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					The Need for Reasonableness

Blinded veterans have been well served by Prosthetics and Sensory Aids Service
(P&SAS) when it comes to the provision of computers, peripherals and software
as well as local services and training.

The comprehensive computers for the blind national standardized package
requires a partnership between P&SAS and the veterans. The expectation is that
both Prosthetics and the veterans will be reasonable. Lack of reasonableness by
either party will lead to a lack of faith, loss of the sense of partnership and will
result in unnecessary conflict.

To ensure understanding and standardization careful attention was paid to the
language in the PCMP documents. The resulting document was endorsed by the
BVA, BRS and P&SAS. The PCMP documents are extremely comprehensive
and were written in clear language that communicated the intent of the
committee. Reasonable men met and over time worked out the structure of a
reasonable set of guidelines.

It is vitally important that all parties impacted by the policies to thoroughly read
them and understand the details within. This type education will ensure
reasonableness.

The intent of the provision of computers, peripherals and software is to meet the needs of most
blinded veterans. The intent was not to meet the needs of high end computer users or those with
specialized needs. Flexibility exists in Prosthetics to meet the special needs and circumstances.
The work group was in agreement that most blinded veterans are not high end computer users.
For most blind veterans, the computer is a tool used to accomplish specific tasks in order to meet
some basic individual goals. Based on historical data, it was determined that goals for computer
use mostly revolved around basic E-mail, Internet and word processing.

The question of what is considered reasonable will come to the forefront when veterans request
upgrades and replacements of hardware, software and peripherals. This issue is the most likely
point where potential problems between P&SAS and blind veterans will develop. For this reason,
there must exist clear understanding of what is to be considered reasonable.

What is reasonable varies with the particulars of a request. This is where the use of the word
“justified” comes into play. The veteran will need to justify the reasonableness of requests for
replacements and upgrades.

There are some clear clinical indications of when a request is not considered reasonable. These
criteria have been in place for years and are used by P&SAS in decision making. Generally a
request of any kind of prosthetic will be considered unreasonable if there is no need that can be
justified by he requester. Just because a veteran feels a request is justified does not satisfy the
definition of a request being reasonable and/or justified.

Whether a request is considered reasonable can be in some instances related to the level of
vision remaining if any. A particular access software upgrade may be considered reasonable or
not based on such variables as skill level of the veteran, vision status, goals and circumstances.
A request for a JAWs access software upgrade by a very functional blind veteran may be
reasonable while that same request by a low end user may be unreasonable.

Care has to be taken to minimize the chance that a change such as a software upgrade does not
result in a veteran being made dysfunctional after the change. Depending on the benefits to be
gained in the upgrade the decision has to be carefully weighed. Using this reasoning, it can be
seen that an upgrade may be beneficial for one veteran and detrimental to another.

Noting the above, what would be considered as reasonable justifications for access software to
be upgrade?

       Elimination of significant flaws of an earlier version
       Improvement that significantly improves function
       Compatibility with new hardware/software

Improvements that do not have direct application to the end user would be considered less
important when considering the reasonableness of a software upgrade. Some upgrades make
improvements in areas that while important are not really noticeable to the basic user. This is
important to consider since the upgrade may actually cause a problem for the end user. For
example, a basic user may have learned to use the current program relatively well. They may be
quite functional but it has taken a lot of practice and determination. To change the software with
an upgrade that significantly changes things may cause the veteran to now not know how to use
the program effectively and will require additional learning the veteran is not prepared to
undertake.

Now, an Upgrade of an access software program such as Zoom Text is generally handled easier
by a low vision veteran since improvements usually involve enhancement of the visual effect and
increased the screen reader capabilities. If the low vision veteran is dependent on the screen
reader features when using e-mail and browsing the Internet then an upgrade may be considered
significantly beneficial and thus justified. On the other hand improvements in an upgrade may
offer no noticeable functional benefit. The veteran is just as functional using the current version.
In such case, if the veteran cannot identify why the upgrade will increase functioning in a
significant manner then the request will not be considered reasonable and thus not justified.

Rule The request for an upgrade must be reasonable. Reasonableness must be
justified. Justification is considered reasonable when the upgrade results in a
significant increase in functioning. At no time is an upgrade justified due to a
desire to have the newest technology if no increase in function would result.

There is flexibility in P&SAS to meet the needs of those veterans with special needs that are
covered under the general language of the PCMP Computers for the Blind guidelines. There still
needs to be reasonableness and justification but higher end users who are doing volunteer work,
attending school of working may have special needs. The same would apply to blind veterans
with additional disabilities requiring accommodations. This could include speech input, Braille
devices, special keyboards and other input devices and so forth. No item is restricted from
issuance if the veterans can justify the need.

Note: Justification for upgrades is straightforward. Issuance requires demonstration of a
functional need.
General questions to be answered:

       Why is the upgrade needed?
       What will it do that the current item will not?
       Can the veteran learn to use the upgrade?
       Will the veterans suffer loss of pre upgrade functioning?
       Has there been a significant improvement in technology?

Anti-virus software:

It was the intent of the computers for the blind workgroup that anti-virus software be provided and
such language was specifically included. The provision of such software was deemed essential to
protect the computer and manage service call expenses generated due to virus infections. There
is no language in the documents to preclude provision of upgrades of anti-virus software. At the
current time AVG anti-virus software is available free of charge through an Internet download.

Hardware upgrades:
In general, the criteria for providing upgrades or replacement of hardware follow the same rules
as software. Hardware can be replaced if there is a significant technology improvement that
results in features that significantly improve performance that allows the veteran to be more
functional. A particular veteran must be able to demonstrate that the improvement enables him or
her to be more functional.

Example: Stand alone scanner technology provides a good example of how technology
upgrades can significantly improve hardware capabilities. In recent years scanners have
drastically improved:

       Quality of speech output
       Speed of processing text to speech
       Reduction of size and weight
       Increased ease of use
       Better text recognition


These type improvements make the devices superior to previous models and an upgrade will
generally result in the veteran being more functional in accessing text. Having said this there is
still a requirement that an individual veteran demonstrate improved function. This could be as
straightforward as being able to hear and understand the speech output with the new unit
functionally better.

Note: It is unreasonable to upgrade to new technology merely to have new technology. An
upgrade to new technology requires a justified need based on demonstration of significantly
improved functional outcomes. There is no intent in the national contract to keep a computer,and
peripherals current. It would be impossible. No one does that sunce computer technology is
constantly changing.

Computer upgrades:

Computer technology is getting faster. The demand for increased power to properly run more
sophisticated games drives the Markey. Those with serious multi-tasking needs may also profit
from increased processor speed. This would also apply to new faster memory and video card
processing. These new innovations do not usually improve the functioning of a computer being
used by a basic blind veteran computer user. . For the average blind veteran, moving from a 2.4
Gig processor to a 3.0 Gig and increasing memory from 512 to I Gig will make no noticeable
difference. These type improvements in technology will become the standard of issue based on
market demand from gamers. What will make a difference is when the access software improves
and becomes more powerful and requires more capacity from a computer.

For the higher end user doing multi tasking there may be a sound justification for a faster
processor if such can be justified.

Note: The question to be answered is why does a certain piece of hardware need to be
replaced? What is lacking in the current hardware being used? How will the change significantly
improve some type of access or task performance? VA P&SAS has a long standing rule
prohibiting the replacement of any prosthetic device just to have the newest version on the
market unless improvements in technology result in increased safety and reduced risk

Example:

An example of a reasonable request for an upgrade-replacement would be if a blind veteran has
a need to do a lot of printing in B&W. The veteran has a color ink jet printer. The veteran
requests the replacement of the current printer with a B&W laser printer. It would be cost effective
to replace the ink jet printer due to the reoccurring expense of VA providing ink cartridges. The
justification would be that the veteran is doing a lot of printing and is using an excessive amount
of ink cartridges. In this type situation, it would be reasonable to convert to the use of a laser
printer since toner cartridges have a significantly longer life.

Replacement of a CPU

There is no specific rule about when to replace a computer CPU. The replacement of a computer
system would follow the same rules as everything else. Most people use their computer for years
without considering the need for a replacement. A replacement is usually considered if the device
becomes plagued with electronic problems, suffers a damaging electrical surge or no longer
meets their needs due to changing goals. Perhaps the individual was just doing e-mail and then
decided to get into gaming; the current quite functional computer could immediately be
inadequate since it would not adequately run the gaming software. There might also be a
requirement for a better video card, audio card, power supply, faster processor and additional
memory. When one looks at the cost of individual parts it would make sense and be reasonable
to replace the unit.

Note: If the current computer is still meeting the veterans needs, there would be no reasonable
justification for a replacement. Replacement of failed components would be done until the unit
becomes obsolete.


Monitor replacements:

Unless a veteran specifically request and needs a CRT monitor for some reason, all replacement
monitors should be LCD flat screens. The 19" LED monitor is the current standard for those with
functional vision. A 15” LCD monitor is provided to the blind. If a veteran feels that a 19” LCD
monitor is not large enough then he/she would need to justify the need. The justification would
need to include some measurable benefit. There could be a justified need, but that needs to be
supported by a clinical assessment.
In summary

The comprehensive program developed by the VA supporting the evaluation,
issuance, training, service and replacement and upgrades of computers,
peripherals and software is very flexible. Due to the active involvement and
partnership of BRS, BVA and P&SAS during the development of guidelines, the
resulting national guidelines ensure standardization and reasonableness.
Reasonableness by all parties will ensure the continuation of a successful
program.

				
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posted:5/19/2012
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