‘Profound alarm’: US veterans agency roiled by fight over anti-discrimination provisions

The US Department of Veterans Affairs has enthusiastically joined Donald Trump’s war on DEI – demanding that staffers report colleagues who engage in diversity initiatives, banning LGBTQ+ pride flags from VA hospitals and shuttering an office investigating why Black veterans are more likely to have their mental health disability claims rejected.

Last week, VA secretary Doug Collins tweeted that “VA is now squarely focused on Veterans – not out-of-touch, woke causes such as DEI and gender dysphoria treatments.”

Collins’ pronouncement comes as he faces tough questions from US Senate and House members in the wake of a Guardian report that the agency had quietly removed language from its hospital bylaws that explicitly barred discrimination based on patients’ marital status or political views.

Seventy House members wrote to express “profound alarm” that doctors and other VA medical providers “will now be able to refuse treatment” based on veterans’ political views or whether they are unmarried, widowed or part of a same-sex couple.

Collins and his agency have pushed back with a series of puzzling statements, saying the bylaw changes were merely a “formality” and were required by a Trump anti-transgender executive order banning “gender ideology extremism” – even though the Trump order says nothing about marital status or political affiliations.

Especially novel – given the VA and the Trump administration’s adamant anti-DEI stance – was the agency’s argument that the bylaw changes did not matter because unmarried or politically active patients would still be protected by a 2013 Obama administration DEI directive.

Kayla Williams, an Iraq war veteran who is a former VA assistant secretary for public and nongovernmental affairs and former director of the VA’s Center for Women Veterans, said the agency’s explanation “doesn’t make any sense”.

“If this change isn’t going to lead to any of the things we’re worried about, why would they make it?” she asked. “They’re talking out of both sides of their mouth. You know they don’t like Obama policies.”

The VA told the Guardian the directive “remains in effect” and that “under no circumstances whatsoever would VA ever allow any employee to refuse to provide appropriate care to any eligible veteran”.

The VA declined requests to make Collins available for an interview. On Tuesday, the Guardian sent the agency a five-page email that included 19 questions and details of the issues examined in this story. The VA press secretary, Peter Kasperowicz, responded with a 126-word statement that ignored nearly all of the Guardian’s questions. The statement said the Guardian and the story’s author “are purveyors of disinformation with a history of maliciously false reporting on Veterans issues. Nothing they say can be trusted.”

“Here is the truth: Under Secretary Collins, VA doesn’t tolerate discrimination against Veterans or VA employees on any grounds, and multiple federal laws and VA policies prohibit discrimination,” the statement added. It cited federal code sections that address discrimination in employment and cover overall healthcare eligibility and enrollment practices at VA, but are silent on the subject of discrimination involving veterans who are patients.

The statement also cites the VA’s Obama era anti-discrimination directive. The protections for veterans included in the directive include language that forbids discrimination based on “gender identity and transgender status”. But advocates say the agency is actively discriminating against transgender veterans under Trump by denying them many healthcare services.

In the same document that ordered changes to the medical bylaws, VA leadership also required hospital directors to “remove” education and outreach materials “that provide information about gender identity, gender diversity or gender inclusivity”. Physical items like posters and brochures “may be discarded”, according to the document. Archived and inactive digital material “may be automatically restricted”, the document says, as part of efforts by the VA’s technology unit to “identify and hide documents”.

The Guardian asked the VA about the directive to remove and restrict records. The VA did not respond.

Doron Dorfman, a law professor at Seton Hall who specializes in healthcare discrimination, said the medical bylaw changes were especially concerning because – unlike protections for race, sex, age, national origin and disability, which are enumerated in federal law – the Trump administration can wipe away rights for equal medical treatment on the basis of marital status and politics by rescinding the 2013 directive.

The nearly 100 members of Congress who have signed letters complaining about the changes indicated they are not satisfied with the agency’s assurances.

Senators led by Richard Blumenthal of Connecticut, the ranking Democrat on the Senate veterans affairs committee, and Senate minority leader Chuck Schumer of New York, called the revisions “deeply dangerous and pernicious in practice and principle”.

Under questioning from Senator Patty Murray during a 24 June public hearing, Collins reiterated his position that the bylaw changes were meaningless.

“Nothing was changed that actually affected” protections for veterans, he said.

“When you take words out, people hear them,” Murray, a Democrat from Washington state, pressed. “Therefore, I’m asking why don’t you put them back in?”

Collins refused. “No,” he said. “I can’t believe we’re still talking about this … No one is being discriminated against at VA.”

After the hearing, they continued the argument over social media – with Collins accusing Murray of “lying” and Murray replying: “Did you or did you not explicitly REMOVE language requiring health care professionals to care for veterans regardless of their politics & marital status?”

Collins’ social media comment about DEI being an “out-of-touch, woke cause” came in a separate exchange with Representative Ilhan Omar, in response to the Minnesota Democrat’s charge that the agency’s plans to cut 30,000 staffers will “devastate veterans who depend on timely care and benefits”. Collins touted the rollback of diversity, equity and inclusion programs as one of the “commonsense reforms” that are allowing the agency to better serve veterans.

Collins has also pushed back against the Guardian – appearing on conservative outlets Fox News, Newsmax and Barstool Sports to denounce the news organization’s reporting on the bylaw changes. He called the story “fabricated”, “ridiculous” and “false and unbelievable”.

Both the VA and White House demanded a retraction. The Guardian amended the story with additional context provided by the VA after publication, but did not retract it.

VA officials took a similar tack in March when the Advocate, a national LGBTQ+ publication, revealed the Trump administration had “quietly reversed” an agency policy ensuring gender affirming care for transgender veterans. The agency’s press secretary, Kasperowicz, demanded a retraction. “No such policy change has been made,” he said.

Three days later, the VA publicly announced that it had reversed the policy and declared that it was ending gender-affirming medical care for transgender veterans.

“All eligible Veterans – including trans-identified Veterans – will always be welcome at VA and will always receive the benefits and services they’ve earned under the law,” Collins said. “But if Veterans want to attempt to change their sex, they can do so on their own dime.”

The agency said the move was required by Trump’s 20 January executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” – the same order that the agency is now citing to justify the hospital bylaw changes. Trump’s executive order declares that there are “two sexes, male and female” that are “not changeable and are grounded in fundamental and incontrovertible reality”.

A lawsuit filed on 9 June by a transgender veteran with the backing of the Yale Law School’s Veterans Legal Services Clinic alleged that her hormone treatments had been wrongly discontinued.

Four days after being sued, the VA reversed itself, and agreed to resume the veteran’s hormone therapy. The veteran then dropped her suit before the court of appeals for veterans claims – leaving the underlying legal issues unresolved.

“It should not require a federal lawsuit for VA to fulfill its obligation to provide healthcare for veterans injured during service,” law clinic member Hillary Browning said. She said the VA “should reassess any decisions terminating or denying gender-affirming care for other transgender veterans”.

Representative Maxine Dexter, a Democrat from Oregon, and a physician who worked for eight years at VA hospitals, said she saw the changes in the medical bylaws and the removal of protections for trans veterans as part of a larger plan to politicize the VA. “As doctors we’re supposed to treat the patient in front of us, whoever they are,” she said.

New barriers

Legal experts say the recent changes to the VA’s medical bylaws created a murky situation where individual medical officers and patients will be left to themselves to interpret what is legal and what is not.

Dr Ken Kizer, the former head of the VA healthcare system, said the changes open up the possibility that doctors could refuse to treat veterans based on their “reason for seeking care – including allegations of rape and sexual assault – current or past political party affiliation or political activity, and personal behavior such as alcohol or marijuana use”.

The legal experts and veterans advocates said the impact of the revisions would probably fall hardest on female veterans, LGBTQ+ veterans and those who live in rural areas where there are fewer doctors.

After the bylaw changes were publicly reported, veterans in multiple states told the Guardian that they worried whether their own recent problems accessing care were linked to the rollback of explicit anti-discrimination protections.

Air force veteran Domonic Medley, 43, who is gay and lives in Dothan, Alabama, said he had to drive four hours roundtrip to Montgomery to receive routine injections of prophylactic HIV medication after staff at his local clinic said they were “unable” to administer the jab. He suspects discrimination.

“I’m not asking to undergo open heart surgery in my small, community based clinic,” he said. “I’m asking to receive a very simple injection, which just happens to be most commonly prescribed to gay men.”

After the Guardian’s story was published in June, Medley complained to an infectious disease specialist at the VA in Montgomery. The doctor tried to set Medley at ease, saying the prescribed medication might be “unfamiliar” to clinic staff, but added that he “was never made aware of any reason why the dose could not be given”.

The doctor also told Medley she had since been notified that the “medication could be given locally by the nursing staff at the Dothan clinic with some pre-planning”.

In April, Carrie Sutton, a 13-year Navy veteran, received a call from a wellness coach from the Department of Veterans Affairs’ “whole health” team. The coach asked her: “What do you want your health for? What brings you joy and happiness?”

Sutton, a former cryptologist who served a tour combating pirates off the coast of Somalia, told the coach she wanted her family and community to feel safe, but she added that she was upset by the plans to lay off tens of thousands of VA workers. Sutton wanted “to not have the VA gutted, to be able to have VA care and that VA employees feel safe”, her medical record shows.

Soon after, Sutton’s appointment with a neurologist near her hometown of Conesville, New York, was cancelled. She could still receive treatment for service-connected migraines and fibromyalgia, the agency said, but her permission to get treatment in her community had expired and would not be renewed. Sutton, a survivor of military sexual trauma, would now have to drive more than two hours roundtrip to a major VA medical center to see a doctor. Sutton believes she was punished for speaking out.

“I have to think it was what I said,” she said. “I can see no other reason why.” She filed a complaint with the patient advocate at her VA medical center.

The VA declined to comment on Medley and Sutton’s experiences, despite signed releases from both veterans. “I’m not really surprised they didn’t actually address the issue,” Sutton said. It “seems to be the current trend in the country right now. There is no transparency.”

Lois Weithorn, a professor at the University of California San Francisco School of Law, said denials of care might ultimately have to be addressed through litigation, but that the changes to the medical bylaws “could cause substantial delays in the provision of care to veterans, and create difficult obstacles for sick veterans who must challenge denials of care”.

‘Fairly and equally’

The VA runs the nation’s largest integrated healthcare system, serving 9 million veterans a year across 170 hospitals and more than 1,000 clinics.

Like any large hospital system, the VA has long struggled to ensure benefits are provided equitably. A 232-page report, published by the agency in 2022, found that Black and Native American veterans received significantly lower quality healthcare than non-Hispanic white veterans, while women veterans over 65 years old faced “large gaps in quality” compared with male veterans in the same age group.

The report also found “female veterans of reproductive age” reported far worse patient experiences than male veterans of the same age group, while Black, Asian and Hispanic veterans reported worse experiences than whites.

Disparities have also been endemic when it comes to the provision of benefits. A 2023 report by the Government Accountability Office, the investigative arm of Congress, found the VA was far more likely to deny disability claims filed by Black veterans than white veterans.

Under President Joe Biden, the VA worked to confront these problems, including deploying a team within the VA’s Office of Equity Assurance to address the disability benefits issues for Black veterans.

In March, the VA “liquidated” the office of equity assurance, placing staff on administrative leave, according to the investigative news outlet ProPublica.

The VA said the office was being liquidated because there is no longer discrimination at the VA.

Under Collins’ leadership, press secretary Kasperowicz told ProPublica, the VA “treats all veterans and beneficiaries fairly and equally, so the Office of Equity Assurance is no longer needed”.

Richard Brookshire, a former US army combat medic and co-founder of the Black Veterans Project, called that statement “laughable”.

Brookshire, an Afghanistan war veteran, noted that during the first Trump administration, the VA produced an internal report that found just 43% of Black veterans’ post traumatic stress disorder claims were approved compared to 57% for non-Hispanic white veterans. The report provided a detailed analysis of where disparities were greatest based on a long list of factors, accounting for the veterans’ income, age, education, the state where the veteran lived and the war where the veteran served.

“They know this is happening,” Brookshire said. “They just don’t want to do anything about it.”

Chilling effect

Veterans and VA employees said the Trump administration’s clampdown on diversity efforts has created a chilling effect with far reaching consequences.

In Seattle, Iraq war veteran and former army intelligence sergeant Selena Coppa said she spent almost half of a recent therapy session talking to her therapist “about their own fear of getting fired because they had participated in various forms of political activity”.

Staffers’ concerns rose two days into Trump’s second term, when then acting VA secretary Todd Hunter sent an all staff email that asked VA workers to report colleagues who are “using coded or imprecise language” to “disguise” diversity efforts.

“Failure to report this information within 10 days may have adverse consequences,” the email said.

In the months that followed, Coppa said, posters and pamphlets providing information on sexual health, disease transmission and suicide prevention disappeared from the women’s clinic in Seattle. Rainbow flags have also been removed and some of the most caring clinicians have quit, Coppa said.

“What’s going to be left and who’s going to be left?” she said. “It’s like a grim horror movie” that also impacts the healthcare available to straight veterans.

The women’s health medical director at another VA hospital, in California, said basic information about women’s healthcare – including posters and pamphlets – was also removed from her hospital. Half of the staff of the women’s clinic have either resigned or are looking for work, she said. “You can’t erase the word ‘gender’ without impacting women,” she said, requesting anonymity to avoid being publicly attacked.

The Guardian asked the VA about reports of disappearing pamphlets, loss of staff and low morale at VA women’s clinics. The agency did not answer.

‘Seriously compromised’

Experts say the lack of gender affirming care will have a major impact on trans veterans’ mental health, experts say. VA researchers have found elevated rates of suicide among lesbian, gay, bisexual and transgender veterans – with trans veterans dying by suicide at more than twice the rate of cisgender veterans.

The VA did not answer a question from the Guardian about the mental health impacts of ending gender affirming care.

In Pittsburgh, transgender Navy veteran Rayven Greer lost her therapist, when he resigned.

The therapist, a licensed clinical social worker, said he could not ethically continue to treat Greer because he had been instructed that, consistent with Trump’s executive order, he had to refer to his patient by her birth name and gender in his clinical notes. The therapist spoke on condition of anonymity because he feared online attacks and unwanted political attention to his new employer.

Greer, a survivor of military sexual trauma who suffers from post traumatic stress disorder, said she is now struggling to create a relationship with a new therapist in an atmosphere where her identity as a trans woman is being held in question.

“I get ‘sirred’ all the time,” she said. “It’s very obvious that I look like Rayven. I use she/her pronouns, but they refuse to follow that.”

The VA’s updated clinical practice guidelines for treating trans veterans direct staff to address veterans by their preferred name and pronoun, saying that doing so “demonstrates respect”, but Greer said that hasn’t been her experience. VA clinicians regularly refer to her as a “MALE” in her VA medical record.

The VA did not respond to questions about Greer’s care, despite a signed release from the veteran.

Harold Kudler, a psychiatrist who served as a top VA mental health official under Obama and the first Trump administration, said the changes at the VA are not small matters.

“A psychotherapist who can neither be present nor genuine with patients is seriously compromised,” Kudler said. “By creating an environment in which neither veteran nor clinician feels safe in speaking frankly and honestly, there can be no new understanding, no growth, and no healing.”