Veterans Health Administration Services for the Blind or Visually Impaired
The Veterans Health Administration (VHA) has shared several resources with VisionAware to provide you with an overview of available VHA services for veterans and service members, such as those returning from Iraq and Afghanistan, who are blind or visually impaired. The Continuum of Care Fact Sheet is available for download and includes an outline of resources and services.
Overview of Blind Rehabilitation Service
Blind Rehabilitation Service and Centers
Blind Rehabilitation Outpatient Specialists
Visual Impairment Service Team Coordinators
Nationwide Vision Rehabilitation System
Intermediate Low Vision Clinics
Advanced Low Vision Clinics
Visual Impairment Services Outpatient Program
Eligibility for Health Services
Applying for Health Benefits
Does Vision Loss Have to Be Service-Related
Veterans Administration Resources
Overview of Blind Rehabilitation Service in the Department of Veterans Affairs
In 2010, the Veterans Health Administration (VHA) became the first national healthcare system to integrate rehabilitation services for patients with visual impairment seamlessly and completely into its health benefits, providing rehabilitation care to veterans and service members with visual impairments ranging from mild visual impairment to total blindness.
The Blind Rehabilitation Service (BRS) continuum of care ensures early intervention for patients whose vision loss results from progressive diseases like age-related macular degeneration, diabetic retinopathy, and glaucoma, as well as those veterans and service members whose vision loss results from the wounds and trauma of war. BRS vision and blind rehabilitation professionals are required to be certified by the Academy for Certification of Vision Rehabilitation Professionals (ACVREP) or an equivalent credential. Rehabilitation programs are accredited by the Commission on Accreditation of Rehabilitation Facilities. Services provided in veterans’ homes must meet the standards of The Joint Commission. BRS staff undergo peer-professional boarding before hire. They must achieve necessary credentials and meet the knowledge, skills, and abilities required by the position.
The reorganization expanded a program centered on 10 existing inpatient blind rehabilitation centers to a continuum of care spread throughout the entire VHA healthcare system and includes veterans’ homes and communities.
VHA estimates that there are more than one million visually impaired veterans over the age of 45 in the United States. That number is likely to grow as the average age of veterans rises. Within this group approximately 157,000 are legally blind and approximately 1,026,000 have low vision ranging from 70/70 and increasing in severity. About 80 percent of all visually impaired veterans have progressive disabilities cause by age-related macular degeneration, glaucoma, diabetic retinopathy, and acquired brain injury.
VHA committed approximately 50 million dollars from 2007 to 2010 to establish a comprehensive nationwide rehabilitation system for veterans and service members with visual impairments. Under this plan, VHA’s Veterans Integrated Service Networks (VISN) regions redesigned their delivery of blind rehabilitation services to care for veterans with low vision as well as for those with legal blindness.
Current Programs
Blind Rehabilitation Service and Centers
The historical foundation of Blind Rehabilitation Service (BRS) since 1948 has been the inpatient blind rehabilitation centers (BRCs). There are now 13 BRCs providing 274 inpatient beds. Programs are located in West Palm Beach, FL; San Juan, PR; Augusta, GA; Birmingham, AL; Biloxi, MS; Tucson, AZ; Waco, TX; Long Beach, CA; Palo Alto, CA; Tacoma, WA; Chicago, IL; West Haven, CT; and Cleveland, OH.
Blind Rehabilitation Centers (BRCs) are residential inpatient programs that provide comprehensive training and adjustment to blindness, offering a wide variety of skill courses designed to help blinded veterans achieve their full potential in independence. These skill areas include orientation and mobility, communication skills, activities of daily living, hobbies and crafts, woodworking, household and car repair, visual skills, computer access training, and social/recreational activities. Veterans are also assisted with their emotional and behavioral adjustment to blindness through individual counseling sessions and group therapy meetings. The peer atmosphere allows newly admitted veterans to understand and emulate the accomplishments of those who were admitted earlier and have made strides in their newfound abilities. Nurses oversee veterans’ medication management, provide personalized health counseling, and assist veterans with any other medical needs. Veterans also work with recreation therapists to embrace both diversional and therapeutic recreation pursuits.
Veterans reside at the inpatient programs for an average of about five to six weeks. Some veterans return for refresher courses if their circumstances or vision changes, or they have new goals for rehabilitation.
Blind Rehabilitation Outpatient Specialists
Blind Rehabilitation Service (BRS) has been adding Blind Rehabilitation Outpatient Specialists (BROS). BRS has 93 BROS assigned to medical centers around the country. BROS provide outpatient training programs for visually impaired veterans, teaching skills in the veterans’ home environment, community, job site, or at the veterans’ local VHA facility. A BROS has advanced technical knowledge and competencies at the full performance level in at least two of these specialties: orientation and mobility, daily living training, manual skills, and visual skills. BROS must obtain two certifications from ACVREP.
Visual Impairment Service Team Coordinators
BRS also deploys 166 Visual Impairment Service Team (VIST) Coordinators who serve as specialty case managers across the VHA medical system; they are present in almost every VHA healthcare system. The VIST Coordinators ensure that visually impaired veterans get all the benefits and services that they are entitled to; VIST Coordinators also manage referrals to medical and rehabilitation programs throughout the continuum and in the veterans’ communities. VIST Coordinators provide outreach to find visually impaired veterans who do not realize the services that are available to them. Outreach to the medical facility healthcare professionals, to the community, especially community eye care providers, to organizations and agencies that include or serve blind veterans, and any other avenues for identifying and including eligible veterans for case management and rehabilitation. VIST Coordinators also provide counseling for veterans and information and education for their family members and significant others. VIST Coordinators may be certified by ACVREP or may have credentials as counseling professionals.
Newest Programs
Nationwide Vision Rehabilitation System
Blind Rehabilitation Service (BRS) has established a nationwide vision rehabilitation system that ensures that veterans with visual impairment get the earliest appropriate rehabilitation care and technology when that care is needed and in a setting that is convenient for them. Even moderate visual impairment makes driving, recognizing faces, reading, writing, and medication management more difficult. These programs are designed to provide services at the earliest point of vision loss to maximize independence, provide adjustment to sight loss, and to increase quality of living. Early intervention with vision rehabilitation also mitigates potential problems and safety issues such as falls, burns, or medication errors. The need for early intervention, combined with the expansion of services to provide care for service members returning from combat operations in Iraq and Afghanistan were the catalyst for VHA rapidly reorganizing its blind rehabilitation services.
This continuum of care is progressive in the complexity of services that it delivers. VHA eye care specialists provide basic low vision care at all VHA eye clinics. This care includes limited vision rehabilitation, such as spectacle adjustments, specialized placement of bifocals to accommodate patients’ preferred retinal loci, lighting and glare controls, prescription of easy-to-use magnifiers, and suggestions for improving home lighting and improving contrast.
Intermediate Low Vision Clinics
The 22 intermediate clinics deal with more complex low vision assessment, devices, and training. These clinics provide devices such as spectacle-mounted microscopes, telescopes, and other hand-held optical devices, as well as training in their use. The clinics will also evaluate veterans for the difficulty they have in everyday situations and provide the level of care and interventions needed, such as training visual and cognitive skills. Veterans are instructed in such daily tasks as reading, activities of daily living, managing their finances, correctly taking their medications, preventing falls at home, and making small household repairs. An eye care specialist and a Certified Low Vision Therapist staff these clinics.
Advanced Low Vision Clinics
The 22 advanced outpatient clinics provide the most technologically advanced devices and more comprehensive interventions and training. Examples of devices available to visually impaired veterans in these clinics include electronic magnification devices such as closed circuit television systems that magnify print more than standard optical magnifiers. Special bioptic telescopes can also be provided that allow some visually impaired veterans to drive again where this technology and the patient’s driving ability meets the state’s legal mandates for driving. Emerging technology such as head-born devices that recognize familiar faces, read text, etc. can be evaluated. Advanced low vision clinic staff can instruct orientation to the environment and safe travel skills that complement the use of vision devices. Advanced clinics are also more interdisciplinary partnering with rehabilitation and other medical services to address co-morbidities or medical issues that can impact a veteran’s safety. A Certified Orientation and Mobility Specialist, a Certified Low Vision Therapist, and an eye care specialist staff these clinics.
Visual Impairment Services Outpatient Program
There are also eight short-term lodger programs available called VISOR (Visual Impairment Services Outpatient Program). The VISOR intervention consists of programs (about two weeks) intended for veterans whose needs for rehabilitation can be met with a shorter program, and who do not require medical support or caregiving (unless a companion accompanies the veteran). The VISOR programs at VHA medical centers provide overnight accommodations in a hospital-based unit setting or at a nearby hotel. The programs offer living skills training, orientation and mobility, low vision rehabilitation, and computer assisted training. VISORs also provide intermittent rehabilitation appointments for veterans who are within easy driving distance of the program.
Eligibility for Health Services
A veteran may qualify for vision rehabilitation if he or she served in active military service and was discharged under any condition other than dishonorable. There are minimum duty requirements and enhanced eligibility criteria.
Applying for Health Benefits
Veterans must be enrolled in VHA Health Benefits to get BRS services. Applications are available online or veterans can go to their local VHA healthcare facility. For help filling in the form, call 1-877-222-VETS (8387) Monday through Friday a.m. to 8 p.m. eastern standard time.
After application, veteran patients are assigned to a VHA medical team and then receive a vision examination by an eye care specialist. Their eye care specialists for vision or blind rehabilitation refer veterans with visual impairments.
Does One’s Vision Loss Have to Be Service Connected to Obtain VHA Services?
According to the Office of Public Affairs Benefits Manual, veterans receiving VHA care for visual impairment may receive VHA prosthetic appliances, equipment, and services that assist in overcoming the disability of vision impairment when requested by their VHA eye care or vision rehabilitation provider. Prosthetic benefits for visual impairment, access technology, such as computers, smart phones, and tablets — and any other equipment deemed appropriate to overcome the disability of visual impairment. Blind veterans, who are approved for a guide dog and receive a dog after training by an accredited guide dog school, may also receive service dog benefits including veterinary care and equipment that is required as long as the guide dog is working.
Needed services should be discussed with the VIST coordinator.
In addition to this information, Gale Watson, M.Ed., CLVT, National Director of the Blind Rehabilitation Service for the Department of Veterans Affairs (VHA) has written an article for VisionAware on “Re-Dedicating Ourselves to Veterans.”
Veterans Administration Resources
Veterans Crisis Line: 1-800-273-8255