VA Health Care: Better Data Needed to Assess the Health Outcomes of Lesbian, Gay, Bisexual, and Transgender Veterans

What GAO Found

The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) analyzes national-level data by birth sex to assess health outcomes for women veterans. For example, it analyzes frequency data to identify their most common health conditions. However, VHA is limited in its assessment of health outcomes for the lesbian, gay, bisexual, and transgender (LGBT) veteran population because it does not consistently collect sexual orientation or self-identified gender identity (SIGI) data.

VHA officials stated that providers may record veterans’ sexual orientation—which can be used to identify lesbian, gay, and bisexual veterans—in non-standardized clinical notes in electronic health records. However, without a standardized field, providers may not be consistently collecting these data, and VHA does not know the total number of these veterans in its system. VHA officials recognize the importance of consistently collecting these data, but have yet to develop and implement a field for doing so.

VHA collects SIGI data—which can be used in part to identify transgender veterans—in enrollment, administrative, and electronic health record systems. Although VHA has worked to improve the collection of these data, GAO found inconsistencies in how VHA records SIGI and, according to VA, 89 percent of veterans’ records lack SIGI information. VHA added a field to collect this information in the administrative system; however, these data are not linked to electronic health records. As such, VHA providers cannot see the data during clinical visits when determining the appropriate services for transgender veterans, such as screening certain transgender men for breast and cervical cancers, as required by VHA policy. VHA’s plan to link SIGI data across both systems has been postponed several times, and the data remain unlinked.

VHA Sexual Orientation and Self-Identified Gender Identity (SIGI) Data Collection Limitations, Fiscal Year 2020

Until VHA can more consistently collect and analyze sexual orientation and SIGI data for the veteran population served, it will have a limited understanding of the health care needs of LGBT veterans, including any disparities they may face.

Why GAO Did This Study

VHA provides care to a diverse population of veterans, including women and LGBT veterans. These veterans may experience differences in health outcomes that are closely linked with social or economic disadvantage, and VA considers it important to analyze the services they receive as well as their health outcomes to improve health equity.

House Report 115-188 included a provision for GAO to review VA’s data collection and reporting procedures for information on veterans’ gender and sexual orientation. This report describes how VHA assesses health outcomes for women veterans and examines the extent to which VHA assesses health outcomes for LGBT veterans.

GAO reviewed VHA directives and VHA’s Health Equity Action Plan. GAO interviewed officials from VHA’s Women’s Health Services and LGBT Health Program, VHA researchers who focus on women and LGBT veterans, and representatives from other health care systems with experience collecting gender and sexual orientation information.

What GAO Recommends

GAO is making four recommendations to VA to consistently collect sexual orientation and SIGI data, and analyze these data to assess health outcomes for LGBT veterans. VA concurred with GAO’s recommendations and identified actions it is taking to address them.

For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.

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  • Switzerland’s Largest Insurance Company and Three Subsidiaries Admit to Conspiring with U.S. Taxpayers to Hide Assets and Income in Offshore Accounts
    In Crime News
    The Department of Justice today filed a criminal information charging Swiss Life Holding AG (Swiss Life Holding), Swiss Life (Liechtenstein) AG (Swiss Life Liechtenstein), Swiss Life (Singapore) Pte. Ltd. (Swiss Life Singapore), and Swiss Life (Luxembourg) S.A. (Swiss Life Luxembourg), collectively, the “Swiss Life Entities,” with conspiring with U.S. taxpayers and others to conceal from the IRS more than $1.452 billion in offshore insurance policies, including more than 1,600 insurance wrapper policies, and related policy investment accounts in banks around the world and the income generated in these accounts.
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  • Secretary Antony J. Blinken and Canadian Foreign Minister Marc Garneau Before Their Meeting
    In Crime Control and Security News
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  • Global Coalition to Defeat ISIS Meeting on ISIS Threats in West Africa
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  • Statement from Assistant Attorney General Eric Dreiband and Acting U.S. Attorney for the District of Columbia Michael Sherwin on Legal Victory Protecting Religious Worship in the Nation’s Capital
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  • Department of Justice Awards over $1.8 Billion in Grants to Assist Victims Nationwide
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  • International Trio Indicted in Austin for Illegal Exports to Russia
    In Crime News
    A four–count federal grand jury indictment returned in Austin and unsealed today charges three foreign nationals – a Russian citizen and two Bulgarian citizens – with violating the International Emergency Economic Powers Act (IEEPA), Export Control Reform Act (ECRA), and a money laundering statute in a scheme to procure sensitive radiation-hardened circuits from the U.S. and ship those components to Russia through Bulgaria without required licenses.
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  • Secretary Pompeo’s Call with Japanese Foreign Minister Motegi
    In Crime Control and Security News
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  • Justice Department Settles Investigation into Language Barriers in the Hazleton Police Department
    In Crime News
    The Justice Department today announced it has reached a settlement agreement with the Hazleton Police Department (HPD) and the City of Hazleton, Pennsylvania, to help people with limited English proficiency (LEP) communicate with the police.
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  • Former Veterans Affairs Doctor Pleads Guilty to Three Civil Rights Offenses
    In Crime News
    A doctor of osteopathic medicine who formerly worked at the Veterans Affairs (VA) Medical Center in Beckley, West Virginia, pleaded guilty today to three counts of depriving veterans of their civil rights under color of law by sexually abusing them.
    [Read More…]