A transgender veteran’s advocacy group has filed a second lawsuit against the Department of Veterans Affairs. The legal action is aimed at compelling the agency to include “gender-affirming” surgery for former service members.

The organization, as well as others, have pressed Veteran’s Affairs for years to cover surgeries intended to help former service members “transition” to the opposite sex, arguing that it is essential for their mental health. This lawsuit is the latest development in their fight to have the procedures covered by government benefits.

In a federal complaint filed Monday, the Transgender American Veterans Association (TAVA) challenged the Department of Veterans Affairs’s (VA) denial of a 2016 petition asking the VA to begin the process of expanding its health benefits to cover gender-affirming surgery for transgender veterans.

While other gender-affirming treatments — including hormone therapy, fertility preservation and hair removal — are covered by the VA, the department has effectively banned transgender veterans from accessing surgery since 2013, when a department directive stated that the VA “does not provide sex reassignment surgery.”

VA Secretary Denis McDonough at a 2021 Pride Month event in Orlando said the department planned to expand care for transgender veterans to include surgery but cautioned that implementing the change would take time.

TAVA’s lawsuit, filed Monday in the U.S. Court of Appeals for the Federal Circuit in Washington, D.C., claims the VA’s refusal to provide gender-affirming surgery “defies clear medical consensus” and discriminates based on sex and transgender status. It asks the court to review the VA’s denial of the group’s 2016 rulemaking petition and to direct the VA to provide gender-affirming surgery.

Josie Caballero, the organization’s vice president, vowed that TAVA “will not stand idly by as VA continues to discriminate against and breaks its promises to transgender veterans” and stated that the agency’s “refusal to provide gender-affirming surgery is an affront to the dignity and well-being of transgender veterans.”

The first lawsuit was filed in January 2024 and is also aimed at having Veteran’s Affairs help former service members suffering from gender dysphoria.

The lawsuit from the Transgender American Veterans Association seeks to compel the VA to codify in its regulations verbal assurances the department has made that it would begin providing those services, said Rebekka Eshler, the president of the association.

She said the surgeries are needed to reduce the risk of suicides, depression, and psychological distress for transgender people who live with gender dysphoria.

“It would also mean that those veterans do not have to seek this care through private doctors, which is often prohibitively expensive,” the transgender veterans association said in its lawsuit, which it said was filed in the United States Court of Appeals for the Federal Circuit in Washington.

The veterans first petitioned for the rule change in May of 2016. Since then, the VA has held hearings and prepared multiple proposed rules for cost-benefit analysis, the association said. But while the VA currently provides hormone therapy and other services to transgender veterans at some locations, it has failed to change its rules in a timely manner and provide any coverage for the surgeries, the group said.

“I get phone calls from veterans that are so in crisis that they are calling us because they can’t handle it anymore and they are wanting to go kill themselves,” Eshler said.

The American Civil Liberties Union (ACLU) has been involved in the effort to allow taxpayer funds to be used for “gender-affirming” treatments for veterans. The organization notes that “transgender veterans have fought for the Department of Veterans Affairs to end its discriminatory restrictions on the forms of gender-affirming care that are provided by VA clinics and covered by VA insurance” and argued that “political extremists in Congress threaten to undo that progress and defund health care not only for transgender veterans, but for hundreds of thousands of transgender people who benefit from federally-funded programs like Medicare and Medicaid.”

Republicans in the legislature have pushed legislation barring federal funds from being used to support “gender-affirming” surgeries for anyone, including veterans.