"(2) The findings of fact by the Secretary, unless substantially contrary to the weight of the evidence, shall be conclusive; but the court, for good cause shown, may remand the case to the Secretary to take further evidence, and the Secretary may thereupon make new or modified findings of fact and may modify his previous action, and shall certify to the court the transcript and record of the further proceedings. Such new or modified findings of fact shall likewise be conclusive unless substantially contrary to the weight of the evidence.

"(3) The court shall have jurisdiction to affirm the action of the Secretary or to set it aside, in whole or in part. The judgment of the court shall be subject to review by the Supreme Court of the United States upon certiorari or certification as provided in title 28, United States Code, section 1254."

ENCLOSURE No. 2. AMENDMENT TO S. 2759

(Transfer to District of Columbia)

On page 18, line 15, after the word "includes" insert "the District of Columbia,”. On page 23, strike out beginning with line 21 down to and including line 13 on page 24.

On page 24, line 15, strike out "13." and insert "12."

On page 24 after line 19, insert the following:

"VOCATIONAL REHABILITATION PROGRAM IN THE DISTRICT OF COLUMBIA

"SEC. 4. (a) The personnel, property, records, and unexpended balances of appropriations, allocations, and other funds (available or to be made available), which the Director of the Bureau of the Budget determines relate primarily to the provision of vocational rehabilitation services in the District of Columbia or the performance of functions of a State licensing agency under the act of June 20, 1936 (20 U. S. C., ch. 6A), are transferred from the Department of Health, Education, and Welfare to the District of Columbia for use in providing such services in the District of Columbia.

“(b) The Commissioners of the District of Columbia are hereby authorized, within available appropriations, to take such action as may be necessary to secure for the District of Columbia the benefits of the Vocational Rehabilitation Act, as amended by this act, and the act of June 20, 1936 (20 U. S. C., ch. 6A).”

ENCLOSURE NO. 3. AMENDMENT TO S. 2759 (RANDOLPH-SHEPPARD ACT)

Page 24, after line 19 (and after the insert in Enclosure No. 2), insert the following:

"AMENDMENTS TO RANDOLPH-SHEPPARD VENDING STAND ACT

"SEC. 5. (a) (1) Section 1 of the act of June 20, 1936 (20 U. S. C. ch. 6A) is amended by striking out in any Federal building' and inserting on any Federal property' in lieu thereof, and by striking out ', in the discreation of the head of the department or agency in charge of the maintenance of the building,'. Such section is further amended by adding at the end thereof the following new sentence: 'In authorizing the operation of vending stands on Federal property, preference shall be given, so far as feasible, to blind persons licensed by a State agency as provided in this act; and the head of each department or agency in control of the maintenance, operation, and protection of Federal property shall, after consultation with the Secretary of Health, Education, and Welfare, and with the approval of the President, prescribe regulations designed to assure such preference for such licensed blind persons without unduly inconveniencing such departments and agencies or adversely affecting the interests of the United States.

(2) Paragraphs (1) and (4) of section 2 (a) of such act are each amended by striking out in Federal and other buildings' and inserting on Federal and other property' in lieu thereof. Such paragraph (4) is further amended by inserting articles dispensed automatically or in containers or wrapping in which they are placed before receipt by the vending stand,' after tobacco products,' by striking out 'building' and inserting in lieu thereof property': by striking out custodian' and inserting in lieu thereof department or agency in control of the maintenance, operation, and protection'; and by inserting in accordance with the regulations prescribed pursuant to section 1' after 'State licensing agency'.

"(3) Section 2 (b) of such act is amended by striking out the third sentence thereof.

"(4) Section 2 (c) of such act is amended by striking out ‘approval of the custodian having charge of the building in which the vending stand is to be located' and inserting in lieu thereof 'approval of the head of the department or agency in control of the maintenance, operation, and protection of the Federal property on which the stand is to be located but subject to regulations prescribed pursuant to section 1'.

"(5) Section 6 of such act is amended by adding at the end thereof the following new subsection:

"(d) The term "Federal property" means any building, land, or other real property owned, leased, or occupied by any department or agency of the United States or any instrumentality wholly owned by the United States, or by any department or agency of the District of Columbia or any Territory or possession of the United States.'

(b) The amendments made by subsection (a) shall become effective July 1, 1954."

STATEMENT BY OVETA CULP HOBBY, SECRETARY OF HEALTH, EDUCATION, AND

WELFARE

Mr. Chairman and members of the committee, I welcome the opportunity to appear before you today in supoprt of S. 2759. This bill was introduced by the chairman of the Committee on Labor and Public Welfare to give effect to the administration's recommendations for extending the opportunity for vocational rehabilitation to more disabled persons. These recommendations constitute a basic part of the administration's program for improving the health and wellbeing of the American people.

Recent hearings before your committee have been concerned with proposals for better health facilities and a new grant structure to finance programs for prevention, care, and research. Other health proposals are scheduled for future consideration. These measures will be incomplete unless we take steps, at the same time, to deal with the residual disability which so often follows in the wake of serious illness and injury.

Chronic diseases and the disablement they produce loom very large in the health problems of this country. In addition to those crippled by disabling disease or illness, thousands of others will be the victims of disabling accidentsin industry, on the farm, on the highway, and at home-despite the progress being made in accident prevention and safety education.

Rehabilitation is the process which has been developed to deal with disability. It restores a physically handicapped person to the point where he can take care of himself in the home or even better, also assume a position in productive employment. The latter is called vocational rehabilitation.

In 1920, largely as a result of the needs and the experience growing out of World War I, the Congress determined that the Federal Government should assist the States to establish vocational rehabilitation services for all our people. The original act authorized Federal grants to each State for this purpose, to be administered under approved State plans. The State programs today cover a wide range of services, including, for example, the complex combination of services that teaches the blind person or the paraplegic how to perform the activities of daily living and simultaneously trains him in a new trade.

These programs are now in operation in all of the 48 States, the District of Columbia, Alaska, Puerto Rico, and Hawaii. In all States there is a rehabilita tion agency under the State board of vocational education. In 16 jurisdictions this agency serves all types of disabled, including the blind. In 36 jurisdictions, separate agencies administer services for the rehabilitation of the blind.

The relationship between disability and public dependency is a significant one. At present the Federal-State public-assistance programs support about 1 million persons who themselves are disabled or, in the case of the aid to dependent children program, whose father or mother or other caretaker is disabled. Thousands of these disabled persons can be rehabilitated and returned to useful employment and self-support.

At this point, Mr. Chairman, I should like to ask Mr. Rockefeller to present additional background information in graphic form portraying the scope and accomplishments of the present program.

BACKGROUND CHARTS

Chart A.-Two million persons who can be rehabilitated to work

Each year an estimated 250,000 persons disabled by disease, accidents, or congenital conditions come to need vocational rehabilitation in order to work. Only about 60,000 disabled persons are rehabilitated each year under the present State-Federal program. It is easy to understand, therefore, why there are some 2 million disabled persons in the United States today who need vocational rehabilitation services.

Chart A gives a rough picture of the nature of these 2 million who could be rehabilitated-by cause of disability, age group, and institutional or noninstitutional status. Disease, and particularly chronic disease, is the cause of about 88 percent of all disabling conditions. Accidents account for about 10 percent of the total problem of disability. The other 2 percent results from congenital conditions.

The majority of the disabled who can be rehabilitated are within the age limits 14 to 64; a small portion, about one-twentieth, are 65 years of age or older. About one-tenth, roughly 200,000 are currently confined to various types of institutions-tuberculosis sanatoriums, mental hospitals, and chronic disease hospitals. Restoration of this group to gainful work would help to reduce hospital and institutional loads. The remaining nine-tenths reside outside of institutions and hospitals.

Chart B.-The rehabilitation process

Chart B illustrates the way in which the State programs operate.

Disabled persons are referred to the rehabilitation agency from many sources― doctors, hospitals, welfare agencies, employment services, schools, and others. Their contacts are with the rehabilitation counselor. He is the State agency representative and is the key to all that follows.

Through interviews with the client and study of reports from other agencies, the counselor learns the individual's needs and problems. A general medical examination is obtained from a physician of the community. This is often supplemented with examinations by medical specialists.

With these medical data, the case study, and an appraisal of the client's abilities, eligibility is established and the counselor arrives at a vocational diagnosis. Together with the client, a complete rehabilitation plan of services is worked out. The services may include one or more of the following:

Medical services.

Artificial appliances.

Training.

Transportation and subsistence during rehabilitation.
Occupational tools and equipment.

Placement and followup on the job.

Some disabled persons may require all of these services; others may need only

a few.

The charges for provision of medical services, subsistence, transportation, and tools are conditioned upon the client's ability to pay.

The rehabilitation agency, through the counselor, is the coordinating force which brings together all of the medical, psychosocial and vocational services to meet the needs of the disabled persons.

Chart C.-Types of disability

Vocational rehabilitation services are made available to all types of disabled persons of working age who have substantial job handicaps resulting from disability. Some disabilities are readily apparent, such as amputations. Others are hidden, such as tuberculosis, heart disease, and epilepsy.

About 41 percent of the 64,000 rehabilitated during fiscal 1952 were vocationally handicapped because of orthopedic impairments. These impairments resulted from many causes-diseases such as poliomyelitis and arthritis, plus accidents and congenital conditions.

Twelve percent were blind or had severe loss of vision.

Eight percent were deaf or hard of hearing.

Seven percent were mentally ill.

The remaining 32 percent included persons with impairments such as tuberculosis (9 percent), heart disease (4 percent), and other diseases.

Chart D.-Job groups

Chart D shows that rehabilitated persons (left bar) are established in all occupational groups in proportions generally comparable to those for all employed 46293-54-pt. 2—3

persons in the United States (right bar). About 11 percent of the disabled persons rehabilitated in 1952 entered professional, semiprofessional and managerial occupations, such as accountants, engineers, teachers, draftsmen, laboratory technicians, whereas about 18 percent of our total labor force is employed in this broad group of occupations. The proportions in the other categories also compare very closely with the national percentages.

Under the present act, housewives, under certain conditions, can be accepted for vocational rehabilitation. During the fiscal year 1952, a total of 5,039 disabled women were rehabilitated as homemakers.

Chart E.-Effect of rehabilitation on earning ability

Of the 64,000 disabled rehabilitated in fiscal 1952, 76 percent were unemployed when they started their vocational rehabilitation. Only 24 percent were working in one way or another. These in the latter group were engaged in temporary or part-time jobs, unsuitable or unsafe employment, or were in danger of having to stop work because of their disabilities.

When starting their rehabilitation the total earnings of the 64,000 were at the rate of $17 million a year. After rehabilitation the group's earning power was increased to $115 million a year. This amount does not include the earnings of farmers and family workers.

Although not shown on the chart, the economics of rehabilitation may be reflected in other ways. It is estimated that these 64,000 persons rehabilitated in 1952 will, during the remainder of their working years, repay about $10 to the Federal Government in Federal income taxes for each Federal dollar spent for their rehabilitation.

Also about 12,000 of this group of 64,000 were receiving some public assistance at the time their rehabilitation was started. To maintain these disabled people on assistance for a single year would have cost around $8.5 million. Their rehabilitation for useful work cost about $6 million.

Chart F-Changes in program emphasis; services provided, 1942 to 1952

Chart F shows, for fiscal year 1952, the percentage of the 64,000 who were provided with training, physical restoration, tools, and equipment, and so on. All persons, of course, receive the basic services of guidance, counseling, and placement.

Chart F contrasts present practice with the program as it operated in 1942 (when there were 21,757 rehabilitants), just prior to the enactment of the present law. Prior to October 1943 the services authorized under the act were confined to counseling, training, placement, and to a limited extent, the provision of artificial appliances. (Appliances account for the 12 percent identified on the chart as "physical restoration.") Federal funds could not be used to remove or reduce a disability. Disabled persons who required substantial medical rehabilitation were not generally accepted.

The amendments of 1943 authorized funds to be used to remove or reduce disabling conditions before the rest of the rehabilitation process was undertaken. Hence many more rehabilitants today receive the services designated on Chart F as physical restoration.

Chart G-Federal and State expenditures, vocational rehabilitation

Chart G shows the Federal and State financial investment in the rehabilitation program in 1943 and during the past 6 years.

In 1943 total program costs amounted to about $6 million, the highest total program expenditures prior to the 1943 amendments. Within the past 6 years (1949-54) total program expenditures have increased steadily, reaching $37 million of State and Federal funds in fiscal 1954.

The right-hand portion of the chart shows, percentagewise, the division of expenditures between the States and Federal Government.

Prior to the 1943 amendments, expenditures for vocational rehabilitation were matched on a 50-50 basis. Beginning in fiscal 1944, the Federal Government assumed responsibility for 100 percent of necessary State expenditures for administration and counseling and guidance (50 percent of the balance). This resulted in a higher Federal percentage share.

The Federal share has been reduced from 69 percent in 1950 to an estimated 62 percent for 1954.

Chart H-Rehabilitations and unmet needs, 1920–53

Chart I provides a picture of the 33-year period of accomplishments against the backdrop of annual need-an estimated 250,000 disabled persons. Four basic

1 Not included in oral presentation.

conclusions are apparent: First, the program has made substantial strides since it was undertaken in 1920; second, progress has been particularly marked since the expansion of the program in 1943; third, since 1949 there has been a leveling off of the number of disabled persons rehabilitated annually; finally, the program falls far short of meeting the need in terms of the annual number of disabled persons who come to need vocational rehabilitation in order to work.