Seeking Ethics Advice from Agency Ethics Officials (posted 04/03/18)
Memo below:
Ethics Advice Memo

TQCVL Template updated (posted 03/19/18)

Please review and comply with this important Office of Academic Affiliations memorandum regarding the updated TQCVL that is required for all VHA trainees (paid and WOC).

TQCVL Memo Spring 2018

Legal Blindness Coding (posted 02/27/18)
Please review this important message from Drs. Ballinger and Joy regarding coding for Legal Blindness that may have significant impact on future VERA allocations at your VA medical facility:
When coding for Legal Blindness, you will need to type H54.8 in an active note and then add it to the problem list as the correct ICD-10 code.
If you have any questions, please contact Dr. Ballinger for additional assistance.

The Use of Glass Bead Warmer in Veterans Health Administration Facilities (posted 02/27/18) 

2018-01-23 The Use of Glass Bead Warmers in Veterans Health Administration Facilities

FY 19 Approved Associated Health and Nursing Training Allocations Memo (posted 01/22/18)
This message is being sent on behalf of Drs. Jones and Ayvazian, Acting Chief of Health Professions Education/Director of Associated Health and Clinical Director of Nursing, respectively.
OAA is pleased to announce nursing and associated health stipend allocations for the 2018-19 academic year.  Please see the attached memorandum (embedded below) for instructions on how to access the approved training allocations report for your facility.  We also ask that you share this information with your facility/discipline training directors and have them review the report carefully to verify for accuracy.
If any associated health or nursing discrepancies are identified please have training directors notify the DEO, the national profession lead, and OAA’s associated health or nursing section. OAA must be notified of discrepancies by e-mailing or the Nursing POC, no later than Wednesday, March 14, 2018. If you are returning any position(s) that you are unable to fill following a profession-specific match you must also notify OAA through the newly created AH and Nursing Field Filled Positions database (OAA Support Center).
Reports are available at the following links:
  1. Allocation Plan for Associated Health and Nursing Trainees (by funding source):
  2. Allocation Plan for Associated Health and Nursing Trainees by Discipline (report may be useful for discipline leads):
If you have questions for associated health stipends, please e-mail For any nursing education questions please e-mail
This message is sent with the No-Reply-All function enabled to decrease email traffic.  You may reply directly to this message and/or forward this email to others. Thank you.

Memo-Approved Associated Health and Nursing Allocations FY19

Prevention and Control of Seasonal Influenza with Vaccines (posted 11/21/17)
For your awareness:
1013(1) D 2015-02-05

New Trainee Satisfaction Survey Intro Field Letter (posted 10/20/17)
The new Office of Academic Affiliations VA Trainee Satisfaction Survey (TSS), which replaces the VA Learners’ Perceptions Survey (LPS), is now available.

Flyer VA-TSS 08_17
TSS poster tear-off horizontal 08_17

Please update your orientation and training materials with this new TSS information and encourage your optometry trainees to complete it when indicated
Haag-Streit RME update (posted 09/06/17)

Haag-Streit RMU update 09052017

FY19 Associated Health and Nursing Allocation Requests and Standards of Excellence Forms Due October 11 (posted 08/30/17)
The FY 2019 Office of Academic Affiliations Program Announcement for requesting VA Optometry Residents starting July 1, 2018 has been released.
Please work with your local VA facility ACOS for Education / Designated Education Officer to request VA Optometry Resident positions by October 11, 2017.
This message is being sent on behalf of Drs. Ken Jones and Mary Dougherty:
Attached (embedded below) please find the FY 19 Associated Health and Nursing Allocation Requests/Standards of Excellence (SoE) Reports memo and program announcement (including instructions). The program announcement provides policies and procedures for the preparation and submission of SoE forms and position requests for academic year (AY) 2018-19(FY 19) funding support for trainees in associated health and nursing professions. Both the SoE submission and position request report will be entered on-line through the Office of Academic Affiliations support center. (See Attachment B of program announcement for instructions and direct link). Please note that the deadline for submitting SoEs and providing allocation requests to OAA is Wednesday, October 11, 2017. 
SoE reports are not available and will not be submitted this year for the following nine professions: Chiropractic Care, Licensed Professional Mental Health Counseling, Marriage and Family Therapy, Nursing, Occupational Therapy, Optometry, Physical Therapy, Psychology, and Social Work
Please distribute this information widely in an effort to ensure that training directors for associated health professions who plan to request funding begin collaborating with their local education office and complete their profession-specific SoE, which may be found at Please contact with any associated health education questions and  with nursing-related questions.

Memo-Standards of Excellence and Position Requests for Associated Health and Nursing

Program Announcement – FY 19 SoE and Position Requests for AH and Nursing

FY 17 Vision Research Program Announcement (posted 05/18/17)
OAA has completed development of a new “VA Trainee Satisfaction Survey (VA-TSS)”. This new survey is significantly shorter than the former VA Learners’ Perceptions Survey (LPS) as well as mobile device compatible. The new survey opened on August 9th, 2017, and replaced the “VA Learners’ Perceptions Survey (LPS).”
Below are some highlights of the new VA-TSS:
  1. It is short and concise and takes under 5 minutes to complete;
  2. It is optimized for use on mobile and other smart devices;
  3. It is designed to reduce the response burden on busy trainees while increasing participation;
  4. It allows respondents to add comments on questions where they are dissatisfied or very dissatisfied (150 character limit);
  5. It uses branching logic to efficiently display programs, specialty, and sub-specialty categories according to the clinical training program selected.
The VA-TSS focuses on overall satisfaction of the trainees with their clinical training experience and with VHA as a training system and potential employer of choice. With expected higher response rates we hope it will provide more data to help you improve specific aspects of your educational programs.
The access page to the new TSS survey remains at
The direct link to the survey has changed to:
Please change any local references from the former “LPS” to the new “TSS” survey as necessary.  Additionally, please find attached a hard copy of the survey and additional promotional materials for use in your facility.
Flyer VA-TSS 08_17
TSS poster tear-off horizontal 08_17

FY 17 Vision Research Program Announcement (posted 05/18/17)
Please review this FY 17 Vision Research Program announcement and consider submitting a proposal:

Rescission of Performance of TBI specific ocular health and visual functioning exams (posted 04/26/17)
Please review this VHA Notice 2017-35 regarding the rescission of VHA Directive 2008-065. RESCISSION OF VHA DIRECTIVE 2008-065
Current Clinical Guidance is provided by the Vision Center of Excellence (VCE) Clinical Recommendation for the Eye Care Provider document: EYE AND VISION CARE FOLLOWING BLAST
The VCE document can also be accessed on the VA Optometry Service intranet website at:

Tonosafe tip shortage (posted 04/19/17)

Please review this message from Dr. Michael White about the national shortage of Tonosafe disposable tonometer prisms:

As most have heard, there is a national shortage of the Tonosafe disposable tonometer prisms.  Here is a list of alternatives.  I have not verified the accuracy and/or reproducibility of any of these devices. 

Easyton Plus:
Luneau L900 TonoJet:
Keeler Tonomate:—keeler-disposable-applanation-prisms-1237.htm
Icare rebound tonometer: 

There is also the tonopen, NCT devices, and the original reusable tonometer prisms

Memorandum:  Clinical Recommendations for Eye Care Providers:  Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury (posted 3/21/17)
Please see the attached memorandum signed by Dr. Lynch with attachments regarding Clinical Recommendations for Eye Care Providers:  Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury (TBI).  Refer questions to Felix Barker, VCE Associate Director of Rehabilitation and Reintegration, by email at or by phone at (301) 400-1130.

03072017 — Clinical Recommendations for Eye Care Providers – Assessment and Management of Oculomotor Dysfunctions Associated with Traumatic Brain Injury

Oculomotor Dysfunctions Assoc w TBI – intro
Oculomotor Dysfunctions Assoc w TBI – Algorithm cards
Oculomotor Dysfunctions Assoc w TBI – Rehab
Oculomotor Dysfunctions Assoc w TBI – Panel

Exemption to Hiring Freeze Memo (posted 3/20/17)


Decommissioning the VistaWeb Application for Computerized Patient Record System (CPRS) Users (posted 3/20/17)

Please see the attached memorandum ‘Decommissioning the VistaWeb Application for Computerized Patient Record System (CPRS) Users.’
The Department of Veterans Affairs (VA) will decommission VistaWeb, a legacy Intranet application used to review remote patient health records and replace it with the Joint Legacy Viewer (JLV).
The VistaWeb application is not structured to meet Federal two-factor authentication mandates.  Rather than invest limited resources to make VistaWeb compliant, VA will transition from VistaWeb to JLV.  The JLV application meets security mandates, is already available across the enterprise, and will offer what VistaWeb does along with many additional benefits.
JLV is used at every VA medical center and available from every Veterans Health Administration (VHA) care site.  Since JLV availability on October 1, 2014, nearly 40,000 VA staff uses JLV.  It enables users’ viewing of comprehensive electronic health records from all VA, Department of Defense, and community health information exchange partner facilities where a patient receives care.  In a fast and secure way, to best meet the users’ need, each user can customize the display of health records.  JLV also displays data not available in VistaWeb, resulting in more complete records access, with imaging being the one exception; JLV is incorporating an Image Viewer scheduled to be in place prior to VistaWeb decommissioning.
The specific schedule for transitioning all VHA users from VistaWeb to JLV is evolving due to planning efforts and software enhancements in progress.  However, we anticipate readiness to begin during the 3rd quarter, fiscal year    (FY) 2017.  We also anticipate a goal completing the transition and shutting down VistaWeb is by the end of FY 2017.  The following sites to be validated for the transitioning process are El Paso VA Health Care System (HCS), VA Puget Sound HCS, and VA Central Iowa HCS.  A phased national transition will follow with approximately 10-15 parent VistA or Health Care System sites per week migrating from VistaWeb to JLV.  During each weekly phase, we will assist local staff to change the VistaWeb button in CPRS to JLV and support users through the transition.  VistaWeb will remain available for contingency use on the CPRS Tools menu throughout transitioning.
Nearly 100 percent of VistaWeb users have JLV access and are encouraged to begin using JLV at any time.  A banner is in place within VistaWeb with links offering training and login information for users who wish to start transitioning. 
Briefings are in progress with many national groups regarding the upcoming transition, and our communication plan will ensure key communities and end users are prepared.  A toolkit is being developed to assist staff in the field with communicating and facilitating the transition and additional information is available at the Transition to VA’s Joint Legacy Viewer.
Thank you for the opportunity to share information about the transition from VistaWeb to JLV to enable more secure and efficient care and services to Veterans.  The VistA Evolution Program Management Office team would welcome the opportunity to share additional information and answer any questions you might have. 
Should you have further questions, please contact our team Clinical Co-Leads: Dr. Murielle Beene, Chief Nursing Informatics Officer, VHA, at (202) 590-6884 or by email at; and Dr. David Massaro, Acting Senior Advisor for Health Informatics, VHA, at (615) 390-0745 or by email at
03152017 — Decommissioning the VistaWeb Application for Computerized Patient Record System (CPRS) Users

PIV Logical Access Policy Modification for Trainees (posted 3/02/17)

Please see below the latest policy clarification stating that Health Professions Trainees (HPTs) are not subject to the 5 day waiting period for an exemption to the requirement to log onto VA IT systems with PIV credentials.  Trainees will be granted an immediate exemption, and be permitted to use a username/password until a PIV card can be issued.  (check out at the MEMO first, because it clarifies the “attachment.”)

Trainees Policy

Eligibility for beneficiary travel for special disabilities care (posted 3/02/17)

Please read the below memorandum and new regulations for beneficiary travel.
Note that visually impaired Veterans receiving care, not only in inpatient BRCs, but also in outpatient clinics, will receive travel reimbursement for their programs – if VA provided them with temporary lodging.  Those programs may include vision impairment services in BRS outpatient rehabilitation (VISORs) and BRS intermediate and advanced low vision clinics. Vision impairment centers to optimize remaining sight (VICTORS) are also included if hoptel accommodations are provided to patients.
Veterans will be provided payment for travel costs to outpatient VISOR and low vision clinics when they stay in a hoptel while receiving rehabilitation services.   Hoptels may also be off-campus hotels or motels that have an arrangement with a VHA medical facility to provide lodging.
Please direct any questions to the resources provided at the end of the Beneficiary Travel memorandum pdf.

Eligibility for Beneficiary Travel for Special Disabilities Care 03022017

VHA Pharmacy Policy: in-patients (posted 3/01/17)

There is a new VHA Directive on Inpatient Pharmacy Services that provides recommendations about ophthalmic medications.
On page 16, it provides specific guidance concerning multi-dose ophthalmic drops expiration dates:
(9) Use of multi-dose products stored in ward stock centralized areas and outpatient surgical and procedure clinics must be labeled with an expiration date upon opening or entering the multi-dose product (e.g., to include but not limited to parenterals, insulin, ophthalmic drops) that does not exceed 28 days; or a shorter expiration date when recommended by the manufacturer

VHA Directive 1108.06, Inpatient Pharmacy Services, 02-08-2017

Informal Guidance for VA staff participating in accreditation site visits (posted 2/27/17)

Please see  updated guidance (attached and highlighted section below) pertaining to VA employees serving as site visitors at VA facilities. OAA’s Deputy Chief Officer released this guidance to Designated Education Officers on Friday, and we encourage you to share this with your profession’s training directors and chiefs.  VA employees must be on official duty status when completing a site visit at another VA medical center and must NEVER be on authorized absence or annual leave.  Please note that VA DOES NOT endorse VA staff participating in site visits in their personal capacity due to potential criminal conflicts of interest violations

Guidance on Site Visits Feb 2017

Learner’s Perception Survey 2017 Mid-Year Results Available (posted 2/08/17)

The Office of Academic Affiliations has compiled some new reports for the Learners’ Perceptions Survey (LPS) taken between August 15, 2016 (2017 survey start date) and January 19, 2017 (default 2017 in the report Year selection pick list). These results represent a midyear analysis, with 3,409 surveys completed or partially completed. By the end of the academic year on June 30, 2017, we expect to have about 16,000 surveys completed.
These 2017 midyear reports are now available for your facility or VISN, provided that at least 8 trainees responded to the survey for the group or class of interest.  Note, there was a reduction made by VHA in FY15 reducing the required minimum response size from 10 to 8 respondents, we hope this change will increase the likelihood of viewing specific LPS result sets.  Sample size minimum requirements are necessary to protect the anonymity of respondents.
Please watch this 13 minute tutorial video to understand how to view, save, and print the reports.
Link to Report Landing Page:
Note that national program offices have the ability to run a national report by discipline by selecting <Specialty Group> at the following link: (see screenshot below).


Free Online Course: Recognizing the Signs of mTBI during a Routine Eye Exam (posted 01/30/17)

Access: contact or other information will never be shared. 
Course Description, Objectives, Authors and Credit Type:

VA Guidance for Federal Hiring Freeze (posted 01/27/17)

From the acting secretary, Bob Snyder:
I know many of you are anxious about the impact of the Presidential Memorandum entitled “Hiring Freeze” issued on January 23, 2017.  The Memorandum imposes a freeze on filling vacant positions existing as of noon on January 22, 2017, as well as a freeze on filling new vacancies.  It applies to all executive branch departments and agencies.

Let me be clear that the Memorandum addresses “vacant positions” and “a long-term plan to reduce the size of the Federal Government’s workforce through attrition.”  The Memorandum does not change the status of any current VA employee.

We have been working with the Office of Management and Budget (OMB) as well as the Office of Personnel Management (OPM) on interpreting many aspects of the President’s Memorandum.  We will be issuing clarifying guidance and implementing instructions as it becomes available from OMB and OPM. 

The first VA issuance was published on January 26, 2017, authorizing VA human resources offices to proceed with:

·        The employment and onboarding process for individuals who received a job offer prior to January 22, 2017;

·        Detail assignments;
·        Career ladder promotions;
·        Excepted service appointments that confer non-competitive conversion to competitive   service; and
·        Personnel actions involving restorative rights, reasonable accommodations, and any other actions required to comply with law and collective bargaining agreements. 

The Presidential Memorandum authorizes me, as Acting Secretary of VA, to exempt from the hiring freeze any positions that I deem necessary to meet national security or public safety responsibilities.  To that end, today I exempted a range of occupations from the hiring freeze in this memo.
I want to be clear, though we remain committed to ensuring that our Veterans receive the quality care and benefits they deserve, this is not business as usual.  These exemptions are in line with the President’s intent.
Please let your supervisors know if you have any questions or concerns.  Thank you for everything you do to support Veterans.

Signed Exemption to Hiring Freeze Memo with Exempted Occupations

Major Changes Implemented to VHA Employee Conference Attendance Process (posted 01/27/17)

Due to VHA’s committed and proper oversight of employee conference attendance through the EES Events Division, new guidance has been released to lift some previous restrictions and tedious processes.
On Jan. 26, VHA Under Secretary for Health Dr. David Shulkin issued VHA Implementation Guidance on Planning and Executing Conferences in accordance with VA Financial Policies and Procedures, Volume XIV, Chapter 10.  Most significantly, this new guidance has removed oversight requirements for VA attendance at non-Federal external conferences, and implements new oversight requirements for VHA employees attendance at Federally sponsored external conferences.
VHA approving officials must continue to exercise discretion and judgment in ensuring that all conference expenses are appropriate, necessary and managed in a prudent manner in accordance with Federal Travel Regulations; Vol XIV Travel Policy; and Volume XVI Chapter 1, Government Purchase Card Program
Following are significant implemented changes depending on the type of conference:
Non-VA Sponsored Conferences:
  • Removal of oversight requirements for VA attendance at non-Federal external conferences
VA-Sponsored or Co-Sponsored Conferences: 
  • The Responsible Conference Executive (RCE), or a designated representative, must physically attend the conference and must be trained in their duties. The VA Corporate Travel Management and Reporting Office will create and distribute this training.
  • Approving officials are authorized to provide one-time approval for recurring VA sponsored or hosted conferences (e.g., annual conferences) within the overall limits of their approval authority. The VHA EES Events Division Director will assess requests for treatment of a conference as a recurring event.
  • Events with estimated costs of less than $20,000 and attended by 50 or fewer individuals will be approved at the local level. These events are not reportable but planning, approval and oversight must comply with all applicable Federal laws, regulations and policies. These events must use the standard VHA Local Conference Approval template.
Non-Federal Sponsored External Conference
  • A non-Federal conference is an event that meets the definition of a conference* and is not sponsored by a Federal agency. An example is an event that meets licensure and certification requirements or is attended to maintain professional proficiencies sponsored by a professional organization.
  •    VHA employees may attend a non-Federally sponsored external conference if approved by their VHA approving official. Effective Jan. 26, VHA employees do not need to request approval through the VHA ACES system to attend a non-Federal conference.
Federal Non-VA Sponsored External Conference
  • A Federal non-VA conference is an event that meets the definition of a conference* and is sponsored by a Federal agency. An example is a professional training event that meets licensure and certification requirements or is attended to maintain professional proficiencies, such as those events sponsored by the National Institutes of Health, Office of Personnel Management, Department of Defense or other Federal agencies.
  • VHA employees must use ACES to request and receive approval to attend a Federal non-VA sponsored conference.
  • No expenditure of VA appropriated funds for attendance at a Federal non-VA sponsored conference may occur without documented ACES approval.
  • If the Federal non-VA sponsored conference is not listed, it must be added to the ACES database for review and approval for VHA employee attendance.
  • If you are uncertain if a conference is a non-Federally sponsored conference or a Federal non-VA sponsored conference, please contact the VHA Conference Support Team.
Finally, changes in approval authority for VA-sponsored and co-sponsored conferences and for Federal non-VA conferences, in accordance with the new Office of Management and Budget memo:
  • Above $500,000: VA chief of staff approval (formerly was a waiver request to the VA Secretary)
  • Above $100,000 and up to $500,000: under secretary for health, no further delegation (formerly required Deputy VA Secretary approval).
  • Up to $100,000: Delegated by the under secretary for health (no change from previous policy)
For more information, please visit the Conference Guidance Microsite or contact the VHA Conference Support Team.
*New Definition of a Conference:
Conference: A meeting, retreat, seminar, symposium or event that involves attendee travel. The term “conference” also applies to training activities that are considered to be conferences under 5 Code of Federal Relations §410.404.
Office of General Counsel memorandum dated Oct. 26, 2016, “Conference Clarification,” has already opined that the following events are not considered a conference:
  • Veterans outreach events (e.g., sports programs)
  • Traditional ceremonies (e.g., change of command, ground breaking, official military awards and funerals)
  • Events at which VA is conducting recruitment activities
  • Formal classroom training coursework at established government or commercial training facilities (e.g. Law Enforcement Training Center and VA Acquisition Academy)
Source: VA Financial Policies and Procedures, Volume XIV, Chapter 10

Vision Center of Excellence Newsletter: Frontlines of Eye Care (posted 01/11/17)

From the Vision Center of Excellence:

The Vision Center of Excellence (VCE) is pleased to share our Fall 2016 issue of the Frontlines of Eye Care. With a focus on vision health issues relevant to Service members and Veterans, VCE supports information sharing and encourages collaboration. The attached issue features an article on the ocular manifestations of mosquito transmitted diseases and brief reviews of recently published peer reviewed articles. Frontlines of Eye Care Fall 2016
We believe this resource will be informative and useful to your efforts.
Please let us know your thoughts on any of the topics contained in this edition. Additionally, we encourage you to spread the word about Frontlines by sharing with your colleagues and residents.
Vision Center of Excellence (VCE)
Department of Defense
Department of Veteran Affairs
Phone: 301-400-1130

Performance Based Rewards 2017 (posted 12/13/16)

For FYs 2017 through 2024, VA’s spending on all types of awards – including individual performance and special contribution awards, group awards, and 3Rs incentives – is subject not only to the government-wide OMB/OPM guidance, but also to VA-specific spending caps set by the Congress in the Comprehensive Addiction & Recovery Act of 2016 (CARA).  For awards paid out in FY 2017, CARA caps VA’s total awards spending at $230 million, which is nearly 30 percent less than VA spent on individual and group awards and 3Rs incentives in Fiscal Year 2016.  Review the attachment below to see a list of Frequently Asked Questions:

FAQ and Award Distribution Chart – Award Budgets 2017 12092016

CPRS Training Video (posted 11/16/16)

Please review these trainee orientation materials from the Office of Academic Affiliations that may be useful for your VA Optometric Residency and Externship program trainees.

CPRS News Magazine – CLE CPRS Basic Training Hour 2015-16 (bcove)

Clinician CPRS Training Video Acknowledgement
CPRS Basic Training in 30 Minutes Evaluation
CPRS PG1 2015 Updates Sept 2015 v2.0 CPRS 30.70
Imed Pocket Guide

2017 ICD-10-CM Codes (posted 10/19/16)

Please review this important message from the VA Optometric Service EMR/IT Subcommittee:

NOTICE To all optometrists from the VACO Optometry  Electronic Medical Records/Information Technology subcommittee:

CMS has updated The 2017 ICD-10-CM codes for FY 2017. The codes are effective October 1, 2016 through September 30, 2017.

The VA had rolled out the new codes, and many stations were updated as of 10/18/2016 in CPRS w/o notice to providers.  Eye care code changes were significant with this new roll-out.   

IMPORTANT, PLEASE NOTE: You can still search, find and code the OLD, inactivated codes with a manual search within CPRS.   You then see all your codes at the bottom under your note and think you’re OK. 

THIS ACTION WILL RESULT IN INCORRECT CODING.   If you selected any inactivated codes, they will DISAPPEAR from the encounter form when you refresh the patient chart.  The coding package rejects them, potentially leaving you with ACTION REQUIRED and/or inaccurate coding.  Beware!

For further information please see the following link:

This link has a numerical code conversion table and other relevant information on these changes. Please note that CMS will continually update codes going forward each fiscal year.

Direct Scheduling Implementation update Posted 4-28-2016

As Direct Scheduling for routine care in Optometry and Audiology is implemented nationwide, there have been numerous inquiries about how those VA sites not currently scheduled for the initial Rapid Process Improvement Workgroup (RPIW) site visits can proceed independently.

The below memorandum from the Acting Deputy Undersecretary for Operations and Management (10N) details the requirements for independent implementation.

There is also an Optometry Access Workgroup led by Drs. Cantrell and Varanelli that can assist you in this endeavor.

If you are interested in being listed within the HQ Optometry Access Group, please contact Ms. Gernhart.

Audiology and Optometry Direct Scheduling Implementation Update

Drug Testing for all New Hires Posted 3-3-2016

Based on recommendations from the VA’s Office of the Inspector General (OIG), the VA agreed to implement drug testing of 100% of applicants tentatively selected for employment in a Testing Designated Position (TDP). This testing requirement will commence on March 1, 2016 as indicated in the attached memorandum from the Assistant Secretary, Human Resources Administration.

There is one lab in Minneapolis, MN that will be processing ALL pre-employment drug tests for the entire VA. This means there will be a significant slowdown in our ability to bring new hires on-board as quickly as you would like. Many of our candidates won’t give their notice to their current employer until they’ve received the firm offer. The firm offer will not happen until ALL pre-employment requirements have been met, including the drug testing.

Anyone who is currently in the process of completing their pre-employment will NOT be subject to this requirement.

Medical residents and interns (medical, dental, optometry and podiatry), and affiliated health professions trainees/students (e.g., student nurses, psychology trainees, pharmacy residents, psychology interns) are excluded

This exclusion of trainees only applies to drug testing in the applicant phase/on-boarding process and not to when they are on their continuous, temporary appointments as trainees. Language from the directive reads, “Note: all health professions interns, residents, fellows, students and trainees are the only groups of candidates for TDPs who are excluded from testing as applicants.”

Therefore, random drug testing is still a possibility for appointed trainees, and candidates selected to train in VA should be made aware of the potential for random drug screening (this has not changed as part of the mandate noted below). You may review the directive for drug testing during the on-boarding process at (intranet)

Module 6: ICD-10 Coding Posted 9-16-2015

Please review Module 6 on ICD-10 Coding developed by the VA Optometry IT Subcommittee:

Module 6: ICD 10 coding

New Employee Orientation for Trainees/students Posted 6-19-2015

For those VA facilities with Optometric Education Programs, please review this guidance from the Office of Academic Affiliations regarding the need for “New Employee Orientation”.

Please review the attached guidance clarifying that the only mandatory training requirement for trainees is completion of the Mandatory Training for Trainees (MTT) or the MTT-refresher course. The policy referenced was established in 2011, and this guidance is intended to highlight the appropriate orientation and mandatory training practices for your incoming students. Please share this correspondence widely with each profession’s training directors and HR officers. While certain face to face orientation programs may be useful (if short, targeted and appropriate), the full employee NEO is NOT acceptable practice.

Trainee NEO Guidance

A second document attached is a template to facilitate communication of important information to your trainees. This is a document that was developed at the Bay Pines VA and may prove useful to you in your orientation processes. Please don’t feel obliged to use this if you already have things organized!!

Orientation Template for Arriving Trainees

Trainee Hiring Flexibilities Posted 5-18-2015

Please review this message from the Office of Academic Affiliations about hiring flexibility for Title 38 health professions trainees

Hiring VA Trainees

Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA series: Posted 5-11-2015

Please review Module 5 of the Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA series:

Module 5 of the Coding and Billing for Optometrists Relative Value Units (RVUs) in VHA series

Productivity and Staffing Guidance for Specialty Provider Group Practice Posted 5-11-2015

Please review these two VHA policies on Productivity and Staffing Guidance for Specialty Provider Group Practice

VHA Directive 1065, Productivity and Staffing Guidance for Specialty Provider Group Practice
VHA Handbook 1065.01, Productivity and Staffing Guidance for Specialty Provider Group Practice

Performance of Therapeutic Laser Eye Procedures in VHA Facilities Posted 5-11-2015

Please review this recently released VHA policy on Performance of Therapeutic Laser Eye Procedures in VHA Facilities.

Performance of Therapeutic Laser Eye Procedures in VHA Facilities

Guidance- Fingerprinting, Badging, and NACIs for Health Professions Trainees Posted 4-20-2015

Below is guidance developed by the VHA Trainee On-Boarding Demonstration Project (TONB) specifically for Education staff who process health professions trainees.

The content have been reviewed and approved by the Office of Operations, Security, and Preparedness (OSP) – HSPD-12 Program Management Office.

The guidance in this document is based on policy, and best-practices identified by the TONB.

The document is available on the OAA Intranet homepage under Education Program Resources – PIV and Non-PIV Badges.

Fingerprinting, Badging, and NACI Processing of Health Professions Trainees

Disease-Specific OPPE and Joint Collaboration of Care Reviews Posted 3-18-2014

As required by the VHA Eye Care Handbook 1121.01, Appendix C and as agreed to by your local VA medical facility Care Collaboration Agreements, there should be a disease-specific Ongoing Professional Practice Evaluation (OPPE) component within the overall OPPE process in which Optometry reviews the care provided by Optometry for patients diagnosed with AMD, diabetes and glaucoma.

In addition, there should be quarterly Joint Collaboration of Care Reviews between Ophthalmology and Optometry to improve the process of care.

o AMD Disease-Specific Component for OPPE
o Basic Low Vision Care for OPPE
o Continuum of Care or VICTORS Low Vision Care for OPPE
o Diabetes Disease-Specific Component for OPPE
o Glaucoma Disease-Specific Component for OPPE
o Joint Collaboration of Care Review Forms

Please continue to perform these required reviews so that we may continually improve the eye care services provided to our Nation’s Veterans.

VHA Handbook 1121.01 has information about Visual Impairment Prevention for Veteran Patients in Appendix C as well as sample Care Collaboration Agreements in Appendices D, E, and F.

VHA Handbook 1121.01, VHA Eye Care

Revised Guidance: Billing for Services by Associated Health Staff in their Teaching Capacity Posted 6-2-2014

Please review this revised OAA guidance about supervision and billing for services provided by optometry students as well as other Associated Health trainees (excluding optometry residents and fellows)

Billing for Services

VA Optometry Service PACT Recommendations Posted 4-7-2014

These VA Optometry Service Patient Care Aligned Teams (PACT) Recommendations were developed by the VA Optometry Service productivity workgroup.

Please consider using them when planning for Community-based Outpatient Clinics (CBOCs) and VA medical facilities for provision of primary optometric eye care and vision rehabilitation services.

VA Optometry Service PACT Recommendations

Coding and Billing for Optometrists: RVUs in VHA, Part 4: CPT Coding – The Key to RVUs Posted 6-2-2014

Please review this fourth module on CPT Coding – The Key to RVUs within the Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA series developed by the VA Optometry Service IT Subcommittee.

CPT ICD training program part 4

Coding and Billing for Optometrists: RVUs in VHA, Module 3: ICD-9 Coding – The Present Posted 8-27-2014

Please review this third module on ICD-9 coding – The Present within the Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA series developed by the VA Optometry Service IT Subcommittee.

CPT ICD training program icd-9 coding, part 3

Coding and Billing for Optometrists: RVUs in VHA, Part 2: DSS, Labor Mapping & RVUs Posted 3-20-2014

Please review this second module on DSS, Labor Mapping and RVUs within the Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA series developed by the VA Optometry Service IT Subcommittee.

If there are any questions, please contact the VA Optometry Service IT Subcommittee Authors directly

Coding and Billing Program Part 2

Coding and Billing for Optometrists: RVUs in VHA, Part 1 – Introduction Posted 2-4-2014

Please review this initial Part 1 – Introduction module about Coding and Billing for Optometrists: Relative Value Units (RVUs) in VHA developed by the VA Optometry Service IT Subcommittee.

Coding and Billing Introduction

Labor Mapping for VA Optometrists Posted 3-10-2014

This is the 3rd, and perhaps one of the most important steps in ensuring that VA Optometrists are properly labor mapped so that the Administrative, Clinical, Research and Teaching components are properly calculated. For VA Optometrist Specialty Physician Productivity, the Clinical component is the only one used for RVU productivity determination.

These Decision Support System (DSS) Labor Mapping and Related VHA Policies/Information documents, along with the Labor Mapping Business Rule Guidance from the VACO Office of Efficiency, Productivity, and Staffing (OPES) should be helpful in completing this very important task:

The relevant VHA policies to assist with this project may be viewed by clicking onto the following intranet links:

• Decision Support System (DSS) Labor Mapping and Related VHA Policies/Information:
o Patient Care Data Capture, VHA Directive 2009-002
o Physician and Dentist Labor Mapping, VHA Directive 2011-009
o Primary Care Direct Patient Care Time, VHA Directive 2006-060
o Primary Care Management Module, VHA Handbook 1101.02
o Product Department/ALBCC Master List, FY 2013

On the OPES website, the Mapping Guidance documents can be viewed here (See Attachments 3 & 4).

Please work with your VA facility Chief of Optometry or immediate supervisor so that s/he may work with the VA facility Decision Support Service (DSS) Service Office to correct/revise/validate the labor mapping information for each VA Optometrist at every VA medical facility.

Task Force for Specialty Care Posted 1-15-2014

Please review the December 20, 2013 post about the Task Force for Specialty Care, and access the link to the OPES website at: to view materials that will assist with the VHA transition to RVUs as a measure of Optometry Productivity.

To assist your VA facility with the Person Class Taxonomy Code and Occupational Series changes, please review the “Audit of Active Providers” document for guidance.

Tiered Productivity Standards
FY13 Productivity Outlier Report
Audit of Active Providers

Optometry DSS Identifiers (Stop Codes) Posted 10-4-2013

The first task to be accomplished is to ensure that the appropriate DSS Identifiers (Stop Codes) are utilized to properly capture Optometry Workload.

This information is posted on the Administrative Page, Administration section of the VHA Optometry Service intranet website at:

The 408 DSS Identifier is the one that is designated for Optometry and should be used in every VHA Eye Clinic to capture Optometry Workload, and dependent upon the DSS Identifier instructions should be used in the Primary (P), Secondary (S), or in Either (E) the primary or secondary position.

For those Veterans with a $50 co-pay requirement for the initial Optometry (408) examination needing further medically necessary care, such as contact lenses, low vision rehabilitation, etc., there should be no further co-pay requirement in the following DSS Identifier clinics: 197, 218, 220, 437, 438, 439, and 449.

The 197 + 408 DSS Identifier combination should be used for the Polytrauma/TBI Ocular Health and Visual Functioning Examination and optometric Brain Injury Vision Rehabilitation Care Clinics.  See DSS ID-TBI Visual Function Exam Memo-2010

For Low Vision Rehabilitation services, the Visual Impairment Advisory Board (VIAB) Continuum of Care DSS Identifiers in the preferred Primary & Secondary combination sequence include:

  1. 218 + 408 for optometric care provided in the 13 Blind Rehabilitation Service (BRS) designated inpatient Blind Rehabilitation Center Clinics. See: Blind Rehabilitation Center Locations from BRS website, 10-2013,
  2. 220 + 408 for optometric care provided in the 12 BRS designated VISOR & Advanced Outpatient Blind Rehabilitation Clinics (Appendix H, VHA Handbook 1174.05),
  3. 437 + 408 for optometric care provided in the 3 Optometry VICTORS (Lake City, FL; Northport, NY; and Palo Alto, CA,) and 22 BRS designated Advanced Low Vision Clinics (Appendix G, VHA Handbook 1174.05),
  4. 438 + 408 for optometric care provided in the 22 BRS designated outpatient Intermediate Low Vision Care Clinics (Appendix F, VHA Handbook 1174.05), and
  5. 439 + 408 for optometric care provided in an outpatient Low Vision Care Clinic within a VHA Eye Clinic (that includes all other optometric low vision rehabilitation services not within the BRS designated or Optometry VICTORS clinic sites).

VHA Handbook 1174-05 Outpatient blind and Vision Rehabilitation Clinic Procedures

The 408 + 449 DSS Identifier combination should be used for Contact Lens Care Clinics, and/or for Eyeglasses fittings and adjustments with separate titles for the Contact Lens Clinic or Eyeglasses Fittings & Adjustment Clinic, as appropriate. See: DSS ID Contact Lens Services

n addition, DSS Identifier 718 for Diabetic Retinal Screening, 428 for Telephone/Optometry, and the 408 + 719 DSS Identifier combination for My HealtheVet Secure Messaging should not have a co-pay requirement.

Those VA Optometrists performing Compensation &Pension (C&P) Examinations should use the 408 + 450 DSS Identifier combination, and/or the 408 + 448 DSS Identifier combination for Integrated Disability Evaluation System (IDES) Examinations.

Please work with your local Decision Support Service (DSS) Office and VA facility leadership to ensure that the appropriate DSS identifier (Stop Code) Clinics are fully implemented.

FY14 Active DSS Identifiers

Optometry Service Mail Groups and VA Facility Transfers Posted 9-13-2013

Whenever you transfer to another VA facility, especially to a different state, your e-mail address is updated in Outlook at the new facility. This automatically removes you from any mail groups that you were a member of at your previous facility.

If you are planning on transferring to another VA facility or, if you know an optometrist who has transferred VA facilities, please make sure to let Kathy Gernhart know when your email address has been updated in Outlook at the new facility. Once your Outlook email address has been updated at the new facility, she can add you back to any optometry mail groups you once belonged.

Transferring facilities is also a good time to review your information in the Optometry Service Directory and provide updates.

You may contact Kathy Gernhart ( for any questions, requests to be added to optometry mail groups, and/or updating your information in the Optometry Service Directory.


Publications in Peer Reviewed Eye Journals Posted 9-11-2013

Announcement from the VA Optometry Service Director’s Office:

There continue to be questions from VA Optometrists about what peer reviewed journal publications are acceptable to the VACO Optometry Professional Standards Board (OPSB) for Special Advancement and Promotion requests.

There are peer reviewed journals that charge authors fees to have articles published on-line. When journals that charge fees for publication were discussed with select members of the optometry academic community, it was generally acknowledged that publications in these journals were not considered to be acceptable for academic achievement, advancement or promotion.

After thoroughly reviewing the situation, there are recommendations from the American Academy of Optometry that detail publications in peer reviewed journals acceptable for Fellowship consideration that the OPSB members decided to endorse.
Clinical Candidate Point System Handout
Peer Reviewed Journals from AAO

There may be peer reviewed non-eye journals [such as American Journal of Public Health (APHA Journal), Journal of Rehabilitation Research & Development (VA Journal), Military Medicine (AMSUS Journal), etc.] as well as other eye and non-eye journals that may be acceptable on a case-by-case basis.

Please review this listing and consider submitting articles for publication in the appropriate journal.

Update on Legal Blindness Posted 2-28-2011

Please review the recent Social Security Administration clarification regarding the determination of Legal Blindness:

How do we evaluate specific visual problems?

a. Statutory blindness. Most test charts that use Snellen methodology do not have lines that measure visual acuity between 20/100 and 20/200. Newer test charts, such as the Bailey-Lovie or the Early Treatment Diabetic Retinopathy Study (ETDRS), do have lines that measure visual acuity between 20/100 and 20/200. If your visual acuity is measured with one of these newer charts, and you cannot read any of the letters on the 20/100 line, we will determine that you have statutory blindness based on a visual acuity of 20/200 or less. For example, if your best-corrected visual acuity for distance in the better eye was determined to be 20/160 using an ETDRS chart, we will find that you have statutory blindness. Regardless of the type of test chart used, you do not have statutory blindness if you can read at least one letter on the 20/100 line. For example, if your best-corrected visual acuity for distance in the better eye was determined to be 20/125+1 using an ETDRS chart, we will find that you do not have statutory blindness as you are able to read one letter on the 20/100 line.

In addition within VHA, the best corrected visual acuity should be determined with central (primary gaze) and not eccentric viewing.