to strengthen systems of care for veterans and their families. Our policy and community education efforts are unique: they reflect decades of community-based service delivery for VA benefits, housing, healthcare, and employment services. Our research informs best practices for serving the LGBTQ+ veteran community at the local, state, and federal levels.

In 2015, we conducted a focus group with 17 veterans who identify as transgender to better understand healthcare needs among transgender veterans. We found great need for cultural competency trainings for healthcare providers and for support for LGBTQ+ veterans in navigating the VHA system. We also found a need for improved access to trans-specific care—including gender alteration surgery.

In fact, one of the most common complaints among participants was their inability to receive gender alteration surgery. As one veteran observed, “[i]t’s a shame that people in prison can get it, and they’re not even giving it to veterans.” Similarly, another participant lamented the gap between trans-specific care at a private provider and at VHA: “Kaiser opened a multi-specific transitions clinic there, which is specifically designed for trans people…it’s very friendly, very comfortable, and I got really great care there…it really seemed odd…that as a VA employee, I qualified for [gender alteration surgery], but as a combat vet, I don’t.” Yet another veteran explained that they’d “been struggling to get [alteration] surgery for the past 14 years.”  And that the “VA is way behind.”

The VHA needs to listen to veterans. While VHA is rightly famous for pioneering new life-saving procedures, when it comes to LGBTQ+ veterans, it is lagging far behind.

For VA to continue to be a healthcare leader, regulations should be amended to allow for medical decisions to be made by VA medical professionals based on current standards of care.

The VHA’s comprehensive and integrated care system is the largest in the country. It is also one of the most successful: VHA has provided us with countless breakthroughs in medical research. It also outperforms the private sector on most measures of quality, cost, access, and patient satisfaction.

Swords to Plowshares conducted in-depth interviews with 22 veterans in San Francisco to understand their perceptions of VHA care. Participants consistently rated their VA care favorably. According to one veteran, “my experience with the VA has been good,” and as a result, they considered themselves “a huge advocate of the VA.” Similarly, another veteran said they were “amazed at how [the VA] works.”  Many highlighted satisfaction with the comprehensiveness of VHA care. As one veteran observed, “I’ve got one [provider] for mental health, I’ve got two primary [care] doctors, and I’ve got one for the eye. I’ve got one for podiatry, I’ve got one for my hands. So I’ve got a crew.”

The VHA’s excellence should benefit all veterans. For this to happen, the VA must, at a minimum, provide all with medically-necessary care. Instead, current regulations single out LGBTQ+ veterans for exclusion. This discrimination runs counter to VA’s mission to care for all eligible veterans. It is also bad medicine. For instance, Cornell University’s “What We Know Project” found that among 56 peer-reviewed studies of alteration surgery over the last 25 years, 93% reported individuals who completed gender transition had positive outcomes. In a similar vein, the American Medical Association, American Psychological Association, and six former U.S. Surgeon Generals all agree that alteration surgery can be necessary to treat gender dysphoria and critical to transgender individuals’ overall quality of life.

The VA should fulfill its duty to provide medically-necessary care to LGBTQ+ veterans, not adhere to antiquated policies that undermine the strengths of VA Care. We join the international community of researchers, healthcare providers, and professional healthcare organizations in support of eliminating the VA’s discriminatory, categorical exclusion for transition-related healthcare from their medical benefits package.

If individuals or organizations want to comment to support transgender veterans, they have until September 7, 2018 and can submit their comments on the public comments page:

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