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4.8. Prosthetic Representative
a. Role. The Prosthetic representative will ensure that:
(1) A copy of a certified VA Form 21-4502, is on file in the veteran's outpatient treatment file to support eligibility determinations; or if the veteran's eligibility for adaptive equipment is based on a service connected ankylosis, a copy of the veteran's VA Form 21-6796, Rating Decision, will be filed. If the veteran is seeking only medical equipment, the Prosthetic representative will ensure that the veteran is enrolled in VA's health care system. NOTE: A VA Form 21-4502 will not exist for these veterans since they have no eligibility for the automobile grant.
(2) The veteran has a valid driver's license and is capable of operating a motor vehicle, if operational equipment is authorized.
(3) Reimbursement for a replacement vehicle does not exceed two vehicles in any 4-year period.
(4) All adaptive equipment authorized is consistent with VA policy, e.g., cost limitations have not been exceeded, the equipment has been approved for issue to VA beneficiaries, etc.
(5) Prescriptions have been written and are supported by medical findings for all items where a prescription is required.
(6) The supplier has certified that the amounts billed do not exceed the usual and customary cost for the items or services furnished.
(7) The equipment furnished has been inspected (if required).
(8) The veteran's request for adaptive equipment is processed within 5 days after all information, invoices, prescriptions, reviews, inspections, etc., have been completed. After posting to the veteran's VA Form 10-2319, Record of Prosthetic Services, the original VA Form 10-1394, Application for Adaptive Equipment — Motor Vehicle, the window sticker and supporting invoices will be forwarded to the Finance activity of the regional office having jurisdiction over the veteran's case. Copies of the VA Form 10-1394 and all supporting documentation concerning the processing of the claim are to be filed in the veteran's Consolidated Health Record.
(9) Requests for automobile adaptive equipment for veterans undergoing a course of vocational rehabilitation will be processed in the same manner as those veterans eligible for adaptive equipment under 38 U.S.C. Chapter 39 with the following exceptions:
(a) VA Form 28-8861, Request for Medical Services - Chapter 31, is required from the Vocational Rehabilitation and Education (VR&E) case manager before any action is taken to furnish, repair or replace automobile adaptive equipment.
(b) Replacement equipment is subject to the limitations or authorization of supplies issued under the regulations, policy and procedures for implementing the provisions of 38 U.S.C. Chapter 31.
NOTE: It should be noted that these procedures are considerably more stringent in relation to the replacement of equipment than those for replacement under the authority of 38 U.S.C. Chapter 39. In general, adaptive equipment will only be authorized for one vehicle during the veteran's training program unless a replacement vehicle is required because of loss of the modified vehicle due to circumstances beyond the veteran's control, e.g., fire, theft, court action, etc. Title 38 U.S.C. Chapter 15 veterans are not eligible for automobile adaptive equipment.
b. Responsibilities. The Prosthetics Representative is responsible for the administration of the automobile adaptive equipment program at each medical center which has jurisdiction over a given geographical area. All Prosthetics Representatives will ensure that the following conditions are met:
(1) All approved vehicle modification vendors are informed that pre-authorization is required before any work is initiated.
(2) Information is provided to the medical staff, veterans or their representatives on the adaptive equipment which has been tested and found to meet the VA standards of safety and quality.
(3) Local procedures are developed in accordance with the policies stated in this chapter to ensure effective, economical and uniform administration of the adaptive equipment program at their facility. Written guidelines concerning automobile adaptive equipment will be published in a separate facility memorandum or included in the facility memorandum on Prosthetic Services. These guidelines will contain specific instructions regarding the evaluation, prescription, patient referral for, and authorization of, automobile adaptive equipment.
(4) All applications for adaptive equipment submitted by beneficiaries are reviewed to determine that the applicant is eligible, licensed, and that the provision of the requested adaptive equipment to the veteran is within the limitations stated in this Handbook.
(5) Direct contact is maintained with local distributors, installers, service and repair facilities, state licensing authorities, etc., in connection with providing adaptive equipment for specific beneficiaries.
(6) Reimbursements to applicant, a company, or other third parties that furnished adaptive equipment, repairs, or services to the veteran are approved.
(7) The beneficiary is assisted in arranging for special driver training, when requested or when it is apparent that an applicant requires training.
(8) Workmanship is inspected for all vehicle modifications and low-effort steering systems purchased. The inspection will include, at a minimum, functional testing and observation of the structural integrity of the installation. It will also include verification and documentation of serial numbers, the type of equipment and identification of the vehicle in which they are installed. Copies of inspection reports and all documentation supporting an adaptive equipment claim will be filed in the veteran's Consolidated Health Record and Adaptive Equipment file maintained in Prosthetic Service.
(9) Eligible veterans will not be required to obtain bid quotes.