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having existed in some form in the VA since the late 1930s. Id.
at 113, 1976 U.S.C.C.A.N. at 6405. The report distinguishes the
CWT program from the incentive therapy (IT) program then
authorized in 38 U.S.C. section 618 (in 2000, substantially,
section 1718(a)). The report distinguishes the two programs not
on therapeutic and rehabilitative grounds but on the grounds that
patients participating in the IT program are paid from
appropriated funds and generally perform tasks of a custodial or
clerical nature at administration health care facilities. Id.
The report describes the operation of the CWT program as
follows: “VA patients perform work on the projects as a
medically therapeutic activity, and are supervised by VA medical
personnel. Participating patients are paid from the proceeds of
the contract.” Id. Appended to the report is a report of the VA
requested by the Committee on Veterans’ Affairs on medical bills
pending before the committee. That report (the VA report)
contains a section-by-section analysis of S. 2908, supra. The VA
Report explains in some detail the goals and value of the VA’s
therapeutic and rehabilitative work programs as medical
treatment:
The value of compensated work programs as a therapeutic
modality is widely acknowledged. They provide therapeutic
(psychosocial and/or physical) rehabilitation of the
participant. Participation induces motivation, heightens
self-esteem and breaks institutional patterns through the
use of remunerative work with the expectation of either
increasing the participant’s potential for adjustment to the
community, or preventing regression from present functional
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