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January 2009

**VA's Prosthetics and Sensory Aids**

The Department of Veterans Affairs (VA) has become a world leader in
prosthetics and rehabilitation through an integrated delivery system
designed to provide prosthetic and sensory aids, devices, assistive aids
and repairs to disabled veterans in order to facilitate treatment of
their medical conditions.

VA's Prosthetic and Sensory Aids Service (PSAS) is the largest and most
comprehensive provider of durable medical equipment and prosthetic
devices in the world. Although the term "prosthetic device" may suggest
images of artificial limbs, it actually refers to any device that
supports or replaces a body part or function.

VA provides a full range of equipment and services to veterans. These
range from items worn by the veteran, such as an artificial limb or
hearing aid; those that improve accessibility, such as ramps and vehicle
modifications; and devices surgically placed in the veteran, such as
hips and pacemakers.

The number of veterans seeking prosthetic services from VA exceeded 1.9
million in FY 2008. As the demand increased, so did the budget to
provide them, going from \$532 million in 2000 to \$1.6 billion in 2008.
Although the number of veterans seeking services continues to rise, the
primary reason for the increased spending is the cost of the products
and services provided, especially costs of new technologies.

VA provides items prescribed by appropriate VA clinicians. Items may
range from a \$2 cane tip to a \$100,000 microprocessor-controlled
bionic knee that replaces muscle activity to bend and straighten the
knee. Regardless of cost, VA's mission is to provide the most
appropriate technology to veterans in a timely manner.

**Specialists, Services, Training**

One of the many avenues to providing the best devices to veterans is
through VA's prosthetic and orthotic laboratories. As of August 2007,
all 63 VA prosthetic and orthotic labs earned certification by one of
the two national accrediting organizations. Eight of these labs are also
accredited by the National Commission on Orthotic and Prosthetic
Education, enabling them to participate in residency programs of the
nine prosthetic and orthotic programs in U.S. universities and colleges.

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**Prosthetics & Sensory Aids 2/2/2**

One of those nine schools, California State University--Dominguez Hills,
is relocating to the Long Beach VA Medical Center campus. This
collaboration with the prosthetic educational system, which includes a
contractual training program, will further strengthen clinical care by
providing training courses for VA's orthotic fitters.

VA has 131 board-certified prosthetists and orthotists working at its
labs, a standard that far exceeds the private sector. After assessing a
patient, an orthotist designs and fabricates a custom orthopedic
appliance, such as a brace or splint, to meet the veteran's physical
challenge, and fits it to a patient's extremity or spine. A prosthetist
works with a veteran amputee to perform a mechanical assessment, design
a custom prosthesis, fabricate custom sockets, order components,
assemble the prosthesis and perform an alignment process to ensure that
the veteran can use the prosthesis to its highest potential.

Specialized equipment in the laboratories enables the prosthetist and
orthotist to design, fabricate, repair and adjust the veteran's
appliances. VA is a leader in the use of the newest computer-aided
design and manufacture (CAD/CAM) equipment. Prosthetic representatives,
prosthetists and medical specialists in various disciplines are part of
VA medical centers' amputation care teams, responsible for assessing a
veteran's prosthetic needs. The team prescribes a prosthesis based on
the veteran's medical condition, needs and stated goals, and evaluates
its functionality after it is made and delivered to the veteran.

Whether provided by VA prosthetists or through one of more than 600
contracts with nationally accredited local prosthetists, VA pays the
full cost of a limb as well as all repairs. This applies to all devices
provided through prescriptions. VA prosthetists support all the
specialty clinics that require a prosthetic device for a veteran, such
as spinal cord injury, audiology, blind rehabilitation and podiatry.

**Special Programs**

In addition to providing devices, VA also administers three unique
programs to assist veterans with disabilities. An annual clothing
allowance is available to veterans with a service-connected condition
who, because of the disability, must wear a device or use a prescribed
ointment that damages outer clothing.

VA also provides a Home Improvement and Structural Alterations grant.
The grant is given to alter the home of a veteran who needs access.
Examples include ramps, railings, lowered countertops, flooring, widened
doorways and accessible bathrooms. The one-time maximum amount (\$1,200
for non-service-connected veterans and \$4,100 for service-connected
veterans) depends on the veteran's service-connected rating.

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**Prosthetics & Sensory Aids 3/3/3**

In keeping with its dedication to providing equipment to address all the
needs of veterans, VA administers the Automobile Adaptive Equipment
program. This program provides equipment and training that some
service-connected patients need to enter, exit and operate a motor
vehicle once they have been awarded an automobile grant and completed
driver's training with an approved driver evaluator. A patient who does
not meet the criteria to operate a vehicle can still be approved for
equipment to enter and exit a vehicle.

**Iraq and Afghanistan**

This wide breadth of equipment and services VA can provide is not
limited to veterans of a particular period of service. VA is sensitive
to the needs of the newest veterans, who comprise less than 5 percent of
the work of its Prosthetics and Sensory Aids staffs nationwide. At the
end of fiscal 2008, VA had provided equipment to 89,152 veterans of
Operation Enduring Freedom and Operation Iraqi Freedom, in addition to
millions of veterans from earlier periods. The majority of those
veterans were not seriously wounded and do not require complex devices.
Many require small, inexpensive devices such as braces or eyeglasses.

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