Earlier this week, Secretary Denis McDonough ordered a review of VA policies to ensure that transgender Veterans and employees do not face discrimination on the basis of their gender identity and expression. Once completed, this review would put VA policies in line with Department of Defense policies and President Biden’s executive order ensuring that transgender Americans are treated with dignity and respect, and are able to live their lives free from worry that they could be discriminated against because of who they are.
The policy review that the secretary is mandating is far-reaching, requiring VA to examine the entire slate of services that the department provides to Veterans to ensure maximum equity and inclusivity, including the delivery of medically necessary, gender affirmation care and procedures.
However, some of the most impactful changes could also be the most basic, such as those that would afford Veterans the basic dignity of being recognized for how they self-identify. To that extent, changes could include ensuring that VA systems are able to accommodate a Veteran’s preferred name and pronouns when interacting with VA.
Ensuring better access to VA services could vastly improve the lives of LGBT Veterans, who are more likely to report poor health conditions and suffer from multiple chronic conditions than other Veterans. This disparity is partly a result of having to face stigma and discrimination, resulting in LGBT Veterans forgoing needed medical care.
The situation becomes more acute when examining the barriers that exist for the more than 134,000 Veterans and 15,000 service members who identify as transgender. The issues facing the Veteran community as a whole are magnified significantly for transgender and gender-diverse Veterans. Ensuring access to VA care and services could have a significant impact to this underserved community. Transgender Veterans, for example, die by suicide at almost six times the rate of the general population, and access to gender-affirming health care could significantly reduce suicidality.
Homelessness among transgender Veterans also increased by 89% between 2015-2018, even though it decreased by 48% among all Veterans. A strategy for reducing homelessness that addresses the specific barriers that transgender Veterans face could effectively end the prevalence of housing instability within the community.
Finally, better access to the array of VA Veteran readiness and employment services could improve the lives of transgender workers who are at greater risk of poverty and unemployment.
VA will be welcoming to all Veterans
The good news is that the department is not starting from scratch. Although VA still has a long way to go in ensuring that transgender Veterans are afforded the full scope of VA services that other Veterans are afforded, this policy review would build on the disparate efforts and programs across the department that are currently in place to ensure that VA is welcoming to all Veterans regardless of their gender identity and expression.
All VA Medical Centers, for example, have LGBT Veteran care coordinators who work with staff to ensure that LGBT Veterans receive the same level of care even after “coming out” to their providers. Additionally, programs like PRIDE are training VA employees to deliver a group wellness class to LGBT Veterans that teaches skills for coping with the specific challenges they face, including accessing VA care.
These programs are bridging some of the gaps in services that LGBT Veterans receive, and a 2015 survey that showed 87% of transgender Veterans being always or mostly treated respectfully indicates that we are more than ready and able to fully close that gap.
Fulfilling our commitment
A review of policies and procedures across VA would standardize the services and support that we provide to LGBT Veterans and could amplify the pre-existing programs that are already creating a more inclusive environment for all Veterans. This review, and the changes that it could herald, would bring us closer to fulfilling our commitment to care for those who shall have borne the battle.