Why VA Prosthetics Decisions Vary — and What We Can Do About It
If you’ve tried getting a medical device approved through VA Prosthetics, odds are you’ve seen this:
One VA approves it in days
Another says no — with no change in diagnosis or documentation
Same veteran condition. Same device. Same clinical rationale
What Gives? At JhetVet Gov Con, we help companies navigate VA procurement — but more than that, we advocate for clarity in a system that was built to serve veterans. When approval patterns start feeling random, we don’t shrug. We dig.
What’s Driving the Inconsistency?
Different interpretations of CPR and PARIS
The Clinical Practice Recommendations (CPRs) and Prosthetics Acquisition Resource Information System (PARIS) exist to guide prosthetics decisions. But they’re not plug-and-play. They’re subject to local interpretation. One prosthetist sees clinical need. Another sees “not covered.”Budget and staffing pressure
Some VA prosthetics departments are operating under tighter budgets, with fewer staff. That means more scrutiny — and sometimes, more delays or conservative approvals.Gaps in training and awareness
Newer technologies like neuromodulation, smart orthotics, or medical alert systems may not be widely understood — especially if CPRs haven’t caught up. When in doubt, staff may default to denial or request added documentation.Local discretion still rules
Even with national contracts and standardized HCPCS codes, local prosthetics teams have latitude. One facility might view a device as essential. Another might see it as optional. The rules feel fluid — because, in practice, they are.
Why it Matters — Beyond the Paperwork.
This variation affects real outcomes:
Veterans get conflicting info about what they qualify for
Physicians spend extra time writing justifications — and get second-guessed
Vendors face unpredictable decisions that stall delivery and compliance
This isn’t just administrative friction. It slows care. It erodes trust.
What Needs to Change?
Let’s be clear — this isn’t about blaming prosthetics staff. These folks manage massive caseloads, rising costs, and constant policy shifts.
But we still need to ask hard questions:
What’s the operational definition of “medical necessity” used across VISNs?
Are outdated CPRs or PARIS codes contributing to denials?
Would national guidance on newer technologies help?
How do we increase transparency without overwhelming already stretched teams?
Bottom Line
The VA prosthetics system works — but not always equitably. And when it doesn’t, veterans wait, clinicians redo their work, and vendors spin their wheels.
At JhetVet Gov Con, we’re not here to throw stones. We’re here to fix what’s fixable. We work with vendors, clinicians, and VA leadership to make care and technology easier to deliver — not harder.
If you’ve seen inconsistent approvals, we want to hear from you.
What helped? What didn’t? What would make this easier to get right — the first time?
