VA Health Care:

More Outpatient Rehabilitation Services for Blind Veterans Could Better Meet Their Needs

GAO-04-996T, Jul 22, 2004

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In fiscal year 2003, the Department of Veterans Affairs (VA) estimated that about 157,000 veterans were legally blind, and about 44,000 of these veterans were enrolled in VA health care. The Chairman of the Subcommittee on Health, House Veterans' Affairs Committee, and the Ranking Minority Member, Senate Veterans' Affairs Committee expressed concerns about VA's rehabilitation services for blind veterans. GAO reviewed (1) the availability of VA outpatient blind rehabilitation services, (2) whether legally blind veterans benefit from VA and non-VA outpatient services, and (3) what factors affect VA's ability to increase veterans' access to blind rehabilitation outpatient services. GAO reviewed VA's blind rehabilitation policies; interviewed officials from VA, the Blinded Veterans Association, state and private nonprofit agencies, and visited five Blind Rehabilitation Centers (BRC).

VA provides three types of blind rehabilitation outpatient training services. These services, which are available at a small number of VA locations, range from short-term programs provided in VA facilities to services provided in the veteran's own home. They are Visual Impairment Services Outpatient Rehabilitation, Visual Impairment Center to Optimize Remaining Sight, and Blind Rehabilitation Outpatient Specialists. VA reported to GAO that some legally blind veterans could benefit from increased access to outpatient blind rehabilitation services. When VA reviewed all of the veterans who, as of March 31, 2004, were on the waiting list for admission to the five BRCs GAO visited, VA officials reported that 315 out of 1,501 of them, or 21 percent, could potentially be better served through access to outpatient blind rehabilitation services, if such services were available. GAO also identified two factors that may affect the expansion of VA's outpatient blind rehabilitation services. The first involves VA's longstanding position that training for legally blind veterans is best provided in a comprehensive inpatient setting. The second reported factor is VA's method of allocating funds for medical care. VA is currently working to develop an allocation amount that would better reflect the cost of providing blind rehabilitation services on an outpatient basis.

Status Legend:

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  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendation for Executive Action

    Recommendation: The Secretary of Veterans Affairs should direct the Under Secretary for Health to issue, as soon as possible in fiscal year 2005, a uniform standard of care policy that ensures that a broad range of inpatient and outpatient blind rehabilitation services are more widely available to legally blind veterans.

    Agency Affected: Department of Veterans Affairs

    Status: Closed - Implemented

    Comments: On October 20, 2006, VA's Acting Under Secretary for Health signed a VHA Executive Decision Memorandum (EDM) setting aside resources to improve low vision and blind rehabilitation care for veterans. Three levels of service were funded by the EDM: Intermediate Low Vision Care, Advanced Ambulatory Low Vision Care, and Outpatient Blind Rehabilitation. Each VA network was required to implement a plan for the provision of services for veterans with impaired visual acuity and blindness. VA's 10 existing inpatient blind rehabilitation centers would continue to provide intensive eye care programs, but each network would also provide outpatient-based blind rehabilitation care. VA reported in July 2007, that it is continuing to implement a comprehensive nationwide rehabilitation system for veterans and active duty personnel with visual impairments. A review team composed of staff from the Blind Rehabilitation Service and the Visual Impairment Advisory Board are working with the VISNs to establish implementation plans--plans are completed for 19 VISNs at this time.