The VA MD Health Care System has a LGBT Veteran Coordinator and the current health care policy welcomes veterans, whatever their sexual orientation. (Amy Davis, Baltimore Sun video)
When Tracy Robertson served in the Air Force nearly 30 years ago, she didn’t dare reveal to anyone that she was a lesbian.
“We had to be very careful,” said the 54-year-old from Baltimore. “Not only could you get thrown out, but my biggest fear was that you could go to jail.”
That distrust and fear of the military simmered for years after Robertson left the service. The U.S. Department of Veterans Affairs, the health system for former military personnel, thinks sentiments like this are keeping many lesbian, gay, bisexual and transgender veterans like Robertson from using the services they are entitled to.
The federal agency is working to embrace the very service members the military once ostracized even as the Trump Administration takes steps that could make such veterans feel unwelcome.
“This is a group that has been long neglected historically and we know that we have to put extra effort into making them feel welcome and creating an environment where they feel comfortable,” said Michael Kauth, a director with the VA’s LGBT Health Program.
Under the initiative, the VA has placed coordinators in its hospitals, including the one in downtown Baltimore and elsewhere in the region. Doctors, nurses and social workers were trained to be culturally sensitive when treating these former service members. A website was created outlining the rights of these veterans and signs and other marketing materials were placed in the lobby of VA facilities. “We Serve All Who Served,” reads one sign located in a VA annex building in Baltimore. “Excellent Care Has No Boundaries.”
“It’s hard to get past fear,” said Jillian Silveira, the LGBT veteran care coordinator for the Baltimore VA. “But we want them to know that we want to be their provider of choice. They deserve the benefits they earned.”
The outreach efforts were started under the Obama Administration after repeal of the “don’t ask, don’t tell” policy that allowed lesbian, gay and bisexual troops to serve openly in the military for the first time. Legislation a few years later also lifted a ban on transgender men and women who serve.
The Trump Administration has attempted to roll back the olive branch extended to transgender soldiers with an order in March that forbids people who require or have undergone gender transition from serving. That order is being challenged in court.
For the second year, Trump also refused to acknowledge LGBT Pride, a month-long celebration held every June to celebrate the community.
The VA is moving ahead with its outreach anyway. LGBT coordinators and veterans will march in parades and man booths at gay pride celebrations around the country this month. The VA has never had a policy of not serving the LGBT veterans, Kauth said, but agency officials know that the perception of the military influences perceptions of the VA.
The military doesn’t track the sexual orientation of its soldiers, but one count by think tank The Williams Institute estimates there are about 1 million LGBT veterans.
“We know from research that many LGBT veterans come to the VA and expect to be treated just like they were in the military under ‘don’t ask, don’t tell’ and then the transgender ban,” Kauth said. “Many veterans don’t distinguish between the VA and the military and see it as the same organization. That belief creates a high hurdle for us in letting them know LGBT people will be treated well and will get good health care.”
Trump’s stance could make it more difficult to attract people who already may be reluctant to use military services for fear their benefits will be taken away or that they won’t be treated humanely, advocates said. They worry things could go back to how they once were.
“The older the veterans are the more they remember how things were and how society was,” said Kimberly Morris, a transgender woman who is on the board of the Transgender American Veterans Association who served in the Marines for 20 years. “It is fear out of how things used to be.”
Morris served in the military as man, but now lives as a woman. She used to pay out of pocket to see counselors to avoid revealing to military and VA officials that she was transgender. Now, she said, she gets great care from the VA.
Mark Procopio, executive director of the Maryland LGBTQ advocacy group FreeState Justice, lauded the VA’s efforts
“There are members of our community who have served and have secured these benefits that they have a right to,” he said. “I think it is good that the VA is attempting to have stronger, more affirmative, high quality care for this community, and they are also reaching out and making sure they feel comfortable using these benefits.”
Procopio added that there would be challenges gaining trust because of the rhetoric of the Trump Administration. There are also many LGBT people who were unfairly discharged because of their sexuality who don’t qualify for services, he said. At least one advocacy group is trying to help these soldiers get those discharges overturned, Procopio said.
Shirley Maniece, 60, hid her sexual orientation while serving in the Air Force in law enforcement and food service from 1979 to 1985. The Rosedale woman said she also was sexually assaulted by a superior while serving, which also tainted her experience.
After leaving the military she led a wayward life jumping from job to job. She often felt depressed with no real purpose. She wanted to bury the memories of her military life, but was never able to.
Ironically, it was the VA that helped her move on.
A friend suggested she try to get help from the military health system. She was a little reluctant, given her past experience. But when she went, she found doctors, nurses and staff that were supportive and helped her work through her trauma. She bonded with other veterans with similar experiences.
“I was finally able to work through my issues in a safe environment,” Maniece said. “I felt free for the first time in years. I no longer felt like I was drifting.”
Robertson also suffered episodes of depression so severe after leaving the military that she could not work. Being unable to live openly as a lesbian contributed to her feelings of inadequacy, she said.
The Baltimore VA Medical Center is joining other VA centers in turning to a treatment called battlefield acupuncture, among other therapies, to treat pain in former service members as part of an effort to reduce reliance on opioids that no longer work or have lead to substance use problems.
While LGBT people go to the doctor for the flu, migraines and broken arms just like anyone else, they also may have unique medical needs, such as anxiety from not being accepted by society. Transgender patients may be living as one gender, but still have the body parts of another. So a transgender man still may need to get a yearly mammogram or pap smear.
Part of Silveira’s job is to make sure doctors and other providers are sensitive to these issues.
“A patient may still need a pap smear even though they are a guy with a full-on beard,” she said.
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Since the VA doesn’t track sexual identity, it is hard to officially track how well the outreach is working. But Kauth said there is evidence that it is. They know through medical codes that about 9,000 transgender patients have gotten hormone replacement and other medical treatments. He said it used to be far fewer.
Heather Hurlburt, a senior analyst with the Palm Center, said support from the rank-and-file military seems to be offsetting the negative affects the Trump Administration’s stance could have on deterring people from using VA services.
“Folks are continuing to get health care both active duty and at the VA,” Hurlburt said. “What is most remarkable is the military uniform leadership is continuing to go out of its way to say that transgender service is welcome.