Veterans advocates are threatening legal action to force Veterans Affairs officials to provide gender-confirmation surgery options to patients, a promise made by department leaders more than two years ago.

In a letter to VA attorneys sent Monday, members of the Transgender American Veterans Association and Yale Law School Veterans Legal Services Clinic said the move may be necessary given the slow pace of work on the issue within the department. The groups said they want VA to unveil a formal rulemaking plan detailing when they will begin providing the surgeries.

“Transgender veterans have waited far too long for the medically necessary health care they require,” said Rebekka Eshler, president of TAVA, in a statement. “It is high time that Secretary McDonough follows through on his public promises to the transgender veteran community. Statements are nothing without action.”

The National Center for Transgender Equality has estimated that there are more than 134,000 transgender veterans in America today, and another 15,000 transgender individuals serving in the armed forces.

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In the past, VA officials have estimated that as many as 4,000 veterans nationwide would be interested in the procedures, also known as gender reassignment surgeries. The department does offer other support for transgender veterans, but those services have come under criticism from conservative lawmakers in recent months.

In July 2021, McDonough announced that the department for the first time would begin offering the surgeries at some department medical centers, part of a larger effort to make VA “more welcoming” to all veterans.

But in the 28 months since the announcement, no formal steps have been taken to move ahead with the medical procedures. In an interview with Military Times earlier this month, McDonough acknowledged the delay, saying he was still working through how to proceed on the issue.

“As the person who called for this and as the person who will be defending the policy when we do it, when I’m ready to move ahead, I’ll do it,” he said. “This is an important suite of care for vets.”

But TAVA officials — who first publicly called for action on the issue nearly eight years ago — said the delay unnecessarily endangers the health of transgender veterans.

“VA’s failure to provide gender confirmation surgery subjects transgender veterans, including TAVA members, to increased risk of physical harm, psychological distress, and suicide,” the groups wrote. “Forcing veterans to seek [surgery options] outside of VA facilities disrupts their continuity of care, resulting in financial, physical and emotional harm.”

VA officials have not said how much adding the surgeries to its available medical offerings would cost. Advocates said they plan to file legal action against the department in mid-December unless a plan forward is announced.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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