The Department of Veterans Affairs strives for excellence in patient care and veteran's benefits for its constituents through high quality, prompt and seamless service to United States veterans.
The program provided 5,700,000 prosthetic item/services in the form of prosthetic appliances, sensory aids, medical equipment, medical supplies, surgical and dental implants, therapeutic devices and repair services during fiscal year 2005. The Veterans Health Care Eligibility Reform Act of 1996 significantly impacted the number of prosthetic item/services provided.
Uses and Use Restrictions
Funds may be used for case management of the eligible veteran by administrative control, purchasing and/or fabrication and repair of prosthetic appliances and equipment.
Appliances and services are provided only for the use and benefit of the disabled veteran to whom they are furnished.
The program also includes the replacement and repair of appliances and training in the use of artificial limbs, artificial eyes, wheelchairs, aids for blind, hearing aids, braces, orthopedic shoes, eyeglasses, crutches and canes, medical equipment, surgical and dental implants, medical supplies, and automobile adaptive equipment.
Any disabled veteran or authorized representative on his behalf meeting the criteria below may apply for prosthetic appliances or services.
VA may not furnish sensory-neural aids, e.g., eye glasses, hearing aids, etc., other than in accordance with guidelines established by the Secretary.
Veterans eligible for prosthetic services are service-connected veterans seeking care for a service-connected disability; veterans with compensable service-connected disabilities generally rated 10 percent or more; former prisoners of war, veterans discharged or released from active military service for a disability that was incurred or aggravated in the line of duty, and veterans who are in receipt of Section 1151 benefits; veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound; veterans who have annual income and net worth below the "means test" threshold; all other veterans who are not required to pay a copayment for their care, i.e., veterans of the Mexican border period and World War I, compensated zero (0) percent service-connected veterans who are receiving statutory awards, veterans exposed to a toxic substance, radiation or environmental hazard (limited to certain disabilities); and veterans who must pay a copayment for their care. Ineligible veterans are nonservice-connected veterans residing or sojourning in foreign lands.
Aplication and Award Process
This program is excluded from coverage under E.O.
Eligible veteran may request prosthetic services through their primary care provider when reporting in person to any VA Medical Center as well as by correspondence, telephone, or authorized community physician prescription.
38 U.S.C. 1162, 38 U.S.C. 1701, 38 U.S.C. 1710, 38 U.S.C. 1712, 38 U.S.C. 1713, 38 U.S.C. 1714, 38 U.S.C. 1717, 38 U.S.C. 1719, 38 U.S.C. 1723, 38 U.S.C. 1724, 38 U.S.C. 3104, 38 U.S.C. 3901, 38 U.S.C. 3902, 38 U.S.C. 3903, and 38 U.S.C. 8123.
Range of Approval/Disapproval Time
All prosthetic requests require an initial action within five working days. Custom fabrication or design may increase the time before an item/service can be delivered.
A veteran who is administratively refused prosthetics services by a local VA health care facility may appeal to the Board of Veterans Appeals. Determinations of the Veterans Health Administration involving the need or nature of medical treatment as distinguished from legal or basic eligibility for medical services, are not appealable.
Formula and Matching Requirements
Length and Time Phasing of Assistance
For veterans in receipt of special monthly compensation or increased pension based on the need for regular aid and attendance, assistance is maintained for as long as eligibility continues (usually for life). Veterans are entitled to receive prosthetic services for as long as they are receiving VA treatment.
Post Assistance Requirements
(Value and Repair of Prosthetic Appliances, Home Oxygen, and Home Respiratory Therapy Supplies) FY 07 $1,236,275,000; FY 08 est $1,320,834,000; and FY 09 est $1,454,528,000.
Range and Average of Financial Assistance
$10 to $25,000. Average: $118.
Regulations, Guidelines, and Literature
38 CFR 17.150, 17.151, 17.152, 17.153, 17.154, 17.155, 17.156, 17.157, 17.158, 17.159.
Regional or Local Office
Initial contact should be made with the Prosthetic Representatives in 124 VA field stations, any VA outpatient clinic, CBOC or any veterans' service organization representative. See Appendix IV of the Catalog for the address of the nearest Veterans Hospital Facility.
CHIEF Prosthetics and Clinical Logistics Officer (10f), Department of Veterans Affairs, Washington, DC 20420. Telephone: (202) 254-0440. Fax: (202) 254-0470.
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