SECTION - APPLICATION (To be completed by beneficiary - If more space is eded, attach a separate sheet & identify by item number.)

11. IF PAYMENT OR REIMBURSEMENT REQUESTED COMPLETE THE FOLLOWING: (Attach Certified Invoice) MAKE PAYMENT TO (Check and give address)

NOTE: "SUSPENDED" includes revoked, expired, terminated, etc. If restoration date is unknown, place "NA" on date line. VA FORM

SECTION III-APPROVAL AND AUTHORIZATION (To be completed by Prosthetic Representative or Physician)

18. THE FOLLOWING ADAPTIVE EQUIPMENT IS APPROVED FOR INCLUSION WITH OR INSTALLATION ON, THE SPECIFIC VEHICLE DESCRIBED IN ITEM 7 ON THE REVERSE OF THIS FORM. COSTS, INCLUDING INSTALLATION UNLESS AUTHORIZED SEPARATELY, WILL NOT EXCEED THE TOTAL AMOUNT INDICATED BELOW FOR EACH ITEM (See NOTE below):

19. REIMBURSEMENT OR PAYMENT TO THE VENDOR(S) OR INDIVIDUAL(S) NAMED BELOW, IN THE TOTAL AMOUNTS SPECIFIED FOR EACH, IS AUTHORIZED AS A PROPER CHARGE FOR ADAPTIVE EQUIPMENT PREVIOUSLY PURCHASED BY THE APPLICANT UNDER AUTHORITY OF VA REGULATION 1808:

1. Complete all items in Section 1 of this form in duplicate and sign the form.

2. If you are requesting adaptive equipment or services, the Veterans Administration will determine your eligibility and complete Section II and pertinent parts of Section III, after which the original will be given or sent to you.

3. After approval, you should normally give the original of this form to the seller of your choice, who will deliver the equipment or services authorized (see also paragraphs 3 and 4, below).

4. In the event you must obtain some of the equipment on a mail-order basis, or cannot use this authorization for any other reason, you may pay for an authorized item or service and apply for reimbursement from the Veterans Administration. In such cases, you must present a paid invoice properly certified (see below).

5. After receipt of the items or services authorized, sign and date the receipt in Items 24 and 25, and direct the seller's attention to the instructions below. This certification signifies that the adaptive equipment, installation or service is satisfactory, the servicing information on the invoice has been verified to the best of your ability and the charges appear to be reasonable.

INSTRUCTIONS TO SELLER

1. Upon receipt of this form, insure that Section II and III have been completed and signed by the Veterans Administration.

2. Perform the services authorized in Item 18 of the form, or by the attached VA Form 10-2421 (for repairs).

3. For repairs, complete all copies of the VA Form 10-2421 (if attached), and attach the original and copy 2 to the original of this form. For other items or services, or if no VA Form 10-2421 is attached, prepare your own invoice, itemizing each separate item or service provided with the cost of each. Identify the make, model, and year of the automobile or other conveyance and include the following certification on either the VA Form 10-2421 or your own invoice, as appropriate:

"I certify that the amounts billed hereon do not exceed the usual and customary costs for the items or services furnished. (Signature of Company Official)

4. Attach the 2 copies of VA Form 10-2421 or 1 copy of your certified invoice to the original of this form and mail to the VA Office shown in Item 21.

NOTE: No cost will be entered for factory installed basic items such as automatic transmission, etc., However, approved costs for these items will generally be less than, and may never exceed, the factory recommended prices.

SECTION - APPLICATION (To be completed by beneficiary - If more space is needed, attach a separate sheet & identify by item number.) 1. APPLICANT'S NAME AND ADDRESS

2. VA CLAIM NO.

11. IF PAYMENT OR REIMBURSEMENT REQUESTED COMPLETE THE FOLLOWING: (Attach Certified Invoice) MAKE PAYMENT TO (Check and give address)

NOTE: "SUSPENDED" includes revoked, expired, terminated, etc. If restoration date is unknown, place "NA" on date line.

SECTION III APPROVAL AND AUTHORIZATION (To be completed by Prosthetic Representative or Physician)

18. THE FOLLOWING ADAPTIVE EQUIPMENT IS APPROVED FOR INCLUSION WITH OR INSTALLATION ON, THE SPECIFIC VEHICLE DESCRIBED IN ITEM 7 ON THE REVERSE OF THIS FORM. COSTS, INCLUDING INSTALLATION UNLESS AUTHORIZED SEPARATELY, WILL NOT EXCEED THE TOTAL AMOUNT INDICATED BELOW FOR EACH ITEM (See NOTE below):

19. REIMBURSEMENT OR PAYMENT TO THE VENDOR(S) OR INDIVIDUAL(S) NAMED BELOW, IN THE TOTAL AMOUNTS SPECIFIED FOR EACH, IS AUTHORIZED AS A PROPER CHARGE FOR ADAPTIVE EQUIPMENT PREVIOUSLY PURCHASED BY THE APPLICANT UNDER AUTHORITY OF VA REGULATION 1808:

24. SIGNATURE OF BENEFICIARY

25. DATE

I CERTIFY THAT I have received the items or services authorized in item 18 and/or 19, above.

INSTRUCTIONS TO VETERAN OR SERVICEMAN

1. Complete all items in Section 1 of this form in duplicate and sign the form.

2. If you are requesting adaptive equipment or services, the Veterans Administration will determine your eligibility and complete Section II and pertinent parts of Section III, after which the original will be given or sent to you.

3. After approval, you should normally give the original of this form to the seller of your choice, who will deliver the equipment or services authorized (see also paragraphs 3 and 4, below).

"I certify that the amounts billed hereon do not exceed the usual and customary costs for the items or services furnished.

(Signature of Company Official)

4. Attach the 2 copies of VA Form 10-2421 or 1 copy of your certified invoice to the original of this form and mail to the VA Office shown in Item 21.

NOTE: No cost will be entered for factory installed basic items such as automatic transmission, etc., However, approved costs for these items will generally be less than, and may never exceed, the factory recommended prices.

Senator TALMADGE. The next witness is Mr. Charles L. Huber, national director of legislation, Disabled American Veterans. We are very happy to have you back with us again.

STATEMENT OF CHARLES L. HUBER, NATIONAL DIRECTOR OF LEGISLATION, DISABLED AMERICAN VETERANS, ACCOMPANIED BY WILLIAM FLAHERTY AND WILLIAM GARDINER, DAV

Mr. HUBER. Thank you, sir. Mr. Chairman, I am accompanied this morning by Mr. William Flaherty and Mr. William Gardiner.

Senator TALMADGE. We are delighted to have you, gentlemen. Mr. HUBER. Mr. Chairman, members of the subcommittee, we appreciate the opportunity to present the views of Disabled' American Veterans, with respect to several bills referred to the committee which seek to improve the disability compensation and dependency and indemnity compensation programs.

At the outset, the DAV wishes to associate itself with remarks made by the subcommittee chairman when he introduced for himself and all other members of the committee, S. 3067, the Veterans Disability Compensation Act of 1974. You stated in true and touching terms that the service-connected disabled veteran "has in the past year once again become a casualty. This time the casualty has been produced not by a bullet or shrapnel, but by increases in the cost of living which have deprived many disabled veterans living on fixed incomes."

We share the chairman's hope that these hearings "can be completed quickly, so that the full committee and, thereafter, the full Senate can consider the (measure) at the earliest possible time."

As you know, Mr. Chairman, our National Commander, John T. Soave, appeared before the full Committee on Veterans' Affairs on February 27. He informed the committee that inquiries reaching us at national headquarters are manifesting concerned interest in the need for compensation adjustments. The saddest inquiries come regularly from the seriously disabled veterans, all expressing their dire situations due to the higher costs of food, clothing, housing, fuel, and other basic necessities. Those veterans whose only income is their fixed monthly compensation payments are hit hardest by runaway inflation, and are desperately struggling to survive.

Mr. Chairman, all of us are acutely aware of the fact that the cost of goods and services increased dramatically since this committee so thoughtfully improved and updated the compensation program in August 1972. Available statistical data show that overall living costs have gone up by approximately 12 percent, and the food prices are up a record breaking 20-25 percent. Current trends clearly indicate that we can expect still further substantial increases in retail prices in the months ahead.

These facts and circumstances give great urgency to the need for early action on the compensation legislation now before the committee. It is our feeling that any proposed increase in compensation rates should, in all fairness, take into account not only the loss in purchasing value since the 1972 compensation increase, but also an estimate of the additional loss which will occur between the present and the next review of the program by this committee and the Congress.