The behavioral adjustment and psychological stability of those in the close interpersonal environment of the veteran are often as important a determinant of the veteran's recovery and rehabilitation as his medications or individual psychotherapy. As special training and expertise in the provision of family therapy and counseling are required, the function is performed by qualified mental health professionals. Mental health professionals have specialized training in family therapy systems and methods. The mental health professionals assigned to this function are administratively placed within their respective services in the hospital and have a professional assignment to that mental health program which is most appropriate for providing this outpatient family service. This will usually be the Mental Hygiene Clinic, Day Hospital, or a Substance Abuse Program. There is no statistical data bank that we are aware of which relates to the number of such services provided to veterans' family members. RESPONSE OF THE VETERANS' ADMINISTRATION TO WRITTEN QUESTIONS SUBMITTED BY HON. STROM THURMOND, A U.S. SENATOR FROM THE STATE OF SOUTH CAROLINA Question 1. Answer 1. Dr. Custis, do you have any figures on how many veterans who are in receipt of pension benefits are earning wages in Incentive Therapy programs, or sheltered workshops? During Fiscal Year 1982, there were 1,050 patients in the 41 VA Comprehensive Work Therapy programs who were nonservice-connected veterans receiving a pension. During that same year, 6,461 patients who were in the Incentive Therapy program were nonservice-connected veterans in receipt of a pension. We have recently received statistics from VA medical centers participating in these programs on veterans who were involved in the programs. We are trying to determine from these figures the number of veterans receiving pensions who are also wage earners. Question 2. Answer 2. Question 3. Answer 3. Do you know the average earnings of veterans in these programs? The Compensated Work Therapy budget for FY 1983 was approximately $3,045,934. Of this amount, $2,184,662 was obligated, leaving a balance of $893,154. The average earnings for veterans in this program has little meaning since patients are paid either by piece rate or hourly, depending on the contract and the program. The average amount for geriatric patients would be significantly lower than the average earnings for patients in a vocational/employment readiness program. Therefore, the overall average of $164.38 in Compensated Work Therapy has little meaning. Within the total number of patients, a certain number may earn as little as $5.00 and be discharged or change programs. The average income earned in Incentive Therapy was $166.37. This, too, is misleading since the majority of all patients in domiciliaries are in the program from one day to one year which could represent a patient earning as little as 50 cents. Has the VA taken a position regarding the exemption of income from Incentive Therapy programs in computing pension benefits? The VA has not at this time taken a formal position on the merits of this proposal. RESPONSE OF THE VETERANS' ADMINISTRATION TO WRITTEN QUESTIONS SUBMITTED BY HON. RUDY BOSCHWITZ, A U.S. SENATOR FROM THE STATE OF MINNESOTA Question 1. The Senate, led by Senators Cranston and Simpson, has a clear record of support for allowing a delimiting date extension because of alcohol or dependence why does the VA continue to cling to its belief these dependencies are willful misconduct? Answer 1. With regard to Senator Boschwitz's first question, we have enclosed a 'white paper" on alcoholism and drug abuse conditions, vis-a-vis VA monetary benefits, which we prepared in August 1982, as a technical service for the Committee, in response to similar inquiries raised at that time. This "white paper" relates the historical development of the law, regulations, and Agency policy concerning alcoholism and other drug dependency conditions as "willful misconduct". It also discusses the serious administrative problems and potential impact of proposed amendatory legislation being considered in this area. The VA's position on "willful misconduct", as more fully detailed in the enclosed document, has not changed. Moreover, we would point out that the Congress, in enacting the provision for delimiting date extension based on disability, clearly expressed its intent that the VA adhere to its existing regulations and policy on alcohol and drug abuse conditions when implementing the "willful misconduct" bar included in such legislation. We consider ourselves bound by, and have consistently followed, this congressional mandate. Question 2. Is the VA willing, with this Committee, to put together an administrative or legislative remedy to the GI Bill delimiting date issue that takes into account the VA's fears of being forced to expand the disability compensation program in later years Answer 2. In the course of previous attempts by the Senate to initiate and have enacted amendatory legislation in this area, this Agency responded to a request by the Senate Veterans' Affairs Committee for assistance in addressing certain shared concerns. Unfortunately, we did not then find such concerns susceptible of satisfactory resolution. Nevertheless, in response to Senator Boschwitz's second question, we again will be pleased to cooperate with the Committee and provide any technical assistance requested. Question 3. How many veterans have been denied an extension because of the "willful misconduct" criteria? Answer 3. Please note that the Veterans' Administration has, for some time now, maintained statistics on a fiscal year basis concerning requests for extensions based on disability. However, these statistics (see enclosed copy of fiscal year 1983 report) reflect only the numbers of chapter 34 and chapter 35 requests for extension approved and denied. Unfortunately, neither the compiled fiscal year reports, nor the regional office reports from which statistics for the former are drawn, identify the underlying reason for denial (e.g., "willful misconduct") as to any claims reported in the "denied" category. Consequently, we do not have data reasonably available to us with which to respond to this question. ALCOHOLISM AND DRUG ABUSE AUG 11 1982 VA BENEFITS A. Background Under various Federal statutes, the Veterans Administration [VA] 18 proscribed from paying certain gratuitous benefits where disability or death is due to the individual's "willful misconduct." The proscription extends to compensation for service-connected disabilities [38 U.S. C. § 310], pension for disabilities which are not service connected [38 U.S.c. 521(a)], education benefits payable under an extension of the applicable delimiting period [38 U.S.c. § 1662(a)(1)], and dependency and indemnity compensation for survivors of veterans [38 U.S.C. § 410]. Current VA regulations define willful misconduct at 38 C.F.R. $ 3.1(n). The regulations by which alcoholism and drug usage are labelled willful misconduct are 38 C.F.R. § 3.301 (c) (2) and (3). The statutory forerunners of the disability benefit programs 37-524 0-84--15 The 1931 Decision was incorporated into VA regulations and remained in effect until a modification in 1964. Administrator's Decision No. 988, August 13, 1964, made a distinction between disabilities which are the primary result of drinking alcoholic beverages and those which are the remote, organic, secondary effects. The former, acquired when an individual willingly achieves a drunken state and undertakes a task for which he or she is physically or mentally unqualified (such as driving an automobile while intoxicated), are said to be due to willful misconduct. Disabilities acquired as the secondary result of the chronic use of alcohol were no longer included in the willful misconduct category because they were not considered to be the usual and probable effects of drinking alcohol and, because of their insidious development, were not reasonably foreseen by the individual. That is, even though alcohol may have been consumed over long periods to experience the intoxicating effects, the individual would not have expected or willed the diseases or disabilities which sometimes appear as the secondary effects of that consumption. Under A.D. 988, the remote, organic, secondary effects of chronic alcohol use were excluded from the definition of willful misconduct. The same criteria were applied to the proximate and secondary effects of drug usage. The two Administrator's Decisions just referred to have formed the basis for the Agency's regulations on willful |