New or replacement vehicles must be processed through the facility equipment replacement program. These replacement vehicles can be either medium-sized or full-sized automobiles, or mini or full-size vans to accommodate the veteran trainee with more severe disabilities. Selection of the type and size of vehicle is determined locally, based on need and previous history of training and disability types. Each medical facility Director has the discretion to replace the current automobile or van. Reusable portions of add-on adaptive equipment may be retained for installation in, or on, the new vehicle. If funding is available and justification of the need to replace the present vehicle(s) can be provided, documentation must be submitted to the local OAL Officer utilizing the appropriate Integrated Funds Distribution, Control Point Activity, Accounting and Procurement Package (IFCAP) equipment replacement procedures, or as prescribed by existing VA policy.
NOTE: The following specifications, current at the time of issuance of this Handbook, are subject to change due to changes in vehicle design and technological advances. Specific needs will, for the most part, be left to the discretion of the local driver rehabilitation center programs officials.
(1) Automobiles. The basic automobile utilized in driver rehabilitation may be a mid-size or full-size two-door or four-door sedan. The following specifications are suggested:
(a) Color-keyed carpeting, windshield washer and wipers, heater, courtesy lights, lamps and switches, clock, and all other equipment customarily furnished.
(b) Automatic transmission.
(c) Power-locked doors.
(d) Power windows, power steering, and power brakes.
(e) Electric outside mirrors.
(g) Tilt-adjustable steering wheel.
(h) Split-bench front seat with individual controls for six-way power movement.
(i) Deicer and defogger on the rear window.
(j) Belts; i.e., for shoulder, chest, and lap.
(k) AM-FM radio.
(l) State of California emission controls on all vehicles issued in that State.
(m) Suggested optional equipment includes: rear window wiper, vinyl or leather upholstery, remote keyless entry, remote starting, heavy duty battery and alternator to accommodate large lift systems and a special electronic package, and free delivery (free on board (FOB)) to destination, i.e., to the nearest dealer who prepares the automobile for driveway delivery.
(2) Full-size Vans. Full-size vans require:
(a) Full-size windows;
(b) A V-8 engine with handling and towing package, which meet National Highway Traffic Safety Administration (NHTSA) specification for gross motor vehicle weight capacity;
(c) Automatic transmission;
(d) A sliding side or side cargo door;
(e) Cruise control;
(f) High-capacity air conditioning;
(g) Tilt-steering wheel;
(h) Power steering;
(i) Power windows;
(j) Power brakes;
(k) Power-door locks;
(l) Power-outside mirrors;
(m) AM and FM stereo; and
(n) A conversion package.
(3) Mini-vans. Mini-vans require:
(a) Full-size windows;
(b) A V-6 engine;
(c) Automatic transmission;
(d) A Sliding-side door;
(e) Cruise control;
(f) Three-zone climate-control air conditioning;
(g) Tilt-steering wheel;
(h) Power windows;
(i) Power brakes;
(j) Power-door locks;
(k) Power-outside mirrors;
(l). AM and FM stereo; and
(m) Accommodations for a drop-floor, ramp-kneeling system which meet NHTSA gross motor vehicle weight capacity.
(4) Maintenance and Repair. Routine vehicle servicing is mandatory. All maintenance and repair work on the driver rehabilitation automobile is the responsibility of the VA medical facility. Arrangements may be made with the medical facility's Engineering Service to maintain the vehicle at its peak performance. If Engineering Service does not keep current maintenance records on the vehicle, it is the responsibility of the driver rehabilitation specialist to maintain an up-to-date, legible, and complete service maintenance record on each vehicle assigned to the program. NOTE: As result of recent surveys for accreditation by the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission (TJC), the PM&RS Program Office recommends a weekly maintenance schedule be maintained with the vehicle.
(5) Government Services Administration (GSA) Credit Card. It is suggested that a GSA credit card be issued and utilized to expedite vehicle servicing. Major repairs or maintenance costs may be requested and approved under local VA policy.
(6) Selection of Vehicles for Client. The driver rehabilitation specialist is responsible for advising the patient about the types of vehicles appropriate for the Veteran's accessibility and equipment needs.
(7) Parking Space. Parking sites for the driver rehabilitation vehicles must receive priority rating at all facilities having Driving Rehabilitation Programs. Parking sites must be immediately accessible to the classroom or clinical area in which the patient receives appropriate pre-driving instruction. Efforts need to be made to have adequate room for egress and ingress for the disabled trainee on both sides of the vehicle, and in case of a van, adequate room must be maintained at the sides and rear for wheelchair lift systems.
(a) When not in use, the Driver Training Vehicle must be kept in a secure location and adequate precautionary measures need to be in place such as security checks provided by Medical Facility Security.
(b) Any damage or loss must be reported to OAL Service (90), in accordance with VA Handbook 7002.
(9) Insurance. To ensure that adequate liability coverage is provided enrolled driver trainees, an annual commercial automotive liability insurance contract has been established to automatically cover all designated driver rehabilitation vehicles, including leased vehicles at any VA medical facility in which an approved Driver Rehabilitation Program is functioning. Coverage under the contract is for personal liability and property damage. All changes in driver rehabilitation vehicle inventory must be immediately reported to the PM&R Program Office to ensure the applicable vehicles are added, or removed, from the national insurance contract. When the enrolled driver trainee is personally injured during the course of VA-sponsored training, a claim for medical care may be filed with VA. NOTE: Information on specific insurance claims may be received by contacting PM&RS VHA Central Office staff (117), or VHA Fleet Management Office.
(10) Safety. All rules for the safe operation and maintenance of the driver rehabilitation vehicle are to be based on Federal and State laws and regulations governing the area in which the vehicle is operating. Local policies regarding emergency procedures and protocols must be available in the driver rehabilitation vehicle at all times.
(11) Transfer of Vehicle. Transfers of driver rehabilitation vehicles from one driver rehabilitation center to another is authorized, initiated, and coordinated by the sending facility with notification to PM&RS VHA Central Office staff (117). Transfers of vehicles must be coordinated through the Chief, OAL, at both the losing and gaining facilities.
(12) Loaned Vehicle. Using driver rehabilitation vehicles on a loan basis from an automobile dealership is discouraged; however, such practice is permissible under certain conditions. Most importantly, the dealer needs to provide adequate and documented proof that the vehicle is insured by the dealer. VA cannot accept responsibility of providing comprehensive insurance on a loaned vehicle. If acceptable, the loaned vehicle needs to be used as a supplemental training vehicle for the VA-issued, or purchased vehicle, and not as a replacement. The loaned vehicle must meet the specifications and standards maintained by VA for use as a driver rehabilitation vehicle and needs to be used for driver rehabilitation purposes only. NOTE: Loaned vehicles and/or equipment must be reported to the Chief, OAL.
(13) Restriction in Use of Driver Rehabilitation Vehicle. Use of vehicles purchased and leased for the VA Driver Rehabilitation Program for purposes other than driver rehabilitation is strictly discouraged. VA Driver Rehabilitation Program vehicles shall be used only for official purposes and use of the vehicle for driver rehabilitation purposes must take precedence over any other need. Family members of persons being trained in the driver rehabilitation vehicle may not drive or ride in the training vehicle. It is permissible, for VA employees to ride in the vehicle for evaluation, orientation, or teaching purposes; clinical training students in the allied health disciplines who have VA appointments may ride in the vehicle, as long as such involvement is undertaken within a phase of their active clinical internship. For safety precautions, the adaptive equipment must not be utilized by unauthorized personnel or untrained VA employees; the inappropriate use of such equipment may pose a safety hazard to non-disabled operators and is strictly prohibited.
(14) First Aid Kits, Fracture Splints, and Road Emergency Kits. Automobiles used in driver rehabilitation must be equipped with first-aid kits, universal precaution packages, fracture splints, and road emergency kits (safety triangles, booster cable, etc.).
(15) Telephone. Cellular telephones are mandated. A global-positioning system (GPS) may also be purchased and is highly recommended. Specific approval and licensing must be processed through the local telecommunication office.
b. Adaptive Equipment for Driver Rehabilitation Vehicles
(1) Adaptive Equipment for Automobiles. Adaptive equipment, which is to be purchased by the medical facility for installation, must include the following:
(a) Hand control (reversible) with optional dimmer switch and horn button;
(b) Ignition key adapter;
(c) Dimmer switch on steering column;
(d) Transfer bar inside (portable);
(e) Steering devices (spinner knob, v-grip, tri-pin, and amputee ring);
(f) Assorted safety belts;
(g) Panavision rear view mirrors;
(h) Parking brake extension;
(i) Left-foot gas pedal;
(j) Right-turn signal adapter;
(k) Shift lever extension;
(l) Spinner mount receivers for various assistive devices;
(m) Driver training sign;
(n) Slide boards-varied designs;
(o) Instructor braking system;
(p) Instructor rear view mirror; and
(q) Instructor eye-check mirror.
(2) Van Modification and Adaptive Equipment. Van modification and adaptive equipment must include:
(a) Power doors and switches in the steering area and right rear fender;
(b) A side-mount lift and/or side-ramp system;
(c) A dropped-floor with leveling and appropriate wheelchair flooring;
(d) A raised roof with structural support and insulation (a full-size van must have, in addition, a headliner);
(e) A removable 6-way power transfer seat base;
(f) An occupant-restraint system with wheelchair tie-down system in the driver station;
(g) An occupant-restraint system with wheelchair tie-down in the passenger area;
(h) A variable steering and braking system with backup;
(i) An extended-steering column, as applicable;
(j) A key extension;
(k) An electric emergency brake;
(l) A dual back-up battery system;
(m) Hand control (reversible) with dimmer switch and horn button;
(n) Spinner mount receivers for various assistive devices;
(o) Steering devices such as: spinner knob, v-grip, tri-pin, and amputee ring;
(p) An instructor and/or dual steering system for high-tech driving systems;
(q) An instructor and/or dual braking system;
(r) A turn signal extension;
(s) A gear shift extension;
(t) A secondary control system for high-tech driving systems, e.g., touch-pad, voice- activated system, etc.;
(u) An instructor rear-view mirror; and
(v) An instructor eye-check mirror.
(3) Maintenance and Safety. Routine maintenance and weekly safety checks of all adaptive equipment must be scheduled and documented. Driver rehabilitation specialists need to be able to identify the operational defects of the adaptive equipment; other specialists such as medical facility engineers, vendors, and the manufacturing representatives of the equipment, may be consulted. A copy of the safety policies and procedures must be maintained in the vehicle at all times.
(4) Program Guide on Adaptive Equipment. VHA Handbook 1173.4, Automobile Adaptive Equipment Program, is available on-line at VHA Publications web site (http://www1.va.gov/vhapublications/) for the use of all VA medical facilities having an official designated Driver Rehabilitation Program.
c. Clinical Evaluation for Adaptive Equipment. The following areas of clinical evaluation are defined.
(1) Vision. Portable vision devices provide an evaluation of certain vision factors necessary to perform a safe driving task. Equipment must be available to measure the following: visual acuity, color perception, field of vision, depth perception, glare recovery, and night vision.
(2) Reaction Time. A device is used to measure reaction time from acceleration to braking.
(3) Cognitive and Perceptional Screening. In screening of basic cognitive and perceptional motor materials, identification and/or verification of a potential problem must be referred to the appropriate professional for a more in-depth evaluation.
(4) Neuromotor Assessment. This is a physical assessment of range of motion, strength, sensation, coordination, and endurance.
d. Simulation Equipment
(1) Utilization. Simulators create a classroom driving situation, which duplicates the visual, aural, and biomechanical environment of driving without motion. The simulator increases the number of patients who can be trained by providing driving experience in a classroom setting. It is an important tool in evaluating and determining the physical and mental capabilities of all types of disabled patients.
(2) Training. At the time of purchase of a simulator, a minimum of 1 full day of training must be incorporated into the purchase order. Driver rehabilitation specialists must be totally familiar with operation and maintenance of the simulator, as well as how the equipment can be incorporated into the training program for disabled drivers. NOTE: Before purchasing a simulator, the Office of the Director, PM&RS, VA Central Office, needs to be consulted.
(3) Space. It is recommended that a single room, measuring approximately 18' by 16,' needs to be provided for projection-type simulator training at a driver rehabilitation center.