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Date:

Veterans

Administration

87

Memorandum

To:

Legislative Affairs Staff (101E)

From:

Director Prosthetics & Sensory Aids Service (121)

Subj

Review, Comments and Cost Estimate Concerning Draft Legislation for
Hearing Impaired Veterans.

1. We have reviewed the proposed draft legislation to provide "devices for the hearing impaired in the case of any veteran who is totally deaf (including telecaptioning decoders)". We offer the following comments concerning this draft legislation:

a. Proposed language - concur as written. The specific intent of the draft legislation is to provide telecaptioning devices to totally deaf veterans. Section 601(6)(A)(1) is the only section where specific devices are identified as prosthetic services in Title 38 USC. Other available items for the hearing impaired are already provided as past medical services.

b. Five year cost estimate our estimate is based on providing these devices to totally deaf veterans, those with a primary diagnoses for deafness rated 80% or more disabling. It includes both SC and NSC since the telecaptioning devices would be considered as part of medical services. The information concerning potential eligibles was obtained from the Statistics Review and Analysis Division, the item cost is based on the average cost of these items plus a small amount for inflation. The estimate assumes 100% participation by these veterans.

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We recommended that M&S support the draft legislation. A recent General Counsel opinion limits the provision of this device only to those veterans who suffer a "morbid" mental condition as a result of their deafness. We believe that the isolation which accompanies total deafness is so severe that it affects the mental and physical health of all totally deaf veterans. Therefore, we support the issuance of any device which reduces this isolation.

2. If you have any questions concerning our comments or cost estimate, please contact my office.

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Date:

To:

From:

Subj:

Veterans
Administration

April 4, 1984

Legislative Affairs Staff (1015)

Memorandum

RECEIVED

APR 5 1984

LEGISLATIVE AFFAIRS
STAFF

Acting Director, Mental Health and Behavioral Sciences Service (116A1)

Review, cost estimate, and brief comments concerning draft legislation.
Subtitle: Concerning language of Section V: Post-traumatic Stress Disorder

1. Provisions for a new Associate Director for Post-traumatic Stress Disorder are unlikely to make positive changes. The existing staff of Mental Health and Behavioral Sciences Service spends a substantial amount of time addressing the activities proposed in this legislation.

2. Establishment of a task force on the care and treatment of Post-traumatic Stress Disorder appears intended to bypass the role of Mental Health and Behavioral Sciences Service and of Professional Services in Central Office by directly advising the Chief Medical Director on policies concerning the listed items. Provision of a task force to advise Mental Health and Behavioral Sciences Service on these matters with travel funds may be of some value.

3. Establishment of the new position of Associate Director and of a task force seems unlikely to make a major change in DM&S operations. If DM&S chooses to increase its emphasis on the treatment of Post-traumatic Stress Disorder it has the authority to do so without additional legislation.

4. Five year cost estimates for the various provisions of this bill:

(a) Position of Associate Director, Mental Health and Behavioral Sciences
Service for Post-traumatic Stress Disorder including salary, physicians
bonus, and moving costs, first year approximately $110,000; second through
fifth years $340,000, secretary (GS-7) five years at $18,000 per year
($90,000).

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(b) Special education and training programs: Assuming that the Associate Director will conduct special education and training programs, the following assumptions will be made for cost estimates:

(1) Training will be held in each medical district.

(2) Approximately six facilities per medical district on the average will send a treatment team of five people for a total of thirty people per training episode. Assuming eight training episodes per year at a average cost of $500 per person plus $2,000 for trainers, yearly costs will be $136,000 per year or $680,000 for five years. It is important to observe that the Regional Medical Educational Centers (RMEC) have been providing training on the treatment of Post-traumatic Stress Disorder to medical center personnel. For purposes of this cost estimate, however, it is assumed that RMEC will continue its own program as a way to provide training support for Vet Centers, and advanced training for additional personnel or personnel who have completed training in their own medical district.

VA FORM 2105

MAY 1983

U.S. GOVERMENT PRINTING OFFICE 1987 301-488/2979

(c) Task Force costs:

1. Assuming twelve members from the field and four from VACO.

2. Assuming three two day meetings per year for two years.

3. Assuming each meeting will be two and one half days.

4. Finally, assuming some task force site visits for program review
purposes.

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If the task force meets at the same rate for five years Total Cost

equals $181,500. ✓

ROBERT L. CUSTER, M.D.

TESTIMONY OF A PANEL CONSISTING OF DONALD L. CUSTIS, M.D., CHIEF MEDICAL DIRECTOR, VETERANS' ADMINISTRATION, ACCOMPANIED BY D. EARL BROWN, JR., M.D., ASSOCIATE DEPUTY CHIEF MEDICAL DIRECTOR; A. AUDLEY HENDRICKS, ASSISTANT GENERAL COUNSEL; AND MARJORIE R. QUANDT, ASSISTANT CHIEF MEDICAL DIRECTOR FOR ADMINISTRATION Dr. CUSTIS. Thank you, Mr. Chairman. We are pleased to be here, Mr. Chairman, to present the views of the Veterans' Administration on the legislation pending before your committee. Our official testimony fully discusses each of these bills on today's agenda, so in the interest of time I will not repeat that analysis, but will make some brief opening remarks and my colleagues and I are prepared to respond to the questions concerning these measures.

These bills contain many attractive features, but in some instances we do have reservations and would counsel modification.

For example, in the case of S. 2514, we already have an extensive program of VA community interaction functioning primarily under our social work service. I would like to submit a summary of these activities for the hearing record. I think you will find them impressive. I would hope that in the coming weeks we could work with your staff to further develop this particular provision.

Mr. Chairman, S. 2514 is directed in part to concerns about VA drug and alcohol treatment and VA management of post-traumatic-stress disorder care. The proposal would have a number of farreaching changes in the area of drug and alcohol treatment. Among these are provisions which would impose systemwide limitations on the clinical management of these patients.

We believe, Mr. Chairman, that the VA clinician who is providing all of the care of the individual patient should retain the flexibility to provide treatment based on his or her clinical judgment. We did hear, Mr. Chairman, and we appreciate the opinion you expressed on this subject in your opening remarks.

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