Home → VA Prosthetics → VA Handbook 1173.16 - Driver Rehabilitation for Veterans with Disabilities Program → Appendix C - Operational Guidelines
16.13. Appendix C - Operational Guidelines
1. INSTRUCTOR-PATIENT RELATIONSHIP
Central to the VA Driver Rehabilitation Program is the instructor-patient relationship
during the period from receipt of the physician’s referral to the attainment of a Certificate
of Training. The Driver Rehabilitation Specialist is well-versed in treating disabilities and
in identifying residuals and/or deficits that may affect a patient’s driving capabilities.
The guidance in this directive is critical to the Driver Rehabilitation Specialist in eliciting
a Driver Rehabilitation Program specific to the needs of each patient and within the
patient’s physical and emotional capabilities.
2. TYPES OF DISABILITIES THAT ARE TREATED IN THE VA DRIVER
c. Traumatic Brain Injury (TBI);
e. Neurological and brain disorders;
f. Amputation, i.e., upper and lower extremities;
g. Orthopedic problems;
h. Mental health problems; and
i. Disabilities associated with aging.
3. GENERAL BEHAVIORAL OBJECTIVES EXPECTED OF PATIENTS
a. The patient must acquire knowledge of all areas of the Driver Rehabilitation
Program specific to their individual needs which may include both didactic theory and
b. The patient needs to develop a favorable psychological attitude toward common,
everyday driving responsibilities.
c. The patient is to become as proficient a driver as possible through use of the
most current education, teaching, and rehabilitation techniques (e.g., search, identify,
predict, decide, execute (SIPDE)).
NOTE: The use of adaptive equipment and vehicle modification enables as many
disabled individuals as possible to become independent in their transportation needs.
4. PRE-DRIVING ASSESSMENT AND EVALUATION
The Driver Rehabilitation Specialist must ensure the following areas are addressed
as part of the initial assessment and evaluation:
a. Initial Contact. Conduct initial contact with patient (driver rehabilitation
candidate) in an interview atmosphere.
b. VA Form 10-9028, Driver Training Functional Evaluation Record. This form
is available as a guide for the assessment process. This is an optional form that can be
filled out by the Driver Rehabilitation Specialist
(https://www.va.gov/vaforms/medical/pdf/vha-10-9028-fill.pdf). NOTE: This is an
internal VA web site not available to the public.
c. History. Obtain from patient the history of the patient’s driving record, including
any citations, accidents, or suspensions, as well as military defensive driving strategies
that may have been taught to the Veteran.
d. Medical Clearance. Inform patient of steps to be taken to obtain medical
clearance, if such is required from the state medical authority.
5. SCREENING PERFORMED BY DRIVER REHABILITATION SPECIALIST
a. Visual acuity, depth-perception, color-vision, peripheral-vision, night acuity, and
glare recovery (tests may be administered by use of visual screening tools).
b. Functional muscle testing.
c. Basic perceptual test (e.g., dynamic figure-ground).
d. Range of motion of all extremities, plus neck, if feasible. If lower extremities are
non-functional, emphasis on exactness of upper extremity range of motion becomes
e. Coordination testing.
f. Hearing (subjective).
g. Balance (static and dynamic).
h. Activity tolerance and susceptibility to fatigue.
j. Bowel or bladder control.
k. Reaction time, i.e., response time from accelerator to brake.
l. Sensation and proprioception.
m. Functional activities of daily living (ADL).
n. Educational training (classroom portion).
NOTE: If the Driver Rehabilitation Specialist believes the driver requires further
screening, the Driver Rehabilitation Specialist may proceed with additional testing as
outlined in paragraph 6.
6. OPTIONAL SCREENING TO BE PERFORMED BY OTHER SERVICE STAFF
MEMBERS, AS APPROPRIATE TO THE PATIENT’S MEDICAL AND/OR MENTAL
a. Standard psychological tests, if applicable, administered by a staff psychologist
and/or neuropsychologist to determine candidate’s emotional and mental capacities to
operate a motor vehicle.
b. Extensive perceptual tests given by qualified health care professional.
c. Evaluation of patient’s communication and hearing potential, to be administered
by audiologist and speech pathologist.
d. Advanced visual evaluation as indicated by an optometrist or ophthalmologist.
7. DRIVING SIMULATOR
The Driver Rehabilitation Specialist needs to be aware of the many benefits and limitations of the driver simulator as an evaluation tool and instructional device. Included in this understanding of the simulator are its design, concepts, capabilities, limitations, and preventive maintenance.
8. VALID DRIVER’S LICENSE
The Driver Rehabilitation Specialist must be sure the patient has a valid driver’s
license or valid learner’s permit before beginning on-the-road driving. Coordination with
the local DMV is essential. If it is determined that the patient’s license had been
suspended, cancelled, or revoked, the patient must be discontinued from the program
until such time as permission has been obtained from the DMV to resume the training.
NOTE: Some patients may not be required to take written, vision, and/or driving
examination at the DMV.
9. COUNSELING AND EDUCATION
In counseling the patient, it is essential to:
a. Remind patients of their responsibilities.
b. Discuss the perils of being under the influence of alcohol and illicit drugs, as well
as prescribed and non-prescription medications, when driving.
c. Review potential distractions during driving such as cell phone use, setting GPS
systems, passenger behavior, etc.
d. Educate the individual about strategies to eliminate potentially dangerous
compensatory mechanisms learned while on active duty when driving in the civilian
e. Elaborate the position that, “Driving is a privilege, not a right.”
10. FOUR PHASES OF IN-VEHICLE INSTRUCTION
During all four phases the instructor must continually emphasize the benefits of
a. Phase One Instruction. Phase One instruction includes:
(1) Training in methods and techniques for the Veteran’s ingress and egress to the
(2) Evaluating the need for assistive and prosthetic devices;
(3) Orienting the patient to vehicle controls and add-on adaptive equipment;
(4) Assisting the patient to assume proper body positioning and alignment (e.g., seat
height, position of legs);
(5) Teaching mirror references, including “blind spot” checks and tests;
(6) Noting passenger responsibilities (e.g., seat belts, lock doors);
(7) Emphasizing pre-driving check which includes external (e.g., lights) and internal
(e.g., gas supply) considerations;
(8) Practicing ingress and egress of mobility aids; and
(9) Preparing lesson plans and course routes for all steps of vehicle in motion
training, such as:
(a) Starting and stopping;
(b) Right and left turns;
(c) Centrifugal forces;
(e) Parking with no obstacles;
(f) Reaction time (accelerator to brake);
(g) Smooth acceleration and braking; and
(h) Visual tracking.
b. Phase Two Instructions. Phase Two is initiated only after student has mastered
all steps in Phase One. Phase Two is carried out in a quiet residential area with light
traffic and no hills, and includes:
(1) Limit-line approaches to intersections;
(3) SIPDE Drills. Search (visual scanning), Identify (possible hazards), Predict
(possible consequences of hazards), Decide (what to do if potential hazard becomes a
reality), Execute (carry out planned action);
(4) Two-second rule for following behind vehicles;
(5) Lane changes;
(6) U-turns and three-point turnabouts;
(7) Parallel parking;
(8) Emotional stability behind the wheel; and
(9) Training in the following five steps of the Smith System:
(a) Aiming high in steering;
(b) Getting the big picture (for visual lead time to assess the situation ahead and
sides for action);
(c) Keeping your eyes moving;
(d) Making sure oncoming traffic can see you; and
(e) Leaving yourself an “out” (to prevent a conflict).
c. Phase Three Instructions. Complex driving includes taking the patient
downtown, on hills, traffic circles, and to congested roads:
(1) Hill driving, uphill and downhill parking, speed control;
(2) Passing other vehicles;
(3) Hazardous driving situations (e.g., inclement weather, stuck accelerator, brake
failure, flat tire);
(4) Changing traffic flows; and
(5) Awareness of pedestrian hazards.
d. Phase Four Instructions. Phase four includes:
(1) Freeway entry and exit;
(2) Car control;
(3) Emergency stops; and
(4) Night driving, to include: glare avoidance, visibility reduction, and fatigue with
NOTE: In all lessons, goals and expectations must be discussed with the patient prior
to in-vehicle training, and a critique must follow road performance. Specifics of driving
techniques not included in the preceding are to be covered as road conditions arise. No
specific number of lessons is prescribed for a patient with a certain disability. It may
take a spinal cord injured patient (X) lessons to adjust to using hand controls, or it may
take a stroke victim (Y) lessons to learn to compensate for the patient’s affected side.
11. CERTIFICATE OF TRAINING.
Upon completion of the in-car training, the patient may be scheduled for a driving
examination at the DMV. A Certificate of Training may be given to the patient at this
time, signifying successful completion of the course.
12. SELECTION OF VEHICLE.
The Driver Rehabilitation Specialist assists the patient in the selection of an
appropriate vehicle, vehicle modification, and proper add-on adaptive equipment to
meet the patient’s needs according to current eligibility requirements, either as a driver
or as a passenger.
13. DOCUMENTATION OF CLINICAL CHART.
The Driver Rehabilitation Specialist must document the patient’s progress in the
medical record from time of initial evaluation and/or assessment until completion of the
Driver Rehabilitation Program. Documentation must follow local VA medical facility
policy and be in compliance with appropriate accreditation standards (i.e., Joint
Commission and the Commission on the Accreditation of Rehabilitation Facilities