The VA Office of Inspector General Office of Healthcare Inspections assessed whether patients with diabetes mellitus and additional risk factors for lower extremity amputation received annual foot care in accordance with Veterans Health Administration (VHA) requirements. The study population consisted of patients with a diagnosis of diabetes mellitus and one or more of the following risk factors for amputation during July 1, 2009–February 28, 2010: peripheral vascular disease, peripheral neuropathy, and Charcot joint disease with foot deformity. We used a two-stage approach to evaluate the annual rate of patient encounters with VA or fee-basis foot care specialists. We first examined administrative data for evidence of specialized foot care and then conducted a focused electronic health records review of a randomly selected sample of patients for whom there was no evidence of annual care in administrative data. We estimated the VHA compliance rate for annual foot care in this population at increased risk to be 66.2 percent, and we are 95 percent confident that the actual compliance rate is between 64.95 and 67.49 percent. We recommended and the Under Secretary for Health agreed to implement a plan to ensure compliance with VHA’s requirement that patients who are at increased risk for amputation be examined by a foot care specialist at least once each year.