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In a win for trans veterans, VA adds gender identity to medical records

One transgender veteran said being able to list their gender identity on health records will allow them to give doctors a more complete picture of who they are.

Veterans’ health records can now include their gender identity, the Department of Veterans Affairs announced Wednesday.

The department said it began including gender identifiers in its national medical record system last month “to help VA providers better understand and meet the health care needs of Veterans,” including transgender and gender-diverse veterans.

It added the categories “transgender male, transgender female, non-binary, other or does not wish to disclose” as options in its gender identity field. Nonbinary refers to an individual whose gender identity is neither exclusively male nor female. 

Denis McDonough, the secretary of veterans affairs, said in a statement that the VA’s goal “is to align the department’s policies and procedures with the president’s vision for a more inclusive government.” 

“All Veterans, all people, have a basic right to be identified as they define themselves,” McDonough said, according to the news release. “This is essential for their general well-being and overall health. Knowing the gender identity of transgender and gender diverse Veterans helps us better serve them.”

Trans veterans said though it might seem like a small change, it’s meaningful and will make it easier for them to get health care.

Image: Landon Marchant, an Air Force veteran, said they are “completely and utterly blown away” that the VA added a gender identity field to medical records.
Landon Marchant, an Air Force veteran, said they are “completely and utterly blown away” that the VA added a gender identity field to medical records.Mackenzie Hunter

Landon Marchant, who uses gender-neutral pronouns and left the Air Force in 2011 on an honorable discharge, said they are “completely and utterly blown away” that the department made gender identifiers on medical forms a priority. “Changing health databases and medical records is not as easy as updating a form in Excel,” they said.

Marchant said without a field for gender identity on their medical forms, they often have to go through unnecessary details about their medical history every time they see a new provider, which they described as exhausting. They were assigned female at birth, transitioned in 2012 and updated all of their gender markers to male. But they identify as nonbinary and use gender-neutral pronouns, which can confuse providers who aren’t competent in trans care.

They said they saw a social worker recently who assumed they were “unstable” in their gender identity because they use gender-neutral pronouns. 

“And then she proceeded to tell the rest of my psychiatric care team that, and I had to go sort that out,” Marchant said, adding that these types of misunderstandings are common. “People assume they know my pronouns, people assume things about me because they see me passing as male, and then I have to go explain, actually, I also need routine female reproductive care and all of these other aspects of medical care.” 

Marchant said many of those miscommunications could be avoided if providers could look at their file and see gender identity, sex assigned at birth and pronouns, which they said would give providers a more “complete picture.” The new VA policy doesn’t mention the addition of a section for pronouns, but a VA spokesperson said it is developing a pronoun field to add to its health record system.

“In direct communication, VA policy requires staff to use a Veteran’s chosen pronoun,” the spokesperson said in an email. “Staff are also required to use a Veteran’s preferred name, and that information is incorporated into our health record systems.”

Avalisa Ellicott, communications director for advocacy group Transgender American Veterans Association, said including gender identity will make medical record systems more consistent. Previously, she said, some providers would only see a patient’s legal name instead of their chosen name, and they would accidentally use the wrong name, an action known as deadnaming. Trans people who are deadnamed or misgendered will be less likely to get care, Ellicott said.

“If you go to an appointment for your hormone therapy, and the person refers to you by your deadname and is using the wrong pronouns, how likely are you to continue going back to that place?” she said. “So people were going out within their own communities and finding other people and paying more money and not receiving the benefits that they worked hard for.”

She said the policy change is just one of many efforts by President Joe Biden’s administration to support trans service members and veterans and, in some cases, undo Trump administration policies. Just after he was inaugurated, Biden reversed Trump’s ban on trans people enlisting and openly serving in the military. In June, the VA announced it would start the yearslong process of creating a federal rule to offer gender-affirming surgeries for trans veterans.

Sheri Swokowski, who lives in Madison, Wisconsin, and served in the Wisconsin National Guard as a federal civil servant and on active duty, said adding gender identity to health records is a great step forward, but she’s worried about how long it will take for every part of the VA to enact the change.

Sheri Swokowski served in the Wisconsin National Guard for more than 30 years.
Sheri Swokowski served in the Wisconsin National Guard for more than 30 years.Courtesy Sheri Swokowski

“It’s kind of a crapshoot,” she said. “All of the VA organizations that are out there are all led by different individuals and are all located in different parts of the country. Some parts of the country are less accepting of transgender people and older people.” 

Swokowski said rather than creating more policies to foster a safe environment for trans veterans, she hopes the VA will enforce the military’s values of treating everyone with dignity and respect. 

In addition to enforcing its current values and rules, Ellicott said the VA should institute mandatory training for all medical professionals.

“There are a lot of courses and classes that are optional,” Ellicott said of trans-specific medical training. “I think mandatory training on trans-related health care, and just how to interact with trans people, would do a lot for the VA and do a lot for our veterans.” 

She said including gender identity on forms is an important change, even if it’s small, because then providers can’t ignore who someone is. 

“It’s a way to highlight that this is important for veterans, and this is important for people to feel comfortable coming to the VA for care,” she said.

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