Opinion | Civil Rights

VA's decision on transgender veterans is a step in the right direction

The views expressed by contributors are their own and not the view of The Hill

What is a veteran's life worth? 

This is a question that lawmakers and stakeholders have found themselves confronted with often over the past two decades, as they grapple with the aftermath of 20 years of war, questions over Veterans Affairs' (VA) massive funding increases during a time when other government agencies faced spending cuts, and numerous policies and strategies to curb the veterans suicide epidemic, which have, thus far, yielded unflattering results.

The Biden administration has decided to address this question, in part, by wading into the culture war. The administration recently announced that the VA will take the required steps to provide gender-confirmation surgery, a procedure it explicitly banned in 2013, for transgender veterans.

Earlier this week, VA Secretary Denis McDonough announced the decision, noting that LGBTQ veterans experience suicidal thoughts and mental illness at much higher rates than other veterans.

McDonough specifically stated that "[w]e're making these changes not only because they are the right thing to do but because they can save lives" as well as his wish to overcome a "dark history" of discrimination within the agency.

Predictably, VA's decision was praised by those on the left and criticized by those on the right. 

House Veterans' Affairs Committee Chairman Mark Takano (D-Calif.) stated that "VA must be inclusive of all veterans who have served, regardless of their identity." 

By contrast, Rep. Mike Bost, (R-Ill.), the committee's ranking member stated, "This announcement clearly has more to do with advancing a radical liberal agenda than serving veterans" and added that the Biden administration "should rethink their priorities immediately." 

As the culture wars wage on at the VA and elsewhere, the debate ultimately centers around a central issue for VA: Does the agency have the responsibility to save the lives of each and every veteran, even those of individuals whose lifestyles some policymakers may disagree with? And if yes, does that mean providing health care treatments that, although some people may personally disagree with, results in improved mental health outcomes? Or, as outlined by Bost, should the VA be focused on funding other priorities that impact larger numbers of veterans? 

Of course, the answers to these and other questions about VA's priorities and decisions are answered by those that win elections. And, right now, that is the Biden administration.  

First, it's important to acknowledge Bost's point about priorities. According to VA, less than 4,000 veterans would be interested in gender conforming surgery, although according to the National Center for Transgender Equality, there are approximately 134,000 transgender veterans. And, if VA's experience is anything like the Pentagon's, the number of surgeries may be smaller than anticipated

However, VA can and should be able to focus on more than one priority at a time. As noted by Jennifer Dane, executive director of the Modern Military Association of America: 

"Rep. Bost is completely correct in that care for veterans who've experienced toxic exposure must be a priority, but this shouldn't be an either-or equation. . .  Gender affirming care is also a life-saving necessity for some veterans, as supported by leading medical experts. The priority for all of us should be the delivery of quality, equitable and accessible healthcare for all veterans."

Second, Republican lawmakers certainly don't have to like the decision, and they can certainly score political points by attacking it, just as Democrats did during the Trump administration when he banned transgender individuals from serving in the military. 

But, ultimately, the fact remains that all veterans lives are invaluable, and given the lackluster results of the combined previous efforts to address the suicide epidemic, any decision that saves even one life is ultimately a good thing.

In addition to saving lives, it's also important to note that, for VA and other government agencies, historical trends favor greater inclusion and tolerance over time. 

By way of background, the "dark history" that McDonough referenced in his speech goes back to our nation's founding. Although the military did not explicitly exclude LGBTQ service members until the mid-20th century, "homosexual acts" were grounds for discharge as early as the Revolutionary War, when in 1778, Lt. Gotthold Frederick Enslin became the first soldier to be discharged from the Continental Army for such.

By World War II, psychiatric screening became part of the service induction process. In deep contrast to the nation's increasing efforts to promote racial integration, the prevailing view remained one that homosexual conduct of any kind "constituted an undesirable trait of character," and therefore updated regulations in 1942 provided procedures for rejecting gay draftees. Such policies fluctuated in the following decades due to fluctuating personnel requirements, but in 1981, the Department of Defense issued a new policy stating that homosexuality was incompatible with military service. 

Although mobilized efforts to overturn this policy began shortly after its implementation, the compromising legislation that resulted in 1993, known as "Don't Ask, Don't Tell," resulted in confusion as to its application and implementation, and was finally repealed in 2011. 

With regard to transgender service members specifically, although there was no explicit ban on their service until 1960, that ban remained in effect until 2016, was reinstated in 2017, and repealed again in 2021.

Given the military's historical approach to the LGBTQ community, it is not surprising that VA's capacity to handle the health care needs of such veterans was also inadequate. In 2012, VA instituted its LGBTQ Health Program, but in October 2020, the Government Accountability Office (GAO) found that VA needed better data to address the needs of LQBTQ veterans. GAO, a nonpartisan entity, stated that standardized collection of such data was important because

"VHA provides care to a diverse population of veterans, including women and LGBT veterans. These veterans may experience differences in health outcomes that are closely linked with social or economic disadvantage, and VA considers it important to analyze the services they receive as well as their health outcomes to improve health equity."

All veterans' lives are valuable, including those of LGBTQ veterans. Any steps VA can take to save lives should be praised, not politicized. 

Rory E. Riley-Topping is the founder of Riley-Topping Consulting, where she continues to work with various veterans organizations. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans' Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.

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