A Veterans Affairs hospital in Tucson, Ariz., is expanding treatment to a previously underserved faction of the armed services: transgender veterans.
It's one of the first VA hospitals in the country to open a clinic devoted specifically to the needs of veterans like Sue McConnell.
"In 1994 I was diagnosed with PTSD. I was also dealing with the fact that I was a woman," McConnell says.
McConnell came out as transgender while serving with the Navy in Vietnam, which meant leaving the military. Coming out took a personal toll as well, and her family has shunned her, but she says she simply had no choice.
"I had to be who I am, no matter the cost," she says.
McConnell is one of more than 130 transgender veterans receiving treatment at the Tucson VA. Due to the high demand for these services, the women's clinic at the hospital is now devoting one day a month to the expansion of care for transgender veterans.
"We have been flooded with phone calls since we've announced that the clinic will be opening — patients from all over wanting to know about it, to be able to take advantage of this opportunity," says Sonia Perez-Padilla, the women's clinic director. She's now also in charge of the transgender clinic, which includes a psychologist, social workers, clinical pharmacists and a therapist.
In 2011, the VA central office issued a directive that all Veterans Affairs hospitals begin to provide care for transgender veterans. That's when Perez-Padilla's women's clinic began offering treatment for gender dysphoria, which replaced the previous diagnosis of gender identity disorder.
"There's nothing wrong with these veterans, OK? They're unhappy because there's a mismatch between who they are and their biological organs, but it's not a disorder at all," she says.
Aside from hormone treatment and psychiatric care, the clinic offers a peer support group, something McConnell found helpful.
"The transgender support group gives us an outlet where we can talk about things that we need to talk about — such as clothing, makeup — you know, how to dress, how to act," she says.
But she says the best therapy is knowing she's not alone. "It's kinda like, oh, wow, there is somebody else like me," McConnell says.
Evan Young, a retired Army major and president of the Transgender American Veterans Association, says with so much recent attention paid to gays and lesbians in the military, he feels transgender service members and veterans have been overlooked.
"I get calls — daily — from veterans that have experienced discrimination," Young says. "When 'don't ask, don't tell' was repealed, we kinda got left back in the closet."
While gays and lesbians can now serve openly in the military, transgender people still can't. However, Defense Secretary Ash Carter created a working group in 2015 that's charged with ending the ban. And the VA issued another directive in 2013 clarifying and extending the range of procedures their hospitals are to provide to trans vets.
But Young says despite the progress, transgender veterans are still turned away at some VA hospitals. "For a lot of people, it's your last hope, and when you get that crushed, there's nowhere else to go," Young says.
While many veterans' hospitals around the country offer a range of services for trans vets, the Tucson VA as well as the VA in Cleveland are among the few that offer a standalone clinic.
While the VA offers pre- and post-operative treatment for trans vets, it does not cover the cost of or perform gender reassignment surgery. Perez-Padilla says covering the surgery would be the next logical step as the VA moves to providing equal care to everyone.
"If a veteran has an onset of cancer or a heart condition and needs a transplant — anything that might arise after they've served, we take care of it. We serve all who have served," Perez-Padilla says.
Because she says, regardless of gender identity, all of her patients identify as veterans.