A group of transgender veterans filed a lawsuit Thursday seeking to force the Department of Veteran Affairs to begin providing and paying for gender-affirming surgeries.

The lawsuit from the Transgender American Veterans Association seeks to compel the VA to codify in its regulations verbal assurances the department has made that it would begin providing those services, said Rebekka Eshler, the president of the association.

She said the surgeries are needed to reduce the risk of suicides, depression, and psychological distress for transgender people who live with gender dysphoria.

“It would also mean that those veterans do not have to seek this care through private doctors, which is often prohibitively expensive,” the transgender veterans association said in its lawsuit, which it said was filed in the United States Court of Appeals for the Federal Circuit in Washington.

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A spokesperson for the Department of Veterans Affairs said it does not comment on ongoing litigation. But he pointed to 2021 statements from Veteran Affairs Secretary Denis McDonough, who said the VA was beginning a years long rulemaking process that would result in providing gender-affirming surgeries. McDonough said the VA would use the time to “develop capacity to meet the surgical needs” of transgender veterans.

The decision, he said, will allow “transgender vets to go through the full gender confirmation process with VA by their side.”

The veterans first petitioned for the rule change in May of 2016. Since then, has VA has held hearings and prepared multiple proposed rules for cost-benefit analysis, the association said. But while the VA currently provides hormone therapy and other services to transgender veterans at some locations, it has failed to change its rules in a timely manner and provide any coverage for the surgeries, the group said.

“I get phone calls from veterans that are so in crisis that they are calling us because they can’t handle it anymore and they are wanting to go kill themselves,” Eshler said.

Natalie Kastner, a 39-year-old disabled veteran from Texas, said she went to the VA in 2022 seeking surgery. When doctors there denied her request, she said she took a knife and attempted self castration. She hit an artery and almost died, but doctors were able to save her life.

“I did not go into that bathroom looking to kill myself,” she said. “I went into that bathroom looking to fix myself. I can only imagine how many others have done the same and have not been so lucky and have simply been listed as a suicide.”

Eshler said she hopes the lawsuit also will standardize the care transgender veterans receive, which said said can vary from state to state and even clinic to clinic.

The lawsuit asks the court to compel the VA to respond to the 2016 petition within 30 days.