The Achievement Of A Vocational Goal Is Not Currently Reasonably Feasible.

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8.02. PROGRAM DESCRIPTION

a. The Achievement of a Vocational Goal Is Not Currently Reasonably Feasible. To establish that it is not currently reasonably feasible for a veteran to achieve a vocational goal, a CP (counseling psychologist) must find that the veteran's disabilities currently affect his or her employability to either of the following extents:

(1) The veteran cannot participate in a program of vocationally oriented training and services; or

(2) The veteran is able to successfully pursue vocational training, but it would be highly improbable for the veteran to obtain and retain employment consistent with his or her abilities, aptitudes, and interests.

b. Reasons for Authorizing a Program of IL Services. The VR&C (Vocational Rehabilitation and Counseling) Division may authorize a program of IL services for eligible veterans for whom achievement of a vocational goal is not currently reasonably feasible. This program of rehabilitation services may be furnished to help the veteran to

(1) Function more independently in his or her family and community without the assistance of others or with a reduced level of assistance from others;

(2) Become reasonably feasible for an extended evaluation; or

(3) Become reasonably feasible for a vocational rehabilitation program.

c. Independent Living and Independence in Daily Living. Independence in daily living means the ability of a veteran, either without the services of others or with a reduced level of those services, to live and function within the veteran's family and community. Operationally, independent living is synonymous with independence in daily living.

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d. Program of IL Services and Assistance. A program of IL services and assistance may include the following benefits:

(1) The services provided in 38 CFR 21.35(d), including the counseling, diagnostic, medical, social, psychological, and educational services which the CP determines the veteran needs to achieve maximum independence in daily living;

(2) The subsistence allowance and other monetary assistance authorized by 38 CFR 21.260, 21.262,

21.266, and 21.270; and

(3) The special rehabilitation services under 38 CFR 21.150, 21.152, 21.154, 21.155, and 21.156.

e. Barriers to Independent Living. The goal of an IL program is to increase the veteran's options, resulting in an improved quality of life. options may be limited by skill deficits or by physical, environmental, or psychological factors. For example, some veterans may be able to overcome certain cognitive limitations through training intended to improve problem-solving. Some independent living program participants may need to learn how to manage personal care attendants, use adaptive equipment, and shop for necessities. For others, technological devices such as motorized wheelchairs or vehicle modifications may facilitate independent living. Supportive services, e.g., attendant care and health maintenance programs, may ameliorate the physical factors which increase the veteran's dependence on others. Architectural modifications and advocacy to promote disabled persons, rights to barrier-free access may reduce environmental problems. Peer and professional counseling may decrease psychological hindrances to independence. A disabled veteran's anxiety about discharge from an institution may diminish through interaction with other disabled persons who are successfully adjusting to community living.

f. Independent Living Services and the Rehabilitation Process. The goal of the IL program is not necessarily that the disabled veteran be able to live alone in the community with no supportive services. Rather, the goal is for that individual to have the skills necessary to choose an acceptable life-style and then be able to manage it with as little reliance on others as possible. in some instances, however, the veteran may require continuing services beyond completion of the IL program to maintain the level of independence achieved during the program. (See par. 8.05b below for limitations on these long-term services.)

8.03. ELIGIBILITY FOR PARTICIPATION

To be eligible for a program of IL services, VA must determine that

a. The veteran meets the basic eligibility and entitlement criteria for participation in a rehabilitation program;

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b. Achievement of a vocational goal is not currently reasonably feasible;

c. The veteran has IL needs; and

d. The achievement of an IL goal is currently feasible; that is, VR&C staff members expect the IL services proposed will enable the veteran to live independently in his or her family and community or with reduced dependence upon the services of others.

8.04 SCOPE OF SERVICES

VA may provide a discrete service or a comprehensive program of services necessary to achieve maximum independence in daily living. As part of an IL program, the only vocational courses which VA may provide are those incidental to achieving intermediate IL objectives. Some of the IL services which VA may authorize are listed below:

a. Training in activities of daily living;

b. Training in IL skills;

c. Attendant care during a period of transition (see par. 8.05b below);

d. Transportation when special arrangements are required due to the disabling condition;

e. Peer counseling;

f. Evaluation or training in an IL program;

g. Housing (group, transitional, or housing specifically designed to meet the needs of disabled persons);

h. Advocacy; and

i. other services which 38 CFR 21.160 authorizes.

8.05 DURATION AND LIMITATION OF SERVICES

A program of IL services will not exceed the period necessary to restore independence in daily living. The duration of a program will not exceed 24 calendar months except as indicated in subparagraphs a and b below.

a. Extension for 6 Months. The CP may approve an extension of a program of IL services for up to 6 months if the additional period is necessary and should result in an increase in independence. The CP must carefully document in the veteran's CER (Counseling/Evaluation/Rehabilitation) folder specifically how the additional services should lead to the desired results. No program may exceed 30 months.

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b. Limitation of Selected Services. Some IL needs identified during the initial phase of program planning for a veteran may require services following completion of the program and, in some cases, for the rest of the veteran's life. For example, the veteran might have a life-long need for a personal care attendant and for transportation assistance. Since the time a veteran can participate in the program is limited, program planning must focus on ways to meet these continuous needs following IL program participation. Vocational rehabilitation program funding for long-term needs is limited to the IL program period. During IL program participation the case manager will attempt to secure sources which will continue the assistance beyond the completion of the program. In no instance, however, may the VR&C Division provide these services beyond the maximum 30 months for an IL program.

8.06 MONETARY ASSISTANCE

VA will pay subsistence allowance to a veteran in the IL program under 38 CFR 21.260.

a. Basis for Subsistence. Measure participation on a clock-hour basis. Pay subsistence allowance based on the number of clock hours spent in training directly related to the acquisition of IL skills-such as money management, personal care attendant management, and household maintenance. To measure the rate of pursuit, follow the instructions in 38 CFR 21.310(d).

(1) Reduced Work Tolerance. In view of the severity of the conditions of IL program participants, the CP must determine whether the veteran is entitled under reduced work tolerance (38 CFR 21.312) to a higher rate of subsistence allowance than VA would otherwise pay for a given level of participation.

(2) Limitations on Traditional Medical Therapies. Participation in traditional medical therapies (e.g., occupational therapy, psychotherapy, and physical therapy) will not typically be counted as training time although the case manager will document participation on the veteran's VA Form 28-8872, Rehabilitation Plan.

8.08. PROCUREMENT OF SERVICES

a. Authorization of Services and Supplies. The case manager will authorize the services, incidental goods, and supplies necessary for the veteran to accomplish the goals of an IL program. For these authorizations, the case manager will follow the policies and procedures in part III, chapters 2 and 6. If the case manager anticipates that program charges will require the approval of the Director, Vocational Rehabilitation Service, the regional office should follow the procedures in part II, chapter 3 to make a specific request to obtain approval of costs.

b. Approved Service Providers. Normally VR&C Divisions will use VA facilities to provide IL services to veterans participating in the program. If the VR&C Division cannot make timely, effective, and cost-efficient arrangements for VA facilities to provide these services, then the VR&C Division may follow the procedures described below and use other public, private nonprofit, and for-profit facilities.

(1) Use of VA Facilities. VA medical facilities are likely to be the best resources for VR&C Divisions to obtain authorized services as either part or all of an IILP. If these services are not available through VA medical facilities or the VR&C Division cannot make appropriate arrangements to timely use these facilities, the CP will document this in the veteran's record:

8.10 ROLE OF THE COUNSELING PSYCHOLOGIST

a. Identification of Veterans. The CP must review each case in which a vocational goal is not currently reasonably feasible to determine if a program of IL services may be furnished for one of the reasons in subparagraph 8.02b above. if an IL program is feasible, the CP and the veteran must then develop a program of IL services that addresses the veteran's needs. If a VRS will act as case manager, the VRS will also take part in the plan development (see subpar. 8.12b(1) for detailed instructions on who will act as case manager for IL programs).

b. Provision of IL Services When a Vocational Goal Is Feasible. When establishing a veteran's entitlement to services under chapter 31, the CP must document in the CER folder why the achievement of a vocational goal is not currently reasonably feasible. If vocational rehabilitation is currently reasonably feasible, but the veteran is prevented from participating in a traditional vocational rehabilitation program due to deficient IL skills, the CP should integrate the needed IL services into an IWRP (individualized written rehabilitation plan). The case manager will arrange for these services as a preliminary part of the plan or concurrently with educational or vocational services.

c. Determination of Feasibility for Program of IL Services. In evaluating clients for inclusion in the program of IL services, the CP must determine that it is reasonable to expect an increase in the veteran's level of independent functioning if the veteran receives these services.

(1) Documentation of the IL feasibility determination must be clearly evident in the record of each veteran for whom an IL program is provided.

(2) Outside consultants and the VRP (Vocational Rehabilitation Panel) are recommended for use as the providers of data to support the IL feasibility determination (see subpar. 8.08c above for details concerning the use of an outside consultant, and par. 8.11 below for use of VRP).

(3) When using an outside consultant or the VRP, the CP must assure that either resource has the expertise to address the needs of the veteran under consideration.

d. Denial of IL Services. If the CP determines that the achievement of a vocational goal is not currently reasonably feasible and the CP does not approve a program of IL services, the CP must obtain the VR&C Officer's concurrence in the decision (21 CFR 21.53(f)). If the VR&C Officer does not concur, the CP must work with the VRS case manager and the veteran to develop a plan of IL services.

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c. Veteran's Involvement

(1) IILP Development. The CP will solicit the veteran's cooperation in negotiating and agreeing to the terms of the IILP. When the CP and the veteran have developed, agreed to, and documented the plan's substantive terms, the CP and the veteran will sign the plan to indicate mutual understanding and acceptance of the terms. Unless a VRS will assume case management responsibilities, there will be only two signatures on the IILP. The veteran will receive a copy of the signed plan.

(2) Disagreement About Terms of IILP. If the CP and veteran cannot agree on the terms of the plan, the CP will request that the VR&C Officer review the proposed plan. The VR&C Officer will resolve the disagreement and ensure that plan development continues.

(3) Rights of Review and Appeal. The veteran or his or her representative may request administrative review of a proposed original or amended rehabilitation plan (see pt. I, par. 3.05). Within 1 year of written notification of the CP's decision regarding the veteran's plan, the veteran or his or her representative may appeal the terms of the proposed plan to BVA (Board of Veterans Appeals) by filing a notice of disagreement (see pt. I, ch. 10). VR&C staff members will inform the veteran that any administrative review must take place prior to appealing the decision to BVA. Once the veteran files a notice of disagreement, the VR&C Officer must immediately stop any administrative review in progress and begin appellate processing.

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b. Medical and Physical Therapy Assessment. Standard medical history and physical examination by appropriate medical or physical restoration specialists should include complete assessments of:

(1) Overall physical health;

(2) Ability to regulate and manage own health;

(3) Musculoskeletal and body movement;

(4) Range of motion;

(5) Posture;

(6) Muscle strength;

(7) Functional balance;

(8) Functional mobility; and

(9) Gait.

c. Neurological Assessment. Following brain trauma, the neurological assessment should identify an individual's cognitive, emotional, social, and behavioral assets and liabilities. A comprehensive assessment should address the person's:

(1) Attention and concentration;

(2) Learning and memory;

(3) Recent memory;

(4) Remote memory;

(5) Language;

(6) Speech;

(7) Visual-spatial abilities;

(8) Fine-motor abilities;

(9) Higher-order and executive cognitive abilities;

(10) Emotional adjustment; and

(11) Chemical abuse and dependency.