New VA Gender Affirmation Surgery Policy Sitting on Secretary's Desk

Colorado Springs Vet Center gay pride flag
An outreach coordinator for the Colorado Springs Vet Center attaches a gay pride flag to a mobile counseling center near Club Q in Colorado Springs, Colo., on Wednesday, Nov. 23, 2022. (AP Photo/Thomas Peipert)

It's been two years since VA Secretary Denis McDonough announced that the VA would cover gender affirmation surgery for transgender veterans, but to date, the VA has yet to publish regulations that would allow it to start providing treatment.

On Tuesday, McDonough said the holdup was with him -- that the policy is on his desk and he is "not yet ready" to roll out the rule under the federal regulatory process that would create the benefit.

McDonough did not say why he has delayed his decision, just that he is studying all aspects of the proposal and "all the issues associated with it."

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"When I make the decision, it will be my job to defend it, and so I want to be in the best position to do that," McDonough said during a press conference with reporters in Washington, D.C.

McDonough announced in June 2021 that VA would move to offer surgeries for transgender veterans as part of an effort to provide comprehensive medical care for all veterans and overcome what he described as a "dark history" of discrimination against LGBTQ service members and veterans.

At the time, he cautioned that the federal rulemaking process would take years, adding that VA would use the time to develop the capability and capacity to perform the requested surgeries.

Sentiment against transgender rights has been on the rise in some states, state legislatures and Congress. Two weeks ago, the House Appropriations Committee forwarded a VA funding bill that would prohibit federal funds from being used for gender confirmation care at VA facilities as well as banning Pride flags from VA medical centers.

The proposed legislation, which was adopted 34-27, also barred federal funds from being used to cover the costs of abortions at VA facilities.

In a statement to earlier this month, VA officials said the delay is not related to the anti-transgender movement, adding that developing the policy will take several steps.

"But we are moving ahead, methodically, because we want this important change in policy to be implemented in a manner that has been thoroughly considered to ensure that the services made available to veterans meet VA's rigorous standards for quality health care," VA Press Secretary Terrence Hayes said.

To provide new benefits and health care at VA, the department must follow the federal rulemaking process, during which an interim, proposed rule is published in the Federal Register and the public is invited to comment.

The department would then take the comments into consideration before publishing a final rule.

The timeline can span months or years.

The VA covers other gender-affirming care, including hormone therapy, mental health care, pre- and post-operative care, voice coaching and medically necessary prosthetics.

Surgery, however, is not covered and is specifically barred under current regulations.

Earlier this year, advocates for transgender veterans pressed for protections of transgender service members and veterans and admonished the Biden administration for the delay.

"We must ensure that trans veterans have full access to the spectrum of care at VA. ... Every day that passes, members of the trans veteran community continue to suffer mental health crises and lose their lives to suicide," Lindsay Church, executive director of Minority Veterans of America, said during a press conference in March.

Hayes said it is the mission of VA to care for all veterans, including those who are transgender, and provide them with the "world-class care and benefits they deserve."

"We thank each and every one of these heroes for their service and sacrifice, and we will continue to work to earn their trust, day by day, through our efforts and our actions," he said.

-- Rebecca Kheel contributed to this report. She can be reached at

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime.

Related: The VA Said It Would Cover Gender Affirmation Surgeries. Trans Vets Are Still Waiting.

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