VA Won't Cover Gender-Affirmation Surgery for Transgender Veterans Until It Reviews PACT Act Effects

The Department of Veterans Affairs will not move forward with covering gender-affirmation surgery for transgender veterans while it studies the effects of a sweeping law that expanded VA eligibility to millions of veterans, VA Secretary Denis McDonough confirmed Monday.

McDonough did not rule out proceeding with covering gender-affirmation surgery after the PACT Act analysis is done. But the move further delays the availability of a treatment that transgender veterans have been eagerly anticipating since McDonough first announced the VA would provide it two and a half years ago -- a year before the PACT Act became law.

"We're not ready at this point to initiate rulemaking" to cover gender-affirmation surgeries, McDonough told reporters at his monthly press briefing. "VA has moved methodically ... in its consideration of this important potential change in coverage because it must be implemented in a manner that's been thoroughly considered and ensures that the services made available to vets meet VA's rigorous standards for consistent, high-quality health care nationwide.”

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McDonough has said for months that the policy on gender-affirmation surgery was on his desk, but previously did not elaborate on what outstanding questions he had.

Now, McDonough is saying the PACT Act's expansion of VA eligibility to millions of veterans means the department has to do further analysis of how many transgender veterans will newly enroll in VA health care and what services they will need.

The analysis, being led by VA Under Secretary for Health Shereef Elnahal, is expected to take "several months," after which McDonough promised he will be "prepared to dig into it."

"While we're considering this for further analysis, VA will continue to provide all other types of gender-affirming care to veterans," McDonough added. "To all LGBTQ+ veterans and to all veterans, I just want to be 100% clear that VA is 100% committed to providing you world-class care and a safe, welcoming and discrimination-free environment. Every veteran and every VA employee should feel respected and treated with dignity at VA."

McDonough announced in June 2021 the department would cover gender-affirmation surgeries for transgender veterans, part of a flurry of moves in the early days of the Biden administration to signal support for LGBTQ+ Americans.

The PACT Act, meant to expand health care and benefits to veterans exposed to toxins during their military service, was signed into law in August 2022.

McDonough's June 2021 announcement kicked off a formal rulemaking process, a way to change federal regulations that can sometimes take years. At the time of McDonough's announcement, the VA said it expected the rulemaking process for transgender surgeries to take about two years.

The decision not to move forward for now on covering gender-affirmation surgery was first disclosed in a filing by the VA in a lawsuit brought by transgender veterans.

The lawsuit from the Transgender American Veterans Association, or TAVA, sought to force the VA to respond to a petition first filed in 2016 calling on the department to cover gender-affirmation surgery. The VA's Thursday filing in the lawsuit said the department formally denied the petition, citing the PACT Act analysis, and called for the lawsuit to be dismissed.

In a statement Monday, TAVA expressed disappointment in McDonough's decision but vowed to continue fighting for coverage of surgeries.

"Secretary McDonough has broken his promise to transgender veterans to provide life-saving, doctor-prescribed, transition-related surgical care and denied our petition to initiate the rulemaking process that has been ostensibly in the works behind the scenes for the last three years," TAVA said. "We will not let trans veterans lose hope. This fight is not over!"

While the VA is citing the PACT Act for the indefinite delay, it comes at a time when Republicans have been trying to restrict transgender health care, including at the VA. House Republicans' initial version of the 2024 VA spending bill, which has yet to be passed into law, would ban the VA from providing gender-affirmation surgery or hormone therapy for transgender veterans.

Alluding to the GOP efforts, Democratic lawmakers expressed frustration at McDonough's decision to deny the petition.

"I had hoped VA would be the leader in this space, instead of giving into the extreme conservative wing of the Republican Party, who may be the loudest but are not representative of our country," Rep. Mark Takano, D-Calif., ranking member of the House Veterans Affairs Committee, said in a statement Monday. "The secretary gave me his word this would happen during his nomination process. I am extremely frustrated that it has taken three years for VA to make this disappointing decision."

Related: Yearslong Delay in Covering Transgender Surgeries Prompts Lawsuit Against VA