1.  PURPOSE:  This Veterans Health Administration (VHA) Directive establishes policy
regarding the respectful delivery of health care to transgender and intersex Veterans who are
enrolled in the Department of Veterans Affairs (VA) health care system or are otherwise eligible
for VA care.

2.  BACKGROUND:  In accordance with the medical benefits package (title 38 Code of Federal
Regulations (CFR) section 17.38), VA provides care and treatment to Veterans that is compatible
with generally accepted standards of medical practice and determined by appropriate health care
professionals to promote, preserve, or restore the health of the individual.

a.  VA provides health care for transgender patients, including those who present at various
points on their transition from one gender to the next.  This applies to all Veterans who are
enrolled in VA’s health care system or are otherwise eligible for VA care, including those who
have had sex reassignment surgery outside of VHA, those who might be considering such
surgical intervention, and those who do not wish to undergo sex reassignment surgery but selfidentify as transgender. Intersex individuals may or may not have interest in changing gender or
in acting in ways that are discordant with their assigned gender.

b.  VA does not provide sex reassignment surgery or plastic reconstructive surgery for
strictly cosmetic purposes.