Frequently asked questions.
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.
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?
How Do I Update My Name and Gender in the Defense Enrollment Eligibility Reporting System (DEERS)?
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 our Veterans Administration Liaison.
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.