1. Determine the physical or mental impairment.

   • Impairments are physiologic, biologic, or psychological dysfunctions, disorders, or losses.
   • Physical impairments are produced by any physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the major body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, hemic and lymphatic, skin, and endocrine.
   • Mental impairments are produced by any mental or psychological disorder, such as intellectual disability, organic brain syndrome, mental or emotional illness, and specific learning disabilities.
   • Impairments exist regardless of their impact (or lack of impact) on the everyday activities of the person. Determine the existence of an impairment without regard to medications, prostheses, 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.
   • Determine the primary impairment by assessing which impairment causes the greatest impediment to employment. The primary impairment must be recorded in QE2 and verified either through observation, or by gathering medical information. Other apparent impairments should be noted in QE2 but do not require verification.

2. Verify the physical or mental impairment.

   • Observation. VR specialist observation should be used, when possible, to determine impairment. VR staff are not ‘diagnosing’ but are observing that a person does appear to have an impairment. Observation may be used to verify impairments when:

     • the VR specialist can see the impairment (loss of limb, physical limitations, seizures, etc.); or
     • the individual requires use of assistive technology (use of wheelchair, use of mobility aids, use of hearing aids, etc.).

   • Obtain report from person licensed or certified to make a diagnosis (see Background and Training - Who Can Diagnose under Policy above). If observation is not possible you must obtain some other type of information to verify the impairment. This might include:

     • use of the VR 'Request for Medical Information' form; copies of medical or psychological reports from the source or from the individual; or
     • MDT reports from secondary schools (these are acceptable because individuals licensed to make diagnoses take part in the diagnosis). IEP reports are not acceptable.

   • As a last resort, examinations may be funded to obtain reports. Assure the individual understands that psychological testing may result in a mental health diagnosis and document this discussion in the task notes.

3. Determine the substantial impediment to employment.

   • This requirement means that a physical or mental impairment hinders an individual from preparing for, entering into, engaging in, or retaining employment consistent with their abilities and capabilities.

4. Verify the substantial impediment to employment.

   • In determining whether the person's physical or mental impairment causes or results in a substantial impediment to employment use existing information to the maximum extent possible. This would include VR specialist observations, information provided by other sources such as schools and information provided by the individual or family members. Often, information provided by the individual and family members is sufficient for determining whether an impairment causes a substantial impediment to employment.
   • For new or recent physical or mental impairments, the duration or expected duration of limitations and their seriousness should be considered. Determine whether current functional limitations will be resolved or significantly reduced in seriousness by the end of the usual period of treatment and convalescence for the condition. Temporary, non-chronic impairments (such as broken limbs, sprained joints, or lacerations) usually do not result in long-lasting functional limitations.
   • Specific questions to consider in determining substantial impediment might include whether because of the impairment the individual:

     • Has lost jobs;
     • Has an unstable work history;
     • Can't do the same work;
     • Is limited in the range of jobs in their community;
     • Would be subject to possible discrimination by employers;
     • Would have difficulty preparing for jobs (such as in training situations);
     • Would aggravate their disability by continuing in current job or previous jobs;
     • Is in danger of losing their job;
     • Has had difficulty in school; or
     • Has had difficulty in daily activities.

   • It is possible for a person to meet this criteria if currently working but underemployed. The key is whether the physical or mental impairment hinders the individual from preparing for, entering into, engaging in, or retaining employment consistent with their abilities and capabilities.

5. Determine whether the individual can benefit from VR services.

   • This requirement means that the person could reach an employment outcome if VR services are provided. Employment outcome is full-time or part-time competitive employment in the integrated labor market, supported employment, self-employment, telecommuting or homemaking. Federal regulations make clear the expectation that VR presume any individual with an impairment would meet this requirement.

6. Verify that the individual can benefit from VR services.

   • It is presumed that a person with a disability can reach an employment outcome with the provision of VR services unless there is clear and convincing evidence demonstrating the person is incapable of benefiting from vocational rehabilitation services.
   • In making a decision that a person with a disability is not capable of benefiting in terms of an employment outcome because of the severity of the disability, first determine whether existing information provides clear and convincing evidence the applicant cannot achieve, or does not want to achieve, an employment outcome, such as assessments and reports from previous trial work experiences conducted by a:

     • Vocational Education program;
     • School work experience program;
     • Community Rehabilitation facility program;
     • Sheltered Employment program; or Other current or recent period of vocational services comparable to those that could be provided with extended evaluation services.

   • If existing information does not provide this clear and convincing evidence, VR staff should arrange for trial work experiences in the most integrated setting possible with appropriate supports and assistive technology devices and services.

7. Determine whether the individual requires VR services.

   • Requires vocational rehabilitation services means the person requires a planned and coordinated individualized program of specific vocational rehabilitation services to prepare for, enter, engage in, or retain an employment outcome.

8. Verify the individual requires VR services.

   • To make this decision, consider:

     • the number and duration of specific vocational rehabilitation services required to overcome the person's functional limitations and employment impediments so that he or she can engage in gainful employment;
     • the person's need for specialized services, supports, or accommodations not typically used by the general public; or
     • the need for planning and coordination of multiple or complex services over a long duration to enable the person to prepare for, enter into, engage in, and maintain gainful employment.

9. Complete the eligibility determination in QE2 and placement into a Priority Group. (See Order of Selection Chapter)

Individuals must be determined eligible prior to providing VR services under an Individualized Plan for Employment. Eligibility requirements are:

• Physical/Mental Impairment. The individual must have a physical or mental impairment.
• Substantial Impediment to employment. The impairment must constitute or result in a substantial impediment to employment.
• Benefit from VR Services. The individual must be able to benefit in terms of an employment outcome from the provision of VR services.
• Require VR Services. The individual must require VR services to prepare for, secure, retain, or regain employment.

Eligibility determinations must be made by either a VR rehabilitation specialist or a VR office director. A VR service specialist may indicate to an individual their belief that he or she will be eligible for services and start the career planning process. However, the VR service specialist should clearly explain that only a VR rehabilitation specialist or VR office director has the authority to officially determine eligibility for services.

Eligibility must be completed within 60 days of the application for services unless exceptional and unforeseen circumstances beyond the control of staff preclude making the decision and the individual agrees to a specific extension of time. A QE2 Eligibility Determination extension is required if the decision exceeds 60 days.

Discrimination

Eligibility requirements are applied without regard to gender, race, age, color, or national origin.

Age Restrictions

There is no upper or lower age limit that, in and of itself, results in a finding of ineligibility for any person who otherwise meets the basic eligibility criteria.

Residency

There is no durational or other residency requirement imposed that excludes from services any person who is present in the State.

Open Case in Two States

An individual may have an active case in two state VR agencies at the same time and both VR agencies would be allowed to record a successful employment outcome. Contact the Program Director for Counseling Services to discuss if you learn a case is open in another state VR agency or if the individual tells you they are going to apply for services from another state VR agency.

Non-Citizenship

Only a non-citizen who is authorized by the U S Department of Homeland Security to work can be served by the agency. See Citizenship section in the Application and Transfer to the Employment Program chapter.

Information on Selected Impairments

• Alcohol or drug abuse (including marijuana)
  • A diagnosis of 'abuse' or 'dependence' is acceptable for impairment.
  • Decisions on eligibility will be based on individual circumstances and not on any pre-determined length of sobriety per Federal Regulations.  To assess progress toward abstinence:
    • Consider the steps the consumer is making to establish abstinence (treatment/recovery programs, AA/NA, sponsorship)
    • What is the recovery plan and the assessment of adequate progress toward recovery?
    • Use Best Practices Guide:  https://vris.nebraska.gov/wiki/pages/B5h0v8U9M/VR_Guides_&_Resources.html 
  • Federal regulations indicate that symptoms need not be active for an individual to have a disability, and thus, a substantial limitation to a major life activity (employment). 
  • Previous convictions, felonies and/or incarcerations due to abuse/dependence may be used in describing the impediment to employment as they do have an effect on the individual's ability to obtain employment and/or the types of jobs they might be able to attain.
• Borderline Intellectual Functioning.
  • If Borderline Intellectual Functioning is the diagnosis on a report received from an individual licensed to make such a diagnosis, it will be considered an impairment. Borderline intellectual functioning IQ ranges from 71-84. An MDT signed by a school psychologist or a psychological report signed by a school psychologist with a diagnosis of Borderline Intellectual Functioning would also be acceptable documentation.
  • Note: To document the impairment in QE2, select “borderline intellectual functioning (IQ 71-84)” from the list of impairments under Mental Functioning-Developmental. *Mental Handicap
  • Any diagnosis from an MDT of “mental handicap” will be considered an impairment. The maximum full scale IQ for “mental handicap” is 75. To document the impairment in QE2, select Mental Functioning-Developmental, then select either intellectual disability mild (IQ 50 - 75), intellectual disability moderate (IQ 35 - 55), or intellectual disability severe (35 and under) depending upon the full scale IQ.
• Hearing Impairments
  • See “Eligibility on the Basis of Hearing Loss” chapter.
• Visual Impairments
  • The Commission for the Blind and Visually Impaired (NCBVI) serves individuals who experience visual impairments. Refer any individual who has a visual impairment to NCBVI. If the individual is not eligible based on the visual impairment VR may assess eligibility based on other impairments. VR cannot serve any individual whose only disability is visual. See NCBVI Cooperative Agreement Chapter.

Who Can Diagnose

A diagnosis may only be accepted from individuals licensed and/or certified to make a diagnosis. This is limited to:

• Physicians (including Psychiatrists);
• Physician Assistants (if under the supervision of a licensed physician);
• Psychologists;
• Psychological Assistants or Psychological Associates (under the supervision of a licensed psychologist);
• Advanced Practice Registered Nurses (also called Nurse Practitioners);
• Licensed independent mental health practitioners (licensed to diagnose mental health conditions.);
• Chiropractors; and
• Alcohol and Drug Counselors (licensed to diagnose alcohol and drug disorders only).

VR will accept a diagnosis with the signature of a physician assistant or psychological assistant without the signature of their supervising physician.

Functional Capacities Checklist

Impairments Checklist