Federal Register / Vol. 83, No. 131 / Monday, July 9, 2018 / Proposed Rules 31711 

mine dust consist of interstitial and 

obstructive pulmonary diseases (79 FR 

24819). Interstitial lung diseases, like 

coal workers’ pneumoconiosis (CWP) 

and silicosis, have a significant latency 

period between exposure and disease. 

The health effects from exposure to 

respirable coal mine dust may not be 

realized for a decade or more until the 

disease becomes clinically apparent. In 

addition, the chronic effects of 

interstitial lung diseases, such as CWP 

and silicosis, may progress or worsen 

even after miners are no longer exposed 

to respirable coal mine dust. Thus, 

miners’ exposure to respirable coal mine 

dust before final implementation of the 

Dust rule on August 1, 2016, may 

continue to contribute to the 

development of lung diseases in coal 

miners. New miners hired after August 

1, 2016, are the only cohort of coal 

miners who are unaffected by exposures 

that occurred before full 

implementation of the Dust rule. 

In the preamble to the Dust rule, 

MSHA stated its intent to take the lead 

in conducting a retrospective study 

beginning February 1, 2017 (79 FR 

24867), with an unspecified completion 

date. Since the Dust rule went into 

effect, MSHA has analyzed more than 

250,000 respirable dust samples taken 

by mine operators who use the CPDM 

and by MSHA inspectors who use the 

gravimetric sampler. MSHA’s analysis 

shows that more than 99 percent of the 

samples were in compliance with the 

MSHA respirable coal mine dust 

standards. 

The sample data allow MSHA to 

evaluate the effectiveness of dust 

controls in mines and whether the rule 

results in reduced levels of respirable 

coal dust. However, due to the latency 

between exposure and disease, MSHA 

likely will not be able to evaluate fully 

the health effects of the rule for a decade 

or more. 

While the Agency continues to 

evaluate the respirable dust samples, 

MSHA also is seeking comments, data, 

and information from stakeholders to 

assist the Agency in developing a 

framework to assess the health effects of 

the Dust rule and its impact on the 

health protections provided to coal 

miners going forward. With respect to 

suggested elements for a framework, 

commenters should be specific and 

include detailed rationales and 

supporting documentation, if any. 

Throughout the comment period, MSHA 

will continue to consult with interested 

parties and the Department of Health 

and Human Services’ National Institute 

for Occupational Safety and Health 

(NIOSH), as it collects and evaluates all 

available information, comments in 

response to this RFI, respirable coal 

mine dust sampling data, and 

compliance rates for controlling 

exposure to coal mine dust. 

III. Engineering Controls and Best 

Practices 

As mentioned, since the Dust rule’s 

publication and implementation, MSHA 

has continually evaluated respirable 

dust controls and best practices for 

compliance with the rule’s 

requirements. The Agency has met with 

mine operators and miners to provide 

mine-specific compliance and technical 

assistance. MSHA also held a MSHA/ 

NIOSH-sponsored meeting on 

engineering controls and best practices 

on December 6, 2016. Technical 

assistance materials and other materials 

from the meeting are available on 

MSHA’s website at https://

www.msha.gov. 

MSHA intends to continue its 

consultations and will continue to offer 

technical assistance on best practices for 

controlling coal mine dust and quartz 

exposures. MSHA is interested in the 

engineering controls and best practices 

that mine operators find most effective 

to achieve and maintain the required 

respirable coal mine dust and quartz 

levels—particularly those practices that 

can be replicated throughout coal mines 

nationwide to achieve similar results. 

IV. Data Request 

The purpose of this RFI is to solicit 

comments, data, and information from 

industry, labor, NIOSH, and other 

stakeholders to assist MSHA in 

developing the framework for a study to 

assess the health effects of the Dust rule. 

Commenters should be specific about 

any recommendations they offer, 

including detailed rationales and 

supporting documentation. 

V. National Academy of Sciences Study 

MSHA notes that in the Explanatory 

Statement to the 2016 Consolidated 

Appropriations Act (Pub. L. 114–113), 

Congress directed NIOSH to charter a 

National Academy of Sciences (NAS) 

study to examine and describe: Current 

monitoring and sampling protocols and 

requirements to understand miners’ 

occupational exposure to respirable coal 

mine dust in the United States and other 

industrialized countries; coal mine dust 

composition and application 

procedures, including the impact of new 

rock dust mixtures and regulatory 

requirements; monitoring and sampling 

technologies, along with sampling 

protocols and frequency; and the 

efficacy of those technologies and 

protocols in aiding decisions regarding 

the control of respirable coal mine dust 

and mine worker exposure. Congress 

directed MSHA to provide assistance 

and necessary data to NAS for its study, 

which the Agency has done and 

continues to do when requested. MSHA 

will evaluate the results of the NAS 

study after the report is final. 

David G. Zatezalo, 

Assistant Secretary of Labor for Mine Safety 

and Health. 

[FR Doc. 2018–14536 Filed 7–6–18; 8:45 am] 

BILLING CODE 4520–43–P 

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 


sradovich on DSK3GMQ082PROD with PROPOSALS
31712 Federal Register / Vol. 83, No. 131 / Monday, July 9, 2018 / Proposed Rules 

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 lifethreatening 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 

POSTAL SERVICE 

39 CFR Part 111 

New Mailing Standards for Mailpieces 

Containing Liquids 

AGENCY: Postal ServiceTM. 

ACTION: Proposed rule. 

SUMMARY: The Postal Service is 

proposing to revise Mailing Standards 

of the United States Postal Service, 

Domestic Mail Manual (DMM) section 

601.3.4 to provide for more rigorous 

packaging requirements for mailpieces 

containing liquids. 

DATES: Submit comments on or before 

August 8, 2018. 

ADDRESSES: Mail or deliver written 

comments to the manager, Product 

Classification, U.S. Postal Service, 475 

L’Enfant Plaza SW, Room 4446, 

Washington, DC 20260–5015. If sending 

comments by email, include the name 

and address of the commenter and send 

to ProductClassification@usps.gov with 

a subject line of ‘‘New Standards for 

Liquids’’. Faxed comments are not 

accepted. You may inspect and 

photocopy all written comments, by 

appointment only, at USPS 

Headquarters Library, 475 L’Enfant 

Plaza SW, 11th Floor North, 

Washington, DC 20260. These records 

are available for review Monday through 

Friday, 9 a.m.–4 p.m., by calling 202– 

268–2906. 

FOR FURTHER INFORMATION CONTACT: 

Direct questions to Wm. Kevin Gunther 

at wkgunther@uspis.gov or phone at 

(202) 268–7208, or Michelle Lassiter at 

michelle.d.lassiter@usps.gov or phone at 

(202) 268–2914. 

SUPPLEMENTARY INFORMATION: The Postal 

Service and United States Postal 

Inspection Service (USPIS) have 

observed an increased frequency of 

incidents involving containers of liquids 

rupturing while in Postal Service 

networks. A typical result of these 

incidents is damage to surrounding 

mailpieces and to Postal Service 

equipment. 

When responding to incidents 

involving liquid spills, Postal Service 

employees frequently note that 

mailpieces containing liquids are often 

not marked on the outer mailing 

container as required by DMM 601.3.4. 

Many of these leaking mailpieces 

contain plastic primary receptacles. 

Mailers often do not consider plastic 

primary receptacles to be breakable, and 

therefore do not cushion these primary 

receptacles with absorbent material or 

include secondary containers, as 

specified by DMM 601.3.4. 

The Postal Service and USPIS have 

also observed that spills of nonhazardous materials in relatively small 

quantities can result in damage to 

surrounding mailpieces and cause 

temporary equipment shutdowns. This 

is especially true with viscous or oily 

substances, such as oils and lotions. 

These materials are often mailed by 

First-Class Package Service®. When 

ruptured, they will frequently leak onto 

other lightweight mailpieces containing 

photographs and documents. 

This proposed revision would require 

mailers of all liquids in nonmetal 

containers, regardless of volume, to 

provide triple packaging, including 


sradovich on DSK3GMQ082PROD with PROPOSALS