Transgender veterans who rely on veteran services can be among our most vulnerable community members. NCTE’s federal policy agenda has specific areas of advocacy for transgender veterans: access to healthcare through the Veterans Administration and ability to update records and documentation of military service.
From the National Transgender Discrimination Survey, which NCTE conducted in partnership with the National Gay and Lesbian Task Force, we learned that transgender people seem to be disproportionately represented among the ranks of American veterans. Twenty percent of our sample indicated that they had served—almost twice the level of service among the general American adult population. And 20 percent of the transgender veterans in the sample used the VA system as their primary healthcare provider. In terms of discharge papers, only 35 percent of the veterans in our sample have been able to acquire amended discharge papers (DD-215).
Transgender veterans who use the VA system for their healthcare are more likely to be lower income. In 2008, The Transgender American Veterans Association (TAVA) and The Palm Center conducted a survey of transgender veterans and noted the following:
Only 29 percent of the sample currently used a VA hospital [compared to 20 percent in the NCTE/NGLTF survey]. Transgender veterans who used the VA tended to be middle aged or older, and not working for pay. 70 percent of those using the VA fall between the ages of 46-65. 46 percent were retired, living on social security, or living on some form of non-employment-related income. 35 percent were unemployed due to disability. Only 23 percent were working full-time for pay. Nearly two thirds (63 percent) of those who used the VA had an annual income of less than $30,000, with over one third (35 percent) making less than $15,000 a year.
Access to Healthcare
Transgender veterans/retirees and their dependents and survivors can access earned healthcare through a seemingly complex set of facilities and coverage programs (VHA, Tricare, CHAMPVA, etc), which are run by a web of agencies, laws, regulations and directives. To ultimately allow fair and equal access to transgender veterans, each of these agencies will need to make policy changes. NCTE has prioritized policies to ensure access to healthcare for transgender people and we will work as long as it takes to get veterans the medically necessary healthcare they need and have earned.
Most urgently, NCTE has been advocating for fair and equal access to existing services and facilities. Recently we had our first significant victory for veterans when, on June 10th, the Veterans Health Administration issued a directive for VHA facilities ensuring that transgender veterans will be treated equally and respectfully at all facilities. The directive includes clear guidance that transgender veterans will be treated with respect and their transgender status and medical history treated with utmost privacy. The directive also clarifies explicitly that transgender veterans should have full access to the range of medical care that is guaranteed to all veterans. Further the VHA reiterated that existing VA regulatory prohibitions against conducting or paying for sex reassignment surgery do not apply to medically necessary, nonsurgical care ordered by doctors to treat transgender veterans, nor do they apply to needed surgeries for adults with intersex conditions. For a complete analysis of this directive, please see NCTE’s resource.
NCTE is very proud of the advocacy and technical assistance we did on this directive with allies including the Transgender American Veterans Association (TAVA), the National Gay and Lesbian Task Force, the National Center for Lesbian Rights, Advocates for Informed Choice (AIC), and others.
This victory is only a start, however. Much work remains before transgender veterans are fully able to live equally to non-transgender veterans. Below are some of the policy areas still on NCTE’s veterans health agenda.
- NCTE and allies will soon release a comprehensive model policy for VA facilities for the appropriate treatment of transgender veterans. This policy will be offered to VA facilities nationwide for their adoption.
- Now that the VHA explicitly requires proper treatment of transgender veterans, it is clearly necessary for frontline providers to receive training on what that means. The VHA immediately should undertake a cultural and medical competency program.
- Unfortunately, VHA regulations still prohibit the agency from providing or paying for sex reassignment surgeries. TRICARE and CHAMPVA regulations also prohibit these health plans from covering some transition-related care. These agencies should begin immediately the process of reevaluating the regulatory prohibitions regarding transition-related care based on contemporary medical evidence and accepted clinical guidelines.
When servicemembers leave the military, they receive a Certificate of Release or Discharge from Active Duty (commonly called a DD-214). These forms are necessary for veterans to access various veterans’ benefits such as health and educational benefits, special mortgage rates, preferential hiring programs, etc. When veterans show DD-214 papers that expose a former pre-transition identity, they are exposed to the dangers of pervasive disrespect, discrimination and violence.
The complication for transgender veterans with these forms is that DD-214s are considered historical documents meant to reflect facts at the time of separation (discharge or retirement) and are amendable only because of factual error (e.g. wrong rank listed or misspellings) or injustice (for instance, earned medals being initially denied). This means that transgender veterans frequently must out themselves as transgender while trying to access earned services and benefits. Though they don’t have clear written policies, the individual services do appear to issue amended records of service but these are generally physically attached to the original DD-214 with the old information.
The Department of Defense and all service branches individually should work with NCTE and allies to revise policies related to the issuance of amended discharge papers.
Veteran and Retiree Databases (DEERS and DFAS)
The Defense Finance and Accunting Service (DFAS) is a Departent of Defense agency that provides provides finance, payroll and accounting services for the civilian and military members of the Department. DFAS pays all military and civilian personnel, retirees, annuitants and some contractors and vendors.
The Defense Enrollment Eligibility Reporting System (DEERS) is a database for service members, retirees, dependents, and others. It is an especially important database for those people who are eligible for TRICARE, which is an insurance plan that pays for civilian healthcare for military personnel and retirees as well as their eligible dependents).
Transgender military retirees and dependents have found it exceedingly difficult to change information in these databases and, once they have changed it, to keep it changed. The Department of Defense should immediately work to create protocols and policies that will allow transgender retirees and dependents to simply and reliably change names and gender markers in the DFAS and DEERS databases.
NCTE will continue to work for transgender veterans to ensure that they receive the benefits they need and deserve in a manner that is respectful and equal. For additional information, please review the following resources: