By Autumn Shelton, West Virginia Press Association and “When All Are Counted” project
BECKLEY, W.Va. – Although the former United States military policy “Don’t Ask, Don’t Tell” has been repealed for more than a decade, the personal risks and concerns associated with that discriminatory law still remain for many of the nation’s veterans.
In July, NPR released a story, “LGBTQ Vets Still Suffering the Consequences of ‘Don’t Ask, Don’t Tell,'” that stated “an estimated 114,000 troops were forced out of the military because of their sexual orientation,” during the 17 years the policy was in place.
“Veterans who received an ‘other than honorable’ discharge from the military under ‘Don’t Ask, Don’t Tell’ were ineligible for veterans’ benefits. That meant missing out on benefits like free VA healthcare, VA-backed home loans or funds for college tuition,” the story continued, noting that only a fraction of veterans have since been reinstated due to policy change.
Even though VA medical clinics did not have the “Don’t Ask, Don’t Tell” policy, which would have prevented LGBTQ+ veterans from receiving necessary medical care, some of those who served were still terrified of having their status as a member of the LGBTQ+ community revealed, putting their health, as well as their careers, in jeopardy.
Today, the VA has implemented new steps to ensure a welcoming, inclusive environment for LGBTQ+ veterans, but a major hurdle still exists — getting veterans to feel comfortable discussing their status with their provider.
To help with this endeavor, every VA medical center now has a LGBTQ+ Care Coordinator. The LGBTQ+ Care Coordinator for the Beckley VA Medical Center is Brandi Coronado.
Coronado, along with Beckley VA Medical Center Public Affairs Officer Sara Yoke, discussed the role of the LGBTQ+ Care Coordinator, and the ongoing stigma for LGBTQ+ veterans, for the “When All Are Counted” project.
“Due to my time in the military, I know that there is still a stigma associated with being a member of the LGBTQ+ community,” Coronado began. “I didn’t encounter a lot of individuals who were open about being LGBTQ.”
Coronado served in the U.S. Army for eight years. She now holds a Master of Social Work degree, and said she began her work as a Beckley VA Medical Center LGBTQ+ Care Coordinator because she saw the need for veterans to have increased mental health support.
“I thought this would be a good opportunity for me to really get into this program and help the veterans know that someone will be there to support them,” Coronado said. “As a social worker, I work with marginalized populations — those who don’t have a voice.”
Coronado explained that the VA has estimated that there are one million veterans who are members of the LGBTQ+ community nationwide.
When asked how many LGBTQ+ veterans receive care at the Beckley VA Medical Center, which provides services to veterans in 11 of West Virginia’s southern counties, Coronado said she can’t make an estimate.
“At Beckley, right now, I couldn’t even put a number on it because there is not a lot of reporting on LGBTQ+ veterans,” Coronado said. “We are still building it. That’s one of the things we want to focus on — is asking veterans about their sexuality, their pronouns, and being able to pull data on that, because we don’t have any right now.”
Coronado is not the only healthcare provider who lacks sufficient data on marginalized populations.
Historically, members of the Black, LGBTQ+ and Disability communities have been described as “statistically insignificant” when it comes to healthcare data collection. This lack of public health data can lead to higher instances of substance abuse, certain cancers, sexually transmitted diseases, cardiovascular disease, depression, anxiety, suicide, and more.
“A lot of veterans are not forthcoming about it because of the military stigma,” Coronado continued. “And, a lot of people don’t realize that although the VA is affiliated with the military, the VA never had the ‘Don’t Ask, Don’t Tell’ policy. We have always been open to serving LGBTQ veterans, it just hasn’t really been talked about.”
Coronado said that she has talked to veterans who have admitted they never spoke about being LGBTQ+ because they didn’t know the VA stance, or their provider’s stance.
“I think being in a rural West Virginia community exacerbates that even more,” Coronado said.
In addition to this lack of understanding regarding VA policy, she explained that the current nationwide political climate causes concern among LGBTQ+ veterans, further restricting their ability to receive specific healthcare.
“Even though it seems to be a more accepting environment, there are political events that might stop this acceptance. I think that is a fear some veterans have; that in the future we could go backwards instead of forwards,” Coronado said.
“We know that being LGBTQ+ can lead to a higher risk for HIV or other sexually transmitted infections, and members of the LGBTQ+ community need additional cancer screenings and preventative care, but overall if they are afraid to come forward with that, then it does make it harder to determine that they are at a higher risk,” Coronado said. “Also, from a mental health standpoint, we know that veterans in the LGBTQ+ population are at a higher risk for intimate partner violence, military sexual trauma and suicide. That creates barriers as well, because if a veteran is not comfortable talking about their status, then it’s harder to recognize all of those other things that could be going on in their lives.”
In southern West Virginia, Coronado said that mental health concerns and intimate partner violence, which are often topics that are difficult for veterans to discuss, have become the primary services needed for LGBTQ+ veterans.
To help veterans engage in these difficult discussions, Coronado said she makes it a point to ensure the privacy of every veteran who needs healthcare.
“We abide by HIPAA (the Health Insurance Portability and Accountability Act of 1996, which requires protection of patient health information),” Coronado said. “If a LGBTQ+ veteran discloses their health information to me, I check with them to make sure that it’s okay to put that information in their patient records.”
Coronado explained that the Beckley VA Medical Center is working to include this information in patient records for data collection, but they want to make sure veterans feel comfortable sharing their healthcare information first.
“We also discuss with veterans, if we are referring them to a provider, if they want that provider to know their sexuality,” Coronado said. “I just discuss with them what they are comfortable with. Even if they tell me what their sexuality is, I don’t want to assume that it’s okay for me to share that information with other providers. So, I always have that discussion with them.”
Coronado said that while the Beckley VA Medical Center is able to accommodate 98 percent of veterans with their healthcare needs, others may be referred for community healthcare due to physical distance from a VA Medical Center.
Also, veterans may have specific requests, such as receiving counseling services from a provider who can relate to them on a personal level, such as a transgender counselor providing services to a transgender veteran, Coronado said. In this case, every attempt is made to get these services for the veteran.
“I always have connections to national LGBTQ+ programs,” Coronado said. “I would reach out to others to see if they could accommodate the veterans request.”
Telehealth services, through VA Video Connect, is another option that veterans have for specific healthcare needs.
“Every veteran is able to access that,” Coronado said, adding that the VA provides veterans with an iPad if they do not have access to a computer or device that would allow them to virtually connect with a provider.
The ultimate goal, Coronado said, is to make sure that employees at the Beckley VA Medical Center create an inclusive environment for all.
“The VA offers a lot of employee training on LGBTQ+ veterans, and transgender veterans specifically,” Coronado said, noting there are “at least” 20 different training programs a VA employee can go through to learn more about LGBTQ+ healthcare.
“We are also getting ready for a program called “At Ease,” Coronado explained. “It will be in-person for all employees and will orient them to proper terminology, how to discuss preferred pronoun use and how to discuss health disparities and challenges that veterans in the community face.”
The training will also include information on what a provider should do if they accidentally misgender a patient. Coronado said she plans to provide this training on a yearly basis.
For veterans who need transgender services, Coronado said the Beckley VA Medical Center currently offers mental health, gender affirming hormone therapy and community care referrals.
“We also have specific substance abuse, intimate partner violence, suicide prevention, whole health services, and infertility care,” Coronado said. “Right now, we provide all medically necessary gender affirming care for transgender veterans, with the exception of surgical intervention, but we do that through community care.”
Coronado stated that while the Beckley VA Medical Center does not have a large need for transgender services for veterans, she expects to see the number rise as more veterans become aware of the VA’s inclusivity.
“We want veterans to ‘Do Ask, Do Tell,’” Coronado said of the Beckley VA Medical Center. “We are inclusive, we are not going to discriminate against any type of veteran, and we have an abundance of services specifically for them. If there is something we don’t offer, then we will do everything in our power to get a veteran somewhere that does offer that service.”
Yoke added, “I would like to emphasize that our executive leadership — all of them — are very passionate about this topic and are continuing to create a healthcare environment where every veteran feels safe and secure in speaking their truth, while receiving the care they have earned.”
“It’s about taking that step and coming to the Beckley VA Medical Center to find out about the services,” Coronado said. “I would also like to add that we can help veterans who were discharged because of ‘Don’t Ask, Don’t Tell’ apply for discharge upgrades.”
“I feel like the national VA is headed in the right direction,” Coronado concluded, regarding their inclusivity policy. “I think our big thing is finding LGBTQ+ veterans, and making them feel comfortable coming out to us, so they can receive the care they need.”
About “When All Are Counted”
—The “When All Are Counted” project, directed by the Charleston-based nonprofit advocacy group Think Kids and funded by a grant from the Robert Wood Johnson Foundation, has two goals — to advocate for those who have historically been considered “statistically insignificant,” especially in the Black, Disability and LGBTQIA+ populations, and to create a statewide healthcare data surveillance system that includes everyone, not just those in the majority white population.
To make a change, and ensure that all are counted, residents throughout West Virginia are encouraged to participate and provide insight for this project. Those who wish to help may visit the “When All Are Counted” project website to register for updates, read informative articles written by the communications team, and discover upcoming dates for in-person and virtual focus groups.