Lesbian, Gay, Bisexual and Transgender Veteran Care - San Francisco VA Health Care System
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San Francisco VA Health Care System


Lesbian, Gay, Bisexual and Transgender Veteran Care

The Department of Veterans Affairs (VHA) is committed to providing quality care to all Veterans inclusive of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) Veterans. Excellent care has no boundaries.

We Serve All Who Served poster

LGBT refers to lesbian, gay, bisexual and transgender identities. The ‘Q’ refers to queer identities, as well as those who are questioning their sexual orientation and/or gender identity. The + sign is meant to be inclusive of sexual orientations and gender identities beyond LGBT, including pansexual, asexual, agender, gender non-conforming, gender diverse, nonbinary, gender neutral and other identities.

San Francisco VA Health Care System seeks to promote the health, welfare, and dignity of LGBTQ+ Veterans and their families. We are committed to making sensitive and high-quality health care accessible. Our employees are prepared to provide personalized, patient-centered care in a safe, affirming, and welcoming environment.

You Are Not Alone 

The United States is home to an estimated one million LGB service members and Veterans, with an estimated 65,000 LGB people serving in active duty. Over 134,000 U.S. Veterans are estimated to identify as transgender, with over 15,000 trans people estimated to be serving in active duty. LGBT people have a long history of serving the US military with honor and distinction, and have also made notable contributions to LGBT communities at large. For example, the rainbow and transgender pride flags were both designed by U.S. Veterans-Gilbert Baker, a gay Army Veteran, and Monica Helms, a transgender Navy Veteran, respectively. Likewise, historical San Francisco LGBT rights activist and politician, Harvey Milk, was a distinguished Navy Veteran, after whom a U.S. Navy ship is planned to be named.

We at SFVAHCS recognize that diverse populations have distinct needs, and we train our staff in culturally and clinically competent care for LGBT Veterans. SFVAHCS is focused on providing the most respectful health care environment possible. We hope you choose SFVAHCS and join our growing team of Veterans and staff to build upon our diverse community and health care system.

LGBT Veteran Services

LGBT Care Coordinator

All VA health care systems have a LGBT Veteran Care Coordinator who serves as the point of contact for LGBT Veteran’s care needs. If you have questions about our LGBT Program, or need help with coordination of your care, please contact Michael Burnias, PsyD, at (415) 281-5126.

Trans Health Clinic

The Trans Health Clinic was established in October of 2017 as a means of improving health care for all gender minority Veterans in the greater San Francisco Bay Area. This clinic is staffed by physicians (including an endocrinologist), nurses, mental health providers, and a social worker, and offers a variety of services in one location. The clinic is located inside our Women’s Health Clinic in Building 203, Floor 1, B-Wing. The clinic is available on the 2nd and 4th Mondays of the month, by appointment only. If you are interested in hearing more about services available through the Trans Health Clinic, please call the Trans Health Clinic Coordinator, Kaela Joseph, PhD at (415) 221-4810 ext. 2-3956.

What about gender affirming surgery?

Per national policy, the VA does not provide or fund gender affirming surgeries or other procedures such as electrolysis. SFVAHCS, however, does offer assistance with pre and post-surgical care needs, such as:

  • Letters of support for gender affirmative surgeries and procedures performed in the community
  • Assistance setting up after care plans for surgeries performed in the community
  • Pre-surgical counseling for those with questions about navigating the surgery process
  • Post-surgical medical care
  • Post-surgical sexual health care  
Providers at SFVAHCS are happy to work with you to access surgeries and other procedures through MediCal, MediCare, Kaiser, Healthy San Francisco, and other avenues you may be eligible for.

Not living in or around San Francisco?

We recognize that the San Francisco Bay Area houses a number of qualified gender affirming surgeons, and that many Veterans may travel here from other cities/states to receive transition related care. We encourage you to work with your local facility to establish any care that you may need while visiting San Francisco, and are happy to answer any questions you may have about services that would be available to you while you are here. Please Note: You will need to enroll in SFVAHCS to utilize services at our main facility and community based outpatient clinics (CBOC’s). For information on enrollment, please visit the enrollment section of our website.Not living in or around San Francisco?

Affirmative Psychotherapy Services 

At SFVAHCS, we strive to provide comprehensive, culturally sensitive individual and group therapy for Veterans identifying as LGBT, as well as those who are questioning, or who hold other sexual or gender minority identities (ex. non-binary, intersex, gender non-conforming, queer, pansexual, non-monogamous, kinky, etc.). Additional services include affirmative family and couples therapy, as well as sex therapy services for those who have difficulty with sexual functioning or satisfaction. We recognize that sexual and gender identities are just one part of what makes you who you are, and strive to take a holistic, intersectional approach to care- meaning we work with you to establish treatment plans that incorporate all of your cultural identities.

Some Veterans just want to learn more about what LGBT-related services and supports are available. We can provide consultation directly to Veterans, and to providers, in those cases. Every Veteran has the right NOT to be “outed” as LGBT in their medical record by any provider. Our providers know that gender expression, identity, and sexuality can be personal issues, especially for our Veterans. Each Veteran has the right to decide what works best for them. We encourage very open and collaborative conversations with your health care providers about this personal matter.

Some LGBT Veterans prefer to be seen at the San Francisco, Fort Miley Campus, even if that is not where they receive their primary care. If you are a Veteran who is seen at a SFVAHCS Community Based Outpatient clinic (Downtown San Francisco, San Bruno, Santa Rosa, Ukiah, Clearlake, or Eureka), or are seen in another nearby healthcare system such as Palo Alto, Northern California, or Fresno, please contact our LGBT Care Coordinator and Staff Psychologist, Michael Burnias, PsyD, at (415) 281-5126 for more information about travel options, and remote services such as V-Tel (video conferencing visits from Fort Miley to other clinics). Wellness and Therapy Groups

Trans Health & Wellness Group (aka The Trans Support Group)

  • Where: San Francisco VA Fort Miley Campus (4150 Clement Street, San Francisco) in Bldg. 8, Room 313
  • When: 1st, 3rd and 5th Thursdays of each month from 5 – 6:30 p.m.
  • Who: This group is open to all Veterans who identify as transgender, non-binary, gender non-conforming, gender questioning, or another gender minority identity.
  • What: This group is broadly focused on positive coping strategies that promote overall wellbeing. The group is structured around a check-in with all group members and a group discussion about various topics of the day, which are collaboratively selected by group members and facilitators.
  • Referrals: This is an open, drop-in group. If you would like to talk to a group facilitator prior to attending, please contact Staff Psychologist, Kaela Joseph, PhD, at (415) 221-4810 ext. 23956.

Dialectical Behavioral Therapy Skills Training for LGBTQ+ Veterans

  • Where: San Francisco VA Fort Miley Campus (4150 Clement Street, San Francisco)
  • What: The Dialectical Behavior Therapy Skills Training Class teaches skills to build your best life.  Skills focus on mindfulness and connecting with the present moment, managing emotions, increasing interpersonal effectiveness, and tolerating distress. The group also teaches members how to be skillful when faced with invalidation, such as discrimination on the basis of sexual or gender minority status. 
  • When: This is a weekly group led by the psychology fellow in Interprofessional LGBT Health and has consistent membership from week to week (not a drop-in format). 
  • Referrals: To learn more, please contact Dr. Michael Burnias at (415) 281-5126.

Longstanding Gay/Bisexual Men's Psychotherapy Group

  • Where: San Francisco VA Fort Miley Campus (4150 Clement Street, San Francisco)
  • What: Gay/Bisexual Men’s Psychotherapy Group is for men interested in working on personal growth in a group format.  It is led by two mental health professionals and has consistent membership from week to week (not a drop-in format). 
  • When: Weekly
  • Referrals: To learn more, contact Rob Daroff, MD, Staff Psychiatrist, at (415) 221-4810 ext. 2-4366.

Training Programs

Stephen M. Rao Fellowship in Interprofessional LGBT Health Care

San Francisco VA Health Care System has a Psychology Postdoctoral Fellow program specializing in Interprofessional LGBT health care. Our fellow is stationed at the San Francisco VA Medical Center (SFVAMC), Bldg. 8, and is also available Wednesdays at the Downtown San Francisco VA Clinic (401 3rd Street). The fellowship was established nationally to promote LGBT-affirmative knowledge and practices across VA Medical Centers and to propel the Veterans Health Administration (VHA) to become a leader in LGBT health care.

Dr. Stephen M. Rao, one of the founding psychologists and supervisors of this fellowship, and a beloved colleague at SFVAHCS, passed away from cancer in May 2014. In honor of Dr. Rao's 20-plus years serving LGBT and other underserved populations, and his time specifically working with Veterans, we have named our local fellowship in his honor. Our hope is to continue Dr. Rao's legacy of compassionate, Veteran-centered care to all of the Veterans we serve here at SFVAHCS. For more information, please visit our online fellowship brochure.

Psychology Externship in Outreach and Administration in Women’s and LGBTQ Healthcare

This is a supplemental practicum experience for psychology doctoral candidates to learn various aspects of outreach and administrative tasks behind the care of Women and LGBTQ Veterans in the SFVAHCS. For more information about this program, please visit our online, externship brochure.

National LGBT Program Trainings

Several trainings in LGBT Veteran Care are available through the national LGBT Program website. For community providers working with LGBT Veterans, provider toolkits can be found at the following liks: Lesbian Gay and Bisexual Veterans Toolkit Transgender Veterans Toolkit

Staff and Community

LGB and Transgender Special Emphasis Programs

LGBT VA staff, as well as heterosexual and cis-gender allies are invited to participate in the LGB and Transgender Staff and Allies Special Emphasis Programs of the Equal Employment Opportunity Office.

The goals of these programs are to:

  • Raise awareness about LGBT Veterans and staff at SFVAHCS • Provide support and social opportunities for LGBT staff • Increase hiring at SFVAHCS of LGBT persons, particularly Veterans • Increase enrollment at SFVAHCS among LGBT Veterans • Provide mediation for LGBT concerns and issues

Lesbian, Gay, and Bisexual Special Emphasis Program

Program Manager: Michael Burnias, Psy D    Contact: (415) 281-5126

Transgender Special Emphasis Program

Program Manager: Vacant

LGBT Community Outreach


SFVAHCS is actively involved in the recruitment of LGBT Veterans and distribution of information about VA health care services available through outreach at community events, round table community discussions, pride festivals and parades, and more. For more information about participating in community events contact Kaela Joseph, Ph.D., at (415) 221-4810 Ext. 23956.

Relevant Policies and Services

Non-discrimination: Our non-discrimination policy prohibits discrimination based on sexual orientation or gender identity (actual or perceived) (VHA Directive 1019).

Visitation: SFVAMC allows for a same-sex partner, family member, friend, or other individual to be present with the patient for emotional support during the course of their stay. Same-sex partners are recognized as the patient’s family, even if the parties are not legally married.

Advanced Directives: Patients may designate any person as a decision-maker for care should they become unable to make these decisions. This includes designating a same-sex partner as a surrogate decision-maker. Advanced Directives agents are chosen by the Veteran and do not need to be biologically related.

Documentation in Medical Records: San Francisco VA maintains the confidentiality of information about sexual orientation and sexual behavior, as it does with all other private health information. For more information on accessing or making changes to your medical records, please visit the medical records page of our website.

Changing Your Name and/or Gender in Your Medical Record: Your name in the medical record will reflect your legal name. You have the right to request that name and gender are updated as appropriate. There are established procedures for changing your name and gender, available from Member Services at 415-221-4810 Ext. 2-4066, or toll-free at 877-487-2838. The Member Services Office is located in Bldg. 2, Ground Floor, room 49.

Restrooms: You have the right to use restrooms and other public accommodations that correspond with your self-identified gender, regardless of appearance.

Treatment Rooms and Hoptel: When staying at VA facilities, you have the right to be housed in a room that corresponds with your self-identified gender, regardless of appearance. If accommodations cannot be made for any reason (ex. space limitations, no women identified Veterans in a facility during a given stay), alternative options such as private rooms and other accommodations will be discussed.

Waiting Areas: Per national VA policy, no waiting area can exclude Veterans or those accompanying Veterans on the basis of gender. You are welcome in all waiting areas at our facilities.

For a comprehensive list of policies, please visit the VA LGBT Policies Website.

Concerns and/or Complaints: If you feel you are not being provided with compassionate care at San Francisco VA, we encourage you to make your concerns known. Concerns regarding a specific Service (e.g., Mental Health, Primary Care) should be directed to the corresponding contact person for that Service. This information can be easily found on this website through the Services Page. In addition, you are encouraged to discuss any concerns with our Patient Experience Specialists at 415-221-4810, ext. 2-6650, located in Bldg. 200, Ground floor lobby, Room GA-154.)

LGBTQ+ Veteran Care Coordinator (VCC) Program

Every VA facility has a local LGBTQ+ Veteran Care Coordinator (VCC) who can connect you with services and help you navigate specialized resources.

Health Information

To learn important information about the unique health risks of LGBTQ+ Veterans, download these relevant fact sheets. Here you can also find information about relevant services offered by VA.

Gay, Bisexual, and Queer
Health Care Fact Sheet

Gay and Bisexual Men Health Care Fact Sheet

Lesbian, Bisexual, and Queer
Health Care Fact Sheet

Lesbian and Bisexual Women Health Care Fact Sheet

Women and Gender Diverse Veteran
Health Care Fact Sheet

Transgender Women Health Care Fact Sheet

Men and Gender Diverse Veteran
Health Care Fact Sheet

Transgender Men Health Care Fact Sheet


Michael Burnias

LGBTQ+ Updates