Information for Blind or Low Vision Veterans

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Uniformed soldier stands in front of an American flag

By Gregory L. Goodrich, Ph.D.

Blindness/ low vision due to brain injury undoubtedly dates back to the earliest history of our species. One can easily picture a fight between two early homo sapiens, with one hitting the other on the head with a rock or club. If the fight didn’t kill the injured party, there was a reasonably good chance that the injured party would have double vision, difficulty visually tracking a moving object, and/or have a large part of their visual field missing. A substantial percentage of the brain is involved in vision and visual processing, so any injury to the brain has a good chance of impacting vision.

Effect of the Wars in Afghanistan and Iraq on Traumatic Brain Injuries and Blindness

It can be argued that despite the ancient history of blindness/ low vision due to brain injury, the wars in Afghanistan and Iraq highlighted that head injury often leads to blindness/ low vision and/or visual dysfunctions. These wars have resulted in over 253,000 traumatic brain injuries (TBI)I. How many of these TBIs resulted in blindness or dysfunction is not known. Kevin Frickeii has estimated that between 2000 and 2011, over 54,000 U.S. troops experienced an eye injury or visual changes/dysfunction. He estimated the direct medical cost for these troops to be 2.82 billion dollars. The projected cost to the economy over the lifetime of these individuals, including rehabilitation, lost wages, and other costs, is estimated to be an additional $24.286 billion.ii.

While the number of U.S. troops with blindness/ low vision due to combat injuries is significant, their numbers pale compared to civilian TBI-related vision changes. Each year, some 1.7 civilians incur a TBI.iii. Most cases are mild TBI, with about 25% rated moderate or severe. However, even the so-called “mild” TBIs can negatively impact visual function. We don’t know how many TBIs result in blindness/ low vision or visual dysfunction. Generally accepted estimates range from 20% to 40%, but some are higher. The most conservative estimate (20%) suggests at least 340,000 TBIs each year that result in vision changes/dysfunction.

Types of Visual Dysfunction Caused by TBI

The most common visual consequence of TBI is visual dysfunction. These dysfunctions include deficits in accommodation, convergence, saccades, pursuits, and others. The consequences can be dramatic. Impaired reading or the ability to read for only short periods is common. In more extreme cases, the ability to drive safely may be impaired. Thus, these dysfunctions affect a person’s ability to do everyday activities and may interfere with education, work, and even social life.

Visual Acuity and TBI

Interestingly, visual acuity following a TBI is not often affected, and it is one reason the visual consequences of TBI are frequently overlooked. After all, if you have 20/20 acuity, what could be wrong? In addition to the binocular/oculomotor dysfunctions mentioned above, the person might have lost half their visual field or a quarter, or their fields may be constricted. In such cases, the person may bump into things and, surprisingly, they often don’t realize that a significant portion of their visual field is missing. Knowing they sustained a TBI, the person might think, “I’m clumsy” or “It’s my brain injury that causes this.”

As we celebrate the commitment and sacrifices of our men and women veterans, let’s remember that all too many have returned home with a brain injury and resulting visual problems. Eye care professionals can help by inquiring about their patients, whether or not they are veterans, and whether or not they experienced a TBI. If so, specific eye examination techniques should be provided, and referrals should be made as needed.

How Family and Friends Can Help

Family and friends can help if a veteran has difficulty with reading or other visual tasks by encouraging the veteran to have a comprehensive eye examination. While brain injuries can’t be reversed, the visual consequences can be effectively addressed. If we do this with veterans, we’ll raise the general awareness of vision changes and dysfunction following TBI and improve care for civilians and veterans. It is a truism that war leads to dramatic improvements in medicine. We can make this true for TBI-related vision changes as well.

i. http://www.health.mil/Research/TBI_Numbers.aspx accessed October 31, 2012

ii. K. Fricke (2012). Costs of Military Eye Injury, Vision Impairment, and Related Blindness and Vision Dysfunction Associated with Traumatic Brain Injury (TBI) without Eye Injury. Report prepared for the National Alliance for Eye and Vision Research.

iii. http://www.cdc.gov/traumaticbraininjury/statistics.html

iv. Gianutsons, R., Visual Rehabilitation following acquired brain injury, AOTO, 1997

Blinded Veterans Association (BVA)

From its humble beginnings, BVA has strongly advocated for world-class VA Orientation and Mobility training for veterans who experience vision changes. Pictured here, BVA member Maurice Toler receives instruction from O&M Instructor Vijaya Dabir at Washington, DC VA Medical Center.

History of BVA

BVA traces its beginnings back to the final days of World War II, when a courageous group of approximately 100 recovering service members, blinded in combat, gathered together in a brotherly union at an Army Convalescent Hospital near Avon, Connecticut. The historic meeting, which began at 8:45 a.m. on March 28, 1945, resulted in a lasting institutional framework through which blinded veterans could help and serve one another for decades to come.

A trust fund set up within the American Foundation for the Blind (AFB) was instrumental in BVA’s early history and crucial to its survival. In addition, Kathern “Kay” Gruber, AFB’s Director of Services for the War Blind, was a faithful advisor and morale booster during the Association’s early years.

On its 65th anniversary, BVA is a nonprofit Veterans Service Organization of more than 11,000 members and chartered by the United States Congress to be the exclusive voice for blinded veterans before the legislative and executive branches of government.

Eligibility

All legally blinded veterans, estimated to be 158,000 nationwide, are eligible for membership. An overwhelming majority of this number are seniors who have lost sight due to age-related Macular Degeneration, Glaucoma, Retinitis Pigmentosa, and Diabetic Retinopathy. There is no charge for any of the services provided to both members and nonmembers of the organization. A National BVA Auxiliary organization and its local and regional groups comprise spouses, relatives, and friends of blinded veterans. The Auxiliary and its members support the BVA mission and provide voluntary service to individual blinded veterans.

Services to Seniors

BVA services to seniors include full-time Field Service Representatives and veterans who are blind or low vision, in various parts of the country. Field reps provide inspiration, encouragement, and practical assistance in the Department of Veterans Affairs (VA) benefit claims process. They understand the complexities and emotions behind the process because they have been through similar experiences. They are effective role models in helping newly blinded veterans find and follow the road to independence. A meaningful adjunct to the BVA Field Service Program, and an essential vehicle for assistance to blinded veterans, are the more than 60 volunteer offices in VA Medical Centers, regional offices, and outpatient clinics.

What BVA Does

Provides a Voice for Blinded Veterans

Since its small beginnings, BVA has been a strong voice for blinded veterans in various venues. In addition to its annual presentation of legislative priorities before a joint session of the House and Senate Committees on Veterans Affairs, BVA presented oral and written testimony to Congress seven times in 2009 on legislation affecting recently injured service members and older veterans with vision changes. Throughout the year, BVA also educates members of Congress about the needs of blinded veterans. The Association works closely with VA to ensure all veterans who are blind or low vision have access to its world-class rehabilitation training programs, technology, and counseling. It collaborates with organizations for and for the blind to ensure that all blind individuals are afforded the rights, services, and accommodations they both deserve and have earned.

Disseminates Information

One of BVA’s most significant responsibilities is disseminating information and offering practical help to blinded veterans and their families. The organization promotes public awareness of sight loss through its website (www.bva.org), display tables at community events, media campaigns, and its quarterly magazine, the BVA Bulletin.

Provides Scholarships

Scholarship funds are available annually to the spouses and dependents of children/grandchildren of blinded veterans, regardless of whether the blinded veterans are members of BVA. Eligibility for the funds is also not limited to the families of veterans whose blindness is connected to their military service.

Offers Support

Regional groups, which number 54 across the country, offer blinded veterans support, friendship, and opportunities for recreation and socializing with one another. They also provide a locally-based organization through which blinded veterans can unite to effect change in the national organization. The groups also work to change the customs, ordinances, and attitudes toward community members who are blind or low vision.

National Convention

Gatherings of the BVA membership nationally are the much anticipated annual conventions. The 67th National Convention in Galveston, Texas, for example, brought members together to draft resolutions in official business meetings and participate in guest speaker forums, panel discussions, workshops, and training sessions on issues relating to blindness and veterans. The convention exhibit hall featured companies wishing to introduce new products and technologies relating to vision changes.

APH Directory of Services—You may not realize how many helpful services are available. Servicemen and their family members can search for local agencies that can help.
Blinded Veterans Association—The Blinded Veterans Association is an organization specifically established to promote the welfare of blinded veterans and offers many services to help veterans and their families meet the challenges of blindness. BVA was and is the only veterans’ service organization dedicated to serving America’s blind and low-vision veterans.
Blind Rehabilitation Services, Veterans Affairs. The Department of Veterans Affairs provides Blind and Visual Impairment Rehabilitation Services to eligible Veterans and active-duty Service members. VA is the only national healthcare system that integrates rehabilitation services for patients with vision loss into its health benefits. They provide a variety of benefits listed on their site. Veterans and active duty Service members with vision loss that cannot be corrected with regular eyeglasses and having difficulty with one or more tasks should contact the VIST Coordinator in the VA medical center nearest their home. Information can be obtained by contacting the Blind Rehabilitation Service Program office at (202) 461-7317. To schedule an eye exam, contact your nearest VA medical facility. To find the VA medical center closest to you, use VA’s facility locator. Enter your ZIP code, and a list of the nearest healthcare facilities will be at your fingertips.
Disabled American Veterans—With more than 1.4 million members, Disabled American Veterans (DAV) is an organization of disabled veterans who are focused on building better lives for disabled veterans and their families. DAV provides free assistance to veterans in obtaining benefits and services earned through their military service. It is fully funded through membership dues and public contributions. It is not a government agency and receives no government funds. DAV’s largest endeavor is the National Voluntary Service Program. In 88 offices, a corps of 260 National Service Officers (NSOs) and 26 Transition Service Officers (TSOs) directly represent veterans with claims for benefits from the Department of Veterans Affairs and the Department of Defense. This free service is available to all veterans.
Legal Services Corporation (LSC) is the single largest funder of civil legal aid for low-income Americans nationwide. Established in 1974, LSC operates as an independent 501(c)(3) nonprofit corporation that promotes equal access to justice and provides grants for high-quality civil legal assistance. LSC distributes more than 90 percent of its funding to 134 independent nonprofit legal aid programs with more than 800 offices.
Mental Health Support/Veterans Crisis Line—Many veterans with polytrauma injuries also need mental health support. One can have trouble readjusting to civilian life, have trouble sleeping, or experience mood swings, depression, or other signs of extreme stress. In that case, this crisis line offers free or low-cost assistance and care. For immediate help, call the National Veterans Crisis Line at 1-800-273-TALK (8255). Your call is confidential and can also be anonymous. You may also have a confidential online conversation with a professional on the National Veterans Crisis Line Web Chat site.
National Association of Blind Veterans—The National Association of Blind Veterans (NABV) is a group of veterans whose blindness is both service-connected and not service-connected and who are concerned about the welfare and well-being of other blind veterans. NABV is a division of the National Federation of the Blind.
National Veterans Legal Services Program (NVLSP) Lawyers Serving Warriors® (LSW) Program. This program offers pro bono (that is, free) legal help with disability issues to veterans from all eras. Their current pro bono initiative is to assist veterans with two types of disability claims — applications for Combat-Related Special Compensation (CRSC) and applications to the Physical Disability Board of Review for an increase in the military disability rating.
Polytrauma System of Care (PSC)—The Polytrauma System of Care (PSC) consists of 5 regional TBI/Polytrauma Rehabilitation Centers (PRC) located in Richmond, VA; Tampa, FL; Minneapolis, MN; and Palo Alto, CA, and San Antonio, TX. As veterans recover and transition closer to their homes, the PSC continues to provide a continuum of integrated care through 4 Polytrauma Transitional Rehabilitation Programs (PTRP), 23 Polytrauma Network Sites (PNS), 87 Polytrauma Support Clinic Teams (PSCT), 38 Polytrauma Points of Contact (POC), located at VA medical centers across the country.
Southeastern Guide Dogs —The program provides guide dogs to blind or low-vision soldiers. The program also places companion and therapy dogs with soldiers.
Stateside Legal. LSC granted this organization funds to provide a website to focus exclusively on federal legal rights and resources important to veterans, service members, and families.
Sun Valley Adaptive Sports—Sun Valley Adaptive Sports (SVAS) offers programs for children, teens, adults, and veterans that cover a wide range of disabilities: physical, emotional, developmental, and learning. Programs include alpine skiing, snowboarding, Nordic skiing, whitewater rafting, kayaking, rock climbing, hiking, biking, running, martial arts, skeet shooting, fly-fishing, yoga, theater, swimming, and hot springs. SVAS also offers a skiing program for blind veterans previously wounded in Iraq. All programs are free to participants.
TCAssociates—TCoombs & Associates LLC is an 8(a) certified, Service Disabled Veteran (SDV) owned small business, home-based in the Washington DC Metro area. It is owned and managed by a group of experienced veterans and supported by other IT, telecommunications, security, healthcare, and logistics professionals. TCAssociates sells a full range of products to assist individuals who are blind/low vision, deaf/hard of hearing, and have other disabilities. They also provide on- and off-site training for software and products developed to assist people with disabilities.
Traumatic Brain Injury Center of Excellence | Health.mil—The Traumatic Brain Injury Center of Excellence Defense (TBICoE) supports, trains, and monitors service members, veterans, family members, and providers who have been or care for those affected by traumatic brain injury.
United States Department of Veterans’ Affairs—The mission of the Veterans’ Healthcare System (VHA) is to serve the needs of America’s veterans by providing primary care, specialized care, and related medical and social support services. Approximately a quarter of the nation’s population—approximately 70 million people—are potentially eligible for VA benefits and services because they are veterans, family members, or survivors of veterans. The mission of the VA Blind Rehabilitation Service is to coordinate a healthcare service delivery system that provides a continuum of care for blinded veterans extending from their home environment to the local VA facility and the appropriate rehabilitation setting.
Wisdom 4 Blinded Veterans— A website created for veterans as an informational portal that keeps blind and low-vision veterans updated on various topics. This information is available via the Internet, smartphones, phones, e-mail, text messaging, and Amazon’s Alexa.
Wounded Warrior Project—Wounded Warrior Project® (WWP) serves military service members who incurred service-connected wounds, injuries, or illnesses on or after September 11, 2001, and their families. With advancements in battlefield medicine and body armor, an unprecedented percentage of service members survive severe wounds or injuries. With the mission to honor and empower Wounded Warriors, WWP is the hand extended to encourage warriors as they adjust to their new normal and achieve recent triumphs. Offering various programs and services, WWP is equipped to serve warriors with every type of injury—from the physical to the invisible wounds of war.