[Federal Register Volume 62, Number 106 (Tuesday, June 3, 1997)]
[Rules and Regulations]
[Pages 30240-30242]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-14349]


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DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AI60


Guidelines for Furnishing Sensori-neural Aids (i.e., Eyeglasses, 
Contact Lenses, Hearing Aids)

AGENCY: Department of Veterans Affairs.

ACTION: Interim final rule.

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SUMMARY: This document amends the Department of Veterans Affairs (VA) 
medical regulations to provide guidelines for when VA will furnish 
veterans with sensori-neural aids (i.e., eyeglasses, contact lenses, 
hearing aids). These amendments are necessary to implement a 
requirement imposed in the recently enacted Veterans' Health

[[Page 30241]]

Care Eligibility Reform Act of 1996, Pub. L. 104-262.

DATES: This interim final rule is effective June 3, 1997. Comments must 
be received on or before August 4, 1997.

ADDRESSES: Mail or hand deliver written comments to: Director, Office 
of Regulations Management (02D), Department of Veterans Affairs, 810 
Vermont Avenue, NW, Room 1154, Washington, DC 20420. Comments should 
indicate that they are submitted in response to ``RIN 2900-AI60.'' All 
written comments received will be available for public inspection at 
the above address in the Office of Regulations Management, Room 1158, 
between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday 
(except holidays).

FOR FURTHER INFORMATION CONTACT: Frederick Downs, Jr., Chief 
Consultant, Prosthetics and Sensory Aids Service Strategic Healthcare 
Group (113), Department of Veterans Affairs, 810 Vermont Avenue, NW., 
Washington, DC 20420, (202) 273-8515.

SUPPLEMENTARY INFORMATION: This document amends the VA medical 
regulations set forth at 38 CFR part 17. It adds a new section to the 
regulations to provide specific guidance on when VA will furnish 
veterans with sensori-neural aids (i.e., eyeglasses, contact lenses, 
hearing aids).
    Prior to the enactment of Public Law 104-262, VA's authority to 
furnish prosthetic devices and appliances to veterans on an outpatient 
basis was very limited. That law significantly expanded VA's authority 
to furnish such devices and appliances on an outpatient basis. The new 
law provided that VA could furnish needed prosthetic devices and 
appliances to any veteran otherwise receiving health-care services from 
VA. The law further provided, however, that VA could furnish needed 
sensori-neural aids, a type of prosthetic device, only in accordance 
with guidelines promulgated by the Secretary. This provision in the law 
effectively authorizes VA to impose limitations on the provision of 
those sensori-neural aids.
    This interim final rule provides that VA will furnish needed 
sensori-neural aids (i.e., eyeglasses, contact lenses, hearing aids) to 
the following veterans:
    (1) Those with a compensable service-connected disability;
    (2) Those who are former prisoners of war;
    (3) Those in receipt of benefits under 38 U.S.C. 1151;
    (4) Those in receipt of increased pension based on the need for 
regular aid and attendance or by reason of being permanently 
housebound;
    (5) Those who have a visual or hearing impairment that resulted 
from the existence of another medical condition for which the veteran 
is receiving VA care, or which resulted from treatment of that medical 
condition;
    (6) Those with a significant functional or cognitive impairment 
evidenced by deficiencies in the ability to perform activities of daily 
living, but not including routinely occurring visual or hearing 
impairments; and
    (7) Those visually or hearing impaired so severely that the 
provision of sensori-neural aids is necessary to permit active 
participation in their own medical treatment.
    Examples of medical conditions which could cause visual or hearing 
impairments permitting VA to furnish sensori-neural aids under 
paragraph (5) include stroke, diabetes, multiple sclerosis, vascular 
disease and geriatric chronic illnesses, when they result in visual or 
hearing impairment. Examples of treatment of medical conditions which 
could cause impairments permitting the furnishing of devices under that 
paragraph might include treatment with ototoxic drugs, or performance 
of surgery on the eye or ear, such as cataract surgery.
    Examples of significant functional or cognitive impairment under 
paragraph (6) are: one or more basic activities of daily living 
impairment, cognitive impairment as measured by a mental status 
examination, and recurrent falls with the contributing cause being 
visual impairment.
    An example of when VA might furnish sensori-neural aids under 
paragraph (7) to permit a patient to participate in his or her own 
treatment would be a geriatric patient with a severe visual or hearing 
loss which, combined with other age-related infirmities, makes 
communication extremely difficult or impossible absent receipt of a 
sensori-neural aid. Another example would be a blind veteran with a 
hearing loss who needs a hearing aid to participate in training at a VA 
Blind Rehabilitation Center.
    VA will provide sensori-neural aids to the first four groups of 
veterans because Congress determined in section 104 of Public Law 104-
262 that they have the highest priority to receive VA health-care 
benefits. VA also will provide sensori-neural aids to the fifth, sixth 
and seventh groups of veterans due to their substantial needs.
    This interim final rule also provides that VA will furnish needed 
hearing aids to those veterans who have service-connected hearing 
disabilities rated 0 percent if there is a service-connected organic 
conductive, mixed, or sensory hearing impairment, and loss of pure tone 
hearing sensitivity in the low, mid, or high-frequency range or a 
combination of frequency ranges which contribute to a loss of 
communication ability; however, hearing aids are to be provided only as 
needed for the service-connected hearing condition. VA will provide 
hearing aids to this group because of their service-connected hearing 
disability.
    Section 103(a) of Public Law 104-262 provides that VA ``may not 
furnish sensori-neural aids other than in accordance with guidelines 
which the Secretary shall prescribe.'' Section 103(b) of this law 
requires that the guidelines be established on or before November 8, 
1996 (``(n)ot later than 30 days after the date of the enactment of 
this Act.''). Under these circumstances, the Secretary finds under 5 
U.S.C. 553 (b) and (d) that prior notice-and-comment and a 30-day delay 
of the effective date are impractical, unnecessary, and contrary to the 
public interest, and that there is good cause for dispensing with these 
procedures.
    Because no notice of proposed rulemaking was required in connection 
with the adoption of this final rule, no regulatory flexibility 
analysis is required under the Regulatory Flexibility Act (5 U.S.C. 
601-612). Even so, the Secretary hereby certifies that these regulatory 
amendments will not have a significant economic impact on a substantial 
number of small entities as they are defined in the Regulatory 
Flexibility Act 5 U.S.C. 601-612. These amendments do not affect any 
small entities.
    This regulatory action has been reviewed by the Office of 
Management and Budget under Executive Order 12866.

    The Catalog of Federal Domestic Assistance program number is 
64.013.

List of Subjects in 38 CFR Part 17

    Administrative practice and procedure, Alcohol abuse, Alcoholism, 
Claims, Day care, Dental health, Drug abuse, Foreign relations, 
Government contracts, Grant programs-health, Grant programs-veterans, 
Health care, Health facilities, Health professions, Health records, 
Homeless, Medical and dental schools, Medical devices, Medical 
research, Mental health programs, Nursing homes, Philippines, Reporting 
and recordkeeping requirements, Scholarships and fellowships, Travel 
and transportation expenses, Veterans.


[[Page 30242]]


    Approved: December 23, 1996.
Jesse Brown,
Secretary of Veterans Affairs.

    For the reasons set forth in the preamble, 38 CFR part 17 is 
amended as follows:

PART 17--MEDICAL

    1. The authority citation for part 17 continues to read as follows:

    Authority: 38 U.S.C. 501(a), 1721, unless otherwise noted.

    2. An undesignated center heading and a new Sec. 17.149 are added 
to read as follows:

Prosthetic, Sensory, and Rehabilitative Aids


Sec. 17.149  Sensori-neural Aids.

    (a) Notwithstanding any other provision of this part, VA will 
furnish needed sensori-neural aids (i.e., eyeglasses, contact lenses, 
hearing aids) only to veterans otherwise receiving VA care or services 
and only as provided in this section.
    (b) VA will furnish needed sensori-neural aids (i.e., eyeglasses, 
contact lenses, hearing aids) to the following veterans:
    (1) Those with a compensable service-connected disability;
    (2) Those who are former prisoners of war;
    (3) Those in receipt of benefits under 38 U.S.C. 1151;
    (4) Those in receipt of increased pension based on the need for 
regular aid and attendance or by reason of being permanently 
housebound;
    (5) Those who have a visual or hearing impairment that resulted 
from the existence of another medical condition for which the veteran 
is receiving VA care, or which resulted from treatment of that medical 
condition;
    (6) Those with a significant functional or cognitive impairment 
evidenced by deficiencies in activities of daily living, but not 
including normally occurring visual or hearing impairments; and
    (7) Those visually or hearing impaired so severely that the 
provision of sensori-neural aids is necessary to permit active 
participation in their own medical treatment.
    (c) VA will furnish needed hearing aids to those veterans who have 
service-connected hearing disabilities rated 0 percent if there is 
organic conductive, mixed, or sensory hearing impairment, and loss of 
pure tone hearing sensitivity in the low, mid, or high-frequency range 
or a combination of frequency ranges which contribute to a loss of 
communication ability; however, hearing aids are to be provided only as 
needed for the service-connected hearing disability.

(Authority: 38 U.S.C. 1701(6)(A)(i))

    3. The undesignated center heading preceding Sec. 17.150 is 
removed.

[FR Doc. 97-14349 Filed 6-2-97; 8:45 am]
BILLING CODE 8320-01-U