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S. 2363

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That (a) section 1901 (1) of title 38, United States Code, is amended by striking out all of that part of clause (A) preceding subclause (1) and inserting in lieu thereof the following:

(A) any eligible veteran entitled to compensation under chapter 11 of this title for any of the disabilities described in subclause (i), (ii), or (iii) below, if the disability is the result of an injury incurred or disease contracted in or aggravated by active military, naval, or air service performed during World War II, the Korean conflict, or after January 31, 1955:".

(b) Section 1901 of title 38 is further amended by adding at the end thereof a new paragraph as follows:

"(3) The term 'adaptive equipment includes, but is not limited to, power steering, power brakes, power window lifts, power seats, and special equipment necessary to assist the eligible person into and out of the automobile or other conveyance. Such term also includes (A) air-conditioning equipment when such equipment is necessary to the health and safety of the veteran and to the safety of others, regardless of whether the automobile or other conveyance is to be operated by the eligible person or is to be operated for him by another person; and (B) any modification of the roof of the automobile or other conveyance if needed by the eligible person because of his physical condition.”

SEC. 2. Subsection (a) of section 1902 of such title 38 is amended (1) by inserting "including all state, local, and other taxes,” after “conveyance” the second time it appears; and (2) striking out “$2,800," and inserting in lieu thereof “$3,300,”.

SEC. 3. (a) Section 1903 of title 38 is amended by adding at the end thereof a new subsection as follows:

(e) (1) The Administrator shall provide, directly or by contract, for the conduct of special driver training courses at every hospital and, where appropriate, at regional offices and other medical facilities, of the Veterans' Administration to instruct each eligible person to operate the type of automobile or other conveyance he wishes to obtain with assistance under this chapter, and may make such courses available to any veteran determined by the Administrator to need the special training provided in them even though such veteran is not eligible for the assistance provided under this chapter.

“(2) The Administrator is authorized to obtain insurance on automobiles and other conveyances used in conducting the special driver training courses provided under this subsection and to obtain, at Government expense, personal liability and property damage insurance for all persons taking such courses without regard to whether such persons are taking the course on an in-patient or out-patient basis."

(b) The catch line of section 1903 of such title is amended by adding at the end thereof of a semicolon and the following : "special training courses”.

(c) The table of sections at the beginning of chapter 39 of such title is amended by striking out “1903. Limitations on assistance," and inserting in lieu thereof the following: "1903. Limitations on Assistance; Special Training Courses."

SEPTEMBER 10, 1971. Hon. DONALD E. JOHNSON, Administrator of Veterans Affairs, Veterans Administration, Washington, D.C.

DEAR MR. ADMINISTRATOR: I am writing with respect to implementation of Public Law 91-666, the Disabled Veterans' and Servicemen's Automobile Assistance Act of 1970 which, as Chairman of the Subcommittee on Veterans Affairs, I managed through the Senate last winter.

As you will recall, as a result of an amendment which I introduced in committee, that act amended 38 U.S.C. § 1902 to require in subsection (b) thereof that in addition to an automobile allowance you provide each person eligible for benefits under chapter 39 with the "adaptive equipment deemed necessary to ensure that the eligible person will be able to operate the automobile or other conveyance in a matter consistent with his own safety and the safety of others and so as to satisfy the applicable standards of licensure as established by the State of his residency or other licensing authority.” In addition, the same Senate amendment directed in subsection (c) of $ 1902 that you shall “repair, replace or reinstall all adaptive equipment deemed necessary for the operation of an automobile or other conveyance acquired" under chapter 39 and shall provide, repair, replace or reinstall such adaptive equipment for any automobile or other conveyance which an eligible person may subsequently have acquired.”

Finally, the committee amendment added a subsection (d) in § 1903 directing that you prescribe minimum standards of safety and quality for all adaptive equipment provided under chapter 39. As to standards of safety and quality for adaptive equipment, I note with disappointment the statement in Transmittal Sheet 466 (signed by the Deputy Administrator by your direction) that issuance of “standards of safety [and] ... of standards of quality must ... await accumulation of experience,”. I fully understand the desire to accumulate experience with this program, but I believe the clear direction and intention of section 1903(d) is that you are to prescribe centrally the adaptive equipment to be provided under chapter 39. This requirement was designed to be a new and additional protection for the eligible veteran or serviceman acting as a consumer. I strongly urge you to direct that such safety and quality standards be developed forth with. If necessary for DM&S to have new personnel toward that end, the Senate committee report anticipated that possibility in stating (page 7): "The Administrator would, under the provisions of the committee substitute, establish safety and quality standards for adaptive equipment. Such safety and quality standards are already established for prosthetic devices provided by the Administrator as part of medical treatment under chapter 17, section 612(d) of title 38, United States Code. It is believed that the same capability within the Veterans' Administration Department of Medicine and Surgery can be effectively employed, with the addition of a few personnel positions, which the committee recommends to carry out a similar quality control program for the automobile adaptive devices which the Administrator would provide under the revised chapter 39 contained in the committee substitute."

It was the intention of the Senate, and so far as I am aware, the House, that these new authorities with respect to the provision, replacement, repair, installation, and reinstallation of adaptive equipment were to ensure that the full expenses of all vehicular adaptive devices necessary for the health and safety of the disabled veteran were provided directly by the Veterans' Administration utilizing quality control standards. Consistent with the legislative intent, it is quite reasonable to expect that as to the most seriously disabled paraplegic or quadriplegic veteran the cost of providing necessary adaptive devices and related items might actually exceed the $2,800 maximum automobile allowance provided under section 1902 (a).

I have discussed this new program with various individuals knowledgeable about the affairs of severely disabled veterans as well as those who have had considerable experience with converting conveyances to provide for self-transportation by even the most severely disabled veterans. It seems to me that there inevitably will arise some significant questions with regard to the implementation of the above provisions enacted in P.L. 91–666 and that consideration of these matters by the Veterans' Administration might become somewhat protracted since so many different offices and divisions are involved. Such questions would very likely be entailed in Central Office consideration of applications (of VA Form 10–2641) for approval of special equipment not included in Exhibit A of Circular 10–71–115 costing in excess of $500.

Specifically, it seems to me that the following VA divisions, services and offices all have an interest, expertise, and function with respect to the effective operation of this new program:

Physical Medicine and Rehabilitation Service, Department of Medicine and Surgery (DM&S).

Prosthetic and Sensory Aids Service, DM&S.
Spinal Cord Injury Service, DM&S.
Engineering Service, DM&S.
Assistant Chief Medical Director for Professional Services, DM&S.
Chief Medical Director, DM&S.
Department of Veterans Benefits.
General Counsel.

In view of the above, I respectfully urge that you establish an intraagency committee reporting directly to you or the Deputy Administrator to establish policies with respect to the implementation of the new adaptive devices provisions and to ensure their effective implementation in order that the severely disabled veterans who are the beneficiaries of chapter 39 will be more fully, quickly, and compassionately served and will be afforded thereby the maximum self-mobility under chapter 39.

I would also like to bring to your attention the need to advise all potentially eligible servicemen of their possible eligibility for assistance under this chapter. You will recall that at the time of the bill's enactment by Congress, the Senate very reluctantly-agreed to accept the restrictive House eligibility standardlimiting eligibility for automobiles and adaptive devices only to those veterans of the Vietnam era who had incurred the injury in line of duty-which was not made applicable to Vietnam era servicemen, on the understanding that the Administrator of Veterans Affairs would do everything possible to ensure that every serviceman who might possibly be eligible for assistance under this revised chapter 39 be fully advised of his possible eligibility and be urged to file an application for assistance prior to his separation or retirement.

I would greatly appreciate learning what efforts have been made by the V.A. and the Department of Defense to organize a system of alerting such servicemen of their potential eligibility and assisting them in filing an application prior to their discharge.

In general (and except as noted above), the procedures adopted by the Veterans' Administration (VAR Transmittal Sheet 466 (April 16, 1971) and DM&S Circular No. 10–17-115 (June 4, 1971)) in implementing the provisions of P.L. 91-666 seem to adhere to the intent described in the legislative history. I am very gratified with the response shown by the Veterans' Administration and wish to express my appreciation for the cooperation, alacrity and dedication displayed by the V.A. in acting upon this measure. Thank you very much for your continuing cooperation with the Subcommittee. Sincerely,

ALAN CRANSTON, Chairman, Subcommittee on Health and Hospitals.

VETERANS' ADMINISTRATION,

Washington, D.C., October 28, 1971. Hon. ALAN CRANSTON, Chairman, Subcommittee on Health and Hospitals, Committee on Veterans' Af

fairs, U.S. Senate, Washington, D.C. DEAR MR. CHAIRMAN : I have your letter of September 10, regarding implementation of the Disabled Veterans' and Servicemen's Automobile Assistance Act of 1970.

It was recognized at the outset that the implementation of the law could not be treated routinely. Safety and quality standards for the adaptive equipment, unlike those already developed in the Veterans' Administration for other types of prosthetic devices, involve not only the safety of handicapped drivers, but also the safety of others on the highways. The Department of Medicine and Surgery, through its Prosthetics and Sensory Aids Service, has, therefore, entered upon a special program of study and development of adaptive equipment conducted principally at our Prosthetics Center in New York City. Additional technical personnel have been assigned to the Center for this purpose, and necessary funds have been allocated.

Our Washington people and those in the Prosthetics Center have consulted with agencies outside the Veterans' Administration working in related fields. These have included the Traffic Engineering Safety Department of the American Automobile Association, and the Institute for Rehabilitation Medicine at New York University Medical Center (whose resources are pooled with those of the Center for Safety at New York University). Such cooperation has been welcomed, mutually, and promises to benefit all drivers with handicaps like those of the veterans and servicemen.

In June of this year, Veterans' Administration representatives attended a seminar on Driver-Training for the Physically Handicapped conducted by the New York University Medical Center Institute for Rehabilitation Medicine. The seminar emphasized the limitations of commercially available adaptive equipment; lack of scientific evaluation of the hardware; absence of specifications, standards, or national coordination at the private, state or federal level ; and noninvolvement of the medical community, in adaptive equipment prescription and checkout. Participation of the Veterans' Administration was hailed by faculty and attendees at the seminar as a milestone in the overall handicapped driver program.

In summary, our engineering people feel that too little is known about adaptive equipment for automobiles to rush into the development of quality standards without full investigation of the available market. Upon completion of our evaluation of existing equipment, we will set appropriate standards of safety and quality and develop valid specifications to attain them. In the interim, should details of progress be desired, may I suggest that members of your staff contact Dr. Robert E. Stewart, Director, Prosthetic and Sensory Aids Service.

Your suggestion for an intra-agency committee to ensure effective implementation of the adaptive devices provisions of the law appeals to me. I am asking the Chief Medical Director to give me his recommendations for membership, functions, and responsibilities, of such a committee to be chaired by him, or his designee.

Veterans' Administration Contact Representatives visit all military hospitals in the United States to provide benefit counseling and personalized individual assistance to disabled servicemen. In the military hospital program, these representatives, working with the military personnel, identify patients being admitted early in their period of hospitalization; an interview is scheduled, and, all appropriate applications are completed. This program has been in operation since late 1966. With the passage of the Disabied Veterans' and Servicemen's Automobile Assistance Act of 1970, a directive was issued to our representatives at military hospitals to review their records of patients to insure that each disabled serviceman who had potential eligibility had filed the appropriate application and that the application was forwarded to our regional office for development.

I sincerely hope that the foregoing information will allay any misgivings you may have had about our administration of the letter and spirit of the Disabled Veterans' and Servicemen's Automobile Assistance Act of 1970. Sincerely,

DONALD E. JOHNSON, Administrator.

JANUARY 19, 1972. Dr. ROBERT E. STEWART, Director, Prosthetic and Sensory Aids Service, Veterans' Administration, Wash

ington, D.C. DEAR DR. STEWART : I am quite interested in the Veterans' Administration implementation of Public Law 91-666, the Disabled Veterans' and Servicemen's Automobile Assistance Act of 1970, and particularly in the new subsection (d) in Section 1903 of title 38, added by that law which directs the Veterans' Administration to prescribe minimum standards of safety and quality for all adaptive equipment provided under chapter 39.

Mr. Johnson, Administrator of Veterans Affairs, advised me of your responsibility for undertaking this task and of your activities in the evaluation of existing adaptive equipment for handicapped individuals and for the evaluation of new equipment as it is developed.

I would appreciate a report on your activities so far, including the types of equipment tested, the methods of testing, and the extent to which safety is ensured under varying conditions of hazard. I would also be interested in any steps you have taken to develop equipment as a result of the rather discouraging conclusions reached at the June seminar on Driver Training for the Physically Handicapped conducted by the New York University Medical Center Institute for Rehabilitation Medicine.

I am enclosing for your information letters I have received from Mr. Michael Burns, Executive Director of the Paralyzed Veterans of America, and from Mr. Sanford Arkin, President of the Institute for Mobility Aids, Inc., commenting on the Veterans' Administration report on the implementation of the Disabled Veterans' and Servicemen's Automobile Assistance Act of 1970. Both these gentle. men offer very constructive suggestions on the administration of programs under this Act, and I would greatly appreciate your response to the point they raise. Many thanks for your cooperation with the Subcommittee. Sincerely,

ALAN CRANSTON, Chairman, Subcommittee on Health and Hospitals.

VETERANS' ADMINISTRATION,

Washington, D.C., February 10, 1972. Hon. ALAN CRANSTON, Chairman, Subcommittee on Health and Hospitals, U.S. Senate, Washington,

D.C. DEAR MR. CHAIRMAN: I am pleased to reply to your letter of January 19 which was addressed to Dr. Robert E. Stewart, Director, Prosthetic and Sensory Aids Service, regarding the implementation of Public Law, 91-666, the Disabled Veterans' and Servicemen's Act.

As mentioned in the Administrator's letter to you on October 28, 1971, we took immediate steps to carry out the responsibility assigned to the Department of Medicine and Surgery. Execution of the program to develop minimum standards of safety and quality for all adaptive equipment was delegated to the Director, VA Prosthetics Center, New York, N.Y.

On May 10, 1971, plans for a comprehensive program were submitted. The program was to be conducted by their Bioengineering Research Service and organized in three overlapping phases, evaluation, optimization and specifications development. This sequence of projects was proposed to obtain the advantage of surveying and evaluating all commercially available aids for handicapped drivers and, later, the possible development of improvements. After this, the formulation of an official set of standards and specifications will be undertaken.

Concurrent with these steps, the Director, Prosthetic and Sensory Aids Service, Veterans' Administration Central Office, Washington, D.C., wrote to all 28 known manufacturers of adaptive equipment asking for literature price lists and other material which describes their products. Also requested was information as to whether the equipment had been evaluated by a laboratory, testing company or other source. They were queried regarding special arrangements with driving schools, automobile dealers, installers and other sources which could be helpful to handicapped drivers. General comment and advice was also solicited. The source for the mailing included a list assembled by the American Automobile Association and the Paraplegia News and Accent on Living advertisers.

Twenty-one responses were received ; eleven, however, were in the form of descriptive brochures only. Of the ten letters, one company advised that they had tested their Rest-A-Foot accelerator themselves and the Gresham Driving Aids, Inc., advised that their hand controls were evaluated by the Oldsmobile Division Testing Laboratory many years ago.

With this substantiation of the absence of comprehensive industry-wide engineering quality evaluations, the VA Prosthetic Center recruited two technicians and purchased, as the start in obtaining all marketed driving aids, 30 different items from three of the larger suppliers. Each of these devices is currently being subjected to an engineering analysis of design, materials and construction. An Aetna Driver Simulator, with computer, has just been delivered and when it has been installed and calibrated each item of adaptive equipment will be attached and tested by various handicapped drivers. The technicians will then evaluate the functional utility and the physical requirements imposed on the disabled part of the body, as well as the whole person, under controlled conditions. To road test this equipment, arrangements have been made with the members of the New York Chapter of the Paralyzed Veterans Association, who are now using driving aids, to install the equipment in their personal automobiles.

The schedule calls for completion of the engineering analysis of the items on hand by the end of February 1972. As other manufacturers products are purchased they will be included in the analysis with a final target date of April 1973. Concurrently, the road testing will be conducted with completion programed for the end of June, 1972. Those devices which exhibit sound engineering principles, demonstrates no safety hazards in all of the tests and which are reasonably efficient and durable will be used as models for the establishment of standards and specifications.

The Bioengineering Research Service of the VA Prosthetics Center has conducted similar programs for the past 20 years with components used in artificial limbs, braces, wheelchairs and medical equipment, but the field of automotive adaptive equipment constitutes a new experience. The staff, therefore, has made plans to take advantage of the expertise of the industry in the establishment of these standards and specifications. As few of the manufacturers are familiar with the work of the Bioengineering Research Service, the Director, Prosthetic

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