The C-CDA CG R4 guide includes an extra value for Sexual Orientation “Sexually attracted to neither male nor female sex (finding)“ that is not identified in USCDI, nor in FHIR US Core.  While one could opt to use that in FHIR as well, to avoid confusion, the value sets should be fully aligned so that it is easier to explain that if somebody adds a value, it be used in both FHIR US Core and C-CDA (and effectively any other transactions carrying this information).  We propose that FHIR US Core and C-CDA resolve whether FHIR US Core should add this value, or whether C-CDA CG should remove it.