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 Disabled 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, Washington, 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. Hon. ALAN CRANSTON, VETERANS' ADMINISTRATION, Washington, D.C., February 10, 1972. 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 and Sensory Aids Service, plans to convene a conference of all interested persons. This may possibly be held in conjunction with the National Convention of the Paralyzed Veterans Association in July since so many companies exhibit their products at that meeting. By that time the experience and information developed will enable the staff of the VA Prosthetics Center to deal with engineering and functional problems which have been identified and hopefully, in cooperation with the manufacturers, to develop sound standards of safety and quality and specifications. The target date, based on the above timetable, is December of 1972. No steps have been taken as yet to develop new designs since our engineers are convinced that only by objective technical analysis of the available devices can they furnish effective directions for the development of improvements. Deficiencies must be identified before improvement can be affected. Thank you for your interest. Sincerely yours, 32-022 O-74-4 M. J. MUSSER, M.D., Chief Medical Director. [No. 96] COMMITTEE ON VETERANS' AFFAIRS, U.S. SENATE VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. VANCE HARTKE, The bill as so amended proposes to amend chapter 39 of title 38, United States Code, to (1) authorize monetary assistance for the purchase of an automobile and provide necessary adaptive equipment for veterans and servicemen serving after January 31, 1955, under the same eligibility criteria as are applicable to veterans of World War II and the Korean conflict; (2) expand the concept of adaptive equipment; (3) increase the amount of the automobile grant from $2,800 to $3,300; (4) provide special driver training courses for persons eligible for automobile assistance and certain veterans not eligible therefor; and (5) authorize the Administrator to obtain insurance on automobiles or other conveyances used in conducting the driver training courses and to obtain personal liability and property damage insurance for all persons taking such courses. Subsections (a) and (b) of the first section of the amended bill would amend section 1901 (1) of title 38, United States Code, to authorize monetary assistance for the purchase of an automobile and necessary adaptive equipment for veterans and servicemen serving after January 31, 1955, under the same eligibility criteria as are applicable to veterans of World War II and the Korean conflict. Prior to the enactment of Public Law 91-666 on January 11, 1971, the Veterans' Administration was authorized by 38 United States Code 1901 to pay an automobile allowance of $1,600 to veterans entitled to disability compensation for loss, or permanent loss of use, of one or both hands or one or both feet, or permanent impairment of vision of both eyes to a prescribed degree, which resulted from service in World War II or the Korean conflict. The automobile benefit was also made available to a veteran who incurred a disability of the described nature in the line of duty in service after January 31, 1955, if such disability was shown to have been "a direct result of the performance of military duty." Public Law 91-666 increased the automobile allowance to $2,800 and authorized adaptive equipment necessary to insure safe operation of the vehicle. The law also extended the class of eligible persons to include certain persons who apply while still in service. A serviceman with a prescribed disability incurred in World War II, the Korean conflict, or the Vietnam era, need only establish that such disability on January 11, 1971, increased the automobile allowance from $1,600 to $2,800 and authorized adaptive equipment necessary to insure safe operation of the vehicle. According to the Bureau of Labor Statistics, the average price of new automobiles has not increased since the automobile allowance was last increased in January of 1971. Therefore, we do not favor the increase from the current $2,800 to the $3,300 figure proposed by this bill. Section 3 of the bill would require the Administrator to provide directly, or by contract, special driver training courses at every Veterans' Administration hospital and, where appropriate, at regional offices or other medical facilities of the Veterans' Administration, to instruct persons who are eligible for an automobile under chapter 39 of title 38, United States Code, to operate the type of automobile or other conveyance he obtains with assistance under such chapter. It also authorizes the Administrator to make such training course available to any veteran who he determines is in need of the special training. In addition, the bill would authorize the Administrator to obtain insurance on the automobiles and conveyances used in conducting the training courses, and to obtain personal liability and property damage insurance for all persons taking such courses. The Veterans' Administration has been providing the type of driver training programs contemplated by this bill as part of its medical rehabilitation program. Furthermore, the Comptroller General of the United States, in a Decision dated May 16, 1972 (B-175086), stated that Veterans' Administration medical care funds could be expended, as a necessary component of the Veterans' Administration's medical rehabilitation program, to provide automobile liability insurance coverage for disabled veteran patients being given Veterans' Administration conducted driver training. Such insurance coverage has now been obtained. Thus, it would appear that the purposes sought to be accomplished by this section of the bill can generally be achieved without the need of the specific language proposed. While we would have no objection to having specific reference to this program contained in the law, we question several aspects of the current proposal. For example, rather than requiring these training programs at "every hospital and, where appropriate, at regional offices and other medical facilities," we think it preferable to afford the Administrator maximum flexibility, so that the training can be provided at selected hospitals where the need would be greatest and where the most expertise in this type of training could be marshalled. Accordingly, we would suggest that lines 2 and 3 on page 3 of the bill be deleted. Furthermore, the bill would appear to authorize insurance on all automobiles used in conducting driver training courses even though they might be Government owned. This would, of course, be inconsistent with the settled policy of the United States to assume its own risks and losses in both tort matters and damage to its own property. For this reason, we would suggest that language be added to the proposed subparagraph (2) of the new subsection (e) of section 1903 of title 38, limiting the insurance provision to situations where non-Government owned vehicles are used. Our present training program is conducted as part of the medical care and treatment authorized by chapter 17 of title 38, United States Code, and is therefore limited to those veterans eligible for care under such chapter. The new proposal would broaden eligibility |