VA Blind Rehabilitation Services
Mission
Deliver blindness and vision services that
provide the right care in the right place at the
right time to enable Veterans to maintain their
independence, quality of life, and successful
integration into family and community life.
Who Do We Serve?
Veterans/Servicemembers
--- Legally Blind
--- Low Vision
--- Excess Disability
Definitions of Legal Blindness
Blind by loss of visual acuity:
Legal blindness exists when best corrected central visual acuity in
the better-seeing eye is less than or equal to 20/200.
OR
Blind by loss of visual fields:
visual field dimension in the better-seeing eye is less than or
equal to 20 degrees at the widest diameter, even if central visual
acuity is better than 20/200.
Definition of Low Vision
There is no universal consensus on the definitions for
low vision and blindness. In its broadest sense, low
vision can be defined as any visual impairment that
results in disability and that interferes with the ability to
perform everyday activities and cannot be corrected
medically, surgically, or with conventional eyeglasses.
Definition of Excess Disability
Excess disability is characterized by problems and task
performance difficulties related to vision loss that have a
substantial impact on the person's functional independence or
personal safety, and that are out of proportion to the degree of
visual impairment as measured by visual acuities or visual fields.
Veterans whose vision is better than legal blindness may have
excess disability due to:
Excess Disability (continued)
(1) Sudden or traumatic visual disorder (especially related to
military service).
(2) Disabling co-morbidities (e.g., hearing impairment,
mobility impairment, etc.);
(3) Systemic diseases that cause fluctuating visual
impairment;
(4) Combined losses of other vision functions (e.g., contrast
sensitivity, stereopsis, etc.);
(5) Sudden changes in caregiver status; and
(6) Other reasons.
Blind Rehabilitation Services
• Blind rehabilitation services utilizes an interdisciplinary
team approach, within an integrated system of care
• Coordinates with other key VA programs: Ophthalmology,
Optometry, Social Work Service, Veterans Benefits
Administration (VBA), Polytrauma System of Care
• Blind rehabilitation services include:
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Comprehensive rehabilitation
Adjustment to blindness counseling
Patient and family education
Assistive technology
– Clinical research that advances evidence-based practices
– Intensive case management, life-long care and access to services
Blind rehabilitation Services include:
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Comprehensive rehabilitation
Adjustment to blindness counseling
Patient and family education
Assistive technology
Clinical research that advances evidencebased practices
• Intensive case management, life-long care
and access to services
Patients referred from:
• VHA Eye Care
(ophthalmology, optometry)
• VHA Social Work Service
• VHA Polytrauma System of
Care
• Other VHA health care
providers
• Department of Defense
(DoD) liaisons and Federal
Recovery Coordinators
• Veterans Benefits
Administration (VBA)
Vocational Rehabilitation
and Employment (VR&E)
• Private sector eye care
specialists, other physicians
• Local area vocational
rehabilitation programs, low
vision clinics, and blind
services
• Blinded Veterans
Association (BVA)
• Patient self-referral
• Family members
Blind Rehabilitation Services
• Levels of blind rehabilitation clinical services:
– Intermediate (moderate visual impairment)
• Low vision therapy/visual skills training; activities of daily living
training; communication training
– Advanced (moderate-severe visual impairment)
• All of the above services, plus orientation and mobility training;
adjustment counseling
– Outpatient (severe visual impairment)
• All of the above services, plus computer access training
– Inpatient (severe impairment to blindness; need for intense care)
• All of the above services, plus manual skills training (woodworking,
household and small engine repair), psychology and social work
services, recreation therapy; inpatient medical care for co-occurring
conditions
Program Components
• Visual Impairment Services Coordinators and Teams
• 157 VIST Coordinators
• Blind Rehabilitation Outpatient Specialists (BROS)
• 77 BROS
• Inpatient Blind Rehabilitation Centers
• 10 Centers currently
• Outpatient Vision and Blind Rehabilitation Clinics (new)
• 55 Low Vision Clinics
Program Components
Visual Impairment Services Team
• Visual Impairment Services Team Coordinator:
– Duties include identifying new cases of severe visual impairment,
referring for services, providing adjustment counseling, arranging
reviews of benefits and health care, and education related to
VIST and blindness
– Case manager with responsibility for coordinating services for
visually impaired Veterans, and their families
• Visual Impairment Services Team (VIST):
– Local teams of medical professionals who ensure that severely
disabled visually impaired Veterans are identified, evaluated, and
provided health and rehabilitation services to maximize
adjustment to sight loss
– Ongoing lifetime case management at local VA medical center
– Liaison with Military Treatment Facilities for Service Members
receiving services
Program Components
Blind Rehabilitation Outpatient Specialists
• Blind Rehabilitation Outpatient Specialists (BROS):
– Provide blind rehabilitation assessment and training in home,
community, and job sites as well as clinical care
– Prevent or reduce the need for inpatient blind rehabilitation
program, and meet the needs of those Veterans who are
unable to attend inpatient Blind Rehabilitation Center program
• 77 BROS assigned nationally
• BROS assigned to Walter Reed Army Medical Center
and National Naval Medical Center
• BROS assigned to all Polytrauma Rehabilitation
Centers and Sites
Program Components
Blind Rehabilitation Centers
• Inpatient Blind Rehabilitation Centers:
– Provide comprehensive, interdisciplinary, residential Blind
Rehabilitation Services
– Also provide specialized health care, wellness education, and
adjustment counseling support
• Average length of stay is 5 weeks
• 10 Blind Rehabilitation Centers nationally, all
accredited by Commission on Accreditation of
Rehabilitation Facilities (CARF)
Blind Rehabilitation Centers
10 Centers Nationwide
Blind Rehabilitation Service
Department of Veterans Affairs
Outpatient, Vision, and Blind
Rehabilitation Clinics
• VHA is the only national healthcare system to completely
integrate rehabilitation services for patients with visual
impairments into health benefits
• Provides early intervention for patients whose vision loss
results from progressive diseases
• Provides intermediate and advanced care for patients
who have moderate visual impairment:
– Cannot see to drive
– Cannot see to read or write
– May be at risk for falls
– May be non-compliant with healthcare regimens
Intermediate Low Vision Clinics
Advanced Low Vision Clinics
Outpatient BRCs “VISOR” Clinics
• VA Western HCS,
Buffalo, NY
• East Orange Campus of
New Jersey HCS, East
Orange NJ
• Lebanon VAMC,
Lebanon, PA
• Washington, D.C.
• Hunter Holmes McGuire,
VAMC, Richmond, VA
• Lexington VAMC,
Lexington, KY
• Louis Stokes VAMC,
Cleveland, OH
• Battle Creek VAMC,
Battle Creek, Michigan
• Kansas City VAMC,
Kansas City, MO
• Michael E. Debakey
VAMC, Houston, TX
• VA Eastern Colorado
HCS, Denver, CO
• Minneapolis, MN
BRS Services and OEF/OIF/OND
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BRS Services and OEF/OIF/OND
All Blind Rehabilitation Service
program components actively
support veterans and
Servicemembers of
OEF/OIF/OND.
Visual Impairment Service Team
(VIST) Coordinators
Involvement with Military
Treatment Facilities through
liaisons
Case management in support of
Polytrauma Rehabilitation
programs
Ongoing case management at
local medical centers
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Blind Rehabilitation Outpatient
Specialists (BROS)
BROS assigned to Walter Reed
Army Medical Center and
Bethesda
BROS assigned to all Polytrauma
Rehabilitation Centers
Treat patients in homes,
communities, and local VAMCs
and CBOCs
TBI & Visual Consequences &
Disturbances
• Estimated that 30%-85% of all TBI cases
involve visual disturbances:
• Blurred vision
• Photo-sensitivity (most common)
• Pain & headaches caused by vision
• Source: Journal of Behavioral Optometry,
vol. 18/2007/number 3, pg. 58
TBI & Visual Consequences &
Disturbances
• Change in Field of Vision
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Symptoms: missing movement or objects not in front
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Misplacing /getting lost
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Lack of hygiene on one side (shaving, combing)
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Leaning while talking, tilting head
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Bumping into or tripping over obstacles
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Knocking things over
Visual Consequences of TBI
• Oculomotor Dysfunction/Binocular Disorders
• Abnormalities of vergence (aiming the eyes, either converging or
diverging, in order to see something).
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Symptoms: results in occasional or constant eye strain or sense
that the print on a book is "shimmering" or "floating" on the page
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- Images seem to jump and move
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- losing place when reading
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- skips or rereads words, letters, lines or phrases
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- Words running together
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- reverse numbers/letters
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- Diplopia: double vision
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- Closing one eye
Services and Resources
Services for Visually
Impaired Veterans
Referral to Community
Resources
• Catastrophically disabled
exemption for legally
blind
• Special disability ratings
for blindness
• Prosthetic devices and
technology available
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Talking Books
Groups
Transportation
National Parks
Property tax credits
Other state initiatives for vision
loss
• Local community agencies
• SSA
• Vocational Rehabilitation
Vision Loss and the Family
• Blind Rehabilitation Service works with the
families as well as the Veteran through all
program components: VIST, VISOR, Low Vision
Clinics, BRCs and BROS
• Support & Adjustment: care giving; helping to
motivate Veterans for blind rehabilitation
VIST Coordinators in Virginia
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Myisha Norris
Washington DC VAMC
50 Irving Street NW
Washington DC 20422
202-745-8000 ext. 8621
E-Mail: Myisha.norris2@va.gov
Evelyn Cabrera-Heatwole
Richmond VAMC
1201 Broad Rock BLVD
Richmond, VA 23249
804-675-5221
E-Mail: evelyn.cabreraheatwole@va.gov
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James Stephens
Hampton VAMC
100 Emancipation Drive
Hampton, VA 23667
757-722-9961 ext. 2420
E-Mail: james.stephens@va.gov
Stephanie Sackett (Ayers)
Salem VAMC
1970 Roanoke BLVD
Salem, VA 24153
540-982-2463 Ext. 3356
E-Mail: Stephanie.ayers@va.gov
REFERRALS OF VETERANS
WITH
VISION IMPAIRMENT
TO A VA MEDICAL CENTER
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Veteran needs to be Honorably Discharged from the Military and eligible for VA
Healthcare.
All Veterans with Legal Blindness who have been Honorably Discharged and who are
eligible for VA Healthcare are eligible for VA Blind Rehabilitation Services. These
include both Veterans that are already enrolled into the VA Healthcare System and
those who have never been seen in a VAMC.
If it is a Veteran with vision impairment (not legally blind) who is already enrolled into
VA Healthcare, then VIST is able to see the patient in a timely manner and provide
blind/vision rehabilitation services.
All newly enrolled Veterans with low vision and/or vision impairment (not legally blind)
that are within the income limits set forth by Congress are also eligible for VA Blind
Rehabilitation Services.
For those Veterans with vision impairment (not legally blind) who are not enrolled
in the VA Healthcare System and who are over the income limits set forth by
Congress, then the Veteran will not be eligible for VIST, VISOR or BROS Services
within the Veterans Health Administration.
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WHEN IN DOUBT, JUST REFER