Medicare can no longer automatically deny coverage requests for sex-change operations, a federal appeals panel has decided.

In a groundbreaking ruling, the United States Department of Health and Human Services review board said there was no justification for a three-decade-old agency rule excluding such surgeries from treatments covered by the national health program for the elderly and disabled.

The board said it recognized the procedures are sometimes medically necessary for people who don't identify with the sex they were born with, according to a report by the Associated Press.

The determination favored Denee Mallon, of Albuquerque, New Mexico, a 74-year-old transgender Army veteran who was denied her request two years ago to have Medicare pay for her genital reconstruction.

"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old?" Mallon responded in an email interview ahead of the board's ruling, according to the AP. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."

Mallon was born a man but has lived as a woman on and off since she was a teenager -- and then full time since 2009, the AP story said.

"This decision means so much to me and to many other transgender people," Mallon said in a statement Friday. "I am relieved to know that my doctor and I can now address my medical needs, just as other patients and doctors do."

The appeals board said HHS lacked sufficient evidence in 1981 when it made a "national coverage determination," referenced as an NCD by the panel, holding that Medicare recipients were ineligible for what was then referred to as "transsexual surgery" because the procedure was experimental and medically risky, as well as controversial.

The panel continued that studies and experts have since shown the efficacy of surgical procedures as treatments for gender dysphoria, the diagnosis for people who suffer extreme distress due to the disconnect they feel between their birth sex and their gender identity.

"We have no difficulty concluding that the new evidence, which includes medical studies published in the more than 32 years since issuance of the 1981 report underlying the NCD, outweighs the NCD record and demonstrates that transsexual surgery is safe and effective and not experimental. Thus, as we discuss below, the grounds for the ... exclusion of coverage are not reasonable," the board said.

The board said the Centers for Medicare and Medicaid Services, the agency within HHS that manages Medicare, must eliminate its blanket exclusion on transition-related surgeries within 30 days and re-evaluate Mallon's, now that the policy's been ordered changed.

The ruling does not apply to Medicaid, which provides health coverage for individuals and families with low-incomes and is regulated by the states.