Transgender veterans can currently get treatment at the Department of Veterans Affairs before and after gender reassignment surgery, but by department policy, they can't get the surgery itself.
Just before a public comment period ended Sept. 7 on allowing gender reassignment surgery at the VA, 82 House Democrats and one Republican -- retiring Rep. Ileana Ros-Lehtinen, R-Florida -- joined in a letter to Wilkie urging him to end the ban.
Rep. Julia Brownley, D-California, who headlined the group of lawmakers signing on to the letter, said in a statement that the VA's ban on gender reassignment surgery "is not only discriminatory on its face, it also puts the health and well-being of transgender veterans at risk.
"Let me be clear: Denying any veteran the medical treatment they need to live healthy and productive lives is antithetical to VA's core mission, and to do so based on a prejudiced world-view that disregards scientific consensus is disgraceful," Brownley said.
However, President Donald Trump's stance against transgender individuals serving in the military appears to make any move to lift the ban unlikely.
In July 2017, Trump announced his intention to stop transgender individuals from serving in the military "in any capacity." His initial directive has been blocked by several lower court judges, and the administration is appealing.
On the desk of VA Secretary Robert Wilkie is a petition calling on him to decide whether to lift or extend the ban on sex reassignment surgery. There is no timeline for him to make a decision; VA officials said any announcement would come in the Federal Register.
The petition to lift the VA's ban on gender reassignment surgery was first introduced during the Obama administration in 2016. Then-Defense Secretary Ash Carter lifted the military's ban on transgender individuals serving openly that year.
The Transgender American Veterans Association said in 2016 that gender reassignment surgery is medically necessary in some cases to treat gender dysphoria, a conflict between a person's physical gender and the gender with which they identify.
When there appeared to be no movement on the 2016 petition, the group filed a lawsuit in 2017 that is still on appeal. Following the lawsuit, the VA called for a period of public comment on the petition, which ended Sept. 7.
Both the American Medical Association and the American Psychiatric Association support gender reassignment surgery as a treatment for gender dysphoria.
In a July 9 announcement in the Federal Register, the VA noted that it had received the petition in May 2016 "to amend its medical regulations by removing a provision that excludes 'gender alterations' from its medical benefits package."
"The effect of the amendment sought by the petitioners would be to authorize gender alteration surgery as part of VA care when medically necessary," the VA said in calling for public comment.
According to the VA's website, transgender veterans are eligible for a wide range of services, with the exception of sex reassignment surgery.
"Transgender veterans will be treated based upon their self-identified gender, including room assignments in residential and inpatient settings," the VA said. "Eligible transgender veterans can receive cross-sex hormone therapy, gender dysphoria counseling, preoperative evaluations, as well as post-operative and long-term care following sex reassignment surgeries."
A 2011 directive from the Veterans Health Administration said, "With one notable exception, all medically necessary, transition-related medical and mental health care are provided to transgender patients. The single exception is sex reassignment surgery."
A January 2017 release from the VA estimated there were at that time about 5,000 transgender veterans receiving health care from the agency.
"That is certainly an undercount because not all transgender veterans want to identify themselves to their provider," Dr. Michael Kauth, co-director of VA's National LGBT Program (Lesbian, Gay, Bisexual and Transgender), said in the release.
-- Richard Sisk can be reached at Richard.Sisk@Military.com.