HomeVA ProstheticsVA Handbook 1173.16 - Driver Rehabilitation for Veterans with Disabilities ProgramDriver Rehabilitation Program Procedures

16.14. Driver Rehabilitation Program Procedures

a. Procedures

(1) Referrals for driver evaluation must be received from the physician or service most knowledgeable of the patient's physical and mental problem(s).

(2) Veterans referred for driver rehabilitation, who are not involved with a rehabilitation treatment team, should be considered for a team-based comprehensive rehabilitation needs assessment due to the likelihood of having other physical, behavioral, or functional problems that may need to be addressed.

(3) Treatment may be terminated if the patient is using illegal substances, abusing prescription medication, or consuming alcohol at risky levels. If treatment is terminated because of alcohol or drug problems, the patient should be referred to the VHA Substance Use Disorder Program. The patient may be re-admitted to the Driver Rehabilitation Program only after written certification by the Substance Use Disorder Program manager that the patient no longer constitutes a likely safety risk due to use of drugs or alcohol.

(4) Termination from the Driver Rehabilitation Program, other than for medical reasons, before successful completion of the program will be based upon professional judgment of the driver rehabilitation specialist.

(5) Final determination of patient's capacity to drive and be licensed rests with the appropriate State licensing agency.

b. Determining Eligibility for Driver Rehabilitation

(1) "Eligible Person." For the purposes of this Handbook, the term "eligible person", according to 38 U.S.C. 3901, means:

(a) Any veteran entitled to compensation under chapter 11 of this title for any of the disabilities described in subparagraph 1., 2., or 3. below, if the disability is the result of an injury incurred or disease contracted in or aggravated by active military, naval, or air service:

1. The loss or permanent loss of use of one or both feet;

2. The loss or permanent loss of use of one or both hands;

3. The permanent impairment of vision of both eyes of the following status: central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than twenty degrees in the better eye; or NOTE: Permanent impairment of vision in both eyes, as described in this subparagraph, ordinarily will rule out special driver rehabilitation. It is necessary, that each visually-impaired applicant be separately evaluated since certain vision impairments, as field defects, may not bar participants. Some States will issue a drivers license to wearers of spectacle mounted telescopes that correct vision to 20/40 or better)

(b) Any member of the Armed Forces serving on active duty who is suffering from any disability described in subparagraph 1., 2., or 3. of subparagraph. (a) of this paragraph if such disability is the result of an injury incurred or disease contracted in or aggravated by active military, naval, or air service.

(2) Additional Persons Able to Receive Driver Rehabilitation Training

(a) Any veteran eligible for medical care under 38 U.S.C. Chapter 17, and any member of the Armed Forces who is determined by the VA to need this special driver rehabilitation, even though such Veteran and member are not eligible for financial assistance in the purchase of an automobile or other conveyance under 38 U.S.C. Chapter 39.

(b) Any non-veteran referred as part of an authorized sharing agreement under authority of VHA Directive 1660.1, as described in preceding subparagraph 14b.

(3) Other Participation Criteria

(a) The patient must be eligible for a valid State permit or license.

(b) The patient must be willing to release medical information to the State in accordance with individual Department of Motor Vehicles (DMV) policy.

(c) The patient must not have used illegal substances in the past 45 days and must be in compliance with local state law and vehicle codes regarding operation of a motor vehicle. NOTE: The ultimate goal of the Driver Rehabilitation Program is to return the Veteran back to full driving with appropriate modifications to the vehicle. The program cannot make a legal determination as to whether a Veteran with a progressive disorder can safely operate a motor vehicle. The determination of whether someone should maintain their driver's license is the responsibility of the state in which they reside. Appropriate mechanisms should be developed to refer patients with progressive disorders such as dementia directly to the state for assessment.

c. Referral

(1) The Electronic Consultation Form must be used. A request for "Evaluation for Driver Rehabilitation" from the primary care or attending physician must be sent through the PM&RS, or appropriate care line. Driver rehabilitation services may be provided to inpatients and outpatients, although it is anticipated that the majority will be on outpatient status during training. NOTE: PM&RS evaluates each applicant and accepts only those candidates for training who meet the various minimum requirements.

(2) The consultation must contain:

(a) The medical history of the driving candidate,

(b) A list of medications which may affect driving, and

(c) A list of the concurrent limitations which accompany the patient's primary disability (see App. D) NOTE: It is recommended that the Driver Rehabilitation Specialist work with local computer specialists to develop a consult referral template to ensure all needed information is present on the referral.

(3) Psychiatric Care Status. Referral by the Mental Health Team is required for patients currently under care for a psychiatric disorder. Those referred patients may receive driver rehabilitation if they meet all other eligibility requirements for PM&RS treatment, and they pass the evaluation procedures provided by the PM&RS physician and the Psychiatry and/or Psychology staff.

d. Admission Criteria

(1) The furnishing of driver rehabilitation for persons with disabilities is a medical therapy furnished in the same manner as other therapy.

(2) After determination of legal eligibility by the Business Office, the inpatient or outpatient applicant is referred to PM&RS for physical and/or psychological examinations for the decision as to the medical feasibility of undergoing the special training on an inpatient or outpatient basis. NOTE: Occupational Therapy, Speech Language Pathology and Psychology Service may be consulted to provide an evaluation in those patients with a history of or evidence of significant cognitive deficiencies.

(3) If a decision is reached to obtain training from a non-VA source and a satisfactory source is identified (see subpar. 14g), the medical facility initially receiving and processing the request must complete the required contract (Memorandum of Understanding (MOU)) and pay all charges. For example, if the request is initially processed at the Outpatient Clinic, Oakland Park, FL, and a decision made to obtain contract or MOU services, the necessary contract or MOU must be developed by the VA Medical Facility Miami, FL (the parent facility), and related charges are to be paid by that medical facility. NOTE: VA medical facilities not having special driver rehabilitation activities may obtain consultative services from medical facilities which do.

e. Training of Non-Veterans. According to law, only a "Veteran or member of the Armed Forces, eligible for care under 38 U.S.C. Chapter 17," is permitted to receive driver training. All other individuals have to be referred to non-VA resources for such training (see 38 U.S.C. Section 3903(e)(1)). However, some individual driver rehabilitation centers may qualify as "sharing of health care resources" under 38 U.S.C. Section 8153, and enter into a sharing agreement with other medical facilities. Public Law 104-262, Section 301, "Revision of Authority to Share Medical Facilities, Equipment, and Information," dated October 6, 1996, expanded VA's capacity to enter into sharing agreements with other health care providers.

(1) Agreements for driver rehabilitation services need to be between the local VA facility and appropriate health care facilities, or other governmental agencies, requiring such services. Such agreements must be established according to local and national policies.

(2) Training must only be provided by a Certified Driver Rehabilitation Specialist.

(3) Services must only be provided within excess capacity of the program and must not result in any delay of services to eligible Veterans or Armed Services personnel.

f. Transfers of Veterans to Driver Rehabilitation Centers. When the physician's findings indicate an applicant can be expected to satisfactorily complete a special driver rehabilitation course, and the applicant accepts the plan offered, arrangements must be made to move the person to the nearest VA Driver Rehabilitation Center having authorized accommodations for completing the special training. The use of hoptel beds is encouraged for those patients that do not require overnight nursing care. NOTE: Movement of patients between facilities is governed by VA Handbook 1601B.05 Beneficiary Travel. Direct commuting from a patient's home to the training facility may be utilized when so warranted. Following completion or termination of the training, the patient is to be provided whatever return transportation is needed and for which the patient is entitled to receive under applicable authorities. Funding for these transfers are provided by the "releasing facility" (see App. D).

g. Non-VA Training Programs

(1) Certain situations may demand that a veteran seek driver training at some rehabilitation center other than an approved VA Driver Rehabilitation Program. Such situations could include:

(a) Inability to leave area of residence for family reasons,

(b) Inability to travel long distances to reach the nearest driver rehabilitation center, or

(c) Unavailability of space.

(2) If any of these situations exist, it may be necessary to contract or provide this training through a MOU at the nearest non-VA Driver Rehabilitation Program offering appropriate services to meet the Veteran's needs. It is the responsibility of a knowledgeable PM&RS specialist to review the non-VA facilities to determine whether or not they meet VA standards for training of the disabled; e.g., adequate and safe adaptive equipment, a state-certified instructor, a respectable training record, etc., before the Veteran receives such training, or the contract or MOU is developed to authorize payment of such service.

h. Training in Veteran's Personal Vehicle or Vendor Equipped Vehicle. It is permissible to teach adaptive driving skills to a Veteran in the Veteran's own personal vehicle, or in a vendor-equipped vehicle, as long as the Veteran, or vendor, can show documented proof that the vehicle is covered by the minimum State requirements for insurance. This situation may occur when the Veteran has need for special adaptive equipment or structural modifications of the vehicle not ordinarily utilized or available in the VA driver rehabilitation vehicle(s). NOTE: It is recommended that in such training situations, an instructor's brake needs to be installed prior to beginning the training. Magnetic signs indicating student driver need to be affixed to the vehicle.

i. Certificate Of Training. In order to standardize the certification completion of the VA driver rehabilitation course, VHA Central Office has determined that VA Form 3904, Certificate of Training, is to be awarded to all patients who successfully complete the VA Driver Rehabilitation Program. State licensure is not a prerequisite for obtaining this certificate; in fact, the certificate needs to be given prior to taking the State DMV examination. NOTE: VA Form 3904 can be ordered through the local "forms officer" in Human Resources Management, or from A&MM. The stock number is F05525.

j. Medical Advisory Boards. It is strongly recommended that each VA Driver Rehabilitation Program establishes a local Medical Advisory Board and/or Major Medical Equipment Committee to oversee the operations of the program, and to assist in the medical evaluation procedures in difficult or questionable circumstances.

k. Licensing. The final responsibility for licensing the patient who completes the VA Driver Rehabilitation Program rests with the individual Veteran and the individual State DMV. The VA staff needs to be aware of the State eligibility requirements, and to cooperate with the State, as much as possible,?√°in accordance with the Hospital Insurance Portability and Accountability Act (HIPAA), on behalf of the patient.

l. Night Driving. The ability to drive at night or at dusk is quite different from daytime driving. The glare from lights of oncoming traffic, lower-visual acuity, inability to determine road width, or to see directional signs may be influenced when switching from daylight to nighttime driving. Medical facility authorities are encouraged to support all driver rehabilitation specialists in providing a portion of the teaching program to night instruction.

m. Release of Medical Information. With the patient's written consent, a page(s) of the patient's medical record, which shows the patient's status in the Driver Rehabilitation Program, may be duplicated (with appropriate clearance from the Business Office) and forwarded to the State DMV for determination as to whether or not the veteran can be examined for licensure.

n. Limitations. The goal of the Driver Rehabilitation program is to determine the Veteran's functional ability to drive safely; however, there is no guarantee that participation in the program will ensure safe driving 100 percent of the time.

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