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3.4. Provision of Artificial Limbs
a. Artificial limbs, parts and repairs must be procured, fabricated and issued to eligible beneficiaries by prescription from a designated physician assigned to the Amputee Clinic Team or from the Prosthetic Representative in accordance with the policies and procedures outlined in VHA Handbook 1173.1, VHA Handbook 1173.2, and VHA Handbook 1173.3. Prescription for the initial prosthesis, and any change in the prescription, requires the involvement of the Amputee Clinic team physician, or in the case of a partial foot amputation, the podiatrist assigned to the Amputee Clinic Team. A prescription for a new prosthesis, or a change in the current prosthetic prescription, occurs in conjunction with an appointment in an Amputee Clinic.
b. These artificial limbs (appliances) can be procured from contract vendors where adequate appliance facilities are available, the time required to receive delivery of the appliance is not excessive for patients, and the prices charged for such appliances are reasonable. NOTE: VA Orthotic Laboratories with a certified prosthetist may also be used as a source in the fabrication of preparatory, temporary, and permanent artificial limbs.
c. Eligible veterans, as identified in VHA Handbook 1173.1, who have previously received artificial limbs from commercial sources, will continue to have their choice of vendors on contract with VA or their non-contract prosthetist, providing the prosthetist accepts the VA preferred provider rate for the geographic area. VA facilities with Orthotic Laboratories that have certified prosthetists, or facilities with access to a VA Laboratory, will provide eligible veteran amputees with the preparatory or temporary prosthesis and permanent limbs. NOTE: When the patient has achieved appropriate shrinkage and is ready for a permanent prosthesis, the preparatory or temporary prosthesis is replaced.
d. Terminal devices, i.e., hooks, hands, must be provided with replacement artificial arms. When a terminal device is prescribed, the selection of a particular type of hook and/or hand must be based upon a patient's lifestyle or vocational needs.
e. Recreational artificial limbs, which allow an amputee to participate in a specific recreational or athletic activity, may be provided. The following guidelines need to be followed whenever the issue of a recreational prosthetic appliance is contemplated:
(1) The physician assigned to the VA Amputee Clinic Team must prescribe the prosthesis.
(2) The prescription must indicate the therapeutic, rehabilitative or psychological benefit to be expected or achieved through participation in this specialized activity.
(3) The prescription must indicate that a conventional prosthesis, which is worn daily, is unsuitable for use in the recreational activity either because of environmental factors which would affect the prosthesis, or because a specialized function not available in the conventional limb is required in the activity.
(4) Frequently required prosthetic components (within the limitation of the storage area provided to P&SAS and the Orthotic Laboratories) are to be stocked to expedite patient care.