Chairwoman Buerkle, Ranking Member Michaud, thank you for the opportunity to appear before you and the Subcommittee concerning the capabilities of the Department of Veterans Affairs (VA) to deliver state-of-the-art care to veterans with amputations. I commend your Subcommittee for its continued work to ensure that veterans receive the best possible VA health care.
I am a combat disabled, former US Army infantryman, Vietnam veteran and a bilateral below the knee amputee for over 43 years. I am a retired VA employee with 27 years of service and 12 additional years of experience working for veterans service organizations. I have received prosthetic care from VA, Walter Reed Army Medical Center (WRAMC) and the Walter Reed National Military Medical Center (WRNMMC).
I also have been an amputee peer visitor and mentor for over 21 years primarily at WRAMC but also at the National Naval Medical Center and now at WRNNMC. I have made thousands of visits with wounded warriors and have witnessed firsthand the catastrophic injuries they and their families overcome through quality and comprehensive military health care and rehabilitation. I am a certified trainer for the Amputee Coalition for the Peer Amputee Visitor and the Wounded Warrior Project Peer Mentor programs.
I would summarize my observations about VA’s prosthetics and its Amputation System of Care by noting that while I understand VA has recently initiated internal efforts to design improvements – it’s clear to me that America’s military prosthetic care for warriors with amputations has far surpassed VA’s previous long standing leadership position. In my opinion, VA is going to have to work hard and creatively to regain that leadership.
Now is an opportune time for a full scale program evaluation and development of a new short and long term strategic plan for VA Prosthetics & Sensory Aids Service (PSAS) and the Amputation System of Care. VA’s Amputation System of Care includes -- the Regional Amputation Centers (RAC), Polytrauma Amputation Network Sites (PANS), Amputation Care Teams (ACT), and the Amputation Points of Contact (APOC).
The VA Prosthetics program has been under acting leadership for about 9 months after the retirement of its leader of some 30 years. I understand that the Veterans Health Administration (VHA) is working on a prosthetics reorganization that will include VA acquisition staff taking over the purchasing of prosthetic items over $3,000. From what I have heard of the VA supply function taking over prosthetics purchases – I am very concerned by this change and how it will impact veterans. Prosthetics are a truly individualized extension of one person’s body and mobility, not your typical bulk supply purchases. I don’t believe VA supply staff has the expertise in prosthetics to pull this transfer through without introducing major obstacles for veterans with amputations. Taking prosthetic purchase warranting authority out of PSAS to VA acquisition could dramatically increase complaints from veterans. I also understand VHA is poised to relax its long standing “centralized funding” rules which prohibit VA medical facility managers from diverting prosthetics monies for other uses – a major problem which was originally corrected by “centralized funding” in VHA years ago and has since served veterans with amputations well.
I recommend that this Committee ask VA to freeze its pending reorganization until a full scale program evaluation and new strategic plan can be achieved. I suggest that this effort include representation to include –
- Veterans with amputations from various eras, particularly those wounded in Afghanistan or Iraq who received prosthetic care from VA and a DOD center of excellence
- VA’s Prosthetics & Sensory Aids Advisory Committee
- VA, military and private industry clinicians with stellar amputation and prosthetics experience
- Therapists experienced with amputee rehabilitation
- Private sector prosthetics and orthotics manufacturers
- Veterans service organizations
It’s my sincere belief that majority of the program staff of VA’s PSAS and the Amputation System of Care are dedicated professionals. Given my previous experience as a VA staffer and as a member of a past blue ribbon task force on VA prosthetics development and management, I would recommend that this evaluation and strategic plan include VHA participation but operational control of the effort be centralized to the Secretary of Veterans Affairs. I believe Secretary Shinseki has shown in the past a propensity for deciding to do what’s right for veterans.
From my perspective, certain events of past years epitomize a culture of reluctance on these issues within the senior management ranks of the VHA which appears to me from these past 9 months to be alive and well.
On February 2, 2004, then Secretary Principi told the House Committee on Veterans Affairs –
… I will tell you that one area that I really think that the VA needs to spend more of its resources, and I think the current war highlights it, is building a center of excellence in amputee research and rehabilitation. Again, I go back to our core mission, to care for people who have been wounded and disabled in combat or in training …And we need to do everything in our power to develop the most modern prostheses available for them and to have a rehabilitation program that’s second to none in this country. And I think we’ve lost the edge ... We’re not doing enough …
Secretary Principi’s words of 8 years ago would accurately apply to VA if said again today. The day before Secretary Principi’s testimony he had tasked VHA with implementing the VA Amputee Center of Excellence. I attended that meeting. Four months later VA’s PSAS had identified 14 potential Prosthetics and Orthotics Labs as potentially eligible for upgrade to Amputee Center of Excellence status and indicated a Request for Proposals was imminent. VHA’s work then slowed down in the preparatory stages.
In 2006, in light of no definitive VA progress, S. 2736 was introduced to create five such VA centers. The then Deputy Under Secretary for Health, one VHA leader originally tasked by Secretary Principi in 2004 to implement such a center, testified before the Senate Committee on Veterans Affairs on May 11, 2006 opposing that legislation.
Since that 2006 VA opposition, military medicine has filled the void. DoD has opened two state-of-the-art, multi-million dollar amputee centers of excellence at WRAMC (and recreated anew at WRNMMC) and the Center for Intrepid at Brooke Army Medical Center. The Navy also established the C5 (Comprehensive Combat and Complex Casualty Care) at the National Medical Center San Diego. I have received care from the DC based military centers and have visited both the CFI and the Navy’s C5. To me, VA’s efforts pale in comparison. It’s like day and night, with VA being the night.
Those comprehensive military facilities are primarily for active duty wounded warriors and offer limited access to warriors discharged from the military. According to staff from whom I receive prosthetic care, the real enabler for these military programs and staffing is known as “GWOT Funding” within DoD. My concern is how long will DoD have the funding available to continue these centers? Even if continued at today’s levels for the foreseeable future – these fine military centers do not serve a large number of those no longer in military service.
When today’s warriors are referred to VA and seek the newer, cutting-edge, technologically superior prosthetics they have been accustomed to – will VA be able to meet that demand? DoD centers of excellence provide state of the art and often newly evaluative prosthetics that have allowed the warriors to thrive incredibly, not just in the walking ability -- but also run competitively, compete in the Paralympics, rock climb, play a myriad of sports and other athletic endeavors. Most warriors receive multiple, special purpose prosthetics prior to discharge. VA must develop the clinical expertise necessary to continue that level of clinical care and must have administrative processes in place to ensure warriors receive prosthetics in a timely manner – including increasing the number of prosthetic devices VA currently allows an individual veteran.
Quality and speed are not the only superior aspects of DoD provision of prosthetics – it’s the holistic merging of excellent clinical, physical and occupational therapy, adaptive sports and recreation events and alternative medicine strategies that produces such excellent results. The key question is -- can VA Amputations System of Care meet the needs and expectations of this new generation of warriors and yet maintain its prevalent focus on care for the thousands of amputations performed annually by VA which are usually involve more senior age veterans with post-vascular complications?
Please accept my compliments to you for holding this hearing and for your continued leadership in ensuring state-of-the-art care in VA for veterans with amputations. I would be pleased to answer any questions or provide any additional information you may require.
 Source: http://democrats.veterans.house.gov/hearings/schedule108/feb04/2-4-04/2-4f-04.pdf
 Source: https://www.va.gov/OCA/testimony/svac/060511MK.asp