[Federal Register Volume 83, Number 131 (Monday, July 9, 2018)]
[Proposed Rules]
[Pages 31711-31712]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-14629]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17


Exclusion of Gender Alterations From the Medical Benefits Package

AGENCY: Department of Veterans Affairs.

ACTION: Petition for Rulemaking and request for comments.

-----------------------------------------------------------------------

SUMMARY: On May 9, 2016, the Department of Veterans Affairs (VA) 
received a Petition for Rulemaking petitioning VA to amend its medical 
regulations by removing a provision that excludes ``gender 
alterations'' from its medical benefits package. The effect of the 
amendment sought by the petitioners would be to authorize gender 
alteration surgery as part of VA care when medically necessary. VA 
seeks comments on the petition to assist in determining whether to 
amend the medical benefits package and eliminate the exclusion of 
gender alteration from VA's medical benefits package.

DATES: Comments must be received/submitted on or before September 7, 
2018.

ADDRESSES: Written comments may be submitted through http://www.regulations.gov; or by mail or hand delivery to Director, Office of 
Regulation Policy and Management (00REG), Department of Veterans 
Affairs, 810 Vermont Ave. NW, Room 1063B, Washington, DC 20420; or by 
fax to (202) 273-9026. Comments should indicate that they are submitted 
in response to ``Notice of Petition for Rulemaking and request for 
comments--Exclusion of Gender Alterations from the Medical Benefits 
Package.'' Copies of comments received will be available for public 
inspection in the Office of Regulation Policy and Management, Room 
1063B, between the hours of 8:00 a.m. and 4:30 p.m., Monday through 
Friday (except holidays). Please call (202) 461-4902 for an 
appointment. (This is not a toll-free number.) During the comment 
period, comments may

[[Page 31712]]

also be viewed online through the Federal Docket Management System 
(FDMS) at http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Michael Shores, Director, Office of 
Regulation Policy and Management, Office of the Secretary, Department 
of Veterans Affairs, 810 Vermont Avenue NW, Washington DC, 20420; (202) 
461-4921.

SUPPLEMENTARY INFORMATION: Section 1710 of title 38 United States Code 
(U.S.C.) requires VA to ``furnish hospital care and medical services 
which the Secretary determines to be needed'' for eligible veterans. In 
1999, VA promulgated 38 CFR 17.38, establishing the Department's 
medical benefits package for veterans enrolled in VA's health care 
system. 64 FR 54207 (Oct. 6, 1999). The regulation describes the types 
of medical care and services available for such veterans. Care referred 
to in the medical benefits package is provided to individuals only if 
it is determined by appropriate healthcare professionals that the care 
is needed to promote, preserve, or restore the health of the individual 
and is in accord with generally accepted standards of medical practice. 
38 CFR 17.38(b). Paragraph (c) of that section provides a list of 
medical services the medical benefits package does not include. 
Paragraph (c)(4) explicitly excludes ``gender alterations'' from the 
medical benefits package.
    On May 9, 2016, VA received a Petition for Rulemaking petitioning 
VA to amend its medical regulations by removing the exclusion of 
``gender alterations'' from its medical benefits package. The petition 
asks VA to remove 38 CFR 17.38(c)(4), allowing VA to provide gender 
alteration surgeries.
    As part of its ongoing consideration of the petition, VA now seeks 
public comment on the petition and on whether ``gender alterations'' 
should be included in the medical benefits package. On February 22, 
2018, the Department of Defense issued a report that considered the 
efficacy of gender alteration surgery as treatment for gender 
dysphoria. That report noted considerable scientific uncertainty and 
overall lack of high quality scientific evidence demonstrating the 
extent to which transition-related treatments such as sex reassignment 
surgery remedy the multifaceted mental health problems associated with 
gender dysphoria.
    Commenters are specifically invited to address the following 
questions:
    What evidence is available about the safety and effectiveness of 
gender alterations for the treatment of gender dysphoria and how 
reliable is that evidence?
    Given the challenge of the high rates of Veteran suicide, what does 
the evidence, including peer-reviewed evidence, suggest about the 
impact of gender alterations on the rates of suicide and suicide 
ideation among those suffering from gender dysphoria?
    Given that any addition to the medical benefits package will have 
an associated cost and burden on existing specialists, especially 
urological and vascular surgeons and other highly trained specialists 
who are already in shorty supply nationwide, what is the potential 
impact of adding ``gender alterations'' on Veterans' access to care, 
particularly for Veterans facing life-threatening medical conditions 
waiting to see surgical specialists?
    We are providing a 60-day period from the date of publication of 
this Federal Register Notice for the public to submit comments on this 
subject. VA will consider the comments received, and then determine 
whether to propose a regulatory change in response to the Petition for 
Rulemaking. VA will announce any action it takes in the Federal 
Register.

Signing Authority

    The Secretary of Veterans Affairs, or designee, approved this 
document and authorized the undersigned to sign and submit the document 
to the Office of the Federal Register for publication electronically as 
an official document of the Department of Veterans Affairs. Jacquelyn 
Hayes-Byrd, Acting Chief of Staff, Department of Veterans Affairs, 
approved this document on June 19, 2018, for publication.

Michael Shores,
Director, Office of Regulation Policy & Management, Office of the 
Secretary, Department of Veterans Affairs.
[FR Doc. 2018-14629 Filed 7-6-18; 8:45 am]
 BILLING CODE 8320-01-P