Department of Veterans Affairs VHA DIRECTIVE 2005-048 

Veterans Health Administration 

Washington, DC 20420 October 21, 2005 

 

REFERRAL TO INPATIENT BLIND REHABILITATION CENTERS AND 
CALCULATION OF THE WAITING TIME PRIOR TO ADMISSION 

 

1. PURPOSE: This Veterans Health Administration (VHA) Directive defines policy for 
referring blinded veterans to a Department of Veterans Affairs (VA) Blind Rehabilitation Center 
(BRC), for inpatient training programs, and for calculating the waiting times for admission. 
NOTE: The referral is considered the application. 

 

2. BACKGROUND 

 

 a. The Government Accountability Office (GAO) conducted an evaluation of the waiting 
times for admission to VA BRC Services in 2004. The final report issued by GAO 
recommended that the Under Secretary for Health develop more specific instructions for 
calculating waiting times. This VHA Directive addresses the GAO recommendation and is 
intended to provide direction for the accurate reporting of waiting times for BRC programs. 

 

 b. The waiting time for admission to a BRC is defined as the number of days between the 
date a referral is received at a BRC and the first admission date offered to the applicant. The 
Blind Rehabilitation Service (BRS) National database is used to automatically calculate the 
number of days. 

 

NOTE: The actual admission date must be recorded on the national database, but will not be 
used for reporting a veteran’s waiting time. 

 

 c. The BRS Program Office has developed specific instructions for calculating waiting 
times, data definitions, and referral procedures to address the equitability of, and timeliness of, 
service delivery. 

 

 d. BRC inpatient programs are currently located at the following VHA facilities: 

 

 (1) VA Medical Center, Augusta, GA, 

 

 (2) VA Medical Center, Birmingham, AL, 

 

 (3) Central Texas VA Health Care System, Waco, TX, 

 

 (4) VA Health Care System, West Haven, CT, 

 

 (5) VA Hospital, Hines, IL, 

 

 (6) Puget Sound VA Health Care System, American Lake, WA, 

 

 

THIS VHA DIRECTIVE EXPIRES OCTOBER 31, 2010 


 

 (7) VA Medical Center, San Juan, PR, 

 

 (8) Southern Arizona Health Care System, Tucson, AZ, 

 

 (9) VA Health Care System, Palo Alto, CA, and 

 

 (10) VA Medical Center, West Palm Beach, FL. 

 

 e. The BRS Program Office with the assistance of the VHA Office of Information is 
developing a new National Blind Rehabilitation Database (Blind Rehabilitation Version 5.0) that 
monitors all aspects of BRS delivery for the Visual Impairment Services Team (VIST), the Blind 
Rehabilitation Outpatient Specialists (BROS), and the BRC programs including BRC waiting 
times. This new database package has an expected release time of second quarter of Fiscal Year 
(FY) 2006. All BRS employees are required to use this database for blind rehabilitation service 
delivery. Training is required and can be obtained through the blind rehabilitation website at: 
, or by contacting the National Consultant assigned to the 
catchment area. 

 

NOTE: The current BRS Waiting Times Database is to be used by all BRC programs to 
calculate and report waiting times at BRCs until the new National Blind Rehabilitation Database 
is released to the field. 

 

3. POLICY: It is VHA policy that blinded veteran’s referrals for admission to BRC inpatient 
training programs and the use of the current Waiting Times Database to calculate and report 
BRC waiting times are to be implemented immediately. 

 

4. ACTION 

 

 a. Facility Director. The blinded veteran is considered to be an inpatient of the VA facility. 
As such, application criteria management is generally the same as for any veteran receiving 
inpatient hospital treatment and care. The facility Director is responsible for ensuring that: 

 

 (1) The waiting time data is accurately reported to the BRS Program Office using the 
instructions provided in Attachment A; 

 

 (2) Any necessary eligibility determinations as required by the VA facility housing the BRC 
(e.g., VA Form 10-10, Admission Form, and VA Form 10-10F, Rating Decision Form) are 
conducted. 

 

 (3) An eye examination progress note, or summary, documenting the legal blindness of the 
veteran is signed by an eye care practitioner from whom the following can be readily derived: 

 

 (a) The diagnosis responsible for the vision loss, 

 

 (b) The best corrected central visual acuity of each eye, and 


 

 (c) The visual field of each eye when the visual impairment criteria are not met through 
visual acuity loss. 

 

 (3) A physical examination and history of the veteran is taken which details: 

 

 (a) All medical conditions that may affect progress in the rehabilitation program; 

 

 (b) Pertinent laboratory reports (e.g., Complete Blood Count (CBC) with differential, Chem. 
7, Urinalysis, etc.); 

 

 (c) Current medications (if applicable, include current oxygen prescription and provider of 
oxygen delivery equipment); and 

 

 (d) Chest X-ray, Electrocardiogram (EKG), and past medical reports (as determined 
appropriate by Primary Care Medical Provider). 

 

 (4) A statement of medical stability is provided by the Primary Care Medical Provider as it 
relates to the veteran’s capacity to participate in the BRC Program. 

 

 b. VIST Coordinator. The VIST Coordinator is responsible for ensuring that: 

 

 (1) Application materials are current (within 6 months of application submission date) and 
include the following: 

 

 (a) A cover letter or memorandum containing date of referral, veteran’s name and 
identifying information, type of BRC Program for which the application is being submitted, a 
description of any significant problems or unique circumstances presented by the applicant, and 
identification of VIST Coordinator and referring facility. 

 

 (b) Assessments, when applicable, from other consultative services that provide a 
description of the level of independence and/or assistance needed on activities of daily living 
such as: 

 

 1. Wound care, 

 

 2. Tracheotomy care, 

 

 3. Stoma or ostomy care, 

 

 4. Wheelchair transfers, 

 

 5. Oxygen use, 

 

 6. Medication management, and 

 


 7. Personal hygiene. 

 

 (c) Applications are submitted with completed audiological examinations. Pending 
audiology exams may be submitted. Audiology issues must be resolved within 90 calendar days 
or the application is considered incomplete and returned to the VIST Coordinator. 

 

 (d) A psychiatric or psychological report indicating the applicants capacity to participate in 
the program if there is a history of central nervous system dysfunction, psychiatric diagnosis 
(including substance abuse), or any active treatment for a mental and/or emotional condition. 

 

 (e) An individualized assessment by a mental health professional. This is required to 
determine whether the applicant is able to benefit from blind rehabilitation if the applicant has 
demonstrated current or recent alcohol or substance abuse or dependence. Issues such as 
depression, sleep disorder, seizure, etc. can be successfully managed prior to admission and may 
require ongoing management in the BRC. In cases of suspected alcohol or substance abuse or 
dependence, the psychologist or admission committee utilizes clinical judgment and may request 
that a substance abuse evaluation be conducted by a mental health professional. 

 

 (f) A complete VIST assessment and/or psycho-social report, which must include the 
veteran’s expressed needs and goals, functional capabilities, as well as a description of any 
previous VA and non-VA blind rehabilitation training. 

 

 (2) If the veteran has been evaluated and/or trained by a BROS or other specialist in 
preparation for admission to the BRC, all pre-admission evaluations, assessments, and training 
reports are provided to the admitting BRC Program prior to admission. 

 

 (3) That appropriate medical and eye information is recorded in the veteran’s CPRS file at 
the time of referral for the veteran receiving health care at a VA facility. NOTE: This enables 
the BRC staff to complete a timely decision-making process. 

 

 (4) That a hard copy containing appropriate medical and eye information, for the veteran 
who receives health care from a non-VA provider, is sent to the BRC. 

 

 c. BRC Chief. The BRC Chief is responsible for: 

 

 (1) Data entry and documentation. This means completing data entry in the interim BRC 
Waiting Times National Database on the application status of each application received at the 
BRC. In order to ensure accurate recording for the BRS monthly report (until the new BRS 
database is operational) the “application received” date must be recorded in the same month the 
application is received. The “discharge date” must be recorded in the month of discharge. When 
the new national database is operational, a referral for BRC admission must be submitted 
electronically through the Blind Rehabilitation National Database by the VIST Coordinator. The 
application received date is automatically entered in the database. Applications sent to BRCs are 
automatically placed on the waiting list and placed in the “pending” status until the BRC Chief, 
or designee, starts the review process of the application. Assignment status must be made within 
20 working days of receipt of application of “accept,” or (preliminarily) “cancel,” or “reject” the 


application. Applications (referrals) in the “pending, accept, and in review” status are on the 
waiting list. 

 

 (2) Ensuring that veterans who are on a BRC waiting list receive an offer for a BRC 
rehabilitation start date within 120 days of application receipt. Applications sometimes require 
supplemental information to establish the veterans’ capacity to participate in blind rehabilitation. 
In addition, because blinded veterans are often elderly, they often need to attend medical 
appointments, secure hearing aids, and tend to personal business, so they must be allowed 
sufficient time to make preparations to leave home and attend a BRC for an extended period of 
time. For these reasons, a waiting time of 120 days is considered acceptable. 

 

 (3) Maintaining communication with veterans while they are waiting for BRC admission. If 
prompt blind rehabilitation is needed to address health or safety issues, the BRC must expedite 
admission. In these, cases, the BRC refers the veteran back to the referring VIST Coordinator to 
make every effort to arrange for BROS or other local blind rehabilitation services to address the 
veteran’s pressing needs. The veteran’s application stays on the waiting list during this period. 
If the veteran receives BROS or local services during this period and still desires to attend BRC, 
the veteran’s program will be reassessed and shortened if necessary. If the veteran no longer 
desires to attend a BRC, the veteran’s referral to the BRC should be withdrawn. 

 

 (4) Reviewing the application (referral) to confirm the veteran’s appropriateness for 
admission to the BRC Program. This review considers whether: 

 

 (a) The application is administratively complete. NOTE: An application is considered 
complete if the information listed in subparagraph 4b(2) is included. 

 

 (b) The ocular and vision data documented in the eye exam is consistent with legal 
blindness. 

 

 (c) The veteran’s eye condition is stable and there are no pending treatment procedures. An 
exception to this may be made under the following circumstances, i.e., a direct hospital transfer 
for blind rehabilitation training to a BRC is permitted for a patient who is in immediate need of 
blind rehabilitation services in order to manage health care regimens and health literacy prior to 
hospital discharge. The veteran must be medically stable and the BRC must have a bed available 
for admission. If a bed is not available, the patient awaiting transfer must be given highest 
priority for the next available bed. 

 

 (d) The veteran’s medical and psychological status is stable in order to maximize the 
veteran’s potential to benefit from the program. 

 

 (5) Notifying the VIST Coordinator when additional information is needed in order to 
confirm the appropriateness of the veteran for the program. The VIST Coordinator must respond 
with a plan of action within 10 working days and the requested information must be received 
within 30 days (except for audiology issues which have a 90-day time frame) or an explanation 
provided as to why the information cannot be submitted within the 30-day time frame. The 
application is to be placed in the “in review” status on the national database pending receipt of 


the requested information. If information is not provided in the designated time frame, the 
application is considered “rejected” (incomplete) and returned to the VIST Coordinator. 

 

 (6) Consulting with the referring VIST Coordinator when a review of an application 
indicates that the veteran is not appropriate for admission, before a final decision is made, in 
order to present the rationale for the decision and to consider any extenuating circumstances. 
Cancelled and rejected applications require notification from the BRC to the veteran, with a 
courtesy copy to the referring VIST Coordinator. This notification must provide the rationale for 
the cancellation or rejection along with a recommendation to consult the VIST Coordinator 
regarding alternative services. 

 

 (7) Returning the application to the referring VIST Coordinator when an application is 
rejected due to receipt of an incomplete application; at the same time notifying the Regional 
Consultant. 

 

 (8) Adding each accepted application to the BRC waiting list and informing the veteran of 
this decision by letter. The letter must include an estimated waiting time for admission, as well 
as any cost that may be incurred by the veteran. A courtesy copy of this letter must be forwarded 
to the veteran's VIST Coordinator. 

 

 (9) Forwarding the required documents to the Eligibility Coordinator at the facility where 
the program is located to ensure the applicant is properly enrolled in the VA system. 

 

 (10) Providing information regarding the scope of services and estimated duration of 
training to the veteran after a veteran has been accepted for the rehabilitation program. 

 

 (a) The BRC must provide the veteran scheduled for admission with appropriate information 
concerning clothing, footwear, equipment, details of daily life at the BRC, and any pertinent 
local information. 

 

 (b) The veteran and the BRC must mutually agree upon the reporting date and travel 
arrangements. 

 

 (c) The referring VIST Coordinator (and BROS where applicable) must be notified of these 
arrangements. 

 

 (11) Canceling the application of any veteran who declines three offers of admission to the 
BRC. The veteran must be advised to reapply through the VIST Coordinator when ready to 
attend. Cancelled applications require notification from the BRC to the veteran, with a courtesy 
copy to the referring VIST Coordinator. 

 

5. REFERENCES: None. 

 

6. FOLLOW UP RESPONSIBILITY: The Chief Officer, Office of Patient Care Services 
(11), is responsible for the contents of this Directive. Questions related to blind rehabilitation 
services may be addressed to the Director, Blind Rehabilitation Services, at 202-273-8482. 


 

7. RESCISSION: None. This VHA Directive expires October 31, 2010. 

 

 

 

 

 

 

Jonathan B. Perlin, MD, PhD, MSHA, FACP 

 

Under Secretary for Health 



 

Attachment 

 

DISTRIBUTION: 

CO: 

E-mailed 10/25/05 

 

FLD: 

VISN, MA, DO, OC, OCRO, and 200 – E-mailed 10/25/05 




ATTACHMENT A 

 

INSTRUCTIONS AND DATA DEFINITIONS FOR BLIND REHABILITATION 
CENTER (BRC) WAITING TIMES DATABASE 

 

 

 The interim Blind Rehabilitation Center (BRC) waitlist database can be found on the Blind 
Rehabilitation Service (BRS) website at . Authorized 
users are provided a username and password to access the database. Each BRC Chief, or 
designee, is an authorized user of this database. 

 

1. MAIN PAGE OF BRC WAITING TIMES DATABASE 

 

 a. The main page displays a summary of all information entered on each veteran who has 
applied for admission to the BRC. Records displayed exclude any veteran whose status is 
“Admitted.” Records displayed include veterans in all other status categories. 

 

 b. Select entries can be viewed by highlighting options in the “Select Fields” box. 
Individual or multiple options can be chosen by using the Ctrl key. By holding down the Ctrl 
key and selecting fields via the mouse, the user may select more than one field at a time. NOTE: 
This option is only possible by using a mouse; it cannot be accessed by using the keyboard. 

 

 c. Checking “Show Admitted Veterans Only” displays veterans whose status is “Admitted.’ 

 

 d. Records can be displayed individually, or the user can select the desired number of 
records to be displayed from the “Records per Page” box. 

 

 e. A search for an individual veteran can be performed by selecting “Search by Patient 
Name.” 

 

 f. The Go Key, located by the “records per page selection,” processes the information 
request and shows requested patient data. 

 

 g. Selecting the “National Total” provides average waiting time information and application 
summary totals for all previous and current applications submitted to the ten BRCs. Averages 
and total calculations do not include records that have no data in the fields. 

 

 h. Summary totals for current applications on a waiting list need to be obtained through the 
reports menu. 

 

 i. To add a veteran to the waiting list select “Add New Entry” and follow the instructions in 
paragraph 2. 

 

2. NEW ENTRY AND EDIT PAGE. NOTE: For easiest entry, data needs to be entered 
from left to right and top to bottom on this screen. 

 


 a. Patient name, Social Security Number (SSN), Date Application (App) Received, and App 
Status are required fields. 

 

 b. Dates must be in “MM/DD/YYYY” format. 

 

 c. Dates must be valid. e.g., l to 31 for days, 1 to 12 for months. 

 

 d. If the admitting (admit) date is filled, status can only be “Admitted” or “Discharged.” 

 

 e. If status is “Admitted,” the admit date must be filled. 

 

 f. If status is “Discharged,” the discharge date must be filled. 

 

 g. The program automatically calculates days as soon as two relevant dates are filled in. 

 

 h. If the user deletes information in the days fields after the program has calculated them, 
they are re-calculated when the submit button is clicked. 

 

 i. If a date field is empty, the program automatically erases the relevant days fields 
information that require that date when the submit button is clicked. 

 

3. DATA ENTRY INSTRUCTIONS AND DEFINITIONS 

 

 a. Field #1: Patient Name. Enter veteran’s last name, first name, and middle initial 
(required field). 

 

 b. Field # 2: SSN. Enter veteran’s SSN using dashes (e.g., 123-45-6789). 

 

 c. Field #3: Date App Received at BRC. Enter the date the application was received at the 
__(Name of BRC)__ BRC. Dates must be in “MM/DD/YYYY” format. 

 

 d. Field # 4: Date Application Review Complete. Enter the date the BRC completes its 
review of the application. 

 

 e. Field # 5: Application Status. The application status information is used to generate 
individual and national reports. The following categories for application statuses can be selected 
in the drop down box: 

 

 (1) In-review. Application has been received by the BRC and is being reviewed for 
appropriateness and completion. 

 

 (2) Deferred. requires additional information to determine appropriateness. The reasons 
for deferral should be noted in Field #19, “Reasons Not Admitted” (see subpar. 3p). Careful 
consideration should be given to this category, as an application may remain in this category for 
only 90 days. 

 


 (3) Rejected. When the additional information requested is not received within 30 days. 

 

 (4) Complete. Application review is completed and application is pending acceptance. 

 

 (5) Accept. Application review process has been completed and the application has been 
approved for admission. 

 

 (6) Referral to BROS. The veteran’s needs can be met by BROS. 

 

 (7) Admitted. The veteran has been admitted to the BRC. The admission date must be 
entered in Field #10. 

 

 (8) Discharged. Veteran has been discharged from the BRC. The date of discharge entered 
in Field #17 should be within same month of actual discharge. 

 

 (9) Cancelled. Application has been cancelled by BRC staff or the veteran. Reasons for 
cancellation are entered into Field # 19. An application may be cancelled for one of the 
following reasons. A veteran is not eligible for VA care if the: 

 

 (a) Veteran is not legally blind or is receiving current visual medical treatment. 

 

 (b) Veteran is medically unstable. 

 

 (c) Veteran has mental health issues that prevent effective rehabilitation. 

 

 (d) Veteran has personal or family issues. 

 

 (e) Veteran’s needs are being met by non-VA care. 

 

 (f) Veteran is no longer interested. 

 

 (g) BRC staff is unable to contact the veteran. 

 

 (h) Veteran is deceased. 

 

 (i) The veteran has declined the three “admission” dates that have been offered. 

 

 f. Field # 6: Days from Application Review to Review Complete. The Program calculates 
and completes this field automatically in days as soon as the two relevant dates are entered in 
Field #3 and Field #4. 

 

 g. Field # 7: Date first offered Admit. Enter the date that the veteran is offered admission 
to BRC. 

 

 h. Field # 8: Days from Review Complete to 1st Offer. The Program calculates and 
completes this field automatically in days as soon as the two relevant dates are entered in Field 


#4 and Field #7. 

 

 i. Field #9: Days from Application received to 1st Offer. The Program calculates and 
completes this field automatically in days as soon as the two relevant dates are entered in Field 
#3 and Field #7. 

 

 j. Field # 10: Admit Date. Enter the date of admission to BRC. 

 

 k. Field # 11: Days from 1st Offer to Admit Date. The Program calculates and completes 
this field automatically as soon as the two relevant dates are entered in Field #7 and Field #10. 

 

 l. Field # 12: Days from Application received to Admit Date. The Program calculates and 
completes this field automatically in days as soon as the two relevant dates are entered in Field 
#3 and Field #10. 

 

 m. Fields # 13-16: Type of Program. Select and enter the number 1 for the type of program 
the patient is accepted for, i.e., Reg Admit, Dual Admit, CAT Admit, or Other Admit. Only one 
program type can be selected. 

 

 n. Field # 17: BRC Discharge Date. Enter the date the veteran is discharged from BRC. 

 

 o. Field # 18: Bed Days of Care. The Program calculates and completes this field 
automatically in days as soon as the two relevant dates are entered in Field #10 and Field #17. 

 

 p. Field # 19: Reason not admitted. Enter the reason the veteran was not admitted to BRC 
by using field codes 1-4, identified as follows: 

 

 (1) 1. Not eligible. 

 

 (2) 2. Cancelled. 

 

 (3) 3. Medical Reasons. 

 

 (4) 4. Provide explanation. The field accepts typed explanations such as the: 

 

 (a) Veteran is not eligible for VA care. 

 

 (b) Veteran is not legally blind. 

 

 (c) Veteran is currently receiving treatment for a visual condition. 

 

 (d) Veteran is medically unstable. 

 

 (e) Veteran has mental health issues that prevent effective rehabilitation. 

 

 (f) Veteran has personal or family issues. 


 

 (g) Veteran’s needs are being met by BROS. 

 

 (h) Veteran’s needs are being met by non-VA care. 

 

 (i) Veteran is no longer interested. 

 

 (j) BRC staff is unable to contact the veteran. 

 

 (k) Veteran is deceased. 

 

 (l) The application is incomplete. 

 

 (m) The veteran has declined three offered admission dates. 

 

 q. Fields 20-23: Relate to Previous training in a BRC.

 

 r. Field # 20: Date of Previous Admission. Enter the admission date of previous blind 
rehabilitation training if patient has received prior blind rehabilitation training in a BRC. 

 

 s. Field # 21: Previous BRC Discharge Date. Enter the discharge date of any previous blind 
rehabilitation training in a BRC. 

 

 t. Field # 22: Type of Program for Previous Admission to BRC. Select the type of training 
provided, i.e., Reg, CAT, Dual, or Other. 

 

 u. Field # 23: Total Days Since Last Discharge. The Program calculates and completes this 
field automatically in days as soon as the two relevant dates are entered in Field #10 and Field 
#21. 

 

NOTE: Choose “OK” to save data entries when done, or Cancel to void entries. All records 
can be browsed and edited. 

 

 4. BROWSE RECORD PAGE 

 

 a. Regional Administrators can browse and edit only patient records in their facilities. 

 

 b. Super Administrators can browse, edit, add, and delete patient records in any facility. 

 

 c. Deleting a patient record deletes the record completely from the database without the 
possibility of recovery. 

 

 (1) Records are sorted by patient identification (ID) and not by name. 

 

 (2) Browse buttons function as follows, the button brings: 

 


 (a) Up first patient file entered by earliest date, 

 

 (b) Up last patient file entered by latest date, 

 

 (c) User back by one patient file from current location, and 

 

 (d) User forward by one patient file from current location. 

 

5. REPORT PAGE 

 

 a. Reports can be generated for the status of all records (i.e., the number of applications 
deferred, number of veterans admitted, discharged, etc.) by selecting the option in the “Status” 
box. 

 

 b. For Waiting List Reporting. In the “Status” box, select: “Waitlist.” NOTE: Status 
“Waitlist” does not include veterans whose status is “Cancelled,” “Referred to BROS.” 
“Admitted,” “Rejected,” or “Discharged.” 

 

 c. Select the dates for reporting period. The dates fields refer to the Application Received 
Date. 

 

 d. In order to implement dates in the report, both “From” and “To” dates must be filled. 

 

 e. To include all the records up to a certain date, specify a date like “01/01/1950,” i.e., a 
vintage date for which there is no record with App received date before that date in the “From” 
date field. NOTE: Do not leave it empty. 

 

 f. To include all the records after a certain date, specify a date like “01/01/2030” (a future 
date for which there is no record with App received date after that date) in the “To” date field. 
NOTE: Do not leave it empty. 

 

 g. The calculation for All Average does not include patient records that have no data in the 
relevant fields. For example, in calculating the average admission time in days for three records; 
if one record has no data, one record has “9” entered in the field, and one record has “5” entered 
in the field, the average time in days is calculated as “7.” (5+9) = 7 

 2 

 

 h. Waiting list reports provide the: 

 

 (1) Total number of applications on the waiting list by program type (total number of 
applications in this category). 

 

 (2) Total number of applications on the waiting list by program type (i.e., Reg, CAT, Dual, 
Other). 

 

 (3) Average number of days that applications were received at BRC until the application 


review process was completed (average days application received to review). 

 

 (4) Average number of days from the completion of the review of the application until the 
veteran was offered admission (average days review to offer). 

 

 (5) Total completion time for all applications submitted (total application completion time). 

 

 (6) Average application completion time. 

 

 (7) Average waiting time for veterans on the waiting list for admission to a BRC (average 
days from the time the application was received to the offer of admission date). 

 

NOTE: All reports can be generated for all veterans or for an individual veteran. All reports 
contain names of veterans that meet the report criteria. Information on individual veterans can 
be obtained by double clicking the veteran’s name.