New V A Policy In Effect

[Guest Gina9223]

I was just informed by Monica Helms of TAVA that there is a new VA Policy for Transgender and Intersex veterans.

Directive VA 2011-024

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2416

Thank You to Monica Helms and TAVA for championing this endeavor. This is a win for us!

[Carolyn Marie]

This is GREAT news, Gina. Thank you so much for posting it.

All TG veterans should download and print this advisory and keep it with you to show any VA medical provider or staff member, to ensure that you receive proper care, treatment and are treated with respect as outlined in this memo. We've been hearing that treatment for trans veterans is hit and miss in various VA facilities. This memo should standardize your care.

Now all that's needed is to get the VA to change its policies regarding GRS. That will probably take Congressional action.

Carolyn Marie

[Guest Emily Ray]

Because of the language that is used about SRS or plas

tic surgery for cosmetic purposes it may be possible for medicaly necessary care to provide SRS. Because this directive defines "Gender" as between the ears in order to read this and the code of federal regulations in the same way; GRS is within the bounds of this directive and the Code of Federal Regulations. Because it states that the VA must treat veterans according to contemporary standards the must pay for surgery because that is the standard of care for GID

Thank you for posting it!

Huggs

Emily

[Guest Emily Ray]

I just called my care coordinator and left her a message about the new directive. I reached her voicemail and so I don't have anything new to add. I am hopeful though that in at least some jurisdictions this will be read as I explained in my earlier post.

Huggs

Emily

[Carolyn Marie]

Because this directive defines "Gender" as between the ears in order to read this and the code of federal regulations in the same way; GRS is within the bounds of this directive and the Code of Federal Regulations. Because it states that the VA must treat veterans according to contemporary standards the must pay for surgery because that is the standard of care for GID

Emily, I admit I'm not familiar with whatever section of the CFR's you're citing, but this seems pretty definitive:

"Sex reassignment surgery cannot be performed or funded by VHA or VA.".

Emily, while I admire your determination, I think you will face an uphill battle trying to get a facility administrator or Chief of Staff to accept your interpretation and ignore that very specific prohibition. You may have to talk to the office in D.C. where that policy originated and get them to modify it.

Carolyn

[Guest Emily Ray]

Carolyn

I don't doubt what you are saying and you are probably right but you have to look at the sentence in its entirety. It says "VA does not provide sex reassignment surgery or plastic reconstructive surgery for strictly cosmetic purposes."

The AMA position on SRS is "Wheras, health experts in GID, including WPATH, have rejected the myth that such treatments are "cosmetic" or "experimental" and have recognized that these treatments can provide safe and ..."

Also the IRS has stated that SRS related expenses are deductible as a medically necessary expense.

We are winning the battle and I will continue to push as hard as I can from my end.

Huggs

Emily

[Guest Emily Ray]

Just so that everyone knows exactly what the Code of Federal Regulations says here are the relevant parts.

© In addition to the care specifically excluded from the “medical benefits package” under paragraphs (a) and ( of this section, the “medical benefits package” does not include the following:

(4) Gender alterations.

Gender alterations is not defined in the document, but my conversation yesterday with my psychologist clarified his position. He believed that means reparative therapies which he said were unethical. since this document clearly defines gender as between the ears and not between the legs and it is ambiguous at best in cases where a Dr believes surgery is medically necessary. in regards to SRS the new directive makes a path possible but as Carolyn said not likely.

Huggs

Emily

[Guest Elena]

At the very least that provides a path for a well reasoned brief to be submitted arguing to have that line of reasoning made into official policy. Take what we can get and build from there.

Because of the very large ultra conservative base which most military supporters fall into it is always a real chore to even get the VA to keep up with national policy on more mainstream issues. Unfortunately we are near the bottom of the totem pole right now.

I watch the same sort of stuff happen with the wiccan/neopagan community. Though there has been some real progress there in recent years. Just have to stay the squeeky wheel.

Cheers,

Elena

[Guest Gina9223]

SRS/GRS is nit covered due to Federal LAW. It will take an act of Congress to change that law.

...so, START WRITING YOUR CONGRESS PEEPS! Let's change that law!

Do it, do it now! This new VA directive took 10 years and right now with this congress full of crazies it'll be an uphill fight but we can do it!

[Guest John Chiv]

Emily,

I look forward to hearing what the VA or your care director tells you. I also know how determined you are. From what I read, here is my interpretation. One that transgendered and intersex veterans will be treated with respect and sensitivity and that their health care (tran or non-trans related) is covered. This means whether you go in for a broken finger or something related to being trans, you are there for medical care period, and deserve that care.

I was very heartened to read what they will cover but in two places they say that gender reassignment surgery is considered cosmetic and while it seems that at one point if you can prove it is medically neccessary, there is the sentence Carolyn already quoted.

Which means no payment for surgery. That is government bureaucracy. Confuse the heck out, write the language in such a way that it placates both sides.

But look at all they are covering. If health care insurance companies covered what they are saying for non-veterans and wrote this policy, even though it did not cover surgery, I'd be happy.

This does open the door for surgery being covered in the future. TAVA is to be commended and maybe that is their next goal. You know I support you and believe in you. If anyone can change their mind about you getting surgery covered now, it's you.

Hugs,

John

[Guest Dawn D.]

As many who have worked within the government system know, it's all about interpretation and terminology. My thoughts are that interpretation of whether or not SRS can be considered as "medically necessary" may eventually fall upon the individual directors at each individual VA facility. The very term SRS may need to be adjusted to a more non-descriptive and medically appropriate term. Something like say, 'Genital Remedial Revision'. If there is a medical professional whom can work on that, it could be argued within each VA district.

It's just a tactic to try.

Dawn

[Guest Gina9223]

Well, considering every major medical association out there and the IRS says that SRS/GRS is medically nessassary surgery I wouldn't be too suprised to see that issue to change with in a few years.

Also, some VA hospials have been doing minor things like Orchiectomys. Those facilities may very well go forward first with SRS/GRS.

[Guest lynn319]

i had to stop going to the VA because they will not identify me as a TG person. And they are ShiX when it comes to my overall heath care..

[MackenzieB]

i had to stop going to the VA because they will not identify me as a TG person. And they are ShiX when it comes to my overall heath care..

Please be patient with this recent announcement from the VA. This came from Washington so all VA's will eventually abide by it. But keep in mind that due to the fact that this comes from the top and is still trickling through the VHA system, there will probably be delays in individual Med Centers. I know that, as a staff member at the local VA, I haven't heard a word about it internally as of yet.

If you've had a negative experience in previous relations with the VA you should express those to a Patient Advocate at that center. If it was a transgender issue you may want to see if your particular Med Center has a Minority Patient Advocate, I know that in our local VA that's the point of contact for trans and sexual issues.

[MackenzieB]

i had to stop going to the VA because they will not identify me as a TG person. And they are ShiX when it comes to my overall heath care..

Oops, I was going to include this in my last post. As stated in sec 4.1 (a)...

...Patients will be addressed and referred to based on their self-identified gender. Room assignments and access to any facilities for which gender is normally a consideration (e.g., restrooms) will give preference to the self-identified gender, irrespective of appearance and/or surgical history, in a manner that respects the privacy needs of transgender and non-transgender patients alike. Where there are questions or concerns related to room assignments, an ethics consultation may be requested....

[Guest Donna Jean]

.

It has been suggested that we print the directive out and present it to our VA that we frequent if there are less than desirable situations going on.

This directive should be in the hands of every VA director in the United States and should have been implemented by now (or dang close...)

Here in New Orleans I am taken to the "Woman's Health" section of the VA and they cover my HRT and blood work 100% ....

Don't get stepped on......stand up for your rights!

Donna Jean

[MackenzieB]

.

It has been suggested that we print the directive out and present it to our VA that we frequent if there are less than desirable situations going on.

This directive should be in the hands of every VA director in the United States and should have been implemented by now (or dang close...)

Here in New Orleans I am taken to the "Woman's Health" section of the VA and they cover my HRT and blood work 100% ....

Don't get stepped on......stand up for your rights!

Donna Jean

I called the VA here today and they told me to go to Women's Health as well.

I'm a member of Federal Globe, which is a LGBT group for Fed workers. In an email conversation with the executive director, Lisa Kove, she asked to be informed of any cases of denial of treatment. I copied and pasted the body of the email, as follows...

Dear Caitlen,

Awesome email.

Sorry things are as tough as they are.

We have a long way to go to get things where they need to be.

If you have specifics you can give me of people being denied we will get that information to Durodgio and let him know what is going on. He is responsible at DVA for LGBT diversity. Will need names locations and other relevant details.

ATTN: Kaiden please add the suicide statistics, please find a link on the web that will have updated statistics on the Transgender military page.

ATTN: Autumn and Monica did you know about the suicide statistics?

V/R,

Lisa

I'm not sure if she wants me to gather info and forward it to her or if people should just directly send info to her. I'd prefer to not be involved with any info that could jeopardize anybody's privacy if they're to send it to her directly. I'll find out and post it when I find something out.

And of course disclosing anything at all is voluntary.

[Guest Donna Jean]

.

Good post, Honey......

Thanks!

Huggs

Dee Jay

[MackenzieB]

I'd have posted this earlier but I had a GT appointment up in Seattle. And since it was still light out, I went window shopping downtown. Lol... nobody even looked at me twice which rather surprised me due to my height.

Anyhow Lisa Kove replied to my inquiry. She's like me to gather the info and forward it on to her. So, if you've been denied service and want your incident relayed up to the big dogs, I'll be needing the Name of the VA facility, what was the occurrence (i.e., denial of service from the team member at the check-in desk or whatever) and your name.

For reasons of your privacy I'd prefer you to just message me with it instead of posting the data in the thread here. I'm not going to keep any of the data once it's submitted either so you may want to keep a copy of whatever you send.

This is all strictly voluntary. Hopefully we can make a difference.

[MackenzieB]

Darn itm, I keep forgetting to paste stuff in my posts lately. Here's the body of the email she sent me when I inquired if she wanted everybody to contact her directly or not...

If you can put it altogether like a report and send it to all the above. I will share with Durdgio (DVS) and Anne (OPM).

Sent from my BlackBerry® smartphone, powered by Cricket.

[Guest Julie T]

Hello everyone

As a moderator here, I feel I need to just mention something as a word of caution. Please, do watch that you do not provide personal information, such as exact addresses or contact information, other than the use of the PM here at Laura's. We cannot police everything, so it is up to you.

So be careful? There are four guests here for every member looking at everything you write on the open forums. We do not want you to jeopardize your privacy.

Julie