This year marks the 20th anniversary of the Computer/Electronic Accommodations Program, also known as CAP, which began in 1990 as the Defense Department’s centralized program to provide assistive technology solutions for employees with disabilities.

Shortly after its inception, CAP became the forerunner and industry leader in evaluating, matching, and providing assistive technologies to help employees with disabilities perform the essential functions of their jobs. Employees with limitations in the areas of blindness/low vision, cognition, communication, deafness, or dexterity were evaluated by CAP and provided with technology to help them continue working for the Department of Defense in their specified function.

After CAP’s widespread success, the Defense Authorization Act of 2000 authorized the program to expand its services to other agencies in the executive branch of the federal government. As a result, CAP currently has a partnership agreement with 66 different agencies including the Departments of Justice, Homeland Security, and VA.

In the past decade, however, the scope of CAP’s work has grown exponentially. At the onset of Operation Iraqi Freedom and Operation Enduring Freedom, the program’s leadership realized many of the assistive technologies being provided to disabled federal employees could also benefit injured servicemembers returning home from war. Shortly thereafter, CAP established the Wounded Service Members Initiative in 2004 to “Support, Equip and Empower” wounded American war fighters.

CAP’s WSM initiative supports servicemembers by giving them access to assistive technologies while they recover, equips them with the appropriate assistive technologies based on their limitations, and empowers them for continued employment. In addition to aiding new populations of servicemembers with assistive technology, the WSM initiative has also accomplished something groundbreaking: CAP technology is now helping servicemembers begin the difficult process of coping with their injury and disability.

Assistive technologies allow servicemembers who have lost function in their eyes, or hands, or ears to be able to do the things they once did—especially activities like interacting with digital media. As a result, discovering CAP can be great news and a motivating factor for the many servicemembers who think they have no hope to continue life as they once knew it.

The WSM initiative had mild success after its implementation, helping servicemembers reintegrate physically and digitally. However, during the first four years of its work, the scope of WSM was limited in the number of servicemembers it could reach. Additionally, CAP technology was only accessible to medical facilities that had working relationships with CAP representatives. As a result, the program thrived in facilities such as Walter Reed Army Medical Center and Brooke Army Medical Center, however most servicemembers in other parts of the world never had the opportunity to be evaluated for assistive technology.

This issue was addressed in 2008 with the passage of DoD Instruction 6025.22, titled Assistive Technology for Wounded Service Members, which set the parameters for an interdependent assistive technology delivery system between CAP and military treatment facilities, or MTFs, across the country. DoDi 6025.22 effectively provided sustainable provision of CAP services throughout the Military Health System, and obtained the commitment of MTF commanders to staff CAP representatives at each facility.

CAP has made the process of “discovering assistive technology” easier and more approachable for servicemembers than ever before. By constructing technology “labs” at MTFs throughout DOD, CAP helps create a safe environment for servicemembers to interact with assistive technology. These labs allow servicemembers to watch others benefit from the use of technology, get a hands-on experience for themselves, and help servicemembers overcome the “No sir, I’m fine” mentality that can so often pose barriers to their recovery.

These assistive technology labs emulate CAP’s Technology Evaluation Center, which is located in the Pentagon and is dedicated to the demonstration and evaluation of assistive technologies. CAPTEC has proven invaluable to civilian employees with disabilities and wounded servicemembers in the Washington, DC, area. Establishing assistive technology labs in the MTFs has allowed servicemembers outside the DC area the same exposure to assistive technologies.

On a large scale, the results of DoDi 6205.22 have been astounding. In 2004, when the WSM initiative began, CAP had filled 108 requests; by the first year after its passage, CAP filled 4,589 requests. The WSM program alone has filled over 18,000 requests since it started.

After years of constantly striving to support, equip, and empower more servicemembers with disabilities, CAP now has representatives identified at 57 MTFs worldwide who act as liaisons between rehabilitation staff, patients, and the technology that will change their lives for the better. Occupational therapists, speech therapists, case managers, and rehabilitation professionals at MTFs across the globe can now introduce wounded servicemembers to CAP’s assistive technologies, and the needs of rehabilitating servicemembers can be met in a sustainable way.

These are just a few of the ways CAP eases the transition, promotes the rehabilitation, and catalyzes the reintegration of wounded servicemembers back into society. As CAP reaches more servicemembers across the federal spectrum, the organization has developed a set of best practices and procedures for providing assistive technology. After years of evaluating and working with DoD servicemembers with multiple injuries in the WSM initiative, CAP has developed an expertise in conducting comprehensive needs assessments for a variety of technological needs, and helping people with disabilities regain the capability to operate in a work environment.

To spread this knowledge, and serve even more populations of wounded and disabled patients, CAP works directly with VA in a number of ways. For example, because CAP is a federal disability work-technology program, most employees who participate in CAP cannot take assistive technology with them if they leave federal employment. However, due to the nature of military service, and CAP’s already-thriving work with wounded servicemembers, a public law was passed in October of 2006 that allowed servicemembers to retain their CAP-provided assistive technologies as their personal property—even upon separation from active duty and transition to veteran status.

In addition, because CAP has extensive experience serving polytrauma patients, the program works directly to support VA polytrauma centers in Richmond, Tampa, Palo Alto, and Minneapolis. Representatives work closely with polytrauma providers, clinicians, and case managers to ensure continuity of care and services for individuals who transition from activity duty to veteran status.

Finally, CAP also engages in extensive knowledge sharing with VA, in order to leverage its expertise with VA policy makers and leaders. Currently, VA institutions like the Veterans Health Administration Prosthetic Clinical Management Program are benefiting from CAP’s expertise as they begin implementing new policies and procedures for the provision of prostheses.

CAP has grown immensely over the past 20 years and has had lasting impact both on federal medicine and in supporting the Military Health System. Since its inception in 1990, CAP has filled over 91,000 requests for accommodations. I look forward to the next 20 years to see how CAP will change the face of military and federal medicine, and transform the way servicemembers and federal civilians recover from disabilities.

Michael E Kilpatrick, MD, is director of strategic communications for the Military Health System in the Office of the Assistant Secretary of Defense for Health Affairs.

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