Home » Trans Progressive » My VA gender marker change didn’t quite go as planned

My VA gender marker change didn’t quite go as planned

Commentary: Trans Progressive

Autumn marching in this year’s Pride parade, along with the active duty and veteran service members.

“One can change one’s (Veterans Affairs) record to reflect one’s gender without genital reconstruction surgery.”

This was from the National Center For Transgender Equality’s (NCTE’s) talking points regarding a significant change to Veterans Affairs (VA) policies for transgender veterans. This change of policy on gender markers was clearly intended by the senior leadership of the VA when they put out the new policy document in mid-June, but how the policy is apparently being implemented is different from the initial intent.

In mid-June, I applied at the San Diego Veterans Affairs Health Care Center to have my gender marker changed in my Veterans Affairs (VA) records. This was after the VA announcement that a new Veterans Health Care Administration (VHA) directive (VHA Directive 2011-024) had been released, entitled Providing Health Care For Transgender And Intersex Veterans.

In the new VHA Directive 2011-024, entitled Providing Health Care For Transgender And Intersex Veterans, is the document that the VA announced in June. Paragraph 4. (1)(b) of the directive states the following:

“The documented sex in the Computerized Patient Record System (CPRS) should be consistent with the patient’s self-identified gender. In order to modify administrative data (e.g., name and sex) in CPRS, patients must provide official documentation as per current VHA policies on Identity Authentication for Health Care Services and Data Quality Requirements for Identity Management and Master Patient Index Functions.”

My first request was rejected. I received a letter, dated June 24, 2011, from the San Diego Veterans Affairs Health Care Center’s acting director stating as much.

That second referenced document is apparently the key document for the requirements for gender marker change – VHA Directive 2006-036, Data Quality Requirements For Identity Management And Master Patient Index Functions. It states the following in Attachment A, paragraph 4:

“GENDER: Male or Female must be entered. In case of gender reassignment, legal documentation (amended birth certificate, court documents, etc.) must be required as proof of a legal gender change.”

I provided a copy of my California Driver License to the VA, which has an F as the gender marker with my initial filing. That filing was rejected in a letter to me from the VA.

When I talked on Tuesday, July 12, 2011 to the San Diego VA Medical Center’s privacy officer about the filing, he told me he spoke to the attorneys and staffers at the Identity Management Data Quality (IMDQ) team in Washington, D.C.

In documentation from that group sent to the privacy officer that I wasn’t allowed to see, the conclusion was that my DL with the F as a gender marker was inadequate documentation. They apparently construed the paragraph from VHA Directive 2006-036 very narrowly, believing a surgery letter or an updated birth certificate was the only acceptable documentation.

It should be noted that with some internet searching I did find the current home page for the IMDQ team. I found out that in 2009 the name of the IMDQ team changed to Healthcare Identity Management (HC IdM). Apparently, the key document for HC IdM is the Master Patient Index/Patient Demographics (MPI/PD) Vista; Programmer Manual (Version 1.0) – the relevant thing here is mostly the name change of the team from IMDQ to HC IdM – why the privacy officer didn’t mention the team name change, I don’t know. That bit of information seems pretty important though.

The Palm Center and TAVA did heavy lifting in creating a study that highlighted the problems of disabled veterans. NCTE did the heavy lifting of working with the Obama Administration in addressing the highlighted problems in creating a new policy document.

As a transgender veteran who’s worked with TAVA and the NCTE, I’ve had the pleasure of doing the much lighter, but equally necessary, lift of testing the policy to make sure that the created policy is implemented as advertized. When I tested the new passport policy, the policy worked as advertized; the VA plan hasn’t worked as advertized as yet.

From here we work to have the lower level management at the VA get in step with what the upper level management meant to accomplish. Accomplishing steps such as this is how community activists work together to accomplish our community goals.



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Posted by LGBT Weekly on Jul 21, 2011. Filed under Trans Progressive. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry

5 Comments for “My VA gender marker change didn’t quite go as planned”

  1. Well put, Autumn. Thanks for all you do. It’s good working with you.

  2. This request is in response to the denial letter XXXXXXXX.

    In your denial letter addressed to “Mr. XXXXXX” you stated that “official gender change documentation” is defined as “doctor’s letter, amended birth certificate or court documentation.” None of the documentation listed applies to self-identified gender; however my Veterans record states that I have been diagnosed by a VA doctor and a civilian doctor with Gender Identity Disorder and GID is defined in the VHA directive 2011-024 as: Gender Identity Disorder (GID) is a conflict between a person’s physical sex and the gender with which the person identifies. Being addressed or referred to by my self-identified gender is not the same as changing my sex. The directive states that: “Patients will be addressed and referred to based on their self-identified gender.” I was referred to in the denial letter as “Mr. XXXXXX”.

    VHA DIRECTIVE 2011-024 section 4, paragraph b, sub section (a) states the following:

    (a) Patients will be addressed and referred to based on their self-identified gender. Room assignments and access to any facilities for which gender is normally a consideration (e.g., restrooms) will give preference to the self-identified gender, irrespective of appearance and/or surgical history, in a manner that respects the privacy needs of transgender and non-transgender patients alike. Where there are questions or concerns related to room assignments, an ethics consultation may be requested.
    (b) The documented sex in the Computerized Patient Record System (CPRS) should be consistent with the patient’s self-identified gender. In order to modify administrative data (e.g., name and sex) in CPRS, patients must provide official documentation as per current VHA policies on Identity Authentication for Health Care Services and Data Quality Requirements for Identity Management and Master Patient Index Functions.

    The following is the definition for “sex” and “gender” in VHA directive 2011-024 paragraph 2, section C, subparagraph (1) and (2):
    c. Definitions
    (1) Sex. Sex refers to the classification of individuals as female or male on the basis of their reproductive organs and functions.
    (2) Gender. Gender refers to the behavioral, cultural, or psychological traits that a society associates with male and female sex.

    Page 1 of 2
    With the definitions and directives provided in VHA directive 2011-024 in mind, your letter stated that I need one of the following:
    1) Doctor’s letter: Presumably a letter stating that I have completed some form of SRS (sex reassignment surgery). This letter is not required for the gender change because the directive clearly states that: Patients will be addressed and referred to based on their self-identified gender irrespective of appearance and/or surgical history. My self-identified gender is “female”. Self-identified gender and sex change are not the same.
    2) Amended birth certificate: This document, in the state of Kentucky where I was born and in most states, including Louisiana, would require that I complete some form of SRS prior to getting an amended birth certificate, and by extension, the VA referring to me as a female. This would be in direct conflict with the VHA directive 2011-024 where it states “irrespective of appearance and/or surgical history”.
    3) Court documentation: I am assuming that this documentation would refer to the changing of one’s sex that in some way required the courts approval. I would assume that that would mean that you must have completed SRS or some form of it. That documentation requirement would be in direct conflict with the VHA directive 2011-024 where it states “irrespective of appearance and/or surgical history”.

    As per section (a) I, (the patient) should be referred and addressed in the feminine vernacular irrespective of appearance and/or surgical history. This would negate all of the documents that you stated that I must submit due to the “irrespective of appearance and/or surgical history” part of the directive.
    As per section (b) my documented sex in CPRS should be consistent with my self-identified gender. Self-identified would mean that “I” identified myself a female, not a doctor or the state who issued my birth certificate or any courts decisions.
    If I am required to provide the documentation that you stated in your denial letter to be referred to by myself-identified gender then it would not be self-identified it would be doctor, court, or state identified gender or if SRS is required it would be a legal sex change and that would not be “irrespective of surgical history” as stated in the directive.

    I should have made my initial request for “gender” change more clear. I am sorry for the confusion.
    So I am requesting with this letter, that:
    1) I am addressed in the female vernacular, both oral and written and in all aspects thereof as per the VHA directive 2011-024.
    2) The documented sex in the Computerized Patient Record System (CPRS) be consistent with my self-identified gender (female) as per VHA directive 2011-024.

  3. Sorry, i forgot to say that i was denied for the same thing and for the same reasions. I wanted to know if this reply / appeal sounds good or am i just going to need to go to the white house and sit on his door until he tells the VA to do what they said they would do in the direvtive.

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