ELIGIBILITY:

1. Determine the impairment.
   • Impairments are physiologic, biologic, or psychological dysfunctions, disorders, or losses.
   • Physical impairments are produced by any physiological disorder or condition 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 a permanent 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 (physical impairment you can actually see), or by gathering medical information that verifies the diagnosis. Other apparent impairments should be noted in QE2 but do not require verification.
   • For Social Security, Veterans, and Worker's Compensation information see VRIS - Case Services - Referral to Eligibility section.
   • Information on selected impairments:
     • Alcohol and/or drug abuse or dependence, determine the individual is not actively using and eligibility decision is not being made based on length of sobriety. (See Background and Training below for more information)
     • Hearing loss. Review completed Communication Assessment Form with the individual (required). Optional form: Provide copy of "Good Meeting Rules" for clients. Consider the need for assistive listening devices and a referral to ATP. For hearing aid purchase information see Hearing Aids
     • The Commission for the Blind and Visually Impaired (NCBVI) serves individuals who experience visual impairments. Refer any individual who has an impairment of vision to NCBVI. If the individual is not eligible for NCBVI services based on the visual impairment, VR may assess eligibility based on other impairments. VR cannot serve any individual whose only disability is loss of vision. See VRIS Eligibility- Vision/Sight Impairment
2. Verify the impairment.
   • Observation. VR specialist observation can be used, when possible, to determine impairment. VR staff are not 'diagnosing’ but are observing a person does have an obvious impairment. Observation may be used to verify impairments when:
     • ​​​​the VR specialist can actually see the impairment (amputation, paraplegia, deaf, etc.); or
     • the individual requires use of assistive technology (use of wheelchair, use of mobility aids, use of hearing aids, etc.).
     • If observation is used exclusively to determine eligibility, a very descriptive narrative of the impairment is required to substantiate the VR Specialist's elgibility decision in the absence of medical documentation. 
   • Reports. Obtain report from person licensed or certified to make a diagnosis (See below Background and Training - 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:
     • Request for Medical Information form; copies of medical or psychological reports from the source or from the individual;
     • MDT reports from secondary schools are acceptable for specific learning, speech, language and intellectual disabilities. IEP reports are not acceptable as this is the school's plan for services, not a diagnostic tool. See Background & Training in this chapter for more information.
     • 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.
   • Investigate how the impairment hinders an individual from preparing for, entering into, engaging in, or retaining employment consistent with their abilities and capabilities.
   • Explore the applicant's work and school history for evidence of vocational limitations. (Disability Handbook is available in each Nebraska VR office, for specific impairment information and vocational questions to explore. 
4. Verify the substantial impediment to employment:
   • Currently Working. 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, retaining employment consistent with their abilities and capabilities.
   • Utilize existing information. 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, work experiences 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. 
   • New or recent physical or mental impairments, the duration or expected duration of limitations and their seriousness need to 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.
     • If the individual is still in recovery, it may be too soon to determine permanent functional limitations or the severity.
     • Temporary, non-chronic impairments (such as broken limbs, sprained joints and situational depression) usually do not result in long-lasting functional limitations. 
   • Functional limitations are NOT based on future or projected job goals or environmental factors (lack of transportation, etc.).  The distinction between a substantial impediment to employment for purposes of eligibility and a serious functional limitation for purposes of establishing priority for service is one of degree and scope. The degree and scope is serious if an individual can only perform a function, or can only learn to perform a function with a significant accommodation and/or substantial support.
   • 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 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.
5. Determine whether the individual can benefit from VR services.
   • Determine if the person could reach an employment outcome if VR services are provided. Employment outcome is full-time or part-time competitive, integrated employment, supported employment, self-employment or telecommuting. Federal regulations make clear the expectation that VR presume any individual with an impairment would meet this requirement.
6. Verify the individual can benefit from VR services.​​​​​​
   • It is presumed 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. Utilize Planning and Readiness Factors.
   • In making a decision 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 work experiences conducted by:
     • Sheltered Employment program; or other current or recent period of vocational services comparable to those could be provided with extended evaluation services.
     • Community Rehabilitation facility program;
     • School work experience program;
     • Vocational Education program;
     • If existing information does not provide this clear and convincing evidence, VR staff  must arrange for a Trial Work Experience in the most integrated setting possible with appropriate supports, assistive technology devices and support services. See VRIS Ineligible/No Longer Eligible
   • Can legally work - If non-citizen, lawful presence and eligibility to work verified through SAVE and documented on Citizenship screen. See VRIS: Application & Transfer to Employment Program     
7. Determine whether the individual requires VR services.
   • Determine 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 in gainful employment.
9. Complete the eligibility and priority group determination in QE2. 
   • Use the individual's work history and Functional Capacity Checklist to determine appropriate functional limitations and priority group assignment. See Order of Selection

ELIGIBILITY EXTENSION:

Prior to the 60 day Eligibility Deadline:

1. Discuss the need for an eligibility extension with the client. Explain exactly what caused the delay, what is needed to complete the eligibility determination and why.
2. Obtain agreement with the client for the extension and estimated date it will be completed and outline the specific steps required  for the Eligibility Approval within the additional 60 days allowed. The client needs to agree to the extension for the case to remain open. 
3. Complete the Eligibility Extension screen in QE2 to request Office Director approval. 

• Only one extension is permitted, per case for a maximum of an additional 60 days and a maximun total of 120 days. Whether the extension is 60 additional days or less than 60 days, only one extension is allowed. 
• The Eligibility Extension must be completed BEFORE the actually due date (day 59 or less). Extensions completed prior to 60 days can be backdated by the Office Director to the date the extension was completed.
• If an extension is not completed before the 60th day, is still required but the date approved by the Office Director can no longer be backdated. The actual date the Office Director approves the extension in QE2 will be recorded as the official date.

4. The date the Office Director approved the extension in QE2 is the official approval date. Approving the extension will auto generate a task note in the case file.
5. Once the an extension is completed, every effort should be made to approve the eligibility prior to the agreed upon extension date. 
6. If the extension date expires, the eligibility can still be completed but it will require an Office Director approval. The case can also be closed, if needed. 
7. In the rare occurrence when the eligibility determination exceeds the maximum 120 days without approval:

• The VR staff must enter a task note justifying the rationale for not completing the eligibility within 120 days and the specific steps to be taken by VR and/or the client to alleviate the situation;
• An automated e-mail will be generated to the Director of VR and the Specialist's Office Director for review of the case.
• All eligibilities completed after 120 days require Office Director approval.

ELIGIBILITY: Eligibility must be completed within 60 days of the application for services. Individuals must be determined eligible prior to providing VR services under an Individualized Plan for Employment (IPE).

Eligibility requirements:

• Permanent Impairment (diagnosis)
• Substantial Impediment to employment (functional limitations)
• Benefit from VR Services  (employment outcome from the provision of VR services)
• Require VR Services (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 he or she will be eligible for services. However, the VR Service Specialist should clearly explain only a VR rehabilitation specialist or VR Office Director has the authority to officially determine eligibility for services.

If existing information does not provide clear and convincing evidence for the determination of eligibility, VR Specialist must arrange for a trial work experience in the most competitive, integrated setting possible and provide appropriate supports, if needed. See VRIS  Ineligible, No Longer Eligible  for specific requirements for this determination.

ELIGIBILITY EXTENSION:  If staff  are unable to complete the eligibility determination within 60 days, an Eligibility Extension is required to be completed in QE2 prior to the 60 day Eligibility deadline and Office Director approval is required.

• The Eligibility Extension must be completed BEFORE the actual due date (day 59 or less).
• Only one extension is permitted, per case for a maximum of an additional 60 days for a total of 120 days. Whether the extension is sixty additional days or less than 60 days, only one extension is allowed. 

In the rare occurrence when the eligibility determination exceeds the maximum 120 days without approval:

• The VR staff must enter a task note justifying the rationale for not completing the eligibility within 120 days and the specific steps to be taken by VR and the client to alleviate the situation;
• All eligibilities completed after 120 days require Office Director approval.

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

• Multi-Disciplinary Team (MDT) report from secondary schools for: 
  • Acceptable verification for specific learning, speech, language and intellectual disabilities.
  • Verification must include type and severity (moderate intellectual disability, Learning Disability in Reading Fluency, etc.). 
  • Verifications of Behavior Disorder, Developmental Disability, Other, Multiple Impairments, Mental Handicap, Orthopedic, etc. are general categories and do not qualify as an actual diagnosis, so medical verification will need to be obtained from the diagnosing physician.
  • Additional medical diagnosis to those listed above, included on the MDT require verification from the diagnosing physician. 
  • Individualized Education Program (IEP) reports are not acceptable for diagnosis verification, as this is the school's plan for services not a diagnostic tool.
  • Best practice is to request all available school records when requesting the MDT to assist with career counseling (Psychological exam, IEP, grade transcripts and any work experience reports).
• 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, but the justification and rational needs to focus on the actual functional limitations, not the external situation. Example: Due to drug dependence at a young age, the individual's decision making and skills have been delayed resulting in difficulty problem solving through peer pressure situations. His limited ability in determining the repercussions of his actions has resulted in several thefts convictions to support his drug habit.

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;
• School Psychologists for specific learning, speech, language and intellectual impairments. Information must include specific identification of type or severity (moderate intellectual disability, Learning Disability in Reading, etc.
• 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).
• Audiologist for hearing impairments or ENT

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