Transgender Veterans Sue V.A. Over Gender-Affirming Surgeries

An advocacy group for transgender veterans has filed a lawsuit over the failure of the Department of Veterans Affairs to provide or pay for gender-affirming surgeries.

The federal lawsuit, filed on Monday by the Transgender American Veterans Association, said the decision “amounts to discrimination on the basis of sex and transgender status” and threatens the health of veterans. It also accused the V.A. of letting the issue “languish” in the three years since the department’s secretary, Denis McDonough, said the administration would work to provide the surgeries.

In response to a request for comment, the department said it was unable to discuss the pending litigation.

The Department of Veterans Affairs offers the majority of medical procedures known as gender-affirming care, including hormone therapy, prosthetics and hair removal. But veterans must seek surgeries outside of V.A. hospitals, where they have to rely on private health insurance coverage or pay the costs out of pocket.

Josie Caballero, the association’s acting president, said the cost could force veterans to settle for lower-quality care or delay care, heightening distress.

The National Center for Transgender Equality estimates there are more than 134,000 transgender veterans. In a V.A. survey of transgender and gender-nonconforming veterans conducted in 2022 and 2023, 78 percent of 6,600 respondents said they wanted gender-affirming surgeries. More than half said they had delayed or gone without treatment, and the majority cited cost as the reason.

V.A. doctors already perform procedures that would be considered gender-reaffirming surgeries. For example, a mastectomy would be covered in order to treat or prevent breast cancer, but the same procedure is not covered