Transgender Soldiers Push VA for Coverage

WASHINGTON (CN) – Two transgender military veterans have appealed the denial of their petition for sex-reassignment surgery coverage using Veterans Affairs benefits, arguing the procedure is medically necessary.

Dee Fulcher and Giuliano Silva, joined by the Transgender American Veterans Association, or TAVA, requested that the VA repeal a regulation they say “categorically excludes coverage for ‘gender alterations.’” The VA responded to their request in a Nov. 10 letter.

“VA has been and will continue to explore a regulatory change that would allow VA to perform gender alteration surgery and a change in the medical benefits package, when appropriated funding is available,” the letter states. “While VA has begun considering factors impacting this rulemaking process, it is not imminent.”

Under legal precedent, an agency’s written response stating a possibility of future rule-making with no current plans constitutes a denial of the petition. The transgender soldiers requested a review of the denial in a petition filed Monday in the Federal Circuit.

The VA’s letter goes on to say that although the agency was initially planning on considering changing the regulation as part of its 2016 agenda, it was removed due to the aforementioned exploration and funding requirements.

According to the Philadelphia Center for Transgender Surgery, the procedure costs around $124,400 for female to male and $140,450 for the opposite. The procedure can include, but is not limited to, total facial reconstruction, liposuction as well as breast, buttock and other muscle augmentation.

Fulcher and Silva claim that VA’s denial means they “cannot obtain medically necessary procedures that [their] clinicians have prescribed.”

Both have been diagnosed with gender dysphoria, a psychiatric condition which causes one’s gender identity to fall out of alignment with their biological sex. Sex-reassignment surgery attempts to fix this by altering the patient’s sex organs to align with their gender identity.

The VA does, however, currently provide other services for transgender individuals, including hormone therapy, mental health care, preoperative evaluation and even long-term care following sex-reassignment surgery.

The VA’s own letter stated that “increased understanding of both gender dysphoria and surgical techniques in this area has improved significantly and is now widely accepted as medically necessary treatment.”

This acknowledgment is in line with Fulcher and Silva’s claims sex-reassignment surgery being a treatment for gender dysphoria “is not in dispute within the medical community; all major medical associations recognize this treatment as such.”

Neither the VA nor TAVA responded Wednesday to phone calls requesting comment.