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The Center Square: Transgender veterans sue VA seeking gender-affirming surgery


(The Center Square) – A group representing transgender veterans filed a federal lawsuit against the U.S. Department of Veterans Affairs seeking gender-confirmation surgery for 163,000 transgender veterans.

The Transgender American Veterans Association lawsuit asks for an order that the Department of Veterans Affairs act on the group's 2016 rule-making petition for gender-confirmation surgery.

"Three years ago today, President Biden repealed the military's ban on transgender service members,” TAVA President Rebekka Eshler said in a statement. “Yet when we return from service, we do not receive the same level of healthcare from the VA that other veterans do. The natural next step toward transgender people's true inclusion in the military is for the VA to remedy this gap. Transgender veterans have waited far too long for the VA to provide the gender-affirming surgery so many of us need to survive."

The Department of Veterans Affairs does not comment on pending lawsuits.

The federal agency provides medically necessary gender-affirming care to transgender veterans, but not gender-affirming surgical interventions due to an exclusion in the VA medical benefits package. It also has LGBTQ+ Veteran Care Coordinators in every VA health care system. 

U.S. Secretary of Veterans Affairs Denis McDonough announced more than two years ago that VA would provide gender confirmation surgery. At the time of the announcement, McDonough said it would take time.

"We are taking steps to expand VA's care to include gender [affirmation] surgery, thus allowing transgender Vets to go through the full gender [affirmation] process with VA by their side," he said. "There are several steps to take, which will take time. But we are moving ahead, methodically, because we want this important change in policy to be implemented in a manner that has been thoroughly considered to ensure that the services made available to Veterans meet VA’s rigorous standards for quality health care."

The Transgender American Veterans Association said the department hasn't lived up to the promises it made.

"VA has publicly stated that it intends to provide gender-confirmation surgery to its veteran patients, prepared multiple proposed rules for cost-benefit analysis, and received public comment on the rulemaking petition," an attorney for the group wrote in the lawsuit. "Yet it has taken no formal action granting or denying TAVA's petition in nearly eight years since it was filed. Nor, despite its vague public statements, has VA made this essential care available."

Costs of such care vary widely. A 2022 article in "The Journal of Law, Medicine & Ethics" noted gender-affirming health care services can include mental health support, hormone therapy and reconstructive surgeries. It also noted that "scant information is available about the utilization or costs of these services." The peer-reviewed article found vaginoplasty and phalloplasty are often multi-episode procedures. The total average cost of vaginoplasty per person was $53,645. For phalloplasty, it was $133,911.

TAVA's lawsuit said that a higher percentage of transgender people serve in the military than their cisgender counterparts.

"Transgender people are a disproportionally high percentage of the veteran community," according to the lawsuit. "Over 20% of transgender people in the United States have served in the military."

TAVA member Natalie Kastner attempted the procedure at home.

"VA's failure to provide gender-confirmation surgery has been more dangerous for me than my time in the service," Kastner said in a statement. "Without VA coverage for this surgery, I was financially out of options. I tried to perform my own gender-affirming surgery at home, without any medical training. Were it not for emergency room care, I would have lost my life. I was told that the VA would take care of me because I was willing to risk my life for this country. Instead, I was safer in the service than I am now."