Correction appended, June 4, 2016
The Department of Veterans Affairs has quietly proposed lifting a ban on sex reassignment surgery that has been in place since the early 1990s, in what would be a major shift in its coverage of medical treatment for transgender veterans.
The V.A. is considering a regulatory change that would follow in the footsteps of a similar change Medicare made in 2014, and would align the V.A. with the latest research on treatment options for transgender people, which has evolved since the V.A.’s ban was instituted more than two decades ago.
“At that time some of these surgical procedures were not as well developed as they are now,” says Jillian Shipherd, a co-director of the V.A.’s LGBT health care program. “The science about what the international standards of care are was very different from where we are today.”
V.A. officials have notified the Office of Management and Budget that they intend to use the rule-making process as a way to allow surgery. The V.A. has been working on the change since 2014. They discussed it for the first time in response to a TIME request, in the wake of a petition last month by two transgender veterans seeking to have the ban lifted.
Though not all transgender people need or desire surgery, many seek such procedures to help cope with gender dysphoria, the official diagnosis for individuals who experience “a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her.” Organizations such as the American Medical Association have in the last decade released statements saying that research supports the effectiveness and “medical necessity” of surgery in such cases.
Medicare made the change after that ban had been on the books for 33 years, in response to a lawsuit filed by a transgender woman who is also a veteran. Decades ago, surgical intervention for transgender people was often considered experimental or cosmetic, but the ruling by a Department of Health and Human Services board found that given advances in research and practice, the exclusion is “not reasonable” anymore.
The rule that would end the ban at the V.A. is expected to be reviewed by the OMB in the coming months. If the language passes muster, the rule will return to the V.A. to continue through the rule-making process, during which time the agency will seek public comment on the matter. A spokesperson says the proposed rule would allow V.A. hospitals to perform sex reassignment surgery or provide it in the community. The review process is expected to take up to 22 months.
“V.A. currently provides the whole universe of care for transgender Veterans, except for transition-related surgeries,” V.A. spokesperson Ndidi Mojay says in a statement to TIME. “However, the rule will remove any barriers to transition-related care (including surgeries) as deemed medically necessary by the Veteran’s treatment team.”
The V.A.’s Shipherd says that because the department does not regularly collect data on patients’ gender identity, officials can’t be sure of how many veterans might seek such treatment, though the V.A. released data in 2014 showing that the agency had treated at least 2,500 transgender veterans the previous year.
In 2011, the V.A. released a directive regarding care for transgender veterans that advocates hailed as a landmark decision. Renewed in 2013, it expresses that staff must provide transition-related care “without discrimination.”
Echoing statements from other Obama Administration officials who have been articulating transgender-inclusive stances in recent months, Shipherd says that the move is about the respectful treatment of transgender people. “We really do respect veterans’ self-identified gender identity,” Shipherd says, “and [the Veterans Health Administration] is a safe haven.”
Correction: The original version of this story misstated the status of the V.A.’s potential rule on sex-reassignment surgery. The V.A. has told the OMB that it intends to use the rule-making process as a way to allow surgery.