A Trans Veteran’s Long, Frustrating Path to Getting the Healthcare He Was Promised
Evan Young had been planning for quiet on the morning of July 26th. He was holed up in a Miami hotel more than 1,000 miles away from home, preparing for a long-delayed surgery.
Then Donald Trump tweeted that his administration planned to reinstate a ban on transgender people serving in “any capacity in the U.S. military.” So Young, having spent much of the last few decades weathering the Army’s failed policies around its LGBTQ service members, spent the rest of the day answering a flood of phone calls and emails about what just happened and what might happen next.
Young’s surgery had been a year in the making, a long and tedious process of fighting the Central Arkansas Veterans Healthcare System to cover post-op treatment related to an injury he sustained after a gender-confirming surgery.
“The facts were pretty obvious,” he tells me, his voice low and calm as he describes the chaotic circumstance of the last several months. The Department of Veterans Affairs doesn’t cover gender confirmation surgeries, but it does cover post-op care, including the treatment of surgical complications. “A veteran shouldn’t have to go through all those hoops just to get care. Period. Regardless of if they’re transgender or not.”
Young is right that the written policy was on his side, but he had to navigate the hoops all the same. The issue eventually went all the way up the chain at the VA to the national level, where, because of Young’s persistence and willingness to talk to the press about exactly what was happening to a veteran in need of medical treatment, they agreed that the surgery was in fact covered as post-op care. It didn’t end there, though. Once Young was approved for the procedure, chasing down a doctor in the national system who could perform it became its own struggle.
According to a 2016 survey of 180 military physicians, the overwhelming majority of respondents—nearly 95 percent—reported receiving three hours or less of medical training related to transgender healthcare. The VA is plagued by the same problems as the wider U.S. healthcare system: a profound lack of knowledge about transgender issues, and a shortage of doctors to meet the need. After identifying a doctor in Miami, an additional three months passed as Young waited for the VA to negotiate a business agreement between the local VAs in Little Rock, Arkansas, and Miami.
All the while, through the bureaucracy and the waiting, Young was in pain. “It’s not just the physical discomfort,” Young says of that time spent in limbo. “It’s also mental anguish. Depression.” His life was on hold.
But he had stayed in the VA system for a reason. After a year of fighting, he had managed to create a kind of path for other trans vets to follow if they found themselves in a similar situation—crucial work in a famously rigid and bewildering health care system. But Trump’s tweets, and a subsequent memo to Defense Secretary James Mattis instructing him to develop a plan for implementation, threw all of that into uncertainty.
Mattis has so far said he plans to establish a panel of experts to “provide advice and recommendations on the implementation of the president’s direction.” (Such a panel would be a retread of a study commissioned by the Department of Defense under the Obama administration that concluded that trans servicemembers serving openly has “minimal impact on readiness and health care costs.”) Until then, the future remains unclear, which is something Young has grown used to after 24 years of service in a military that has changed in slow, uneven strides.
The plan had always been to attend West Point. Young, now 47, even had a nomination from his senator ready to go during his high school years in Arkansas. But a busted knee during junior year meant he had to figure out something else. After graduating, Young went to college for about a year and a half before enlisting in the U.S. Army Reserve. He graduated basic training in 1989, worked his way up to sergeant, and eventually received a commission of second lieutenant through an officer training program. In 2013, he retired as a major.
“For a majority of my career, I was a lesbian,” Young tells me of his time in the Army before his gender transition. He had come out privately when he was 19 years old, but stayed closeted in his professional life. He enlisted before Don’t Ask, Don’t Tell and was still serving when it was repealed. “However, just as soon as it was repealed, I came to terms with who I was and decided I wanted to transition,” he says. “That’s when I went back into the closet.”
“You’re afraid somebody is going to find out and so you don’t trust anybody. But you should be able to trust your battle buddy.”
It was hard to stay there. And it’s hard for Young to imagine thousands of soldiers being forced to go back there if Trump’s reversal is implemented and can withstand the two separate legal challenges filed against in August. “It has you on edge all the time,” he says of being closeted while serving. “You’re afraid somebody is going to find out and so you don’t trust anybody. But you should be able to trust your battle buddy. If you can’t, it makes it very hard to do your job.”
Young retired in 2013, in part because of an unrelated medical issue, in part because he felt like it was a race to get out before being outed. Before the Obama administration lifted the ban on trans service members in the summer of 2016, being outed got you a less-than-honorable discharge, which could mean a loss of benefits. The Obama rule also opened up access to healthcare for trans vets, but the debate over how much healthcare, exactly, they should be allowed to receive raged on. As the sun set on the Obama administration, the expectation was that the VA would continue to press forward on these issues under the next president. But then that president was Trump.
It’s hard to quantify, at least with any precision, the harm that would come from Trump’s directives once implemented as actual policy. As it stands, according to a study from the RAND Corp. that was commissioned by the Pentagon, there are up to 10,000 trans service members in the military right now. The consequences of pushing them out span from unit cohesion and the physical safety of active duty soldiers to the logistical nightmare of simultaneously discharging thousands of service members around the world. Soldiers could lose healthcare, jobs, and GI Bill benefits putting them through school and keeping their families housed.
As Young’s battle to secure healthcare shows, the system has been failing its diversifying veteran base for a long time. Since the repeal of Don’t Ask Don’t Tell, studies have consistently suggested many VA offices aren’t equipped to handle issues that might affect LGBTQ populations. It’s been almost give years sine women were cleared for all combat positions, but post-9/11 female veterans still have trouble finding a gynecologist covered by their benefits—which isn’t to mention prenatal care.
So Young has spent his post-military career helping other trans vets navigate their healthcare and benefits under current policy as national president of the Transgender American Veterans Association. And he remains hopeful that the Trump directive will fall apart, either because the administration fails to see it through or the one of the two lawsuits filed against it will succeed in bringing it down. “You know, the transgender policy had already been argued and implemented,” he says of the pending review. “There’s already a plan for transgender people in the military.”
But he also knows that service members are making calculations and contingency plans of the sort he once made, under a military policy he hoped had ended for good. “When you join the military you sign a contract to support and defend the Constitution of the United States. With that signature, you also get the benefit of healthcare,” Young says. “And if that medical care happens to be hormones or surgery, that is up to the doctor, it is not up to some political statement. That’s nothing. We signed that contract with the United States government and that is what we expect in return.”
That same oath reads, just a couple of lines down: “I will obey the orders of the President of the United States and the orders of the officers appointed over me.” In six months, we’ll know what those are.
This story is a part of Rank and File, a series that tells the stories of young veterans and the changing face of the military. Read our introduction here.