Infighting rocked pro-Russian separatists who’ve declared Ukraine’s eastern Donetsk region independent, with heavily armed gunmen seizing the movement’s headquarters and kicking out its leaders.

The Vostok battalion of the self-declared Donetsk People’s Republic seized the regional administration building, clearing away makeshift barriers and checkpoints. They arrested several members of the movement whom they accused of looting in the regional capital, also called Donetsk.

“We’ve begun a cleanup of our ranks -- we want to stop looting so this doesn’t happen any more,” Alexander Maltsev, a spokesman for separatist leader Denis Pushilin, said today by phone from Donetsk. “We detained 12 people yesterday and set up checkpoints around the city.”

Ukraine is battling to keep hold of its easternmost regions, with separatists in Donetsk and Luhansk seeking to break away and join Russia after a pro-European cabinet took charge in Kiev. Dozens of rebels were killed in clashes this week and an army helicopter was downed, causing 14 deaths. Ukraine says the unrest is being stoked by Russia, which denies the accusation.

The allegiance of the Vostok fighters is unclear, with Ukraine complaining of an increasing number of foreign militants arriving in Donetsk and Luhansk to battle government troops. The border service said several truckloads of people broke through into Ukraine this week, while Russian citizens were among the dead at a May 26 shootout in Donetsk’s airport.

Gunmen are traveling from the Caucasus region, according to the Defense Ministry.

President-elect Petro Poroshenko has pledged a rapid military response to the eastern violence, which erupted after Russian leader Vladimir Putin signed an order to annex Ukraine’s Black Sea peninsula in March.

To contact the reporter on this story: Daryna Krasnolutska in Kiev atdkrasnolutsk@bloomberg.net

To contact the editors responsible for this story: Balazs Penz at bpenz@bloomberg.net Andrew Langley, James Kraus

Men inspect the damage at a fuel market hit by a car bomb in the Maarat Al-Naasan area of Idlib May 28, 2014. More than 10 people were killed in the attack, according to activists. REUTERS/Abdalghne Karoof

WASHINGTON (AP) — The State Department confirmed Friday that a U.S. citizen from Florida launched a suicide bombing against Syrian government troops earlier this week in what is believed to be the first time an American has been involved in such attacks since the start of the Syrian civil war.

Opposition forces fighting Syrian President Bashar Assad had earlier claimed that Abu Hurayra al-Amriki was, in fact, an American fighter who carried out a May 25 truck bombing outside a restaurant in the government-held northwestern city of Idlib. Al-Amriki means "the American."

State Department spokeswoman Jen Psaki told reporters on Friday that he was an American. Psaki said it appeared to be the first time an American citizen was involved in a suicide bombing since the start of the three-year civil war in Syria that has killed at least 160,000.

Psaki had no other details. Sen. Bill Nelson, D-Fla., told reporters in Miami Friday that Al-Amriki is from Florida but did not provide any further details.

It's unknown how many people al-Amriki killed in the bombing. Opposition rebels with the al-Qaida-linked insurgency al-Nusra Front said his truck was laden with 16 tons of explosives to tear down the al-Fanar restaurant in Idlib, a gathering site for Syrian troops.

Asaad Kanjo, an opposition activist based in the town of Saraqeb in Idlib province, said he heard that al-Amriki arrived in Syria a few months ago and tore up his American passport upon arrival.

Kanjo said even a local commander with the Nusra Front was surprised about al-Amriki, quoting him as saying that people do all they can to try go to the U.S. to get an American passport, and this man came here and got rid of his.

"From what I heard, I believe he was an American of Arab origin. People said that he spoke Arabic with a foreign accent, and he used to speak classical Arabic," Kanjo said.

He added that al-Amriki was a member of the Nusra Front but was not a commander. "Most probably he came to carry out this attack," Kanjo said.

The truck bombing by al-Amriki was one of four by suicide bombers who attacked over the course of a day in the area in Idlib province.

___

Karam reported from Beirut, Lebanon. Associated Press Writers Eric Tucker and Lara Jakes in Washington and Curt Anderson in Miami contributed to this report.

U.S. says American carried out Syria bombing

The State Department confirms the ID of the suspect involved in the suicide attack. Fought under name Abu Hurayra al-Amriki

SAN FRANCISCO (AP) — Transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries, a U.S. Department of Health and Services review board ruled Friday in a groundbreaking decision that recognizes the procedures as a medically necessary and effective treatment for individuals who do not identify with their biological sex.

Ruling in favor of a 74-year-old Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency's Departmental Appeals Board ruled that a three-decade-old HHS rule excluding such surgeries from the procedures covered by the national health program for the elderly and disabled was unjustified.

"Sometimes I am asked aren't I too old to have surgery. My answer is how old is too old?" the veteran, Denee Mallon, of Albuquerque, New Mexico, said in an email interview before the board issued its decision. "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."

Jennifer Levi, a lawyer who directs the Transgender Rights Project of Gay & Lesbian Advocates and Defenders in Boston, said the ruling does not mean Medicare recipients are necessarily entitled to have sex reassignment surgery paid for by the government.

Instead, the lifting of the coverage ban means they now will be able to seek authorization by submitting documentation from a doctor and mental health professionals stating that surgery is medically indicated in their individual case, Levi said.

Transgender health advocates said that because private insurance companies and state-run Medicaid programs that provide health insurance for low-income individuals often take their cue from the federal government on which treatments to approve or exclude, the decision could eventually pave the way for sex-reassignment surgeries to be a routinely covered benefit.

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In this May 29, 2014 photo, Denee Mallon, right, holds a banner before taking part in the Trans Marc …

No statistics exist on how many people might be affected by the decision. Gary Gates, a demographer with The Williams Institute, a think tank on LGBT issues based at the University of California, Los Angeles, has estimated that people who self-identify as transgender make up 0.3 percent of the U.S. adult population. Over 49 million Americans are enrolled in Medicare.

The appeals board's decisions are binding on HHS unless they are appealed in federal court. The Centers for Medicare and Medicaid Services, the agency within HHS that manages Medicare, opted not to defend the transgender surgery exclusion before the five-member board and had initiated the process for lifting it on its own before Mallon filed her complaint.

The ruling does not apply to Medicaid, which provides health coverage for individuals and families with low-incomes and is regulated by the states. Some states have blanket exclusions on sex reassignment surgeries and the sex hormones transgender people often take during their transitions, while others evaluate claims on a case-by-case basis.

Transgender rights activists hope the action on Medicare motivates private insurers, who often take their cues on what is considered medically necessary, elective or experimental from the federal government to eliminate exclusions on sex reassignment surgeries from their plans.

Mallon was born a man and identifies as a woman.

"When I learned that Medicare denies the essential care I need, I remember saying 'This is not right. They're relying on these archaic reasons to deny me the care my doctor agrees I need? I knew I had to do something to challenge that," Mallon said.

A board rules in favor of a 74-year-old Army veteran who requested to have Medicare pay for her procedure.
Groundbreaking decision

VILNIUS (Reuters) - Lithuania accused Russian warships of harassing civilian vessels in Lithuanian waters in the Baltic Sea on Friday in a protest amid worries in the region about Moscow's assertiveness in Ukraine.

Military activity has increased this year in Russia's Kaliningrad enclave, which borders Poland and Lithuania and houses Russia's Baltic military fleet.

And the United States has sent 600 paratroopers to Poland and the Baltic states to reassure them after Russia annexed Ukraine's Crimea region in March.

"The Ministry of Foreign affairs expressed concern due to recurring Russian military fleet actions in the Lithuanian exclusive economic zone, which violate the sovereign rights and freedoms of Lithuania and other countries," the ministry said after the acting head of the Russian embassy was summoned to the ministry on Friday.

"We encourage Russia to keep to the United Nations Convention on the Law of the Sea and other international law consistently and ensure that such incidents would no longer occur," the ministry said.

Lithuania's defense ministry said Russian warships were found ordering civilian vessels off Lithuania to change course twice this week and once in April, referring to safety concerns due to military exercises in nearby Russian waters.

Modern Russian warships, capable of hitting targets 150 kilometers (95 miles) away, were involved in policing this week. The ships left immediately after a Lithuanian warship arrived on the scene, the ministry said.

A vessel involved in laying an electric cable on the floor of the Baltic sea between Lithuania and Sweden was ordered to move in one of incidents, the ministry said.

(Reporting by Andrius Sytas, Via Stockholm newsroom, editing by Alister Doyle)