My VA Gender Marker Change Didn't Quite Go To Plan

One can change one's [Veterans Administration] record to reflect one's gender without genital reconstruction surgery.

This was from the National Center For Transgender Equality's (NCTE's)talking points regarding a significant change to the Veterans Administration (VA) policies for transgender veterans. This change of policy on gender markers was clearly intended by the senior leadership of the VA when they put out the new policy document in mid-June, but how the policy is apparently being implemented is different from the initial intent.

In mid-June I applied at the San Diego Veterans Administration Healthcare Center to have my gender marker changed in my Veterans Administration (VA) records. This was after the VA announcement that a new Veterans Healthcare Administration (VHA) directive (VHA Directive 2011-024) had been released, entitled Providing Health Care For Transgender And Intersex Veterans.

In the new VHA Directive 2011-024, entitled "Providing Health Care For Transgender And Intersex Veterans," is the document that the VA announced in June. Paragraph 4.(1)(b) of the directive states the following:

The documented sex in the Computerized Patient Record System (CPRS) should be consistent with the patient's self-identified gender. In order to modify administrative data (e.g., name and sex) in CPRS, patients must provide official documentation as per current VHA policies on Identity Authentication for Health Care Services and Data Quality Requirements for Identity Management and Master Patient Index Functions.

My first request was rejected. I received a letter -- dated June 24, 2011 -- from the San Diego Veterans Administration Healthcare Center's Acting Director stating as much.

That second referenced document is the apparently key document for the requirements for gender marker change -- VHA Directive 2006-036, "Data Quality Requirements For Identity Management And Master Patient Index Functions." It states the following in Attachment A, paragraph 4:

GENDER: Male or Female must be entered. In case of gender reassignment, legal documentation (amended birth certificate, court documents, etc.) must be required as proof of a legal gender change.

I provided a copy of my California Driver License to the VA, which has an F as the gender marker with my initial filing. That filing was rejected in a letter to me from the VA.

When I talked on Tuesday, July 12, 2011 to the San Diego VA Medical Center's Privacy Officer about the filing, he told me he spoke to the attorneys and staffers at the Identity Management Data Quality (IMDQ) Team in Washington, DC. (The link is to a bookmark with all their staff contact information from 2006, as well as a list of their resources. These resources include a link to VHA Directive 2006-36.)

In documentation from that group sent to the Privacy Officer that I wasn't allowed to see, the conclusion was that my DL with the F as a gender marker was inadequate documentation. They apparently narrowly construed the paragraph from VHA Directive 2006-036 very narrowly, believing a surgery letter or an updated birth certificate were the only acceptable documentation.

It should be noted that with some internet searching I did to find the current home page for the IQMD Team, I found our that in 2009 the name of the IMDQ Team changed to Healthcare Identity Management (HC IdM). Apparently, the key document for HC IdM is the Master Patient Index/Patient Demographics (MPI/PD) Vista; Programmer Manual (Version 1.0) -- the relevant thing here is mostly the name change of the team from IMDQ to HC IdM -- why the privacy officer didn't mention the team name change, I don't know. That bit of information seems pretty important though.

The Palm Center and TAVA did heavy lifting in New Veterans Administration Healthcare Policy For Transgender And Intersex Veterans