Jim Darby, left, and his husband Patrick Bova at a march for marriage equality in fall 2013 in Springfield, Ill.

Jim Darby, left, and his husband Patrick Bova at a march for marriage equality in fall 2013 in Springfield, Ill.

Jim Darby is starting to feel better about his grave.

Morbid as it sounds, the 82-year-old U.S. Navy veteran is relieved to know that now, thanks to recent LGBT-inclusive policies from the Department of Veteran Affairs (VA), his husband, Patrick Bova, can be buried alongside him in an Illinois military cemetery when the time comes.

“I served my four years, and I’m entitled to that,” said Darby, president and founder of Chicago’s American Veterans for Equal Rights chapter. “Everyone else’s spouse is buried with them. I want my spouse with me.”

A 21-year-old Jim Darby poses on an aircraft carrier in the Mediterranean Sea in 1952 during his service in the U.S. Navy.

Jim Darby, then 21, on an aircraft carrier in 1952 during his service in the U.S. Navy. (Photo courtesy of Jim Darby)

The new burial policy, issued last June after the federal government’s partial lifting of the Defense of Marriage Act, is one of more than 500 LGBT-inclusive initiatives underway at VA facilities across the nation. They address everything from equal visitation for same-sex partners to culturally competent staff training, as well as accommodations for transgender veterans.

Many LGBT veterans, who were accustomed to hiding their identities during service, expect to experience similar stigma after leaving the armed forces. But Darby said the VA has changed dramatically in terms of inclusivity in the last decade.

Although Darby uses private health care, he directs members of his 50-person organization to VA facilities and offers to take them there himself.

“Gay veterans just wouldn’t go near the VA because they assumed they were going to be mistreated or denied treatment,” he said. “Today, they identify. They have the courage to do it, and they know that if they are denied service because of their LGBT status, the shit will hit the fan.”

Filling the Health-Care Gap

The 2011 repeal of “Don’t Ask Don’t Tell,” a Department of Defense policy prohibiting lesbians and gays from being out while serving, opened doors for effective research on the previously unrecognized LGBT population, said Kristin Mattocks, the VA’s associate chief of staff for research and development.

Though it’s hard to track how many of the nation’s 8.3 million veterans identify as LGBT, the VA is likely the largest single provider of health care for LGBT people in the U.S., according to Mattocks’s 2014 study, “Addressing Health-care Needs of Sexual and Gender Minority Veterans.”

The study found that patients who are both veterans and sexual and gender minorities have mental and physical health care needs distinct from those of straight veterans, because they are at greater risk for post-traumatic stress disorder, depression and anxiety disorders, obesity and substance abuse.

“A lot of the work we are doing at this point across the country is identifying unmet needs,” she said. “During military service some people may be targeted because of their LGBT status. It’d be great if their provider knew they were LGBT and could get them access to the care they need.”

The VA’s commitment to comprehensive care is clear in its 2011 directives, which were modified in 2013 to further accommodate transgender and intersex individuals. The current policy does not cover gender reassignment surgery, but does provide for hormone therapy, pre- and postoperative treatment and trans-specific mental health care.

Of the 151 VA Medical Centers in the United States, 121 are registered in the Human Rights Campaign’s 2013 Health Equality Index, which indicates fair and equal treatment of LGBT patients. That marks a substantial increase from the 2012 index, in which only one VA center nationwide participated.

“It’s a growing area of interest,” Mattocks said. “And because people are interested in it, there will probably be more policies and more programs. I’m hoping it will continue to create a positive environment. … It’s the biggest thing we can do to be helpful to LGBT veterans.”

Policy in Action

In Illinois, VA caregivers have taken the national policy to heart and made unprecedented steps toward inclusive care for the 26,000 LGBT veterans they serve statewide.

Cecilia Hardacker, an outside educator from Chicago’s LGBT-focused Howard Brown Health Center, has aided this change during the past two years by leading cultural competency trainings at all three of Chicagoland’s VA centers. She’s traveled to eight facilities throughout the Midwest, working with more than 400 VA employees to clear up misconceptions about LGBT care.

Still, the trainings are usually voluntary for staff, and they’re currently not reaching rural areas, Hardacker said.

“It’s just critical that we have broad enough access to do this training as widely possible,” she said. “The fact that this is not required for nurses or physicians for any training program in the nation is just deplorable.”

Jean Albright, a Chicagoan and U.S. Air Force veteran, said she did not come out as a lesbian to her VA physician after a decade of care at the Edward Hines, Jr., VA Hospital, even when she was asked questions about having sex with men.

“It still felt like the military—and for 20 years I never came out in the military,” she said.

Jenny Garretson, a social worker and women veterans program manager at the Jesse Brown VA Medical Center, works in her office, where she spends some of her time making the facility more inclusive for LGBT veterans. (Photo by Sammy Caiola)

Jenny Garretson at the Jesse Brown VA Medical Center. (Photo by Sammy Caiola)

Eventually Albright felt comfortable enough to come out at the facility, which she said has an exceptionally welcoming women’s program.

That hospital is one of the three Chicago-area VA facilities that work with the city’s LGBT veterans chapter each year to host the “Do Ask Do Tell” Healthcare Symposium.

Jenny Garretson, a social worker and women veterans program manager who has taken the reins on LGBT inclusivity at the Jesse Brown VA Medical Center in Chicago, said her staff’s reactions to the new policies have been overwhelmingly positive. Safe-space materials decorate Garretson’s center, and the rainbow buttons she orders for employees usually disappear shortly after arrival, she said.

“That was really heartening, to see that level of interest,” Garretson said. “People were really hungry for knowledge on how to treat people in a respectful and dignified way.”

New veteran transgender policies progressive, but not enough for some

It’s been almost 100 days since Defense Secretary Chuck Hagel announced that he is open to reviewing the military’s longstanding ban on transgender individuals, and advocates are lobbying to move the process along.

While transgender individuals seeking to join the military may have a long battle ahead, transgender veterans are much closer to achieving a VA policy that meets all of their needs.

The current policy, set forth in the Veterans Health Administration’s 2013 directive for Providing Health Care for Transgender and Intersex Veterans, covers hormone therapy, pre- and postoperative care and mental health resources. It allows veterans to be treated in their chosen gender regardless of how they are registered in the VA’s electronic system and assures that they are placed in treatment rooms in which they feel comfortable.

The one thing it lacks, according to transgender veteran Maryann Cerezo, is coverage for surgery.

Cerezo, who lives in Arkansas and runs a 400-member LGBT Veterans Facebook group, has already begun her transition with the help her VA providers. She is stuck in place until the VA agrees to cover gender reassignment surgery, she said

“We’re not monsters,” Cerezo said. “Just because we’re trans doesn’t mean we’re not capable of serving, and having a decent life and being a decent person. But what we need to continue being decent people, stable people, is surgery.”

In late May, Medicare announced that it would repeal its ban on covering gender reassignment surgery, following a successful lawsuit from a 74-year-old transgender veteran relying on the system for her care in Albuquerque.

While experts say Medicare’s decision will likely influence private insurers to begin covering the procedure, VA researcher Kristin Mattocks said she doesn’t see it happening in their department anytime soon, largely due to logistical concerns.

“There are some issues with changing that policy,” she said. “I don’t know there are an enormous number of people who do the surgery, so part of it is figuring it out from a research perspective. I think that that change will come in time.”

The VA diagnoses an average of 246 veterans with Gender Identity Disorder every year, according to Mattocks’s research. The prevalence of the disorder in the VA is estimated at 22.9 per 100,000 cases, which is substantially more than the 4.3 cases per 100,000 people in the general population.

Cecilia Hardacker, an educator from Chicago’s LGBT-focused Howard Brown Health Center who provides cultural competency training for VA facilities, said she is actually pleased that the VA is not performing gender reassignment surgeries for its transgender clientele at this time, as they probably are not knowledgeable enough about it.

She said the ideal approach would be having the VA refer patients to surgeons who specialize in the field and cover the cost of the surgery.

“I think it’s smart on the part of the VA to say they don’t have the competence so they’re not going to do this,” Hardacker said. “I think they should cover it, but they’re not quite there yet.”

Sammy_CaiolaAbout the Author
Sammy Caiola is a recent graduate of Northwestern University. Click here to learn more about her.