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VHA repeatedly indicates that before any decisions
that affect special disabilities programs are made in the field,
field managers are to consult with program officials at VA Headquarters
(VAHQ). This is not occurring. In fact, the field is extremely
hesitant to talk with program officials at VAHQ. On the rare occasions
they have made contact, it is only to inform officials of their
decisions, regardless of the decision maker’s knowledge or
experience. It seems apparent that field managers have been given
mixed messages. On the one hand, they are told they have decentralized
decision-making authority and are free to manage their networks
or facilities as they see fit, given the available resources.
On the other hand, they are being told in some areas, such as
special disability programs, that they do not have authority to
independently make decisions that affect those programs. The increasing
pressures on these programs may be symptomatic of the continual
erosion of resources for health care. In any event, it is increasingly
more evident that greater centralized management control of the
special disabilities programs is definitely warranted.
These decisions are also difficult to understand
in light of the emphasis VHA has placed on VA moving towards case
management. VIST Coordinators are exactly that, case managers,
and the VIST program has employed this methodology for 30 years
with great success. We applaud VHA for moving in this direction
for all veterans. It seems entirely consistent that these Coordinator
positions should be maintained and more added where appropriate.
The transition to managed primary care does
not preclude the need for the VIST program, as some in the field
are attempting to maintain. The primary care team does not possess
the knowledge, expertise, or time to become experts in the field
of blindness. Without a doubt, the blinded veterans’ medical
needs can be addressed by the primary care team. Issues more directly
related to blindness should be referred back to the VIST Coordinator
to insure the appropriate VA and non-VA resources are mobilized
on behalf of the blinded veteran and his or her family. The family
is directly impacted by the veteran's vision loss and, if not
properly educated regarding the ramifications of sight loss, can
often sabotage the rehabilitation or adjustment process. This
can and does occur despite the best intentions on the part of
family members. Family training is another area in which VA BRS
has made pioneering advancements. It is essential that the family
have realistic expectations for the blinded veteran upon completion
of rehabilitation. Primary care teams cannot be expected to possess
all the knowledge associated with vision loss, rehabilitation,
family adjustment, community resources, and the full range of
VA services available to blinded veterans and their families.
Additionally, VIST Coordinators review the blinded veteran's VA
disability ratings annually to insure they are properly rated
either for disability compensation or pension purposes. As you
know, the VA disability rating schedule is complex. Coordinators
are extremely familiar with those sections of the Code pertaining
to blindness. Even more important in this regard, they have become
familiar with those areas of the Code that allow for Special Monthly
Compensation (SMC) and increases that may be associated with combinations
of disabilities. Knowledge of the latest prosthetic devices, sensory-aids,
and appliances for the blind enhances the Coordinator's ability
to assist blinded veterans. Again, primary care teams do not possess
this knowledge or expertise. It is indisputable that to facilitate
the delivery of comprehensive services to this special group of
veterans, it is imperative that highly qualified and skilled professional
must be dedicated on a full-time basis to achieve the desired
outcomes.
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