As the military services are moving each day in the direction of better supporting LGB dependents (spouses, children, etc.), there are Ts in the military family that the DoD is failing to adequately support.
We don’t hear much about these Ts in the military family, but within the military family there is no question that trans spouses and trans youth exist. In the recent column Lack of cultural competency by DoD leading to marriage inequality I wrote about the added difficulties military couples with a trans spouse can have that preclude their marriages being recognized by the Department of Defense (DoD) in the Defense Enrollment Eligibility Reporting System (DEERS), and that’s certainly a real concern. But DEERS enrolment does so much more than provide simple recognition of family relationships: DEERS enrolment is the Defense Department’s tool for determining what benefits particular military dependents, contractors and retirees are entitled to.
And, one of those benefits is health care.
The health care exclusions for trans (and intersex) dependents are just shy of unabridged. The basis for these exclusions are found in chapter 32 of the Code of Federal Regulations, section 199.4 [which regulates the Civilian Health And Medical Program Of The Uniformed Services (CHAMPUS)], paragraph (e)(7):
“Transsexualism or such other conditions as gender dysphoria. All services and supplies directly or indirectly related to transsexualism or such other conditions as gender dysphoria are excluded under CHAMPUS. This exclusion includes, but is not limited to, psychotherapy, prescription drugs, and intersex surgery that may be provided in connection with transsexualism or such other conditions as gender dysphoria. There is only one very limited exception to this general exclusion, that is, notwithstanding the definition of congenital anomaly, CHAMPUS benefits may be extended for surgery and related medically necessary services performed to correct sex gender confusion (that is, ambiguous genitalia) which has been documented to be present at birth.”
In other words, once an initial diagnosis of gender dysphoria is made, the military health care insurance system for dependents (Tricare) disallows all health care treatments related to the diagnosis. And since those exclusions are codified in the Code of Federal Regulations, these exclusions carry the weight of law – it’s unlawful to use Tricare funds to treat a military dependent or retiree for gender dysphoria.
As a transsexual DEERS enrolled military retiree, I personally live with those absolute heath care treatment exclusions. Those exclusions were put in place to make sure that trans adults like me could not receive treatment related to being transsexual.
But the policy impacts more than trans adults like me. I interviewed Jane*, a military spouse, who is the mother of a trans daughter Mary*. Mary’s father is an active duty servicemember currently serving in the continental United States, so Mary is a military dependent insured by Tricare.
While the servicemember and his family were stationed overseas, Mary was taken to a clinic on base for school immunizations. A doctor at the clinic gave Mary, then living as a boy, a related health care exam. At the end of that exam the doctor told Jane words to the effect of “I believe your son may have gender identity disorder” – gender identity disorder now de-pathologized and renamed gender dysphoria in version 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
So Mary, a dependent of a military servicemember, can receive no treatment for a significant health care condition.
The American Psychiatric Association, the American Psychological Association, the American Medical Association and the World Professional Association for Transgender Health (WPATH) all support removing exclusions for treatment connected to gender dysphoria. For example, the American Medical Association (AMA) stated in 2008?s Resolution 122:
• [Gender dysphoria] is a serious medical condition recognized as such in both the Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision) (DSM-IV-TR) and the International Classification of Diseases (10th Revision) and is characterized in the DSM-IV-TR as a persistent discomfort with one’s assigned sex and with one’s primary and secondary sex characteristics, which causes intense emotional pain and suffering[.]
• [I]f left untreated, [gender dysphoria] can result in clinically significant psychological distress, dysfunction, debilitating depression … An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with [gender dysphoria[.]
• Health experts in [gender dysphoria], including WPATH, have rejected the myth that such treatments are ‘cosmetic’ or ‘experimental’ and have recognized that these treatments can provide safe and effective treatment for a serious health condition[.]
• Physicians treating persons with [gender dysphoria] must be able to provide the correct treatment necessary for a patient in order to achieve genuine and lasting comfort with his or her gender, based on the person’s individual needs and medical history[.]
Mary is a trans youth swept up in policy meant to exclude trans adults like me from receiving treatment at the DoD’s expense.
So for Mary and other trans youth who are the dependents of military servicemembers, is it really appropriate for the DoD to deny insurance coverage for a significant health care condition? A condition that if untreated will leave these trans youth dependents needlessly suffering with psychological distress, dysfunction and debilitating depression?
It’s bad enough that the DoD doesn’t provide insurance coverage for adults diagnosed with gender dysphoria, but not providing insurance coverage for the trans youth dependents of our nation’s servicemembers is unconscionable.
* Names changed to protect anonymity
The simple fact is, the Federal government does not, as a rule, provide such coverage at this time. So, complaining about the military not providing them seems kind of silly.
The simple fact is this, the DoD is being callus and cruel to both its active service personnel and their dependents. The only way to get them to change their draconian rules is to complain, and complain a lot and in all of the right places. The DoD should not be able to exclude transgender medical care for a serious medical condition.
Ur an idiot