O'Donnabhain v. Commissioner

Rhiannon O’Donnabhain (plaintiff), a transgender woman who was born genetically male, was diagnosed with gender-identity disorder (GID) as an adult. GID was widely recognized by medical professionals, including psychiatric professionals who included GID in the DSM-IV-TR, as a debilitating condition that can lead to serious illness or death if not treated. Further, every federal court of appeals ruling on the issue held that GID poses serious medical needs for Eighth Amendment purposes. O’Donnabhain medically transitioned with treatments including feminizing hormone therapy, sex-reassignment surgery, and breast-augmentation surgery. In 2001 O’Donnabhain incurred approximately $22,000 worth of medical expenses related to her treatment, including $4,500 for breast-augmentation surgery. O’Donnabhain claimed a deduction on her 2001 income-tax return based on her medical-care expenses, as allowed under § 213 of the Internal Revenue Code. The Commissioner of Internal Revenue (the Commissioner) (defendant) held that O’Donnabhain’s medical procedures were cosmetic, did not treat an applicable illness or disease, and were not deductible under § 213. In specific reference to O’Donnabhain’s breast-augmentation surgery, the Commissioner noted that O’Donnabhain’s medical records showed that her breasts had grown to a normal size in response to hormone therapy before the augmentation surgery. Responding to O’Donnabhain’s argument that GID was a disease, the Commissioner further held that GID was a mental disorder and not a disease for § 213 purposes, that the procedures meant to treat GID were not scientifically proven, and that the procedures were not medically necessary. O’Donnabhain petitioned the United States Tax Court for a redetermination.