WASHINGTON, DC — While VA has long considered itself a provider of world-class prosthetics care, younger veterans are reporting that the department has yet to adapt to a more active patient population. This has resulted in delays in appointments, long waits for prosthetics and with veterans avoiding VA in favor of DoD facilities.
VA has seven regional amputation centers that do everything from prosthetic fabrication to full inpatient rehabilitation, along with 18 polytrauma/amputation network sites that can provide inpatient and outpatient care and prosthetic labs closer to veterans’ homes. In addition to smaller amputation clinics, this overlapping network of care is intended to cover the full range of veterans’ prosthetics and amputation care needs.
However, that network is being tested by post-9/11 veterans who live a more active lifestyle, wear through their prosthetics at a higher rate and consequently need more appointments with providers and more equipment replaced and repaired.
“The VA system might work [for older patients] but not for a younger patient population who are beating the crap out of their prostheses and trying to live a fulfilling life,” Jose Ramos, vice president of government and community relations for the Wounded Warrior Project, told the House VA Subcommittee on Health last month. “I have four [prosthetic] hands. I have four hands, because I break them fast. Because I’m an active individual.”
In recent years, veterans have come forward with stories of frustrating delays and poor communication with VA prosthetics clinics. Some have resorted to contacting their legislators to resolve the problem.
“One veteran told my team he’s waited for over a year for a new prosthetic leg, [and] for 10 of those months he had to rely on duct tape to hold his prosthetic together,” said Subcommittee Chair Rep. Mariannette Miller-Meeks (R-IA). “There’s still no timeline for when he’ll receive his new prosthetic limb.”
Matt Brown, a U.S. Army veteran, whose left leg was amputated below the knee when he was diagnosed with bone cancer, told the subcommittee that he spent 7 months in a wheelchair following surgery because of delays in getting a prosthetic.
“I learned later that remaining in a wheelchair as long as I did could inhibit physical and mental recovery,” he testified. “I had no idea it would take VA another two years to get me that proper prosthetic, and that I would have to advocate vigorously for myself at every turn.”
Even after he received his prosthetic, Brown encountered frustrating, even humiliating, challenges at VA. During a visit 2 years ago to his prosthetic vendor for routine maintenance, the vendor informed him that they were repossessing the prosthetic because VA had not paid them.
“I left the vendor without the ankle and had to temporarily use an older ankle that wasn’t flexible for the next year,” Brown said.
There are steps VA can take to live up to its promise to veterans, Ramos told legislators.
“First, the VA needs to recognize the unique needs of amputees by not lumping users of prosthetics limbs with those who use hearing aids and wheelchairs,” he said.
VA’s Prosthetics and Sensory Aid Service (PSAS), the office within VA in charge of procuring prosthetics, defines “prosthetic” as any device that supports or replaces a body part or function. In addition to prosthetic limbs, that includes hearing aids, wheelchairs, pacemakers and artificial hips, as well ramps and vehicle modifications.
This generalized definition has hindered VA’s ability to care for amputees and results in PSAS having competing priorities, Ramos said. The office also prioritizes the procurement of prosthetics, while regularly sending veterans to DoD or community providers for clinical care. This is reflected in the office’s budget, which includes only a small amount for clinical care, and which is nested under procurement and logistics.
This lack of focus on dedicated funding for care can lead to long wait times and inconsistent standard of care between VA facilities, Ramos explained. VA should create a separate service for amputee care, as well an Amputee Prosthetics Center for Excellence.
He also recommended VA expand the hiring of prosthetists and in-house fabrication capabilities, provide necessary adaptive equipment to help veterans stay active instead of forcing them into rehab programs that may not be needed and increase funding to support and expand innovative programs like the Mobile Prosthetics and Orthotics team pilot program.
Until VA improves its services, dual-eligible veterans will likely choose DoD facilities for their prosthetics care, Ramos argued. Approximately 43% of veterans use DoD for prosthetics care, 30% use both VA and DoD, and 26% only use VA. On average, DoD delivers new replacement prosthetics to veterans in 28.8 days and repairs them in 29.8. This compares to 87 days for VA to deliver new or replacement prosthetics and 66.4 days for repairs.
Ramos recommended that VA take full responsibility for the prosthetics care of veterans, focusing solely on patient care and reducing the need to refer veterans to DoD or community providers.
“VA has struggled to realize that there is a larger, younger group of active amputees demanding more of their prosthetics,” Ramos said.
