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Vision Care Guide for Veterans

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The Veterans Administration (VA) has provided vision care since it was founded, and those services continue to improve. Preventative care and routine care are included. Glasses and contact lenses may or may not be covered depending on whether there is an underlying condition, service-related injury involved, or other factors.

One way the VA may expand support for veterans with underlying vision conditions is telemedicine, including teleretinal screening. Veterans often suffer the same eye disorders as civilians, but they are more likely to suffer from traumatic brain injuries (TBIs), which can cause vision damage.

Low vision and legal blindness are more common among veterans, so the VA offers several special programs to treat and support former service members. These services do not currently include guide dogs, but the VA can help veterans find service animals.

For veterans and their families without serious eye care needs, additional insurance plans can cover glasses, sunglasses, and contact lenses as needed, or provide supplementary eye care like LASIK. The VA continues to expand its options for treatment, including adjusting a previous ruling about laser treatment so veterans get better support for glaucoma and other conditions.

To get care through the VA, you may need to have your disability rating measured, which may require legal representation for an appeal. There are nonprofit organizations that can help with this, so you can get the best possible vision care with your benefits.

The Veterans Administration Supports Vision Care

The Veterans Administration (VA) has offered vision care to former military service members since its founding. In fact, optometrists were some of the first staff members at the VA in 1947.

By 1960, new laws clarified that optometrists provided medical services, so that more military veterans could access vision care services through the VA. This meant that eye care was not a separate service, but a medical necessity for any eligible veteran.

In 1972, the VA Central Office’s Department of Education and Research approved a first-of-its-kind program to train optometrists within veterans affairs. In 1973, a full-time Director of Optometry was appointed.

In 2008, Congress officially established the VA Vision Center of Excellence (VCA) under the National Defense Authorization Act. As of 2009, there were more than 600 full-time and part-time optometrists on staff with the VA, over 1,000 optometry students, and almost 150 optometry residents.

The expansion of vision care for veterans occurred not only because Congress recognized a need for simple access to quality eye care and surgery for former military service members, but also because there was a great need in the public for more training and residencies to support upcoming optometrists and other eye care specialists. The combination benefits everyone in the United States, whether they have served in the military or not.

Since vision and basic health insurance are not typically combined into one package for US civilians, it may seem unusual for a military veteran to get such a wide range of medical treatment from one organization. As a veteran of the US Armed Forces, your needs will be assessed, and services will be provided based on this assessment. This includes vision care for those who have changing vision, poor vision, and vision problems caused by service-related injuries or accidents.

Routine Eye Exams & Vision Care for Veterans & Their Families

The VA offers several preventative and routine care services, including regular eye exams. Glasses are provided only to veterans who meet certain criteria. Eyeglasses are typically not provided for veterans whose vision problems are normally occurring, like refractive errors.

Sometimes, veterans must pay a copayment for medications or outpatient treatment that is not associated with a service-related condition, and this may include pre-existing vision problems like nearsightedness. However, veterans do not pay a premium for their VA health care or insurance. Veterans with a diagnosed service-related disability of 50 percent or greater are exempt from any copayments.

Veterans are eligible for glasses (and other devices like hearing aids) or related higher order vision care services if they meet the following criteria:

  • They have any compensable service-related injury.
  • They are a former prisoner of war.
  • They have been awarded a Purple Heart.
  • They have received compensation for an injury or an aggravation of an injury that was the result of VA treatment.
  • They are receiving an increased pension due to being permanently house-bound and needing regular attendance.
  • They have a vision impairment caused by an underlying condition that they are already receiving VA services for, like traumatic brain injury (TBI), diabetes, vascular disease, ocular photosensitivity, cataract surgery, or another related eye surgery or injury.
  • They have significant functional or cognitive impairment shown in a reduced ability to perform daily activities.
  • They have a vision impairment that is serious enough that it interferes with their ability to participate actively in medical treatment.

Veterans may be eligible for glasses provided by the VA if their visual acuity on a Snellen eye chart exam is 20/40 or lower in both eyes. Underlying conditions like cataracts that may increase the need for glasses also qualify for coverage with VA health benefits.

Telemedicine May Offer Additional Vision Support

There are 171 VA medical centers and more than 1,000 outpatient sites across the US, but many veterans may live too far from one of these centers to get routine care, especially for serious eye problems. One of the more common vision problems, in the civilian population and among veterans, is diabetic retinopathy, associated with diabetes mellitus.

Young businesswoman using computer in dark office

A telehealth program called teleretinal screening was investigated in 2014, and it was found to improve preventative screening vision care among veterans. About 90 percent of veterans with diabetes mellitus received annual vision care that was needed to diagnose or treat diabetic retinopathy and other related eye conditions. These veterans may not have received such routine care otherwise.

Telehealth has become increasingly important during the COVID-19 pandemic, not just for veterans with vision care needs, but for everyone who needs medical care. Telehealth services like specialty teleretinal screening provided by an ophthalmologist can help veterans get referrals for higher order exams or treatment as needed. If they do not need this higher level of care, they can confirm this with a telehealth appointment and avoid leaving home to do so.

Although this program is not widespread yet, teleretinal screenings and other types of basic eye examinations may be provided through secure online services more often in the future.

Common Eye Injuries & Disorders Among Veterans

Several medical studies show that decreased visual function interferes with quality of life and ability to work, and it increases overall mortality risk.

  • Traumatic brain injury (TBI): This is one of the most common causes of ocular problems in veterans of the Armed Forces. Treating vision changes and damage related to a TBI is also one of the core mandates of the VCA.This branch of the VA has been conducting reviews of studies of TBIs to better understand how to treat related vision problems, diagnose them earlier, and even provide equipment in deployment to reduce the risk of severe damage immediately after the injury.Explosive devices are a widely recognized cause of TBI. The VA also suggests that veterans are increasingly diagnosed with serious conditions like TBI because body armor has improved, which means that more military service members are surviving, but with injuries that may not be immediately recognized. Polytrauma clinics run by the VA have started offering more low-vision screenings for veterans who have diagnosed TBI due to the close association between blast injuries and vision problems.
  • Age-related eye disorders: Although the VA does not provide glasses or contact lenses for what it terms “normally occurring eye disorders” like refractive errors, the government agency does provide treatment for age-related eye disorders like age-related macular degeneration (AMD) or age-related cataracts. These conditions are associated with poor quality of life and increased mortality, so the VA will provide screening and treatment for these eye disorders.
  • Life-limiting eye conditions: Cataracts and glaucoma are common eye disorders in older adults, including in veterans. The VA offers medical care, including surgery, to manage these vision problems.

Treatment for Blind Veterans

In the United States in 2012, there were an estimated 160,000 legally blind veterans. There are thousands more veterans with “low vision,” a condition that can impact quality of life nearly as much as legal blindness.

The VA estimates that there are about 1 million veterans in the US with serious vision problems leading to low or no vision. In response to this growing number, the VA has increased benefits for veterans with low vision.

Basic services for blind veterans provided by the VA may include:

  • A total health and benefits review conducted by the VA Visual Impairments services team to create a treatment plan.
  • Training to help the veteran adjust to their current legal blindness.
  • Home improvements, including structural alterations to the home to improve accessibility.
  • Low-vision aids and training in their use.
  • Electronic and mechanical aids for the blind, including adaptive computers and computer-assisted devices.
  • Braille literature, talking books, and tapes.
  • Help finding resources on guide dogs or other support animals, including assistance with the application process and expenses.

Currently, the established continuum of care for low vision and legally blind veterans through the VA includes:

Inpatient blind rehabilitation centers (BRCs)

BRCs offer unique treatment to support veterans who have been blinded as a result of active duty. These centers help veterans achieve the greatest possible level of independence with several training programs, including orientation and mobility, living skills, manual skills, visual skills, computer access training, physical conditioning, recreation, adjustment to blindness, and group meetings. There are also family programs to support family members of blind veterans.

Visual impairment services outpatient rehabilitation programs (VISOR)

This is a nine-day intermediate outpatient program offering temporary lodging for veterans who are visually impaired and need comfortable and safe overnight accommodation. There are programs for skills training, mobility and orientation, and low-vision therapy. Veterans who qualify for VISOR rather than a BRC should be able to perform some basic daily living skills or activities, like managing their own medication.

Visual impairment centers to optimize remaining sight programs (VICTORS)

About 85 percent of all veterans who enter a rehabilitation program with some maintained level of vision, and who are not yet legally blind, can qualify for a VICTOR program. These programs offer some skills and support therapy for those who can perform basic daily living and work functions but need help managing vision difficulties.

Blind rehabilitation outpatient specialists programs (BROS)

These are vision support services and skills training programs offered through facilities that might be easier for veterans to access, like a VA hospital, home setting, nursing home or assisted living, or occasionally in a work environment.

Service Animals for Veterans Require Outside Organizations

The VA does not provide services animals like guide dogs for veterans, but they can assist in the application process and with some of the expenses. The government agency coordinates with several accredited, non-VA agencies that offer service animals for people with low vision or legal blindness. Once the veteran understands how to work with their guide dog, the dog becomes the veteran’s property.

Happy couple with their dog

The most common service animal is a service dog. Dogs are well-loved pets and easy to train for multiple tasks. A service dog, including a guide dog, is considered an assistive device. A VA assessor will consider this type of support for veterans with low vision or legal blindness. However, the veteran will also be assessed for their ability to care for an animal, including their ability to use support services like veterinary care provided through the VA.

The VA helps pay for veterinary care as well as equipment required for the guide dog, like harnesses or backpacks, through the Prosthetics and Sensory Aids Service. Although the VA does not currently provide service animals of any sort, members of the House of Representatives have proposed another push, in 2021, for the government agency to offer this service itself.

Private Insurance Options for Veterans

The VA covers as many medical needs as possible, but recognizes that some veterans may have private health insurance alongside their VA benefits. Veterans can choose these sources of coverage to supplement VA benefits, and they are not responsible for paying for VA medical services that the government agency bills to their private insurance.

For veterans who have non-service-related conditions that need treatment not provided by the VA, private insurance is a good secondary option. It can be helpful to have a vision insurance plan to support regular vision care needs, like glasses or contact lenses.

  • Tricare is a health insurance program for uniformed service members, veterans and retirees, and their dependents and spouses. This Department of Defense (DoD) military health plan offers several private insurance packages that provide extended coverage of a range of conditions that basic VA health services might not. This can include some basic preventative and routine care services. Tricare offers:
    • One annual eye exam for military service members and veterans.
    • A pair of military-issued glasses as necessary from their military medical/vision clinic.
    • Sunglasses, as necessary.
    • One eye exam every two years for dependents of service members.
    • Glasses for dependents with serious vision care issues.
  • The Federal Employees Dental and Vision Insurance Program (FEDVIP) is a voluntary dental and vision care program available to some federal employees, retired uniformed service members, and active-duty family members. The program offers a choice between five different vision carriers as well as 12 different dental providers. It is sponsored by the Office of Personnel Management (OPM).These vision plans are available:
    • Aetna Vision Preferred
    • Blue Cross Blue Shield FEP Vision
    • MetLife Federal Vision Plan
    • UnitedHealthcare Vision
    • VSP Vision Care

Dependents who sign up for an FEDVIP plan can get an annual eye exam and a free or discounted pair of eyeglasses or contact lenses, depending on which plan they choose.

If you or your family members are not eligible for VA benefits for any reason, and you do not have employer-sponsored health insurance, the VA wants you to be covered. The Affordable Care Act (ACA) established several health insurance marketplaces where you can find the best coverage and enroll immediately.

Important Updates to VA Services

As of August 2020, the VA is rescinding a rule limiting therapeutic laser eye treatments and expanding access to these vision treatments through local optometry programs. These treatments include:

Selective laser trabeculoplasty (SLT)

This procedure lowers intraocular pressure, which helps to slow the progression of glaucoma. It is typically provided to those with glaucoma when prescription eye drops do not effectively lower IOP or no longer lower IOP. This type of laser therapy may also be offered to those who struggle with serious side effects from prescription eye drops.

Yttrium-aluminum-garnet (YAG) laser capsulotomy

This laser therapy treats cloudy vision that might remain after cataract removal surgery. For most people, YAG restores vision back to normal through a rapid outpatient procedure.

VA Vision Care Helps Thousands of Veterans

To qualify for some veterans benefits, like full support for service-related injuries, you may need legal help to determine your disability level. This includes vision disabilities like low vision or legal blindness. Blurry vision, loss of sight, double vision, loss of peripheral vision, and loss of light perception are considered diagnostic criteria to determine whether you have a vision disability that the VA covers.

You are not only eligible for vision coverage, from glasses to surgery, through the VA, but you may also be eligible for other types of compensation, especially if your vision impairment is related to an injury that occurred in active duty.

Navigating this application may seem complicated, especially if you are already struggling. Fortunately, charitable organizations and nonprofits like the Wounded Warrior Project offer assistance that can help you get the care you need through the VA.

References

  1. History of Optometry at the VA. Optometry Cares from the American Optometric Association (AOA).
  2. Editorial: The Department of Defense/Veterans Affairs Vision Center of Excellence. (September 2019). Health.mil.
  3. VA vision care. (April 2020). US Department of Veterans Affairs (VA.gov).
  4. Optometry. (December 2018). US Department of Veterans Affairs (VA.gov).
  5. Health Care for Veterans: Answers to Frequently Asked Questions. (March 2020). Congressional Research Service.
  6. VA Vision Care. (April 2020). US Department of Veterans Affairs (VA.gov).
  7. Prescribing and Providing Eyeglasses, Contact Lenses, and Hearing Aids. (October 2019). US Department of Veterans Affairs (VA.gov).
  8. About VHA. (April 2021). US Department of Veterans Affairs (VA.gov).
  9. Effect of a Teleretinal Screening Program on Eye Care Use and Resources. (September 2014). Journal of the American Medical Association (JAMA), Ophthalmology.
  10. Veterans’ Eye Health. (November 2014). American Academy of Ophthalmology (AAO).
  11. VA Polytrauma Rehab Centers See Strong Connection Between Blast Concussions and Vision Loss. (December 2013). American Academy of Ophthalmology (AAO).
  12. VA Increases Services for Veterans With Vision Loss. (November 2012). American Academy of Ophthalmology (AAO).
  13. Center for Compassionate Care Innovation: Fact Sheet. (May 2018). US Department of Veterans Affairs (VA.gov).
  14. Lawmakers Push VA to Provide Service Dogs to Vets After a Decade of Failed Efforts. (March 2021). Military.com.
  15. Blind Veterans. DAV.
  16. About Us. Tricare.
  17. Doctors of Optometry, Veteran Advocates Salute U.S. Department of Veterans Affairs for Pro-Access, Pro-Veteran Policy Changes. (August 2020). AP News.
  18. Getting Veterans Disability Compensation for Vision or Hearing Loss. NOLO.
  19. Your Benefits Questions, Answered. Wounded Warrior Project.