Experts from The Palm Center are questioning the rationale used by the U.S. Department of Veteran Affairs (VA) in a decision to withdraw a proposed rule change that would have allowed veterans access to gender affirming surgery. On Monday, the VA withdrew that proposal over concerns about funding.

In questioning the decision, The Palm Center released a study revealing that the cost of implementing this rule would cost even less than approximately one one-hundredth of one percent of the VA’s annual budget. The study was conducted in December of 2014 as the VA considered implementing this rule, but was not released publicly until today. 

“We don’t pit one veteran against another and demonize some as less deserving as others. No one would ever ask, for example, ‘why is the VA treating people for heart disease when combat vets are having trouble receiving care?'" said the Palm Center Director Aaron Belkin. "Absent some extraordinary expense, we don’t make veterans fight among each other about who deserves medically necessary care. We take care of all of them.” Belkin added that the VA’s emphasis on appropriated funding makes no sense. “The VA offers many of the surgeries that transgender veterans need, such as hysterectomies, to non-transgender veterans, so it is unfounded to claim that Congressional approval is required to provide specific procedures,” he said. “If the VA didn’t have to wait for Congress to appropriate funds for hormones and counseling that it provides to transgender veterans, then surely there’s no need for a surgery-specific appropriation.”

In a statement to, the VA says it will “continue to explore a regulatory change that would allow VA to perform [gender affirmation surgery] and a change in the medical benefits package, when appropriated funding is available.”

In September, VA took significant steps to ensure that transgender veterans are treated with respect at VA facilities and have equal access to some medically necessary health care, including treatment of gender dysphoria. Unfortunately, the VA categorically excludes gender affirming surgery, which is often essential to the health and wellbeing of transgender veterans.

HRC sent a letter to VA Secretary Robert McDonald in September asking the department to repeal its categorical exclusion on medically necessary gender affirming surgery from medical benefits. The letter highlights the VA exclusion is inconsistent with the past several years of federal court decisions and federal agencies, like the Department of Defense, recognition that discrimination on the basis of sex includes discrimination on the basis of gender identity. Moreover, such discrimination is in direct violation of Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in medical care on the basis of sex, including gender identity.

HRC urged the VA to swiftly repeal the exclusion and issue new regulations expressly extending medical benefits to gender affirming surgery. The denial of this most basic benefit violates the dignity of all transgender veterans.

On June 30, 2016, Secretary of Defense Ash Carter announced that the Department of Defense was finally lifting the decades-old ban on transgender people being able to openly serve in the U.S. military. Until then, the estimated 15,500 actively serving transgender members of the military were forced to serve in silence by medically out-of-date regulations.

Filed under: Transgender, Military

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