By Kelley Bouchard
A Maine veteran and his 21-year-old daughter are challenging a 46-year-old federal statute that prohibits the Military Health System from covering medically necessary surgical treatments for gender dysphoria sought by dependents of service members.
The family, represented by GLBTQ Legal Advocates & Defenders (GLAD), filed a complaint Monday in U.S. District Court in Portland against Secretary of Defense Lloyd Austin, the U.S. Department of Defense and Tricare Health Plans, which administers the Military Health System for active duty, reserve and retired personnel.
The father, identified as John Doe in the lawsuit, is a retired 23-year veteran of the Air Force and Marine Corps who receives health coverage through the military system. His daughter, identified as Jane Doe, is a transgender woman who is a college student and remains on his health plan. Both live in Sagadahoc County.
As recommended by doctors, Jane Doe began treatment for gender dysphoria when she was a young adult. But while Tricare covers her hormone replacement therapy, it doesn’t cover essential surgical care, the lawsuit states.
“I just want what others who have served their country want — the ability to take care of my family,” the father said in a statement. “My family has served right alongside me. My wife and I want our daughter to be healthy and happy like any parents would. My daughter shouldn’t be denied the healthcare she needs just because she’s transgender.”
The father and daughter are challenging a 1976 statute that excludes coverage for transgender dependents’ medically necessary care. They say Section 1079 of the U.S. military medical code violates their constitutional rights to equal protection and due process, as well as the federal Rehabilitation Act of 1973, which prohibits discrimination in federal programs.
“People who have sacrificed to serve our country should not be denied the ability to care for their families,” said GLAD attorney Ben Klein. “The U.S. military is taking steps to ensure transgender service members are treated fairly and with the respect they deserve. There is no justification for Tricare to deny coverage for service members’ loved ones, just because they are transgender.”
Klein declined a request to speak with the father and daughter.
Healthcare experts and professional health organizations, including the American Medical Association and the American Psychological Association, recognize gender-affirming surgeries as safe, effective and medically necessary treatments for gender dysphoria, the lawsuit says.
The lawsuit also asserts that gender affirming surgical procedures are the only medically necessary treatments that the government covers for active-duty military members but denies for their dependents.
Rep. Chellie Pingree, D- 1st District, said Monday that she had yet to review details of the lawsuit, but she urged Tricare to update its coverage rules.
“Anyone who has served our country in uniform deserves the full benefits they have earned, including for their loved ones,” Pingree said in a statement. “If treatment or surgery was needed for any other condition, there wouldn’t be such a discriminatory denial of care. Tricare, like all insurers, must update their coverage to reflect modern day needs.”
Sen. Angus King of Maine, an independent, was reviewing details of the lawsuit, his office said. Maine’s senior senator, Republican Susan Collins, “will follow this case as it moves through the court system,” her office said. U.S. Rep. Jared Golden, D- 2nd District, didn’t respond to requests for an interview.
The Department of Defense referred a reporter’s inquiry to the Department of Justice, which didn’t respond Monday to a request to discuss the lawsuit.
Gender dysphoria refers to the psychological distress individuals may experience if the sex they were assigned at birth conflicts with their gender identity, according to the American Psychiatric Association.
Diagnosed with Gender Dysphoria
Assigned male at birth, Jane Doe knew she was female by age 12 and was diagnosed with gender dysphoria at 17, the lawsuit says.
“Like most young people whose gender identity is incongruent with their assigned sex, Jane struggled with the mental and physical effects of dysphoria, including acute anxiety, racing thoughts, a rapid heartbeat and social isolation,” the lawsuit states.
Jane Doe has socially transitioned to female, using female pronouns, dressing and grooming herself as a woman and legally changing her name and gender designation on her birth certificate. She has furthered her transition with hormone replacement therapy and counseling, which Tricare covers, the lawsuit says.
But when she sought coverage for physician-recommended removal of visible facial hair, Tricare denied it was medically necessary. The complaint says she paid for the procedure but doesn’t say how much.
Tricare also refused to reimburse her for facial- and voice-feminization surgeries, and it denied coverage for prescribed vaginoplasty to construct female genitalia, the lawsuit says.
“Jane has been and continues to be unable to obtain coverage as a Tricare beneficiary for this necessary gender transition surgery,” the lawsuit states. “As a result, Jane continues to suffer the effects of the serious but highly treatable condition of gender dysphoria.”
The lawsuit asks the court to require Tricare to cover Jane Doe’s medically necessary gender-affirming surgeries and award damages to be determined at trial.