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The Trump administration quietly reversed the policy, which means trans veterans won't be protected from discrimination at VA facilities.
Transgender people who have served the United States in uniform in the military will no longer be treated with dignity at Veterans Affairs facilities. The Department of Veterans Affairs on Friday afternoon rescinded Directive 1341, a policy that for years ensured transgender, nonbinary, and intersex veterans received respectful, clinically appropriate health care, The Advocate has learned.
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The directive provided clear protections for these veterans against discrimination within the VA system and established standards for their care, including access to hormone therapy, mental health support, and the ability to use VA facilities in accordance with their gender identity.
Directive 1341, officially titled Providing Health Care for Transgender and Intersex Veterans, was first issued in 2018 to affirm the VA's commitment to equitable health care for transgender and intersex veterans. It specified that transgender veterans be housed according to their gender identity in VA residential treatment programs and allowed them to use bathrooms and other facilities that align with their gender identity. The directive has undergone multiple updates, with amendments in 2020, 2023, and 2024 to strengthen LGBTQ+ health care protections further.
Related: VA psychologist resigns over worry about Trump’s ‘unethical’ orders restricting care for trans vets
However, internal VA documents reviewed by The Advocate outline key changes that have taken place as of Wednesday "VHA facilities have changed signage for intimate spaces such as bathrooms and locker rooms, which are now designated by sex (M, F) or unisex. Sex-segregated spaces such as inpatient and residential rooms will be maintained based on sex. Within that limit, inpatient and residential room assignment decisions should be made in line with clinical guidance to best support the health and safety of the veteran. For external public-facing communications that previously used the term 'gender' as a synonym for 'sex,' all references have been changed to 'sex' before reposting documents," one of the slides reads.
The presentation notes that VHA Directive 1341 would be rescinded because its terminology conflicts with President Donald Trump's "Defending Women" executive order. On January 20, Trump declared that the U.S. government only recognizes two genders according to sex assigned at birth, effectively denying trans identity. While the rescission presentation affirms the VA's commitment to continuing care for transgender veterans, it notes that there would be specific guidance for only "some areas of care." In a chat group conversation reviewed by The Advocate, one VA provider expressed particular concern about this vague language, worrying that it could allow for further restrictions in the future.
Related: Trump will ban trans women from women's prisons by removing trans inmates from rape protections
A VA doctor, speaking on the condition of anonymity out of fear of retaliation, described the decision as deeply troubling in a conversation with The Advocate. "This policy change is going to cause a lot of harm. Transgender veterans are already at significantly higher risk of suicide, and removing these protections will only deter them from seeking care at the VA, even when they are in crisis," they said. "The messaging from VA is that this won't impact patient care, but actions speak louder than words."
The anonymous doctor also revealed growing concerns over internal monitoring within the VA, saying that employees are afraid to continue providing certain types of care that may be deemed controversial, even if they are clinically indicated. "There's an email address where VA staff can essentially report each other. If someone decides that the care I provide does not align with their ideological beliefs, they could report me," they said. "It creates a climate of fear."
Screenshots of a conversation thread among VA providers, reviewed by The Advocate, reveal that some staff members discovered a remote monitoring and forensics tool called EnCase Enterprise Agent installed on their systems, raising further concerns about internal surveillance.
The Department of Veterans Affairs did not respond to The Advocate's request for comment.
The Modern Military Association of America, Minority Veterans of America, SPARTA, and Out in National Security condemned the move in a joint statement calling it a betrayal of veterans who have honorably served their country. "This decision will exacerbate our already devastatingly high suicide rates and push more veterans into crisis for no reason other than hate," Lindsay Church, executive director of Minority Veterans of America, said.
Related: Trump revokes Biden's order that lifted trans military ban, clearing way for new ban
Research from the Williams Institute underlines the heightened risks that transgender veterans face. Transgender people serve in the military at nearly twice the rate of their cisgender peers but experience significantly higher rates of discrimination, mental health challenges, and barriers to care. Advocates argue that the rescission of Directive 1341 strips away the protections designed to address these disparities.
"Today, the Department of Veterans Affairs (VA) rescinded the Veterans Health Administration’s (VHA) Directive 1341 — a lifesaving policy that ensured transgender, nonbinary, and intersex veterans received respectful, clinically appropriate health care, a joint statement by the LGBTQ+ advocacy groups read. "The directive protected access to hormone therapy, mental health care, and other vital services, while guiding VA facilities in providing culturally competent care. Its repeal threatens the dignity and well-being of countless veterans who rely on VA for equitable and inclusive health services."
The group said the change "is certain to have catastrophic mental and physical health consequences."
Rachel Branaman, executive director of the Modern Military Association of America, pointed to the broader implications of the policy shift. "Combined with the administration's planned cut of 80,000 VA employees, these actions demonstrate a blatant disregard for the nation's commitment to those who have served," Branaman said in a statement. "We must demand accountability and fight to restore these vital protections by urging Congress to protect veterans' rights and ensure they receive the respectful, clinically appropriate care they deserve without fear of discrimination."
Dr. Mary Brinkmeyer, a former VA psychologist who resigned from her position at the Hampton VA Medical Center in protest in February, said the repeal confirmed her worst fears. "It absolutely confirmed concerns because we'd been assured repeatedly by National LGBTQ+ Health that these directives were almost impossible to rescind. But obviously, rules are being disregarded all over the place, not just with LGBTQ Health," she told The Advocate.
Brinkmeyer explained that the directive was rescinded to comply with the "Defending Women" executive order, which defines gender as binary and fixed at conception. "I think trans veterans will be less likely to come to the VA for care if they are not allowed to use the bathrooms that match their identities. Unfortunately, I also think they will be less likely to seek emergency care if they are suicidal because they won't want to be housed in an inpatient unit in a way that disregards their gender identity," she added.
SPARTA President Emily Shilling, who is suing the Trump administration to block the Pentagon's ban on trans service members, called it a betrayal.
“The foundation of military service is trust, trust in leadership, in our fellow service members, and in the promise that if we give our all, we will be taken care of,” Shilling said. “Yet today, transgender service members are being forced out, denied basic dignity at the VA, and are now being stripped of the healthcare promised to every veteran who served honorably. This is a betrayal of that sacred trust, one that weakens our force, our veterans, and the nation we swore to defend."
