The future of transgender troops has been in question since President Trump Tweeted that they would no longer be allowed to serve.
Transgender veterans are wondering how the president's pronouncement will impact the ongoing effort to open the Veterans Health Administration to their needs.
Navy veteran Kristen Dancer served as a corpsman in Fallujah in 2006. With the help of VA doctors, Dancer transitioned to being a woman in 2016. She gets her medical care at the VA hospital in La Jolla. The VA does not offer transition surgery, but it does provide services like hormone therapy, counseling and speech pathology.
"They help feminize our voice to help put us in a better tone and a better range," Dancer said.
Like other veterans who made their transitions after they served, Dancer feared President Trump's threat to ban transgender service members will turn back the clock at the VA.
"I don't know if that means that, based on his Tweets, whether we're all going to be kicked to the curb and we have no place in the VA and any type of military services," Dancer said.
Transgender veterans have always been allowed to use VA services, but the system has become increasingly responsive to their needs. In 2012, the VA created its LGBT Health Program. A 13-page national directive outlines how transgender vets should be treated. The VA requires each hospital system in the country to have an LGBT coordinator.
"Certainly, coming out now to a provider, we encourage that. It's more like 'do ask, do tell,'" said Jeri Muse, LGBT coordinator in San Diego.
The Clinton-era policy of "don't ask, don't tell" did not apply to people who are transgender. Gay and lesbian troops were allowed to serve openly in 2011. It wasn't until June 30, 2016 that Secretary of Defense Ash Carter announced that transgender service members could serve openly.
Clinicians are now encouraged to asked about a patient's birth sex. The VA in San Diego has gone a step further and has begun offering to certify clinicians in LGBT medicine.
"You have to remember that a transgender woman may still need a prostate exam and a transgender man may need breast screenings and gynecological exams," Muse said.
The Pentagon was in the middle of coming up with a long-term policy for transgender service members, when Trump tweeted in July: "The United States government will not accept or allow transgender individuals to serve in any capacity."
The military has not changed anything since the Tweets. Media reports have said the White House is close to issuing guidance to the Pentagon. Both the military and the VA have said nothing without specific direction from White House.
The Transgender American Veterans Association is concerned. Board member Zander Keig said he wonders whether a large number of troops will be discharged immediately if the president's tweet becomes official policy.
"It could be that hundreds of people find themselves administratively separated from the military and they're just thrust into this new civilian life," he said.
Whatever happens at the active duty level could create a sudden influx of new patients at the VA, which could impact care throughout the system, because transgender vets mostly require the same services as other patients.
A report commissioned by the Pentagon estimates there are 15,500 transgender troops on activity duty and another 134,000 veterans. Defense secretary James Mattis questions the figures for troops on active duty. No one has an exact count of how many transgender people have been in the U.S. military. Most hid that part of themselves while they served.
Veronica Zerrer initially joined the service in 1976. As a retired officer, she was asked to return to duty during the Iraq War. She wanted to serve, but by that time she had transitioned to being a woman.
"I couldn't, because that was still in the era of 'don't ask don't tell,'" Zerrer said. "Let alone addressing any transgender concerns. I could have easily lost my military retirement."
There was a time when LGBT troops could be given less-than-honorable discharges, making them ineligible for most VA benefits. With so many unanswered questions, Zerrer and other transgender veterans worry they may face the kind of dilemma, which they thought a thing of the past.