This week Robert Wilkie was confirmed as Secretary of Veterans Affairs. I had the honor of serving under him as Director of VA’s Center for Women Veterans during his brief tenure as Acting Secretary and recognize the vast array of urgent issues that will immediately require his attention once he is sworn in – not least of which is calming the personnel churn that has plagued the department in recent months.
Among these matters is determining whether VA should amend its regulation on providing medical care for transgender veterans. As part of his nomination process, Wilkie said if he were to be confirmed, VA’s policy on providing care to transgender veterans “will remain unchanged.” This would be good news if VA currently provided all medically necessary care to transgender veterans; however, it does not.
“Gender alterations” is one of a handful of treatments specifically excluded in VA’s medical benefits package, and the Department is currently requesting comments on whether that rule should be eliminated. As Secretary, Wilkie should oversee a change to VA policy that would fulfill our national obligation to provide medically necessary, effective care to eligible veterans.
As I learned while working on the RAND report Assessing the Implications of Allowing Transgender Personnel to Serve Openly, transition-related surgery is a component of the consensus-based treatment standards for gender dysphoria endorsed by the American Medical Association, American Psychological Association, American Academy of Family Physicians, and other respected professional associations. Major insurers, corporations focused on recruiting top talent by offering comprehensive health insurance plans, and a growing number of states have accepted the strong body of supporting evidence. The DoD report questioning the science has been thoroughly refuted and is not considered credible by medical experts.
Wilkie affirmed that his top clinical priority as Secretary will be to reduce veteran suicide. To achieve that goal, it is essential that he remove this discriminatory exclusion: there is strong evidence that suicidality decreases significantly among transgender individuals who receive appropriate care. Suicide is a growing public health crisis nationwide, and the suicide rate in the veteran population has been growing faster than in other sectors of society. It is foolish to deny necessary care to transgender veterans, leading them to experience an even higher burden of minority stress and sending the implicit message that they are less deserving of care than their fellow veterans. [Veterans in crisis should contact the Veterans Crisis Line.]
Some transition-related surgeries, such as mastectomies and hysterectomies, are already provided by VA as part of care for other conditions. The surgical skills for other gender transition surgeries are similar to those needed to repair complex blast injuries to genitals, the unfortunate prevalence of which has led to recent advances in care: further enhancing surgical skill in this area will benefit non-transgender veterans as well. If VA is unable to provide timely access to in-house providers with needed expertise, the recently-signed VA MISSION Act will ensure no veteran experiences delays in accessing needed care.
Compared to the estimated $10 billion electronic health record transition that is one of Wilkie’s stated top priorities, ensuring transgender veterans have equitable access to medically necessary care may seem unimportant. I hope that Secretary Wilkie, the son of a combat wounded veteran and a reservist himself, viscerally understands the fundamental need to treat all veterans equally, in an environment of dignity and respect. All of those “who shall have borne the battle” committed themselves to serving our country; now we must fulfill our national commitment to care for them.
Continuing to deny the full range of transition-related treatment to transgender veterans is not just bad medicine, it is a discriminatory affront to our national values.
Kayla Williams is a Senior Fellow and Director of the Military, Veterans, and Society Program at the Center for a New American Security. She previously served two years as Director of the Center for Women Veterans at the Department of Veterans Affairs, serving as primary advisor to the Secretary on policies, programs and legislation affecting women veterans. Prior to that, she worked at the RAND Corporation, where she did research related to veteran health needs and benefits, international security and intelligence policy. She is the author of “Love My Rifle More Than You: Young and Female in the U.S. Army,” a memoir of her deployment to Iraq.