Testimony 

Before the Committee on Veterans’ 

Affairs, House of Representatives

United States Government Accountability Office

GAO

For Release on Delivery 

Expected at 9:30 a.m. EDT 

Thursday, July 22, 2004 VA HEALTH CARE 

More Outpatient 

Rehabilitation Services for 

Blind Veterans Could Better 

Meet Their Needs 

Statement of Cynthia A. Bascetta 

Director, Health Care—Veterans’ 

 Health and Benefits Issues 

GAO-04-996T 
www.gao.gov/cgi-bin/getrpt?GAO-04-996T.

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-04-996T, a report to the 

Committee on Veterans’ Affairs, House of 

Representatives 

July 22, 2004

VA HEALTH CARE

More Outpatient Rehabilitation Services 

for Blind Veterans Could Better Meet 

Their Needs 

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. 

Locations of VA Outpatient Blind Rehabilitation Services, May 2004 

Blind Rehabilitation Outpatient Specialists, total = 23

Visual Impairment Center to Optimize Remaining Sight, total = 3

Visual Impairment Services Outpatient Rehabilitation, total = 1

Source: VA.

Puerto Rico

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. 

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). 

GAO recommends that the 

Secretary of Veterans Affairs 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. In 

commenting on a draft of this 

testimony, VA concurred with our 

recommendation. 
Page 1 GAO-04-996T 

Mr. Chairman and Members of the Committee: 

I am pleased to be here today to discuss the health care rehabilitation 

services the Department of Veterans Affairs (VA) provides to legally blind 

veterans. In fiscal year 2003, VA estimated that about 157,000 veterans 

were legally blind,1

 and about 44,000 of these veterans were enrolled in VA 

health care. Since the 1940s, the demographics of VA’s blind veteran 

population have changed from young veterans totally blind as a result of 

traumatic injury to primarily older veterans whose legal blindness is 

caused by age-related eye diseases. 

You expressed concern that VA has not updated its delivery of care 

options for blind rehabilitation programs by offering, in addition to 

inpatient services, a range of outpatient services closer to where veterans 

live.2

 To determine how VA serves the needs of legally blind veterans and 

what role outpatient training services could play, we 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. 

To address these issues, we met with officials from VA’s Rehabilitative 

Strategic Health Care Group, including the Blind Rehabilitation Service 

Program Office (program office). We also met with VA’s directors for 

ophthalmology and optometry. We reviewed applicable policies and 

procedures regarding VA’s blind rehabilitation services, its strategic plan 

for blind rehabilitation, and its planning documents for special disability 

populations. To determine what blind rehabilitation services were 

available to veterans, we visited five medical centers offering blind 

rehabilitation services and met with Blind Rehabilitation Center (BRC) 

officials as well as case managers and rehabilitation specialists who work 

 1

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

with ordinary glasses or contact lenses, is 20/200 or less in the better eye (measured by the 

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

better eye. For example, a legally blind person can read only the big “E” on the eye chart or 

sees as if looking through a paper towel tube. 

2

This work was requested by the Chairman, Subcommittee on Health, Committee on 

Veterans’ Affairs, House of Representatives and the Ranking Minority Member, Committee 

on Veterans’ Affairs, United States Senate. 
Page 2 GAO-04-996T 

with legally blind veterans.3 We asked BRC officials and case managers to 

evaluate veterans on the waiting lists for admission to these BRCs as of 

March 31, 2004, to identify those who could potentially be better served 

through access to outpatient blind rehabilitation services, if such services 

were available. We also interviewed case managers who were located at 

medical centers without a BRC and representatives of the Blinded 

Veterans Association to gain their perspectives on the types of care that 

would benefit legally blind veterans. In addition, we met with officials 

from state and private nonprofit agencies in Arizona, Illinois, and 

Washington to learn about the blind rehabilitation programs they offer 

older citizens.4

 Our review was conducted from September 2003 through 

July 2004 in accordance with generally accepted government auditing 

standards. 

In summary, VA provides three types of blind rehabilitation outpatient 

training services, but they are available only in a few VA locations. These 

services range from short-term programs provided in VA facilities to 

services provided in the veteran’s own home. VA also believes that some 

legally blind veterans could benefit from increased access to outpatient 

blind rehabilitation services. In fact, VA officials reported to us that 21 

percent of veterans on the waiting lists for admission to the five BRCs we 

visited could potentially be better served through access to outpatient 

blind rehabilitation services, if such services were available. Finally, two 

factors affect the expansion of VA’s outpatient blind rehabilitation 

services. The first involves VA’s long-standing position that training for 

legally blind veterans should be provided in a comprehensive inpatient 

setting. This delivery model has not kept pace with VA’s overall health 

care strategy that reduces its reliance on inpatient care and emphasizes 

more outpatient care. The second reported factor affecting the use of 

outpatient blind rehabilitation services is its method of allocating funds for 

medical care. VA’s Visual Impairment Advisory Board (VIAB) believes that 

the funds allocated for basic outpatient care for legally blind veterans do 

not cover the cost of providing blind rehabilitation outpatient services. 

The VIAB is currently working with VA’s Office of Finance and Allocation 

 3

We visited the BRCs located in Tucson, Arizona; West Palm Beach, Florida; Augusta, 

Georgia; Hines, Illinois; and American Lake, Washington. These BRCs were selected based 

on differences in geographic location and the number of beds available at the BRC. 

4

We selected these states because they were in the same geographic location as three of the 

BRCs we visited. 
Page 3 GAO-04-996T 

Resource Center5 to develop an allocation amount that would better 

reflect the cost of providing blind rehabilitation services on an outpatient 

basis, which could provide an incentive to expand this care. We are 

recommending that VA take action to ensure that a broad range of 

inpatient and outpatient blind rehabilitation services is more widely 

available to legally blind veterans. 

In 1944, President Franklin D. Roosevelt made a commitment that no 

servicemen blinded in combat in World War II would be returned to their 

homes without adequate training to meet the problems imposed by their 

blindness, according to VA. From 1944 to 1947, the Army and Navy 

provided this rehabilitation training. In 1947, responsibility for this training 

was transferred to VA, and in 1948, VA opened its first BRC to provide 

comprehensive inpatient care to legally blind veterans. 

In 1956, blind rehabilitation services were expanded to include veterans 

whose legal blindness was not service-connected. Because of this 

expansion, the demographics of VA’s blind veteran population shifted 

toward predominately older veterans whose legal blindness was caused by 

age-related eye diseases. Expanded eligibility also caused an increase in 

demand for services. VA responded to this demand by opening 9 additional 

BRCs in the United States and Puerto Rico for a total of 10 facilities with 

241 authorized beds. (See table 1.) As of May 5 2004, VA reported that 

there were 2,127 legally blind veterans waiting for admission to BRCs.6

 5

The Allocation Resource Center is responsible for developing, implementing, and 

maintaining management information systems that provide data for the Veterans Health 

Administration’s budget process. 

6

See U.S. General Accounting Office, VA Needs to Improve Accuracy of Reported Wait 

Times for Blind Rehabilitation Services, GAO-04-949 (Washington, D.C.: July 22, 2004). 

Background 
Page 4 GAO-04-996T 

Table 1: Location of VA’s Blind Rehabilitation Centers, the Year Each Was Opened, 

and the Number of Authorized and Staffed Beds, as of May 2004 

 Bedsa

Location Year Opened Authorized Staffed

American Lake, Washington 1971 15 12

Augusta, Georgia 1996 15 15

Birmingham, Alabama 1982 32 32

Hines, Illinois 1948 34 34

Palo Alto, California 1967 32 27

San Juan, Puerto Rico 1986 12 11

Tucson, Arizona 1994 34 27

Waco, Texas 1974 15 15

West Haven, Connecticut 1969 34 27

West Palm Beach, Florida 2000 18 18

Total 241 218

Source: VA.

a

Authorized beds are the total bed capacity of the BRC. Staffed beds are the beds available for 

admission of patients. According to VA’s Capacity Report for 2003, the number of staffed beds may 

be less than authorized beds because the local medical center may have eliminated staff positions, 

imposed a hiring freeze, or experienced difficulties in recruiting qualified personnel. 

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

blind,7

 with more than 60 percent age 75 or older. About 44,000 legally 

blind veterans were enrolled in VA health care. VA estimated that through 

2022, the number of legally blind veterans would remain stable. (See 

fig. 1.) 

 7

All legally blind veterans are given priority 4 status and currently are eligible to enroll in 

VA health care. 
Page 5 GAO-04-996T 

Figure 1: Estimated Age Distribution of Legally Blind Veterans, Fiscal Years 2003, 

2012, and 2022 

The National Institutes of Health (NIH) considers the increase in agerelated eye diseases to be an emerging major public health problem. 

According to NIH, the four leading diseases that cause age-related legal 

blindness are cataract, glaucoma, macular degeneration, and diabetic 

retinopathy, each affecting vision differently. (See fig. 2 for illustrations of 

how each disease affects vision.) Cataract is a clouding of the eye’s 

normally clear lens. Most cataracts appear with advancing age, and by age 

80, more than half of all Americans develop them. Glaucoma causes 

gradual damage to the optic nerve—the nerve to the eye—that results in 

decreasing peripheral vision. It is estimated that as many as 4 million 

Americans have glaucoma. Macular degeneration results in the loss of 

central visual clarity and contrast sensitivity. It is the most common cause 

of legal blindness in older Americans and rarely affects those under the 

age of 60. Diabetic retinopathy is a common complication of diabetes 

impairing vision over time. It results in the loss of visual clarity, peripheral 

vision, and color and contrast sensitivity. It also increases the eye’s 

0

20,000

40,000

60,000

80,000

100,000

120,000

<55 55-64 65-74 ≥75

2003 

2012 

2022

Age of legally blind veterans

Number of legally blind veterans

Source: Atlanta VA Rehabilitation Research and Development Center.
Page 6 GAO-04-996T 

sensitivity to glare. Nearly half of all diabetics will develop some degree of 

diabetic retinopathy, and the risk increases with veterans’ age and the 

length of time they have had diabetes. 

Figure 2: Vision and Vision Loss Due to Age-Related Eye Diseases 

Normal vision

Cataract Glaucoma

Age-related macular degeneration Diabetic retinopathy

Source: National Eye Institute, U.S. National Institutes of Health.
Page 7 GAO-04-996T 

To assist legally blind veterans, VA established Visual Impairment Services 

Team (VIST) coordinators who act as case managers and are responsible 

for coordinating all medical services for these veterans, including 

obtaining medical examinations and arranging for blind rehabilitation 

services. There are about 170 VIST coordinators, who are located at VA 

medical centers that have at least 100 enrolled legally blind veterans. VIST 

coordinators are also responsible for certain administrative services such 

as reviewing the veteran’s compensation and pension benefits. Almost all 

of VA’s blind rehabilitation services for veterans are provided through 

comprehensive inpatient care at BRCs, where veterans are trained to use 

their remaining vision8

 and other senses, as well as adaptive devices such 

as canes, to help compensate for impaired vision. VA offers both basic and 

computer training. (See table 2 for examples of the types of skills taught 

during basic and computer training.) 

 8

About 85 percent of those who are legally blind have some usable vision. 
Page 8 GAO-04-996T 

Table 2: Examples of Training Courses Offered at Blind Rehabilitation Centers 

Basic training Examples of skills taught 

Visual skills • Maximizing remaining vision through the use of 

alternative scanning or viewing techniques 

• Using magnification devices or closed circuit televisions 

to read or write 

Orientation and mobility • Moving around the home 

• Traveling through different environments 

• Using adaptive devices, such as telescopic devices for 

reading street signs 

Living skills • Cooking and eating 

• Doing laundry or changing light bulbs 

• Typing or keyboarding 

Manual skills • Using hand and power tools 

• Problem solving and organization of work 

Leisure skills • Going to sporting events 

• Playing golf or fishing 

• Developing a hobby, such as woodworking 

Adjustment counseling • Using counseling, therapy, and social interaction with 

others who have similar visual impairments to learn to 

adjust to blindness 

Computer training Examples of skills taught 

Computer skills • Operating a computer 

• Searching the Internet 

• Sending, receiving, and reading e-mail 

Source: VA Blind Rehabilitation Service. 

In fiscal years 2002 and 2003, VA spent over $56 million each year for 

inpatient training at BRCs. During this same time period, VA spent less 

than $5 million each year to provide outpatient rehabilitation training for 

legally blind veterans. 
Page 9 GAO-04-996T 

VA offers three types of blind rehabilitation outpatient services to legally 

blind veterans,9

 but these services are available in few VA locations. The 

three types of services include Visual Impairment Services Outpatient 

Rehabilitation (VISOR), Visual Impairment Center to Optimize Remaining 

Sight (VICTORS), and Blind Rehabilitation Outpatient Specialists (BROS). 

The services range from short-term outpatient programs provided in VA 

facilities to home-based services. Figure 3 identifies the locations 

throughout the United States and Puerto Rico where these services are 

offered.10

 9

Some VA low vision eye clinics also provide limited outpatient rehabilitation training to 

legally blind veterans whose remaining vision can be enhanced through the use of 

magnification devices. However, while VA has overall workload data for its eye clinics, it 

cannot disaggregate the data to identify how much low vision training is provided to legally 

blind veterans. 

10All of VA’s outpatient programs also treat low vision veterans in addition to those 

veterans who are legally blind. VA defines low vision as when the patient has significant 

uncorrectable visual impairments of 20/70 up to, but not including, 20/200. 

Blind Rehabilitation 

Outpatient Services 

Are Available in Few 

VA Locations 
Page 10 GAO-04-996T 

Figure 3: Locations of VA Outpatient Blind Rehabilitation Services, May 2004 

VISOR is a 10-day outpatient program located at the VA medical center in 

Lebanon, Pennsylvania, that offers training in the use of low vision 

equipment, basic orientation and mobility, and living skills. Serving 

veterans in the surrounding 13-county area, it is primarily for veterans who 

can independently perform activities of daily living and who require only 

limited training in visual skills and orientation and mobility, such as 

traveling within and outside their homes. According to a VISOR official, 

the program is meant to provide training to veterans while they wait for 

VISOR 

Blind Rehabilitation Outpatient Specialists, total = 23

Visual Impairment Center to Optimize Remaining Sight, total = 3

Visual Impairment Services Outpatient Rehabilitation, total = 1

Source: VA.

Puerto Rico
Page 11 GAO-04-996T 

admission to a BRC or to veterans who do not want to attend a BRC. 

Veterans who participate in this program are housed in hoptel beds11

within the medical facility. In fiscal year 2003, 54 veterans attended the 

VISOR program; about 20 to 30 percent of these veterans were legally 

blind. According to a VISOR official, there is no waiting list for this 

program and the local medical center provides the necessary funding for 

it. 

VICTORS is a 3- to 7-day outpatient program for veterans in good health 

whose vision loss affects their ability to perform activities of daily living, 

such as personal grooming and reading mail. The program provides the 

veterans with a specialized low vision eye examination, prescriptions for 

and training in the use of low vision equipment, and counseling. There are 

three VICTORS programs located in VA medical centers in Kansas City, 

Missouri; Chicago, Illinois; and Northport, New York. Veterans are housed 

in hoptel beds within the medical facility or in nearby hotels. In fiscal year 

2003, VICTORS served over 900 veterans; about 25 to 30 percent of these 

veterans were legally blind. According to VICTORS officials, the wait time 

for admission to VICTORS varied from about 55 to about 170 days. The 

medical center where the program is located funds the services. 

BROS are blind rehabilitation outpatient instructors who provide a variety 

of short-term services to veterans in their homes and at VA facilities. 

BROS train veterans prior to and following their participation in BRC 

programs, as well as veterans who cannot or do not choose to attend a 

BRC. BROS training addresses veterans’ immediate needs, especially those 

involving safety issues such as reading prescriptions or simple cooking. 

There are 23 BROS throughout VA’s health care system, with 7 located in 

the VA network that covers Florida and Puerto Rico. In fiscal year 2003, 

BROS trained about 2,700 veterans, almost all of whom were legally blind. 

Wait time for BROS services varied from about 14 to 28 days according to 

 11A hoptel is temporary lodging where no medical care is provided. 

VICTORS Services 

BROS Services 
Page 12 GAO-04-996T 

the BROS we interviewed. BROS are funded by the medical centers where 

they are located.12

VA officials who provide services to legally blind veterans told us that 

some veterans could benefit from increased access to outpatient blind 

rehabilitation services. We obtained this information by asking VA to 

review all of the veterans who, as of March 31, 2004, were on the waiting 

lists for admission to the five BRCs we visited and to determine whether 

outpatient services could meet their needs. VA officials reported that 315 

out of 1,501 of these veterans, or 21 percent, could potentially be better 

served through access to outpatient blind rehabilitation services, if such 

services were available. The types of veterans VA believes could 

potentially benefit from outpatient services include those who are very 

elderly or lack the physical stamina to participate in a comprehensive 28- 

to 42-day BRC program and those who have medical needs that cannot be 

provided by the BRC. For example, some BRCs are unable to accept 

patients requiring kidney dialysis. In addition, some veterans do not want 

to leave their families for long periods of time13 and some legally blind 

veterans are primary caretakers for their spouses and are unable to leave 

their homes. VA officials also told us that veterans in good health who can 

independently perform activities of daily living and require only limited or 

specialized training could also be served effectively on an outpatient basis. 

A VA study concluded that there is a need for increased outpatient 

services for legally blind veterans. In 1999, VA convened a Blind 

Rehabilitation Gold Ribbon Panel to study concerns about the growing 

number of legally blind veterans. The panel examined how VA historically 

provided blind rehabilitation services and recommended that VA transition 

from its primarily inpatient model of care to one that included both 

 12In connection with VA’s fiscal year appropriations for 1995, the Senate Committee on 

Appropriations had recommended including $5 million for blind rehabilitation services to 

alleviate the lengthy waiting lists for such services. The conference committee agreed. See 

S. Rep. No. 103-311 (1994), H. Conf. Rep. No. 103-715 (1994). In addition to the BROS, these 

funds were also used to establish a BRC in Augusta, Georgia, and additional staff positions 

for VIST coordinators and computer specialists. 

13A 2003 study of 150 veterans located in the southeastern United States who were 

recommended for BRC training by their VIST coordinators but who did not attend, found 

that 59 percent cited a reluctance to leave home for an extended period as an important 

reason for non-participation. Williams, M., Help-Seeking Behavior as a Predictor of 

Participation in Department of Veterans Affairs-Sponsored Visual Impairment 

Rehabilitation. A Dissertation (Decatur, GA.; 2003). 

Outpatient Services 

Provide Opportunities 

to Benefit Veterans 
Page 13 GAO-04-996T 

inpatient and outpatient services. In 2000, VA established the VIAB to 

implement the panel’s recommendations. The VIAB drafted guidance for a 

uniform standard of care policy for visually impaired veterans throughout 

VA’s health care system. This guidance outlined a continuum of care to 

provide a range of services from basic low vision to comprehensive 

inpatient rehabilitation training, including use of more outpatient services 

from both VA and non-VA sources. In January 2004, a final draft of the 

uniform standard of care policy was forwarded to VA’s Health Systems 

Committee for approval. The committee believed additional information 

was needed for its approval and requested additional analysis that 

compared currently available blind rehabilitation services with anticipated 

needs. VA plans to complete this analysis in the first quarter of fiscal year 

2005 and then resubmit the uniform standard of care policy and the 

additional analysis to the Health Systems Committee. VA officials were 

unable to provide a timeframe for the Health Systems Committee’s 

approval. 

Some VIST coordinators have already provided outpatient services to 

legally blind veterans by referring them to state and private blind 

rehabilitation services. For example, in Florida a VIST coordinator 

referred veterans to the Lighthouse for the Blind for computer training at 

its outpatient facility if they did not live near and did not want to travel to 

the BRC. A VIST coordinator in Oklahoma arranged contractor-provided 

computer training in the veteran’s home for veterans with a 20 percent or 

more service-connected disability. The coordinator issued the computer 

equipment to a local contractor; the contractor then set up the equipment 

in the veteran’s home and provided the training. Another VIST coordinator 

in North Carolina referred all legally blind veterans to state service 

agencies, including veterans waiting for admission to a BRC. Each county 

in that state had a social worker for the blind that referred its citizens to 

independent living programs for in-home training in orientation and 

mobility and living skills. The state provided this training at no charge to 

the veteran and VA paid for the equipment. 

Recently, VA has begun to shift computer training from inpatient settings 

at BRCs to private sector outpatient settings. VA’s goal was to remove 

from the BRC waiting list by July 30, 2004, those veterans seeking 

admission to a BRC only for computer training. In spring 2004, VA issued 

instructions stating that the prosthetic budget of each medical center, 

which already paid for computer equipment for legally blind veterans, 
Page 14 GAO-04-996T 

would now pay for computer training.14 Additionally, the Blind 

Rehabilitation Service Program Office asked BRCs to identify all the 

veterans waiting for admission for computer training and refer them back 

to their VIST coordinator for local computer training. If BRC and VIST 

coordinator staff determined that local computer training was not 

available or appropriate for a veteran, they were to provide an explanation 

to the program office. On May 5, 2004, 674 veterans were waiting for 

admission to a BRC for computer training. As of July 1, 2004, 520 veterans 

were removed from the BRC waiting list because arrangements were made 

for them to receive computer training from non-VA sources or they no 

longer wanted the training. 

There are two factors that affect VA’s expansion of outpatient services 

systemwide. One factor is the agency’s long-standing belief that 

rehabilitation training for legally blind veterans can be best provided in a 

comprehensive inpatient setting. The second reported factor is VA’s 

method of allocating funds for blind rehabilitation outpatient services, 

which provides local medical center management discretion to provide 

funds for them. 

Some VA officials told us that one factor affecting veterans’ access to 

outpatient care has been the agency’s traditional focus on providing 

comprehensive inpatient training at BRCs. VA has historically considered 

the BRCs to be an exemplary model of care, and since 1948 BRCs have 

been the primary source of care for legally blind veterans. However, this 

delivery model has not kept pace with VA’s overall health care strategy 

that reduces reliance on inpatient care and emphasizes outpatient care. 

VA’s continued reliance on inpatient blind rehabilitation care is evident in 

its recent decision to build two additional BRCs in Long Beach, California, 

and Biloxi, Mississippi.15 We have, however, observed some recent changes 

that may affect this reliance on inpatient services. For example, VA has 

new leadership in its blind rehabilitation program that has expressed an 

interest in providing a broad range of inpatient and outpatient services to 

meet the training needs of legally blind veterans. Further, as previously 

 14According to VA officials, the funds allocated for prosthetics maybe used only for 

prosthetic care—e.g. purchase of prosthetic items and veteran training in the use of these 

items. 

15See Department of Veterans Affairs Capital Asset Realignment for Enhanced Services 

(CARES): Secretary of Veterans Affairs CARES Decisions. (Washington D.C.; May 2004). 

Factors that Affect 

Expansion of Blind 

Rehabilitation 

Outpatient Services 
Page 15 GAO-04-996T 

discussed, the VIAB’s draft continuum of care policy recommends a full 

range of blind rehabilitation services, emphasizing more outpatient care, 

including VICTORS, VISOR, and BROS. 

VA blind rehabilitation officials also told us that they believe changes to 

VA’s resource allocation method could provide an incentive to expand 

blind rehabilitation services on an outpatient basis. The VIAB believes that 

the funds allocated for basic outpatient care for legally blind veterans do 

not cover the cost of providing blind rehabilitation services. Veterans 

Integrated Service Networks (networks)16 are allocated funds to provide 

basic outpatient care for veterans, which they then allocate to the medical 

centers in their regions. Both the networks and the medical centers have 

the discretion to prioritize the use of these funds for blind rehabilitation 

services or any other medical care. Some networks and medical centers 

have made outpatient blind rehabilitation training a priority and use these 

funds to provide outpatient services. For example, the network that covers 

Florida and Puerto Rico has used its allocations to fund seven BROS that 

are located throughout the region to provide outpatient blind 

rehabilitation services to legally blind veterans in their own homes or at 

VA facilities. Currently, the VIAB is working with VA’s Office of Finance 

and Allocation Resource Center to develop an allocation amount that 

would better reflect the cost of providing blind rehabilitation services on 

an outpatient basis, which could in turn, provide an incentive for networks 

and medical centers to expand outpatient rehabilitation services for legally 

blind veterans. 

Many legally blind veterans have some vision, which frequently can be 

enhanced with optical low vision devices and training that includes 

learning to perform everyday activities such as cooking, reading 

prescription bottles, doing laundry, and paying bills. Since the 1940s, VA’s 

preferred method of providing training to these veterans has been through 

inpatient services offered by BRCs. Because of its predisposition toward 

inpatient care, VA has developed little capacity to provide this care on an 

outpatient basis uniformly throughout the country. For the last 10 years, 

VA has been transitioning its overall health care system from a delivery 

model based primarily on inpatient care to one incorporating more 

outpatient care. Outpatient services for legally blind veterans, however, 

have lagged behind this trend. Recently, VA drafted a uniform standard of 

 16VA has organized its medical facilities into 21 regional health care networks. 

Conclusions 
Page 16 GAO-04-996T 

care policy that recommends a full range of blind rehabilitation services, 

emphasizing more outpatient care, including more services provided by 

VISOR, VICTORS, and BROS type programs. Making inpatient and 

outpatient blind rehabilitation training services available to meet the needs 

of legally blind veterans will help ensure that these veterans are provided 

with options to receive the right type of care, at the right time, in the right 

place. 

We are recommending that the Secretary of Veterans Affairs 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. 

We provided a draft of this testimony to VA for comment. In oral 

comments, an official in VA’s Office of the Deputy Under Secretary for 

Health informed us that VA concurred with our recommendation. 

Mr. Chairman, this concludes my prepared remarks. I will be glad to 

answer any questions you or other Members of the Committee may have. 

For further information regarding this testimony, please contact Cynthia 

A. Bascetta at (202) 512-7101. Michael T. Blair, Jr., Cherie Starck, Cynthia 

Forbes, and Janet Overton also contributed to this statement. 

Recommendations 

Agency Comments 

Contact and 

Acknowledgments 

(290402) 
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441 G Street NW, Room LM

Washington, D.C. 20548

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Contact:

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470

Congressional 

Relations

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548

Public Affairs Jeff Nelligan, Managing Director, NelliganJ@gao.gov (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548