Report to Congressional Requesters

United States Government Accountability Office

GAO 

July 2004 VA HEALTH CARE

VA Needs to Improve 

Accuracy of Reported 

Wait Times for Blind 

Rehabilitation 

Services 

GAO-04-949 
www.gao.gov/cgi-bin/getrpt?GAO-04-949.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cynthia A. 

Bascetta at (202) 512-7101. 

Highlights of GAO-04-949, a report to 

congressional requesters. 

July 2004

VA HEALTH CARE

VA Needs to Improve Accuracy of 

Reported Wait Times for Blind 

Rehabilitation Services 

GAO found that the average length of time VA reported that veterans wait for 

admission to BRCs was inaccurate. Some data used to calculate wait times 

were incomplete or incorrect. For example, at one BRC GAO found that one 

or more of the data elements used to calculate the wait times—the date the 

BRC received the application, the earliest admission date offered to the 

veteran, and the date the veteran was admitted to the BRC—were missing 

from 31 percent of the records and incorrect in 13 percent of the records. 

GAO also found missing or inaccurate data at two other BRCs. In addition, 

GAO found that BRCs used different procedures for their calculations, which 

also contributed to the inaccurate average wait times. For example, two 

BRCs correctly ended the wait times calculations on the earliest admission 

date offered to the veteran, while the other three BRCs ended the wait times 

calculations on the date the veteran was admitted to the BRC. To enable VA 

to accurately assess wait times, it is essential for VA to develop more 

comprehensive instructions to calculate average wait times and for BRCs to 

adhere to them. 

The Department of Veterans Affairs 

(VA) provides rehabilitation 

services to legally blind veterans. 

These services are intended to help 

them acquire the skills necessary to 

become more independent. Almost 

all of VA’s rehabilitation services 

for legally blind veterans are 

provided at Blind Rehabilitation 

Centers (BRC), an inpatient 

program. VA reported that the 

average length of time a veteran 

waited to be admitted to a BRC 

increased from 168 to 210 days 

from fiscal years 1999 through 

2003. GAO was asked to examine 

the accuracy of veterans’ wait 

times for admission to BRCs. 

GAO’s objective was to determine 

whether the average wait times for 

veterans seeking admission to 

BRCs reported by VA were 

accurate. GAO reviewed VA 

policies and procedures for 

determining the average length of 

time veterans wait to be admitted 

to a BRC. GAO also visited 5 of 

VA’s 10 BRCs to evaluate the 

reliability of the data used to 

calculate wait times. 

GAO recommends that the 

Secretary of Veterans Affairs direct 

the Under Secretary for Health to 

instruct (1) the program office to 

develop more specific instructions 

for calculating wait times and 

(2) the BRCs to adhere to these 

instructions by developing 

procedures to compile complete 

and accurate information. VA 

concurred with GAO’s 

recommendations. 
Page i GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

Letter 1

Results in Brief 2

Background 2

VA’s Reported Wait Times for Accessing BRCs Were Inaccurate 4

Conclusions 5

Recommendations for Executive Action 6

Agency Comments 6

Appendix I Scope and Methodology 7 

Appendix II Comments from the Department of Veterans Affairs 9 

Table 

Table 1: Location of VA’s Blind Rehabilitation Centers and the 

Number of Authorized Beds 3

Abbreviations 

BRC Blind Rehabilitation Center 

VA Department of Veterans Affairs 

VIST Visual Impairment Service Team 

Contents 

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Page 1 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

July 22, 2004 

The Honorable Bob Graham 

Ranking Minority Member 

Committee on Veterans’ Affairs 

United States Senate 

The Honorable Rob Simmons 

Chairman 

Subcommittee on Health 

Committee on Veterans’ Affairs 

House of Representatives 

The Department of Veterans Affairs (VA) provides rehabilitation training 

services for legally blind1

 veterans that are intended to enable them to 

acquire the skills necessary to develop personal independence, such as 

using magnification devices for reading. Almost all of VA’s rehabilitation 

services for legally blind veterans are provided at Blind Rehabilitation 

Centers (BRC), a residential inpatient program. VA reported that the 

average length of time a veteran waited to be admitted to a BRC increased 

from 168 to 210 days from fiscal years 1999 through 2003. In 2003, VA 

reported that approximately 2,100 legally blind veterans received care in 

BRCs, with average wait times ranging from 77 to 343 days. 

Congress has been concerned for more than 10 years about the length of 

time veterans wait to receive training at BRCs. In 1993 and again in 1995, 

Congress noted that veterans were unable to access services at BRCs in a 

timely manner and encouraged VA to provide more services. You 

expressed concern about the accuracy of the length of time VA reports 

that veterans wait for admission to BRCs. Our objective was to determine 

whether the average wait times for veterans seeking admission to BRCs 

reported by VA were accurate. 

 1

VA defines legal blindness as when the patient’s best-corrected central visual acuity with 

ordinary eyeglasses or contacts is 20/200 or less in the better eye (as measured by the 

Snellen Visual Acuity Chart) or when the field of useful vision is 20 degrees or less in the 

better eye. People who are legally blind can only at best read the big “E” on the eye chart or 

see as if they are looking through a paper towel tube, according to VA. 

United States Government Accountability Office

Washington, DC 20548 
Page 2 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

To assess the accuracy of VA’s reported wait times, we visited 5 of VA’s 10 

BRCs that we selected based on differences in geographical location and 

the number of beds available at the BRC. We met with BRC officials and 

other VA employees who manage the health care provided to legally blind 

veterans. We reviewed the procedures they followed to calculate veterans’ 

wait times and analyzed documents2

 to evaluate the reliability of the data 

used to calculate wait times at 3 of the BRCs. We were unable to assess 

the data at the other 2 BRCs because application packages were not 

available. After veterans were discharged, 1 BRC required that the 

application packages be destroyed and the other BRC returned the 

packages to the medical facility that referred the veteran. We also met 

with officials from VA’s Blind Rehabilitation Service Program Office 

(program office), which has responsibility for blindness-related services, 

to review its policies and procedures regarding wait times calculations. 

Our review was conducted from September 2003 through July 2004 in 

accordance with generally accepted government auditing standards. (See 

app. I for additional information on our scope and methodology.) 

The average length of time VA reported that veterans wait for admission to 

BRCs was inaccurate. Some data used to calculate wait times—the date 

the BRC received the application, the earliest admission date offered to 

the veteran, and the date of admission—were incomplete or incorrect. In 

addition, we found that BRCs used different procedures for their 

calculations, which also contributed to the inaccurate average wait times. 

We are making two recommendations to improve the accuracy of VA’s 

reported BRC wait times. VA agreed with our findings and 

recommendations and indicated that it will provide a detailed action plan. 

In 2003, VA estimated that about 157,000 veterans were legally blind, about 

44,000 of them were enrolled in its health care system, and about 2,100 

received rehabilitation training in BRCs. The blind rehabilitation program 

is designed to improve the quality of life for veterans who are legally blind. 

VA’s Visual Impairment Service Team (VIST) coordinators are responsible 

for managing legally blind veterans’ access to rehabilitation services, 

including reaching a decision with the veteran about appropriate training 

 2

These documents included veterans’ applications for BRC admission, printouts from the 

BRC’s electronic database used to manage the wait list, and veterans’ computerized 

medical records. 

Results in Brief 

Background 
Page 3 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

and other services. VIST coordinators prepare the veteran’s application to 

a BRC and ensure that the veteran has the medical examinations required 

for admission, such as hearing examinations and low vision testing. VA’s 

10 BRCs provide training to legally blind veterans on an inpatient 

residential basis. Table 1 lists the location of the BRCs and the number of 

beds authorized for blind rehabilitation services. 

Table 1: Location of VA’s Blind Rehabilitation Centers and the Number of 

Authorized Beds 

Location Authorized bedsa

American Lake, Washingtonb 15

Augusta, Georgiab 15

Birmingham, Alabama 32

Hines, Illinoisb 34

Palo Alto, California 32

San Juan, Puerto Rico 12

Tucson, Arizonab 34

Waco, Texas 15

West Haven, Connecticut 34

West Palm Beach, Floridab 18

Total 241

Source: VA. 

a

As of May 2004. 

b

BRCs evaluated by GAO. 

The training BRCs offer is comprehensive and individualized with the goal 

of helping legally blind veterans meet their personal goals and achieve a 

realistic level of independence. They offer a basic rehabilitation program 

and computer training. The basic program trains veterans in such areas as 

orientation and mobility (e.g., moving around the home or using a cane to 

travel through different environments) or visual skills (e.g., using closed 

circuit television or magnification devices to read or write checks). 

Computer training teaches veterans how to operate a computer; search the 

Internet; and send, receive, and read e-mail messages. 

Each month, BRCs are required to submit a report to the program office 

that includes their calculation of the average number of days veterans 

waited to be admitted to a BRC for training during the past 6 months. VA 

defines an applicant’s wait time as the number of days that elapse from the 
Page 4 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

date the BRC receives the application to the earliest admission date 

offered to the veteran. 

Wait times reported by the program office were not accurate for two 

reasons. First, we found that some data VA used to calculate wait times 

were missing and some that it used were incorrect. Second, VA did not use 

consistent procedures to calculate wait times. 

We determined that data elements BRCs used for calculating wait times 

for both basic and computer training—the date the BRC received the 

application, the earliest admission date offered to the veteran, and the date 

the veteran was admitted to the BRC—were missing or inaccurate. For 

example, during our review of data at one BRC, we found that one or more 

of the data elements used to calculate the wait times were missing from 

31 percent of the records and incorrect in 13 percent of the records. We 

also noted missing or incorrect data elements during our review of records 

at two other BRCs. Specifically, at one BRC we reviewed 30 records and 

found missing or inaccurate data in 24 of them. At the other BRC, we 

found inaccurate data in 8 of 16 records. At the remaining two BRCs, we 

could not validate the completeness or accuracy of records used to 

calculate wait times because application packages were not available. 

After veterans completed their training, one BRC required that the 

application packages be destroyed and the other BRC returned the 

packages to the medical facility that referred the veteran. In addition, we 

found weaknesses in the way the BRCs ensured complete and accurate 

data. For example, none of the BRCs stated they validated data entry. Also, 

none of them checked their databases for completeness (Is the data 

element filled in or has it been left blank?) and reasonableness (Is the date 

the BRC received the application earlier than the first admission date 

offered to the veteran?). Further, one of them did not check for format 

accuracy (If the data element is a date, is it formatted as a date, such as 

5/24/2004?). 

We found that the five BRCs we visited followed different procedures for 

determining the average time a veteran must wait for admission to a BRC. 

According to VA instructions, the BRC is to average the number of days 

that elapsed from the date the application was received to the earliest 

admission date offered to the veteran for veterans admitted during the 

past 6 months. However, the instructions do not stipulate whether the 

application package must be complete before putting the veteran on the 

VA’s Reported Wait 

Times for Accessing 

BRCs Were 

Inaccurate 

Data Used to Report Wait 

Times Were Missing or 

Inaccurate 

Procedures Used to 

Calculate Wait Times Were 

Inconsistent 
Page 5 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

wait list or the length of time BRCs allow VIST coordinators to submit the 

missing information. This lack of specificity resulted in BRCs using 

different procedures to calculate their wait times. 

Although all five BRCs began their calculations when they received the 

veteran’s application—even if it was not complete—they allowed VIST 

coordinators different lengths of time to provide the missing information. 

According to the BRC officials at these locations, the BRCs accepted 

incomplete packages as long as the basic information needed to process 

the application was present, including documents to prove eligibility, a 

recent physical examination, and an eye examination proving legal 

blindness. For example, one BRC official stated that the results of hearing 

examinations were not essential to approve applications but were needed 

before veterans were admitted for training. VIST coordinators who 

submitted incomplete applications could get their veterans on the wait list 

earlier than VIST coordinators who waited to submit complete 

applications. BRCs allowed different lengths of time for VIST coordinators 

to provide missing information before removing veterans from the wait 

list. For example, one BRC removed veterans with incomplete applications 

from the wait list after 30 days, while another waited at least 6 months. 

Not all BRCs used the same procedures to stop the wait times calculation. 

The program office instructs BRCs to stop the wait times calculation on 

the earliest admission date offered to the veteran. Two BRCs correctly 

ended the wait times calculation on that date, while the other three ended 

the wait times on the date the veteran was actually admitted, even if the 

veteran had refused earlier admission dates. For example, one veteran was 

offered an admission date of October 27th. The veteran declined that date 

and two subsequently offered dates and was finally admitted on June 7th 

of the following year. Because the veteran’s first offer date was October 

27th, according to the program office instructions the wait times should 

have stopped on that date. Instead, the BRC included the additional time 

between October 27th and June 7th in its wait times calculation. In this 

example, the BRC calculation overstated the veteran’s wait times by over 7 

months. 

While VA reports BRC wait times for veterans, the information does not 

accurately reflect the time veterans wait for admission. Data used for 

calculations are often incomplete or inaccurate. In addition, BRCs 

followed different procedures for calculating wait times because VA’s 

instructions do not specify whether application packages must be 

complete before putting the veteran on the wait list or the length of time 

Conclusions 
Page 6 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

BRCs allow VIST coordinators to submit the missing information. For VA 

to accurately assess wait times, it is essential for VA to develop a 

consistent process for determining average wait times and for BRCs to 

adhere to it. 

To improve VA’s ability to effectively manage care for legally blind 

veterans, we recommend that the Secretary of Veterans Affairs direct the 

Under Secretary for Health to instruct (1) the program office to develop 

more specific instructions for calculating wait times and (2) the BRCs to 

adhere to these instructions by developing procedures to compile 

complete and accurate information on the length of time veterans wait for 

admission to BRCs. 

In commenting on the draft of this report, VA agreed with our findings and 

conclusions. VA stated that the report accurately conveyed the variability 

and complexity of reporting wait times for admission to BRCs. VA 

concurred with our recommendations and indicated that it will provide a 

detailed action plan. VA’s written comments are reprinted in appendix II. 

We are sending copies of this report to the Secretary of Veterans Affairs 

and other interested parties. We also will make copies available to others 

upon request. In addition, the report will be available at no charge at the 

GAO Web site at http://www.gao.gov. If you or your staff have any 

questions about this report, please call me at (202) 512-7101 or Michael T. 

Blair, Jr. at (404) 679-1944. Cherie Starck, Cynthia Forbes, and Janet 

Overton were key contributors to this report. 

Cynthia A. Bascetta 

Director, Health Care—Veterans’ 

 Health and Benefits Issues 

Recommendations for 

Executive Action 

Agency Comments 
Appendix I: Scope and Methodology 

Page 7 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

To determine whether VA accurately reports average wait times for 

veterans seeking admission to Blind Rehabilitation Centers (BRC), we 

examined the policies and procedures VA used to calculate the length of 

time veterans wait for admission. We met with and obtained 

documentation from officials at the Blind Rehabilitation Service Program 

Office and from the five BRCs we visited. We selected the five BRCs 

located in Tucson, Arizona; West Palm Beach, Florida; Augusta, Georgia; 

Hines, Illinois; and American Lake, Washington, based on differences in 

geographical location and the number of beds available at the BRC. We 

met with BRC officials and veterans’ case managers. We reviewed 

documentation on the procedures BRC staff followed to calculate 

veterans’ wait times to assess the quality of the data the five BRCs 

maintained. We also reviewed veterans’ paper application packages for 

BRC admission, printouts from the BRC’s electronic database used to 

manage the wait list, and veteran’s computerized medical records. 

At the first BRC we visited, we compared the date the application was 

received at the BRC in the electronic and paper files for a judgmentally 

selected sample of 16 applicants. We identified data elements that were 

inaccurate in either the paper or electronic records in 8 of the 16 records. 

At the second BRC, we chose a random sample of 100 veterans, stratified 

by fiscal year, from the 578 that were admitted in fiscal years 2000 through 

2003. A BRC official then provided printed copies of the data from the 

electronic file used to calculate the wait times and the folders containing 

the paper application packages. We reviewed the selected files to compare 

the data elements used for calculating wait times—the date the BRC 

received the application, the earliest admission date offered to the veteran, 

and the date the veteran was admitted to the BRC—from the two sources. 

We determined that one or more of these data elements were missing from 

31 percent of the records with a margin of error of plus or minus 

8 percent. Additionally, we found that one or more of these data elements 

were inaccurate in 13 percent of the records with a margin of error of plus 

or minus 6 percent.1

For the remaining three BRCs, we attempted to verify that the problems 

we found at the first two BRCs were also found at the other facilities. At 

the third BRC we randomly sampled 10 admissions each from fiscal years 

 1

The categories of records with missing data elements and those with inaccurate data 

elements are not mutually exclusive. 

Appendix I: Scope and Methodology 
Appendix I: Scope and Methodology 

Page 8 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

2001 through 2003.2 A BRC official provided printed copies of the data 

from the electronic file used to calculate the wait times and the folders 

containing the paper application packages. We reviewed the two sources 

to compare the data elements used for calculating wait times. To 

determine if similar data problems also existed at this BRC, we compared 

the percentage of inaccurate or missing data elements to a tolerable level 

of 10 percent—that is, not less than 10 percent of the records at this BRC 

had one or more inaccurate or missing data elements. We found that 24 of 

the 30 records had inaccurate or missing data elements. We confirmed that 

the percent of inaccurate and incomplete data elements was not less than 

10 percent by performing a one-sided significance test at the 95-percent 

confidence level. We were unable to assess the data at the other two BRCs 

because application packages were not available. After veterans 

completed their training, one BRC required that the application packages 

be destroyed and the other BRC returned the packages to the medical 

facility that referred the veteran. Our results from these five BRCs cannot 

be generalized to other facilities. 

 2

We had planned to sample from fiscal years 2000 through 2003 but records from fiscal year 

2000 had been destroyed. 
Appendix II: Comments from the Department 

of Veterans Affairs 

Page 9 GAO-04-949 VA Wait Times for Blind Rehabilitation Services 

Appendix II: Comments from the Department 

of Veterans Affairs 

(290316) 
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