a. VA policy requires that certain items of automotive adaptive equipment be issued on the prescription of a physician. Such prescriptions must be based upon a knowledge of the skills and abilities required for safe and effective driving, the limitations imposed by disease and disability, and how these limitations can be compensated for by adaptive equipment and driver rehabilitation. Current adaptive equipment allows many disabled individuals to drive who could not do so a few years ago, and advances in adaptive equipment technology are appearing at an accelerated pace. As adaptive equipment becomes more sophisticated, it becomes mandatory that the prescription be individualized. In addition, more sophisticated driver rehabilitation becomes necessary. Thus, although the prescription must be issued by a physician, it will most likely be developed as a team effort involving the physician, the driver rehabilitation specialist and the prosthetic representative.
b. In many cases, the problem is simple. For example, in the case of the loss of or loss of use of an extremity, the adaptive equipment needed is standardized (see par. 19.). In other cases, particularly those with multiple handicaps, an individualized prescription is needed. Unless the physician has had the opportunity to keep abreast of the current state-of-the-art in adaptive equipment, it is best to have applicants evaluated by a driver rehabilitation specialist. The physician should report any defects or limitations identified that might affect driving to the driver training instructor as part of the referral. The driver rehabilitation specialist can make an evaluation of the applicant under simulated driving conditions and in actual adapted vehicles. The final prescription for adaptive equipment will then reflect the applicant's needs and demonstrated abilities, and is more likely to assure safe and effective driving.