VA Falls Short on Providing Specific Health Care to LGBT Veterans, GAO Report Finds

A veteran rides during the San Francisco Pride Parade and Celebration 2019.
A veteran rides during the San Francisco Pride Parade and Celebration 2019 on June 30, 2019 in San Francisco, California. (Photo by Arun Nevader/Getty Images)

The Department of Veteran Affairs can't systematically analyze the health of LGBT veterans because it doesn't consistently collect data on sexual orientation or self-identified gender identity, according to a recent report by the Government Accountability Office.

The VA's Veterans Health Administration analyzes national-level data by birth sex to assess health outcomes for veterans -- for example, analyzing frequency data to identify the most common health conditions.

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However, VHA is limited in its assessment of health outcomes for the lesbian, gay, bisexual and transgender veteran population because it does not consistently collect sexual orientation or self-identified gender identity, or SIGI, data.

VHA officials told the GAO that veteran health care providers may record veterans' sexual orientation in non-standardized clinical notes in electronic health records. However, without a standardized field, providers may not be consistently collecting this data. VHA does not know the total number of LGBT veterans in its system, the report found.

VA spokeswoman Christina Noel said that in July 2020, VA updated its Survey of Healthcare Experiences of Patients Program to include questions asking veterans to self-report their sexual orientation and gender identity, which will help the department better assess LGBT Veterans' health care outcomes and patient satisfaction.

"Every VA medical center has LGBT Veteran Care Coordinators and VA offers extensive educational resources for staff on the unique health care needs of these veterans," she said.

However, VHA's electronic health record system, the Computerized Patient Record System, does not have a standardized field for providers to record SIGI information like with sex and race, and VHA does not know how many records contain sexual orientation data. Federal internal control standards call for management to obtain relevant data on a timely basis.

According to VHA officials, the absence of such a standardized sexual orientation field in CPRS is due to a system created many years ago when society greatly stigmatized lesbian, gay, and bisexual identities, and the military still had a ban on service by openly gay or lesbian personnel. That policy, "Don't Ask, Don't Tell," was overturned in 2010.

Until VHA is able to consistently collect this information, providers' ability to deliver appropriate care may be affected, which could also hurt veterans' health outcomes. For example, VHA researchers told the GAO that lesbian, gay, and bisexual veterans risk a higher likelihood of suicidal thoughts compared with their heterosexual peers. The researchers also said that without consistent sexual orientation data, their work was limited to small samples.

As a system originally designed to serve mainly men, VHA has reported that it has struggled in the past to provide sufficient sex-specific services and an environment of care sensitive to women's privacy needs.

Jennifer Dane, a former Air Force intelligence analyst and the interim executive director of the Modern Military Association of America, a LGBTQ veteran rights advocacy organization, said a non-standardized documentation system puts LGBT veterans at risk from discrimination at the hands of providers.

And though the policy barring gay and lesbian service members is no longer on the books, VHA acknowledges that these veterans may still face barriers to equitable health care, or experience stigma, prejudice, discrimination, and violence, which may affect the care they receive and their health outcomes.

Dane said that, while there was a lot of room for improvement by the VHA, it has made some progress. In 2012, the VA created the LGBT Health Program, which provides policy recommendations, provider education programs, and clinical services to support personalized health care for LGBT veterans.

VHA policy notes that all people have both a gender identity and a sexual orientation. Furthermore, according to VHA, while LGBT individuals may share similar experiences of stigma and discrimination, those who are lesbian, gay, and bisexual may have different health concerns than those who are transgender. In 2017 and 2018, VHA issued updated directives on collecting data on veterans' sexual orientation and SIGI.

Editor's Note: This story has been updated to remove an inaccurate quote. We regret the error.

Related: Tracking of Veteran Suicides at Military Facilities in Disarray, GAO Finds

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