Lesbian, Gay, Bisexual and Transgender Veteran Care - Ralph H. Johnson VA Medical Center
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Ralph H. Johnson VA Medical Center

 

Lesbian, Gay, Bisexual and Transgender Veteran Care

The Department of Veterans Affairs (VHA) is committed to providing quality care to all Veterans including lesbian, gay, bisexual and transgender (LGBT) Veterans. Excellent care has no boundaries.

We Serve All Who Served poster

Ralph H. Johnson VA Medical Center seeks to promote the health, welfare, and dignity of LGBT Veterans and their families. We are committed to making sensitive and high quality health care accessible. Our policies and practices focus on ensuring a safe, welcoming, and affirmative environment of care for LGBT Veterans. Our employees receive training in clinically competent care that is responsive to the unique needs of LGBT Veterans.

Welcome LGBT Veterans. We thank you for your service! 

 

LGBT Veteran Care Coordinator (VCC) Program

As of March 2016, each VA facility has a local LGBT Veteran Care Coordinator (VCC) who is appointed by their facility leadership. The VCC is responsible for promoting best practices for serving LGBT Veterans and connecting LGBT Veterans to services.

 

Looking for an LGBT Veteran Care Coordinator? Click here: http://go.va.gov/LGBTVCC

You Are Not Alone 

The United States is home to an estimated one million LGB service members and Veterans, with an estimated 65,000 serving on active duty. It is estimated that 134,000 Veterans identify as Transgender, with more than 15,000 trans people estimated to be serving on active duty. LGBT people have a long history of serving the US military with honor and distinction and have also made notable contributions to LGBT communities at large.

 

LGB Veteran Health and Information:

 

VHA Directive 1340 issued July 6, 2017:

 

“It is VHA policy that all staff members provide clinically appropriate, comprehensive, Veteran-centered care with respect and dignity to LGB Veterans. Clinically appropriate care includes assessment of sexual health as indicated with all patients, and attention to health disparities experienced by LGB people. It is VHA policy that any attempts (formal or informal) by VA staff to convert or change a Veteran’s sexual orientation are prohibited. “

 

“Veterans are made aware that open communication with providers about sexual orientation, sexual attractions, and sexual behavior is a part of routine care that will be delivered with respect and without judgement or bias. “

 

Fertility for LGBT patients:

  • Cryopreservation is allowable when in accord with generally accepted standards of medical practice (e.g., to preserve fertility prior to hormone therapy which may render the patient permanently sterile). 
  • The VA provides up to 6 cycles of IUI under the general medical benefits package for enrolled birth sex female Veterans.
  • Except in specific cases, VA regulation prohibits provision of assisted reproductive technologies, like IVF, to Veterans (See VHA Directive 1332 Infertility Evaluation and Treatment .) VA may provide assisted reproductive technologies to Veterans who have a service-connected condition that results in their inability to procreate. The service connected condition must cause the infertility.  Gender Dysphoria is not a service-connected condition. If eligible for assisted reproductive technologies due to a service-connected condition, other restrictions may apply.  Donated gametes, embryos and surrogacy are also prohibited as part of this legislation. For example, egg and sperm must come from the Veteran and legal spouse and may not be donated. One member of the Veteran couple must have an intact uterus and use of a surrogate is not a covered benefit. To be eligible for IVF the transgender man (birth sex female) Veteran must meet the following requirements:
  • Service connected condition causing infertility
  • Legally married to a spouse who can produce viable sperm
  • Intact uterus and at least 1 functioning ovary
  •  

Transgender Veteran Health and Information:

Below are general policy guidelines from the VHA Directive 2011-024 Providing Health Care for Transgender and Intersex Veterans. The directive was reissued in 2018 as VHA Directive 1341.

 

  • “It is VHA policy that medically necessary care is provided to enrolled or otherwise eligible intersex and transgender Veterans, including hormonal therapy, mental health care, preoperative evaluation, and medically necessary post-operative and long-term care following sex reassignment surgery. Sex reassignment surgery cannot be performed or funded by VHA or VA.”
  • “Patients will be addressed and referred to based on their self-identified gender.”
  • “All other health services are provided to transgender Veterans without discrimination in a manner consistent with care and management of all Veteran patients.” This policy includes intersex Veterans.

 

What the VA Policy Means:

  • Transgender and intersex Veterans are eligible for VA care. No aspect of a Veteran’s gender disqualifies them from necessary care through the VA.
  • Procedures deemed cosmetic by the VA such as electrolysis are NOT covered.
  • Eligible Veterans qualify for services through VA, including: cross-sex hormone treatment, evaluations for cross-sex hormones and care post-sex reassignment surgery.
  • Sex reassignment surgeries (SRS) are NOT covered by the VA policy.
  • While Veterans are on hospital grounds receiving their VA care, it is expected that they will be treated with the same respect as other service men and women.
  • If a Veteran asks to be referred to by a certain name or pronoun, this should be respected and used regardless of appearance/presentation.
  • Sexual reassignment surgery is NOT a prerequisite for amendment of sex in CPRS EMR.

 

**It is important to note that not all transgender Veterans want gender affirming medical treatments. For those who do, they may choose to undergo some treatments and not others. For those who are interested in gender affirming medical interventions, it may be important to help explore multiple available options, including the financing of those options. If Veterans use additional medical insurance, including Medicare, these plans might be able to cover medical interventions that the VA does not.

 

The VA does currently provide hormone therapy, pre-surgical and pre-hormone evaluations and letters of support, speech or voice therapy, gender affirming mental health care, and all other general health care.

The VA does not currently provide or fund gender affirming surgical procedures. It does, however, cover pre-and post-operative medical care. In some cases, surgical procedures that are considered gender affirming to some may be performed for other medical reasons (e.g., mastectomy due to breast cancer or back pain, orchiectomy due to prostate cancer or other urological concerns).

 

How to make a Name change:

Transgender Veterans may ask to change their name in CPRS. Before a Veteran can change his or her name in CPRS, individuals must FIRST legally change their name in a court of law, following the law in their state of residence. To do this, consult the National Center of Transgender Equality at https://transequality.org/. A Veteran does not need to be on cross-sex hormones or have had any surgical procedures.

After one’s name has been legally changed, individuals may request for a form to complete from the Privacy Office as well as provide the necessary supporting documentation (see below). The request should be submitted in writing to the Privacy Office at the Ralph H. Johnson VA.

A request for a name change in CPRS is a request for amendment of records. It is not considered an administrative request.

  1. Official supporting documentation for a name change include the following documents. TWO are needed for a name change:
  • An official name change court order
  • A letter from the Social Security Administration (SSA) stating that all required documentation has been received and they will be issuing the requestor a new SSA card
  • A valid State Driver’s license/State issued ID card (Laws regarding change of name on Driver's license vary by state)
  • A new SSA card with the name change
  • An amended birth certificate or valid passport. Expired documents are not acceptable

 

How to make a Gender change:

*NOTE: Sexual reassignment surgery is NOT a prerequisite for amendment of sex.

An amendment request to change the Birth Sex requires that the individual submit the request in writing along with one form of un-expired Primary Identification and one form of Secondary Identification that displays the current Birth Sex.  The Primary Identification verifies the person’s identity and the Secondary Identification verifies the updated Birth Sex.

 

Primary IdentificationSecondary Identification
  • State-Issued Driver's License with photo
  • Passport with photo
  • Federal, State, or Local Government-issued photo ID containing name and DOB
  • Amended Birth Certificate
  • Court Order for Birth Sex Change
  • Signed License+d Physician’s Statement on Office Letterhead (see requirements below)*

*An original statement from a licensed physician must include ALL of the following information:

  • Physician’s full name
  • Medical license or certificate number
  • Issuing state of medical license/certificate
  • Address and telephone number of the physician
  • Language stating that he/she has treated the person or reviewed and evaluated the medical history of the applicant. He/she also has a doctor/patient relationship with the applicant which is evident in having one or more clinical encounters between doctor and patient.
  • Language stating that the patient has had appropriate clinical treatment for Birth Sex transition to the new Birth Sex (specifying male or female).
  • Language stating, “I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct.”

 

VHA Services Regarding Sex Reassignment Surgeries
What VHA Will DoWhat VHA Will NOT Do
  • Provide mental health and medical evaluation for sex reassignment surgery (SRS)
  • Provide pre- and post-operative care for SRS 
  • Provide or pay for sex reassignment surgery (SRS)
  • Provide or pay for cosmetic procedures (e.g., electrolysis)

However, VHA may perform any of the isolated procedures that comprise SRS (listed above) or cosmetic procedures if they are deemed medically necessary for reasons other than gender transition.

VHA Services Regarding Prosthetic Devices:

The VA provides the following Prosthetic and Sensory Aids Devices for transgender and intersex veterans:

  • Wigs
  • Packers
  • Stand-to-Pee Devices
  • Gaffs
  • Chest Binders
  • Surgical Compression Vests
  • Breast Forms
  • Dilators

Resources and Support


For more information about the LGBT Health Program, email:
VALGBTProgram@va.gov

LGBT Veteran Care Coordinator (VCC) Program

As of March 2016, each VA facility has a local LGBT Veteran Care Coordinator (VCC) who is appointed by their facility leadership. The VCC is responsible for promoting best practices for serving LGBT Veterans and connecting LGBT Veterans to services.

Health Information

To learn important information about the unique health risks of LGBT Veterans, download these relevant fact sheets. Here you can also find information about relevant services offered by VA.


Gay and Bisexual
Men
Health Care Fact Sheet

Gay and Bisexual Men Health Care Fact Sheet

Lesbian and Bisexual
Women
Health Care Fact Sheet

Lesbian and Bisexual Women Health Care Fact Sheet

Transgender
Women
Health Care Fact Sheet

Transgender Women Health Care Fact Sheet

Transgender
Men
Health Care Fact Sheet

Transgender Men Health Care Fact Sheet

Contact

Kathie Hermayer M.D., M.S.
Attending Physician, LGBT Coordinator
843-214-7030
Kathie.Hermayer@va.gov

Kristy Watters
Psychologist, LGBT Coordinator
843-214-7030
Kristy.Watters@va.gov

Susan Storm, LMSW
LGBT Staff Special Emphasis Program Manager
843-789-7384
Susan.Storm@va.gov

Resources

LGBT Updates