Important Resources

Public Law 104-262, a 35-page document on all the health services that the VA provides.

Boston VA Policy -Management of Transgender Veteran patients

 

Know Your Rights!

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?

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.

Assuming VA health services do not have the in-house expertise necessary for treating GD, can I be referred to civilian doctors and have the costs underwritten by VA?

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.

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?

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.

Can I establish a service connection and disability rating based solely on Gender Identity Disorder?

Although Gender Identity Disorder (GID) is a treatable condition cataloged 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 theThe World Professional Association for Transgender Health’s Standards of Care.

Can the VA provide medical care for intersex and transgender veterans?

It is VHA policy 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 post-operative and long-term care following sex reassignment surgery. Sex reassignment surgery cannot be performed or funded by VA.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

Does VA distinguish between transsexual gender-confirmation surgery and intersex surgery?

Yes. The Directive is very clear on this: the prohibition on providing for surgery does not apply to veterans with intersex conditions who need surgery to “correct inborn conditions related to reproductive or sexual anatomy or to correct a functional defect.” VHA is able to allow intersex treatments because the regulation barring sex reassignment surgery does not have any application to intersex conditions, and VHA is aware of the difference between transgender and intersex veterans.

How can I have my VA and DOD records changed to reflect my new name and gender identity?

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.

DD-214. Recent litigation has made it possible for veterans to change their name on the DD 214 form. Here is a comprehensive guide to changing your name on your DD 214: Military Records Resource Jan 2015 FINAL. In addition, if you wish to speak to an attorney on this issue, please contact the LGBT Bar Association: http://lgbtbar.org/who-we-are/staff/. To learn how these veterans changed their name on their DD-214, please read these articles: http://lgbtbar.org/what-we-do/programs/trans-military-advocacy/

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.  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’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.

How Do I Update My Name and Gender in the Defense Enrollment Eligibility Reporting System (DEERS)?

In order to change your name and gender in DEERS, the DEERS/RAPIDS Service Project Office for your military department must submit a request to Defense Human Resources Activity (DHRA) for review and implementation. A gender (or name) change in DEERS will not affect the eligibility of any of your existing dependents for military benefits.

What Documents Should a Name and Gender Change Request Include?
The Service Project Office of your military department should submit scans of the below documentation for DHRA review, with the subject line “DEERS Record Change Request ICO First Name Last Name”.

  • Two forms of identification that are listed as acceptable on the federal Form I-9, one of which is a government-issued picture ID. Passports, driver’s licenses and Social Security cards are recommended, but the Department of Defense will accept all documents on page 9 of the I-9 list (http://www.uscis.gov/sites/default/files/files/form/i-9.pdf).
  • If name change is requested, a court order legally changing your name.
  • If gender marker change is requested, a signed statement, on office letterhead, from a licensed physician. The statement must include the following information:
    • Physician’s full name;
    • Medical license or certificate number;
    • Issuing state or other jurisdiction of medical license/certificate;
    • DEA registration number assigned to the physician;
    • Address and telephone number of the physician;
    • Language stating that the physician is your physician and has a doctor/patient relationship with you;
    • Language stating you have had the appropriate clinical treatment for gender transition to male/female (for a definition of appropriate clinical treatment see question three below); and,
    • Language stating “I declare under penalty of perjury under the laws of the United States that the forgoing is true and correct.”

How will I know that my DEERS record has been updated?
DHRA will confirm with the Service Project Office when the record has been updated. The Project Office must then follow existing Service procedures to send an update to Defense Finance and Accounting Service (DFAS), or the Service equivalent pay office, to allow DFAS, or the Service equivalent pay office, to update its system with the corrected gender.

Can I change my gender in DEERS if I am in active duty service?
No. Gender in DEERS cannot be changed for active duty service members. So long as the military branches continue to list transgender status as disqualifying, attempting to change your gender in DEERS could put you at risk of discharge or other negative repercussions.

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.?

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.

If VA personnel refuse to treat me in accordance with my gender identity, to whom should I complain?

The VA is required by VA Directive 2013-003 (February 8, 2013) to provide medically necessary care to inter-sex and transgender veterans. Patients will be addressed and referred to based on their self-identified gender. Room assignments and access to any facilities for which gender is normally a consideration (e.g., restrooms) will give preference to the self-identified gender, irrespective of appearance and/or surgical history, in a manner that respects the privacy needs of transgender and non-transgender patients alike. Where there are questions or concerns related to room assignments, an ethics consultation may be requested. The documented sex in the Computerized Patient Record System (CPRS) needs to be
consistent with the patient’s self-identified gender.

If you have had any problem with any of the above mentioned at the VA, a visit with the facility’s Patient Advocate may resolve the situation.  For information concerning denial of service, please email our Veterans Administration Liaison.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

Will the VA Health System pay for my Sex Reassignment/Gender Reassignment/Gender Confirmation Surgery (SRS/GRS/GCS)?

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)

11.01 PURPOSE
This chapter establishes the Department of Veterans Affairs (VA) policy for gender reorientation (sex change).

11.02 POLICY
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.

Will VA pay for pre- and post-op care?

Yes. The directive that covers what the VA will and will not do can be found here: http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863