HomeVA ProstheticsVA Handbook 1173.2 - Furnishing Prosthetic Appliances and ServicesVA Prosthetics and Orthotic Laboratories

2.6. VA Prosthetics and Orthotic Laboratories

a. Scope

(1) The size of a VA Prosthetic and Orthotics Laboratory will vary depending on the needs of the VA medical center. Laboratories may be established as a necessary part of patient treatment services in any VA medical center when analyzed as cost-effective.

(2) The Prosthetic and Orthotic Laboratory will be assigned organizationally to the Prosthetic Service.

(3) Prosthetic and orthopedic appliances, when required to be custom-fabricated for specific veterans, may be procured from commercial vendors where adequate facilities are conveniently available. However, existing VA Prosthetic and Orthotic Laboratories will be used as a primary source and will be utilized to the fullest extent possible.

(4) Laboratories employing two or more technicians will serve as a referral source for the fabrication of orthotic and/or prosthetic devices for other VA facilities without a Prosthetic and Orthotic Laboratory or for those facilities with smaller laboratories.

(5) In field facilities having established VA Prosthetic and Orthotic Laboratories, the Chief Consultant, Prosthetic and Sensory Aids Service Strategic Healthcare Group (SHG), will periodically conduct an evaluation to ensure that the:

(a) Laboratory is being properly utilized to its full capacity; that the quality of appliances fabricated is completely satisfactory to prescribing physicians and is at least equal to the best available from local commercial vendors.

(b) Needs of the patients are being fully met through a combination of internal fabrication and commercial procurement.

(c) Laboratory is operating as efficiently and economically as possible.

(d) Current staffing is proper for the amount of work being done.

(6) In field facilities not having a VA Prosthetic and Orthotic Laboratory, but desiring to establish one, a request for authority, with full justification, will be submitted to the Chief Consultant, Prosthetic and Sensory Aids Service SHG, through the appropriate Network Director.

(7) VA Prosthetic and Orthotic Laboratories have been established at selected VA facilities (see App. C).

b. Responsibility

(1) The Chief Consultant, Prosthetic and Sensory Aids Service SHG, is responsible for the formulation of policies, standards, and scope of VA Prosthetic and Orthotic Laboratory activities, including, but not limited to, providing training and technical assistance to the laboratories, participating in the development and recommendation of space, equipment, and funds to be provided, and recommending proper staffing levels.

(2) The Director of a facility in which a VA Prosthetic and Orthotic Laboratory is located will be responsible for assuring that other VA facilities requesting services from the laboratory are afforded fair and equitable priorities, and the requirements of any one facility (including the Director's own) do not take precedence over any other. The Director will be responsible to the same degree for successful operation of this activity as for the conduct of other activities that solely benefit the Director's own facility.

(3) The Prosthetic representative will ensure that the quality of the appliances fabricated is satisfactory to patients and prescribing physicians, the time required for delivery is not excessive or will not result in prolonged hospital stays for patients, and the prices charged for such appliances are reasonable.

d. The Prosthetic and Orthotic Laboratory Supervisor is responsible to the Prosthetic Program Manager, for the efficient and economical administration and operation of the laboratory in accordance with established policies, standards and procedures.

c. Procedure

(1) VA Prosthetic and Orthotic Laboratories design, fabricate, repair, and fit custom-made artificial limbs, braces, corsets, surgical belts, arch supports, and similar appliances for VA beneficiaries on receipt of a properly prepared VA Form 10-2529-3, from any facility. The fabrication of permanent type artificial limbs may be authorized in accordance with the following policy:

(a) Non-service connected veterans who are new amputees will be provided a preparatory limb using conventional endoskeletal componentry. Once the veteran has achieved appropriate shrinkage and is ready for a permanent prosthesis, the socket may be replaced and the limb cosmetically finished. These veterans will not be referred to a commercial contractor unless such action is necessary to expedite the treatment process.

(b) Eligible veterans will select their provider for artificial limbs from the listing of contract vendors, including capable VA Prosthetic and Orthotic Laboratories. Service connected veterans who have obtained their most recent limb from a non-contract provider will be allowed to have their subsequent limb manufactured by the VA non-contract provider as long as the prosthetist is willing to accept the geographic VA preferred provider payment rate for the State in which the prosthetist performs this service. The VA Prosthetic and Orthotic Laboratory will be on the same listing, and may be selected to fabricate definitive limbs.

(2) Prosthetic and Orthotic Laboratories designated as Orthopedic Shoe Last clinics may fabricate or modify custom-made orthopedic shoes.

(3) Prosthetic and Orthotic Laboratories will store, modify as necessary, fit, and issue prefabricated orthotic devices, i.e., corsets, belts, elastic hosiery, and other appliances provided under centralized distribution programs or purchased from commercial sources.

(4) Prosthetic and Orthotic Laboratories must repair artificial limbs, braces, wheelchairs, and other appliances in possession of eligible veterans on receipt of VA Form 10-2529-3 or on presentation by the veteran of a valid PSC.

(5) Prosthetic and Orthotic Laboratories may participate in clinical evaluation studies of newly developed prosthetic and orthotic devices initiated by the Chief Consultant, Prosthetic and Sensory Aids Service SHG.


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