VHA Directive 1193.01: Complete Guide to Prosthetics and Sensory Aids Policy

Table of Contents#

Core Purpose & Background of VA Prosthetics Policy
Eligibility Criteria for Covered Benefits
Full Scope of Covered Prosthetics & Sensory Aids 3.1 Prosthetic Devices 3.2 Sensory Aids 3.3 Ancillary Support Services
Step-by-Step Process to Access Benefits
Common Misconceptions Debunked
Key Policy Updates: 2021–2026
Tips for a Smooth Approval Process
Conclusion
References

1. Core Purpose & Background of VA Prosthetics Policy#

Prior to 2021, VA governed prosthetics and sensory aids benefits through a patchwork of separate policies, leading to inconsistent coverage across regional VA facilities. Categories of prosthetic and rehabilitative items and services varied from one VA medical center to another, meaning a veteran in one state might receive a device that a veteran with the same condition in another state could not access.

VA addressed this problem through two key policy actions:

The PARIS Rule (Effective January 27, 2021): Published as a final rule in the Federal Register on December 28, 2020, the Prosthetic and Rehabilitative Items and Services regulation established, for the first time, nationwide categories of prosthetic and orthotic services, sensory aids, and medical devices VA is authorized to provide. The rule codified eligibility criteria and defined 15 categories of covered items and services at 38 CFR 17.3200 through 17.3250.
VHA Directive 1173: Originally issued June 27, 2008, and revised most recently on March 27, 2023 (with an expiration date of March 31, 2028), this directive establishes policy and oversight responsibilities for the Prosthetic and Sensory Aids Service (PSAS).

Together, these policies ensure:

Standardized coverage rules for all prosthetic and sensory aids across every VA medical center and community care provider network
Coverage of the most medically appropriate device for a veteran's functional needs, rather than the lowest-cost available option
A "direct and active component" standard: items must serve as a direct and active component of a veteran's medical treatment and rehabilitation, not solely support comfort or convenience
Joint decision-making between the veteran and clinician on which device best meets the veteran's treatment or rehabilitation needs

The PARIS rule applies to all enrolled VA patients. As the largest and most comprehensive provider of prosthetic devices and sensory aids in the country, VA provided approximately 21 million prosthetic devices and items to veterans in fiscal year 2020, serving more than 52% of all veterans treated in VA.

2. Eligibility Criteria for Covered Benefits#

To access prosthetics and sensory aids benefits, you must meet 3 baseline requirements:

You are actively enrolled in VA health care: If you are not yet enrolled, you can apply online via VA.gov, by phone at 1-877-222-8387, or in person at your local VA medical center.
You have a documented medical need: A VA-authorized health care provider (or community care provider approved by VA) must confirm the device is required to treat a diagnosed medical condition, improve your functional ability, or prevent further health decline.
The device meets the medical necessity standard: Under the PARIS rule, the requested device must serve as a direct and active component of your medical treatment and rehabilitation, as determined under both the "promote, preserve, or restore" standard in 38 CFR 17.38(b) and the supplemental "direct and active component" standard in 38 CFR 17.3230(a).

Copay Information#

Most eligible veterans pay $0 out of pocket for devices covered under these policies. Copays for prosthetic items generally apply only to non-service-connected conditions and depend on your VA priority group and income level. Copays are fully waived if you:

Have a service-connected disability rating of 10% or higher
Have a 100% permanent and total (P&T) disability rating
Are a Purple Heart recipient or former prisoner of war
Have a household income below VA's annual national income threshold
Are receiving care for a service-connected condition

3. Full Scope of Covered Prosthetics & Sensory Aids#

The PARIS rule defines 15 categories of prosthetic and rehabilitative items and services. VA covers a far wider range of devices and supports than many veterans realize, split into 3 core categories:

3.1 Prosthetic Devices#

All medically necessary prosthetic devices are covered, including but not limited to:

Upper and lower extremity prosthetics (including high-tech myoelectric and microprocessor-controlled limbs for eligible patients)
Orthopedic braces, splints, and spinal implants
Post-mastectomy prosthetic breasts and related garments
Cardiac devices (pacemakers, defibrillators, left ventricular assist devices)
Diabetic supplies, including insulin pumps and continuous glucose monitors
Ostomy and urological prosthetics and related supplies
Voice prosthetics for patients who have undergone laryngectomy
Wheeled mobility and seating systems (manual wheelchairs, power wheelchairs, scooters)
Implants surgically placed in the veteran (e.g., hips, knees, cochlear implants)
Home respiratory equipment (CPAP machines, oxygen equipment)

3.2 Sensory Aids#

Sensory aids for auditory, visual, and other rehabilitative needs are covered, including:

Hearing aids, bone-anchored hearing aids, and cochlear implants
Assistive listening devices (including amplified phones, fire alarm alerts for hard-of-hearing patients, and loop system equipment for home use)
Low-vision aids (prescription magnifiers, adaptive glasses, screen reading software, and tactile navigation tools)
White canes, guide dog harnesses, and mobility support accessories for visually impaired veterans
Communication devices for veterans with speech impairments
Sensory regulation tools for veterans with TBI or sensory processing challenges

3.3 Ancillary Support Services#

The policies do not only cover the cost of the device itself: all related support is also included, at no extra cost for eligible veterans:

Custom fittings and adjustments for prosthetic and sensory devices
Repairs, replacement parts, and full device replacements for normal wear and tear or changes in your medical condition
Training to use your new device (including physical therapy for prosthetic limbs and assistive tech training for sensory aids)
Follow-up appointments with your provider to monitor device performance
Reimbursement for travel costs to attend fittings and training appointments, if you qualify for VA travel benefits

4. Step-by-Step Process to Access Benefits#

Accessing prosthetics and sensory aids benefits follows a standardized, nationwide process:

Schedule a provider appointment: Meet with your VA primary care provider or relevant specialist (orthopedist, audiologist, optometrist, etc.) to discuss your functional needs and symptoms.
Submit a medical necessity request: Your provider will write a prescription for the device and submit a formal medical necessity justification to your local VA Prosthetic and Sensory Aids Service (PSAS) office.
Wait for review: Standard requests are typically reviewed within 14 business days, while urgent requests (for example, a replacement prosthetic after a device breaks unexpectedly) may be reviewed on an expedited basis.
Receive approval and fitting: If your request is approved, PSAS will connect you to a VA fabrication lab or contracted community vendor to custom fit your device.
Complete training and follow-up: You will be scheduled for any required training to use your device, plus follow-up appointments to make adjustments as needed.
File an appeal if denied: If your request is denied, you can work with a VA patient advocate to gather additional supporting documentation and file a formal appeal.

5. Common Misconceptions Debunked#

Misconception	Fact
Only veterans with service-connected disabilities qualify for benefits	Any enrolled veteran with a documented medical need is eligible for coverage, even for non-service-connected conditions. Copays may apply for non-service-connected care, but low-income and disabled veterans qualify for waivers.
VA only covers basic, low-tech prosthetics	The PARIS rule explicitly requires coverage of the most medically appropriate device for your needs, including high-tech microprocessor prosthetics and cochlear implants, if supported by clinical evidence.
You have to pay for repairs or replacements out of pocket	All repairs, adjustments, and replacements for normal wear and tear or changes in your medical condition are fully covered under the policy for eligible veterans.
Sensory aids only include hearing aids and glasses	Coverage extends to a wide range of assistive technology, including screen readers, home alert systems for hard-of-hearing patients, communication devices, wheeled mobility systems, and guide dog equipment.

6. Key Policy Updates: 2021–2026#

VA has issued several important updates to prosthetics policy since the PARIS rule took effect:

2021 — PARIS Rule Takes Effect (January 27, 2021): The final rule established nationwide categories of prosthetic and rehabilitative items and services, replacing the prior patchwork of inconsistent facility-level policies. VHA Notice 2021-06 rescinded older, fragmented prosthetics policies that were superseded by the new regulation.
2022 — PACT Act Expansion (August 10, 2022): The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act (PACT Act) expanded VA health care and benefits for veterans exposed to burn pits and other toxic substances, increasing the number of veterans eligible for VA care and, by extension, prosthetics services.
2023 — VHA Directive 1173 Revised (March 27, 2023): VA updated its primary prosthetics directive, reaffirming policy and oversight responsibilities for PSAS with a revised expiration date of March 31, 2028.
2026 — Streamlined Prosthetic Limb Procurement (April 22, 2026): VA Secretary Doug Collins exempted approximately 95% of prosthetic limb orders from contracting officer reviews and authorized local purchasing agents to source directly from local suppliers when prices are set by Medicare. These changes reduced average wait times for prosthetic limbs by 10 days immediately, with VA expecting a further 42% drop in delivery times — from 94 days to 54 days — as facilities fully implement the new process. More than 45,000 veterans rely on VA each year for major limb loss care.

7. Tips for a Smooth Approval Process#

Follow these tips to avoid delays or denials of your request:

Bring all private medical records related to your condition to your provider appointment, to help them build a strong medical necessity justification.
Be specific about how your condition impacts your daily life: share details about challenges with working, caring for yourself, or participating in hobbies, to help your provider explain why the requested device is necessary.
Follow up with your local PSAS office if you do not receive a decision within the standard review window. Contact information for your local PSAS team is available through the VA facility locator at va.gov.
Work with a VA patient advocate if your request is denied: advocates can help you identify gaps in your application and gather additional supporting documentation before you file an appeal.
Ask your provider about peer support: most VA facilities have peer mentors who are veterans that have gone through the process of accessing prosthetics or sensory aids, and can share tips and guidance.

8. Conclusion#

VA's prosthetics and sensory aids policies — anchored by the PARIS rule and VHA Directive 1173 — ensure all enrolled veterans have equal access to the life-changing prosthetics and sensory aids they need to live full, independent lives. With the 2026 streamlining of prosthetic limb procurement, VA is also working to reduce wait times and deliver devices faster. If you believe you may be eligible for these benefits, reach out to your local VA provider or patient advocate to start the process: you have earned these benefits through your service, and VA has clear rules in place to help you access them.

9. References#

U.S. Department of Veterans Affairs. (2020). Prosthetic and Rehabilitative Items and Services; Final Rule. 85 FR 84245. Retrieved from https://www.federalregister.gov/documents/2020/12/28/2020-27014/prosthetic-and-rehabilitative-items-and-services
U.S. Department of Veterans Affairs. (2023). VHA Directive 1173: Prosthetic and Sensory Aids Service. Retrieved from https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=10223
U.S. Department of Veterans Affairs. (2026). VA speeds up delivery of prosthetic limbs to Veterans. Retrieved from https://news.va.gov/press-room/va-speeds-up-delivery-of-prosthetic-limbs-to-veterans/
U.S. Department of Veterans Affairs. (2026). VA Prosthetic and Sensory Aids Service (PSAS). Retrieved from https://www.prosthetics.va.gov/psas/index.asp
U.S. Department of Veterans Affairs. (2022). Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act). Retrieved from https://www.va.gov/resources/the-pact-act-and-your-va-benefits/