Forum Proceedings

Abstract | Market Information | Growth | Review of Common Disorders
| Technologies Currently Available for Low Vision and Blindness | Assessment of Technology Needs |
Recent Legislation | Funding Services | References

Abstract

The Industry Profile (IP) provides an overview of the vision industry that focuses on topics relevant to technology transfer. These topics are varied as the successful transfer of technologies to disability markets is dependent on a number of factors that include medical information, market information, legislation, funding, and manufacturer and resources in the vision industry. The information presented in this document provides a brief snapshot of the information contained in the full IP.

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Market Information

Visual impairment has many implications for the millions of Americans who report having the disability. Assistive technology (AT) is often needed to enable people with visual impairments to complete many tasks associated with school, work, and community living. As a basis for collecting primary market research related to technology for people with visual impairments, it is important to first identify the current state of knowledge and practice in the field. This task is often seen as difficult due to the range of methodologies used to research the levels of functional limitations associated with visual impairments.

The most frequently reported estimates regarding the prevalence of visual impairment in the United States are presented in the table below along with the definitions of visual impairment used in each study. The reported prevalence of visual impairments ranges from a minimum of 3.4 million Americans to a maximum of 13.5 million Americans, and the prevalence of severe visual impairment ranges from 1 million to 7.2 million (Shoemaker, 2002; Lighthouse International, 1995).

(Adams, Hendershot, and Marano, 1999; McNeil, 2001; Shoemaker, 2002; Lighthouse Inc., 1995)

Visual impairment has been identified as one of the four most significant contributors to lost independence among older Americans (Alliance for Aging Research, 1999). In fact, more than half of all people who are blind are over 65. The Table 2 shows the correlations between age and visual impairment. The chart illustrates that as age increases, so do the proportions of people who have visual impairments.

Table 2: Visual Impairment and Aging

(Adapted from: U.S. Census Bureau, 2001 and National Center for Health Statistics, 1997)

Ethnic origin has also been determined to be a primary correlate of the prevalence of visual impairments. According to the Baltimore Eye Survey, 27% of African Americans reported blindness due to age-related cataracts. In contrast, only 13% of Caucasians reported blindness resulting from the same impairment. Additionally, 30% of all cases of blindness in Caucasians resulted from age-related macular degeneration, whereas none of the responding African Americans reported the same (Tielsch, 2000). These variations challenge both individuals and the medical community to raise awareness of the visual impairments associated with certain ethnic groups, so as to provide the proper prevention information and treatment options.

According to the National Advisory Eye Council, the economic impact of visual disorders and disabilities was approximately $14.2 billion in 1981. By 1995 this figure was estimated to have risen to more than $38.4 billion per year. Eye diseases and disorders cost our nation $22.3 billion in direct costs and $16.1 billion in indirect costs every year (National Alliance for Eye and Vision Research, 2002).

Growth

The following chart is based on estimates of self-reported vision impairment from the 1995 Lighthouse National Survey on Vision Loss. By the year 2030, there will be 14.8 million Americans, ages 65 and over who have a visual impairment. Of this number, 7.7 million are expected to have a severe visual impairment (Lighthouse International, 1995).

Table 3: Prevalence of Visual Impairment and Severe Visual Impairment

(Adapted from McNeil, 2001 and Adams, Hendershot, and Marano, 1999).

According to sources reported by the National Federation of the Blind, a loss of vision affects 50,000 new people in the United States every year (National Alliance for Eye and Vision Research, 2002). Unfortunately, even with today's modern medical advancements most people who undergo treatment for a visual impairment will not have their sight fully restored (Lighthouse International, 2000). Low vision products and services will still be required by these individuals, thereby sustaining the same growth rate as has been experienced over the last ten years (Goodrich and Bailey, 2000).

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Review of Common Disorders

Glaucoma is a disease of the eye that is caused by a gradual degeneration of cells in the optic nerve. The loss of these cells leads to a gradual narrowing of the field of vision beginning at the periphery (Shoemaker, 2002). Primary Open Angle Glaucoma, which affects approximately 2.2 million people over the age of 40 in America alone, has no known cause (Racette, Wilson, Zangwill, Weinreb, and Sample, 2003). Onset generally occurs later in life and people over 60 are six times more likely to get glaucoma than the younger population (Glaucoma Research Foundation (GRF), 2003). In some cases congenital glaucoma will be found in children as young as two and three. Not only do these children experience more signs and symptoms of eye disease, but these cases directly relate to an inability of fluid to drain from the eye (McLeod, Wisnicki, and Medow, 2000). Common symptoms of Glaucoma include elevated inter-ocular pressure, optic disk cupping, and visual field loss (Shoemaker, 2002). Major risk factors include advanced age, African or Hispanic descent, heredity, and prolonged smoking or steroid usage (Weih, Nanjan, McCarty, and Taylor, 2001; Liebmann, 2003; GRF, 2003). While there is no way to prevent glaucoma, it can be successfully treated if diagnosed early.

Age-related macular degeneration (MD) is caused by the malfunction of photosensitive cells in the macula which results in a loss of the central field of vision (Macular Degeneration Foundation, 2003). Although the disease affects nearly 1.7 million Americans over the age of 50, no exact cause is known (Shoemaker, 2002). In rare cases, juvenile MD occurs as a result of mutated genes. Juvenile MD is generally an inherited condition (MDF, 2003). Dry MD is the most common form of the disease in older adults, totaling approximately 85% to 90% of all cases. It is related to the development of drusen, or small yellow fat deposits, under the macula. These deposits cause the macula to thin and dry out which relates directly to the loss of vision (American Macular Degeneration Foundation (AMDF), 2003). There is no known treatment or cure for Dry MD. Wet MD accounts for approximately 10% of all cases of MD in older Americans. It is caused by the growth of new blood vessels that bleed and leak fluid into the macula causing distorted vision and the formation of scar tissue (Shoemaker, 2002; AMDF, 2003). Laser therapy is often used as a treatment in Wet MD, but this intervention does not guarantee that vision will be saved.

Optic nerve atrophy (ONA) is caused by tissue damage in the optic nerve resulting in either partial or profound loss of vision (Douglas, 2002). The causes of ONA vary widely. The most common type, Ischemic Optic Neuropathy, most often impacts older Americans. It is caused by poor blood flow to the optic nerve. The prevalence of the non-arteritic type is estimated to be between 6,500 and 29,000 people in the United States, while the prevalence for the arteritic type is around 1,000 cases (Younge, 2001). In adults, major causes include multiple sclerosis, brain tumor, or stroke (Douglas, 2002). In children, ONA is commonly caused by anoxia, tumors, hydrocephalus, heredity, and rare degenerative disorders (Blind Babies Foundation, 2002). Once vision is lost through ONA, it cannot be recovered.

Diabetic Retinopathy is a visual disorder associated with diabetes that causes retinal blood vessels to leak leading to macular edema. In more advanced stages, often called the proliferative stage, new blood vessels grow along the retina and in the vitreous humor (Shoemaker, 2002; National Eye Institute (NEI), 2000). It is estimated that nearly 5.4 million Americans, half of those with juvenile diabetes and some with adult onset diabetes, will develop this disorder (Shoemaker, 2002). Diabetic Retinopathy is the leading cause of new blindness in persons aged 25-74 years, and is responsible for more than 8000 cases of new blindness each year (Valero & Drouihet, 2001). Vision loss from Diabetic Retinopathy generally worsens over time. One treatment of Diabetic Retinopathy includes photocoagulation, a laser surgery that is generally used to destroy leaking blood vessels that contribute to the development of macular edema (Shoemaker, 2002). In cases when the vitreous humor fills with blood, a virectomy is performed to remove the liquid in the eye and replace it with a salt solution (NEI, 2000).

Retinitis Pigmentosa (RP) is a progressive disorder that results from the degeneration of photoreceptor cells, commonly known as rods and cones, in the periphery of the retina. As these cells degenerate, gradual vision loss occurs. The disease often first occurs in adolescence and continues to progress as the individual ages. RP affects an estimated 50,000 to 100,000 people in the United States (Healthcommunities.com, 2004). It is a genetic disorder that is linked to more than 70 different genetic defects (de Beus and Small, 2003). In cases where the rod cells are primarily affected, vision loss generally begins as night blindness and as it progresses vision loss occurs in the periphery (Foundation for Fighting Blindness (FFB), 2003). Another form of RP, known as rod-cone dystrophy, central vision and color perception are primarily affected. RP is caused by a group of hereditary disorders that include Usher's syndrome, Leber's congenital amaurosis, Laurence-Moon-Biedl syndrome, and Bassen-Kornzweig syndrome. There is no known cure for RP (FFB, 2003).

Cataracts result from a clouding (opacification) of the normally slightly yellowish lens of the eye (NEI, 2003). The loss of transparency causes light to be diffused as it enters the eye which impacts the clarity of the visual image (Chylack, 2000). In other words, the lens slowly develops a greenish and later a brownish tint which impedes the ability of light to pass through the lens (Mayo Foundation, 2002). Symptoms of cataract include blurred vision, light sensitivity, double vision, and a fading or yellowing of colors. Night vision is generally impacted as is the amount of light needed to complete near tasks (American Academy of Ophthalmology (AAO), 2003). While the most common types of cataracts are age-related, other types of cataracts do develop, including secondary cataracts (commonly result from other diseases such as glaucoma or diabetes), traumatic cataracts (may develop as a result of injury to the eye), or radiation cataracts (which develop as a result of exposure to radiation) (AAO, 2003). Congenital cataracts, a very common cause of blindness in the pediatric population, can result in bilateral vision impairment if not treated carefully (McLoed, Wisnicki, and Medow, 2000).

While many older Americans experience visual impairment at a greater rate than people under the age of 50, pediatric visual impairments, including those listed above, affect America's youth. The primary causes of visual disability for children in the United States include cortical vision impairment, retinopathy of prematurity, and hypoplasia (McLeod, Wisnicki, and Medow, 2000).

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Technologies Currently Available for Low Vision and Blindness

Technology has a profound impact on the lives of people who are blind or visually impaired. It can greatly enhance vocational, occupational, and social opportunities on a daily basis. A wide range of assistive technologies have been developed in the areas of activities for daily living, computer access, access to graphics, and wayfinding. A summary of available technologies is described in the following section.

Throughout the course of their daily lives, people with visual impairments must perform a variety of tasks. These include taking medication, paying cash for items in a store, matching clothes, cooking meals, reading, and writing. Without the aid of some very simple devices, these tasks could prove difficult if not impossible. Magnification devices allow people with low vision to complete many of these near vision tasks by optimizing remaining vision. Telescopes allow people with low vision to complete tasks associated with distance and mid-range activities. In many cases, task lighting enables the user to optimize the viewing environment. Large print, talking, and tactile devices allow users to see, hear, or feel information in their environments that would otherwise prove inaccessible. For example, a large print or talking alarm clock can be imperative in getting off to work on time. Watches that feature dots next to numbers allow someone to "feel" what time it is. Often times, labels or tags can be placed on items to aid in identification. Large print, Braille, and auditory materials can provide access to the written word.

Computers are becoming more important in the daily lives of people in the 21st century. In fact, five out of the top ten fastest growing professions are computer related (Bureau of Labor Statistics, 2003). People who are blind and visually impaired must have equal access to computers in order to remain competitive in today's labor market. There are a number of accommodations available that can provide this access. Screen magnification, large monitors, keyboard labels, and glare filters all improve access to computers for people with visual impairments. Simple programs can be installed to allow both speech output and speech input. Braille output, typically via refreshable Braille displays or Braille embossers are often preferred by people who are blind. Scanning and optical character recognition (OCR), allow the printed word to be scanned into the computer to enable easy access for people who are blind or visually impaired. Access to the internet has now been mandated by Section 508 of the Rehabilitation Act (PL 105-220) to ensure accessibility to the World Wide Web, although much work remains to be done in this area. Haptic feedback, which allows the user to obtain information from the computer in the form of a felt sensation, is also available through technologies, such as the haptic mouse, that provide access to texture and shape that is displayed on the computer screen (Jupiter Media Corporation, 2003).

Navigational aids for the blind include technologies that assist in orientation, mobility, and spatial perception. The most common device used by people who are blind and visually impaired is the long or white cane. These simple devices are easy to use after training, lightweight, and inexpensive. Laser canes that bounce laser beams off obstacles at head height and in the path of travel send audible signals back to the user thus increasing the utility of the standard white cane. Many more complex devices are becoming available for use as navigation aids. Remote Infrared Signage (Talking Signs^®) uses remote infrared transmitters with imbedded information to directly orient people who have a hand-held receiver to decode the messages as they move towards a goal. Additional transmitters constantly update them as to the progress towards that goal. Clear path indicators use ultrasonic beams to identify a clear path cone of travel for the user. Obstacles are reported to the user via auditory and vibratory signals to keep the user on a clear, unobstructed path.

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Assessment of Technology Needs

The evaluation of assistive technology was listed as one of the mandated assistive technology services in the Technology Related Assistance for Individuals with Disabilities Act of 1988 (Tech Act) (PL 100-407). The law states that "the evaluation of the needs of an individual with a disability, including a functional evaluation of the individual in the individual's customary environment" is a necessary portion of AT services. A comprehensive evaluation should be conducted before any device is recommended for a person who is blind or visually impaired. This assessment should consider the individuals' current functional level, the prognosis for future visual functioning, a realistic look at the activities to be conducted, and the environment in which these activities will take place. Any assessment that disregards a portion of the assessment tasks described above will likely result in frustration for the user and needless cost as a result of abandoned technology. In many cases, multiple devices will be needed to ensure that the majority of the activities the person will be required to complete in a day can be done as independently as possible. Training is generally required to successfully use the devices prescribed. There are a variety of resources and centers that provide assistive technology evaluation and training services. It is advisable to contact the various state agencies responsible for the rehabilitation of people who are blind and visually impaired to locate these resources in local communities.

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Recent Legislation

Recent legislation has focused on improving the access of people with disabilities to education, employment, services, and information. Ensuring that students with disabilities are able to get high quality education is vital to ensure their prosperity in American society. To promote this access, Congress passed the Individuals with Disabilities Education Act Amendment of 1997 (IDEA) through which children with disabilities would receive the services necessary for them to receive a free and appropriate public education (FAPE) that meets their education and related services needs (Rehabilitation Engineering and Assistive Technology Association of North America (RESNA), 2003c). As a means to that end, IDEA '97 states that the Individualized Education Plan (IEP) team shall "consider whether the child requires assistive technology devices and services." It further states:

"In the case of a child who is blind or visually impaired, the IEP team shall provide for instruction in Braille and the use of Braille unless the IEP team determines, after an evaluation of the child's reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child's future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the child (PL 105-17, 1997)"

A bill entitled Improving Educational Results for Children with Disabilities (HR 1350) is currently making its way through Congress (House Education and Workforce Committee, 2003a). In the Bill Summary, the House Education and Workforce Committee (2003b) promises that this new bill will ease compliance issues and ensure that all children are learning. This bill incorporates components of both IDEA and the proposed Instructional Materials Accessibility Act (IMAA) of 2002 [Note: The IMAA of 2002 mandates access to textbooks and other print materials for students who are blind, visually impaired or otherwise print disabled by creating a system for the acquisition and distribution of such materials (American Federation for the Blind, 2002)]. In the current draft of this bill, the AT provisions outlined in this law will remain as amended in 1997 (Smith and McGinley, 2003). The IMAA provisions are included in both the House of Representatives and Senate versions of this proposed law (National Association of State Directors of Special Education (NASDSE), 2003).

The landmark civil rights legislation of 1990, the American's with Disabilities Act (ADA) (P.L. 101-336), prohibits discrimination on the basis of disability and mandates reasonable accommodation by employers for people with disabilities. For many people with blindness and visual impairment this means that they will be provided with the accommodations necessary to complete essential job functions if they choose to disclose their disability. The law allows for exceptions to be made in the case that the accommodation would create an undue hardship for the employer.

Rehabilitation services for people who are blind and visually impaired began with the opening of the Perkins School, which was first known as the New England Asylum for the Blind, in 1832 (Rubin and Roessler, 1987). Since that time services to people with disabilities has been mandated by the Rehabilitation Act and its amendments. While all other disabilities groups receive services through the vocational rehabilitation program in their state, people with visual impairments have a separate rehabilitation facility. The National Federation for the Blind supports continued separation of rehabilitative services for people who are blind based on the fact that these agencies are better equipped to meet the needs of people who are blind and visually impaired (National Federation for the Blind, 2003).

Access to information has long been a barrier to people with visual impairment and blindness. As a result, Congress amended the Rehabilitation Act in 1998 to include Section 508 which requires that federal agencies provide equal access to information to all people with disabilities whether they are employees of the federal government or members of the public at large (Government Services Administration, 2002).

Additional legislation, entitled the Medicare Vision Rehabilitation Services Act (S.1967/H.R.2484), has been introduced to both the House of Representatives and the Senate that would improve upon the sporadic coverage of vision related services currently offered by Medicare. This legislation would provide uniform national coverage for older Americans who require vision rehabilitation services. In addition, the bill would establish qualifications under Medicare for specialized vision rehabilitation professionals and describes how their services could be covered for the first time (Medicare Now, 2003)

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Funding Services

Current public policy often fails to sufficiently address the funding of assistive technology (National Council on Disability (NCD), 2000). In addition, there are many available sources of funding for assistive technology that a prospective user must be able to navigate to secure needed accommodations. The likely source of funding will depend on the environment in which the technology will be used.

Title III of the Assistive Technology Act of 1998 (P.L. 105-394) authorized funds for the establishment of an alternative financing program for people with disabilities to obtain assistive technology. Alternative loan funds have been established with Title III money in 32 states and territories (Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), 2003b). A full listing of these programs can be viewed at http://www.resna.org/AFTAP/state/index.html. The loan programs are experiencing an exceedingly high level of success. In the first year of the program, three quarters of survey respondents who received funding reported an "improved quality of life or life satisfaction" after obtaining loans for the equipment and services they needed. The majority of loans provided to survey participants were guaranteed loans. Other loan programs consist of revolving loan programs, non-guaranteed low interest loans, interest buy down loans, traditional interest loans, and small grants. Data from the Alternative Financing Programs for Assistive Technology and Telework (2004) at the University of Illinois at Chicago can be obtained from http://128.248.232.70/aftap/getstarted.htm. The survey is currently updated on a daily basis as additional results are returned. These loan programs are making it possible for many people with disabilities who could not obtain a standard bank loan, as evidenced by higher expenses to income ratios, to get the funding they need to purchase assistive technology (RESNA, 2002). Obtaining funding through this mechanism is not guaranteed. People with disabilities must apply for loans and some are denied. There are 16 states that offer loan programs through financing from other sources. Information on these state programs can be obtained by visiting http://www.resna.org/AFTAP/state/otherloans.html (RESNA, 2003a).

The United States Department of Veterans Affairs (VA) will pay for assistive technology for veterans with service related disabilities when it is deemed necessary as part of the overall medical or rehabilitation intervention. In order to qualify, veterans of active service must have received an honorable or general discharge from military service (North Dakota Interagency Program for Assistive Technology (IPAT), n.d.) Additional information on eligibility is available at the US Veterans Administration website at http://www1.va.gov/elig/page.cfm?pg=1. According to the Veterans Health Administration (VHA) Handbook (2002), veterans who are blind are eligible to receive, "mechanical aids for the blind, and repairs to these aids…to overcome the physical and economic impairments associated with blindness when the veteran is enrolled under Title 38, U.S.C., Chapter 17, Section 1705." The VA has provided a broad definition of aids for the blind that includes "any prosthetic device or piece of equipment, or animal, used in assisting a legally blind or visually impaired beneficiary in overcoming the impairments associated with blindness and vision loss." The list of available technologies includes devices specially designed for people who are blind, devices designed for sighted persons but approved for people who are blind, and guide dogs (VHA Handbook, 2002).

State vocational rehabilitation agencies are charged with assisting people with disabilities who qualify for service employment in their communities. As a part of these vocational rehabilitation services, assistive technology may be purchased if necessary to enable the person to obtain or maintain paid employment. All state vocational rehabilitation programs for the blind provide assistive technology services and devices to some degree. Not all people with visual impairments will be entitled to AT through this source as state vocational rehabilitation programs are considered funding sources of last resort. In addition, payments of all services available through these programs are based on eligibility requirements. Therefore, some services will be offered for a fee based on the individual's income and resource level (United States Department of Education, 1999). All expenditures are based on customer need and employment goal.

The Social Security Administration lists assisting people with disabilities to become more independent through employment as one of its primary goals. The employment support provisions were created to assist people with disabilities to re-enter the workforce while maintaining the safety net of cash benefits while the person moves towards financial independence (Social Security Administration (SSA), 2003). To that end, the Social Security Administration offers work incentives for both the Supplemental Security Income (SSI) program and the Social Security Disability Insurance (SSDI) program. The eligibility requirements and items that qualify for payment under the work incentives vary between programs. A full review of these employment supports can be found in the Social Security Publication number 64-030, entitled the 2003 Red Book: A Summary Guide to Employment Support for People with Disabilities under the Social Security Disability Insurance and Supplement Security Income Programs. This document is available for download at http://www.ssa.gov/work/ResourcesToolkit/redbook.html.

Under the requirements of the Individuals with Disabilities Education Act (IDEA), school systems must provide assistive technology devices and services to students who require them to receive a free and appropriate public education. Any device that is purchased by a school system for the benefit of a student with a disability remains the property of the school and not that of the student. Funding through IDEA has not always been delivered as promised by the legislation. Golinker (2000) states that many schools fail to provide assistive technology devices and services on the basis of cost. It is important that the student with a disability, or an advocate who works in their interests, ensures that AT is considered in the development of each Individualized Education Program (IEP) and that the technology is acquired by the school system as mandated by the legislation.

Students in grades K-12 who are not eligible for assistive technology devices and services under the Individuals with Disabilities Education Act, may be eligible under Section 504 of the Rehabilitation Act. This section of the law calls for non-discrimination on the basis of disability in programs receiving federal financial assistance and is applicable to both local education agencies, employers, and colleges, universities and other post-secondary institutions (Government Services Administration, 2002). While Section 504 does call for reasonable accommodation for students with disabilities, it is less stringent than the requirements under IDEA. Post-secondary education institutions who receive federal financial assistance must provide accommodations to their students including students who are blind or visually impaired. Covered devices and services may include readers, Brailled or large print materials, and computer accommodations (i.e., screen readers). The school must provide these services "unless doing so would result in a fundamental alteration of the program or would result in undue financial or administrative burdens," neither of these exclusionary measures are easy to document (PACER Center, 1994). Under Section 504, the student with a disability is responsible for disclosure of disability and accommodation requests. In cases where the disability is not immediately apparent, the student will be asked to provide documentation of disability.

The Americans with Disabilities Act of 1990 calls for the prohibition of discrimination for otherwise qualified applicants with disabilities in employment. Under this law, employers who have 15 or more employees for 20 or more weeks a year must provide reasonable accommodations to allow qualified applicants with disabilities to perform the essential functions of a job. Reasonable accommodations generally refer to "acquisition or modification of equipment or devices, appropriate adjustment or modifications of examinations, training materials or policies, the provision of qualified readers or interpreters, and other similar accommodations for individuals with disabilities." Additional reasonable accommodations include accessible facilities, job restructuring, reassignment to vacant positions, and part-time or modified work schedules (Equal Opportunity Employment Commission, 1997). Accommodations that present an undue hardship to employers are exempt from the law. The burden of proof for undue hardship is such that very few accommodations would be excluded under this tenet of the law.

There are some additional considerations when pursuing funding for assistive technology. In cases where a third party pays for the assistive technology devices or services for a person with a disability, there is often a negotiation related to what specific device is offered. For example, if three similar devices can be effective to complete the activity, a third party payer such as a school district or employer will choose a lower cost option. The person with a disability may then offer to offset the cost of the higher priced item in order to obtain the desired device. In cases where a student in a local educational agency is transitioning to employment, it may be beneficial to seek collaborative funding through the school district and the state vocational rehabilitation agency. A cooperative funding agreement would allow the student to take the technology with them into employment after graduation. Finally, it is important to note that some private organizations may assist in the funding of assistive technology. These organizations often have a social mission that includes serving a specific need in the community. The involvement of these groups varies among communities, depending on the specific needs of the members in the respective group's community, with fundraising being the major source of contribution. An example of this type of organization is the Lions Club. The consumer can identify local organizations by contacting the local Chamber of Commerce. Workers compensation programs may be another potential source of funding for assistive technology. States often require physical and vocational rehabilitation benefits be provided to injured workers to enable them to re-enter the workforce. Assistive technology may be purchased if deemed necessary to allow the injured worker to become employed. For additional information, please see http://www.dol.gov/esa/regs/statutes/owcp/stwclaw/stwclaw.htm.

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References

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