1. Impairment (diagnosis): The applicant must have been determined by qualified personnel to have a physical or mental impairment. (See Policy: Who Can Diagnose). Disability/Impairment exist regardless of the impact (or lack of impact) on the everyday activities of the individual. Determine the existence of a permanent impairment without regard to medications, prostheses, accommodations, or assistive devices that may control symptoms or correct losses. A person with epilepsy has an impairment even though medications may control symptoms of the disorder. A person with a hearing loss has an impairment even though the condition is correctable with a hearing aid. 
   1. New or recent impairments. The duration or expected duration of limitations and their seriousness need to be considered. Determine whether current limitations will be resolved or significantly reduced in seriousness by the end of the usual period of treatment and convalescence for the condition. If the individual is still in recovery, it may be too soon to determine permanent functional limitations or the severity. Temporary, non-chronic conditions (such as broken limbs, sprained joints, and situational depression) usually do not result in long-lasting functional limitations.
   2. Relevant impairment(s) which result in a functional limitation to employment must be recorded in QE2 and verified either through observation (physical impairment you can see), or by gathering medical information to verify the diagnosis. 
   3. Observation: VR specialist observation can be used, when possible, to determine a physical impairment that is observable. VR staff are not 'diagnosing’ but are observing a person with an obvious physical impairment. If observation is used exclusively to determine eligibility, a very descriptive narrative of the impairment is required to substantiate the VR Specialist's eligibility decision in the absence of medical documentation. 
   4. Reports: Obtain a report from persons licensed or certified to make a diagnosis. (See Policy - Who Can Diagnose in this chapter). If observation is not possible, you must obtain some other type of information to verify the impairment. This might include:
      1. Existing medical Information: Eligibility relies on existing information to the maximum extent possible. This may include, but not limited to counselor observations, information provided by the individual and family, medical records, integrated work experiences, Pre-Employment Transition Service information, and/or determinations made by officials of other agencies, copies of medical or psychological reports from the source or from the individual. 
      2. MDT Reports: Secondary school reports are acceptable for specific learning, speech, language, and intellectual disabilities only. IEP Reports are not acceptable as this is the school's plan for services, not a diagnostic tool. Best practice is to request all available school records (Psychological exam, IEP, grade transcripts and any work experience reports) when requesting the MDT to assist with eligibility and career planning. See Multi-Disciplinary Team (MDT) report from secondary schools in the Policy section of this chapter for more information.
      3. VR funded medical examinations: As a last resort, examinations may be funded to obtain reports when there are no existing medical records, or the records are inadequate. Assure the individual understands that psychological testing may result in a mental health diagnosis and document this discussion in the task notes.
   5. Determine primary impairment. VR needs to assess which impairment causes the greatest impediment to employment. This is not necessarily the order the impairments are listed on the medical report, but rather a determination by the VR Specialist as to which impairment causes the greatest barrier to employment. If other impairments exist, determine their level of impact on the individual's vocational functioning and rank accordingly (secondary, tertiary). We must seek enough information to determine the cause of the difficulty in preparing for, obtaining, securing, retaining, advancing in, or regaining employment consistent with the individual's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. NOTE: A disability of vision cannot be the primary impairment. It can be secondary or tertiary if the individual does not meet NCBVI eligibility criteria. If an individual is eligible for NCBVI, they need to work with that agency. For further guidance on impairments of hearing, vision and drug and alcohol, see policy section of this chapter. The Disability Handbook is available in each Nebraska VR office, for specific impairment information and questions to explore.  
2. Substantial Impediment to Employment: A determination utilizing documentation, as well as observation and input from the applicant, that the impairment results in a substantial impediment to employment. For vocationally relevent impairment(s), investigate how the impairment hinders the applicant from securing, retaining, advancing in, or regaining employment consistent with their abilities and capabilities. Only those vocational limitations resulting from the person's impairment(s) or disabilities are considered. These limitations must also be separated out from those resulting from other situational factors or their complicating consequences. The performance of work, training, and independent living functions can be affected by a variety of factors other than the person's disability. Significant other factors include age, geographic location, cultural expectations, poverty, lack of transportation, etc. Ensure the eligibility determination is based on the individual's impairment(s) and resulting functional limitations, not situational factors. The other factors are relevant for planning and should be addressed in the development of the Individual Plan for Employment (IPE) but are not part of the eligibility process. Determine eligibility based on how the individual's impairment(s) have prevented them from working, advancing, or significantly restricted the condition, manner, or duration under which the individual can work. Refer to Functional Capacity Checklist and Impediment Questions attached to this chapter in the forms section.
3. Requires VR Services: A determination by a qualified vocational rehabilitation counselor employed by Nebraska VR that the applicant requires vocational rehabilitation services to prepare for, obtain, secure, retain, advance in, or regain employment that is consistent with the individual's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. To make this decision, consider the following:
   1. The individual's need for specialized services, supports, or accommodations not typically used by the public.
   2. The need for planning and coordination of multiple or complex services over a long duration to enable the person to secure, retain, advance in, or regain employment. 
   3. Situations where an individual may not require VR services:
      1. When the applicant is already receiving the services needed for employment and does not require any additional VR services to complete the existing services or plan for employment.
      2. When services needed for employment are readily available without VR providing, paying for, arranging, coordinating, or otherwise enhancing the service.
4. Benefit from Services: On the assumption everyone can work, Nebraska VR has determined if an applicant has a verified impairment, impediment to employment, and requires VR Services; it is then presumed the applicant can benefit from services. Once an individual has completed the VR Application the assumption of benefit exists. Ineligibility determinations will only occur after the initial eligibility determination and an exploration of the individual's abilities, capabilities, and capacity to perform in realistic work situations will be conducted. If there are eligibility concerns consult with the office director and review the Program Manual Chapter Ineligible/No Longer Eligible
5. Priority Group Assignment:  An individual’s priority will be determined at the time of eligibility based on the individual’s specific functional limitations (communication, interpersonal skills, mobility, self-care, self-direction, work skills, or work tolerance) of their disabling condition(s). Functional capacities are NOT based on projected limitations the individual may have in the future or other situational factors (age, geographic location, cultural expectations, poverty, lack of transportation, etc.). Functional limitations are based solely on the individual's impairment(s) that result in a substantial impediment to employment. Use the Functional Capacity Checklist and Disability Handbook to assist in determining the appropriate limitations and priority group assignment. When the agency is under an Order of Selection, those with the most significant disability or disabilities will be served first. See Program Chapter Order of Selection 
   1. 1. Nebraska VR Priority Group assignment: 
         1. Priority Group 1: Has a severe physical or mental impairment resulting in a rating of very low in two or more of the 7 functional areas. 
         2. Priority Group 2: Has a severe physical or mental impairment that results in a very low rating in one functional area. Verified SSDI or SSI recipients qualify for priority group two at a minimum and are assessed to determine whether they qualify for priority group one.
         3. Priority Group 3: All eligible individuals. These individuals must have a low rating in at least one of the seven functional areas.
6. QE2 Functional Capacity screen must be completed AND approved to finalize the eligibility process and the assignment of the priority group. Upon QE2 ELIGIBILITY completion, the following will occur: 
   1. QE2 will generate the appropriate eligibility letter to be sent by the VR State Office to the client and a case file task note indicating the eligibility/Priority Group Letter has been sent. Note: If the individual requires the Eligibility/Priority Group letter to be in Spanish, the VR Staff checks the "Spanish communication," box located in the client's personal information section of QE2. This will serve as notice for the eligibility letter to be sent in Spanish. A copy of the eligibility letter will be sent to the local VR Office to be uploaded into the client's electronic casefile.
   2. The VR Specialist will proceed based on the letter generated to the client. A client in an open priority group may begin receiving services immediately. Those in a closed priority group may be placed on a waiting list. If the client has not already stated a preference for being placed on the waiting list, contact them to determine their interest in being placed on the waiting list. If there is no response to the Eligibility/Priority Group letter and multiple attempts have been made to contact the individual by a variety of methods, to include a contact and 15-day letter, the case may be closed by the VR Specialist. The date of the letter serves as notification and timeline in the process. An official Termination letter must be sent. See Program Manual Termination chapter.
   3. A client can be moved to a higher priority group at any time if information becomes available indicating additional or more severe functional limitations exist or they begin receiving SSI/SSDI. Utilize the individual's work history and Functional Capacity Checklist to determine appropriate functional limitations and priority group assignment. The local VR Office completes the following:
      1. Enter the reasons for the priority group upgrade in a TASK note, 
      2. Update the QE2 Functional Capacity screens, and
      3. The local VR Office sends OOS Upgrading Priority Group Letter.
7. Information and Referral to other agencies. Nebraska VR must discuss with the applicant their eligibility and priority group assignment, as well as provide information and referral to community resources, if not already provided.

Presume eligibility for applicants who are verified as SSI/SSDI Recipients.

Title II or XVI of the Social Security Act has determined these individuals have met all the eligibility requirements and are presumed eligible. Verify eligibility for SSI/SSDI recipients by obtaining a BPQY.  A person is considered eligible for such benefits unless the BPQY identifies that benefits have been terminated or they meet one of the circumstances in the EXCEPTIONS, below.  Any status such as suspended, or overpayment, means the person is still eligible for SSI/SSDI benefits.  

EXCEPTIONS:

1. SSDI RECIPIENT WHO HAS REACHED FULL RETIREMENT AGE AT TIME OF APPLICATION: At Full Retirement Age (FRA) a person previously eligible for SSDI will become eligible for SSA Retirement benefits, rather than benefits based on their disability, thus they cannot be presumed eligible for VR services.  To determine FRA, the VR Specialist uses the chart below.  If the person has reached FRA, they are treated as a non-SSI/SSDI recipient for the purposes of determining eligibility. Use the following chart to determine Full Retirement Age (FRA)

2.  SSI RECIPIENT WHO IS AGE 65 OR OLDER AT TIME OF APPLICATION: At age 65, a person previously eligible for SSI due to disability becomes eligible for SSI benefits due to age. Presumptive eligibility does not apply for a person who receives SSI and is age 65 or older, and the VR Specialist determines eligibility as they would a non-SSI/SSDI recipient. 

See Benefits Orientation         

a. For SSI/SSDI-eligible applicants, obtain the SSA-confirmed diagnosis from the information that accompanies the BPQY sent by the SSA and enter it on the Impairments Screen in QE2.

b. Note how to determine the primary impairment in #1 then proceed to #5 and #6 to determine Functional Capacity and Priority Group and provide information and referral.

Eligibility Requirements:

1. Impairment (diagnosis): The applicant must have been determined by qualified personnel to have a physical or mental impairment. (See Policy: Who Can Diagnose). Disability/Impairment exist regardless of the impact (or lack of impact) on the everyday activities of the individual. Determine the existence of a permanent impairment without regard to medications, prostheses, accommodations, or assistive devices that may control symptoms or correct losses. A person with epilepsy has an impairment even though medications may control symptoms of the disorder. A person with a hearing loss has an impairment even though the condition is correctable with a hearing aid. 
   1. New or recent impairments. The duration or expected duration of limitations and their seriousness need to be considered. Determine whether current limitations will be resolved or significantly reduced in seriousness by the end of the usual period of treatment and convalescence for the condition. If the individual is still in recovery, it may be too soon to determine permanent functional limitations or the severity. Temporary, non-chronic conditions (such as broken limbs, sprained joints, and situational depression) usually do not result in long-lasting functional limitations.
   2. Relevant impairment(s) which result in a functional limitation to employment must be recorded in QE2 and verified either through observation (physical impairment you can see), or by gathering medical information to verify the diagnosis. 
   3. Observation: VR specialist observation can be used, when possible, to determine a physical impairment that is observable. VR staff are not 'diagnosing’ but are observing a person with an obvious physical impairment. If observation is used exclusively to determine eligibility, a very descriptive narrative of the impairment is required to substantiate the VR Specialist's eligibility decision in the absence of medical documentation. 
   4. Reports: Obtain a report from persons licensed or certified to make a diagnosis. (See Policy - Who Can Diagnose in this chapter). If observation is not possible, you must obtain some other type of information to verify the impairment. This might include:
      1. Existing medical Information: Eligibility relies on existing information to the maximum extent possible. This may include, but not limited to counselor observations, information provided by the individual and family, medical records, integrated work experiences, Pre-Employment Transition Service information, and/or determinations made by officials of other agencies, copies of medical or psychological reports from the source or from the individual. 
      2. MDT Reports: Secondary school reports are acceptable for specific learning, speech, language, and intellectual disabilities only. IEP Reports are not acceptable as this is the school's plan for services, not a diagnostic tool. Best practice is to request all available school records (Psychological exam, IEP, grade transcripts and any work experience reports) when requesting the MDT to assist with eligibility and career planning. See Multi-Disciplinary Team (MDT) report from secondary schools in the Policy section of this chapter for more information.
      3. VR funded medical examinations: As a last resort, examinations may be funded to obtain reports when there are no existing medical records, or the records are inadequate. Assure the individual understands that psychological testing may result in a mental health diagnosis and document this discussion in the task notes.
   5. Determine primary impairment. VR needs to assess which impairment causes the greatest impediment to employment. This is not necessarily the order the impairments are listed on the medical report, but rather a determination by the VR Specialist as to which impairment causes the greatest barrier to employment. If other impairments exist, determine their level of impact on the individual's vocational functioning and rank accordingly (secondary, tertiary). We must seek enough information to determine the cause of the difficulty in preparing for, obtaining, securing, retaining, advancing in, or regaining employment consistent with the individual's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. NOTE: A disability of vision cannot be the primary impairment. It can be secondary or tertiary if the individual does not meet NCBVI eligibility criteria. If an individual is eligible for NCBVI, they need to work with that agency. For further guidance on impairments of hearing, vision and drug and alcohol, see policy section of this chapter. The Disability Handbook is available in each Nebraska VR office, for specific impairment information and questions to explore.  
2. Substantial Impediment to Employment: A determination utilizing documentation, as well as observation and input from the applicant, that the impairment results in a substantial impediment to employment. For vocationally relevent impairment(s), investigate how the impairment hinders the applicant from securing, retaining, advancing in, or regaining employment consistent with their abilities and capabilities. Only those vocational limitations resulting from the person's impairment(s) or disabilities are considered. These limitations must also be separated out from those resulting from other situational factors or their complicating consequences. The performance of work, training, and independent living functions can be affected by a variety of factors other than the person's disability. Significant other factors include age, geographic location, cultural expectations, poverty, lack of transportation, etc. Ensure the eligibility determination is based on the individual's impairment(s) and resulting functional limitations, not situational factors. The other factors are relevant for planning and should be addressed in the development of the Individual Plan for Employment (IPE) but are not part of the eligibility process. Determine eligibility based on how the individual's impairment(s) have prevented them from working, advancing, or significantly restricted the condition, manner, or duration under which the individual can work. Refer to Functional Capacity Checklist and Impediment Questions attached to this chapter in the forms section.
3. Requires VR Services: A determination by a qualified vocational rehabilitation counselor employed by Nebraska VR that the applicant requires vocational rehabilitation services to prepare for, obtain, secure, retain, advance in, or regain employment that is consistent with the individual's unique strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice. To make this decision, consider the following:
   1. The individual's need for specialized services, supports, or accommodations not typically used by the public.
   2. The need for planning and coordination of multiple or complex services over a long duration to enable the person to secure, retain, advance in, or regain employment. 
   3. Situations where an individual may not require VR services:
      1. When the applicant is already receiving the services needed for employment and does not require any additional VR services to complete the existing services or plan for employment.
      2. When services needed for employment are readily available without VR providing, paying for, arranging, coordinating, or otherwise enhancing the service.
4. Benefit from Services: On the assumption everyone can work, Nebraska VR has determined if an applicant has a verified impairment, impediment to employment, and requires VR Services; it is then presumed the applicant can benefit from services. Once an individual has completed the VR Application the assumption of benefit exists. Ineligibility determinations will only occur after the initial eligibility determination and an exploration of the individual's abilities, capabilities, and capacity to perform in realistic work situations will be conducted. If there are eligibility concerns consult with the office director and review the Program Manual Chapter Ineligible/No Longer Eligible
5. Priority Group Assignment:  An individual’s priority will be determined at the time of eligibility based on the individual’s specific functional limitations (communication, interpersonal skills, mobility, self-care, self-direction, work skills, or work tolerance) of their disabling condition(s). Functional capacities are NOT based on projected limitations the individual may have in the future or other situational factors (age, geographic location, cultural expectations, poverty, lack of transportation, etc.). Functional limitations are based solely on the individual's impairment(s) that result in a substantial impediment to employment. Use the Functional Capacity Checklist and Disability Handbook to assist in determining the appropriate limitations and priority group assignment. When the agency is under an Order of Selection, those with the most significant disability or disabilities will be served first. See Program Chapter Order of Selection 
   1. 1. Nebraska VR Priority Group assignment: 
         1. Priority Group 1: Has a severe physical or mental impairment resulting in a rating of very low in two or more of the 7 functional areas. 
         2. Priority Group 2: Has a severe physical or mental impairment that results in a very low rating in one functional area. Verified SSDI or SSI recipients qualify for priority group two at a minimum and are assessed to determine whether they qualify for priority group one.
         3. Priority Group 3: All eligible individuals. These individuals must have a low rating in at least one of the seven functional areas.
6. QE2 Functional Capacity screen must be completed AND approved to finalize the eligibility process and the assignment of the priority group. Upon QE2 ELIGIBILITY completion, the following will occur: 
   1. QE2 will generate the appropriate eligibility letter to be sent by the VR State Office to the client and a case file task note indicating the eligibility/Priority Group Letter has been sent. Note: If the individual requires the Eligibility/Priority Group letter to be in Spanish, the VR Staff checks the "Spanish communication," box located in the client's personal information section of QE2. This will serve as notice for the eligibility letter to be sent in Spanish. A copy of the eligibility letter will be sent to the local VR Office to be uploaded into the client's electronic casefile.
   2. The VR Specialist will proceed based on the letter generated to the client. A client in an open priority group may begin receiving services immediately. Those in a closed priority group may be placed on a waiting list. If the client has not already stated a preference for being placed on the waiting list, contact them to determine their interest in being placed on the waiting list. If there is no response to the Eligibility/Priority Group letter and multiple attempts have been made to contact the individual by a variety of methods, to include a contact and 15-day letter, the case may be closed by the VR Specialist. The date of the letter serves as notification and timeline in the process. An official Termination letter must be sent. See Program Manual Termination chapter.
   3. A client can be moved to a higher priority group at any time if information becomes available indicating additional or more severe functional limitations exist or they begin receiving SSI/SSDI. Utilize the individual's work history and Functional Capacity Checklist to determine appropriate functional limitations and priority group assignment. The local VR Office completes the following:
      1. Enter the reasons for the priority group upgrade in a TASK note, 
      2. Update the QE2 Functional Capacity screens, and
      3. The local VR Office sends OOS Upgrading Priority Group Letter.
7. Information and Referral to other agencies. Nebraska VR must discuss with the applicant their eligibility and priority group assignment, as well as provide information and referral to community resources, if not already provided.

1. Determine the status of the Worker Compensation (WC) case. Contact one of the Rehabilitation Specialists at the Workers' Compensation Court (402-471-6468). This is public information, and a release is not required, but best practice is to ask the applicant's permission and call the individual in your office.
   1. If the WC case is settled/closed - proceed as a regular VR referral.
   2. If the WC case is not settled - determine if the applicant has reached Maximum Medical Improvement (MMI).
      1. If the individual has NOT reached MMI - Do not proceed with the VR Application. It is difficult to determine VR Eligibility until MMI has been met, as there is a question of permanent impairment. Explain this to the applicant and encourage them to recontact Nebraska VR after reaching MMI.
      2. If the individual has reached MMI it is recommended the individual and the VR Specialist or Office Director contact the Court Certified Rehabilitation Specialist (if one has been assigned) together while the client is in the VR office to understand the direction of the WC case and what additional services Nebraska VR can provide. If a decision is made to open a Nebraska VR case, the Court Certified Rehabilitation Specialist should be added to the information release for future communication. If the client has a Worker Compensation Lawyer, this name should also be added to the release.
   3. An individual being referred to Nebraska VR can be referred for one of two reasons:
      1. Placement Services - A referral for placement services from a Court-Certified Rehab Counselor must be made to the Office Director who will assign the case to an Employment Specialist. Certified Rehab Counselors have access to all available services for the WC client, except placement services and may need VR's assistance in this area. This case will still need to follow VR Eligibility and Process.
      2. Case Coordination - A referral for case coordination or a self-referral does not need to go to the Office Director first. Case coordination requests are VR services not provided by the Worker's Compensation Certified Rehab Counselor, insurance company, etc. VR does not supplant services that should be provided by other agencies or individuals.
2. Conduct Initial Meeting. Determine if the request for services is consistent with Nebraska VR Policy. 
3. Determine eligibility and priority group assignment.
   1. Information required for eligibility can be obtained from the Court-Certified Rehab Counselor, Worker's Compensation Court, lawyer, medical professional and/or from the individual.
   2. If there is disagreement about the job readiness of the individual the VR Specialist and Office Director should discuss the issues with the Court-Certified Rehab Counselor. If resolution is not reached, contact the VR Program Director of Counseling.
4. Develop Individualized Plan for Employment (IPE)
   1. The VR Plan must be consistent with the WC Plan.
   2. Information needed to justify the IPE can be obtained from the Court-Certified Rehab Counselor and from the individual. The individual may have participated in vocational and/or Loss of Earnings Assessments that can be useful in development of the IPE.
   3. The client and VR Specialist must agree to the job goal on the approved Workers' Comp Plan.
   4. The Nebraska VR IPE must include the same job goal as the approved Workers' Compensation Plan.
   5. If there is disagreement about the appropriateness of the job goal, the VR specialist and Office Director should discuss the issues with the Court-Certified Rehab Counselor. If resolution is not reached, contact the VR Director of Counseling.
5. Proceed with services and follow all VR rules and regulations regarding case contact, service provision and case closure. 

US Department of Veterans Affair (VA) - Veteran Readiness and Employment Services (VR&E) provides benefits and services that enable transitioning service members and veterans with service-connected disabilities and an employment barrier, to prepare for, obtain and maintain suitable employment.

Staff from Nebraska VR and Veteran Readiness and Employment Service (VR&E) will work collaboratively in serving veterans who are eligible for both programs prepare for, obtain, and retain employment.

• Medical and vocational information will be shared between both agencies, when needed with the appropriate release.
• Both agencies prepare written plans with the veteran. These will be provided to the other agency when needed.
• When both agencies and the veteran agree on a plan the Veteran Readiness and Employment Service will pay for many of the services needed. VR may fund those services not already available to the veteran.
• All VR rules and regulations are still applicable.

Veteran Readiness and Employment (VR&E) referrals to VR 

1. Provide the Initial Meeting. (Initial Meeting)
2. Determine Eligibility 
3. Develop the IPE in collaboration with the VR&E worker to determine agreed upon employment goal, coordinate services to avoid duplication.

VR referrals to VR&E

1. Refer individuals to VR&E if you believe the individual is a veteran with a service-connected disability.
2. Client can apply through the US Department of Veterans Affairs website: How to apply for Veterans Readiness and Employment
3. Contact the VR&E staff member assigned to coordinate services. If the veteran is eligible for VR&E services and VR&E staff agree with the Nebraska VR client's IPE they will likely help pay for necessary services. If comparable services and benefits are currently available and ready for immediate use, they must be used to meet, in whole or part, the cost of the program services. 
4. Maintain contact with the VR&E worker.