First reported on Thursday by Time Magazine, the proposed rule has appeared in the Federal Register, the publication in which the U.S. government announces changes in regulations. According to the Department of Veterans Affairs, the change was under consideration beginning in 2014, but became public after only the media report this week.
“Due to the prior limited knowledge about both gender dysphoria and effective transition-related procedures, surgical procedures in particular were not deemed to be medically necessary,” the abstract says. “However, increased understanding of both gender dysphoria and surgical techniques in this area have improved significantly, and surgical procedures are now widely accepted in the medical community as medically necessary treatment for gender dysphoria.”
The abstract says the rule change would allow the department to make on a case-by-case basis a decision on whether gender reassignment surgery is warranted.
Although the procedure was considered outside the mainstream in years past, major health organizations, including the American Medical Association, have determined gender reassignment surgery is effective and may be medically necessary for transgender people.
A Department of Veterans Affairs spokesperson said the new policy is under consideration now that medical science has validated has validated gender reassignment surgery.
“VA currently provides many services for transgender veterans to include hormone therapy, mental health care, preoperative evaluation, and long-term care following sex reassignment surgery,” the spokesperson said. “The VA is exploring a regulatory change that would allow VA to perform gender alteration surgery and a change in the medical benefits package. Increased understanding of both gender dysphoria and surgical techniques in this area has improved significantly and is now widely accepted as medically necessary treatment.”
Despite the publication in the Federal Register, the Veterans Affairs spokesperson said the rule hasn’t been formally proposed. Once that happens, it will be sent to the White House Office of Information & Regulatory Affairs for interagency review, then released for public comment.
Ashley Broadway-Mack, president of the American Military Partner Association, said the proposed rule change is “incredibly welcome news” for transgender veterans and their families.
“So many veterans rely on the VA for important medical care that they have earned serving our nation, including transgender veterans,” Broadway-Mack said. “Gender confirmation surgery is often a critically important and medically necessary treatment for transgender veterans, and lifting this ban is long overdue.”
The proposal is to the change enacted by Medicare in 2014 lifting the ban on gender reassignment surgery for individuals who receive coverage through that program.
Further, the proposal follows up on an earlier rule change announced in January lifting the prohibition on transition-related care under TriCare for military families. However, that proposed change was for dependents of active duty members of the armed forces, not veterans or active duty members. Moreover, it wouldn’t cover gender reassignment surgery, which the Pentagon is ostensibly prohibited from covering for family members by statute under 10 U.S.C. 1079(a)(11).
According to the Palm Center, a San Francisco-based think-tank on sexual minorities in the U.S. military, an estimated 134,000 veterans are transgender.
The new rules for transition-related care are proposed as the Pentagon under the direction of Defense Secretary Ashton Carter is conducting a review of the medical regulation prohibiting openly transgender people from serving in the armed forces. Although Carter initiated the review with the goal of implementing the transgender service, the review has apparently stalled out.
Aaron Belkin, director of the Palm Center, said the Pentagon review of transgender service, the proposed rule change for TriCare and the proposed rule change at the Department of Veterans Affairs are completely independent in terms of process.
“Given that this has been in the works for two years, there’s no political connection,” Belkin said. “It’s not as if there’s any coordination that I’m aware of between people who are working on the VA rule and people who are lifting the ban.”
But Belkin said the rule proposed by the Department of Veterans Affairs if enacted “would lead to continuity of care that doesn’t exist now.”
“What’s happening now is the care that the VA gives is different from the care that the military gives, which means that service members leave the military and then self-medicate for transition-related care, like they’ll go to Thailand and get surgery,” Belkin said. “And then they’ll come back to the VA, and then the VA, which doesn’t give surgery, but does deal with post-operative complications, has to deal with the medical situation not having any medical record from the military because it’s not the military that’s provided the care.”
It remains to be seen whether the Pentagon implement openly transgender by the end of the of the Obama administration. Belkin said he doesn’t have information as to whether that will occur.
“I am worried about whether or not language about complicated processes and the need for additional studies signals ongoing delay,” Belkin said. “I’m concerned there’s been no explanation for why we’re almost six months late on a process that shouldn’t have even required six month in the first place. And I’m concerned there’s no timeline for what comes next, so I do not know what is going to happen.”
Belkin declined to comment on the extent to which the Palm Center is engaging with the Pentagon over the course of the military review on transgender service.