Transgender veterans sue the VA for gender-affirming surgery

An advocacy group for transgender veterans is suing the government over its exclusion of gender-confirmation surgery in veterans’ health benefits.

The Department of Veterans Affairs covers almost all transition-related care for veterans, including hormone therapy, voice training, fertility preservation and hair removal. However, if trans veterans want to receive surgery — such as genital and breast procedures — they are required to either use private health insurance or pay out of pocket. Such operations are covered for active-duty service members.

The Transgender American Veterans Association, or TAVA, formed in 2003, filed a petition in May 2016 asking the VA to start a rulemaking process to amend its health benefits to cover gender-confirmation surgery for trans veterans. In the almost eight years since, the VA has not responded to or denied the petition, despite agency officials saying publicly over the years that the department will change the policy.

TAVA’s lawsuit, filed Thursday in the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., asks it to compel the VA to respond to its 2016 petition within a reasonable time.

TAVA President Rebekka Eshler told NBC News on Wednesday ahead of the filing that transgender veterans often email her asking when the policy will change, because they struggle with persistent gender dysphoria — and sometimes even suicidal ideation — when they can’t access the care they need. Gender dysphoria is the distress that results from a misalignment between someone’s sex assigned at birth and their gender identity.

“Enough is enough,” she said. “How can I stand here and keep saying, ‘Just be patient,’ and not do anything when these veterans are reaching out because they’re at death’s door? They can’t handle it anymore. This is about building this trust back with the VA. They keep using us for political gain, but not keeping their word and keeping their promise.”

Gary Kunich, a public affairs specialist for the VA, said the department does not comment on potential or pending litigation.

In June 2021, Veterans Affairs Secretary Denis McDonough announced that the department was “taking the first necessary steps to expand VA’s care to include gender confirmation surgery,” which he said would take time, CNN reported.

“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 of quality health care,” heh said at the time.

However, more than two years later, Eshler said, TAVA hasn’t received any updates on a policy change or a response to its 2016 petition, which makes it difficult for the group to move the process forward without a lawsuit.

In the meantime, Natalie Kastner, 39, a veteran who served as an Army combat engineer, said she has started to lose hope that the policy will ever change.

Shortly after she started hormone therapy about a year and a half ago, she told her doctor that she wanted to have an orchiectomy, or surgical removal of the testicles, for a variety of reasons. She is diabetic and was worried about the long-term effects of her testosterone blocker, spironolactone, on her kidneys, and she struggled with gender dysphoria. But her doctor told her that the VA excludes gender-affirming surgery from its benefits.