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All references such as (302) are to diagnostic codes in the World Health Organisation's ICD-9 manual from 1977, superseded in 1992 by the ICD-10.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