Sunday, 26 December 2010

TS, IS, and the US Military

Army Regulation 40–501 lays out the Standards of Medical Fitness required for service in the US Army.

All references such as (302) are to diagnostic codes in the World Health Organisation's ICD-9 manual from 1977, superseded in 1992 by the ICD-10.

Homosexuality is listed in the ICD-9 under code 302.0 as a mental illness, a "psychosexual condition".

2–27. Learning, psychiatric and behavioral disorders

n. Current or history of psychosexual conditions (302), including, but not limited to transsexualism, exhibitionism,
transvestism, voyeurism, and other paraphilias, do not meet the standard
3–35. Personality, psychosexual conditions, transsexual, gender identity, exhibitionism, transvestism, voyeurism, other paraphilias, or factitious disorders; disorders of impulse control not elsewhere classified

a. A history of, or current manifestations of, personality disorders, disorders of impulse control not elsewhere classified, transvestism, voyeurism, other paraphilias, or factitious disorders, psychosexual conditions, transsexual, gender identity disorder to include major abnormalities or defects of the genitalia such as change of sex or a current attempt to change sex, hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis or dysfunctional residuals from surgical correction of these conditions render an individual administratively unfit.

b. These conditions render an individual administratively unfit rather than unfit because of physical illness or medical disability. These conditions will be dealt with through administrative channels, including AR 135–175, AR 135–178, AR 635–200, or AR 600–8–24

AR 135–175 Separation of Officers
AR 135–178 Enlisted Administrative Separations
AR 635–200 Active Duty Enlisted Administrative Separations
AR 600–8–24 Officer Transfers and Discharges

2–14. Genitalia

a. Female genitalia.

(5) History of major abnormalities or defects of the genitalia such as change of sex (P64.5), hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis (752.7), or dysfunctional residuals from surgical correction of these conditions does not meet the standard.

(9) Uterus, congenital absence of (752.3), or enlargement due to any cause (621.2) does not meet the standard.

b. Male genitalia

(1) Current absence of one or both testicles, either congenital (752.89) or undescended (752.51) does not meet the standard.

(5) History of penis amputation (878.0) does not meet the standard.

d. History of major abnormalities or defects of the genitalia, such as a change of sex (P64.5), hermaphroditism, pseudohermaphroditism, or pure gonadal dysgenesis (752.7) or dysfunctional residuals from surgical correction of these conditions does not meet the standard.

I am not a lawyer, and I think it would take one, a good one, to deal with this tangled mess.

The problem is in the various subsidiary regulations about "Administrative Discharge". AR 635–200 is the only one that's clear; there, Transsexuality is called out specifically, as a category like sea-sickness that may be cause for separation. But AR 135–175 requires that the medical condition be proven to interfere with effectiveness, or that it be classified as a "personality disorder". It's difficult to see how an Intersex condition could be so classified, though in the ICD-9 anyway, transsexuality is so defined. The other two deal with personality disorders, or medical issues that would require medical, not administrative, discharges, or that would preclude induction if found during the early part of service. At least, that's from a first reading.

And of course, homosexuality is in all those regulations too, as a medical condition requiring discharge. This will have to be changed as part of the DADT repeal process.

And that leads to the question - why not deal with IS and TS issues too at the same time? Update the regulations so they're at least current with the state of medical knowledge in 1992, as opposed to 1977? I suspect the reason why the ICD-9 has persisted is simply because that was the last version that had homosexuality listed as a mental disease, and without that justification, something like DADT was needed to keep the Gays out - or at least closeted.

As for IS - exactly what military duties require the presence of a uterus, or two testes (one will not do) and a penis? The Spanish Army was faced with a similar issue not that long ago. A great deal of fun was poked at the Spaniards by many Americans, not realising that their Army had exactly the same bizarre requirements.

The ICD-11 is due out in 2015. The current controversy about the US DSM-V will certainly have some effect on the content. In the meantime, we have regulations based on 40 year old medical standards, words such as "hermaphrodite" within them whose medical definition has changed, and an enormous mess. All due to successful attempts to inject religious and political ideology and the "ick" factor into what should be a scientific issue.

Yes, there are some Intersex conditions that should be excluded on the same grounds as other medical issues. The requirement for constant hormonal maintenance for example. Yet post-menopausal women are allowed to serve. Let's have a level playing field, with the same kind of latitude shown to IS and TS people as is shown to others with similar medical issues. No more, no less. Only medical conditions that actually cause significant decrease of military efficiency should be excluded, those with a mild, treatable level or no level at all should be allowed.

Lest I be accused of wanting to compromise military effectiveness in the name of political correctness, consider cases like this one.
Frederick Melvin Franks, Jr. is a retired General of the United States Army. He is considered a military visionary and a distinguished combat commander, famous for having commanded the Gulf War coalition VII Corps in the highly successful "Left Hook" maneuver against fourteen Iraqi divisions, a number of whom were Iraqi Republican Guard, defeating or forcing the retreat of each with fewer than 100 American casualties lost to enemy action, a feat unmatched in modern warfare.
While fighting in Cambodia he was severely wounded, and after a series of unsuccessful surgeries, lost his left leg, which was amputated below the knee. Franks fought to remain in a combat unit, something not normally granted amputees, and was eventually permitted to remain in combat arms.
How many body bags would have been filled had he been thrown out of the military for not meeting arbitrary medical requirements?

How much talent has already been wasted?
Preece, who was 51 at the time, worked then — as she does now — for the Library of Congress, where she helps make hiring decisions for the Congressional Research Service (CRS), the U.S. Congress's analysis agency. She had decided to recommend an ex–Special Forces colonel named David Schroer to be CRS's terrorism specialist. Schroer was a dream candidate, a guy out of a Tom Clancy novel: he had jumped from airplanes, undergone grueling combat training in extreme heat and cold, commanded hundreds of soldiers, helped run Haiti during the U.S. intervention in the '90s — and since 9/11, he had been intimately involved in secret counterterrorism planning at the highest levels of the Pentagon. He had been selected to organize and run a new, classified antiterrorism organization, and in that position he had routinely briefed Defense Secretary Donald Rumsfeld. He had also briefed Vice President Dick Cheney more than once. Schroer had been an action hero, but he also had the contacts and intellectual dexterity to make him an ideal congressional analyst.

But now, about three weeks before Schroer was to begin work at CRS, he told Preece over a Chinese lunch that he had a personal matter to reveal: after years of cross-dressing in private, he was preparing to start living full time as a woman. He would also probably have sex-reassignment surgery. And so he planned to start at CRS as Diane Jacqueline Schroer, not David John Schroer.
At a time when the US Army is granting wavers for gang-members, racists and others of questionable character because not enough recruits are coming in, I think these issues should be re-thought. Just as they were in Australia, where we too could no longer afford the luxury of wasting such precious human resources just because of irrational distaste.

I repeat - exactly what military duties require the presence of a uterus, or two testes (one will not do) and a penis?


RadarGrrl said...

As the eighth Canadian Forces member to transition in uniform, don't get me started. I can tell you first hand that, just like the whole DADT thing, any problems that might occur will be manufactured. There are no real barriers. I am living proof of that.

Anonymous said...

Geeze, where to start. With 20 years experience in the US Military I’ve dealt with Transgender, Intersexed and service members who were injured in the line of duty in such a manner that they lost reproductive organs.

Everyone got a med board to determine their ability to do the job and meet the physical standards. Except for the two CAIS women I worked with who were rubber stamped and had to fight to just stay in until the end of their contracts. Intersexed people simply are not allowed out of the gate. I’m lucky, when it was discovered that I was IS, my doctor refused to send me to a medical board simply because he knew that our command would not benefit from losing me.

As for Transgender service members, I’m proud to say I know several who are allowed to serve their nations military openly and receive the appropriate medical care. Sadly, the US military acts like a childish bully when it comes to US military members who are Transgender. I also know a good number of active duty US military who are transgender and I help them the best I can. Over the past 5 years, I’ve heard stories from those service members that quite frankly can be quite horrific. It’s getting better, but it’s too slow and too little and while they drag their feet the commands do not seem to try to keep the persons private medical information private and at times it seems like they target those people for institutional harassment (like taking point on patrols endlessly or being given the worst job they can find) and all too often, they drag the person along for months with no clue as to when they’ll be discharged and then abruptly discharge them with little notice. (like, being told for 18 months that they’ll be discharged in 90 days but after 18 months of waiting for the discharge process to officially start, get woken up at 6am being told to pack up and get out with no prior notice.)

Sadly, I just don’t see the US DoD moving in any good direction with these issues at all. If anything, with DADT being repealed I think you’ll see them digging in their heels on these issues for the next 5 to 10 years conservatively.

Rob said...

Why all the fuss? Why would anybody in their right mind want to serve in the military anyway?

RadarGrrl said...

@ Rob: Because I've spent over half my life in the service of my country. What have you done for yours?

Rob said...

@RadarGrrl: What have I done for my country? I've paid taxes; I've been a teacher to the next generation; I've donated money to the needy; I've volunteered for charitable organizations.

Anybody who believes that the only way to serve one's country is to join a war machine (that's what the military is) has a lot of thinking and soul-searching to do.

Zoe Brain said...

@Rob - I'll quote Churchill (often attributed to Orwell) on the subject.

"We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm."

Orwell wrote in his essay on Kipling,

"He sees clearly that men can only be highly civilised while other men, inevitably less civilised, are there to guard and feed them."

In his 1945 "Notes on Nationalism", Orwell claimed that the statement, "Those who ‘abjure’ violence can only do so because others are committing violence on their behalf" was a "grossly obvious" fact.

RadarGrrl said...

@ Rob: I'm not going to dignify your response with a response of my own.

Rob said...

@Zoe: And you can add to those quotes the following from Thomas Friedman: "McDonalds cannot flourish without McDonnell Douglas, the designer of the F-15" (just as well I don't eat McDonalds crap).

Orwell's essay on Kipling pointed out that humanitarianism and pacifism in highly-industrialized nations are a "sham" - e.g. the following quote:
"All left-wing parties in highly-industrialized countries are at bottom a sham, because they make it their business to fight against something which they do not really wish to destroy"

"A humanitarian is always a hypocrite, and Kipling's understanding of this is perhaps the central secret of his power to create telling phrases."

This means that the quotes from Churchill, Friedman, Dubya, etc. - which justify war - are seen to have legitimacy. I think that Einstein understood this when he wrote:
"The course of events in the last few years has once more shown how little we are justified in leaving the struggle against armaments and against war spirit to the Governments". Einstein hoped for an organized global system of conscientious objection - to make "the problem of pacifism an acute one, a real struggle ..."

Maybe I'm an idealist; the only conflicts I like to see are ones such as Gould vs Conway-Morris or Huxley vs Wilberforce or Curtis vs Shapley or Bohr vs Einstein or the Black Hole War (information paradox): conflicts in which no children are murdered by "smart weapons".

I'd like to see a world similar to the one depicted in Aldous Huxley's "Island" ... but I won't see it in my lifetime.

Keep up the good work, Zoe.

Anonymous said...

The US Army (& I assume other services) can and does allow post-op TS to serve on active duty on rare cases where the individual in question has "critical" skills...