January 19, 2022

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Veterans Health Care: Agency Efforts to Provide and Study Prosthetics for Small but Growing Female Veteran Population

9 min read
<div>The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) provides veterans with prosthetic services to assist with their mobility, vision, and hearing needs. The proportion of prosthetics VHA provided to female veterans has been small compared to the share provided to male veterans. However, in fiscal years 2015 to 2019, this proportion grew from 6.8 percent to 7.9 percent and accounted for about $889.1 million of the $15.4 billion total cost of prosthetics. Artificial limbs comprised a relatively small number of the total prosthetics VHA provided to veterans in fiscal years 2015 to 2019; however, veterans who use artificial limbs have complex needs and are significant users of health care services. VHA provided prosthetic services to a small but growing female veteran amputee population (almost 3 percent of veteran amputees in fiscal year 2019), who were generally younger than male veteran amputees. VHA has established an individualized patient care approach in its Amputation System of Care that seeks to address the prosthetic needs of each veteran, including accounting for gender-specific factors. VHA officials said that using a standardized, multidisciplinary approach across VA medical facilities also helps them incorporate the concerns and preferences of female veterans. For example, veterans are provided care by a team that includes a physician, therapist, prosthetist (clinician who helps evaluate prosthetic needs and then designs, fabricates, fits, and adjusts artificial limbs), and other providers as needed. Female veteran amputees GAO spoke with at one VA medical facility said they were satisfied with their VHA care. They also noted a lack of commercially available prosthetic options that VHA providers can use to meet women's needs. Examples of Female Veterans' Artificial Limb Prosthetics Women are generally studied less than their male counterparts in prosthetic and amputee rehabilitation research. VHA designated prosthetics for female veterans a national research priority in 2017, and has funded eight related studies as of May 2020: four pertain to lower limb amputation, three pertain to upper limb amputation, and one pertains to wheelchairs. VHA officials noted the importance of this research priority and the ongoing challenge of recruiting study participants due to the small female veteran population. VHA researchers said they employ various tactics to address this challenge, such as using multi-site studies and recruiting participants from the non-veteran population. Women are the fastest growing veteran subpopulation, with the number of female veterans using VHA health care services increasing 29 percent from 2014 to 2019. Female veterans accounted for an estimated 10 percent of the total veteran population in fiscal year 2019. They are eligible to receive a full range of VHA health care services, including obtaining prosthetics. House Report 115-188 included a provision for GAO to review VHA's prosthetic services for female veterans. This report examines 1) trends in prosthetics provided by VHA to female veterans; 2) characteristics of the female veteran population with limb loss and how VHA provides prosthetic services to these veterans through its Amputation System of Care; and 3) VHA's research efforts and the challenges that exist in studying prosthetics for female veterans with limb loss. GAO analyzed VHA documents, as well as data from fiscal years 2015 to 2019 on prosthetics and veterans with amputations. GAO interviewed agency officials from VHA central office and officials and female veteran amputees at two VA medical facilities selected for expertise in amputation care and prosthetics research activities. In addition, GAO interviewed VHA researchers conducting studies on prosthetics for female veterans. GAO provided a draft of this report to VA. VA provided general and technical comments, which were incorporated as appropriate. For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov.</div>

What GAO Found

The Department of Veterans Affairs’ (VA) Veterans Health Administration (VHA) provides veterans with prosthetic services to assist with their mobility, vision, and hearing needs. The proportion of prosthetics VHA provided to female veterans has been small compared to the share provided to male veterans. However, in fiscal years 2015 to 2019, this proportion grew from 6.8 percent to 7.9 percent and accounted for about $889.1 million of the $15.4 billion total cost of prosthetics.

Artificial limbs comprised a relatively small number of the total prosthetics VHA provided to veterans in fiscal years 2015 to 2019; however, veterans who use artificial limbs have complex needs and are significant users of health care services. VHA provided prosthetic services to a small but growing female veteran amputee population (almost 3 percent of veteran amputees in fiscal year 2019), who were generally younger than male veteran amputees.

VHA has established an individualized patient care approach in its Amputation System of Care that seeks to address the prosthetic needs of each veteran, including accounting for gender-specific factors. VHA officials said that using a standardized, multidisciplinary approach across VA medical facilities also helps them incorporate the concerns and preferences of female veterans. For example, veterans are provided care by a team that includes a physician, therapist, prosthetist (clinician who helps evaluate prosthetic needs and then designs, fabricates, fits, and adjusts artificial limbs), and other providers as needed. Female veteran amputees GAO spoke with at one VA medical facility said they were satisfied with their VHA care. They also noted a lack of commercially available prosthetic options that VHA providers can use to meet women’s needs.

Examples of Female Veterans’ Artificial Limb Prosthetics

Women are generally studied less than their male counterparts in prosthetic and amputee rehabilitation research. VHA designated prosthetics for female veterans a national research priority in 2017, and has funded eight related studies as of May 2020: four pertain to lower limb amputation, three pertain to upper limb amputation, and one pertains to wheelchairs. VHA officials noted the importance of this research priority and the ongoing challenge of recruiting study participants due to the small female veteran population. VHA researchers said they employ various tactics to address this challenge, such as using multi-site studies and recruiting participants from the non-veteran population.

Why GAO Did This Study

Women are the fastest growing veteran subpopulation, with the number of female veterans using VHA health care services increasing 29 percent from 2014 to 2019. Female veterans accounted for an estimated 10 percent of the total veteran population in fiscal year 2019. They are eligible to receive a full range of VHA health care services, including obtaining prosthetics.

House Report 115-188 included a provision for GAO to review VHA’s prosthetic services for female veterans. This report examines 1) trends in prosthetics provided by VHA to female veterans; 2) characteristics of the female veteran population with limb loss and how VHA provides prosthetic services to these veterans through its Amputation System of Care; and 3) VHA’s research efforts and the challenges that exist in studying prosthetics for female veterans with limb loss.

GAO analyzed VHA documents, as well as data from fiscal years 2015 to 2019 on prosthetics and veterans with amputations. GAO interviewed agency officials from VHA central office and officials and female veteran amputees at two VA medical facilities selected for expertise in amputation care and prosthetics research activities. In addition, GAO interviewed VHA researchers conducting studies on prosthetics for female veterans.

GAO provided a draft of this report to VA. VA provided general and technical comments, which were incorporated as appropriate.

For more information, contact Jessica Farb at (202) 512-7114 or farbj@gao.gov.

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