Breaking news: VA OD physician-level recognition legislation signed into law

A new law, long advocated for by the AOA and Association of Armed Forces and Federal Optometric Services (AFOS), provides physician-level recognition for Department of Veterans Affairs (VA) doctors of optometry, helping better meet veteran demand for eye care by closing a widening doctor recruitment and retention gap.

On Jan. 2, President Joe Biden signed into law the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. The reform bill is notable for its sweeping list of VA policies, including adding optometry to the physician pay scale and giving the department the latitude to offer increased pay awards, bonuses and annual evaluations.

“Including the over 1,000 optometrists within the physician pay administration system with passage of the Elizabeth Dole Act will support VA’s efforts to hire the most qualified providers faster,” says Jeanette Carbone Varanelli, O.D., who served 13 years as chief of optometry at John D. Dingell VA Medical Center prior to joining the Veterans Integrated Service Network (VISN) 10 Clinical Resource Hub. “Raising the entry-level salary and earning potential as a career VA optometrist provides the opportunity to offer a more competitive compensation package to retain providers that understand how to support and care for the unique needs of our nation’s veterans.” 

Vision and eye health care is the third-most requested service by veterans—behind only primary care and mental health care—with VA doctors of optometry providing roughly 70% of essential primary and medical eye care services. Often the only licensed independent eye care practitioner available at their site, VA optometrists: 

• Practice at 95% of VA sites where eye care is offered. 
• Provide 73% of the 2.5 million selected ophthalmic procedures. 
• Provide 99% of services in low-vision clinics and blind rehabilitation centers. 

Yet despite the key role that optometry plays in the delivery of VA health care nationwide, VA optometrists were included in the general schedule (GS) pay scale, which has gone largely unchanged since 1976.  

When 2004 legislation created a new pay scale for allopathic and osteopathic physicians to remain competitive with private-sector opportunities, dentists, podiatrists and optometrists were initially left out. Over time, dentists and podiatrists were added to the physician pay scale, but optometry remained in the GS pay scale with a pay cap far below that of the private sector in many regions. The unfortunate consequence meant numerous vacant optometry positions at VA facilities went unfilled, a problem magnified by the fact that over 20% of the VA optometry workforce is at or near retirement with many having reached the legislative pay cap.

H. Lindsay Wright, O.D., AFOS executive director, calls signing of the VA bill a critical step forward for doctors of optometry and the veterans they serve.

“Moving optometrists to the physician pay scale appropriately recognizes the essential role optometrists play as frontline providers of eye and vision care within the VA health care system,” Dr. Wright says. “This legislation ensures that we can continue to recruit and retain highly skilled doctors of optometry to deliver the quality care our veterans deserve, while elevating the profession to where it belongs—alongside our physician colleagues.” 

⏩ Analysis: Comprehensive eye exams more cost-effective than military vision screenings. 

Coalescing support for VA optometry’s inclusion in physician pay scale

The AOA and AFOS have prioritized VA optometry’s pay scale discrepancy as a top federal priority, most recently briefing optometry’s advocates during AOA on Capitol Hill in April 2024. In over 300 meetings with members of Congress, advocates canvassed the capital to build support for the pay scale fix and ensure the VA could retain and recruit optometrists to better compete with the private sector. But even before that, optometry’s advocates have championed the issue alongside veterans’ organizations and directly to the VA itself. 

As far back as August 2022, the VA acknowledged the pay discrepancy with a memo that noted optometry’s current salary structure was “inadequate” and that “many VHA Optometry departments were unable to hire VA Optometrists.”  

Leading Veterans Service Organizations (VSOs), including American Veterans (AMVETS) and Disabled American Veterans (DVA), also cast support behind adding optometry to the physician pay scale, so doctors of optometry could receive a market-based pay analysis in determining salaries. 

“VA must immediately address the issue of optometrists at the VA being among the most undervalued practitioners within the system,” noted Bill Clark, AMVETS national commander, in March 2024 testimony before the Joint Hearing of House and Senate Committees on Veterans’ Affairs. “Despite their integral role in providing essential eye care services to veterans, VA optometrists are the only independently licensed practitioners not included on the VA physician pay scales. This oversight has led to a significant and troubling trend: a mass exodus of highly qualified optometrists from the VA and considerable challenges in recruiting top-tier talent.” 

Clark continued: “Addressing this disparity is essential for maintaining the standard of care that veterans need and deserve, ensuring they have access to the best possible eye and vision health care services.” 

In a letter to VA Secretary Denis McDonough, Michael Jernigan, Blinded American Veterans Foundation president, noted that addressing this issue is critical to maintaining a workforce capable of providing the best possible care to the nation’s veterans. 

“The combination of limited practice scopes and inadequate compensation is deterring top-tier optometrists from choosing a career with the VA,” Jernigan warned in alluding to a separate advocacy scope battle over the establishment of national optometry standards of practice.  

The VA has the largest clinical education program for optometrists in the U.S., with more than 200 VA residents training in VA sites nationwide. What’s more, another 1,300-1,400 students are trained annually at a VA site during their fourth-year externship. As a result, many doctors of optometry choose to pursue a career in the VA, and the recent congressional action will help ensure the recruitment and retention of those doctors. 

Save the Date: AOA on Capitol Hill 2025 

Interested in getting involved and advocating for the profession at the federal level? Join optometry’s advocates at AOA on Capitol Hill, the AOA’s single-largest annual advocacy event in Washington, D.C., moving to an all-new date, Sept. 28-30, 2025. 

Further information about AOA on Capitol Hill 2025 will become available on the AOA’s Calendar of Events page in the months ahead.